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Bloggingheads
05-14-2008, 07:02 PM

David Thomson
05-14-2008, 07:21 PM
Human beings are innately selfish. The at least metaphorical reality of Original Sin is alive and well on planet Earth. We cannot reform medical care unless the citizenry realizes that it ultimately pays the full price of their medical care---whether directly or indirectly. The stupid wage and price controls enacted during WW II caused enormous damage. Workers could not opt between more money in their paycheck or health insurance. Thus, they subtly started to foolishly believe “the company is paying for my health insurance.”

osmium
05-14-2008, 07:43 PM
in the example of tracey, who unfortunately had her first heart attack at 16 and required a defibrillator in her mid-twenties, an extra real-world element many people deal with was left unmentioned in the example.

it is very likely that someone in this situation would have been on a parent's insurance when becoming sick. after school, they will have to have their own. the only way this is affordable for someone with a pre-existing condition is to have a bulk employer's plan in most cases, because for an individual insurers raise the price to absurd levels to discourage this person away from their company.

this can of course be all right. however, the current job market is based quite a bit on entrepreneurship and specialization. unless such a person has generous and wealthy parents, pursuing something ambitious like that would be untenable, due to questions of future health risk.

to achieve the benefits of money-pooling, there needs to be some mechanism to prevent insurers from selectively driving people away in the name of higher profits.

AemJeff
05-14-2008, 07:50 PM
I have a small quibble. Just use "data" as a mass noun: "the data."

More importantly, I'm really happy to listen to a serious discussion of health care economics that doesn't (so far, I'm only about forty minutes in) use the term "socialized medicine," an idiotic, useless, manipulative term that blocks any attempt at a honest evaluation of this issue.

AemJeff
05-14-2008, 08:01 PM
to achieve the benefits of money-pooling, there needs to be some mechanism to prevent insurers from selectively driving people away in the name of higher profits.

Amen! People with chronic illnesses find themselves in a horribly weak position, with limited choices between often untenable situations. Providing health care options only to people until they're no longer healthy is obscene.

David Thomson
05-14-2008, 10:15 PM
"...use the term "socialized medicine," an idiotic, useless, manipulative term that blocks any attempt at a honest evaluation of this issue."

Really? It has been my experience that often those who shy away from accurately describing something as socialist when indeed that’s what is---are trying to get away with an Orwellian use of language. It is essentially an attempt to put lipstick on the pig.

Cheaplazymom
05-14-2008, 10:45 PM
This is a very interesting diavlog and a timely subject. But I do take issue with Michael's concern over "moral hazard". When people have medical coverage and they feel somewhat protected from unknown and often huge costs of care, they are more likely to go to the doctor when they are sick, ie. when they should go. If they do not have insurance, or they will have to shell out thousands of dollars before coverage kicks in, they do NOT go to the doctor when they are sick. This may prove that people without money to pay the doctor do not go to the doctor, but it doesn't prove that they go to the doctor when they aren't sick, or simply because it is free. I think most people hate going to the doctor. HATE IT! It is demoralizing and fraught with anxiety and uncertainty all the way down the line. We do not have a culture or a health care system that promotes positive preventative care.

I think its lovely that there are places in this country where consumers can avail themselves of quality integrated medicine. I don't live in one. I also know that medical care rarely comes with a price tag that consumers can evaluate, let alone have a choice in the matter. Those stupid dressing gowns? Overpriced tylenol? Crappy food? Noisy shared hospital rooms? Given the choice (and the money), one could have a private nurse at the Ritz Carlton with room service. The whole system sucks and should be scrapped.

AemJeff
05-14-2008, 10:55 PM
Really? It has been my experience that often those who shy away from accurately describing something as socialist when indeed that’s what is---are trying to get away with an Orwellian use of language. It is essentially an attempt to put lipstick on the pig.

Well David, given the multifaceted wisdom on so many topics, acknowledged by no less than James Wolcott, that you bring to bear with your laser-sharp arguments - I guess I'll just have to concede the point. Since the word "socialized" can be placed before the word "medicine" - with intentionality and firmness - how could I possibly argue that it's merely a language stunt, intended to shut down debate before it can even begin?

JLF
05-14-2008, 11:05 PM
Why not a universal risk pool? That would mean a consortium of all health insurers providing policies that cover whatever we decide is basic coverage, which would then allow the individual insurers to offer boutique policies to cover optional surgeries, etc. The issue of copay/deductibles set at levels to discourage overuse could be ameliorated with refundable tax credits at that level, which would then give those needing treatment but without the disposable income the option of treatment or the $1,000 or whatever in April.

Harold, Maude and the insurance companies would never stand for something that derails the gravy train. But if faced with the alternative of something (participation) or nothing (being barred from writing any other kind of health insurance) I suspect they would accept the half loaf.

Frooplog
05-14-2008, 11:10 PM
I wish libertarians (God bless them) would simply admit that their objections to things like Canadian style universal health insurance is simply market fundamentalism. They can marhsal some nifty numbers but in the end it comes down to the fact that they simply do not want government to do much of anything.

David Thomson
05-15-2008, 12:00 AM
“I wish libertarians (God bless them) would simply admit that their objections to things like Canadian style universal health insurance is simply market fundamentalism.”

Do you really want Canadian health care? Our next door neighbor offers its citizens lousy medical assistance. So much so, affluent Canadians often travel to the United States when they are seriously sick. Everybody should see the thought provoking movie, “The Barbarian Invasions.” It is hardly a right wing rant. On the contrary, it is a very left-wing film endorsing euthanasia. The radical leftist professor is dying---and his son does everything possible to get the best help possible. To be blunt, it is a serious indictment of the Canadian health care system. You can obtain a used copy of this movie for only a few dollars from Amazon.com. Watch it once and you will never again envy the Canadians.

jh in sd
05-15-2008, 12:13 AM
AemJeff, Thou shalt not quibble! "Data" is plural, and as a writing tutor, I appreciate anyone's attempt to use proper grammar.

This is a great diavlog. One point that was not explored was the extent to which litigation has played a role in driving up healthcare prices. Often extensive testing is done on patients to rule out conditions because the doctor wants to cover his bases when it come to the possibility of litigation. I have a brother and a brother-in-law, both doctors, who have attested to this fact.

AemJeff
05-15-2008, 12:28 AM
AemJeff, Thou shalt not quibble! "Data" is plural, and as a writing tutor, I appreciate anyone's attempt to use proper grammar.

jh, I have to say that the proper usage would earn me a lot of funny looks among the engineers at work. However, I bow to your professional judgment.

Eastwest
05-15-2008, 12:43 AM
OK, all at once now: Everybody into the Pool!

Not much interested in arguing on this one. For those genuinely interested in solving this difficulty with heartlessly letting your fellow citizens die early and unnecessarily, the problems and solutions are really fairly obvious. It's primarily the "special interests" already sharking around in the pool who constitute the obstacle.

Probably the biggest problem: the 25% (?) who actually don't have any problem with their fellow citizens croaking early and for no good reason (or maybe even prefer it.)

FrontLine did an excellent job in looking at how it's done in five other democracies (U>K>, Japan, Germany, Taiwan and Switzerland). Takes sixty minutes, nicely broken into individual country segments. Here are the URLs for on-line streaming, the website, and the transcripts:

Watch at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Explore the topic at dedicated website: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Read the transcript: http://www.pbs.org/wgbh/pages/frontline/haditha/etc/script.html

Recommendation: For those uncomfortable about supposedly less available "Cadillac care" or "add-ons," consider pulling out your wallet. I'm sure an "aristocrat's wading pool" can be arranged, complete with full-time babysitters.

EW

bjkeefe
05-15-2008, 12:50 AM
jh, I have to say that the proper usage would earn me a lot of funny looks among the engineers at work. However, I bow to your professional judgment.

Speaking as a former engineer, I question the merit of appealing to engineers on matters of grammar. ;^)

I do think you make a good point, Jeff. There are times when treating data as a plural noun sounds a little forced, especially if people using the term keeps interrupting themselves to correct themselves. The solution I reach for when treating data as plural starts to sound stuffy is to use data set; e.g.,

The data we have are good -> The data set we have is good
The data we have are insufficient -> The set of data we have is insufficient

Eastwest
05-15-2008, 12:51 AM
Anyone willing to give a quick (and honest) thumbnail as to the basis for HRC and Edwards insisting BHO's Healthcare Plan leaves a significant percentage of currently uninsured still out in the cold?

(If I recall HRC was claiming that, of the 400,000 uninsured in Oregon, for instance BHO would only cover half, i.e. 200,000...)

Not looking for an argument. Just want the facts.

Thanks,

EW

AemJeff
05-15-2008, 12:57 AM
The data we have are good -> The data set we have is good
The data we have are insufficient -> The set of data we have is insufficient

Or in true Engineerese: We've got good data. Alternatively: The data sucks!

AemJeff
05-15-2008, 01:00 AM
Thanks EW. I'll watch those tomorrow.

bjkeefe
05-15-2008, 01:13 AM
I, like EW, am not much interested in health care policy debates. I do think Shannon and Michael did a much better job in this diavlog than do most people when discussing this topic. AemJeff gave a good example of why this was so: avoiding the loaded term "socialized medicine." I was happy not to hear such clichés and happy not to hear too many heart-tugging anecdotes.

In the end, though, I had trouble seeing what Michael was proposing that was much different from what we have now, which I think we all can agree is a pretty bad system. Most of what I heard sounded like the usual libertarian philosophy -- give people more choices and trust to market forces to make everything better. The problem is, that's pretty much what we're already doing. The market, left to itself, doesn't smooth itself out. You always end up with pockets of plenty and pockets of shortage, you always get providers that band together and gain so much clout that they hamper competition, you always see the formation of special interest groups whose wishes don't line up well with the overall population, and you always end up with Congress being influenced by these narrow groups.

So, if I wanted to be cynical, I'd suspect Michael of pushing for a plan that really isn't a plan -- it's more of an appearance of a plan that tries to hide the real goal, which is to do nothing. Except cut government spending, involvement, and oversight, of course.

I don't really think that Michael is that extreme. He did sound as though he genuinely wanted to make improvements to the health care system in this country. I agree with many of his complaints; e.g., people will ask for more health care when they don't have to pay for it, doctors will prescribe more treatment when they can just bill an insurance company or Medicare for it, and so on. I just had trouble seeing what he wanted that is new or different, and to the extent that I understood it, how it would be implemented. Also, I have a lot less confidence than he does that the average person will be able to make sensible health care choices, even if I stipulate that they somehow could be provided as he proposed.

bjkeefe
05-15-2008, 01:18 AM
Or in true Engineerese: We've got good data. Alternatively: The data sucks!

Yeah, saying the grammatically correct the data suck sounds a little clunky. Okay, I concede, sometimes data should be treated as a collective noun, like crowd or Congress or Pink Floyd, especially when speaking.

But in writing, I would always treat data as a plural noun.

Eastwest
05-15-2008, 01:44 AM
OK, I should have known that an Obama Rave Site would not be the place to get an answer on that question. Just found the answer, courtesy of Krugman in the NYT, in a November 30th, 2007 column entitled "Mandates and Mudslinging":

http://www.nytimes.com/2007/11/30/opinion/30krugman.html

The basis for calling Obama's program phony is real. Adults who feel too "special" to buy health insurance can just bag it. (This robs the whole program of huge cost-reducing potential which would of course require that everybody be in the pool.)

Krugman goes on to point out that Obama essentially lies about the Edwards and HRC plans, taking what Krugman calls "cheap shots," and deliberately obscures the obvious faults in his own plan which is, after all, not universal, and hence much more expensive.

EW

travis68
05-15-2008, 01:46 AM
Good talk. I just wish that Michael had let Shannon speak more and not bull over her thoughts. It shows that he's not truly listening.

Michael's idea of giving money to Medicare patients and letting them choose the health care plan would fail *unless* insurance companies were required to accept all people who apply. Otherwise, insurance companies would keep out the sick and accept only the healthy. Even if the companies were required to do so, it's likely they would be very reluctant to offer full service plans because it's likely that the sick would gravitate towards those full plans and eventually bankrupt them. (The healthy would gravitate to the cheap plans so they could keep the difference.)

Any private form of health insurance eventually runs into the problem of pre-existing conditions. Michael wants people to join health care plans before they are sick. That's all well and good, but for myriad reasons, there will be people who lose their insurance. What are they supposed to do if they have a pre-existing condition?

I come to these conclusions reluctantly, because I would much rather see a free-market solution but health has unique issues that make a health uninsurance market unworkable.

hans gruber
05-15-2008, 02:43 AM
Moral hazard is most commonly used to describe the situation where somebody engages in risky behavior that they wouldn't otherwise engage if they did not have insurance (the uninsured motorist might drive extra carefully compared to somebody insured for 1,000,000 in liability). Or, perhaps, in the case of medical insurance, an individual might be more likely to engage in contact sports or start a fist fight than an individual without medical insurance (hey, so what if I break my arm?).

What Cannon describes as "moral hazard" is actually described as ex post moral hazard in the literature, which is to say there is no change in risky behavior because of the presence of insurance. In this case of so-called "moral hazard" an individual chooses medical treatment they would not otherwise because they are insured. Duh! That's why they have insurance, because they cannot afford the small chance of catastropic illness, so they get insurance! And then, when they get sick, they expect the insurance to pay. Novel idea, isn't it? It seems a little rotten to label using one's insurance precisely for what it is intended as "moral hazard" but that's exactly what Cannon has bought into. This is not to say this phenomena isn't important and doesn't have bad effects on the industry as a whole, but it should not be lumped into the concept of "moral hazard." Perhaps "bottom line hazard" would be a more apt description (of course, the important concern is this effect's relation to medical inflation)!

hans gruber
05-15-2008, 02:56 AM
Do you really want Canadian health care?

It depends. If I were a person with a lot of job insecurity and a chronic, serious medical condition. I would want it, yes, absolutely. This is the main problem we need to address if we want to stave off socialized medicine--people with high medical bills who cannot afford private insurance and cannot get a job that provides it. A Romney style system which requires everybody to be insured but doesn't price out the chronically ill seems like the way to go, from my admittedly limited knowledge of the subject.

otto
05-15-2008, 04:42 AM
This was interesting -- but are either of these two bloggers? Its seemed to be an edition of wonkingheads.tv.

harkin
05-15-2008, 08:07 AM
Reading through Michael's page at Cato, I found this recent article which shows the biased and intrusive practices of the government in regards to discouraging citizens from getting HSAs:

"HSA opponents offer no evidence that unlawful HSA withdrawals are a serious problem, and they can't say why random audits aren't enough to deter them. They are highly suspicious when Americans take money out of their HSAs — but equally suspicious when they leave it in. And tax breaks for the wealthy appear to be kosher, unless they let workers control their earnings." (http://www.cato.org/pub_display.php?pub_id=9393)

These are the people who want to take charge of the nation's health care.

Eastwest
05-15-2008, 08:30 AM
Moral hazard is most commonly used to describe the situation where blah blah blah blah blah

Think your indulging in a whole lot of extra chatter on a simple concept.

In contexts like these, it just refers to whether or not you've got any "skin in the game."

EW

JLF
05-15-2008, 08:58 AM
Yeah. That too. But the principal thing they don't want is to pay higher taxes for someone else's health care . . . or much of anything else for that matter. Generally speaking, then, they tend to be healthy people with good incomes, and other resources. You don't see many poor or disadvantaged Libertarians.

AemJeff
05-15-2008, 09:09 AM
Yeah. That too. But the principal thing they don't want is to pay higher taxes for someone else's health care . . . or much of anything else for that matter. Generally speaking, then, they tend to be healthy people with good incomes, and other resources. You don't see many poor or disadvantaged Libertarians.

Give them their due. At the heart of libertarianism is a noble goal. I'm all for for maximal liberty. Movement Libertarians seem to define "liberty" as distance from the State. I think that's simplistic, I want freedom from the tyranny of private entities, as well. That last requires a strong, enforceable legal framework, which is why liberals favor a more robust role for the State than do Libertarians. We (liberals) tend to see the Libertarian project leading to a Hobbesian hell. But, I'd still count myself as a (small-"el") libertarian.

JLF
05-15-2008, 09:22 AM
Agreed. All want government to stay out of our business; few acknowledge the fact that government is less intrusive than business in saying how we live our lives.

I spoke to my doctor the other day, as conservative a man as any, and he was decrying the time and money he had to spend (30% to 40% of his practice) just shuffling paperwork for private insurers. He thinks he'd be money ahead with a single payer (and a break on his malpractice insurance.)

brucds
05-15-2008, 09:33 AM
David Thomson recommends a comedy-drama movie as evidence that the Canadian healh care system "sucks."

Quite frankly, as EastWest notes, this is - pure and simple - a stupid argument. Not just the part about watching that movie, but the whole deal about "European" vs. "American" health insurance systems.The evidence is in. Ha been for a long time. The US health care "system" doesn't provide coverage or outcomes as effectively as, say, the French and is prohibitively more expensive to boot. That Frontline documentary is a good place to start looking at these facts.

I've tried to wrap my mind around serious arguments against socializing health insurance (not delivery, as in England) and, frankly, find it impossible. Unless one has zero interest in empirical data and comparing the cost/benefit of actually existing approaches to health care but prefers anecdotes - which can be collected to suggest damned near anything and certainly exist in plenty for anyone taking that tack as a critic of the US health care system - there is ZERO evidence that a system of private insurance or the "worst of both worlds" private/government financed system we now have even remotely approaches the cost-benefits of a system like the French. Fixing it with "health savings accounts" is a joke in response to true universal health insurance coverage. There is NOTHING substantive to this argument other than market fundamentalism. No cost savings. Certainly no ethical imperative. No advantage in outcomes. Nothing.

David Thomson's response about Canada is testament to just how lame the opponents of truly universal health coverage are. "Get this movie on Amazon! It'll just cost you a few bucks." Yeah. Excellent suggestion. I'd suggest anyone seriously on the fence spend a few bucks and an hour and a half watching "Barbian Invasion" and then watch the Frontline (for free) that EastWest linked and get back to me about which one of them is a total fucking idiot.

brucds
05-15-2008, 09:48 AM
Just as an addendum, the Democrats' reforms are political cowardice. Perhaps necessary in the current climate if you're running for President, like a lot of political cowardice, but they are dumb, Rube Goldberg approaches that improve access significantly but aren't viable long term solutions - especially re: cost containment and true universality. At best they're transitional (which is why I find Obama's approach more honest given they're all constructed as a political pitch. He doesn't claim that bullshit about mandates is true "universal coverage." Mandates are as much a sop to insurance companies as anything. He simply promises to expand access and affordability, will consider mandates - despite the problems of enforcing them - if coverage lags and admits that single payer is the better system if it were politically viable. Clinton claims her non-existent patchwork plan holds a promise of "universal health care" because it includes mandates which, as we see in Massachusetts, is bullshit. Krugman has this "mandates" bug up his butt because he's been too chickenshit to talk openly about his fears that Obama can't win because of his race. The "liberal conscience" and all that.)

hans gruber
05-15-2008, 12:10 PM
In contexts like these, it just refers to whether or not you've got any "skin in the game."

The only two similiarities between regular moral hazard and what Cannon describes is that it costs insurance companies money! If people would spend the same amount on their care without insurance, they probably wouldn't have insurance in the first place (that's why they have insurance)! My objection to the use of the term is that moral hazard usually described what is unethical or inappropriate behavior. There is absolutely nothing inapproriate, unexpected, or unethical about using one's insurance to purchase covered medical procedures/medicines to further one's health, even if one wouldn't purchase those medicines and procedures in the absence of insurance. That is my objection and I don't think it's entirely trivial. =)

jh in sd
05-15-2008, 01:06 PM
AemJeff, My son is graduating with a mechanical engineering degree, and when I rag on him about his usage, he tells me that proper grammar does't matter. I guess the other engineers here concur. Oh well, it won't stop me from trying.

Often we get so used to hearing words used improperly that they begin to sound awkward when used correctly. "Data" would be a perfect example. But I will say, "A pox on anyone who uses 'myself' incorrectly." (That would include John McCain, who did it just yesterday).

AemJeff
05-15-2008, 01:47 PM
All kidding aside, I think we're witnessing something interesting. "Proper" grammar is a matter of usage. That is, there's no reason for a grammatical rule, ultimately, except observed usage. Irregular verbs are examples of grammatical constructs that, while not conforming to the (seeming) a priori rules governing conjugation, are nonetheless "correct," i.e. examples of proper usage. I think "data" is an example of a word that's in transition from set of usage rules to another.

I just looked it ("data") up on dictionary.com - and saw the following usage note:


Data is a plural of datum, which is originally a Latin noun meaning “something given.” Today, data is used in English both as a plural noun meaning “facts or pieces of information” (These data are described more fully elsewhere) and as a singular mass noun meaning “information”: Not much data is available on flood control in Brazil. It is almost always treated as a plural in scientific and academic writing. In other types of writing it is either singular or plural. The singular datum meaning “a piece of information” is now rare in all types of writing. In surveying and civil engineering, where datum has specialized senses, the plural form is datums.

It seems we're all correct, to a degree.

bjkeefe
05-15-2008, 02:40 PM
jh:

But I will say, "A pox on anyone who uses 'myself' incorrectly."

Sing it, sister. That one drives me crazy, too.

graz
05-15-2008, 02:42 PM
. But I will say, "A pox on anyone who uses 'myself' incorrectly." (That would include John McCain, who did it just yesterday).

I myself would like to know what the rule is?

bjkeefe
05-15-2008, 02:50 PM
I myself would like to know what the rule is?

Nice!

I actually like that usage. Just don't say anything like "Joe invited Bill and myself over for dinner" or "Myself and Bill went over to Joe's house."

graz
05-15-2008, 02:52 PM
Okey Dokey.

bjkeefe
05-15-2008, 02:54 PM
AemJeff:

Good post. I agree with all of it.

I'm less prickly about usage than I used to be, and accept more the changing nature of language. But sometimes, it seems worth fighting a short-term holding action.

And I do love to say datums (in the civil engineering sense), just to bait people into "correcting" me.

Anyuser
05-15-2008, 03:20 PM
Isn't calling medical care unnecessary a conclusion that can be reached only after the fact? Two events are frequently labeled unnecessary: referral to specialists and lavish diagnostic tests, especially radiology. But these events are a way of playing the odds. The odds are that your headache is a caused by tension, but there's a 1 in 100 chance that it's caused by a brain tumor. So, an MRI would turn out to be unnecessary for 99 such patients, but a potential life-saver for 1. If 1% benefit is trivial, pick your own pivot point. 5%? 20%? The vloggers would economically involve the patient in playing the odds. Here's 50,000 bucks, grandma. Do you want to bet with it that a heart by-pass will get you a couple more years (like a selfish old bitch), or wouldn't you rather leave it for us? Grandma with 50,000 bucks is a simple problem. Ever met anybody with a badly sick kid? They would bankrupt themselves and, for that matter, the United States of America to keep their kid alive. Is the moral percentage of benefit lower for a kid compared to grandma? Is it moral that some people can afford to bet $50,000, but others can't?

It's also tricky to waver between assessing odds for individuals versus society. Trading some percentage of lives for some economic benefit makes sense for society, but not for the dead patients. That's why the criteria for denial of coverage have to be imposed from on high.

[edit: I first used "has" with "criteria." Worse than goofing up "data."]

bjkeefe
05-15-2008, 03:49 PM
Anyuser:

[edit: I first used "has" with "criteria." Worse than goofing up "data."]

LOL!

Liked your thoughts in the rest of the post, too, especially the part about the sick kid considerations.

fedorovingtonboop
05-15-2008, 11:36 PM
you guys did a great job filling an hour with interesting info! however, debating the details of out type of health care seems kinda pointless to me when you see virtually any other westernized country has a more efficient system than us but i guess the reality is that troglodyte cons getting in the way of univ. coverage will prevent change from happening for a long time.