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Tags Affordable Care Act , donald trump , health care issues , health insurance issues

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Old 23rd January 2017, 04:22 PM   #241
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Because freedom.
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Old 23rd January 2017, 04:43 PM   #242
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Greta Van Susteren just failed (in my book) her new position on MSNBC. She had the chance to call the Republican spouting his, GOP plan re ACA: care will be cheaper and mandates will go away, (a contradiction) then he claimed Trump would lower taxes and regulations on business and the middle class and the deficit will magically improve as the economy picks up. (BTW there was a recent report out showing under Obama the annual deficit was down to something like 3% from double digits when he took office.) Then all smiles she said, I'll have you back to see if you accomplished what you said.

Fits this assessment: Greta Van Susteren Serves Up Softballs in MSNBC Debut
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Old 23rd January 2017, 04:44 PM   #243
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Originally Posted by sunmaster14 View Post
Yes, of course. The life and death, urgent care situation is the first (and only ) example any anti-free health care market people give when arguing that the health care market is fundamentally immune to free market solutions.
Such situations are the issue in a nutshell. Preventative care is ethically equivalent but more drawn out in time.
The reason I am skeptical is that I am unaware of people demanding that medically unnecessary interventions, eg cosmetic surgery, be paid.

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No, apparently you don't see what I'm saying. What you wrote is a non sequitur.
Ok, I don't get it then.
You gave the example of people operating unsafe vehicles. That is banned and prosecuted to protect their health, and the health and property of others. The motivation is more extended, but that isn't your point, right?
I can also see that penalizing something and paying to fix it is not the same. But to the public enforcing such legislation both are an expense. So in these narrow economic terms, which I thought were the point here, it is the equivalent.
What am I missing?

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You claimed we have a right to life. How does that work with such a definition? Do you really think that I have a right to call in the government to expend $1 million of health care resources to keep me alive?
Why not?
If there is a hostage situation, would you ask the police to run the numbers to determine how long a stand-off may last?
And if yes, do you think most people would?

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They go hand in hand. If the means don't exist, then it makes no sense to talk about it as a right.
We're talking about the means.

Quote:
And it would be really bad public policy to make laws that establish such a right.
The dominant school of thought in liberal democracies is that the fundamental rights, like the right to life, exists prior to and independently of the state. Laws are to safe-guard these rights but do not establish them.

You talk of bad public policy: Bad implies some goal or standard by which public policy is judged. What is that?

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Yes, it does. State-of-the-art means resources at the leading edge of technology, which, by definition, exists only in limited quantities.
Which definition is that?

I can see how in some areas of technology, state-of-the-art would come in the form of a prototype. It may be impossible to manufacture sufficient quantities to satisfy the demand in a short time span.
I can also see how something like that could happen in medicine, in principle but I'd really like a real-world example.
I'm thinking that in medicine, some capacities must already exist to produce a large enough sample size to demonstrate efficacy. And, anyways, producing new drugs in existing plants is easier, afaik, than, eg, producing a new line of computer chips.

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I am grateful that the rest of the world wants to hold dollars and thus is willing to run a large trade surplus with us. It means we can consume more than we produce, which is a nice situation to be in.
Not a Trump fan then.

Quote:
In the case of health care, though, the rest of the world benefits from us not having a single payer system. Because of the high prices we pay for health care, particularly the state of the art stuff, health care companies are incentivized to develop new diagnostic equipment, new treatments and new medicines. Which the rest of the world eventually benefits from, with a small time lag after Americans get access. If we went to single payer, we would cut back our spending, and research and development would dry up.
That's not clear to me. For one, the US has had a single payer system, for a substantial part of the population, for quite some time. Medicare pays for those above age 65, and those are the heaviest consumers of health care resources.
Also, most hospitals in the US are required to treat all emergencies, regardless of ability to pay. So for that class of treatments, there is a sort of universal health care.
Come to think of it, I see how that's a sweet deal. Because of patents, there will be a monopoly on some new treatments. And hospitals are forced to contract. I wouldn't want to run a hospital in the US.
I can see how the lack of a market mechanism for this class of treatments should make them much more profitable in the US than elsewhere.

But that's not the entirety of health care.
In a universal system, a treatment will be paid for, for each individual who can benefit from it, rather than only those who can pay.
The higher number of customers in a universal system may still lead to a higher profit, even if the price is open to negotiations.

Some innovations may be more incentivized in universal systems. If you look at chronic diseases (or preventative measures) then the incentive is biggest with a health care provider that can't off-load expensive patients.
That's especially true for interventions that can't be patented.

I don't see how you can tell which effects dominate without a serious look at the data. Even then I think it would be difficult work.

Quote:
It means that instead of rich people buying access to better health care, you have politically connected or "important" people getting access to better health care. If a bureaucrat is making the decision about which treatment is covered, don't you think that the bureaucrat is susceptible to the normal pressures? Obviously, he will be doing favors for people. Might not even see it as immoral. After all, the people he helps are visible to him, whereas the people who are screwed (by being shuffled back in the queue) are largely invisible. This is simple human nature.
Ok, I reread your previous statements and here's my attempt at putting it together:
You're not talking about countries like the UK and Canada here, right?
You're talking about some (hypothetical?) country where it is impossible to get health care for money.
Furthermore, this country is unable to provide some specific, effective treatment to all those who need it.
In money-based system these limited treatments would go to the highest bidders. In the non-money based system, it still is necessary to pick who is treated.
Who exactly that is depends on the political system and who has the greatest influence.

So if you look at it like that, the most-money way of allocation is just another possible scheme (and presumably also based on who has the most influence, though you didn't say that).

Is that what you were trying to say? Did I miss anything?

Quote:
The point of free markets is to let people spend money the way they see fit. According to their own cost-benefit calculus. If somebody is too poor to afford a treatment, then, yes, it's unfortunate, although perhaps they can convince their friends to help out, or a charity, or make a public fundraising effort. The point of a free market is to allow people to express their preferences, not to weed out unproductive people. That's just cynical nonsense.
If that is the point of free markets, wouldn't it be best if everyone was provided with the same amount of money? To maximize their ability to express their preferences?
Actually, given your ideas about health care below, I think I know the answer. I'd really like to know more about how such a thing might work, though.

Even so, what does it matter what you see as the moral justification of free markets? Whether you label an outcome as "the point" or an unintended consequence doesn't matter to the actual outcome.

Quote:
Do I want to spend $10,000 to get knee surgery? Do I want to spend the extra money to get the best surgeon available, or will I seek a discount and let somebody a few years out of residency operate on me? Do I need a private room, or am I willing to save a few shekels by going semi-private? Do I want generic medicines or branded? Do I want the the state-of-the-art medicine with fewer side effects, or am I willing to tolerate a little incontinence of stomach upset in order to save a few more shekels. There are literally dozens of cost-benefit decisions to make for each procedure. Or at least there would be if we had a free market in health care.
I see now. The choice is the end, not a means to an end.

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That's not what I was talking about. The government gives you the money regardless of whether you are sick. You make your health care purchasing decisions on your own, as needed. The main idea is here.

No, it would be a stipend outside of employment. See the link above.
Hmm... I think that would need a lot of work to hammer out. I can see how the system is supposed to incentivize taking care with your health so that you can get cash. But health care spending varies greatly with age and whether someone has a chronic condition.
For most working age people, this would be basically free money.

How about this: The health of groups or individuals is turned into bonds. The government guarantees the payout of a certain sum for each day the individual/group remains in good health. These bonds are auctioned off to the highest bidder.
The bond-holder now has a financial incentive to provide preventative care to the individual or group, and also to get them to take up those offers.
There are some reasons why I think my proposal wouldn't work, but wanted to show an example of how free market incentives need not come from consumer choice.

Perhaps we should spare a thought to the role of preferences in the market:
Someone wants to have some fun. He could spend the money on any number of things. Maybe he wants to go for sports, or maybe he wants to read a book.
He is the only one who knows what gives him the greatest kick; where he gets the most for his buck. When he pays for whatever he likes, he directs resources. If he goes to a gym, he helps maintain the gym. It will remain available for the likes of him, rather than being re-purposed. If he buys a book, then the author can continue to write full-time.
Moreover, the mere possibility of getting the money, incentivizes business-minded people to come up with things that people might want.
Markets are good at allocating resources in ways that reflect the wishes of the general population.
In fact, markets are really versatile. We use the same system to 1)allocate resources efficiently, 2)incentivize people to work, and 3)identifying preferences; perhaps also other things I'm missing. I think the fact that we require one and the same system to do so many different things for so many different people is a problem but damned if I know a better solution. Anyway, back on topic...
Here, information flows from the consumer to the producer.

But now let's look at how this works in a medical context. You think you may need treatment. So you go to a qualified medical professional. She diagnoses you and offers treatment options. How does she know? Obviously she knows because scientific studies have been done and she learned about them.
Here the information flows exactly in the opposite direction: From producer to consumer!
That seriously limits the point of consumer choice. You have correctly pointed out that there is room for a consumer to express his preferences but most of those have to do with comfort and entertainment and not with with health care in itself.
That leaves the patient to chose between different treatments. This gives some information on what people want but it doesn't matter. You can't just produce more treatments of that kind. You can't tell R&D to produce a treatment with certain properties. The properties are dictated by whatever the facts happen to be.
There's really only the option to take it or leave it but that's just going to be mostly a reflection of his affluence.

Bottom line is: Consumer preferences in health care are much less important than in other areas.
If you go back to the history of the last century and look at the soviet, central planning economies (compared to the mixed economies of the west), you will find that central planning worked extremely badly for entertainment or consumer satisfaction in general. But it did work fairly well for health care.

Quote:
No, they have Medicare for all. I'm talking about Medicaid, which compensates providers at a much lower rate and basically sucks. The British safety net is too high. I think we could guarantee a level of care commensurate with the state-of-the art as of 10 to 15 years prior. The British system is more like 2 years prior. Of course, they can only get away with that by relying on the US to pay the lion's share of R&D and also by having a somewhat healthier population (which is a cultural and demographic benefit rather than a consequence of policy).
Ok, I'll have to take your word for it. I couldn't tell state-of-the-art medical care today from 10 or 15 years ago. I think few people could. To us, that is still basically the same.
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Old 24th January 2017, 01:01 AM   #244
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Originally Posted by Dr. Keith View Post
I should have read your links before replying:
As that great poet Homer put it: Facts are meaningless. You could use facts to prove anything that's even remotely true!
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Old 24th January 2017, 01:04 AM   #245
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Originally Posted by GnaGnaMan View Post
...snip....

Ok, I'll have to take your word for it. I couldn't tell state-of-the-art medical care today from 10 or 15 years ago. I think few people could. To us, that is still basically the same.
Systems like the UK NHSs really show how powerful market forces can be. The commercial pressure for a new drug or new technology to get to a price that the NHSs will pay for treatment is immense. If you can get NICE recommendation you are on the gravy train.
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Old 24th January 2017, 01:56 AM   #246
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Originally Posted by sunmaster14 View Post
Yes, it does. State-of-the-art means resources at the leading edge of technology, which, by definition, exists only in limited quantities.
[...]
In the case of health care, though, the rest of the world benefits from us not having a single payer system. Because of the high prices we pay for health care, particularly the state of the art stuff, health care companies are incentivized to develop new diagnostic equipment, new treatments and new medicines. Which the rest of the world eventually benefits from, with a small time lag after Americans get access. If we went to single payer, we would cut back our spending, and research and development would dry up.[...]
The British system is more like 2 years prior. Of course, they can only get away with that by relying on the US to pay the lion's share of R&D and also by having a somewhat healthier population (which is a cultural and demographic benefit rather than a consequence of policy).
That is some of the most uninformed twaddle I've read in a long time.

We have a Private Healthcare market in the UK. We have our fair share of wealthy elite types here as well and they don't as a general rule use the NHS. People that can afford private health care here, pay for private healthcare, usually via insurance. While the US does indeed bankroll some of the R&D in medical procedures, it certainly wouldn't "dry up".

A similar market would develop in the US as in other developed western nations, whereby the richest would still pay for private healthcare, with all the bells and whistles that they can afford to pay for, and the majority of the population would use the "free" option.

New treatments and drugs will still make pharma companies HUGE profits, even if you magically removed the USA from the market. The rest of the world is a pretty big place and demand for healthcare isn't going anywhere.

Profits for new treatments might decline slightly but they'd still be large enough to drive R&D into new ones quite happily.
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Old 24th January 2017, 02:00 AM   #247
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Block grants for medicaid....the beginning of the end of it.
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Old 24th January 2017, 02:01 AM   #248
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Originally Posted by Ambrosia View Post
That is some of the most uninformed twaddle I've read in a long time.
It is kind of telling, though, that conservatives believe that profit is the only motive for health care.
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Old 24th January 2017, 02:07 AM   #249
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Originally Posted by thaiboxerken View Post
It is kind of telling, though, that conservatives believe that profit is the only motive for health care.
They ought to make all politicians, of any political persuasion, who end up running a health department spend one day following a junior doctor, or an Ambulance crew.

Come to think of it that might not be a bad idea for a lot of other professions too.
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Old 24th January 2017, 05:45 AM   #250
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Originally Posted by Ambrosia View Post
They ought to make all politicians, of any political persuasion, who end up running a health department spend one day following a junior doctor, or an Ambulance crew.
The Democrats have a leg up here because they like the ambulance chaser type. Hell, they even ran one for Vice President in 2004 (although he turned out to be a skirt chaser too).
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Old 24th January 2017, 06:09 AM   #251
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Originally Posted by Dr. Keith View Post
I should have read your links before replying:
Actually, you should have read the actual report those links reference. As a lawyer, I'm sure you would have quickly understood how meaningless they are (and how circular the reasoning is).

Here are the metrics used for the grade:

Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.

Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.

Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.

Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.

I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
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Old 24th January 2017, 06:30 AM   #252
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Originally Posted by sunmaster14 View Post
I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
...i.e., I have no argument and hope someone else is capable of making my argument for me.
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Old 24th January 2017, 06:33 AM   #253
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Originally Posted by sunmaster14 View Post
I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
On average it is not, because more people in the US have to go without.

By your logic pre-revolutionary France had no famine problem, because the people who did get to eat, ate like kings.
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Old 24th January 2017, 06:43 AM   #254
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Originally Posted by Beelzebuddy View Post
On average it is not, because more people in the US have to go without.

By your logic pre-revolutionary France had no famine problem, because the people who did get to eat, ate like kings.
That's the conservative ideology. Poor people don't matter.
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Old 24th January 2017, 06:56 AM   #255
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Originally Posted by sunmaster14 View Post
I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
Or to put it another way, I'm only interested in those metrics that show the system I'm emotionally invested in, in a good light rather than a "basket" of metrics comparing systems as a whole.

That's a bit like me writing to the English Football Premiership and suggesting that rather than considering points awarded for games won and drawn - in which my team, the mighty Middlesbrough FC*, does pretty poorly - they should rank teams by number of goals conceded - in which Middlesbrough is mid-table thanks to a large number of dreary 0-0 draws and 0-1 losses.


* - When people ask me if I'm a football fan I usually respond "No, I support Middlesbrough"
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Old 24th January 2017, 08:00 AM   #256
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Originally Posted by sunmaster14 View Post
...snip...

I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
I'm genuinely curious. What metric(s) do you think we should be using in comparing healthcare between countries?
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Old 24th January 2017, 08:08 AM   #257
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Originally Posted by thaiboxerken View Post
That's the conservative ideology. Poor people don't matter.
"You can't be hungry, because I have a sandwich!"
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Old 24th January 2017, 08:16 AM   #258
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Originally Posted by sunmaster14 View Post
Actually, you should have read the actual report those links reference. As a lawyer, I'm sure you would have quickly understood how meaningless they are (and how circular the reasoning is).

Here are the metrics used for the grade:

Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.

Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.

Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.

Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.

Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.

I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.

It's up to you to explain your unique perspective as to why quality, access, efficiency, equity and mortality are "stupid" metrics. I doubt someone who needs care that he can't get -- more likely to be an American than anybody else in the First World -- would agree.
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Old 24th January 2017, 08:19 AM   #259
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Originally Posted by sunmaster14 View Post
The Democrats have a leg up here because they like the ambulance chaser type. Hell, they even ran one for Vice President in 2004 (although he turned out to be a skirt chaser too).
i.e. I can't come up with a suitable counterpoint to that, so here's a partisan joke that's tangentially related to the longest word in the paragraph.
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Old 24th January 2017, 09:10 AM   #260
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Originally Posted by sunmaster14 View Post
I leave it as an exercise to you to understand why most of those metrics are stupid and have little to do with whether or not the health care being delivered is high quality or not.
Originally Posted by Bob001 View Post
It's up to you to explain your unique perspective as to why quality, access, efficiency, equity and mortality are "stupid" metrics. I doubt someone who needs care that he can't get -- more likely to be an American than anybody else in the First World -- would agree.
Yeah, I'm assuming that he objects to measuring the system as a whole. The problem is that I pay for the system as a whole and I was commenting on the system as a whole, so I'll stick to metrics that measure the system as a whole.
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Old 24th January 2017, 09:34 AM   #261
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Originally Posted by Dr. Keith View Post
Yeah, I'm assuming that he objects to measuring the system as a whole. The problem is that I pay for the system as a whole and I was commenting on the system as a whole, so I'll stick to metrics that measure the system as a whole.
No, I'm objecting to the double counting and circular reasoning. The claim is that the US pays the most for healthcare but gets worse results. But the metric they are using for results includes the fact that some people forego needed health care because it costs more than they're willing to pay (or are able to pay). Another metric is equity, which would make a place where everybody gets equally crappy health care score higher than a place where everybody gets better health care but some get phenomenal health care.

Also, the metric having to do with overall health is misleading since it fails to account for cultural and demographic differences, as well as differences in consumer preferences. Even some of the seemingly objective measures, like infant mortality, are not objective. First, infant mortality is measured more conservatively in the US (e.g. deaths of infants born severely prematurely, or with certain birth defects are counted in the US, and they are not in other countries; also the counting is more honest); second, infant mortality is closely tied to low birth weight which is closely tied to teenage pregnancy, which is far more of a problem in the US than in other developed countries.

The only objective measure is what percentage of people with serious diseases are restored to health? I have seen studies that show the US does extremely well on these objective measures (e.g. various types of cancer), although even here there are differences in measurement. It's possible, for example, that, in the US, breast cancers are flagged which wouldn't have been harmful even without treatment.

Perhaps the most fundamental "problem" is that the US has a culture of personal responsibility, at least greater than exists in European countries. If somebody doesn't make a minimal effort to take care of their health or see the doctor when they need to, then it's on them. In Europe, people are more likely to be treated as wards of the state. That will give you better results for the most irresponsible people, but I think for 75-80% of the people, it doesn't help.
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Old 24th January 2017, 09:51 AM   #262
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Originally Posted by sunmaster14 View Post
The only objective measure is what percentage of people with serious diseases are restored to health?
Okay. You say you've seen studies on this subject. Can we see these studies, please?

Quote:
If somebody doesn't make a minimal effort to take care of their health or see the doctor when they need to, then it's on them. In Europe, people are more likely to be treated as wards of the state. That will give you better results for the most irresponsible people, but I think for 75-80% of the people, it doesn't help.
What does this even mean? Do you think in Europe the government forces people to go to the doctor if they feel ill? Do you think in Europe that people who don't go to the doctor can sue the government for any negative consequences of not having done so?
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Old 24th January 2017, 09:53 AM   #263
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Originally Posted by sunmaster14 View Post
Perhaps the most fundamental "problem" is that the US has a culture of personal responsibility, at least greater than exists in European countries. If somebody doesn't make a minimal effort to take care of their health or see the doctor when they need to, then it's on them.
No, it is on us. They walk into the emergency room a basket case and we have to stitch them back together at great cost.

Now, I think the right would like to change the law so that hospitals could turn away the indigent, but I don't see how that would improve your argument. And I think that is completely counter to the Trump quote that started this thread.

Do you think Trump wants to be the president known for removing the safety net so that poor people could be pushed out to die in front of the hospital?
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Old 24th January 2017, 10:03 AM   #264
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Originally Posted by Dr. Keith View Post
Do you think Trump wants to be the president known for removing the safety net so that poor people could be pushed out to die in front of the hospital?
No, but he wants to be the proud Republican who repealed that Muslim-communist-atheist inspired Romneycare Obamacare and if the price for that is a few dead poor people then that's acceptable......
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Old 24th January 2017, 10:05 AM   #265
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Originally Posted by sunmaster14 View Post
No, I'm objecting to the double counting and circular reasoning. The claim is that the US pays the most for healthcare but gets worse results. But the metric they are using for results includes the fact that some people forego needed health care because it costs more than they're willing to pay (or are able to pay).
The costs are also figured per capita. There's no double counting or circular reasoning, the US really does have crappier health care than our contemporaries.

Quote:
Perhaps the most fundamental "problem" is that the US has a culture of personal responsibility, at least greater than exists in European countries. If somebody doesn't make a minimal effort to take care of their health or see the doctor when they need to, then it's on them. In Europe, people are more likely to be treated as wards of the state. That will give you better results for the most irresponsible people, but I think for 75-80% of the people, it doesn't help.
That is the precise opposite of how the US health care system works. For those who can't afford health insurance, regular checkups and preventative care are the first things to go. So problems develop and fester until they are genuine emergencies, and then it's on you, because your costs now need to subsidize their treatment.
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Old 24th January 2017, 11:16 AM   #266
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Originally Posted by Squeegee Beckenheim View Post
Okay. You say you've seen studies on this subject. Can we see these studies, please?
Well, here's a Lancet study. Look at p. 993 (p. 17 of the PDF). I'll note also that health results/outcomes are often dependent on culture/ethnicity/genetics. I broke down the numbers once (as best as I could) and found that Japanese Americans live longer than Japanese, and that held true for other Americans of Asian descent. I think you'd find the same thing holds for Americans of European ancestry compared to Europeans of European ancestry. Also for African Americans compared to those of African descent in other countries. Despite the fantasy world in which progressives believe they reside, the real world actually has inconvenient genetic differences between different people, which impacts health and longevity (e.g. blacks are more prone to high blood pressure and obesity)

Quote:
What does this even mean? Do you think in Europe the government forces people to go to the doctor if they feel ill? Do you think in Europe that people who don't go to the doctor can sue the government for any negative consequences of not having done so?
There is less hand-holding, and certainly less coercion, in the US when it comes to encouraging patients to take their medicines or come to followup appointments. One of the biggest problems with patients on Medicaid is not showing up for appointments (roughly 1/3 of appointments are no-shows) and not taking their prescriptions according to directions. There is certainly no penalty in the US for either, or even a stigma, except to one's health of course. Some of it is cultural. Americans are less trusting of and respectful of authority figures.
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Old 24th January 2017, 11:21 AM   #267
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Originally Posted by Beelzebuddy View Post
The costs are also figured per capita. There's no double counting or circular reasoning, the US really does have crappier health care than our contemporaries.
You misunderstand my point. The claim is that the US has worse quality health care despite the fact that health care costs more money per capita. And yet, one of the key measures of quality is the cost itself (part of what is called efficiency). Another measure is access (which depends on cost). Another measure is equality (which depends on cost).

Quote:
That is the precise opposite of how the US health care system works. For those who can't afford health insurance, regular checkups and preventative care are the first things to go. So problems develop and fester until they are genuine emergencies, and then it's on you, because your costs now need to subsidize their treatment.
Preventative care in general is not cost-effective. That doesn't mean we shouldn't devote resources to it, since cost-effectiveness is not the only metric we're trying to optimize, but the fact is preventative care is not always a good thing. It doesn't make sense for me to get a colonoscopy every year, for example, even though it would probably lower my chance of getting colon cancer.
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Old 24th January 2017, 11:29 AM   #268
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Originally Posted by kookbreaker View Post
$5 says they just try to put a party hat on their 'state lines and more deregulations' bit they've been pushing as an alternative.
Removing the state boundaries and the independent regulations within each state actually would help.
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Old 24th January 2017, 11:31 AM   #269
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Originally Posted by MRC_Hans View Post
Health insurance for everybody is a good idea. In my country, we have had that for three generations. But where is Mr. Trump going to find the money?

Hans
okay, I'm a little slow... but isn't this the same argument made by the other side when it was ACA on the floor? Hasn't it been the republicans/conservatives saying "where will you find the money" and democrats/liberals saying "it doesn't matter, that's not the point, it's about the people"?
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Old 24th January 2017, 11:32 AM   #270
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Originally Posted by sunmaster14 View Post
Well, here's a Lancet study. Look at p. 993 (p. 17 of the PDF).
This is a study that looks at survival of certain kinds of cancers. Your assertion was that the "only objective measure is what percentage of people with serious diseases are restored to health". This seems like a very small subset of the data you'd need to go some way to establishing that the US scores well there.

Quote:
There is less hand-holding, and certainly less coercion, in the US when it comes to encouraging patients to take their medicines or come to followup appointments.
Citation?

Quote:
There is certainly no penalty in the US for either, or even a stigma, except to one's health of course.
And you believe that there are legal penalties in Europe for missing a medical appointment or not taking prescribed medicine?

Quote:
Some of it is cultural. Americans are less trusting of and respectful of authority figures.
Citation?
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Old 24th January 2017, 11:33 AM   #271
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Originally Posted by Trebuchet View Post
There was alrrerady insurance for everybody before Obamacare, they just had to pay for it. That'll be the new plan.
Not quite. There were quite a few people previously who were denied coverage, regardless of whether they were willing to pay or not.
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Old 24th January 2017, 11:37 AM   #272
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Originally Posted by sunmaster14 View Post
You misunderstand my point. The claim is that the US has worse quality health care despite the fact that health care costs more money per capita. And yet, one of the key measures of quality is the cost itself (part of what is called efficiency). Another measure is access (which depends on cost). Another measure is equality (which depends on cost).
I understand your point. Your point is wrong. They've factored those effects correctly.

Quote:
Preventative care in general is not cost-effective. That doesn't mean we shouldn't devote resources to it, since cost-effectiveness is not the only metric we're trying to optimize, but the fact is preventative care is not always a good thing. It doesn't make sense for me to get a colonoscopy every year, for example, even though it would probably lower my chance of getting colon cancer.
This is also incorrect. Preventative care is very cost effective, up to a point. I notice you're not arguing for no colonoscopies at all, despite that being exactly what people without insurance or the means to pay are currently entitled to.
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Old 24th January 2017, 11:54 AM   #273
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Originally Posted by sunmaster14 View Post
Preventative care in general is not cost-effective.
I'm going to have to ask to see your evidence for this one.
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Old 24th January 2017, 12:02 PM   #274
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Originally Posted by Ambrosia View Post
I'm going to have to ask to see your evidence for this one.
I know where he's going with this.

One current trend in health care is finding that too much screening can actually be disadvantageous, because all tests can throw false positives. If you get, say, a mammogram every week, sooner or later they'll find something that looks off enough for further investigation, despite it being intrusive, and expensive and almost certainly fruitless.

It may be hard to imagine someone able to understand the above without also coming to appreciate the positive effects of preventative care, but that's our sunmaster14. No facts are too apparent for him to circumspectly ignore in pursuit of his bias.
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Old 24th January 2017, 12:08 PM   #275
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Originally Posted by Emily's Cat View Post
Not quite. There were quite a few people previously who were denied coverage, regardless of whether they were willing to pay or not.
I was thinking about this earlier - do you know what the figure was?
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Old 24th January 2017, 12:15 PM   #276
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Originally Posted by thaiboxerken View Post
It is kind of telling, though, that conservatives believe that [yuuuge] profit is the only motive for health care.
ftfy
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Old 24th January 2017, 12:20 PM   #277
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Originally Posted by Ambrosia View Post
They ought to make all politicians, of any political persuasion, who end up running a health department spend one day following a junior doctor, or an Ambulance crew.

Come to think of it that might not be a bad idea for a lot of other professions too.
And Libertarians and Republicans need an education in how the free market works (they are working on drugs for Alzheimer's because that is a huge market) and doesn't work (new antibiotics won't be profitable compared to a copy cat, but not better, drug designed to take a slice of the viagra market) in health care.

It might open their eyes to the uninformed belief that pharmaceutical and medical device R&D investment only comes from yuuuuge profits as opposed to merely huge profits.
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Old 24th January 2017, 12:22 PM   #278
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Originally Posted by Random View Post
I'm genuinely curious. What metric(s) do you think we should be using in comparing healthcare between countries?
A heart transplant for Dick Cheney is a good measure.
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Old 24th January 2017, 12:24 PM   #279
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Originally Posted by Ambrosia View Post
i.e. I can't come up with a suitable counterpoint to that, so here's a partisan joke that's tangentially related to the longest word in the paragraph.
Counterpoint: it is a myth that suing doctors for malpractice is the cause of skyrocketing health care costs.
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Old 24th January 2017, 12:27 PM   #280
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Originally Posted by Ambrosia View Post
I'm going to have to ask to see your evidence for this one.
He is using the previous insurance company metrics, it's cheaper if we let the customer die of cancer than pay for said cancer treatment.
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