So you're telling me Obama swung to the right when he started campaigning?

11/8/2012 10:52:37 AM

I'm telling you that even during the 2008 Democratic primary debates, Obama was calling for cost controls and efficiency measures to bolster our current employer-based system. I remember his speeches at the time, and how he opposed Edwards' and Hillary's plans that called for universal coverage. He kept repeating that the problem was excessive cost, not the availability of care.

Then he flip-flopped after the election and made it all about spreading coverage, with little in the way of cost controls.

[Edited on November 8, 2012 at 11:06 AM. Reason : 2]

11/8/2012 11:06:25 AM

Quote :

" He kept repeating that the problem was excessive cost, not the availability of care. "

11/8/2012 11:07:59 AM

Yeah, I kinda bungled the wording on that. But his healthcare platofrm in 2008 revolved around lowering healthcare costs, not providing universal coverage.

11/8/2012 11:18:26 AM

it's close enough

facepalm was directed at our president.

11/8/2012 11:22:35 AM

Quote :

"They don't care. The sense of morality about profits in the health care industry is more important to them than people getting the care they need."

its not even so much about profits in the provider space as it is woeful incompetence.


e:

also preventative maintenence is a good thing (and covered 100% by many insurance plans), but people still dont take advantage of it. there has to be a component of healthcare reform that puts some of the ownership of patient health on the patient.

[Edited on November 8, 2012 at 3:19 PM. Reason : a]

11/8/2012 3:16:40 PM

Quote :

"the problem was excessive cost, not the availability of care."

this is correct.

11/8/2012 3:17:34 PM

Quote :

"Then he flip-flopped after the election and made it all about spreading coverage, with little in the way of cost controls."

Requiring all Americans to have health insurance is a cost control. Its THE cost control.

11/8/2012 4:09:24 PM

lol no

11/8/2012 4:12:51 PM

Uh, yes, it is. Preventative care and contraception is more cost-effective than emergency room visits and abortions/unwanted children.

11/8/2012 4:40:45 PM

I mean, it's probably not as cost effective as letting people die in the streets, so the most cost effective option would be repealing EMTALA

11/8/2012 4:41:39 PM

Quote :

"also preventative maintenence is a good thing (and covered 100% by many insurance plans), but people still dont take advantage of it. there has to be a component of healthcare reform that puts some of the ownership of patient health on the patient. "

What are these mythical health care things that keep people from incurring larger medical bills later? Should I walk into a doctor's office right now and ask about this plethora of helpful things? It certainly hasn't come up in my previous visits.

I mean, here's a graph:

http://www.aarp.org/health/medicare-insurance/info-10-2009/fs144_costs.html



Here's another graph!

http://worldofdtcmarketing.com/true-costs-of-healthcare-and-drug-development/cost-of-healthcare-in-the-u-s/



Neither of them help your point!

Quote :

"Uh, yes, it is. Preventative care and contraception is more cost-effective than emergency room visits and abortions/unwanted children."

We're not talking about Planned Parenthood, we're talking about the health care bill. I don't see where this cost reduction is coming from. Is Obamacare going to reduce teenage pregnancies? Maybe you think the doctor's office will proudly take it upon themselves to provide real sex-ed to the abundance of abstinence-only school district kids. Oh what a lovely fantasy!

11/8/2012 5:15:38 PM

Quote :

"Can we also stop pretending that health care is something that can ever be adequately addressed by a "free market" approach? Can we please acknowledge that there is an inherent uniqueness to health care that makes it impossible for a "private" system to ever work?"

Thank you Shrike. Can you imagine a system where the main driving force determining people's health, or lack thereof, the profit motive? Why, that would lead to companies collecting as much money as they could and then trying to limit services through things like lifetime caps, and pre-existing conditions.

Let's see ... Money is handled through private insurance, and services are provided in the private sector. That makes it socialism? It was the least socialistic way of reforming healthcare - which everyone seems to think it has needed for at least 30 years.

And yes, I'm sure they are trying to bankrupt the insurance industry by making sure that everyone has to buy their product, at least some minimum preset level. /sarcasm

[Edited on November 8, 2012 at 5:22 PM. Reason : *~<]Bo]

11/8/2012 5:20:23 PM

Quote :

"Thank you Shrike. Can you imagine a system where the main driving force determining people's health, or lack thereof, the profit motive?"

While I can't make heads or tails of most of this, consider:

Can we have a system where the main driving force is people's health?

Really, can you imagine that? Perhaps we'll create a system where we put people in charge, and those people in charge are told that the main goal is to have as good of health as possible for everyone. But is everyone down the line motivated by that? Are even those people at the top motivated by this? Or are they just motivated with pleasing whoever is bankrolling the thing?

You know who actually cares about the health of an individual? That individual. Maybe instead of working to provide everyone with good health care, we'll just take the money we would spend on the health care (or mandated be spent), and hand that money to individuals. It then follows that they're better motivated (and more capable) than anyone else out there to get the best health outcome.

Oh wait, even better idea! While we do that, why don't we give these "individuals" the best tools possible to take care of their health. But if they're paying for it from their own pocketbook, then we need to make sure it's as efficient as possible. Maybe the best way to do this is then to limit the kinds of products they can buy, and who can sell it to them, as little as possible.

...just maybe...

11/8/2012 5:35:44 PM

I thought Shrike covered that ... When people need heath care they are in no position to shop around. When they don't need it they don't buy it. On the other side, people that issue it try and limit their costs (i.e. more profit) by not paying for it. That is why we need something other than the profit motive - i.e. some form of health care reform. And it happened all through the private sector (other than the ground-rule regulations).

11/8/2012 6:03:51 PM

Quote :

"When they don't need it they don't buy it."

You say this, but I don't believe this is the problem you're solving. Why would this dictate mandating covering birth control or Viagra, or even meds that last for someone's entire life. "Sick" should be something that happens temporarily, or it kills you. Our health insurance today is something that pays for people to be supported for chronic conditions (or non-conditions) for the rest of their lives. In that light, it's no surprise that it's become expensive and people have opted out. Indeed, people don't buy "it" when they're well because it's not the product you sell it as.

11/8/2012 6:39:59 PM

Quote :

"When people need heath care they are in no position to shop around."

Bullshit. Unless you're going to the ER, just about everything else could be shopped around. People don't because with how screwed up insurance and medical billing is, most places can't or won't give you a quote.

11/8/2012 7:56:49 PM

Quote :

"Right, but that's the thing, when someone makes a poor decision in how they buy health care, it's the responsible consumers of care that pay the penalty."

BECAUSE THE GOVERNMENT MANDATED IT!!! Government made the fucking problem, yet you are saying this is a failure of the market? What in the hell are you smoking, dude?

Quote :

"Again, this is unique to health care."

No, it's unique to government meddling and distortions in the market! There is LITERALLY no other product or service that the government mandates be provided to anyone who requests it, with or without payment. Stop and think about that. Emergency Healthcare is the ONLY service that has such a government mandate, and it's the only service that has the problem of costs of non-payers being pushed prohibitively onto the payers. This is not a coincidence.

Quote :

"Again, you're assuming consumers will act rationally. What if they don't?"

So your solution is to remove any incentive for consumers to act rationally whatsoever?

Quote :

"No it's not. Emergency care and expensive treatments for unforeseen chronic conditions is the reason why health care is such a problem. It's why we need insurance."

I agree, and those things are GREAT for insurance to pay for. Unfortunately, that's not what insurance pays for nowadays.

Quote :

""Certain label" is what sells the product...if it was labeled 5% beef nobody would buy it. So his analogy is actually quite on the spot."

Maybe so, but the label doesn't also outlaw other competing forms of the product, and therein lies the rub.

Quote :

"We need actual socialized healthcare."

So you admit that we don't have a free market, yet you claim the free market has totally failed and we must pursue socialized solutions. Stop and think about that... Privatization isn't the problem; the privatized distortion caused by government action is the problem.

Quote :

"Costs are out of control because privatization funnels government money to the private industry. "

No. Costs are out of control because the people consuming the good are insulated from paying the actual cost of the good. No amount of added government regulation will fix that. In your next statement, you recognize that there is no market feedback, but you fail to connect the dots to see precisely why that feedback is not there: the disconnect between the purchaser and the payer. It's no wonder, then, that you advocate for widening that disconnect via socialized means.

Quote :

" there has to be a component of healthcare reform that puts some of the ownership of patient health on the patient."

How are you going to do that when the person is insulated from paying for their own medical care? One of the GREAT things insurance does is price BY RISK. Yet Obamacare SPECIFICALLY removes the ability of insurance companies to do that in any meaningful way. We've gone BACKWARDS from what you think we should do.

Quote :

"And yes, I'm sure they are trying to bankrupt the insurance industry by making sure that everyone has to buy their product, at least some minimum preset level. /sarcasm"

Failing to enforce that requirement yet requiring that all companies accept any applicant, no matter what, is what will bankrupt the insurance companies.

Quote :

"I thought Shrike covered that ... When people need heath care they are in no position to shop around."

And I already covered that. If you falsely limit the scope of competition only to the point of purchase, then of course it breaks down. Then again, if I build a man out of straw, I'm pretty certain I can beat the stuffing out of him pretty good, too.

11/8/2012 10:58:28 PM

Quote :

"Privatization isn't the problem; the privatized distortion caused by government action is the problem."

Which is an inherent part of privatization by the government. Thus, privatization is the problem.

Quote :

"So you admit that we don't have a free market, yet you claim the free market has totally failed and we must pursue socialized solutions.."

I have never claimed the free market failed, I am saying that there has not been, is not now, and has not been proposed a free market. It's not on the table.i also don't understand why you phrase it like a "gotcha" when I said it explicitly. It's part of my point in fact. I already said, explicitly, there is no free market. Government privatization is not a free market.
Privatization=/=free market

Quote :

"No. Costs are out of control because the people consuming the good are insulated from paying the actual cost of the good. No amount of added government regulation will fix that."

This is the nature of privatization, you can't stop increased costs with privatization. Governments only control is negotiating rates, and that doesn't work long term. Obamacare, our health care system, proposed vouchers... it's all privatization and all increases the costs for the reasons you state.

Socializing medicine doesn't have the same problem of not having feedback because the money is staying in government service. With the government providing healthcare, there is no incentives to increase costs, there are incentives to keeping them from rising,


We need actual socialized health care. This doesn't replace the free market, it would still exist and finally be actually a free market (as free as medicine can be)

11/8/2012 11:30:32 PM

Quote :

"BECAUSE THE GOVERNMENT MANDATED IT!!! Government made the fucking problem, yet you are saying this is a failure of the market? What in the hell are you smoking, dude?"

That's right, I forgot I'm debating with a racist who believes we should just let poor people bleed out in hospital parking lots if they can't provide payment. Carry on then.

11/8/2012 11:41:27 PM

Some kinds of preventive care save money (esp. vaccinations), but in general, government-subsidized preventive care for all manner of rare disorders costs money and deteriorates health in the long run, as people who aren't really at risk end up motivated by fear to get those low-cost screenings anyway, and some of the better-hyped ones (like mammograms) are inherently dangerous, with the benefits outweighing the danger for only small groups of the population (like the elderly and women with family, and especially personal, histories of breast cancer): http://www.politifact.com/truth-o-meter/statements/2012/feb/10/barack-obama/barack-obama-says-preventive-care-saves-money/

11/9/2012 12:22:08 AM

Even TED has hosted talks damming mammograms

http://www.youtube.com/watch?v=DqbM1ZrpTQg

Basically, it's an entrenched culture that we have to do this procedure at a given time for everyone because of the public perception of breast cancer=bad. It's painful and it often doesn't help. The medical establishment had basically started ignoring the facts coming out of research.

11/9/2012 8:24:18 AM

hey now, don't you start coming between me and overpriced pink stuff

11/9/2012 8:39:43 AM

TED is trash and always has been, it's an idiot's idea of what smart people sound like

11/9/2012 9:16:53 AM

Exactly, real researchers don't communicate their ideas to the community through seminars.

11/9/2012 9:52:23 AM

this isn't on topic, but real researchers have issues with the way we do a lot of screenings too, its not just TED talks. at least that is my understanding from print and tv media, so who knows.

11/9/2012 10:29:47 AM

So are you automatically not a real researcher when you give a TED talk? Nothing could be more absurd.

There is a problem with the application of research to the practice of mammograms, and I heard about it through TED talks. I'm not a doctor, so it's not like I should have read it through the literature instead. It's as good as a news article, depending on the publication you're reading.

11/9/2012 10:40:04 AM

Quote :

"Uh, yes, it is. Preventative care and contraception is more cost-effective than emergency room visits and abortions/unwanted children. "

yes, but thats not what increased coverage gets you. increased covereage gets you increased coverage. even for things like checkups or standard prevenative screenings, people dont do that shit even if they have insurance and it covers the entire cost. people dont take care of themselves, and this myth that the uninsured are costing all the money is idiotic. plenty of insured people do the exact same goddamn things.

as mrfrog points out, the leading causes of long term health costs are all preventable without any patient doctor interaction whatsoever. healthy eating and exercise would do 1000000000000x more good than any amount of money you want to throw at the problem. i know this conflicts with the talking points from your latest democrat newsletter, but its the truth.

Its pretty hard for a politician to say "hey, you dumb shits should eat better. we're gonna let insurance charge yout extra for bad health choices." and very easy to say "eat whatever the fuck you want, we'll pay for it later. also here are some more corn subsidies to keep junkfood prices low. go hog wild."

now this is mostly about fixing the inputs. By reducing the rate of chronic disease (through prevantative maintenance) you can decrease long term costs. Most chronic disease in middle-late age is a result of personal choices. after that it becomes age, which we cant fix (yet). The reductions that are possible dont have anything to do with insurance coverage.

Then you get into the costs of actual care once someone does enter the hospital or the doctors office. These costs are a result of what goes on inside those facilities, regardless of the inputs. This is what insurance pays for. The only way to fix these costs is by fixing the problems inside the facilities. Most of it wouldnt be hard, it would just take a while. Things like proper usage of EMR systems. Checks on documentation, perscriptions, tests, etc... Basically implementing process controls so things dont fall through the cracks. Right now if the hospital fucks up and discharges a patient incorrectly and the patient has to come back, the hospitals make more money. The system rewards fuckups. Under obamacare there are now penalties for such readmissions, which is a good thing. I dont think it goes far enough, but its a good start. Forcing hospitals to examine their processes will close gaps, increases quality of care, and lower costs inside the hospital. This, in turn, lowers insurance costs.

You can hem and haw about insurance all you want, but its a symptom of the problems in our healthcare system, not the cause.

11/9/2012 11:37:18 AM

The biggest problem with obamacare is that it will save money and people wont understand why. People will confuse the savings from the real cost controls with the smoke and mirrors of the individual mandate. This will make it harder to justify more cost controls.

11/9/2012 11:43:06 AM

Quote :

""When people need heath care they are in no position to shop around." Bullshit. Unless you're going to the ER, just about everything else could be shopped around. People don't because with how screwed up insurance and medical billing is, most places can't or won't give you a quote."

This is the point that has the greatest sway on my position. I mean, who do you think you're helping and hurting really?

If I was in charge of reforms, the first thing I would do would be to make major hospitals post "open market" prices for most major procedures. Not prices you can get by calling, but prices you can look up, schedule an appointment, and just hand the money over.

But no one would ever even begin considering this, because it runs a complete 180 degrees of the structure we've set up, where a doctor lists what he/she did, then the desk looks up what they can charge for it, and they're paid that regardless of any other factors.

11/9/2012 2:32:16 PM

During the Obamacare debate, a proposed cost-control from the Administration was to create a division set up to track typical charges for various procedures. They were going to build up a database of expected costs for different operations, much like how every auto shop uses the same reference book for time and materials spent on oil changes, brake jobs, tune-ups and the like. At the mechanic, it doesn't really matter if one brake job takes 5 hours and the next one only 2. They all bill a standardized 4.2 hours per brake job, plus the cost of new rotors, pads etc. That way they can quote you ahead of time and stick with the quote unless something else is discovered in the process of performing the job.

Doctors and hospitals killed this proposal because they saw it as too restrictive.

11/9/2012 2:59:11 PM

Quote :

"During the Obamacare debate, a proposed cost-control from the Administration was to create a division set up to track typical charges for various procedures. They were going to build up a database of expected costs for different operations, much like how every auto shop uses the same reference book for time and materials spent on oil changes, brake jobs, tune-ups and the like."

http://www.youtube.com/watch?v=3-Ilc5xK2_E&t=7m13s

"medicare will also create a bunch of experiments around the country to test different ways of paying doctors, hospitals, and other providers"

That youtube video was posted somewhere in TSB, I can't find where. But anyway, it sounds like this bit from the video is "educating" me on the point that they'll preform experiments that sound exactly like the thing you say it won't do.

Is this the same thing? I talk about this a lot, so I want to be clear with my understanding. My main concern is how it will affect costs. The only actual arguments I hear for how it will try to lower costs are:
- It widens the pool of people with health insurance
- It provides some experiments to lower costs

Now, the latter point might only apply to medicare in the first place. But then again, it sounds like it might just not apply at all. I need to know, since this is an important point in the discussion.

[Edited on November 11, 2012 at 4:10 PM. Reason : ]

11/11/2012 4:09:12 PM

Denny's owner plans 'Obamacare surcharge'

A man who owns 40 of the restaurants says he has no choice if he wants to stay in business.

http://finance.yahoo.com/news/florida-restaurateur-to-impose-surcharge-for-obamacare.html

11/16/2012 12:12:17 AM

What does that valve to do with this topic?

11/16/2012 6:50:02 AM

Headline: Business owner raises prices/fires employees, claims he has no choice, blames scapegoat, water wet

11/16/2012 9:50:23 AM

actually, it's more like this:
Headline: Gov't adds more regulations. Business owner passes cost of compliance onto consumers, as usual

Quote :

"Which is an inherent part of privatization by the government. Thus, privatization is the problem. "

No. Getting gov't out of something it should have never fucked with in the first place was the problem. You are saying that "privatization" is the problem, as if the only way medical care could ever be administered is at the end of a bureaucrat's queue. "Privatization" might not be the same as "free market", but you seem to be decrying any and all attempts to get us back to a free market as "evil privatization." It's a great catch-22 you've got going on there

Quote :

"That's right, I forgot I'm debating with a racist who believes we should just let poor people bleed out in hospital parking lots if they can't provide payment. Carry on then."

Shocker. Shrike heads straight to the race card. True or false: hospitals must provide some kind of service to any and all people who enter the emergency room, no matter how serious or minor their affliction, due to a law. Now, who passes laws?

[Edited on November 30, 2012 at 11:46 PM. Reason : ]

11/30/2012 11:41:32 PM

Pre-obamacare, post-obamacare, vouchers, other proposals... None of them are keeping government out of it. What they all are though is funneling government money to private companies.

Privatization.


It's a problem, we have no free market solution even being proposed

1/9/2013 7:09:03 PM

Quote :

"Gov't adds more regulations. Business owner passes cost of compliance onto consumers, as usual"

Actually, that's not how it usually works, that's how intellectually lazy, free market charlatans claim it works because it's convenient to their anti-government rhetoric. You can go ahead and pass the costs to your consumer, but if your competitor instead decides to accept a reduced profit margin, you can kiss your remaining sales goodbye. What you decide to do depends on whether you'd rather have a low-profit business or no business at all.

[Edited on January 10, 2013 at 1:28 PM. Reason : .]

1/10/2013 1:25:11 PM

^lol. you're right, no business has ever managed to succeed after increasing their prices or charging more than a competitor.

when the government makes it more expensive to run a business, of course many of them will raise prices to compensate. but to hell with profits, you'd rather they just accept higher costs, grin, bear it, and take it up the ass, just like you expect all the evil rich people in this country to do.

1/10/2013 2:03:13 PM

And then the competitor goes out of business because their margins are too thin and they can't grow or expand their market.
Then the first person who passes on their cost becomes one of only a couple of vendors, which leads them to be accused of a monopoly and price gouging.

1/10/2013 2:07:17 PM

Quote :

"You can go ahead and pass the costs to your consumer, but if your competitor instead decides to accept a reduced profit margin, you can kiss your remaining sales goodbye. "

That claim has already been eviscerated, but you can feel free to continue clinging to it

1/11/2013 1:04:29 AM

Quote :

"You can go ahead and pass the costs to your consumer, but if your competitor instead decides to accept a reduced profit margin, you can kiss your remaining sales goodbye. What you decide to do depends on whether you'd rather have a low-profit business or no business at all. "

No doubt. And then when a competitor's "reduced profit margin" turns out to be too low, they will close. Then, the remaining competitors, facing less competition, will not just raise prices a little, but enough to drive profits above where they were before the regulation. Such is why industry is usually in favor of regulation: it usually drives small competitors out of business and the resultant loss of competition more than compensates for the regulatory burden.

[Edited on January 11, 2013 at 1:44 AM. Reason : .,.]

1/11/2013 1:42:42 AM

And if any option on the table was a free market solution with no government intervention then this would be relevant.

But they aren't so it's not.

1/11/2013 6:08:37 AM

Quote :

"That claim has already been eviscerated, but you can feel free to continue clinging to it"

Ah yes, this "claim" that is based on elementary school reasoning that only requires that you assume that not every company is operating at a hair-thin margin.

Quote :

"No doubt. And then when a competitor's "reduced profit margin" turns out to be too low, they will close. Then, the remaining competitors,"

You mean the ones that went out of business? Zombie companies?

[Edited on January 11, 2013 at 9:26 AM. Reason : .]

1/11/2013 9:24:32 AM

We need socialized healthcare, not this privatization shit.

3/11/2013 4:23:51 PM

I don't have any interested in pooling risk with people that don't give a shit about their health or their body.

I don't mind if someone wants to blow up to 500 lbs and die at age 40. I think it's sad and I can empathize with them and the people in their lives that will be affected, but it's not my place to say they can't or shouldn't do it. If you're going to hold a gun to my head and say that I have to help them pay for the consequences of their actions, it becomes my problem. It's not a problem I asked for, though. I don't want any part of your grandiose vision where everyone does what's right for "the greater good", and "society" is becomes synonymous with "all individuals ruled by the same government".

Socialized health care works (relatively) well in a small country where people are already fairly healthy. It would work horribly in a giant country where the majority of people know more about optimizing calorie intake at Golden Corral than the fundamentals of nutrition.

[Edited on March 11, 2013 at 5:45 PM. Reason : ]

3/11/2013 5:43:35 PM

luckily you not wanting to be forced to pay for something is pretty insignificant

3/11/2013 5:48:53 PM

Yes, I'm aware that you don't consider other people or their concerns. That just makes you an asshole, it says nothing about the rightness or wrongness of your position.

3/11/2013 5:51:29 PM

^^^ you realize under ANY system, you pool risk with unhealthy people?

It's why emergency rooms charge so much (not because they're dicks, but because they're making up for the free healthcare they give poor people). This is an implicit form of risk pooling.

You could argue that Hospitals shouldn't provide care to people who can't pay, but you'd be imposing your own morals onto the hospitals, since i bet most of them would do so voluntarily.

[Edited on March 11, 2013 at 5:56 PM. Reason : ]

3/11/2013 5:55:53 PM

^^ I do consider other people's concerns, which is why i think we need socialized medicine. you do not consider other people's concerns, only your own. you are an asshole.

3/11/2013 5:57:21 PM