RPGDX > Forums > Off Topic > U.S. health care reform

tcaudilllg · Posted: Fri Jul 24, 2009 12:37 pm Post subject: U.S. health care reform

I know you guys, most of you, don't live in the U.S. (or a lot of you don't), so this may come across to you as academic. But in the States, a form of universal care is finally appearing.

Now I know that health care is expensive, and that it has to be paid for one way or another. In most countries, it's through the levy of a high tax. In the U.S., it's looking like a tax on the (perpetually) super-rich and a partial repeal of the infamous Bush tax cuts on those persons. There are humanitarian arguments for universal care, but in my view it's simply economic: there is an oligopoly in place -- a form of "consensus" being held between insurers and not challenged -- or set of them that is essentially covertly conspiring to elevate prices. We saw this kind of thing with the oil markets recently, and with the housing markets to some extent. But oligopoly is a big problem besides.

The only way to beat an oligopoly, once it has emerged, is by the entry of a competitor who is indifferent to it and upholds the rules of fair competition. There are two ways in which this competitor can emerge: by choice of individuals to fight it out -- if they have sufficient organization! -- or by government sponsorship of a perfect competitor. As it is, the people who would otherwise bring order to the health care market seem to be simply deferring to the government because it's not a matter of a want which is being offered, but a need.

It's nothing more than a philosophical issue. Let the government do it: this industry probably shouldn't even exist. The entry of the government competitor will gradually decline membership in private plans, but not in a way that is catastrophic. Ultimately the public option is only a prelude for the elimination of the reigning oligopolies: when it is the taxpayer who is paying the tag for HMO execs' golden parachutes, the enemies of oligopoly will have leverage to take control of all those aspects of the health market which do not obey the rules of fair competition.

This is the American approach to universal care: the introduction of a perfect competitor who offers services that the private competitors are simply unwilling to match. Ironically the oligopolies are the instruments of their own demise: without tying health care costs to taxes, there is no pressure on the oligopolies to reduce costs, because the burden of paying the costs is not collective. But put the individual voter on the hook, and government intervention sweeps in like a tide. The oligopolies will be destroyed by the self-same impulse which spawned them:

Greed.

RampantCoyote · Posted: Fri Jul 24, 2009 4:04 pm Post subject:

Yes, I can't wait for my health care to be managed with the efficiency of the Department of Motor Vehicles, the care and compassion of the IRS, and the thriftiness of the stimulus package. I'm looking forward to having my job eliminated because small businesses who got by with limited health care before are now forced to pay a fine for not paying for the expanded package mandated by the government (or, optionally, they just get rid of employees to save costs). (What will really happen - been there, done that - is I'm gonna be forced to be self-employed, because my employers can't afford "employees" that it is required to insure, but it can pay for independent contractors).

I am looking forward to the upcoming lack of innovation and new medical research as hospitals and doctors are forced to focus on limiting costs instead of providing better health care. I look forward to the government limiting my quality of health care. I am thrilled to have my taxes increased to pay for it all (and if you believe it is ONLY gonna be paid for by the "super-rich", I have a bridge in Brooklyn I want to sell ya).

Oh, and let's get ready for doctors to limit the number of "public option" patients they allow, like they currently do with Medicare, until the private health insurance is completely destroyed (as you suggest) and we're all on effectively socialized medicine.

And THAT, I fear, will resemble my experiences with an HMO back around 1991. I have a problem with my knees - a "lateral patellar tilt." My knees are on kinda sideways. As a kid, I thought everybody's knees were at an angle like that.

Anyway, when I was in college and on an Air Force ROTC scholarship, I started experiencing some problems with all the marching and running I was doing. I went to the local doctor to get them looked at, and he was ready to set me up for surgery the very next week. But I couldn't pay for that, and I had to go through my mom's insurance. Which was an HMO (Kaiser Permanente). What this involved:

#1 - I had to get an appointment with a primary care physician. This took about a week, for non-life-threatening issues.

#2 - He told me that my next step, before surgery, was to get an appointment with a specialist, who could then recommend me for surgery. That would take a year. Not for the surgery - just to have an appointment with the specialist. It was absolutely useless for me - I was going to have to get a medical discharge from the Air Force if I had to wait that long. In the end, they expedited things - I received my appointment. Set for TEN MONTHS LATER.

#3 - After getting the recommendation from the specialist, it could take between 1 to 3 years to get surgery. When I explained to the doctor that it was completely unreasonable, he answered that they had patients with cancer and other life-threatening issues that were far more important than my knees, and those had to come first. In other words, medical care was being rationed, and I was at the bottom of the queue.

In the end, I was forced to take a medical discharge from the Air Force. In retrospect, I do not feel any regrets about losing that career opportunity (or the scholarship that came with it), but I still seethe with anger at the absolutely crappy medical system that forced the issue.

And I am terrified that our entire country's medical system will soon resemble it.

I am first to agree that we *NEED* change in our health care system. (Does ANYBODY honestly feel that the status quo is wonderful?) We need to make sure that people can go to the doctor when they need to. Pure capitalism is insufficient when it comes to humanitarian need. And I'm seeing more and more of my income going to pay insurance companies which in turn refuse to pay any but the most basic of costs. I don't know where that money is going, but something stinks, and I think the big medical insurance companies are rotten to the core.

But what's on the table (so far) doesn't fill me with warm fuzzies yet. Not even close. So far the only part of the health care reform that I can really get behind (and even IT is pretty vague right now) is the initiative to computerize medical records.
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tcaudilllg · Posted: Fri Jul 24, 2009 8:51 pm Post subject:

Harry Reed is smarter than that. He won't let that happen.

No one said doctors were going to be allowed to pick their patients. That's one of the FIRST things to go. That said, if a doctor limited public option patients and I found out about it, I would not only boycott his office, I would sign a petition to have his medical license stripped. We haven't yet made ENOUGH use of the medical potential in this country.

What it probably means in the long run is the end of private practices. Instead more people will be going to the hospital for their care. (except for the more unusual stuff) That will be a good thing: doctors will be working harder instead of raking it in like crazy just because they went through X years of med school. Working hard, like the rest of us.

They didn't ALWAYS make this much money. Although it's been going on for 40-odd years, managed care wasn't always the norm in the United States. The original culprits were the equipment manufacturers and drug companies, who charged exorbitant fees for their life-saving innovations. This trend was abetted by the emergence of private ensurers, who calculated that total costs over the period were predictable and could be covered with a profit by charging potential patients a steady fee over an extended period. (and if they didn't fit the model, they could always be denied coverage) At this point a new industry emerged that never should have existed. We must turn back the clock and start over.

Here's my experience with the current system. I broke my nose when I fell one night. It was a bad break: the bone fractured and my nose became dis-aligned. I got reconstructive surgery for it a month later. The half-hour procedure ran $5000 altogether, of which my dad's insurance paid $4000, or 80%. I was left to pay $1000 dollars, $500 for the anesthesia and $500 for the surgery. It's been seven years and I've not paid back one red cent. And why should I? Complications from the surgery have emerged: at times when my nose gets dry, I begin bleeding profusely and must hold my nose until it clots. Even afterward, I get sick from the dried blood. Only three days ago I had a headache because my nose had become minorly misaligned during sleep. This misalignment, which I had to correct myself by pushing at it gently until it was repositioned (I could tell such when the pain ebbed), was painful enough that I had to stop everything else I was doing.

But this is the best part: the surgery might not have been necessary if I had been admitted within a week of the break, because before then the nose could have been realigned. As it was, the surgeon said, he needed to re-break the nose because it had already healed in an off-position. But I had requested admittance from the same hospital the day after the break, and was refused. So, that's my health care horror story.

I've got another one, though: when I was a kid, I had horrible acne. I tried all the commercial creme treatments and none of them worked. My parents agreed that the only effective treatment would be medication, but when I asked they always seemed to put off the actual appointment for it. When I asked them about it later, they told me why: they couldn't afford it.

No one expects a perfect bill from the outset. But I think there's going to be a tweaking process over the next few years. Whatever this bill becomes, will not be the last word on health care in America. But we need to start somewhere.

RampantCoyote · Posted: Sat Jul 25, 2009 5:18 am Post subject:

Sorry. Maybe you can trust Harry Reed, Obama, and their underlings and bureaucrats and - most especially - their successors - with your health care. Personally, I don't trust those dipshits in Washington DC any further than I can throw 'em. And I'm not just talking about the current crop.

These are the same losers who keep trying to get videogames classified as pornography or having them studied by the center of disease control as potentially hazardous infectious who-the-freak-knows-what. And the ones who pretty much let the economy go out of control in a wild old party, for which we are enduring the mother-of-all-hangovers now.

Do you really want those goobers determining the limits of your health care? And don't think for a second that it's an unlimited resource. On native American reservations, they have an expression:

"Don't get sick after June."

This is because the "free health care" that the government is contractually obligated by treaty to provide native Americans living on reservations is underfunded (but hey, they keep costs down!), and the money typically runs out mid-year. According to the above Associated Press article, "American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease."

Medicare's projected bankruptcy has now been advanced from 2019 to 2017, by their own admission. Eight years from now.

This is NOT a stellar track record for our government's management of health care.

And I don't think for a minute that a popular, charismatic demagogue is gonna change that.
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Rainer Deyke · Demon Hunter Joined: 05 Jun 2002 Posts: 672

Socialized health care works in many countries that have it, even in countries where the government is otherwise as stupid as the US government (or worse). Which is to say:

It's easier to get health care there than in the USA.
It's overall cheaper to get health care there than in the USA.

Only the very rich benefit from the current system in the USA.

All governments are incompetent, but it would take a very special kind of incompetence to fuck up the health care system in the USA worse than it already is. Which won't stop congress from trying, of course.

DeveloperX · Posted: Sat Jul 25, 2009 7:27 am Post subject:

I do not trust, nor will ever trust any doctor / medical field personnel.

To hell with the pharmaceutical bastards who only lie to everyone to make a fucking buck!

There is no such thing as disease or sicknesses. Its all a damn lie.
The truth is that its a lack of proper nutrition & hydration!

I'm so sick and tired of hearing about how people gotta go to a motherfucking doctor all the time.

My friend's mom is on 17 different medications...not one of the fucking things does she need. What she NEEDS is to drink 12 glasses of water a day and eat healthy ORGANIC non pesticide-laden garbage fake fucking food that the mass majority of this fucked up planet consumes!

My grandmother doesn't even know who I am, because she never got the right nutrition she needed, and went to and listened to a motherfucking doctor who just put her on goddamned blood-thinning drugs that destroyed her health even more!
Alzheimer's? nope, its not what they tell you it is, Its fucking malnutrition!

Asthma? its not some incurable disease. Its lack of the proper nutrients that the human lifeform is intended to have!
For years people have been lied to and taught to believe in these motherfucking bastards called "doctors" and "physicians" and to trust their words...ITS ALL DESIGNED TO CAUSE YOU MORE GRIEF, AND MAKE YOU SPEND MORE MONEY TO LINE THEIR POCKETS WITH GOLD!

Every fucking TV channel has a zillion commercials for drugs.
This fucking country is so damned blind to the fact that the media is pushing these fucking things on to people, making them think they NEED them...its all bullshit!
Nothing more than some sick bastard's idea to fuck over the population!

Overweight? Its caused by the toxins that are in the conventional food products, and the hormone injections in the meats and dairy products!

I swear if they start that fucking mandatory vaccination bullshit, I WILL certainly start killing anyone who tries that shit with me!!
I'll put their fucking heads on pikes on my lawn!

...

..ahem..excuse my language...I get VERY pissed about anything like this..
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RampantCoyote · Posted: Sat Jul 25, 2009 7:33 am Post subject:

The health care in this country is actually really great...

... if you can afford it.

And that's kind of the problem. "Affordable health care" and "quality health care" are pretty much on opposite ends of the spectrum.

In fact, a Gallop poll in 2004 suggested that in general, Americans were more happy with the QUALITY of the health care in this country than those in Canada and Great Britain were with there. Cost (in the U.S.) was the biggest issue.

The LA Times in 2007 talked about a lot of the problems with waiting lists and delayed surgeries in Canada, Great Britain, and Sweden (which are kinda the textbook examples of universal health care that politicians and academics love to cite). Maybe that's exaggerated - I dunno.

But after my wonderful little HMO experience, that's EXACTLY what I think about.

Just so folks know where I'm coming from - my stepfather died about 18 months ago from cancer that should have been found / treated MUCH earlier --- but he was laid off from his job and had to start his own business just before he was supposed to go get his regularly scheduled colonoscopy. It was a couple of years before he was able to get insured to the point where he could afford the colonoscopy. By that time, the cancer had become quite advanced in his system.

Ironically, his business included selling health insurance.

He'd probably be alive today had he been able to get the colonoscopy before getting laid off and losing his insurance.

So yeah. I'm right there with a lot of people saying, "That's not fair, that's not right!" We need portability, and we need a safety net. We need some serious reforms ---

And the suckiest part is that the reforms we need the most, we aren't gonna get, because the industries that need the reform are spending millions in lobby and campaign money to make sure those proposals are off the table. So what we're gonna be left with is a stinking pile of watered down BS that lets the government take more of our paychecks and then dole it out back to us in ever-smaller parcels that limit how we can apply it, and they will expect us to hold them up as heroes for giving us back what was already ours.

And we probably will.
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RampantCoyote · Posted: Sat Jul 25, 2009 7:39 am Post subject:

Heh - DeveloperX, while I'm not so passionate about the subject as you, and probably a bit more moderate in my approach, I think in a lot of ways you are probably right.

I won't go so far as you, but I think we are WAY over-prescribed in this country.

But we're also living to be about 20% older, on the average, than our great-grandparents in this country (another reason health coverage is going through the roof --- insurance companies' actuarial tables have been depending upon us dying off before we could collect). So it's not all bunk. :)
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Nodtveidt · Posted: Sat Jul 25, 2009 11:05 am Post subject:

I also do not trust the medical "profession", an industry that tried to steal my second daughter simply because she was born at home. Their excuse? "It was a non-sterile birth." There is no such thing as a sterile birth; it's a myth perpetrated by this industry and pushed onto people to force them to give birth in a hospital, where it will cost them a mint, especially if they have no insurance. Puerto Rico has the highest Cesarean rate in the world: 49%. It is completely idiotic. The ironic part is that we have the best medical colleges in the West here in PR, yet abominations like this occur...of course, it doesn't help that all the best medical students who graduate here are spirited away to the USA mainland, leaving us with the lowest graduates.

So...what do you call the guy who graduated last in his class at medical school?

You call him "Doctor".
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tcaudilllg · Posted: Sat Jul 25, 2009 1:43 pm Post subject:

tcaudilllg · Posted: Sat Jul 25, 2009 7:41 pm Post subject:

Speaking of health, the mother of a friend of my girlfriend is apparently dying of swine flu, so watch out for that.

tcaudilllg · Posted: Mon Jul 27, 2009 4:14 am Post subject:

Does anyone know about those co-ops they're talking about in the Senate? They're supposed to lower costs but I don't understand how they work.

Oh my god:

http://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act

Bush's guy actually lied to the Congress. Why did he not get prosecuted for that? That's fraud. And look at that: it cost more to integrate the health industry into Medicare than it cost without it. It's not right to call this a "give away"... this is fraud.

RampantCoyote · Posted: Mon Jul 27, 2009 7:24 pm Post subject:

A really good commentary by a Harvard economics professor on why public option, single-payer idea scares half the population, and not the other:

Who Do You Trust?

I'm in the group that trusts profit-motivated organizations with competition far more than I trust the federal government.

Of course, the problem we now have is that insurance / health-care is HIGHLY non-portable, so it's not like you can switch providers in a heartbeat because yours is failing to meet its obligations.

I wonder how different it would be if it were easy to switch companies instead? But unfortunately, our system doesn't work that way.
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tcaudilllg · Posted: Mon Jul 27, 2009 10:01 pm Post subject:

I think it would be best for Congress to vote for the public option and send it to the Senate. There its merits can be duly considered along with the co-op plan. (which is the only alternative on the table). Shouldn't take more than a month.

I don't expect the co-op plan to stand up to debate because it can't be proven to lower health care costs over the long term. Only government interference will break the oligopolic condition and lower costs.

One thing that's for certain: these subsidies to the drug companies are pissing me off.

Speaking of which, why isn't Obama tackling that? He's got the majority: now is the perfect time to repeal all of the Republican stupidity of the past eight years.

Rainer Deyke · Demon Hunter Joined: 05 Jun 2002 Posts: 672

Private health insurance is a scam, pure and simple.

The insurance companies make money by insuring healthy people, but they lose money by paying the medical expenses of sick people. Once you need health insurance, the insurance companies no longer want you as a customer, because you're losing them money. So they do everything they can to get rid of you. What are you going to do, sue them? Too bad you can't afford a lawyer after all your medical expenses. Move to another provider? Good riddance, and good luck finding another company that'll take you with your preexisting condition.

I don't trust those monkeys in Washington at all, but at least they have some kind of incentive for actually providing health care.