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  1. #71
    Senior Member Tiltyred's Avatar
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    Quote Originally Posted by Just Some Guy View Post
    There's a difference between not force feeding her and knowingly increasing the morphine drip to fatal levels. Perhaps you misspoke, in which case I'd strongly suggest clarifying, but I'm not trying to pass moral judgment, just saying that it might not be the best idea to mention what could be construed/misconstrued as a conspiracy to commit homicide.

    The world is full of busybody snitches and overly aggressive/ethically-challenged law enforcement and prosecutors. The internet is no exception, so if made an error in your explanation, it would probably be a good idea to clarify. For instance, maybe you meant that the morphine drip was increased to ease the suffering as she died of self-imposed starvation, not to actually induce death.
    That's what I said.

    (shifting subject)

    You should have a Living Will anyway, so nobody would need to convene a "Death Panel" for you.

    I hate scare tactics!

    FMcA, are you an agitator?

  2. #72
    Senior Member Lateralus's Avatar
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    Quote Originally Posted by Seymour View Post
    I agree with Haphazard, in so far as the system we have (and had) in the U.S. is extremely far from a free market system with effective competition. Both tying insurance to one's employer and not having national competition limit any positive free-market effects. I would have preferred they moved everyone to individual selection from health care exchanges (or some other open market) with insurance companies competing nationally. That would have been a reasonable test-case to see if free-market healthcare could be effective.

    Of course, I would have preferred a single-payer system (like medicare) but that wasn't politically feasible.
    "Insurance" for anything but catastrophic health issues doesn't make sense, in general. Insurance works well when events are unpredictable and catastrophic. That's why home owners insurance, life insurance, auto insurance, etc. work (not prohibitively expensive). But health "insurance" that covers predictable events, like routine doctor visits, prescription medications, and long-term care doesn't actually work. It only serves to increase costs.

    I started a thread on this specific issue a while ago. Unfortunately, people are so accustomed to the concept of health insurance, we'll probably never see insurance applied correctly again. I gave up any hope that we'll ever move toward a perfect system (my ideal system) a while ago. So now I just hope that whatever system we get doesn't make things worse. Unfortunately, most people who prefer more "right-wing" solutions refuse to see any possible merit in "left-wing" solutions, and instead rant about death panels, bankruptcy, or whatever other crap popped into their heads.

    What I hope is that the government subsidies for preventative medical care saves us enough money (by diagnosing illnesses earlier) that the cost of these subsidies can be justified. That is a legitimate possibility. The only question is, can we actually implement a system that accomplishes this.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

  3. #73
    reborn PeaceBaby's Avatar
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    Quote Originally Posted by Lateralus View Post
    "Insurance" for anything but catastrophic health issues doesn't make sense, in general. Insurance works well when events are unpredictable and catastrophic. That's why home owners insurance, life insurance, auto insurance, etc. work (not prohibitively expensive). But health "insurance" that covers predictable events, like routine doctor visits, prescription medications, and long-term care doesn't actually work. It only serves to increase costs.
    Well-expressed. I hadn't considered this framework and it gives me food for thought. Thanks!
    "Remember always that you not only have the right to be an individual, you have an obligation to be one."
    Eleanor Roosevelt


    "When people see some things as beautiful,
    other things become ugly.
    When people see some things as good,
    other things become bad."
    Lao Tzu, Tao Te Ching

  4. #74
    Vaguely Precise Seymour's Avatar
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    Quote Originally Posted by Lateralus View Post
    "Insurance" for anything but catastrophic health issues doesn't make sense, in general. Insurance works well when events are unpredictable and catastrophic. That's why home owners insurance, life insurance, auto insurance, etc. work (not prohibitively expensive). But health "insurance" that covers predictable events, like routine doctor visits, prescription medications, and long-term care doesn't actually work. It only serves to increase costs.

    [...]

    What I hope is that the government subsidies for preventative medical care saves us enough money (by diagnosing illnesses earlier) that the cost of these subsidies can be justified. That is a legitimate possibility. The only question is, can we actually implement a system that accomplishes this.
    Heh, after I read your first paragraph I was going to reply pretty much with your last paragraph. Coverage of routine care is bad only in so far as increased consumption of those services leads to overall increased expense. We would hope that the opposite is the case, and that some hyper-expensive emergency room visits can be prevented with routine care.

    I was also mulling over what things exert downward pressure on cost in the current system. Currently the treatments insurance companies cover is the treatment that most people get. Clearly that sometimes prevents people from getting coverage for expensive experimental treatment and hence steers people towards covered treatments. Whether that's good or bad depends on the efficacy and expense of covered treatments.

    In some single payer systems, the collective bargaining power of the government allows it to secure better deals than individuals could. Right now hospitals negotiate with insurance companies for the rate of reimbursement (presumably trying to maximize their payments and number of covered patients, while insurance companies prefer to pay out as little as possible).

    Unless insurance companies collude (no idea how that works) it seems like insurance companies have less bargaining power against providers of services and medication than a single payer would in a single payer system. However, given the near-monopoly status of providers in given states, they may have more bargaining power than one might think (since a single company may effectively hold a percentage of the population of the state hostage). Even insurance companies aren't concerned with keeping premiums low so long as they remain profitable.

    You'll also note that at no point does are ordinary individuals involved with negotiations or are made aware of expenses. Employers deduct health care premiums, and employees do not generally select health care providers (certainly not beyond picking between two or three at best). Price negotiations happen between employers, insurers and medical service/medication providers. The levels of governmental reimbursement for medicare and medicaid and rates set by law (in some cases) provide a baseline level of reimbursements. Note that not all providers accept medicare and medicaid.

    It's a very odd, convoluted system which seems to necessitate lots of bureaucracy.

    Our relationship with big pharmaceuticals is also odd since they, as corporations, are duty-bound to spend money in the most profitable directions (for example, advertising and developing the next viagra, social anxiety drug or hair-loss treatment), not necessarily the most generally beneficial ones. This doesn't means that drug companies are evil, but direct advertising does affect where the most profit can be made and where research money is spent.

    At any rate, I think most would agree that our existing system is too byzantine and wasn't keeping costs down. The new changes are mostly minor tweaks that seem unlikely to be sufficient to control costs in the long run. The changes should eliminate some of the worse insurance company practices and result in more people being covered. I think a second round of changes would be needed to control costs, but I doubt the political will exists for that to happen any time soon. It still seems ludicrous that we pay so more much than any other developed country and likely will continue to do so.

  5. #75
    Senior Member Lateralus's Avatar
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    Quote Originally Posted by Seymour View Post
    Heh, after I read your first paragraph I was going to reply pretty much with your last paragraph. Coverage of routine care is bad only in so far as increased consumption of those services leads to overall increased expense. We would hope that the opposite is the case, and that some hyper-expensive emergency room visits can be prevented with routine care.
    There are two aspects of subsidized routine care that will push costs upward. First, there will be no direct pressure from consumers to keep costs low. If a doctor were to raise what he charges for a routine checkup, patients will probably never know about it (since it's covered by insurance), so the doctor has a lower risk of losing patients when he raises his prices, which means there is less incentive to keep costs down. Secondly, there's the cost of insurance, which includes the cost of bureaucracy. All the people who handle claims (and deny claims) get paid a salary.

    Co-payment is supposed to help with the first problem, but that's still not perfect. The larger the co-payment, the more individuals are exposed to the cost structure. But larger co-payments put more pressure on low income patients, which is what the system is trying relieve.

    As for the second problem, a single payer system could drastically reduce these costs. But so could a system modeled after Japan's (I have a link about Japan's system in a previous post). Regardless of the direction we go, we HAVE to cut down on the bureaucracy. I wonder how much money insurance companies spend in efforts to NOT pay claims. If we had a more streamlined system, much of that waste could be eliminated.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

  6. #76
    Vaguely Precise Seymour's Avatar
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    Quote Originally Posted by Lateralus View Post
    There are two aspects of subsidized routine care that will push costs upward. First, there will be no direct pressure from consumers to keep costs low. If a doctor were to raise what he charges for a routine checkup, patients will probably never know about it (since it's covered by insurance), so the doctor has a lower risk of losing patients when he raises his prices, which means there is less incentive to keep costs down. Secondly, there's the cost of insurance, which includes the cost of bureaucracy. All the people who handle claims (and deny claims) get paid a salary.

    Co-payment is supposed to help with the first problem, but that's still not perfect. The larger the co-payment, the more individuals are exposed to the cost structure. But larger co-payments put more pressure on low income patients, which is what the system is trying relieve.

    As for the second problem, a single payer system could drastically reduce these costs. But so could a system modeled after Japan's (I have a link about Japan's system in a previous post). Regardless of the direction we go, we HAVE to cut down on the bureaucracy. I wonder how much money insurance companies spend in efforts to NOT pay claims. If we had a more streamlined system, much of that waste could be eliminated.
    I don't think it's routine check-ups that make our healthcare so expensive, but I could be wrong. It's true you don't want someone to dash to the doctor for every sniffle and hang-nail, but even low co-pays would help with that, I'd think. I do think there's probably some unnecessary testing that goes on that does drive up costs, but I don't feel comfortable opining on what makes for a reasonable test.

    Agreed on the bureaucracy being part of the rising expense.

    I personally would be fine with a Japanese-like system, but that's definitely more government price control than might play well here politically. The comparatively minor tweaks that just passed were described as "socialism" and "government take-over," even though it's fairly similar to the system Republican then-Governor Romney passed here in Massachusetts several years ago. The influx of patients into the system did create a primary care physician shortage here, so I wonder if we'll have similar issues as the national program gets ramped up.

  7. #77
    Senior Member Lateralus's Avatar
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    I didn't say routine check-ups are what make the system so expensive.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

  8. #78
    Vaguely Precise Seymour's Avatar
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    Quote Originally Posted by Lateralus View Post
    I didn't say routine check-ups are what make the system so expensive.
    Sorry, I was responding to your example of "If a doctor were to raise what he charges for a routine checkup, patients will probably never know about it (since it's covered by insurance), so the doctor has a lower risk of losing patients when he raises his prices, which means there is less incentive to keep costs down."

    I find it difficult to see how co-pays for non-routine services would make a huge difference, unless they were significantly higher than they are today. I wonder if one could introduce co-pays for tests of dubious merit and have them be effective? Seems tricky since it seems like there's a lot of contention about what reasonable trade-offs are.

  9. #79
    The Unwieldy Clawed One Falcarius's Avatar
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    Quote Originally Posted by Fecal McAngry View Post
    No, once again the point evades you. We know the UK has de facto "Death Panels." We know they often deny care, with fatal consequences, to those who could survive much longer with proper treatment--the treatment they were denied. The existence of such panels is not in question. But we would find it very difficult to determine the exact number of "victims" because we would almost certainly be forced to depend on statistics proffered by the NHS. Getting the NHS to tell you how many people their Death Panels have killed would be like

    Getting the LAPD to tell you how many times their officers engaged in police brutality between 1960 and 2010

    Getting the U.S. Dept of Defense to tell you how many Iraqi women American soldiers have raped since the start of the U.S. occupation of Iraq

    And so on.
    The truth is, healthcare is already rationed in every country in the world. In the US it is done by individuals struggling to afford even basic medical cover, by insurance corporations refusing treatment, and by government agencies trying to balance budgets especially after one of the longest and deepest global recessions in living memory.

    Not only in the UK but also the US, the legislature ration medical treatment and procedures people should be entitled to receive by refusing to cover anything deemed too expensive; just ask anyone unfortunate enough to have experienced Medicaid or Medicare. The UK has its very own rationing of medical procedures, done by a government body with the rather Orwellian sounding acronym ''NICE'' or the National Institute for Health and Clinical Excellence. In the UK a uninsured baby with a hole in the heart has much greater priority than an old aged pensioner with a kidney problem and medical insurance; the opposite is true in America. Take your pick.

    Finally, considering the US spends about two times that spent in the United Kingdom on heath care, Americans are not exactly healthier for it, nor does America exactly fair too well in a direct comparison of key health performance indicators. So what the hell are Americans getting for their money?
    Quote Originally Posted by Thalassa View Post
    Oh our 3rd person reference to ourselves denotes nothing more than we realize we are epic characters on the forum.

    Narcissism, plain and simple.

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