[hyteckit]

Originally Posted by CRASH HARDDRIVE 

Strawmen rarely do.

How about arguing the actual topic?

what's the actual topic?

Rationed healthcare? Yeah, it's needed because of limited resources and limited funds.

You mean like rationed national defense? Without limits, what's the national defense budget going to be like? 100% of the budget? That would leave 0% for everything else wouldn't it?

[besson3c]

Originally Posted by shifuimam 

The problem is that in Canada, the line is very blurry, and people who do need certain procedures, treatments, or surgeries are put onto long waiting lists. Sometimes, they die before they are able to get the treatment they need.

If you read turtle's WSJ article, you'd see the example of a man who was suffering from seizures and headaches, yet faced more than a four-month wait just to get an MRI to diagnose the problem. Fortunately, he had enough money and lived close enough to the US-Canada border that he went to New York and paid to have an MRI done - which revealed a malignant brain tumor. The waiting list for surgery to remove the tumor was so long that he went back to the United States to have the tumor removed.

Or you would have noticed the anecdote about the 57-year-old man who was denied a hip replacement because he was deemed "too old". That man has another 25-40 years of life left, yet he's not allowed to have surgery performed because the government already has too many people waiting in line to get basic medical care.

What about the woman with a brain tumor that was rapidly racing toward causing permanent blindness? Because Canada's "wonderful" medical system is so convoluted and poorly managed, she was told she'd have to wait. She could have ended up permanently blind or, worse yet, dead. Instead, she used her own money and had the necessary surgery done in the United States.

Is this an optimal situation for you? Would you prefer that the hundreds of thousands of people in the US who have actual serious medical problems be forced onto waiting lists, so that they are essentially put on death row until the government can manage to get them into a publicly-run hospital, where doctors and medical personnel care less because they're not getting paid enough to give a damn?

There are anecdotes all over the map, I'm growing tired of keeping score. You can find numerous anecdotes of people that suffered because they couldn't afford their health care, struggles with insurance companies, stories of medical procedures in countries like Canada with zero wait time, etc. Sorry, but these sorts of anecdotes really don't mean much to me. I'd rather see some pretty charts and graphs

[nonhuman]

Government imposed rations don't work. This has been demonstrated at many points throughout history. Rather than rationing scarce resources we should make use of the most efficient and successful mechanism for allocation of scarce resources yet devised: capitalism.

See the failures of gas rationing during WWII as an example.

[nonhuman]

double post...

[hyteckit]

Originally Posted by nonhuman 

Government imposed rations don't work. This has been demonstrated at many points throughout history. Rather than rationing scarce resources we should make use of the most efficient and successful mechanism for allocation of scarce resources yet devised: capitalism.

See the failures of gas rationing during WWII as an example.

I guess I'll start an ebay for organs.

Liver goes to the highest bidder.

[nonhuman]

Way to ignore my previous post in which I explicitly stated that I'm not, nor do I believe anyone else is, promoting that we get rid of our current organ transplant procedures.

[besson3c]

You know, since stimulus packages are hot on everybody's mind right now, why don't Republicans acknowledge that the possibility of cheap health care options might stimulate new businesses who otherwise could not afford the health care options we have now?

I know I'm changing the topic a little, but I just thought I'd toss this out there...

[hyteckit]

Originally Posted by nonhuman 

We already have a private health care system, there's no need for it to be privatized...

And I don't think anyone is proposing that we change the way that the current transplant system works. Besides, regardless of how much control the US government has over the US healthcare system, the rich will always be able to go somewhere where they are able to buy better care than everyone else gets.

And nationalizing health care doesn't take that option away from you. You can still buy health insurance for more coverage than what public health care provides.. You can still pay out of your pocket for experimental treatment if you can afford it.

[dcmacdaddy]

Originally Posted by nonhuman 

And I don't think anyone is proposing that we change the way that the current transplant system works. Besides, regardless of how much control the US government has over the US healthcare system, the rich will always be able to go somewhere where they are able to buy better care than everyone else gets.

Yes, but right now, the rich can go somewhere in the United States to buy better care than everyone else gets. And I don't want that to happen. I want the system in the United States to be that if you want to use your wealth to get better care than someone else you can do so but you have to go outside the country to get it. I don't want financial well-being to be a determinant of access to health care. I want it to be based on need of patient and likelihood of success of procedure.

Call it Socialist, Fascist, whatever you want. But the minute we let ability to pay to be a determining factor in who gets health-care we have instituted a system of wealth-based rationing of life. If we need to do rationing of life vis a vis healthcare service--determining who gets what service and when and how--I want it to be done based on the needs of the patient and likely benefit to the individual and NOT on one's ability to pay. I am totally OK with the idea of not everyone getting the same level of health care but if health-care service is to be rationed I do NOT want it to be rationed based on personal wealth/ability to pay. I would rather see a poor person have the government pay for a procedure that will give them another 20 years of live than have a rich person pay for the same procedure that would give them only another 5 years of life. If the rich person did want that procedure and wanted to pay for it then they should be forced to avail themselves of medical services in another country and NOT in the United States.

[nonhuman]

Originally Posted by hyteckit 

And nationalizing health care doesn't take that option away from you. You can still buy health insurance for more coverage than what public health care provides.. You can still pay out of your pocket for experimental treatment if you can afford it.

Yes, but if one happens to believe, as I do, that nationalizing the health care system would be a bad thing and would reduce the average quality of care that people will receive, you can surely see how one might not think that's the best option, no?

[hyteckit]

Originally Posted by nonhuman 

Way to ignore my previous post in which I explicitly stated that I'm not, nor do I believe anyone else is, promoting that we get rid of our current organ transplant procedures.

You don't believe rationing works.

[nonhuman]

Originally Posted by hyteckit 

You don't believe rationing works.

The current system isn't rationing.

[hyteckit]

Originally Posted by nonhuman 

The current system isn't rationing.

Sure it is. You are arbitrary attaching the word "rationing", so I'm doing the same.

Limited resources. Who decides who gets it?

Those who would benefit the most from it rather than those who can pay the most for it.

I call that rationing.

Without rationing, the Liver organ would go to the highest bidder on the market.

[nonhuman]

How and when did I arbitrarily attach the word 'rationing' to anything?

There are more than two systems for allocation scarce resources. Capitalism and rationing are not the only methods. Alternatively, we could define rationing broadly and say that capitalism is merely a system of rationing. But in that case it becomes completely meaningless to talk about rationing so I assume we're not using that definition. So I suppose I should have been more clear about what I mean when I talk about rationing in this conversation: I'm talking about the government allocation of resources. As with the decision of what procedure a patient needs, the decision of to whom a donated organ goes is best decided by doctors who understand the realities of the medical situation. Ideally this would be done without involving sentimental attachment to any particular patient or condition, but we're only human. Our current system, while I doubt anyone would call it perfect, does a pretty good job of approaching this ideal: http://en.wikipedia.org/wiki/Organ_t...donated_organs

[dcmacdaddy]

Originally Posted by nonhuman 

The current system isn't rationing.

The current system is MOST DEFINITELY rationing based on ability to pay and one's pre-existing health status.

Insurance companies ration what kind of services one can get--or even if someone can even get health insurance--based on a person's ability to pay (higher premiums up-front or out-of-pocket at time-of-service) or their current (pre-existing) health problems.

That is MOST DEFINITELY rationing. Heck, we haven't even mentioned those without health insurance at all who can't even get basic health care services (annual doctor and dental check-ups). Those individuals have been rationed right out of the health care market based only on ability (or lack thereof) to pay. And before anyone mentions going to the emergency room for those without insurance, tell me this: Do you really think the emergency room is the place to go for a basic check-up or when you simply have a bad cold? And what about "emergency rooms" for dental care? Where are the "emergency rooms" where an individual can get a teeth cleaning?

[turtle777]

Originally Posted by dcmacdaddy 

As long as you are paying for everything yourself, correct.

Sorry, but in a fully blown Socialist system, that's not even an option.
Read the link I posted above, some nice horror stories from Canada.

Some of those patients would be dead if they hadn't come to the US for treatment paid by themselves.

Can't wait for that kind of system to happen in the US.

-t

[dcmacdaddy]

Originally Posted by hyteckit 

Sure it is. You are arbitrary attaching the word "rationing", so I'm doing the same.

Limited resources. Who decides who gets it?

Those who would benefit the most from it rather than those who can pay the most for it.

I call that rationing.

Without rationing, the Liver organ would go to the highest bidder on the market.

Exactly. Your example is rationing based on need as opposed to ability to pay for service. But it is still an example of rationing.

On page 1 I suggested examples of government-rationed services based on "most benefit" as opposed to ability to pay. Of course, that example was based on the government paying for the health-care service provided. But, our health-care in this country is most definitely rationed. And that is not necessarily a bad thing.


My argument is not that rationing is bad but merely rationing should be done on factors OTHER THAN ability to pay for service. I don't think living (or dying) should be decided on the size of one's wallet/pocketbook. I think it should be decided on the likelihood of one benefitting from a medical procedure.

[dcmacdaddy]

Originally Posted by turtle777 

Sorry, but in a fully blown Socialist system, that's not even an option.
Read the link I posted above, some nice horror stories from Canada.

Some of those patients would be dead if they hadn't come to the US for treatment paid by themselves.

Can't wait for that kind of system to happen in the US.

-t

Absolutely!

I am TOTALLY in favor of a system in this country where people who pay out of pocket for optional/extra health-care services have to go overseas to get that service.

How many times do I have to say it: I DO NOT WANT ability to pay to be a deciding factor in what kind of healthcare an individual gets in this country. Having more money shouldn't entitle someone to more/better healthcare than someone with less money. Having a greater need for healthcare should entitle someone to more/better healthcare than someone with less need NOT having a greater sized wallet/pocketbook.

[dcmacdaddy]

Just to reiterate. I believe

1. current health-care service in the United States IS rationed based on ability to pay and pre-existing health conditions
2. rationing access to healthcare IS an acceptable and necessary method to keep healthcare costs lower
3. rationing should BE done based on the needs of the patient and likelihood of benefit from specific procedure(s)/treatment(s)
4. rationing should NOT be done on the patient's ability/willingness to pay

[ebuddy]

Originally Posted by dcmacdaddy 

Absolutely!

I am TOTALLY in favor of a system in this country where people who pay out of pocket for optional/extra health-care services have to go overseas to get that service.

How many times do I have to say it: I DO NOT WANT ability to pay to be a deciding factor in what kind of healthcare an individual gets in this country. Having more money shouldn't entitle someone to more/better healthcare than someone with less money. Having a greater need for healthcare should entitle someone to more/better healthcare than someone with less need NOT having a greater sized wallet/pocketbook.

(D)s get the organ, (R)s die!

I am TOTALLY opposed to the government competing against private industry using my money to lowball, hamper professional creativity, and advancement. We can make all kinds of decisions. 29 year old, non-taxpaying drug abuser is salvageable, but the 56 year old college professor has less time to live? Who gets the organ? Where's the cut-off? When will you people figure out that the 17 year old girl in need of a heart transplant is less fortunate than the 17 year old girl who isn't in need of a heart transplant?

I hear a lot of folks complaining about lacking resources and Rockefeller gets the organ because he's rich, etc... what do you suppose happens when Wyoming is bitching to the Federal government because they've not received sufficient health care allotment? What happens when California gets the lions-share of Federal funding for health care because of their population, yet other States are starved for resources? People die ladies and gentlemen, it is a horrible fact of human nature. I work with a girl who's son has had 8 major heart surgeries and she is almost entirely funded by donations and collections. There are a wealth of organizations and services that exist for just this reason. Do they always succeed? Certainly not, but we've got a wealth of information from other systems that suggest they don't either.

What in all that is good and green gives you the impression our government is resourced to handle our healthcare? They can't even manage a Social Security lock box for crying out loud or even hand out money effectively, but they're going to manage our healthcare? Is this the same government that just over a month ago was being accused of unprecedented civil rights abuses? Unprecedented waste? Unprecedented spending? Fraud? Lying? Lacking transparency???

Egadz people. I'm w/ Turtle, WTF?!?

[turtle777]

Originally Posted by dcmacdaddy 

How many times do I have to say it: I DO NOT WANT ability to pay to be a deciding factor in what kind of healthcare an individual gets in this country. Having more money shouldn't entitle someone to more/better healthcare than someone with less money. Having a greater need for healthcare should entitle someone to more/better healthcare than someone with less need NOT having a greater sized wallet/pocketbook.

Baby Obama on a bicycle, you can't be serious ?

So you want that the government and bureaucrats to decide who lives and dies ?

That's f*cked up.

This means that choices people made in their lives don't count for anything, because in the end, the government is going to equalize everything.

Welcome to Communism 101.

-t

[nonhuman]

You can't ration based on ability to pay. Distributing scarce resources by putting them on the market and then allowing the market to find a price that balances supply and demand in order to allocate those resources is called capitalism. I've said already that it's possible to define this as a form of rationing, but if you do so the word 'rationing' loses any meaning in this context and we need to either find a different word to use to refer to non-capitalistic resource allocation as a sub-category of rationing and stop pretending that 'rationing' then will somehow magically solve all our problems since we're apparently already doing that.

[turtle777]

Here is a novel idea to make healthcare more affordable in the US: get ride of the f***ing ridiculous tort law in the US.

All those effing gold diggers that sue any- and everything make the cost balloon due to excessive insurance premiums.

-t

[dcmacdaddy]

Originally Posted by turtle777 

Baby Obama on a bicycle, you can't be serious ?

So you want that the government and bureaucrats to decide who lives and dies ?

That's f*cked up.

This means that choices people made in their lives don't count for anything, because in the end, the government is going to equalize everything.

Welcome to Communism 101.

-t

No. Where did I say I want "the government and bureaucrats to decide who lives and dies"? I want the decision to be made based on need of the recipient and likelihood of long-term benefit from the procedure. And, as nonhuman has said, doctors are the best ones to decide that. Doctors are the best one to decide if the best use of a hospital bed is for a "29 year old, non-taxpaying drug abuser [instead of a] 56 year old college professor". That's why I want the ability to pay for procedures to be removed from the calculus of who gets what. So doctors don't have to make decisions on necessary and appropriate healthcare based on whether or not it is affordable.

While you and ebuddy are up in arms about "the government" making these decisions on healthcare, you are forgetting the most important group in the country who is best able to make these decisions, the American Medical Association. They could very easily work to draw up criteria for treatment, leaving the decision-making power in the hands of individual doctors based on guidelines/requirements established by the AMA.

The issue then becomes how do you get insurance companies to go along with a system that greatly reduces their profits? And that is something I have yet to think too much about. But I am sure there is a solution that can be found that focuses on the best possible use of health-care resources in this country without using ability to pay as a determining factor. (None of you are naive enough to think health insurance companies are in business to actually help people get better, do you? Providing the cheapest possible health care for the greatest possible profit is their goal.)


Just out of curiosity, does anyone here think ability to pay should be a determining factor in allocating health-care resources? that having more money should be a factor in getting access to health-care services?

[dcmacdaddy]

Originally Posted by ebuddy 

I hear a lot of folks complaining about lacking resources and Rockefeller gets the organ because he's rich, etc... what do you suppose happens when Wyoming is bitching to the Federal government because they've not received sufficient health care allotment? What happens when California gets the lions-share of Federal funding for health care because of their population, yet other States are starved for resources?

You are engaging in more than a fair bit of hyperbole when talking about "starving" and "lions-share", ebuddy. And that type of arguing is (normally) beneath you.

There more equitable distribution of health-care services is the WHOLE point of any such plan, to more equitably distribute finite resources. But, we have patients who fly to other parts of the country now to see specialists, why do you argue as if such a procedure would not be possible with doctors determining how best to allocate/ration/distribute such services (pick your term, they all mean the same thing in regards to the finite resource of health-care). So, the high-needs patient in Wyoming gets to fly to California to see a specialist for their disease. How is that any different than now? Wyoming will still have GPs, and OB-GYNs, and DMDs, and Orthopedists. Nothing I have proposed would suddenly cause a whole bunch of doctors to leave one state for another. Doctors in Wyoming will have just as much ability to decide patients health-care needs as a doctor in California.

[hyteckit]

Originally Posted by nonhuman 

You can't ration based on ability to pay. Distributing scarce resources by putting them on the market and then allowing the market to find a price that balances supply and demand in order to allocate those resources is called capitalism. I've said already that it's possible to define this as a form of rationing, but if you do so the word 'rationing' loses any meaning in this context and we need to either find a different word to use to refer to non-capitalistic resource allocation as a sub-category of rationing and stop pretending that 'rationing' then will somehow magically solve all our problems since we're apparently already doing that.

Rationing: Organ goes to those who benefit the most, not by ability to pay.
Capitalism: Organ goes to highest bidder

You don't believe in rationing.

[nonhuman]

Originally Posted by hyteckit 

Rationing: Organ goes to those who benefit the most
Capitalism: Organ goes to highest bidder

You don't believe in rationing.

I never said I did. I was objecting to characterizing as capitalistic distribution as a form of rationing. While potentially valid, it's a completely counterproductive statement to make in this discussion.

[dcmacdaddy]

Originally Posted by nonhuman 

You can't ration based on ability to pay. Distributing scarce resources by putting them on the market and then allowing the market to find a price that balances supply and demand in order to allocate those resources is called capitalism. I've said already that it's possible to define this as a form of rationing, but if you do so the word 'rationing' loses any meaning in this context and we need to either find a different word to use to refer to non-capitalistic resource allocation as a sub-category of rationing and stop pretending that 'rationing' then will somehow magically solve all our problems since we're apparently already doing that.

Regardless of how you choose to define the term "ration" that behavior is going on right now and going on based on ability to pay.

You can use the term distribution, allocation, apportionment, and capitalism in the context of this discussion regarding healthcare and they all mean the same thing (allowing finite health-care resources to be handed out based on some formula).

You advocate supply and demand as the best formula for handing out these resources. But supply and demand is INHERENTLY based on ability to pay. That would be the demand side of your equation. Someone who has more money can "bid up" the price of a health-care service based on their ability to pay more for that service. I mean, thats Economics 101, right there. So, please try again in explaining how the capitalist system of health-care distribution is not based on ability to pay.

If you want ability to pay for health-care to be a deciding factor in who gets access to it, by all means say so. But don't say in the same post that "You can't ration based on ability to pay" and then say the one system fundamentally predicated on ability to pay "capitalism" is the best method for not requiring health-care to be rationed/distributed/allocated/apportioned based on ability to pay.

Don't get me wrong. I am not some crazy, anti-capitalist, down-with-the-imperialist-profiteers blowhard. It is an excellent system for allocating distribution of limited/finite resources. No doubt about it. But, please don't insult our intelligence and argue out of both sides of your mouth regarding capitalism being a great system for allocating health-car resources and the fact that allocating using this method is not based on ability to pay. The ability to pay for something, and the willingness to do so (and pay more than the next person, if necessary) is THE fundamental premise of capitalism.

[dcmacdaddy]

Originally Posted by nonhuman 

I never said I did. I was objecting to characterizing as capitalistic distribution as a form of rationing. While potentially valid, it's a completely counterproductive statement to make in this discussion.

See my post above. Regardless of what terms you use, capitalism is a form of rationing/allocating/distributing/apportioning a finite resource. In capitalism the method for performing this allocation/distribution/apportionment/ration is supply and demand. And the demand side of the equation is predicated on ability (and willingness) to pay. To argue otherwise is to completely destroy the very notion of capitalism.

[dcmacdaddy]

I've got to run to the library before it closes. I'll be back in an hour or so to continue this discusion.
to all of you for your thoughtful, if at times heated, postings. I am really enjoying this debate.

Cheers!

[nonhuman]

Originally Posted by dcmacdaddy 

Regardless of how you choose to define the term "ration" that behavior is going on right now and going on based on ability to pay.

You can use the term distribution, allocation, apportionment, and capitalism in the context of this discussion regarding healthcare and they all mean the same thing (allowing finite health-care resources to be handed out based on some formula).

That was exactly my point.

You advocate supply and demand as the best formula for handing out these resources. But supply and demand is INHERENTLY based on ability to pay. That would be the demand side of your equation. Someone who has more money can "bid up" the price of a health-care service based on their ability to pay more for that service. I mean, thats Economics 101, right there. So, please try again in explaining how the capitalist system of health-care distribution is not based on ability to pay.

The capitalist system is based on the ability to pay. I never said it wasn't. What I was objecting to was the way this was being referred to as 'rationing'. Not, as I said, because it isn't, but because this redefinition of terms mid-discussion introduces an unnecessary and counter-productive linguistic confusion.

If you want ability to pay for health-care to be a deciding factor in who gets access to it, by all means say so. But don't say in the same post that "You can't ration based on ability to pay" and then say the one system fundamentally predicated on ability to pay "capitalism" is the best method for not requiring health-care to be rationed/distributed/allocated/apportioned based on ability to pay.

I don't want the ability to pay for health-care to be a deciding factor. However the fact remains that someone needs to pay for the health care. I've stated multiple times that I'm not entirely opposed to government money going towards paying for healthcare and that I think it's important that all people have equal access to some minimum standard of healthcare. What I've been saying, however, is that regardless of how my ideals inform my personal vision of utopia, the fact is that capitalism is a very, very good way of distributing scarce resources. Yes, some people lose out. And yes, under a captitalist system the people that lose out are the people that are poor in monetary resources. But under any other system people still lose out, it's just a different resource other than the monetary that determines their 'worthiness'.

If I could wave a magic wand and suddenly ensure that every single person was able to get top notch medical care for free I would. Unfortunately I can't, and neither can the government.

Don't get me wrong. I am not some crazy, anti-capitalist, down-with-the-imperialist-profiteers blowhard. It is an excellent system for allocating distribution of limited/finite resources. No doubt about it. But, please don't insult our intelligence and argue out of both sides of your mouth regarding capitalism being a great system for allocating health-car resources and the fact that allocating using this method is not based on ability to pay. The ability to pay for something, and the willingness to do so (and pay more than the next person, if necessary) is THE fundamental premise of capitalism.

Ironically, I am. I don't like capitalism. I think it's a horrible system that inherently leads to inequality amongst people. I think societies based on capitalism are doomed to always be struggling between the opposed goals of enlightened universal equality, and economic success.

I also just happen to think it's the best system currently available to us so regardless of how much I may dislike it, I'm forced to advocate for it where it's better than the available alternatives.

[ebuddy]

Originally Posted by dcmacdaddy 

You are engaging in more than a fair bit of hyperbole when talking about "starving" and "lions-share", ebuddy. And that type of arguing is (normally) beneath you.

I'm not sure how I've failed to meet the arbitrary standard you've applied to me. Seriously dc, there were a host of extremely valid points regarding "starving" for funds and one community getting the "lions-share" of funding over another. These are very real problems and common complaints from systems often compared to our own. An equitable and unified health-care system is among the most challenging aspects of any healthcare system regardless of what the "ideal" is;
http://ideas.repec.org/p/hpa/wpaper/199613.html
- Alberta Health Minister said the federal government "needs to pony up."
- "The federal government has underfunded health care in Canada, and that has contributed to some of the problems we face," said New Brunswick Premier Bernard Lord.
- Serious hospital cutbacks are threatened at hospitals of every size (small, medium and large) in every region of Ontario. sootoday.com

There more equitable distribution of health-care services is the WHOLE point of any such plan, to more equitably distribute finite resources. But, we have patients who fly to other parts of the country now to see specialists, why do you argue as if such a procedure would not be possible with doctors determining how best to allocate/ration/distribute such services (pick your term, they all mean the same thing in regards to the finite resource of health-care). So, the high-needs patient in Wyoming gets to fly to California to see a specialist for their disease. How is that any different than now? Wyoming will still have GPs, and OB-GYNs, and DMDs, and Orthopedists. Nothing I have proposed would suddenly cause a whole bunch of doctors to leave one state for another. Doctors in Wyoming will have just as much ability to decide patients health-care needs as a doctor in California.

Most of the alleged benefits of a nationalized system are on paper and do not manifest in reality. This is why many of those systems are seeking solutions involving increased privatization. As these systems move away from nationalization, we move towards it with little more than rhetoric to support the notion.

What generally happens in schemes like these first and foremost is waste. A state must spend x-amount to continue getting x-amount. A system that begins to count on x-amount under one administration may experience a different amount under another administration; unable to adjust, they cut professionals, clinics, and hospitals. Medicare, FDA regulations, physician licensing, and insurance regulations are already examples of a mismanaged US healthcare system in fact, 48% government run. Reduced excellence in care due to lacking competition via "assembly-line treatment" (read up on the challenges faced by the VA), reduced pharmaceutical advancement, reduced freedoms, and reduced privacy. Using my tax dollar to compete against... me? The free market? I don't like it.

I generally subscribe to the Warren Buffet philosophy on investment; make sure the business model is strong enough that a moron could run it because sooner or later a moron will be.

[dcmacdaddy]

I'm back. Sorry I didn't reply last night but when I got back from the library I got caught up in watching the Westminster Kennel Club Dog Show with my Mom. (I was glad for who they picked as best in Show but my favorite overall was still the Alaskan Malamute.) Anyway, back to the thread.

[dcmacdaddy]

Originally Posted by nonhuman 

The capitalist system is based on the ability to pay. I never said it wasn't. What I was objecting to was the way this was being referred to as 'rationing'. Not, as I said, because it isn't, but because this redefinition of terms mid-discussion introduces an unnecessary and counter-productive linguistic confusion.

OK. I understand now. I wasn't trying to redefine the terms of the debate but merely get an agreement that capitalism is using ability to pay as a means of apportioning health-care services and the result of using that method (ability to pay) to apportion health-care services was equivalent to rationing.

In other words, capitalism != health-care rationing
capitalism = health-care to those who can pay
∴ resulting in rationing of health-care services

Originally Posted by nonhuman 

I don't want the ability to pay for health-care to be a deciding factor. However the fact remains that someone needs to pay for the health care. I've stated multiple times that I'm not entirely opposed to government money going towards paying for healthcare and that I think it's important that all people have equal access to some minimum standard of healthcare. What I've been saying, however, is that regardless of how my ideals inform my personal vision of utopia, the fact is that capitalism is a very, very good way of distributing scarce resources. Yes, some people lose out. And yes, under a captitalist system the people that lose out are the people that are poor in monetary resources. But under any other system people still lose out, it's just a different resource other than the monetary that determines their 'worthiness'.

I think we are much more in agreement than not. I would suggest that the one area where government might have a vested interest in mandating a universal level of health-care is in the developmental years. Endless studies have shown the benefits to individuals and to health-care expenditures from the provision of regular and preventative medical care at an early age. I would suggest that government mandating/controlling/determining health-care service be for youth from birth-18. This wouldn't have to be extensive services, just making sure that every child has an opportunity to get regular check-ups and all necessary immunizations and regular, scheduled visits to a doctor and dentist. Think about how much could be saved long-term if diseases or other maladies could be caught early on? And not to mention the basic social function of ensuring the populace is as healthy as can be to produce the next generation of citizens.

I would envision a system where a parent gets a child health-care card at the birth of a child that entitles them to certain basic health-care services, completely free, until their child turns 18. In essence, the federal government would "buy" a health insurance policy for that child and pay for it until the child turned 18. Because of the volume buying power that would be held by the government the government should be able to negotiate much lower per-child rates than if individual families were to try and do something themselves. There would have to be discussion as to how much in-depth coverage would be provided for major diseases and illnesses--One of my best friends had leukemia twice before he turned 16 and was lucky to have both parents working in jobs that offered good health coverage--but there could probably be some way to spread out the costs across the pool of insured children. (The majority of kids who rarely get seriously sick and just need the once-a-year doctor visit and twice-a-year dental visits would compensate for the minority of kids who would need major medical services provided to them.) And again, the decision as to what kinds of major care a child would receive on the government's dime would be determined by the child's doctor as influenced by my proposed AMA guidelines for patient care.

And I too don't think that there is any utopian solution to ensure that everyone has access to every medical service they need, when they need it. That is not possible nor even remotely cost effective. My concern has always been--go back and re-read all my postings on this topic in easily dozens of threads over several years, you'll see I say the same thing--is ensuring that ALL citizens of this country get regular basic, preventative health-care. Right now, with over 45 million people un-insured in this country, that is one-seventh of our population that does not have access to regular basic, preventative health-care.

To solve that problem, I would turn to the capitalist system and do two things. Require everyone over the age of 18 to have mandatory health insurance--You would need to show proof of insurance to get a job, driver's license, make a major purchase (house, car)--and require every insurance company to offer a policy to everyone who wants one. So, the government would be mandating that everyone have health insurance and that every insurance company must offer a policy to anyone who asks for one but then the insurance companies could let market forces play out in how they charge their rates, distributing the costs and risks across the pool of insured. For example, smokers would have to pay more to the insurance company for a policy than a non-smoker but they would get a policy and they would not have the choice to not have a policy.

The same positive- and negative-reinforcements used by insurance companies today could be used under such a plan, all within the confines of having market forces determine costs for services and NOT having market forces determine who gets services. The insurance companies would be able to determine costs for services based on risk. So, the 40-something vegetarian runner is going to pay less for their insurance than the 40-something sedentary smoker but they will both have insurance and the more the insurance company has to pay to take care of the sedentary smoker will be offset by the less they have to pay for the vegetarian runner. Just to reiterate, these are all market forces at work here but they are acting on the whole citizenship of the United States as their prospective pool of clients instead of just those who can afford to pay to get insurance.

As I said earlier, health insurance companies are in business to make money and even with the requirement that every citizen must be insured they will find ways to make money. All that would change is that they won't be able to refuse to take on an insured individual based on that person's ability to pay or their existing health status. Their business model would remain fundamentally sound--spreading costs across a large pool of insured--it's just that the size of the potential pool will be greatly increased.


NOTE: I know many people on here would argue that "the government shouldn't be telling me what to do" but we have already established that the government does do that to us collectively in so many other areas (speed limits, national minimum age to buy alcohol, vote, join the military) thus rendering moot such an argument about "the government shouldn't be telling me what to do".

[dcmacdaddy]

Originally Posted by ebuddy 

I'm not sure how I've failed to meet the arbitrary standard you've applied to me. Seriously dc, there were a host of extremely valid points regarding "starving" for funds and one community getting the "lions-share" of funding over another. These are very real problems and common complaints from systems often compared to our own. An equitable and unified health-care system is among the most challenging aspects of any healthcare system regardless of what the "ideal" is;
http://ideas.repec.org/p/hpa/wpaper/199613.html
- Alberta Health Minister said the federal government "needs to pony up."
- "The federal government has underfunded health care in Canada, and that has contributed to some of the problems we face," said New Brunswick Premier Bernard Lord.
- Serious hospital cutbacks are threatened at hospitals of every size (small, medium and large) in every region of Ontario. sootoday.com


Most of the alleged benefits of a nationalized system are on paper and do not manifest in reality. This is why many of those systems are seeking solutions involving increased privatization. As these systems move away from nationalization, we move towards it with little more than rhetoric to support the notion.

What generally happens in schemes like these first and foremost is waste. A state must spend x-amount to continue getting x-amount. A system that begins to count on x-amount under one administration may experience a different amount under another administration; unable to adjust, they cut professionals, clinics, and hospitals. Medicare, FDA regulations, physician licensing, and insurance regulations are already examples of a mismanaged US healthcare system in fact, 48% government run. Reduced excellence in care due to lacking competition via "assembly-line treatment" (read up on the challenges faced by the VA), reduced pharmaceutical advancement, reduced freedoms, and reduced privacy. Using my tax dollar to compete against... me? The free market? I don't like it.

I generally subscribe to the Warren Buffet philosophy on investment; make sure the business model is strong enough that a moron could run it because sooner or later a moron will be.

Your whole reply--and actually your whole argument against what is being discussed--is that the United States would embrace a completely socialized central-payer system like in Canada. Why is that? Why do you assume that is the way the United States would go if we were to try and have some form of socialized health-care? All your arguments above about "x percentages going to the states" is predicated on a centralized model that has the federal government doling out health-care dollars to the states. Why do you assume a) that is the method the United States would choose if it were to implement some form of socialized medicine and b) that that form of socialized medicine is the only method there is to guarantee all citizens access to health-care services?

I don't want to say you are arguing against a straw-man but your arguments are not for/against any specific types of plans that might be implemented in the United States but rather against the shortcomings of one particular type of socialized health-care plan in one particular country. Why is that?

[nonhuman]

My biggest argument against all this is that I don't trust government to make proper choices regarding either health care procedures or the direction in which health care research should go. Admittedly, having profit be the motivating factor behind those things is also less than desireable (but at least is never going to end up in care or research being beholden to out-moded moralities and superstitions). Ideally I woud like to see 'insurance' companies (really what they do is barely insurance anymore) be non-profits. If their main motivation is to enable people to be able to afford the health care they need when they need it rather than to turn a profit for their share-holders I imagine they should be able to do a much better job of ensuring that people get while they need while remaining cost-efficient. Since the general idea is sound (a large group of people pay in a small amount against the very low possibility that any significant faction of them is ever going to need to receive a large amount of benefits) such a system should be quite workable.

The advantage of having multiple non-profit insurance agencies in this model over a single government agency that attempts to fill the same purpose (and admittedly would have a much larger payer base and therefore greater resources at it's disposal) is that the multiple agencies can all try different things if they so choose. If certain people want to pay into a system that provides for preventative care of all customers they can. While if others want to pay into a system that only pays out for urgent care matters giving them a lower premium but higher deductable and leaving them personally responsible for their own day to day health care needs they can also do that. Flexibility to best serve different groups of customers with different needs as well as freedom of choice for individuals to choose the system that best fits their own needs and ideals is a good thing, and something that can never be provided by a nationalized healthcare system.

[ebuddy]

Originally Posted by dcmacdaddy 

I don't want to say you are arguing against a straw-man but your arguments are not for/against any specific types of plans that might be implemented in the United States but rather against the shortcomings of one particular type of socialized health-care plan in one particular country. Why is that?

Why would I assume a US system already 48% government run, entertaining the notion of "rationing healthcare" and/or nationalizing healthcare is going to usurp more authority on our healthcare system? The real question is, what evidence do you have to support any other method of healthcare delivery???

What nationalized healthcare scheme have you witnessed where the Federal entity is not doling out funds to smaller state/province entities? I've not only cited potential problems dcmacdaddy, I've cited problems that already exist today among those aspects of healthcare already managed by the Federal government. Are you saying this would somehow be crafted as a State's rights issue and that those issues of woeful waste and ineptitude would magically disappear? I've certainly never seen that proposal. Perhaps you have a couple on hand to show me?

If what you're saying is that only those who've elected to accept the national healthcare scheme will pay a tax or premium for it, I might soften my stance a smidgen, but you and I both know this will not be sustainable. This degree of bureaucracy would not come cheap. I do not want to be placed into a situation where I'm paying taxes for the Federal government to lowball my insurer. If what you're suggesting is somehow different than a Federal entity doling out money to States, then you're not suggesting nationalizing anything. In fact, you'd be merely suggesting a stage of evolution similar to those systems running from nationalization to privatization.