News Health Care Reform - almost a done deal? DONE

[Sea Cow]

Run the numbers yourself instead talking about what you suspect. If one assumes the average age of the homicides and car wrecks is 25, by itself that moves the longevity of the entire US population down by nearly year, and we only talking about a couple years of difference.
http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf , table 1-5

The fact that the US is an extremely violent place in which large numbers of people appear to drive like maniacs does indeed reduce the life expectancy. In comparison to most of the countries in the report you link to, the difference is worth, as you say, the best part of a year – up to 0.8 assuming 40,000 extra deaths per year and average age of death in murder/car crash of 25.

However, that is not what table 1-5 says. It makes the swing in difference due to fatal injuries between Japan and the US 4.3 years. Now, perhaps unsurprisingly, they don't show their workings in that report. Could that be because they've made their figures up?

It would mean not 40,000 extra deaths per year, but 220,000. Given that about 60,000 people are murdered/die in car crashes each year in the US, this must mean that 160,000 (adjusted for size of population) are resurrected in such incidents in Japan each year. I haven't checked Japan's latest figures, but I doubt this is correct.

BTW I'm assuming you've abandoned your third criterion, genetics? This is a science forum after all. I'm also not quite sure how the murder/road death rate affects infant mortality, in which the US performs very poorly. Are mothers going into labour on the road, perhaps? I can see how the distraction of childbirth might cause them to crash.Facetiousness aside, beware internet 'reports' of dubious provenance. They are likely to be full of crap.

 

[Sea Cow]

My larger point is that it is very difficult to cleanly separate out all of the non-medical care related life expectancy causes, and given we can directly to medical care numbers why try? We have readily available numbers for the treatment of various diseases - cancer, heart disease - which are directly and almost solely dependent on medical care quality, it becomes a waste of time to try and make something of a 5% difference in life expectancy. A similar argument (unrelated causes) applies to a difference of two or three deaths per thousand in infant mortality.

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. Left to our own devices, we will tend to scrimp on health care until we fall seriously ill, at which point we plough everything we have into trying to prolong our lives. This is one reason why health care ought to be provided communally. We're very bad, in the most part, as individuals at judging risk and making rational assessments of how we should spend today to save tomorrow. Sometimes it is good for us all to take such decisions together. This doesn't mean a loss of freedom. In fact, it is quite the reverse.

 

[mheslep]

? This is a science forum after all.

Yes it is. In that vein, you might lay off the polemics and make some posts based on referenced information on actual medical outcome statistics. I am not at all interested in what you may or may not find personally dubious.

 

[Sea Cow]

Yes it is. In that vein, you might lay off the polemics and make some posts based on referenced information on actual medical outcome statistics. I am not at all interested in what you may or may not find personally dubious.

The report you linked to is wrong. Address that point.

Can you explain the 4.3-year swing between the US and Japan in the table you directed the thread to?

 

[mheslep]

The report you linked to is wrong. Address that point.

I am not interested in what you may or may not hand waive away as wrong without argument or reference.

 

[Sea Cow]

I am not interested in what you may or may not hand waive away as wrong without argument or reference.

Did you read my post? I took the trouble to read the link you provided and I have pointed out what is wrong in it and how it is wrong. That is not hand waving. It's fairly simple arithmetic.

Yes, I was sarcastic. I probably shouldn't do that. It is in fact quite a serious problem that such reports are out there and that people are believing them.

 

[Al68]

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. Left to our own devices, we will tend to scrimp on health care until we fall seriously ill, at which point we plough everything we have into trying to prolong our lives. This is one reason why health care ought to be provided communally. We're very bad, in the most part, as individuals at judging risk and making rational assessments of how we should spend today to save tomorrow. Sometimes it is good for us all to take such decisions together. This doesn't mean a loss of freedom. In fact, it is quite the reverse.

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

I can only assume that's some kind of weird joke.

As for the point, a claim that an individual is likely to make bad decisions for himself doesn't justify using force to deny his liberty, despite the fact that such claims have been used by oppressors many times historically.

 

[TheStatutoryApe]

I think the tax penalty qualifies as "prohibiting the free exercise thereof", since there will be a federal penalty imposed on some but not others based on their religious beliefs.

Does the penalty have to be death or prison to qualify?

This would hinge more rightly on the Establishment Clause I believe. I think that the USSC would likely discern a difference here between religious preference and exemption based on nonparticipation. If the law specifies the Amish without exemption for any other members of a group with some form conscientious nonparticipation the court would likely simply state that the law may not discriminate and any persons seeking nonparticipation in the general health care system should be granted exemption status.

Edit: I mentioned the Equal Protection Clause. I think that this would be where the strongest argument would be (my opinion). One could argue that allowing the right of privilege to exemption for some perforce denies that right to others and further does so based on religion in violation of the Establishment Clause. In my opinion though the court would likely say that it must weigh the protected rights of the Amish (and others of a similar mind) against the alleged denial of rights to the population at large and would weigh in favour of the protected rights.

 

[mheslep]

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

I can only assume that's some kind of weird joke.

As for the point, a claim that an individual is likely to make bad decisions for himself doesn't justify using force to deny his liberty, despite the fact that such claims have been used by oppressors many times historically.

Or, from a similar conversation:
"Why do you resist? We only wish to raise quality of life, for all species."
"I like my 'species' the way it is!"
"A narrow vision."

- Locutus of Borg to Lt Worf

 

[Sea Cow]

An individual having his decisions made by the community instead of himself isn't a loss of freedom?

The individual makes the decision as part of the community, rather than individually.

You appear to have a weird idea of freedom that includes the freedom not to be helped by others, the freedom to drown on your own, the freedom to be exploited by those that make ownership claims to resources you need, the freedom to carry the biggest stick you can find.

As for your point about force, all I can say is: eh? You are already forced to pay taxes. If communal provision is paid for out of taxation, the only 'force' is a change in that level. In terms of health care, the US currently has the most expensive system in the world, which provides not very good outcomes overall. Many on this thread seem not to care about the US's overall poor outcomes because the outcomes for the richest in the US are good, they themselves consider themselves well insured, and, well, basically, stuff everyone else. That's your freedom for you.

Remember that we are not all born free. We are all born helpless, and some of us are born into better environments than others in the lottery of life. This is basic stuff, really. If you wish to advocate freedom, you need to do better than this simplistic nonsense. You only seem interested in 'freedom to act'. You seem to ignore 'freedom not to be acted upon'.

To go back to the point, if everyone else is taking poor decisions and pouring too much of their health care money into the crisis at the end of their lives, under your system, that leaves me, the individual, in a worse position. The primary care infrastructure that I may want will not be there. The poor decisions of others acting individually have impinged upon my freedom to not to be acted upon.

Services such as health care are, necessarily, provided communally. Everyone doesn't have their own hospital with staff they've trained themselves, handing out drugs they've come up with in their garden shed. It's a massive collective enterprise. You think you have an effective voice in how that massive collective enterprise is run under your system? Really? You tell the insurance companies how to run things? Where's the accountability? A real, effective say in a communal decision is greater freedom than no say at all.

 

[Sea Cow]

Or, from a similar conversation:
"Why do you resist? We only wish to raise quality of life, for all species."
"I like my 'species' the way it is!"
"A narrow vision."

- Locutus of Borg to Lt Worf

Your quote begs the question: Do you consider those unable to afford decent health care insurance to be part of your species?

Can you explain the 4.3-year swing between the US and Japan in the table you directed the thread to?

Well?

 

[mheslep]

You are ignoring the single most important factor in life expectancy – primary health care.

This is where the US, in particular, falls down. ...

Nicely visualized here:


I'd respond further but at the moment I have go drive like a 'maniac' spewing 'rubbish' out the window while running down the lesser of my species.

 

[Al68]

This is basic stuff, really. If you wish to advocate freedom, you need to do better than this simplistic nonsense. You only seem interested in 'freedom to act'. You seem to ignore 'freedom not to be acted upon'.

This is basic stuff. You are the one ignoring 'freedom not to be acted upon'. You are insisting on 'acting on me' while I have no interest in 'acting on you'.

To go back to the point, if everyone else is taking poor decisions and pouring too much of their health care money into the crisis at the end of their lives, under your system, that leaves me, the individual, in a worse position. The primary care infrastructure that I may want will not be there. The poor decisions of others acting individually have impinged upon my freedom to not to be acted upon.

Failure to meet your needs isn't 'acting on' you.

Services such as health care are, necessarily, provided communally.

Obviously false. Too obvious to debate.

Everyone doesn't have their own hospital with staff they've trained themselves, handing out drugs they've come up with in their garden shed. It's a massive collective enterprise.

No, it's not. In the U.S., it's thousands of different enterprises. Do you really not know this?

You think you have an effective voice in how that massive collective enterprise is run under your system? Really? You tell the insurance companies how to run things? Where's the accountability? A real, effective say in a communal decision is greater freedom than no say at all.

You are the one advocating a "massive collective enterprise", not me. I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

 

[Sea Cow]

I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

That is a system.

 

[Sea Cow]

Failure to meet your needs isn't 'acting on' you.

It is if your needs are not met because someone else has taken a giant share of limited resources. Your concept of freedom requires infinite resource availability.

 

[Al68]

That is a system.

It's not a system in the sense relevant to this discussion. The individual enterprises involved are operated independently, not under common management or control.

It is if your needs are not met because someone else has taken a giant share of limited resources. Your concept of freedom requires infinite resource availability.

This makes no sense. What limited resource are you talking about? What health care resource is running out that can't be produced any more?

What relevant natural resource isn't "infinitely available" as a practical matter for these purposes?

As far as "my" concept of freedom, here I'm using it as a synonym of "liberty". I didn't make it up.

 

[Char. Limit]

I don't want any kind of "system" at all. I want individual private insurance companies to compete for my business.

The problem is, they don't compete for your business. They put prices as high as they want, because they know that eventually, you'll come to them.

It's the underlying principle of most human activities... greed. Can't escape it.

 

[CRGreathouse]

The problem is, they don't compete for your business. They put prices as high as they want, because they know that eventually, you'll come to them.

I'm reluctant to post, but I see this reasoning often and felt the need to address it.

*****

This is clearly not the case, and it shows a lack of understanding of even basic microeconomics. If companies *can* charge any price they want (they can), and they would make more money by doing so, why wouldn't they be charging more *right now*? After all, they are driven by greed, as you say. Why would they charge $800 per month when they could charge $8000 per month?

The reasoning is flawed on two levels. First, even if they were the only company in the business, there are limits on what they'd charge. There's some point at which so many people would be priced out of the market that they would prefer to charge a lower rate (to more people) than a higher. This is what's called the monopoly price. Now if there were many firms competing, so many that no individual firm had pricing power*, then they would charge a lower rate; this is the competitive price. At present, rates are between the two: oligopoly pricing. This happens when there are enough firms to keep the prices well below monopoly rates, but not so many that firms lose their pricing power altogether.

But the real problem, IMO, is not the number of companies or their market power. It's the power the companies have (collectively) over the government itself: regulatory capture, government failure, etc.

Personally I hate health insurance companies, and I dislike buying insurance. (It's worth the price after the employer subsidy so I do buy it... but I don't think it's a good deal at face value, or even half of face value.) But if we're to find a reasonable alternative, we should look at the current system fairly.

* Suppose the going price for wheat was $4.90 per bushel and someone offered to sell you wheat at $5.00 per bushel. You'd decline, obviously -- you could get wheat from anyone else at $4.90. That seller has no market power. On the other hand, a drug company supplying patented medicine has absolute pricing power. They charge monopoly prices (not infinite prices!) because they are able to do so.

 

[NeoDevin]

The reasoning is flawed on two levels. First, even if they were the only company in the business, there are limits on what they'd charge. There's some point at which so many people would be priced out of the market that they would prefer to charge a lower rate (to more people) than a higher. This is what's called the monopoly price. Now if there were many firms competing, so many that no individual firm had pricing power*, then they would charge a lower rate; this is the competitive price. At present, rates are between the two: oligopoly pricing. This happens when there are enough firms to keep the prices well below monopoly rates, but not so many that firms lose their pricing power altogether.

The problem with this reasoning is that major hospitals, emergency response crews, and many of the highly specialized fields of medicine have an effective monopoly at the "point of sale". When someone is dying of a disease/injury, they (often) don't have the option of saying "No thanks, I'll take the next ambulance, they offer better rates." or "Drive me to the hospital 2 counties over, it's cheaper." Furthermore, the "monopoly price" is not determined by what individuals can afford, but rather what the insurance companies/medicare can afford.

 

[mheslep]

[...]
The popularity of this will continue to rise for many months as the gloom and doom predictions prove to be nonsense. Obama should also take a good bump in the polls. Former President Clinton predicts that he will see a 10 point rise in his approval rating.

Tomorrow will be one month after Sunday March 21st passage. When did Clinton say that bump would kick in?
http://www.realclearpolitics.com/epolls/other/president_obama_job_approval-1044.html

 

[mheslep]

As it has done for the past seven years, Congress http://www.bizjournals.com/houston/stories/2010/04/12/daily65.html" to stop the doctor's Medicare pay cut as scheduled by existing law, and in so doing ended any reasonable debate as to whether or not the recent Health Reform law will reduce the deficit when matched with reality: it will not, as was specifically warned about in the last CBO report before passage.

This issue is commonly referred to as the 'doctor fix' in the media, and it refers to Medicare payments to doctors. As mentioned in an earlier post, the US Social Security Act as modified in the Balanced Budget Act of 1997 http://www.cms.gov/SustainableGRatesConFact/01_Overview.asp#TopOfPage". As these cuts would have doctors dumping Medicare in mass, Congress has at the last minute stopped or delayed those cuts for the last seven years, without ever changing what the law required for the following year.

Yet CBO, which reported a ten year deficit reduction of $143 billion to Sen Reid, was obligated to score based on the existing SGR law, i.e. Medicare doctor spending should drop 21% (this year). CBO specifically warned about this dependency in the first of its http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf", page 13:

Key Considerations. Those longer-term calculations reflect an assumption that the provisions of the reconciliation proposal and H.R. 3590 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress.[...]

Many in the opposition had been vocal about this gimick; Rep Ryan http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504074.html" (scroll to 'doc fix').

Well Congress acted on April 15th to revoke these cuts, as everyone knew all along that it would, so the CBO dependency is gone and with it any deficit reduction. CBO forecasts that the doc fix alone will cost http://www.cbo.gov/ftpdocs/113xx/doc11376/RyanLtrhr4872.pdf" over the first ten years, meaning the deficit will increase.

CBO estimates that enacting H.R. 3961 [permanent elimination of the doctor pay cuts], by itself, would cost about $208 billion over the 2010–2019 period.

There are several other serious gimicks in the Health Reform law that also forced CBO to play silly games, but this one as of last Thursday was brought into clear view. So much for

I have also pledged that health insurance reform will not add to our deficit over the next decade, and I mean it.

 

[CRGreathouse]

The problem with this reasoning is that major hospitals, emergency response crews, and many of the highly specialized fields of medicine have an effective monopoly at the "point of sale". When someone is dying of a disease/injury, they (often) don't have the option of saying "No thanks, I'll take the next ambulance, they offer better rates." or "Drive me to the hospital 2 counties over, it's cheaper."

I'm talking about insurance companies, not hospitals. The points about pricing do carry over for hospitals but are much more complicated, since the number of buyers is small (it's an oligopsony).

Furthermore, the "monopoly price" is not determined by what individuals can afford, but rather what the insurance companies/medicare can afford.

Again, I'm talking about insurers not hospitals. But if you think that they (or any other company) could increase their profits by charging, say, 10 times more, why wouldn't they?

 

[NeoDevin]

Again, I'm talking about insurers not hospitals. But if you think that they (or any other company) could increase their profits by charging, say, 10 times more, why wouldn't they?

They did, that's why (almost) no individual can afford a major medical procedure without insurance.

 

[CRGreathouse]

They did

Citation, please.

But even if that were true, why not raise them ten-fold again? Or a trillionfold? It just doesn't hold up logically.

 

[CRGreathouse]

(almost) no individual can afford a major medical procedure without insurance.

Are you suggesting the insurance companies are giving out more benefits than they charge their customers?

 

[NeoDevin]

But even if that were true, why not raise them ten-fold again? Or a trillionfold? It just doesn't hold up logically.

Because even with an effective monopoly, there are limits, as you pointed out earlier.

 

[NeoDevin]

Are you suggesting the insurance companies are giving out more benefits than they charge their customers?

No, I'm suggesting exactly what I said.

 

[mheslep]

They did, that's why (almost) no individual can afford a major medical procedure without insurance.

I expect most could afford one every 5-10 years. Certainly insurance is required to cover the most expensive of them, but many major medical procedures are about the cost of nice new car - http://www.costhelper.com/cost/health/knee-replacement.html" .

 

[turbo]

I expect most could afford one every 5-10 years. Certainly insurance is required to cover the most expensive of them, but many major medical procedures are about the cost of nice new car - http://www.costhelper.com/cost/health/knee-replacement.html" .

Need a bone marrow transplant? Probably $50-250K. Need a liver transplant? Probably >$300K plus ongoing anti-rejection treatments that can run $1500-2500/month or more. Few people could afford that without insurance.

There are some types of cancer that are very expensive to treat, and dialysis for kidney failure is costly and the cost never goes away without a transplant. Treatment and follow-up for bladder cancer could easily run $100K+

 

[mheslep]

Need a bone marrow transplant? Probably $50-250K. [...]

Along with the common course of treatment that eventually ends with a bone marrow transplant, it's closer $1 million total. As I said: Certainly insurance is required to cover the most expensive of them