News Most US doctors now support a national health plan

[Al68]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

Well, then, I'll just try to fix it by taking the brake rotors off, then drive it. Since I skipped the "do no harm" musings.

 

[mheslep]

Thank you. Of every dollar spent for health care in the US, over 30 cents goes to pay for administrative costs. We cannot afford not to have public health care, or at least a public health care option against which private health care must compete.

This not a liberal vs conservative situation. It is an economic choice in which most real conservatives would select the most effective/least expensive option. Ironically, neo-cons rail against the more conservative option almost reflexively. The GOP hard-line is that if you cannot afford health care and preventive treatment, too bad. Not good, because poorer patients that cannot afford preventive health care present themselves to doctors too late to be good prospects for survival and drive up the cost of all our own coverages.

I do not support the public option Turbo, I oppose it. The only thing that drives productivity increases is competition, not having the government control everything. It happens that I don't care to hear any more 'everything is okay, do nothing' arguments either. See the Milton Friedman link above in this line.

Also: I believe the 'competition' between public care and private care argument is spurious, as were the President's comments on same. The public system can subsidize the price down below cost by running up the debt some more. It can, it will, and it has. See a near perfect analogy of Florida running off all the private home owners insurers with their (underfunded) state home insurance system. No Allstate, no Nationwide, no State Farm; they are gone in Florida, run off by the state.
http://online.wsj.com/article/SB124623134986666161.html

 

[Hurkyl]

Fortunately, modern doctors reject that notion due to the Hippocratic Oath.

I don't consider that fortunate. I'd rather when they do nothing, they do nothing because it's the best choice of action.

 

[Al68]

I don't consider that fortunate. I'd rather when they do nothing, they do nothing because it's the best choice of action.

It seems you miss the point of the Hippocratic Oath. The point isn't to not do what is best for the patient. The point is that in the absence of a good reason to do "something", doing nothing is the best choice.

Doing no harm is more important than doing "something".

 

[Al68]

Also: I believe the 'competition' between public care and private care argument is spurious, as were the President's comments on same. The public system can subsidize the price down below cost by running up the debt some more.

Advocates could of course create a non-taxpayer funded entity to compete similar to the USPS. They haven't and they won't. They know they could never compete.

They have always been perfectly free to compete with existing companies, even without any government support.

We are supposed to believe that in the current insurance market there is enough potential for improvement that investing in a new competitor would be a sure way to make enormous profits, yet nobody is interested? Is there a shortage of rich people who want to get richer?

 

[mheslep]

It seems you miss the point of the Hippocratic Oath. The point isn't to not do what is best for the patient. The point is that in the absence of a good reason to do "something", doing nothing is the best choice.

Doing no harm is more important than doing "something".

No, you miss the point. It is indeed to do what is best for the patient, but given imperfect knowledge and the human bodies ability to heal itself, then it may often be the wisest course for the physician to do nothing that has a possibility of doing harm.

All of which has at best an imperfect parallel to economics and the US health system; that mismatch is not improved by repeating 'Hippocratic Oath'.

 

[Al68]

No, you miss the point. It is indeed to do what is best for the patient, but given imperfect knowledge and the human bodies ability to heal itself, then it may often be the wisest course for the physician to do nothing that has a possibility of doing harm.

All of which has at best an imperfect parallel to economics and the US health system; that mismatch is not improved by repeating 'Hippocratic Oath'.

I don't know what point you think I missed, since my post was consistent with this one. The main point is that there is no automatic advantage to "doing something" over "doing nothing". And too many politicians seem to think that doing "something" is always better than doing nothing. And usually, the "something" is worse than doing nothing. That's the parallel.

I never said the parallel was perfect. But your post expands it. In economics also, we have imperfect knowledge and its ability to heal itself.

 

[Hurkyl]

The main point is that there is no automatic advantage to "doing something" over "doing nothing".

And the converse is true as well. I see quite a lot of people in these kinds of discussions who want to exempt the choice to do nothing from requiring justification, almost to the point of being offended at the suggestion that one should consider the merits (or lack thereof) of such a choice.

Such people, when faced with no good option, they will often advocate doing nothing -- even if it happens to be the worst option of all -- because they focus on what's bad about the various ways of doing something, but never weigh that against what might be bad about doing nothing.

 

[Al68]

And the converse is true as well. I see quite a lot of people in these kinds of discussions who want to exempt the choice to do nothing from requiring justification, almost to the point of being offended at the suggestion that one should consider the merits (or lack thereof) of such a choice.

Such people, when faced with no good option, they will often advocate doing nothing -- even if it happens to be the worst option of all -- because they focus on what's bad about the various ways of doing something, but never weigh that against what might be bad about doing nothing.

Inaction isn't equivalent to action. And as a matter of fact, I don't need to justify doing "nothing".

As an obvious example, a crime require a specific action. The cliche defense "I didn't do anything" is a valid defense to an accusation of wrongdoing.

Actions can be crimes. Defining the lack of an action as a crime is the definition of slavery.

There is a famous example in philosophy classes about a railcar with a lever that if pushed would switch tracks and kill someone, but if not pushed would kill 10 people that are on the current track. The moral dilemma is that moving the lever is murder, while doing nothing "fails to save" 10 people.

While people may disagree about whether or not to pull the lever, choosing to "do nothing" is not murder.

 

[Hurkyl]

Inaction isn't equivalent to action.

This is a semantic game, nothing more.

As an obvious example, a crime require a specific action. The cliche defense "I didn't do anything" is a valid defense to an accusation of wrongdoing.

Except, of course, when it isn't. It didn't take much searching to find examples like this.

Another example, although I'm not a lawyer and cannot be sure, is that if you notice that you received property mistakenly (e.g. the cashier at the grocery store gave you too much change) and decide to keep it (an inaction), then you have committed theft.

This isn't made up off the top of my head -- I spent a few minutes actually looking at legalese. Unfortunately, I wasn't able to find anything crystal clear[/size]

Actions can be crimes. Defining the lack of an action as a crime is the definition of slavery.

When did we start talking about crime anyways? I don't see how this is relevant, since we're talking about people whose job it is to make these decisions.

There is a famous example in philosophy classes about a railcar with a lever that if pushed would switch tracks and kill someone, but if not pushed would kill 10 people that are on the current track. The moral dilemma is that moving the lever is murder, while doing nothing "fails to save" 10 people.

It wouldn't be a famous example if it was settled that easily. e.g. an alternative interpretation is that it demonstrates how vigorously people will try to search for any technicality to try and absolve themselves from making a difficult decision.

 

[Al68]

Except, of course, when it isn't. It didn't take much searching to find examples like this.

I notice in this example inaction isn't equivalent to action. Failure to rescue isn't the same as murder.

The bottom line is that most moral codes don't consider inaction to be the same as action. And most laws. That doesn't mean inaction is never wrong of course.

And semantically, if they were the same, there would be no such word as inaction.

 

[mheslep]

..

I never said the parallel was perfect. But your post expands it. In economics also, we have imperfect knowledge and its ability to heal itself.

Alright I'll torture the analogy one more time in hopes of bringing the discussion back on topic (US health care). The body (the economics of the health system) has not been left alone. The patient is on the table, and somebody (the government) stuck a knife in long, long ago. A reasonable course might be to stop any further meddling and have the government pull its knife out: eliminate limitations on state only insurance, eliminate employer based health care that's rigged by the federal tax code and kills competition, cap run away malpractice law suits and consequent defensive medicine costs enabled by tort law. But to just walk away from the table and do noting is not in any sense a reasonable option.

 

[mheslep]

A history of meddling with the US health system:
(Not Krugman, but a comment)
http://krugman.blogs.nytimes.com/20...ot-a-bowl-of-cherries/?apage=7#comment-192283

...the US has not used the standard competitive market model for the last say, 70 years... To understand how we got in this situation we need to understand inflation and the history of the US medical insurance industry.

There are several factors related to the inflation of medical coverage in the United States. One is the amount of doctors available. The American Medical Association beginning in 1910, decided everyone would benefit from fewer, more highly trained doctors, and that medical schools should raise standards, tuition and improve facilities, the number of medical schools then dropped from 131 to 81, and of course the fee doctors charged went up.

Soon after it was the American Hospital Association that expanded prepaid hospital service plans that had just been developed to the community level, a precursor to Blue Cross Blue Shield (set up in the 1930s) this eliminated the need for hospitals to offer competitive prices against each other, as they all began to pull money out of the same pool. Prices again went up.

The real spike in health care inflation happened as a result of what happened in 1940-1960 [*], when we went from under 20mil people insured to 140mil, or aprox. 75% of the country. After which, health care costs went up approximately 6.5% per year until 1970 and continued at a rate of 4% since, until it spiked at 90% in 2004 and then dropped to where we are now, at 85% covered. Despite advancements in technology that have made the same level of health care cheaper, and other methods such as outpatient care, the price of medical coverage is through the roof, but then again so are doctor’s salaries, hospital profits, and the markup on pharmaceuticals...

*due to WWII wage and price and controls and the subsequent special off-the-books tax status of health benefits.

 

[bleedblue1234]

The main issue here is government interference distorting what the market can bear and what the market should bear. The argument currently is that everything costs too much so why don't we subsidize it through the government rather than letting market forces drive the cost of ridiculously expensive drugs down to the point where the average American making a moderate income can afford to purchase them (not just drugs, health care in general).

Also people need to realize that health "insurance" is just that ... insurance against damages. I don't buy house insurance so that if my light bulb burns out I call State Farm to the rescue, on the contrary, I fix it myself. Much the same in health care, people use "health insurance" as if it should cover every facet of medical expenses, rather than covering the 'big issues' (cancer, heart attacks, etc.)

Another factor that pushes health care costs high is just the fact that Americans taken as a whole are pretty unhealthy. We do not eat many good fats (fish, etc.) and we instead consume fats and oils like nobody's business. We choose to forgo prevention and instead look to quick fixes or just 'doing nothing' (and this is especially prevalent in the minority communities.)

Another issue health care costs a considerable amount is government interference in the system through medicare, medicaid, managed care... etc... education and health care costs seem to be going through the roof, and that is what happens when government steps in in unforeseen ways and tries to subsidize or somehow fund health care...

Insurance companies also have a stranglehold on much of government through lobbyist organizations and the like, and they push through drugs through the market so they can make as much profit as possible... and the issue also seems to be like of generic alternatives (some medicines cost a fortune while you can buy generics of other at Walmart for $3-4 per month) and issues with over medicating are also an issue.

So it basically comes down to government interference and societal values concerning what 'health care' really means and what health insurance should provide us... but a government plan is not the answer... considering we have extremely large liabilities moving forward and a lack of any meaningful case where a country on a scale of the United States has had success with a single-payer system.

And the Liberals and a lot of Americans continue to push for a "competing" health plan... well there is no sensible way for a government funded agency to 'compete' with private insurance companies due to the fact A) the government has (virtually) unlimited pocketbooks and can run deficits year after year (amtrak etc.) B) Employers will happily dump coverage for the employees if a public option is available due to the fact that it is cheaper (thus making it the only option) and C) the government program is bound to include all sorts of bureaucracy and waste that this country simply CANNOT afford... we just simply CANNOT afford a new system right now, the best course of action would be to 'reinvent' the old one...

 

[mheslep]

Harvard economist G. Mankiw on http://gregmankiw.blogspot.com/2009/07/costs-versus-efficiency.html"

The bottom line: Low administrative costs are not to be confused with high administrative efficiency. In other words, administrators are not necessarily a deadweight loss to the system.