American Politics XIII

[Commodore]

I just want to smack the shit out of everyone who bought into that euthanasia bullshit.

Not euthanasia, a determination by the state that life-extending care is not worth the cost. This is done in the UK, where they have rationed UHC and perform a statistical analysis that determines how many quality years you have left and how much per year they are willing to pay for it. The house bill sets up a Health Benefits Advisory Comittee that will decide what gets covered.

Just read the versions of healthcare legislation:H.R.3200 in the House. One key proposal is to mandate an "essential benefit package" for every private insurance policy sold in the United States. Currently, individuals and employers usually make these coverage decisions. This legislation creates a new federal Health Benefits Advisory Committee that would decide instead. For example, if you are a single male with no children, the legislation still requires you to have maternity benefits and well-baby and well-child care coverage. You don't want or don't need that coverage? Sorry, you have to pay for it anyway.

Other planned agencies would give the federal government unprecedented and unaccountable control over your healthcare. The so-called Health Choices Administration and the National Health Insurance Exchange would set various standards for all health insurance policies. The president is also pushing for another new agency called the Independent Medicare Advisory Council. Described as a cost-control initiative,it would be made up of five government appointees who would, by determining Medicare reimbursement amounts, in essence decide what would be covered and what would not. The fear of government rationing is based on the premise that once government has such power, especially the ability to control what is covered by your private insurance policy, it also has the power to deny and restrict.

These comissions and commisioners and secretaries are what the death panel label refers to. The legislation is purposefully vague. They tell us that we won't see reduced coverage, but give the state the power to do just that. Indeed, there is no other way to reduce costs in a public system besides rationing care, especially if you are trying to increase the number of people enrolled in the program at the same time.

Obama mentioned that health coverage should not have covered his grandmother's hip replacement since she was dying of cancer, that it should have been paid for out of pocket. He also suggested to a woman that a pacemaker might not be appropriate for her dying grandmother, that a pain pill might be more appropriate. Statements like that tend to freak people out and lead to the elderly coming out to town halls to protest.

Obama has a song about it, to the tune of Randy Newman's

.

[Shryke]

So it's ok as long as the government isn't doing it?

[sologdin]

there is no other way to reduce costs in a public system besides rationing care, especially if you are trying to increase the number of people enrolled in the program at the same time.

dead wrong. the privately-held hospitals, group practices, imaging centers, laboratories, and other adjuncts to the medical profession can accept a reduced rate of return. pharmaceutical concerns can eat my nutsack, considering that their R&D is financed by the public, but they still have the gall to fight for patent extensions. emergency rooms that bill out an aspirin for $40 and an ace bandage for $75 should simply be burned to the ground. and EMS companies that bill out $22 per mile will just have to settle for normal taxi rates, and perhaps, then, bill for actual services rendered, rather than flat $1200 for an ALS1 run or $650 for a BLS non-emergency run, regardless of actual services rendered.

i.e., there's tonsa room to trim waste, inefficiency, corruption, and ludicrous profiteering from the medical professions. the state has an advantage immediately because it need not satisfy the capitalist's lust for unearned return.

[Commodore]

So it's ok as long as the government isn't doing it?

Exactly. Health care resources are by definition limited, they must be rationed, but it should be done by the individual, not the state. If you believe health care is a right, why not abolish all health care mandates and give individuals health care vouchers, so they are empowered to shop around and choose the plan that is best for them (because we know it's not about empowering people, it's about controlling them, and empowering the state).

dead wrong. the privately-held hospitals, group practices, imaging centers, laboratories, and other adjuncts to the medical profession can accept a reduced rate of return. pharmaceutical concerns can eat my nutsack, considering that their R&D is financed by the public, but they still have the gall to fight for patent extensions. emergency rooms that bill out an aspirin for $40 and an ace bandage for $75 should simply be burned to the ground. and EMS companies that bill out $22 per mile will just have to settle for normal taxi rates, and perhaps, then, bill for actual services rendered, rather than flat $1200 for an ALS1 run or $650 for a BLS non-emergency run, regardless of actual services rendered.

i.e., there's tonsa room to trim waste, inefficiency, corruption, and ludicrous profiteering from the medical professions. the state has an advantage immediately because it need not satisfy the capitalist's lust for unearned return.

Soviet central planners thought they could manage prices and costs and salaries efficiently. It doesn't work. The high prices you list are a result of a lack of competition and incentive to cut costs.

[ljkeane]

Not euthanasia, a determination by the state that life-extending care is not worth the cost. This is done in the UK, where they have rationed UHC and perform a statistical analysis that determines how many quality years you have left and how much per year they are willing to pay for it.

That's not true, the statistical analysis has nothing to do with how many years you have left or life extending care. NICE does a cost benefit analysis on drugs to see whether the benefits they offer are reasonable for the price. That's not unreasonable under any system which has finite resources including the US healthcare system. There is not value placed on years of people's lives, just a managing of the resources available to provide the best treatment.

I don't imagine the health insurance companies in the US are willing to spent unlimited amounts on unproven or experimental treatments either.

[Shryke]

Exactly. Health care resources are by definition limited, they must be rationed, but it should be done by the individual, not the state.

Except it's not the individual doing it, it's the insurance company.

[Commodore]

Except it's not the individual doing it, it's the insurance company.

The individual chooses the company/plan that gives them the best coverage.

[Watcher]

The individual chooses the company/plan that gives them the best coverage.

Which is one of the things wrong with the American system. Why should be dependent on the company you work for?

[sologdin]

Soviet central planners thought they could manage prices and costs and salaries efficiently. It doesn't work. The high prices you list are a result of a lack of competition and incentive to cut costs.

commodore--

wtf does the USSR have to do with anything that i wrote? (and the cavalier assertion that soviet healthcare "doesn't work" is not at all persuasive, considering the decline in longevity after the cappy restoration in the FSU.)

yeah, the current system is a cartel in which the state participates.

the cartel has a built-in disadvantage in terms of cutting costs because it is mostly privately-owned and must generally make a profitable return to its investors. this return, from the point of view of services rendered, is waste.

a fine incentive to cut costs, incidentally, is the entry into the alleged marketplace of a public insurer that will place downward pressure on rates by virtue of its lack of profit-motive. this thesis is widely accepted on the rightwing, it seems, but the argument becomes the fallacy ad consequentiam, insofar as the right predicts the end of private insurers. (the problem with that is what exactly?) such is hardly an argument against some limited public insurance, however.

[Watcher]

Except it's not the individual doing it, it's the insurance company.

Yep, my plan has a built in million dollar life time limit but that's alright because it's the free market insurance bureaucratic that determines when I should die, not the evil government.

[sologdin]

of course. if a person dies under a capitalist system, it is the person's own fault, even the person's own sin, for the capitalist system is freedom, and freedom creates personal responsibility. but under a socialist system, there exists no personal freedom, so there can be no personal fault, and, ergo, it is the state's fault.

[Shryke]

The individual chooses the company/plan that gives them the best coverage.

No, generally in the US their company does.

Try again.

Also, the Death Panels was in reference to an addition to the bill that would have paid for 1 end-of-life counseling session every ... 2 years I think it was?

Regardless, it was basically so that a patient could have a meeting with his doctor so we'd never have to deal with another Terry Schiavo.

[TrackerNeil]

The individual chooses the company/plan that gives them the best coverage.

Only to an extent. At the end of the day, you're limited to what the insurance companies offer because unlike large companies, individuals really can't negotiate special deals with the likes of Aetna or IBX. So while individuals can indeed choose the best plan for them, that doesn't mean the plan is good enough for their needs. Also, you have blithely ignored the fact of exclusion of preexisting conditions, which can in some cases virtually ensure that certain individuals will receive no insurance except the most expensive and least useful. That may be choice in a very limited sense (which I suppose fits a limited philosophy like libertarianism) but not in a meaningful sense.

[AndyP]

Not my favorite plan but here is Wyden/Bennit

Wyden and Bennett shake out this inefficient system, Etch-a-Sketch style. Every company must make an accounting of their health care dollars and, over two years, turn that into additional wages for their employees. Each state would create its own Health Help Agency that would offer a menu of private insurance options. Basically, it would be like the Massachusetts Health Connector or the Federal Employee Benefits Plan – only everyone in the state would be in it. Moreover, the level of transparency and aid rendered by such agencies would make it possible for individuals to legitimately choose the plan best for them. Subsidies would be available on a sliding scale based on income.

Why does a conservative like Bennett go for this? Well, first it hits upon the major conservative value of individual choice – you get to choose your own plan, rather than taking or leaving what your employer offers you. It takes the burden of skyrocketing premiums off businesses (though it doesn’t leave them off the hook… more on this in a bit) and prevents more industries from being out-competed by foreign companies benefiting from universal health care. And it’s not government-run health care, the scarecrow of “socialized medicine†anathema to the GOP base.

Why does a liberal like Wyden go for this? Senators with Wyden’s voting record normally tend to favor cutting out the private insurance industry rather than having every American citizen insured through it. But under the plan, the private insurance industry would be far more chastened and regulated than ever before. They would be required to offer their products to all buyers in that state – an end to cherry picking only the health applicants. They would be required to offer community rates – one price for everyone, regardless of pre-existing conditions, past history or genetics. A minimum level of comprehensive benefits based on the Blue Cross Blue Shield selection of the Federal Employee Benefits Program would be established for all Americans – no more insurance options that only come into play if you get hit by a truck. And the state managed health agencies would offer the same options at the same price whether you worked for Google or Angelina’s Pizzeria.

In addition to this dramatic expansion of high-quality coverage, turning all dollars spent on health care into wages would create the single largest pay increase for the American worker in history.

I like the plan in Jaime L thread better.

[The Real Will]

Yep, my plan has a built in million dollar life time limit but that's alright because it's the free market insurance bureaucratic that determines when I should die, not the evil government.

That's just bizarre. Clearly, from the myriad of options open to you, you should have chosen one that was within your means and had no life time limit on coverage. If I were you I'd have picked one with a limited co-payment, no history of denying claims, and one that will bake you cookies as well. After all, under a capitalist system, if there is a demand for cookies with your health insurance, then some enterprising company will offer them.

Seriously? Insurance companies have a life time limit on their policies? I really think you guys need to consider just putting your premiums into a jar at the end of each month and hoping that you have enough should you ever get sick. It sounds like the gamble would be about the same as giving that money to an insurance company.

[Annelise]

Not euthanasia, a determination by the state that life-extending care is not worth the cost. This is done in the UK, where they have rationed UHC and perform a statistical analysis that determines how many quality years you have left and how much per year they are willing to pay for it.

Yeah, I did hear they pull the plug on Grandma and Stephen Hawking in the UK. Stephen Hawking seemed pretty pissed about that, too.

Look, I know you will continue to rock on with the Democrats & government-boogey-men comin' to getcha no matter what anyone here says. But I hope you at least support measures to increase our choices, one way or the other. So we do have the freedom to choose the plan that is best suited to each of us, in reality. Ironically, as near as I can tell, Medicare currently provides the most choice, with all its supplemental options.

[Shryke]

-We absolutely should be on the gold standard. The reason gold works so well is because it's nearly impossible to manipulate and all other currencies are.

And that's where my days of taking this man seriously at all come to an end.

And you say he works for a hedge fund?

Maybe this explains alot about the economy the past few years....

[Annelise]

-Obama absolutely will raise taxes on the middle class because he has to. The deficit is too big.

Well, I sure the hell hope he's wrong about the false recovery and the depression.

As far as raising taxes on the middle class.. I think there might be something to that at some point during his term.

[Shryke]

I have to fully admit that I just don't know a ton about the gold standard. I know what kind of people tend to support it and that it's been sort a fringe belief of late. I know that both parties ripped on Ron Paul for it a bit. But honestly, I just don't know much about it. I had never heard his theory before on how gold is the one thing that can't be manipulated. I asked him what would happen if people lost faith in paper currency and then also lost faith in gold as well and I think his answer was something to the effect of "highly unlikely that will ever happen to gold, very possible it will happen to paper money." He claimed that everyone in his industry owned gold.

(he also admitted that most people in his industry think the ends justify the means...It came off like he was disclosing that financial guys believe it's OK to do anything that makes them the winners. I don't expect that to be news to anyone).

The Gold Standard is terrible for all sorts of reasons.

People went OFF the Gold Standard for a reason. Roller-coaster recessions weren't fun.

[Shryke]

Well, I sure the hell hope he's wrong about the false recovery and the depression.

As far as raising taxes on the middle class.. I think there might be something to that at some point during his term.

I don't see how. It would go against everything he's done before now.

Taxes on the middle-class aren't the best way to raise money, nor are they good for the economy.

Of course, he probably has a fucked up idea of what constitutes "middle class".