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American Healthcare Rant 2: Die Harder
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Sam



Joined: 09 Jul 2006
Posts: 9674

PostPosted: Mon Mar 09, 2009 8:11 pm    Post subject: American Healthcare Rant 2: Die Harder Reply with quote

Okay, because american healthcare has become the embarrasing topic du jour I guess it is time to yet again start blathering about it.

Read this. No seriously, read it. Read it until you feel sick.

/ edit: soundtrack for thread

FACTS THAT MAY OR MAY NOT BE BIASED IN FAVOR OF THE REMOVAL OF THE ACTUARIAL MODEL OF HEALTH CARE

· The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.

· Half of the uninsured people in America owe money to hospitals and a third are being pursued by collection agencies.

· Children without health insurance are less likely to receive medical attention considered reasonable and appropriate for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X-rays or consultations.

· The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Part of this is correlative to the higher risks and lifestyles of poorer demographics and part of this is certifiably due to the consequence of moral hazard models in leaving chronic and/or life threatening conditions untreated.

· Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. The extra spending does not provide us with anything approaching the effectiveness of non-actuarial models.

· We have fewer doctors per capita than most Western countries.

· We go to the doctor less than people in other Western countries.

· We get admitted to the hospital less frequently than people in other Western countries.

· We are less satisfied with our health care than our counterparts in other countries.

· American life expectancy is lower than the Western average.

· Childhood-immunization rates in the United States are lower than average.

· Infant-mortality rates are in the nineteenth percentile of industrialized nations, which means that we have higher infant mortality rates than some developing countries.

· Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita.

· The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration. In contrast, a country like Canada spends only about three hundred dollars per capita.

· And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.

INSIGHT INTO WHY WE HAVE THE ACTUARIAL MODEL

Malcolm Gladwell wrote:
Health insurance here has always been private and selective, and every attempt to expand benefits has resulted in a paralyzing political battle over who would be added to insurance rolls and who ought to pay for those additions.

Policy is driven by more than politics, however. It is equally driven by ideas, and in the past few decades a particular idea has taken hold among prominent American economists which has also been a powerful impediment to the expansion of health insurance. The idea is known as “moral hazard.” Health economists in other Western nations do not share this obsession. Nor do most Americans. But moral hazard has profoundly shaped the way think tanks formulate policy and the way experts argue and the way health insurers structure their plans and the way legislation and regulations have been written. The health-care mess isn’t merely the unintentional result of political dysfunction, in other words. It is also the deliberate consequence of the way in which American policymakers have come to think about insurance.

“Moral hazard” is the term economists use to describe the fact that insurance can change the behavior of the person being insured.
If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you’ll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Insurance can have the paradoxical effect of producing risky and wasteful behavior. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor.

In 1968, the economist Mark Pauly argued that moral hazard played an enormous role in medicine, and, as John Nyman writes in his book “The Theory of the Demand for Health Insurance,” Pauly’s paper has become the “single most influential article in the health economics literature.” Nyman, an economist at the University of Minnesota, says that the fear of moral hazard lies behind the thicket of co-payments and deductibles and utilization reviews which characterizes the American health-insurance system. Fear of moral hazard, Nyman writes, also explains “the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage (for example, national health insurance or expanded Medicare benefits) in the U.S.”

What Nyman is saying is that when your insurance company requires that you make a twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it’s not simply an attempt to get you to pick up a larger share of your health costs. It is an attempt to make your use of the health-care system more efficient. Making you responsible for a share of the costs, the argument runs, will reduce moral hazard: you’ll no longer grab one of those free Pepsis when you aren’t really thirsty. That’s also why Nyman says that the notion of moral hazard is behind the “lack of enthusiasm” for expansion of health insurance. If you think of insurance as producing wasteful consumption of medical services, then the fact that there are forty-five million Americans without health insurance is no longer an immediate cause for alarm. After all, it’s not as if the uninsured never go to the doctor. They spend, on average, $934 a year on medical care. A moral-hazard theorist would say that they go to the doctor when they really have to. Those of us with private insurance, by contrast, consume $2,347 worth of health care a year. If a lot of that extra $1,413 is waste, then maybe the uninsured person is the truly efficient consumer of health care.

The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.

Sered and Fernandopulle tell the story of Steve, a factory worker from northern Idaho, with a “grotesque looking left hand—what looks like a bone sticks out the side.” When he was younger, he broke his hand. “The doctor wanted to operate on it,” he recalls. “And because I didn’t have insurance, well, I was like ‘I ain’t gonna have it operated on.’ The doctor said, ‘Well, I can wrap it for you with an Ace bandage.’ I said, ‘Ahh, let’s do that, then.’ ” Steve uses less health care than he would if he had insurance, but that’s not because he has defeated the scourge of moral hazard. It’s because instead of getting a broken bone fixed he put a bandage on it.


"The Moral Hazard Myth"

"Uninsured in America"

Quote:
Starr Sered and Fernandopulle interviewed a wide range of uninsured Americans with many levels of education, including graduate degrees. Many were employed at the time of their interviews and some had the opportunity to purchase insurance, but for amounts that would significantly reduce their take-home pay, making it unaffordable. Others could not work because of untreated or under-treated health care issues. Still others had been laid off after plant closings, but their chances of securing employment again if the economy improves are slim due to health conditions that have been exacerbated with lack of care. They also demonstrate that adhering to the work ethic guarantees neither health insurance nor steady work and income.

The final chapter of the book outlines suggestions that have been made for universal health coverage in America, but there is no easy solution. The authors argue that the current system for the poor is not economically sound. Without access to preventative care, problems worsen until there is no choice except to visit the emergency room or receive other exorbitantly priced treatment, which may be paid for by Medicaid or may never be paid. They contend that any feasible solution must sever the link between paid employment and insurance and must provide a minimal level of health care for all Americans, much as we provide a minimal level of education via the public schools. They argue that not only is this a humane way to treat citizens, but it is much more cost-effective than the current system.


Now, to take some other stuff into consideration!

BE AWED BY THE FIXATIVE PROFIT MODEL AND ITS OUTCOME: THE PROFIT MODEL MEANS MEDICAL NEGLECT = $$$

http://www.latimes.com/business/la-fi-insure9nov09,0,3065397,full.story?coll=la-home-center

Quote:
One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.


BE AMAZED BY THE STUPIDITY OF ACTUARIAL POLICY: MODELS HAVE INHERENT INCENTIVES, OURS SUCK

http://www.rockridgeinstitute.org/health/logic_of_the_health_care_debate.pdf

Quote:
In a number of respects, this disparity between health insurance and health care comes from the fact that everyone gets sick, will age, and die. At some point in their life, every insured person will cost an insurance company money. Insurance companies can’t make much profit on human health care, unless they exclude or limit people from coverage and benefits. Otherwise, premiums aren’t profit centers, they are just pre-payments for health care we know we’ll need in the future.

To increase profits, insurance policies with benefit limits are commonplace, and no benefits are paid if those limits are exceeded, regardless of needs. You get a debilitating illness, such as cancer, and you receive a maximum payment from the insurance company that is a fraction of the total medical costs. It's as if you were a car and had reached your Blue Book value; you're declared totaled. From there, you pay the full cost of continued treatment, which can be hundreds of thousands of dollars. For people with health insurance, this is one of the main causes of bankruptcy: people have to use up their savings and sell their homes in order to pay uncovered medical costs.


GASP AT DISCOVERING OUR CARE RANKINGS IN THE INTERNATIONAL SPHERE! (spoiler: they suck)

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

Quote:
(CNN) -- An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.

American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.

"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report.


BECOME AWED BY THE PERVERSE PRODUCT OF PROFIT-BASED CARE MODELS: WE EXPLOIT PEOPLE'S DESIRE NOT TO DIE IN MEDICAL CRISIS AS A MEANS OF PRICE-GOUGING

link

Quote:

On Feb. 3, Joyce Elkins filled a prescription for a two-week supply of nitrogen mustard, a decades-old [URL="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/cancer/index.html?inline=nyt-classifier"]cancer[/URL] drug used to treat a rare form of lymphoma. The cost was $77.50.

On Feb. 17, Ms. Elkins, a 64-year-old retiree who lives in Georgetown, Tex., returned to her pharmacy for a refill. This time, following a huge increase in the wholesale price of the drug, the cost was $548.01. ...

The increase has stunned doctors, who say it starkly illustrates two trends in the pharmaceutical industry: the soaring price of cancer medicines and the tendency for those prices to have little relation to the cost of developing or making the drugs.

Genentech, for example, has indicated it will effectively double the price of its colon cancer drug Avastin, to about $100,000, when Avastin's use is expanded to breast and lung cancer patients. As with Avastin, nothing about nitrogen mustard is changing but the price.
Quote:
But people who analyze drug pricing say they see the Mustargen situation as emblematic of an industry trend of basing drug prices on something other than the underlying costs. After years of defending high prices as necessary to cover the cost of research or production, industry executives increasingly point to the intrinsic value of their medicines as justification for prices.

Last year, in his book "A Call to Action," Henry A. McKinnell, the chairman of Pfizer, the world's largest drug company, wrote that drug prices were not driven by research spending or production costs.

"A number of factors go into the mix" of pricing, he wrote. "Those factors consider cost of business, competition, patent status, anticipated volume, and, most important, our estimation of the income generated by sales of the product."

In some drug categories, such as cholesterol-lowering treatments, many drugs compete, keeping prices relatively low. But when a medicine does not have a good substitute, its maker can charge almost any price. In 2003, Abbott Laboratories raised the price of Norvir, an AIDS drug introduced in 1996, from $54 to $265 a month. AIDS groups protested, but Abbott refused to rescind the increase.

And once a company sets a price, government agencies, private insurers and patients have little choice but to pay it. The Food & Drug Administration does not regulate prices, and Medicare is banned from considering price in deciding whether to cover treatments.


GET ACTUALLY JUST A LITTLE SICK AT HOW EASILY YOU CAN GET FUCKED: REVOCATION OR REJECTION OF CARE BASED ON THE WHIMS OF COVERAGE PROVIDERS

http://news.yahoo.com/s/kmbc/3257367

Quote:

Two years ago, Tracy Pierce's life changed dramatically when he was diagnosed with kidney cancer.
"I have no treatment. Three months has gone by and I haven't had any treatment," Tracy Pierce told KMBC's Jim Flink in May 2005.
When Flink talked to Tracy Pierce, his cancer was attacking his body. Despite being fully insured, every treatment his doctors sought for him was denied by his insurance provider. First-Health Coventry deemed the treatments were either not a medical necessity or experimental.
"I don't know what else to do but just wait," Tracy Pierce said last May.
As he waited, his doctors appealed again and again, including a 27-page appeal spelling out that Tracy Pierce would die without care. Coventry dismissed each request.


WATCH POOR PEOPLE GET UNPLUGGED JUST CUZ THEY POOR!

http://www.wfaa.com/sharedcontent/dws/wfaa/latestnews/stories/wfaa051214_lj_african.bb0e76d.html

Quote:
Tirhas Habtegiris was an East African immigrant and only 27 when she died Monday afternoon.

She'd been on a respirator at Baylor Regional Medical Center at Plano for 25 days.

"They handed me this letter on December 1st. and they said, we're going to give you 10 days so on the 11th day, we're going to pull it out," said her brother Daniel Salvi.

Salvi was stunned to get this hand-delivered notice invoking a complicated and rarely used Texas law where a doctor is "not obligated to continue" medical treatment "medically inappropriate" when care is not beneficial.

Even though her body was being ravaged by cancer, this family says Tirhas still responded and was conscious. She was waiting one person.

"She wanted to get her mom over here or to get to her mom so she could die in her mom's arms," says her cousin Meri Tesfay.


OBSERVE THE COUNTEREFFECTIVENESS OF THE SYSTEM: IT ENCOURAGES PEOPLE TO GET SICK, THEN STICKS US WITH A HEFTY TAB

link

Quote:
In the Treatment of Diabetes, Success Often Does Not Pay

With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.

In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.

At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.

But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.

They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.

Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.

Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.

Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.

"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel.


BE ASTOUNDIFIED BY THE INEFFICIENCY AND BUREAUCRATIC MISMANAGEMENT!

http://news.yahoo.com/s/nm/20051103/hl_nm/errors_dc

Quote:
Patients in the United States reported higher rates of medical errors and more disorganized doctor visits and out-of-pocket costs than people in Canada, Britain and three other developed countries, according to a survey released on Thursday.

Thirty-four percent of U.S. patients received wrong medication, improper treatment or incorrect or delayed test results during the last two years, the Commonwealth Fund found.

Thirty percent of Canadian patients reported similar medical errors, followed by 27 percent of those in Australia, 25 percent in New Zealand, 23 percent in Germany and 22 percent in Britain, the health care foundation said.

"Driven up by relatively high medication and lab or test errors, at 34 percent, the spread between the United States and the countries with the lowest error rates was wide," Cathy Schoen, senior vice president of Commonwealth Fund


Now, keep all these in mind when deciding which solution for health care is the most 'appropriate.'

These all act as a brushing on the surface of the issue of core cases for demonstrating what passes as acceptable under our current 'system.' It doesn't even go into any real depth; it's just that the evidence against a private system are so numerous that I can fill your screen with words that just hint at the various arguments you can make in favor of adopting the succesful system used by all other modern nations. These stories, and the umpteen billion others like them, are the start since they analyze the means by which a for-profit system manages profit at the increasing cost of measurable health benefit.

Our model is not used by any other modernized nation in the entire world. It is incredibly surpassed in efficiency and effectiveness by every other high-income nation, to a ridiculous, unacceptable degree. The kicker is that our system is also more expensive than theirs, and we hate ours, and it causes people to suffer and die needlessly.

Some other issues to take into consideration:

PART THE FIRST: CHEAP RHINOPLASTY IS THE RESULT OF A COLLAPSING MEDICAL SYSTEM

The most important doctor in society, the most important doctor you will ever have, is the family doctor. The GP who knows your weight, your blood pressure, complains when you smoke, all of that. As has been noted, they make a decent salary but nothing special. They're in line with what European doctors make.

Until you factor in malpractice insurance, which has been increasing its rates about 20% a year for the past decade or more, while doctor salaries have not kept in line. On account of this, the take-home pay of these doctors most critically associated with health and well-being is going down. (http://www.gnyha.org/3283/File.aspx).

A perfect example of how disastrous this trend is is to look at New York City hospitals' malpractice insurance, which has gone up 147% in five years, to the point where they are shutting down obstetrics divisions.

The end result of all this is that doctors are being chased into lucrative sub-fields in order to maintain their lifestyle. They have bills to pay, but under our current system, doctors are not paid to make people well, they are paid to perform procedures. Even worse, they are only really paid for the procedures they didn't have to perform on people who cannot pay. Many doctors, to maximize their income, are learning to perform the most expensive procedures possible, and they are competing to get into fields where they don't have to do work that they won't get paid for.

If they paid doctors to make people well, you'd have a lot more GP's, who are the ones on the front lines actually doing this. Instead, the 'winners' in the current system are carving out transplant hearts and vacuuming out fat and stapling stomachs and crowding quickly into any and all available fields where you don't have to do shit for anyone who can't pay, and thus, are not forced to accept the poor people of society as a financial liability. Since medical professionals are all crowding these optional procedure fields as fast as possible, prices for these services are going down. It's not a demonstration of how uninfluenced competition is working to our benefit in some fields as much as it it is another hilarious symptom of a collapsing medical system.

Cosmetic surgeons and the like are the 'winners' of our current system. They do completely optional and expensive procedures, only for people who pay out of pocket, they are not forced to work through thieving bureaucratic intermediaries, they are not forced by financially 'unfortunate' policies to care for those who cannot pay, and despite being under the catchall term of a medical profession, they're a little different -- they are actually all but irrelevant to our general health. They cater only to those who have the excess wealth to spend on optional procedures.

The end result is that the government has already been forced to bribe doctors with taxpayer money to remain as essentially skeleton crews in necessary medical fields which HAVE to be staffed (city hospitals, etc) but nearly NO competent doctor would stay in business in if they were forced to rely upon the profit model. Just about every single top doc in places like North Dakota or Arkansas is essentially bribed by the government with huge amounts of supplemental income to not leave. It's another example of how we're trying inefficiently to sneak in socialized solutions to float the broken moral hazard model and still somehow pretend, for the benefit of some schmucks, that it's seaworthy of its own accord.

PART THE SECOND: HELLO MEDICARE PLEASE KEEP MY ILLUSIONS, PRETENSES, AND PARENTS ALIVE

There's also another issue and it becomes evident when you ask seniors what form of healthcare they want. The big old socialized medical care program called Medicare, known alternately as being 'the most popular program in America' and 'the politically untouchable juggernaut.' Socialism, right here in the heart of the dear old U.S. because private medical care wouldn't touch the issue of care for the elderly.

Why? The elderly have the same sort of issue which leaves orphan diseasers to sit in a corner and die. There is no way to make taking care of old people profitable. Good thing that private insurers get to bypass the issue of maintenance of the elderly.

Thanks, Medicare, for being the big bad socialized medical program that makes 'private' health coverage remotely feasible!

PART THE THIRD: KILL GRANDMA

A free market health care system can work but only if nothing forces our hospitals and care networks to do anything for those who cannot pay upfront. In a free market system, you either pay or you don't. If you can't pay, you don't get the service. In the case of medical care, if you don't pay, you die. It's tough, but it's the only way the system can work. Right now, medical providers HAVE to treat people regardless of their ability to pay, in life-threatening situations. This fucks the entire system right up. Because uninsured people don't get stuff looked at when it's minor (because they can't afford to pay), they let things get worse, go to the ER, where they either die or live, and in any event run up huge bills. If the hospital can't get that person to pay, they have to make up for the shortfall elsewhere, or go out of business. So everyone else pays higher rates for things. Which FORCES a kind of socialism on the system anyway.

In order to be a good capitalist, you have to kill grandma. If you cannot pay during a life-threatening ordeal, you have to die. If you don't practice this then all you get is incredibly shitty socialism where everyone ends up absorbing all the costs for the old and the poor anyway even though we're not giving them effective care, just 'necessary' care. Kill grandma. Kill grandma kill grandma and squint real hard and pretend that the mere existence of paltry private charity that will save some people absolves you of any guilt for supporting a system that will leave scores more out on the streets in front of hospitals to die. The problem here is that people's will to actually follow through with their "free market will save the Universe" rhetoric is not strong when faced with an uninsured sick person. Especially an uninsured sick OLD person (who tend to vote in large numbers, and whose population is always increasing) So we start building slipshod systems like Medicare and Medicaid. Kill grandma, otherwise you're a shitty capitalist. You're welcome to say that the free market is the solution to our current woes but you can't pretend that it comes without some extraordinarily worrying sacrifices. If you don't have the balls to kill grandma, then you're going to have to swallow your pride and your 'the free market will save the world' bullshit and stick up for a socialist model.

CONCLUSION


Well, for starters, if you honestly believe that our system is better than a universal health care scheme, or that for reasons of size we would be 'unable' to institute effective universal care here in America, okay, you're being retarded and that's pretty much the long and short of it. The former argument is counter-evidenced by all reasonable metrics, so pursuit of that chain of logic is dissonance with reality of the finest sort; the latter argument is a bald premise evidenced by nothing. Both are blatantly untrue. It's outright stupid to believe them right now.

I care very little about both of those arguments, as they are desperate attempts to prop up an argument that is continuing a guaranteed trek into irrelevance. In the long term, there is no question as to whether or not we will be switching to universal health care. We will. The reason why it is so inevitable is because the current model is collapsing on itself due to issues of medical payment crisis. Hospitals are required to care for people in immediate medical crisis, and it is impossible to make a number of vital civil functions profitable or sustainable, market wise, given that requirement.

The end result is that the government has to prop up urban and rural hospitals with a shitty socialist scheme. As noted, we bribe doctors with taxpayer money to keep them in areas which would otherwise not have doctors. We unabashedly prop the system up. We're just doing this in shitty ways in order to appease the people who want to maintain an illusion that the system works without socialism. This is causing the whole structure to collapse in on it.

To give you a tiny hint about how dire the situation is in America: bankruptcy due to medical crisis remains the single largest cause of bankruptcy in the United States, even during the present time period where the big news is about a financial catastrophe that is causing defaults all over the place.

You read that right: the medical crisis which we've been dealing with for over a decade now has over that timeframe been causing problems still worse than any fallout that the financial crisis has yet achieved. In addition, the financial crisis will throw more and more people into the uninsured category, increasing the costs that the dwindling quantity of insured people have to bear, causing more people to become uninsured. Wow, holy shit, death spiral much?

It's retarded. It's unsustainable. America will have universal health care in our lifetime. And the people who are actively working to prevent this are bankrupt and arguably morally negligent in their quest to perpetuate a broken, terrible, stupid ideology. They must be opposed along every step.

Support for raising taxes to provide universal coverage has already achieved a large plurality. As more and more people move to support of universal coverage from out of opposition and from being undecided, it will achieve a majority within the year.

If you are American, it's your duty to press for universal health care as hard as you can. It's about the most important issue facing us as citizens. Help make the transition as prompt as we can manage. And, above all, never ever ever vote for someone who wants to stop universal health care.

If you are not American, it's your duty to continue to mock the shit out of us and our stupid, worthless medical system, so that we get the idea.


Last edited by Sam on Tue Mar 10, 2009 8:52 pm; edited 2 times in total
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andrew



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PostPosted: Mon Mar 09, 2009 8:27 pm    Post subject: Reply with quote

What is the point of this thread?
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Sam



Joined: 09 Jul 2006
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PostPosted: Mon Mar 09, 2009 8:31 pm    Post subject: Reply with quote

andrew wrote:
What is the point of this thread?


Rehashing and collecting my full argument for universal health care out of a thread that has it as a branch discussion so that it can get its own topic.

Working to draw the argument to the fore as much as possible now that it has become big news under the new administration.

Firmly restating support now that it has become a national priority to overhaul the system.
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Mini J



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PostPosted: Mon Mar 09, 2009 8:39 pm    Post subject: Reply with quote

tl,dr: Sam hates freedom.
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mouse



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PostPosted: Mon Mar 09, 2009 9:04 pm    Post subject: Reply with quote

and he's got all the evidence and points in one place, for easy reference. so when someone start on about how american healthcare is the best in the world, we can point them here (rudy guiliani reads this forum, right?) when someone says insurance companies are not the problem, it's all the rapacious doctors, we can point them here. when someone starts on about how, yeah it would be nice, but the country can't possibly afford it, we can point them here.

sam, you should email a copy of this to every member of congress. the ones who really need to read it won't, of course....but maybe someone in their office will.

our current system is seriously scary. i am extremely lucky - i work for a very large employer which considers health insurance one of the essential benefits, so i have it at a reasonable cost to me (my employer covers most of the costs, and because if our size, the rates are pretty much the same for everyone). i have a couple of potentially serious existing conditions; if i had to get insurance for myself, i'm not sure i could find a company that would cover me, at least not for a price i could afford. and that's stupid. although the conditions i have could cause me considerable suffering and an early death, they aren't really a problem. because i have always had insurance, and always did things like regular physicals, all the conditions were caught early. all are manageable with medication. yes, the medication costs something - but not as much as the things that would happen if i were not medicated. and my conditions are (alas) not at all uncommon. so theoretically, the volume of sales should be enough to keep the price down. (i have no idea whether that happens, however - i think most of mine now have generics, but i don't know what the proprietary ones are costing).

but right now, there are too many people with their eyes fixed firmly on the profits - like the insurance companies, and the pharmaceuticals. and because they make so much profit, they can pay many many expensive lobbyists, who have been doing whatever they have been doing to persuade lawmakers that the current system is the only possible one, and everything else will lead to the utter destruction of america as we know it.


....which i guess it would, in some ways. it's just that some things need to be destroyed to make the world better.
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andrew



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PostPosted: Mon Mar 09, 2009 9:08 pm    Post subject: Reply with quote

I guess my point is: are there really any people left on the board that oppose NHC for any of the reasons refuted by this post?
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tinkeringIdiot



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PostPosted: Mon Mar 09, 2009 9:30 pm    Post subject: Reply with quote

andrew wrote:
I guess my point is: are there really any people left on the board that oppose NHC for any of the reasons refuted by this post?


Well we'll all be able to find out when they post a dissenting opinion.
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Sam



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PostPosted: Mon Mar 09, 2009 9:34 pm    Post subject: Reply with quote

andrew wrote:
I guess my point is: are there really any people left on the board that oppose NHC for any of the reasons refuted by this post?


Yes, but even if there were none, the post is unambiguously not just directed towards them as an audience and is also for supporters of UHC for very directly stated reasons.

In addition: post also addresses statements that were made just this week by person(s) on board who dismiss the viability of UHC, soooooooo
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andrew



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PostPosted: Mon Mar 09, 2009 9:44 pm    Post subject: Reply with quote

I'm having trouble articulating why, exactly, this thread irritates me so deeply. It just seems like yet another excuse for rah rah rah-ing over an issue that's dead and buried.
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picturesofsky



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PostPosted: Mon Mar 09, 2009 10:02 pm    Post subject: Reply with quote

Except your country still has the system, so it's not dead and buried.
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Darkman



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PostPosted: Mon Mar 09, 2009 10:02 pm    Post subject: Reply with quote

andrew wrote:
I'm having trouble articulating why, exactly, this thread irritates me so deeply. It just seems like yet another excuse for rah rah rah-ing over an issue that's dead and buried.


You did say you had heard intelligent arguments against universal health care though. I'd love to hear them. Please note I'm not being sarcastic or condescending or trying to be a general dickhead. I just really want to hear the other side. I know loads of conservatives that tell me daily what socialism is going to do to us but most of them aren't exactly what I'd call... reasonable.
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Sam



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PostPosted: Mon Mar 09, 2009 10:03 pm    Post subject: Reply with quote

Your irritation to the thread has been duly noted. In the grander sphere of things, though, this issue is far from dead or buried and is in fact approaching greater immediate prominence than it has held in over a decade. The timing is ripe.
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andrew



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PostPosted: Mon Mar 09, 2009 10:08 pm    Post subject: Reply with quote

Darkman wrote:
You did say you had heard intelligent arguments against universal health care though. I'd love to hear them. Please note I'm not being sarcastic or condescending or trying to be a general dickhead. I just really want to hear the other side. I know loads of conservatives that tell me daily what socialism is going to do to us but most of them aren't exactly what I'd call... reasonable.

Sorry, no: the responses immediately following mine in the last thread demonstrated pretty clearly that most people here are incapable of distinguishing "bad argument" from "argument I don't agree with," and that failing is pretty much inherent in anyone who claims to never have heard a good argument against NHC.
picturesofsky wrote:
Except your country still has the system, so it's not dead and buried.

The sun is still in the sky in Seattle, but I know it's going to set; I can even reasonably predict what time it will happen. I consider the issue of the sun setting dead and buried.
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picturesofsky



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PostPosted: Mon Mar 09, 2009 10:13 pm    Post subject: Reply with quote

On a whim, I typed "universal healthcare" into facebook and was faced with 20 groups, all of whom buzzed with irritated arguments from people who hated the idea and equated it with communism. Clearly this kind of argument needs to happen with them. Just because you've decided it's right, doesn't mean everyone has.

Sadly, Sam's post is ... really long. It's going to very much fall victim to tl;dr.

And no-one has to preach universal healthcare to me. I work for it Smile
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andrew



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PostPosted: Mon Mar 09, 2009 10:16 pm    Post subject: Reply with quote

picturesofsky wrote:
On a whim, I typed "universal healthcare" into facebook and was faced with 20 groups, all of whom buzzed with irritated arguments from people who hated the idea and equated it with communism. Clearly this kind of argument needs to happen with them.

Well, no, it doesn't, because this argument can't address the points that most of those people have. If someone views NHC as a negative despite its potential benefits because it's gov't sanctioned redistribution of wealth, there is no possible argument because they are right in their assessment even if you disagree with their conclusion.


Last edited by andrew on Mon Mar 09, 2009 10:17 pm; edited 1 time in total
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