On conservative and libertarian stupidity

[Simple Minded]

. . .

the fascinating thing to see is if Universal Health Care ever does become reality, will fat people and old people be hunted down in the streets like vampires? all it would take would be the creation of a new religion.....

An outsider perspective.

Japan, along with many OECD nations, has a system that mostly qualifies as Universal Health Care.

Despite this, there is no collective hunting of either the elderly, now 1/4 of the population, or the obese, who are rare.

Rather, Japan has the highest life expectancy.

Having a healthy population is perceived as a national common good.

and don't forget the trust factor in administrative competence. turn over health care to the same people who manage the post office instead of the doctors I know? really?

[Japan] Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

An enduring part of American culture/mythology is dislike and distrust of government.
At the lower levels of govt, this becomes a self-selecting and self-fulfilling reality.
On the other hand, I've always found it amusing how those at the higher levels of US govt and industry effortlessly move between the public and private sectors despite this widely held perception.

good observations typhoon. when it comes to the "common good," the more monolithic the culture, the easier it is to establish a common identity of "we." and therefore solutions for the common good.

the problem is, improving culture takes generations.

In light of modern tech, I don't see the US becoming more monolithic on the national level anytime soon. see noddy's observations on the world.

the vampire comment was supposed to be humor, but the idea of "fat shaming," if publicly severe enough, might be an effective means to lower health care costs and extend lifespans. yuge increase in obesity in the past few decades in the US.

although one could argue that lowering common health care costs and extending lifespans are mutually contradictory financial goals. I recall data on smokers that showed they have lower overall lifespan costs to society than non-smokers simply because they die sooner, collect less social security, and bypass all the old age health costs. I don't recall seeing stats on lifespan costs of the obese vs. the non-obese.

illegitimacy shaming and illiteracy shaming would be other admirable public ideals.

lots of solutions out there. cramming them down the throats of people who view themselves as "me's" rather than "we" is tough.

[Mr. Perfect]

we have medicare - you deal with that the same as in private hospitals, via triage.

folks die before the end of the queue if its too long, as always.

the argument against medicare is that longer lifespans and lower employment levels is the perfect storm of less resources being spread thinner so for both public and private the solution to that is letting people die.

its not like private has some magic pool of extra money that means you can take more than you give - even when its more efficient and doesnt distort prices as much, its still got the same demographic and economic problems all of our societies face.

insurance only works when people take less than they give, and the only way to avoid that basic fact is via endless growth, otherwise its just another ponzi with a nasty shock for the bottom of the pyramid.

No, private insurance gives you no illusions, the caps and premiums are there when you sign the contract. Gubmint insurance is "universal" "free" and "unlimited", which are lies.

Also private insurance is more dynamic and responsive than gubmint, making it a more effective than gubmint.

The magic money from private care is from the efficiencies.

[noddy]

i agree with most of that and said most of that.

however, government is not sold as unlimted, that is a lie.

you are told they will only cover a percentage and you are told their will be a monster waiting list.

[Mr. Perfect]

Not in America. It's sold as free and unlimited.

[Nonc Hilaire]

Healthcare is an omnibus term. It needs to be broken up into subsets to be properly addressed. You have to eat an elephant one bite at a time.

[Simple Minded]

Healthcare is an omnibus term. It needs to be broken up into subsets to be properly addressed. You have to eat an elephant one bite at a time.

Tis a yugely complex topic in terms of all the usual, vaguely defined categories of fairness, morality, control, intrusiveness, freedom, and social norms. Perhaps the best example ever of "free lunches don't exist."

Trying to define it with simple statistics is even beyond my Simple Minded capabilities.

Easier to just split discussers into two sides, like Climate Change "science."

Add in the Byzantine complexity of US health insurance, and it gets worse. Just found out the other day I can get an MRI with a cash payment of 1/10 of the amount an insurance company would be required to pay. Might be an outlier.

[Nonc Hilaire]

Healthcare is an omnibus term. It needs to be broken up into subsets to be properly addressed. You have to eat an elephant one bite at a time.

Tis a yugely complex topic in terms of all the usual, vaguely defined categories of fairness, morality, control, intrusiveness, freedom, and social norms. Perhaps the best example ever of "free lunches don't exist."

Trying to define it with simple statistics is even beyond my Simple Minded capabilities.

Easier to just split discussers into two sides, like Climate Change "science."

Add in the Byzantine complexity of US health insurance, and it gets worse. Just found out the other day I can get an MRI with a cash payment of 1/10 of the amount an insurance company would be required to pay. Might be an outlier.

Healthcare in the US is largely predicated on exhausting generational wealth. The industry is a monopoly complicit in making sure working capital is not accumulated by citizens.

[Simple Minded]

Healthcare in the US is largely predicated on exhausting generational wealth. The industry is a monopoly complicit in making sure working capital is not accumulated by citizens.

interesting take.

Hmmmm, a war between the health care industry and the federal govt for the prizes of personal estates, or an alliance between the two?

[Nonc Hilaire]

Healthcare in the US is largely predicated on exhausting generational wealth. The industry is a monopoly complicit in making sure working capital is not accumulated by citizens.

interesting take.

Hmmmm, a war between the health care industry and the federal govt for the prizes of personal estates, or an alliance between the two?

It is a system. Medicaid is a loan progam repaid by the estate and a big reason for pricing designed for a monopolistic capitalism and avoiding free enterprise. Nursing homes are $2k/week with no price competition. The CDC ensures that medicine prices stay high.

Much can be avoided with trusts, but the general public does not really know about them and the prices are still far too high.

[Simple Minded]

It is a system. Medicaid is a loan progam repaid by the estate and a big reason for pricing designed for a monopolistic capitalism and avoiding free enterprise. Nursing homes are $2k/week with no price competition. The CDC ensures that medicine prices stay high.

Much can be avoided with trusts, but the general public does not really know about them and the prices are still far too high.

fascinating. I have long thought that eliminating the competition of the free market is a large part of high health care costs.

Do you work in the health care industry? If so, in what capacity?

From talking to friends that are doctors, I know that many of them think the system is ridiculous and that they feel trapped.

[Nonc Hilaire]

It is a system. Medicaid is a loan progam repaid by the estate and a big reason for pricing designed for a monopolistic capitalism and avoiding free enterprise. Nursing homes are $2k/week with no price competition. The CDC ensures that medicine prices stay high.

Much can be avoided with trusts, but the general public does not really know about them and the prices are still far too high.

fascinating. I have long thought that eliminating the competition of the free market is a large part of high health care costs.

Do you work in the health care industry? If so, in what capacity?

From talking to friends that are doctors, I know that many of them think the system is ridiculous and that they feel trapped.

Now I work as a guardian for the elderly helping them get through the system, manage affairs, etc. There is almost no free market in US healthcare. It is a cartel.

[Typhoon]

. . .

Add in the Byzantine complexity of US health insurance, and it gets worse. Just found out the other day I can get an MRI with a cash payment of 1/10 of the amount an insurance company would be required to pay. Might be an outlier.

In Japan, a standard MRI scan will cost you about US$ 100.

[Simple Minded]

. . .

Add in the Byzantine complexity of US health insurance, and it gets worse. Just found out the other day I can get an MRI with a cash payment of 1/10 of the amount an insurance company would be required to pay. Might be an outlier.

In Japan, a standard MRI scan will cost you about US$ 100.

I was quoted a price of $400 for an MRI.

How about the cost of a pound of beef, a gallon of gasoline, or a 4' x 8' sheet of plywood in Japan?

Whenever I have engaged my European friends in this discussion, they always claim the moral high ground of subsidizing health care. Yet, when they are here, they are thrilled at the low prices of staples that don't include subsidized health care costs.

When we enter into the debate of the moral high ground of charging everyone (including the poor) more for staples they buy everyday, to enable lower costs of a service they may or may not need for years, or ever, they get a bit less confident of their previous position.

I think whatever system you are raised in seems normal. Changing that culture takes time.

It is a a pity that the proponents in the US never try discussing the matter with real costs. It is always a claim of free lunches.

No reason it is not doable, just like public roads and schools. School taxes are also paid by people who have no children. Just a matter of everyone paying more for something else to cover costs.

[noddy]

the one aspect of australian government healthcare that has worked out with the biggest benefits to the low end of town is the PBS -
https://en.wikipedia.org/wiki/Pharmaceu ... its_Scheme

this subsidises the established quality of life medicines (heart pills, asthma sprays blah blah) so that those on pensions and social welfare can get them easily - its also very expensive and getting cutbacks every year.

i can see this aspect of it surviving longer than the end of life hospital treatments - it lowers the costs of those conditions going to the next stage, its preventative.

the hospital treatments are probably going to get completely cut in the next decade, we will possibly get to keep accident and emergency however the triage will get uglier.

as i mentioned before, the extremes of this argument are neither here no there, as a society we have the wrong ratio of young people earning good money to old people needing healthcare, nothing is going to avoid that basic demographic failing.

we do spend 90% of our healthbudget in the last year of life, it doesnt matter if its private or public, that maths has the beancounters eyes starting straight at it with burning intensity.

private health insurance, funded by companies just steals resources from your living wage, its no better, i cant see the difference.

insurance against being dead when you are going to die is not a realistic model, nor argument.

[Nonc Hilaire]

Free market economics is not possible in all areas of healthcare. If one falls off a roof or gets hit by a bus there is no shopping around the free market.

If a sensible conservative/libertarian healthcare system is to be adopted three good first steps would be 1) open and transparent pricing and 2) equal application of those prices to everyone and) antitrust action and the elimination of HMO style monopolies which eliminate consumer choice when possible.

[Simple Minded]

noddy,

the only difference is that private insurance is voluntary....... (kinda like buying a pair of size 16 shoes "why didn't you buy a pair of size 16 shoes? well cause they were men's workbooks, and I'm a women who wears a size 8!") and at least here, no one selling private insurance claims it is a free lunch that covers all. they all seem pretty open about what it does not cover.

one of the biggest flaws over here is health insurance covers too much. $20 for a doctor visit, I paid $1.62 for 30 days of pain killer for my hip. the equivalent in the automotive world would be buying insurance to lower your cost of a gallon of gasoline.

you're right on the demographics stats. an open, honest discussion would be nice. tell the yutes how they will get screwed with out the moral overtones. just cost statistics. with lots of creative options.

"sorry chap. you got dementia, statistical cost to the state from here on out is $300,000. but if you take the blue pill, which will kill you quickly due to sexual orgasm exploding your heart, the state will grant a $50,000 waiver for college to the next of kin of your choice. whadda ya say mate? yer not gonna recognize your kids soon anyway......"

[Parodite]

Now this is an informative and fun discussion between a purist libertarian and a conservative with libertarian sympathies.

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Lauren Southern wins hands down. I see very little difference between this Larken Rose and a regressed leftist. Idealistic, ideologically possessed dreamers who must either ignore facts or selectively make some of them look bigger or smaller than they really are; which is a technique also used in drawing caricatures. And if that doesn't help, just lie.

[noddy]

noddy,

the only difference is that private insurance is voluntary....... (kinda like buying a pair of size 16 shoes "why didn't you buy a pair of size 16 shoes? well cause they were men's workbooks, and I'm a women who wears a size 8!") and at least here, no one selling private insurance claims it is a free lunch that covers all. they all seem pretty open about what it does not cover.

one of the biggest flaws over here is health insurance covers too much. $20 for a doctor visit, I paid $1.62 for 30 days of pain killer for my hip. the equivalent in the automotive world would be buying insurance to lower your cost of a gallon of gasoline.

absoluteley, but as nonc reiterated - only some healthcare outcomes actually have choice in them anyway.

accident and emergency visits tend to happen without your consent - workplaces, car, home .. many ways to end up needing to be put back together - do you dump a monster debt on the sub working class for getting run over ?

the actual expensive treatments for long term diseases part isnt covered that well by australian medicare - you get partial payments on life threatening diseases with long queues and you dont get help at all with debilitating long term problems like chronic backs or dentistry.

apparently you lot were promised more, i cant say, anyway nothing here resembles the american arguments very much

the only other thing we get is bulk purchased, subsidized medicines for quality of life with heart problems or asthma or other pill treatable conditions, administered by the local GP - this is to save money on the hospital end and as i mentioned before, is the biggest boon to the poor.

so that gives us 3 seperate part of the story emergencies, long term treatments, preventative maintenance

you're right on the demographics stats. an open, honest discussion would be nice. tell the yutes how they will get screwed with out the moral overtones. just cost statistics. with lots of creative options.

"sorry chap. you got dementia, statistical cost to the state from here on out is $300,000. but if you take the blue pill, which will kill you quickly due to sexual orgasm exploding your heart, the state will grant a $50,000 waiver for college to the next of kin of your choice. whadda ya say mate? yer not gonna recognize your kids soon anyway......"

the last year of life soaks up the vast magority of the funds as increasingly extravagant hail mary's are thrown at near death patients, this will return to a rich persons only game i suspect.

also to reiterate, id prefer a full private choice system but i was born into this one, their is no political movement to get rid of it but their is a bi partisan death by a million cuts occurring to it.

i still dont understand why having your employer to do it is any better or different, its still forcing choices, its still stealing potential wage out of my pocket, its just by other means.

demographics and economics set clear rules on possibility... most insurances dont have 100% usage rate like health, not everyone crashes the car or burns down the house so the model works well enough for staying profitable.

with health its just a matter of when you need to burn the kitty and use every dollar you gave it.

maybe it should be called "health savings" and then a clear model of how much budget you actually have to avoid death is presented.

[Simple Minded]

noddy,

its a fascinating topic. over here, it is never discussed seriously in terms of resources and money. only in terms of moralizing and insults. me thinks even the holiest of adminstrators knows they will look bad eventually.

death panels are not only inevitable, but morally responsible necessities for managing available resources for the common good for the reasons you listed above.

once I am responsible for your health care costs, do I not have a say in regulating your bad habits that result in obesity, high blood pressure, high blood sugar, etc. and also in your habits and lifestyle. should you be allowed to buy a motorcycle, a gun, a ladder, ride a bicycle without a helmet, knee guards and elbow guards, or hike in the outback where immediate medical help is not available? should you be allowed to climb up on the roof and clean out your gutters, mow you own lawn, or buy a banana split on Sunday afternoons?

or should all that simply be the jurisdiction of the bureaucrats in the Ministry of Lifestyle Intrusion?

Alex's tale of crashing his motorcycle was very illustrative. old guy, collecting a pension, 150 hp bike crashes at 120 mph, due to his own fault, $300,000+ medical cost (my estimate) to save him. my young Brits friends are outraged that he was allowed to buy a bike that resulted in him stealing so much of their money thru the NHS. valid point. not allowing old geysers to buy fast bikes is a common good. good law.
Hmmm.... the state spending money on both pensions and health care results in some mutually exclusive fiscal goals.
also valid would be the point that if he were killed instantly, he would have saved them a lot of money in pension costs by buying that bike. govt subsidizing of fast bikes for old geysers so they buy more of them is a common good. good law.
also valid is that as an old guy, Alex overpaid for food, housing, closing, and energy for decades to pay for the health care costs of others during that time, so Alex was entitled to that money.

my preference is for buying health insurance like buying any other consumer good, or auto insurance or home owners insurance for that matter, but it would not make a lot of other people very happy.

the concepts of "me" and "we" are very pesky ideas. don't think the govt over here is going to be successful in making our culture more mono anytime soon despite their moralizing.

[Nonc Hilaire]

We have defacto death panels now in the form of Medicare regulations. When a patient 'plateaus', or stops showing recovery progress and just manages to stay alive they are then denied care for that condition and sent home. There they may die off quietly and out of sight.

[Simple Minded]

We have defacto death panels now in the form of Medicare regulations. When a patient 'plateaus', or stops showing recovery progress and just manages to stay alive they are then denied care for that condition and sent home. There they may die off quietly and out of sight.

true enough. and an effective means of lowering health care costs for the "common good" would be simply raising the bar in terms of who gets medical treatment. no doubt very easy to do using bio-metrics and, of course, financial stats of the recipients. it would be exceptionally easy to automate simply by answering a couple dozen questions about the potential recipient.

younger person, working, paying income tax, low net worth gets medical care because it makes financial sense and is fiscally responsible in consideration of the "common good."

older retiree, not paying income tax, high net worth (ka-ching! 50% estate tax!) does not get any of the scarce resources...... in the name of the "common good."

another option would be allowing old, rich, Fred to choose when he is allowed to take the "needle" and end it all (Soylent Green style). he could even be offered financial incentives in the form of a reduced estate tax rate, or maybe paid college tuition for his heirs, because he is being considerate of the "greater good" rather than simply being "selfish."

all workable solutions in terms of numbers and the concept of the common good, but very uncomfortable situations and discussions, especially when you or your loved ones are Fred.

in a private market, none of the above would be considered, cause it's Fred's money. but in the public sector, the discussions are inevitable. "we" just have not had them yet.

[noddy]

lets start small.

some poor bastard has a car accident and cant afford much beyond food and rent - this is not a crazy theory, the USA has ~5000 serious motor vehicle injuries a month and ~60% have no money in the bank

do we have the slippery slope to death panels, which the communist people call triage, or do we then put them in debtors prison, or should they die in the street as nature intended ?

[NapLajoieonSteroids]

Free market economics is not possible in all areas of healthcare. If one falls off a roof or gets hit by a bus there is no shopping around the free market.

If a sensible conservative/libertarian healthcare system is to be adopted three good first steps would be 1) open and transparent pricing and 2) equal application of those prices to everyone and) antitrust action and the elimination of HMO style monopolies which eliminate consumer choice when possible.

+1

[NapLajoieonSteroids]

Last December, about a week before Christmas, my mother had a stroke which affected her vision. The minute she arrived at the hospital, the grafting started.

Doctors and specialists of all stripes hustling to get on the bill. Nurses not even on her beat, "checking in", to add "care" to the bottom line.

Some really ridiculous: like this guy kept trying to come in and sell us on the idea that it was her knee (which remains to be of zero problems) which really needed care and probably caused the stroke!

It was costing us more money attempting to manage the doctors than to pay for the hospital bill.

Of course the kicker was we received notice less than 24 later from the insurance company that their doctors determined care was unnecessary so they would not be paying for the visit.

We worked out that the determined this approximately half an hour after she actually got to the hospital, an hour before a doctor actually saw her.

================

Now, in our case, it had a happy ending. Despite grim prognostications about a year of recovery, if she recovered at all; my mother's vision recovered 100% within 10 days.

And the insurance company ended up covering it in full. Apparently, it was standard negotiating procedure to deny coverage outright, so that the lawyers would have something to do, I suppose. We handed the letter off to the hospital, which sent a letter to the insurance company about their "experts", and they negotiated the deal.

But it makes me think of the lady my mother was roomed with. She was in her late 20s or 30s and in much worse shape than my mother and without insurance- she had been a drug overdose of some kind. I did not know the details in full, but whatever she did shut off vital organs for a period of time, and while she wasn't a vegetable by the time we showed up, she was having all sorts of problems cognitively and physically that were going to take a long time to heal. She was in real bad shape and in need of serious care and a long road to recovery- who was footing that bill?

[noddy]

She was in real bad shape and in need of serious care and a long road to recovery- who was footing that bill?

sales of soylent green apparently.