FACT-MAN-2 wrote:

Loren Michael wrote:

Wiðercora wrote:

Loren Michael wrote:

I assume it's just a phrase people just use without mind to the meaning, but it could be that the people who do think about it are referring to the scarce aspects of healthcare. It's a limited resource. Rights like the ability to vote, freedom to assemble, these sort of things can be reasonably thought of as qualitatively different.

If it's limited, surely it should be managed by a central authority with the logistical ability to look after such an enterprise, instead of a disaparate group of competing companies.

Food is also limited, and its absence similarly means death. Would you have food production managed by a central authority?

Competition gives incentive to increasing efficiency. Lack of competition provides one less incentive to increase efficiency. If something is scarce, surely we want to be as efficient with it as possible?

This is the theoretical argument that's always posed to justify privately operated healthcare. The problem with it is doesn't reflect the facts of actual outcomes. It's just a theory, and the actual practice of it does not measure up to the theoretical notion.

I think a reasonable alternative view is that the problem is the industry has too much influence over the laws, making for stilted markets that serve the interests of the businesses rather than the consumers.

Incentive you say? My doctor's incentive is to keep me healthy, that's his job, he does it with pride and dedication, because he's a fucking doctor for Christ's sake!

I think your framing of incentives here is simplistic to the point of being useless. Doctors also want to enjoy their lives, make money, take holidays, have nice things, enjoy their families, etc.

The US has a dearth of GPs, and that situation is only going to get worse. The reason pretty clearly involves financial incentives.

There was a thread here
http://www.rationalskepticism.org/news- ... ilit=sicko

Loren Michael wrote:If there's competition, there's incentive to lower costs, improve the product, or both, in the interest of producing a profit.

I basically agree with what you are saying, but that's a big "if" at the front of that sentence. The US spends more per capita for fairly mediocre results. How does that fit into the equation?

I would say that the companies in the US are not competing on quality or value for their consumers, but rather on the basis of minimising operating costs (ie. finding new ways to stiff their members) in an environment where there is no real alternative for the consumer but to purchase "health insurance".

Competition does imply that someone can come up with a better product which is easier said than done. The biggest restriction on the advance of medicine is basic ethics. If we took more risks killed a lot more test patients we would probably save more long term.While a company can take some risks in most areas of captitalism risking the lives of patients generally is a bit of a no no

Wiðercora wrote:

Loren Michael wrote:

Wiðercora wrote:I've often heard opponents of UHC declare that 'healthcare is a privilege, not a right'. This baffles me. Healthcare is one of those things, that if you don't get, you might die - how can not dying not be a right?

I assume it's just a phrase people just use without mind to the meaning, but it could be that the people who do think about it are referring to the scarce aspects of healthcare. It's a limited resource. Rights like the ability to vote, freedom to assemble, these sort of things can be reasonably thought of as qualitatively different.

If it's limited, surely it should be managed by a central authority with the logistical ability to look after such an enterprise, instead of a disaparate group of competing companies.

Not really. Almost everything(pretty much everything economics concerns itself with) is scare. I would say for most things a pricing/market system will allocate it better than an authority.

Although in health care I'm not really convinced the market logic properly applies so I imagine for this specific topic we may agree.

nearestthingtonone wrote:It's one of these extremely dangerous "matters of principle", I think. People who are afraid of communism, for example, see universal healthcare as one step before complete forfeiture of all money to the government in exchange for some cheese - they don't look at it in the way I do, which is that me paying an extra twenty or thirty pounds a month in tax can be the difference between life and death for several people. But then, as I said at the beginning of this post, my cultural background has shown me how it can work. Many people, especially in America, have been subject to hideous propaganda about the state of hospitals in countries with universal healthcare, and how doctors are forced to work for nothing, and other utter fucking nonsense.

We had our own examples of this for a while. The VA hospitals had a terrible record for a long time. Some of the Department of Defense hospitals* have had a horrible track record recently. It has been a popular argument amongst conservatives using examples of those failures as what will become the norm if we allow government to play a bigger role.

They are ignoring the popularity and success in their own country of Medicare and the VA over the last decade let alone all of the other countries who have managed to get workable government system.

*Hopsitals such as Walter Reed are operated by a different body than the VA. The VA has really improved the last 2 decades yet people see problems with Army hospitals and do not recognize they are run by different agencies and wrongly blame the VA.

Ultimate wrote:

mrjonno wrote:You also got the extremely large military in the US , would this really be substainable if civilians also got 'free' education and medical care. I suspect it would really struggle especially when it comes to education where people simply join the military just so they can go to university. A lot of the people in the US who don't want universal healthcare already have universal healthcare ie ex-military and the elderly

I would agree. Though I may note the VA system is one of the most horrible examples of centralized medicine in the world. Obama tried to partially privatize it but backed off after ridiculous level of vitriol from veterans and military personnel. I do think its quite ironic that some of the people that spew the most hate against the president for "socializing medicine" also hate him for trying to make it less socialized.

The VA institutions have scored excellently over the last decade.
http://www.washingtonmonthly.com/featur ... ngman.html

And they have been much better at holding down costs
http://krugman.blogs.nytimes.com/2009/0 ... nd-the-va/

It has been estimated that if Medicare switched its prescription drug plans to ones that mirror the VA it could save $500+/yr per patient.

Loren Michael wrote:
The US has a dearth of GPs, and that situation is only going to get worse. The reason pretty clearly involves financial incentives.

I am hopeful that this will start improving. The AMA was publicly supporting limiting the number of new enrollees for a long time worrying we would have an over supply.
You can see that in Chart 3 there were fewer Med school enrollees being accepted in 2002-03 than in 1982 despite having 70 million more who now needed care.
https://www.aamc.org/download/153708/da ... to2012.pdf

They have reversed this policy recently, but it will take a while for it to ease the shortage.

Loren Michael wrote:

FACT-MAN-2 wrote:
This is the theoretical argument that's always posed to justify privately operated healthcare. The problem with it is doesn't reflect the facts of actual outcomes. It's just a theory, and the actual practice of it does not measure up to the theoretical notion.

I think a reasonable alternative view is that the problem is the industry has too much influence over the laws, making for stilted markets that serve the interests of the businesses rather than the consumers.

And, if by some miracle, this influence the "industry" has over the laws were to be eliminated or even moderated you think that would change the expenditure/outcome relationship? If you do I have a bridge over in Brooklyn I'd like to show you.

What do you think motivates this influence?

Loren Michael wrote:

Incentive you say? My doctor's incentive is to keep me healthy, that's his job, he does it with pride and dedication, because he's a fucking doctor for Christ's sake!

I think your framing of incentives here is simplistic to the point of being useless. Doctors also want to enjoy their lives, make money, take holidays, have nice things, enjoy their families, etc.

Who says they don't? Doctors and other medical practitioners are no different than anyone else in this regard, except that some are greedy and theyl head for the USA where they can become multi-$millionaires selling their medical skills. But those who do not suffer this affliction and are content living a good lifestyle whilst practicing their chosen profession ... they stay at home and enjoy the good life.

Loren Michael wrote:
The US has a dearth of GPs, and that situation is only going to get worse. The reason pretty clearly involves financial incentives.

Of course, there's no money in being a GP, at least not the mega-wealth that specialists achieve, so every GP goes for a specialty because they too are infected with the wealth bug in a society that values money over care. It's just another flaw in the system of selling healthcare.

You failed to address the fundamental question, though, and that is the USA spends $6K per capita on healthcare whereas Canada sends $3K per capita and gets better outcomes pretty much right across the board.

Now, if privately operated healthcare was all so vaunted for its efficiency, how could this be?

One does not need to be a rocket scientist to figure out the answer. So please, give it a go, see how much rope you need to hang yourself. I dare you to answer this question, without resorting to several miles of theoretical market claptrap.

Nicko wrote:

Loren Michael wrote:If there's competition, there's incentive to lower costs, improve the product, or both, in the interest of producing a profit.

I basically agree with what you are saying, but that's a big "if" at the front of that sentence. The US spends more per capita for fairly mediocre results. How does that fit into the equation?

I would say that the companies in the US are not competing on quality or value for their consumers, but rather on the basis of minimising operating costs (ie. finding new ways to stiff their members) in an environment where there is no real alternative for the consumer but to purchase "health insurance".

I haven't familiarized myself with the guts of America's healthcare problems to the degree that I'd prefer but what I've read basically mirrors what you say, if I recall correctly.

I don't think America is an example of a competitive healthcare market.

FACT-MAN-2 wrote:

Loren Michael wrote:

FACT-MAN-2 wrote:
This is the theoretical argument that's always posed to justify privately operated healthcare. The problem with it is doesn't reflect the facts of actual outcomes. It's just a theory, and the actual practice of it does not measure up to the theoretical notion.

I think a reasonable alternative view is that the problem is the industry has too much influence over the laws, making for stilted markets that serve the interests of the businesses rather than the consumers.

And, if by some miracle, this influence the "industry" has over the laws were to be eliminated or even moderated you think that would change the expenditure/outcome relationship?

Possibly. I haven't considered every possible arrangement.

Loren Michael wrote:I think your framing of incentives here is simplistic to the point of being useless. Doctors also want to enjoy their lives, make money, take holidays, have nice things, enjoy their families, etc.

Who says they don't? Doctors and other medical practitioners are no different than anyone else in this regard, except that some are greedy

This is also uselessly simplistic. You're ignoring incentives to say that some people are just qualitatively evil. That's a reflexively easy thing to believe with essentially no explanatory power.

You failed to address the fundamental question, though, and that is the USA spends $6K per capita on healthcare whereas Canada sends $3K per capita and gets better outcomes pretty much right across the board.

Now, if privately operated healthcare was all so vaunted for its efficiency, how could this be?

I haven't said that "privately operated healthcare" is good for efficiency. I've used specific terms to describe my thoughts on efficiency. You can try again.

Loren Michael wrote:

FACT-MAN-2 wrote:

Loren Michael wrote:

FACT-MAN-2 wrote:
This is the theoretical argument that's always posed to justify privately operated healthcare. The problem with it is doesn't reflect the facts of actual outcomes. It's just a theory, and the actual practice of it does not measure up to the theoretical notion.

I think a reasonable alternative view is that the problem is the industry has too much influence over the laws, making for stilted markets that serve the interests of the businesses rather than the consumers.

And, if by some miracle, this influence the "industry" has over the laws were to be eliminated or even moderated you think that would change the expenditure/outcome relationship?

Possibly. I haven't considered every possible arrangement.

Wiggle, wiggle. Anything to avoid facing the facts.

Loren Michael wrote:

fact-man-2 wrote:

Loren Michael wrote:
I think your framing of incentives here is simplistic to the point of being useless. Doctors also want to enjoy their lives, make money, take holidays, have nice things, enjoy their families, etc.

Who says they don't? Doctors and other medical practitioners are no different than anyone else in this regard, except that some are greedy

This is also uselessly simplistic. You're ignoring incentives to say that some people are just qualitatively evil. That's a reflexively easy thing to believe with essentially no explanatory power.

You don't think the existence of greed isn't a factor in deciding that healthcare should be a for profit endeavor? You don't think that an economy that both facilitates and glorifies and celebrates greed doesn't outweigh the moral imperative that healthcare shouldn't be a profit making endeavor and thus fights UHC at every turn?

Sometimes, simplistic explains things a lot better than clouds of inane complexity that's no more than gibberish intended to obfuscate, confuse and mislead.

Loren Michael wrote:

You failed to address the fundamental question, though, and that is the USA spends $6K per capita on healthcare whereas Canada sends $3K per capita and gets better outcomes pretty much right across the board.

Now, if privately operated healthcare was all so vaunted for its efficiency, how could this be?

I haven't said that "privately operated healthcare" is good for efficiency. I've used specific terms to describe my thoughts on efficiency. You can try again.

More wiggle, more dodge ball, more trying to defend the indefensible. A shameful parade of avoiding reality.

Try pulling your head out of the sand sometime, you'd be amazed. I must admit, it does take balls to do this, it takes oomph and courage and a free mind, and even a little hutzpah never hurt.

You should be ashamed, as should all who attempt to defend the indefensible.

But I know you're not ashamed because you've drank all the Kool Aid and can't see the forest for the trees, utterly blinded by the voodoo of capitalism, an archaic system that belongs to the past and has no place in the future.

The facts and evidence are in, the USA spends $6K per capita on healthcare whereas Canada sends $3K per capita and gets better outcomes pretty much right across the board. It takes a rigid mind to not recognize the implications of this reality vis-a-vis which is the better way to do healthcare, rigid and froze in the past, a living dinosaur with no clue, otherwise known as a capitalist apologist who supports a system of greed at any cost and to hell with the health of their fellow citizens.

That wouldn't be you, would it? Nawwwwww.

Talking to you is like talking to a wall.

FACT-MAN-2 wrote:

Loren Michael wrote:I haven't said that "privately operated healthcare" is good for efficiency. I've used specific terms to describe my thoughts on efficiency. You can try again.

It takes a rigid mind to not recognize the implications of this reality vis-a-vis which is the better way to do healthcare, rigid and froze in the past, a living dinosaur with no clue, otherwise known as a capitalist apologist who supports a system of greed at any cost and to hell with the health of their fellow citizens.

That wouldn't be you, would it? Nawwwwww.

Talking to you is like talking to a wall.

Loren Michael wrote:I'm definitely sympathetic to a strong welfare state, including healthcare. Market failure is too much of an issue, the costs and likelihood, as far as I can tell, are too high in the healthcare industry.

Loren Michael wrote:I'm sympathetic to the notion that market forces don't work for some important aspects of healthcare

You can continue to try to bait me and malign a position I do not hold, or you can educate yourself on what my thoughts actually are.

The comfortable prison of your own misconceptions, or down the rabbit hole.

The choice is yours.

Allegedly the US doesnt have competition in its medical care and produces poor results
The rest of the world definitely doesnt have competiion and produces generally better results.

So in theory a full free market make produce wonderful results but there is no evidence for it so shouldnt you go with results that are avaliable when dealing with peoples lives?

mrjonno wrote:Allegedly the US doesnt have competition in its medical care and produces poor results
The rest of the world definitely doesnt have competiion and produces generally better results.

So in theory a full free market make produce wonderful results but there is no evidence for it so shouldnt you go with results that are avaliable when dealing with peoples lives?

Are you talking to me? Because...

Loren Michael wrote:I'm definitely sympathetic to a strong welfare state, including healthcare. Market failure is too much of an issue, the costs and likelihood, as far as I can tell, are too high in the healthcare industry.

Loren Michael wrote:I'm sympathetic to the notion that market forces don't work for some important aspects of healthcare (at least in a way that is satisfying to me), but I'm not willing to say that there isn't some organization that would allow market forces to work in a way I would find satisfying. It's possible that there isn't, but it's also possible it hasn't been discovered yet or it could simply be possible that I haven't been appraised of it.

It looks like my pushback against what I regard to be misconceptions about scarcity and anti-market orthodoxy are being confused for some kind of political position.

Wasn't really aiming at anyone but the 'the US doesnt have a free market in medicine' is a common statement from the right on this forum

I think it is worth noting with everyone complaining about private for profit care that appox 18% of our hospitals are for profit. Most are not for profit and many are public. Also, IIRC, government insurance makes a majority of the payments so I think blaming greedy capitalists is over simplifying things.

mrjonno wrote:'the US doesnt have a free market in medicine' is a common statement from the right on this forum

...but that statement is true.

We should also be wary of another tactic which is to claim credit for all the good things free markets have done, but to not accept market failures because they were not free enough. Heads-I-win-tails-you-lose style.

GT2211 wrote:I think it is worth noting with everyone complaining about private for profit care that appox 18% of our hospitals are for profit. Most are not for profit and many are public. Also, IIRC, government insurance makes a majority of the payments so I think blaming greedy capitalists is over simplifying things.

If someone said only 18% of schools existed to make a profit I'd say that's still too many.