patrick.net

By the way, here is an interesting article about the costs of end-of-life care.

This is clearly a difficult and sensitive subject in and by itself, but the article contains also interesting information about negotiated prices versus list prices, and the variability of both across different providers.

End-of-Life Warning at $618,616: Was It Worth It?

http://www.bloomberg.com/apps/news?pid=20601087&sid=avRFGNF6Qw_w

The cost to benefit ratio of cancer drugs approaches infinity.

Nomograph says

Kevin says

Enough people know how medicare works to speak honestly about it without having to distort the arguments.

The distorted arguments always distill down to a single point: some people may get health care who the opponents feel do not deserve it or are otherwise unworthy. They will oppose this even if it causes themselves great harm and huge expense. It’s a classic example of cutting of one’s nose to spite the face.

Actually, there is more than one point so you are WAY oversimplifying things. I would rather have maximum control over my health care rather than little to none. If we have a public health care system (funded by me a taxpayer) my taxes will confiscate a great portion of the money I could use to seek the care of MY choosing. It is not just about fairness (eg who gets what kind of care) it is about freedom. Freedom to use my income as I see fit and seek the medical and/or alternative of my OWN choosing.

theoakman says

The cost to benefit ratio of cancer drugs approaches infinity.

Yes and the number needed to treat (NNT) even on blockbuster drugs like lipitor is also rather huge. The cost benefit on MANY medications is hard to justify. That is why taxpayers should not be forced to pay for these medications. Antibiotics you can make a case for but so many others are just plain wasteful. I wonder the what the number needed to treat on "Swine flu" is. 100000? is it even that good?

AdHominem says

That is why taxpayers should not be forced to pay for these medications.

My niece is on a therapy for Crohn's Disease that is quite expensive. Without enzyme treatments she would have died long ago, with it she's an otherwise healthy college Senior. So all the members of her health-care group are paying for most of it. Where is the fairness in that? She will NEVER in her life pay a fraction of the price the drug companies assign to it, unless of course she ever has a gap in coverage. Then she will have a "pre-existing condition" and nobody will want to let her join!

Don't get me started on the various HMO doctors who misdiagnosed for years. She'd go in with repeated unexplained vomiting being a primary notable symptom, and they kept thinking "oh just another crazy anorexic teenage girl". She was in hospital more than once near death, and then she'd get better and the doctors would seemingly shrug and it remained a mystery. Finally she was seen by a GI specialist from Atlanta Children Hospital who looked briefly at her fingernails and said "you have Crohn's!" and not long after removing a chunk of already too-damaged intestine and putting her on enzyme she's like any other lively college girl.

If there's one good thing that comes out of this it's an answer for people with pre-existing conditions who will be dead otherwise. There are of course many ways to approach this, but either someone's having to compromise and pay a price, or we "put down" the unfit.

The thing I fail to get with most people is they don't realize they already have very little meaningful choice. There are variances in how they group their price tiers versus deductible, beyond that I don't see much but their choice of logo & corporate colors. You're probably not going to find Dr. House working at your local HMO group. Picking my HMO was largely about which one had closest offices. Choice for most of us amounts to do you want McDonalds or Burger King and are you picking from the dollar menu or getting a combo.

Vicente says

The thing I fail to get with most people is they don’t realize they already have very little meaningful choice.

Actually I think most people do realize this. However most people are not excited about giving the federal government any MORE control over our health than they already have.

It is too bad insurance companies have any say in the matter, and we should work to end this (make all health care expenditures tax deductible, not just for employers but for everyone). But if my choice is between Blue Cross and the VA system. I will go with Blue Cross 11 times out of ten.

AdHominem says

However most people are not excited about giving the federal government any MORE control over our health than they already have.

Does it ever bother you that you are objectively wrong about everything?

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/19/AR2009101902451.html

Troy,

You misrepresent the facts. First of all one poll with a leading question does not public opinion of most Americans represent. Second, the leading question took the demonized insurance companies and played on peoples love of the free market by using the word "competition" in it.

I stand behind my earlier statement.

Pick 1000 random names out of a national phone directory and ask them if they want government to have MORE or LESS control over their health. I think we all know what the most popular answer will be and it rhymes with mess, which is what nearly every federal program is. A mess.

How are those private highways working out? Having trouble thinking of any? Imagine that. I love anti-government types. When I see all of them with signs picketing to close all military installations and shut down the VA hospitals and end MediCare/MedicAid, then I'll think they are serious about their allegedly total belief that all government functions should be strangled in the tub.

AdHominen, did you see the poll that stated how many folks don't know that Medicare IS government run! So for folks to say that they want LESS government makes me wonder how much these folks know about current government involvement.

http://www.publicpolicypolling.com/pdf/surveys/2009_Archives/PPP_Release_National_819513.pdf

"One poll question indicative of how difficult it is to gain public understanding on a complicated issue asked if respondents thought the government should ‘stay out of Medicare,’ something inherently impossible. 39% said yes."

I still get a chuckle when I think about one of the news report about the protests at the health care town halls held by local politicians. One showed a elderly man holding a sign "Stay out of my health care". And I doubt that he passed up Tricare or Medicare just so he could participate in the 'free market". Could you imagine his premiums...hahahah.

Vicente, good insights in the "Crohn" post, about mis/missed diagnoses and choice being mostly an illusion.

The point I was trying to make is people label "government medicine" as SOCIALIST because it's government run. You have a certain form of "socialism" built right into the fabric of having a group insurance plan. You can dress it up all you want with actuarial tables and talk about profits etc. But the core idea is that healthy people pay in constantly, in order to heal total strangers in the plan who are sick. One of the crises we are facing right now with rising HMO costs is that young healthy people without jobs are dropping out, so naturally per-participant costs have to go up. People that talk about "it's not fair that I pay for some welfare momma to get a new liver" and similar really shouldn't be on ANY kind of insurance, because I suspect if they met some of the people being healed on their HMO plans right now, they would disapprove for one reason or another. Why are we healing this person or that one? If you hate the idea of anything smells SOCIALIST I got news for you, you really shouldn't be in any insurance plans either. Pay cash!

Labelling is everything. Again I see most people as opposed to SOCIALIST HEALTHCARE are directly or indirectly invoking old Soviet imagery of people waiting in line for toilet paper. The jibber-jabber about "death panels" alone is pure emotional propaganda. Do you think your insurance company doesn't assign a DOLLAR VALUE to your life and every medical procedure, and decide what does and doesn't get done on the basis of what minimizes costs? Inherent in the insurance-dominated health-care industry is what I can only consider as distributed death panels. Bureaucrats all through the chain make decisions about what are the most cost-effective treatments offered for an illness, and that is the menu they let their doctors offer.

"Labelling is everything. Again I see most people as opposed to SOCIALIST HEALTHCARE are directly or indirectly invoking old Soviet imagery of people waiting in line for toilet paper."

... And yet Obama directly and clearly admitted that certain amendments were inserted into the bill that "violated" (his words) some of the basic tenets of his stated approach... So, were some of the objections over the bill valid, or was Obama lying?

"The jibber-jabber about “death panels” alone is pure emotional propaganda. Do you think your insurance company doesn’t assign a DOLLAR VALUE to your life and every medical procedure, and decide what does and doesn’t get done on the basis of what minimizes costs? Inherent in the insurance-dominated health-care industry is what I can only consider as distributed death panels. Bureaucrats all through the chain make decisions about what are the most cost-effective treatments offered for an illness, and that is the menu they let their doctors offer."

And yet you are convinced that the government can increase people covered, increase service, and decrease cost - even though it cannot do that now in its own government-run programs - all while not putting a dollar value on everything? They can decrease costs while in theory there will be no price limit because bureaucrats and actuaries will not be involved in policy decisions?

I love anti-government types. When I see all of them with signs picketing to close all military installations and shut down the VA hospitals and end MediCare/MedicAid, then I’ll think they are serious about their allegedly total belief that all government functions should be strangled in the tub.

You live in a bubble. You cannot refute the positions of your opponents when you argue against something that is not their position. Who has this alleged "total belief" that "ALL" government functions should be ended? Other than perhaps individualist anarchists, how about... NO ONE???? If you are attempting to argue against conservatives in this fashion, you are arguing from a completely false premise.

Are you a communist? Do you believe that the central government should run ALL functions of society? YES or NO?

No, libertarians just want to keep those gov services that benefit them directly.

"YES or NO"... its all so black and white, isn't it? its all that simple...

Paralithodes says

And yet you are convinced that the government can increase people covered, increase service, and decrease cost - even though it cannot do that now in its own government-run programs

Actually, it does. Medicare admin costs amount to about 7 percent of its budget while the private insurance companies spend about 25 percent. So that would mean that the gov run system is about 3 times as efficient as private insurers.

- all while not putting a dollar value on everything? They can decrease costs while in theory there will be no price limit because bureaucrats and actuaries will not be involved in policy decisions?

This garble needs more of an explanation, please.

kentm says

No, libertarians just want to keep those gov services that benefit them directly.
“YES or NO”… its all so black and white, isn’t it? its all that simple…

I don't know, maybe... Vincente seems to have defined conservativism, albeit incorrectly, in quite black and white terms. Don't you agree? YES or NO?

"Actually, it does. Medicare admin costs amount to about 7 percent of its budget while the private insurance companies spend about 25 percent. So that would mean that the gov run system is about 3 times as efficient as private insurers."

And taxes collected to pay Medicare cover medicare expenditures?

Paralithodes says

I see most people as opposed to SOCIALIST HEALTHCARE are directly or indirectly invoking old Soviet imagery of people waiting in line for toilet paper.”

As an aside, in response to this, if I have to wait in line for toilet paper I'd rather it be because of a real shortage instead of because some private company decided it was more profitable to keep it from me. just a thought.

"This garble needs more of an explanation, please."
The unstated premise, in Vicente's rant about insurance companies putting things in dollar terms, is that the government would not - otherwise why would he mention dollar terms at all? To think that the goverment would not - all while talking about how this could decrease costs - is ridiculous. "Death panels" is of course hysterical hyperbole, but to think that there will be some open-ended spigot to pay for every medical cost - while reducing costs, is funny. Of course the government will put people in dollar terms! And certainly it must! It does now, why would anything with that change?

Paralithodes says

And taxes collected to pay Medicare cover medicare expenditures?

What does that have to do with anything?

Immediate shutdown of VA hospitals, MedicAid, MediCare, any form of medical aid by Federal government to citizens or foreigners.

Yes or no?

I see most people as opposed to SOCIALIST HEALTHCARE are directly or indirectly invoking old Soviet imagery of people waiting in line for toilet paper.”

As an aside, in response to this, if I have to wait in line for toilet paper I’d rather it be because of a real shortage instead of because some private company decided it was more profitable to keep it from me. just a thought.

The statement was incorrectly attributed to me - I think because I copied/pasted incorrectly somewhere.

In any case, if some private company decided it was more profitable to keep it from you, why wouldn't some other company just come in and undercut the price and take all the business?

"Democratic Government is a locus of power derived from the people"

It must be nice living in that fantasy land.

Two thirds of the money buying our "democratic government" comes from the bankers that own this country and just looted it for everything that wasn't nailed down, in case you didn't notice.

The government works only for the corporations that lobby it and bribe it with campaign contributions. Democrat/Republican Left/Right is just window dressing for the masses. Kind of like professional wrestling.

Your leftist belief that our government is "democarctic" and is a "locus of power derived from the people" is charming, quaint and totally unfounded.

Vicente says

Immediate shutdown of VA hospitals, MedicAid, MediCare, any form of medical aid by Federal government to citizens or foreigners.
Yes or no?

Of course not...

Government control over every aspect of the economy? Yes or no?

kentm says

Paralithodes says

And taxes collected to pay Medicare cover medicare expenditures?

What does that have to do with anything?

Asking that question is a joke, right?

Paralithodes says

Of course not…

SOCIALIST!

Vicente says

Paralithodes says

Of course not…

SOCIALIST!

So then it is perfectly accurate and valid to label President Obama a Socialist as well? And all Democrats?

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

Paralithodes says

he unstated premise, in Vicente’s rant about insu...

The idea is that a private health care system puts dollar value ABOVE humanity - as a private company they're designed with profit as the reason they exist, and so its actually in their interest to deny care because thats how they make money. More in, less out, and so the more they can deny service while raising fees, the better. Its simply how their entire structure is designed.

The idea of a gov run health care system is that its NOT run for profit, so they can better respond to and provide actual care to people because the bottom line is not the entire reason they exist.

Thats about as simple as it can be put, and this is the entire problem.

For all the libertarian screaming about individual rights and personal freedoms, you people don't actually seem all that interested in actual people and what honestly helps them, you just seem to be interested in your own little selfish needs, like children screaming "ME" all the time. When I see someone who calls themselves a 'libertarian' I see those seaguls from "Finding Nemo"... saying "mine", "mine", "mine", "mine", "mine" over and over.

I wish you'd just be honest about that instead of hiding your real aims all the time.

Paralithodes says

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

Are you writing in response to me? If you are then:

Because its a stupid question.

I shouldn't have to say this, but do you want a police force, or an army, or a fire dept?...

Nearly every American citizen is a socialist. And yet we hurl this around as a negative label? If we have a person that is entirely self-centered and does only what pleases and advances them and nobody else, we give them labels like..... SOCIOPATH.

YOU are a SOCIALIST! Oh ick!

And yet, to drag this back to Ayn Rand and hardcore Libertarians, SOCIOPATHY IS PRECISELY WHAT THEY WORSHIP!

Of The Fountainhead's hero, Howard Roark: He "has learned long ago, with his first consciousness, two things which dominate his entire attitude toward life: his own superiority and the utter worthlessness of the world." (Journals of Ayn Rand, p. 93.)

Thats about as simple as it can be put, and this is the entire problem.

Black and white, eh?

It's certainly about as simplistic as it can be put. The government cannot claim that it will reduce health care costs, all while ignoring financial budgets and management by not being concerned with money, which is exactly what it must do to accomplish the former. In addition, the health insurance companies profit margins are very small: 2-4%.

"YOU are a SOCIALIST! Oh ick!"

So your argument boils down to this: There are two forms of government: Socialism and Anarchy (no government at all)?

For the fourth time, do you believe the government should control every aspect of the economy? Why will you not answer? I guess it is probably reasonable at this point - given your refusal to answer - to assume that your answer would be a "yes."

Also, do you know what a "strawman" is?

kentm says

Paralithodes says

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

Are you writing in response to me? If you are then:
Because its a stupid question.
I shouldn’t have to say this, but do you want a police force, or an army, or a fire dept?…

So you also believe that if a conservative is against more Federal government expansion, he should be against all local, state, and Federal government functions?

You say that a question (which was a response to an absurd claim) is stupid, but then you essentially ask the same stupid question! Do you really argue that if someone wants a local fire department, then it is unreasonable for them to be against government control over the health care of the entire country?

"When I see someone who calls themselves a ‘libertarian’ I see those seaguls from “Finding Nemo”… saying “mine”, “mine”, “mine”, “mine”, “mine” over and over."

And when many libertarians and conservatives see someone who calls themselves a liberal, they see someone yelling: "We need to contribute more to society ... via the government ... with your money!" (Maybe that is why conservatives - at all income levels - are more likely to contribute to charity than liberals...)

Paralithodes says

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

No, however THAT is not really an issue is it?

Practically speaking the bankers and the Federal Reserve already have control of the economy.

Vicente says

Paralithodes says

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

No, however what we think doesn’t matter.
Practically speaking the bankers and the Federal Reserve already have control of the economy.

No? ANTI-SOCIALIST, CAPITALIST PIG!!!! See how easy it is?

As to your latter comments (after the "No") I agree.

Paralithodes says

Vicente says

Paralithodes says

And why are you not answering the question? Third time: Total government control over all aspects of the economy? Yes or no?

No, however what we think doesn’t matter.

Practically speaking the bankers and the Federal Reserve already have control of the economy.

No? ANTI-SOCIALIST, CAPITALIST PIG!!!! See how easy it is?
As to your latter comments (after the “No”) I agree.

And there it is. You see we are all on the same team, but the PtB want us fighting against one another rather than uniting in defense of ourselves.

It is not government (socialism) that is the problem nor big corporations. It is that Corporatism has hijacked government. Government is not accountable to J6P like it should be, instead it is accountable to Corporatism. The Federal Reserve is perhaps the biggest way government has been hijacked from accountability to the people.

"I believe that banking institutions are more dangerous to our liberties than standing armies. If the American people ever allow private banks to control the issue of their currency, first by inflation, then by deflation, the banks and corporations that will grow up around [the banks] will deprive the people of all property until their children wake-up homeless on the continent their fathers conquered. The issuing power should be taken from the banks and restored to the people, to whom it properly belongs." -Thomas Jefferson

Paralithodes says

Right… The ‘if you are against *more* Federal government, you should be against ALL local, state, and Federal government or you are a hypocrite strawman argument…’ I take it the corollary is that you would be ok with complete government management of all of the economy?

The problem is that most people argue against government run health care because "government can't do anything right". Or the scariest phrase they've ever heard is "I'm from the government and I'm here to help". So, it's not really a strawman in that case, is it?

Paralithodes says

… And yet Obama directly and clearly admitted that certain amendments were inserted into the bill that “violated” (his words) some of the basic tenets of his stated approach… So, were some of the objections over the bill valid, or was Obama lying?

That's not an either/or question. There is an answer c to that...

Paralithodes says

And yet you are convinced that the government can increase people covered, increase service, and decrease cost - even though it cannot do that now in its own government-run programs - all while not putting a dollar value on everything? They can decrease costs while in theory there will be no price limit because bureaucrats and actuaries will not be involved in policy decisions?

Every other civilized nation in the world can do it. Is there some reason why we can't?