patrick.net

bob2356 says

Average life span was 36, would you like to go back?

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

Tee hee. You just got pwned, chanakya.

chanakya4773 says

We can always have insurance for catastrophic medical events. insurance for doctors visit ..etc does not make sense. Insurance should be only used for events which backrupt people and nothing else because insurance is a very in-efficient system. even in single payer universal health care system, it should be the case.

The first logical statement you've made. Health insurance should be catastrophic.

Single payer and universal/public heath care are very different things. Public health care is not insurance in any way shape or form.

chanakya4773 says

Also, like JOHNLAW mentioned US was also mostly insurance free before 1965 so you don't have to go too far to look.

bob2356 says

Health insurance actually dates back to the civil war and became common in the 1930's. Is google not working on your computer? http://www.randomhistory.com/2009/03/31_health-insurance.html

You're not paying attention.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system.

chanakya4773 says

There are lot of private health care insurance companies in india but 90% people don't use them

These don't seem to be complimentary statements.

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

chanakya4773 says

What the fuck are you talking about. can you explain why it worked in the past and it won't work now ?

It DIDN'T work. Are Bob's posts not showing up on your computer?

Homeboy says

chanakya4773 says

When govt started subsidizing insurance is when the problem started.

What do you mean, "when government started subsidizing insurance?" When did the government start subsidizing insurance?

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

Here's your golden age of medicine before they started bothering with silly things like licensing:

Once it was easy to become a doctor. During the nineteenth century the United States saw the emergence of an estimated four hundred proprietary medical schools. Set up to offer medical degrees as part of profit-making ventures, these schools generally had low standards of instruction, poor facilities, and admitted anyone who could pay the tuition. Since the proprietary schools competed with so many other for-profit schools as well as schools affiliated with universities, they advertised incentives to get students for their programs. One school gave free trips to Europe upon graduation to any students who regularly paid fees in cash for three years. Anyone who had the money could get a medical degree and practice medicine. In many of the private proprietary schools, degrees were granted after one year of courses that consisted chiefly of listening to lectures.

http://www.encyclopedia.com/doc/1G2-3468300573.html

1900s:

Most medical schools operated primarily for the benefit of their physician-owners and lacked libraries, laboratories, or even much clinical experience for students. Hospitals were few in number, located only in the largest urban areas, and served primarily the poor. Most surgeries were still done in the home. The nation was flooded with ineffective and sometimes dangerous patent medicines sold directly to the public by charlatans. Diseases such as yellow fever, typhoid fever, tuberculosis, pellagra, and hookworm ravaged entire communities. Government support of health care initiatives was weak at best.

http://www.encyclopedia.com/doc/1G2-3468300224.html

1910s:

Unhealthy Americans

The growing emphasis on medical examinations in the 1910s revealed that most Americans had some kind of health problem. Of 3.76 million men examined for service in World War I, about 550,000 were rejected as unfit; and of the 2.7 million called into service, about 47 percent had physical impairments. In one study examining 10,000 workmen, not one was reported in perfect health. Ten percent were slightly impaired, and the other 90 percent were in varying stages of poor health: 41 percent had problems requiring minor treatment; 35 percent had conditions requiring medical supervision; 9 percent had serious physical impairments requiring systematic treatment; and 5 percent had grave problems requiring immediate medical attention. Among 5,000 citizens of Framingham, Massachusetts, examined as part of a Metropolitan Life Insurance demonstration project to control tuberculosis, 77 percent were recorded as ill with some disease; two-thirds of the defects discovered were supposedly preventable. But Americans did not see themselves as unhealthy. The physicians' examinations found twelve times as much illness as did a house-to-house survey of self-reported sickness.

http://www.encyclopedia.com/doc/1G2-3468300562.html

You want to go back to that, huh?

bob2356 says

He's talking about when it became tax deductable to businesses in 1954 or so. Since he isn't a brilliant student of history he isn't aware that health care insurance exploded during WWII because of wage freezes. Health care insurance was offered instead of raises. But why let facts get in the way?

So he's saying that all healthcare problems started in the 1950s? Because this is how it was in the 1930s:

In the 1930s the biggest health concern of America was how to pay for medical needs. The national income was less than half of what it had been in 1929, and in several states as many as 40 percent of the people were on relief. Many Americans could not pay their medical bills, and visits to physicians and hospitals decreased. Before the Depression, physicians charged a fee-for-service on a sliding scale and collected their bills as best they could. They also saw some patients on a charity basis and passed the expenses along to those who could pay. Loss of medical services and reduced ability to pay meant lower incomes for physicians, too. While doctors as a group fared better than many other professions during the Depression, in many cases they also saw their incomes halved. Hospitals were in similar trouble. Beds went empty as patients could no longer afford a two-week hospitalization, which was the average in 1933. Bills were unpaid, and charitable contributions to hospital fund-raising efforts fell.

http://www.encyclopedia.com/doc/1G2-3468301278.html

Doesn't exactly sound like a utopia to me.

chanakya4773 says

What does all this have to do with licensing versus certification.
There was lot of disease before and its common knowledge...nothing rocket science. Technology and science has advanced quite a lot and improved things including health care. The aircrafts today are much safer than the once in early part of 1900s. It didn't happen because aircraft engineers were licensed versus cerified. it happened because of the progress in the field just like any other field. every field including medicine has advanced. there is no licensing in engineering but it still advanced. Do you think all the software engineers are licensed. why the heck then software field is advancing so fast ?

Did you not read the excerpt about how poor physician training was in this period of history that you seem to think was some sort of utopia that we should strive to return to? What's difficult for you to understand about that?

Software engineering is a very poor analogy to medical practice. Among many other things, if you botch a computer program, people simply won't buy it. If you botch surgery, you kill the patient. Free markets work great for some things, but not at all for others.

chanakya4773 says

how could have insurance system solved this problem ? this was a depression problem not a health industry problem.

You are turning things around. I did not claim that health insurance could solve this problem. YOU are the one claiming that a cash-for-service system would solve all problems. YOU stated that you believe the U.S. should return to whatever we were doing pre-1950s, because of your belief that it worked so well. But I have proven that it did NOT work well, hence your argument is not valid.

It is YOUR claim that government intervention is the source of all problems with the healthcare system in the US. I am simply disagreeing with your premise.

chanakya4773 says

India is one example where there is very little govt intervention and there is literally no insurance system

chanakya4773 says

The public health care system is for the poor and needy and is directly run by govt. its a very small percentage of the total hospitals that india has

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

chanakya4773 says

THERE ARE NO MANDATES ON PRIVATE HOSPITALS AND DOCTORS in india. The private industry is fully free market based.

Maybe you should read a little. Try transition.usaid.gov/in/our_work/pdfs/promise_reality.pdf for a starter. I read the whole paper about 5 years ago (it was a very, very long flight). Lots of interesting tidbits about government regulations on hospitals in India. Try page 40 hospital reimbursement by source. Let's see, 41% government, 35% insurance, 17% employer, 7% other/cash. If you care to read a little further you will find the 17% employer is from government mandated health insurance coverage in certain industries and self insurance by corporations with tax and other government incentives (page 84). So 41% of reimbursements to the hospitals by the government is "a very small percentage"???

Maybe it would be best if you discarded and drew new cards. What other country would you like to point to as a free market medical system?

bob2356 says

Your statements. Very little government intervention. Yet 1.2 billion people are covered by the public health care system and depending on whose number you believe 35-40% use it for their health care. So 480 million people using the public health care system represents very little government intervention??? Really???

Well there is a difference between a roach infested motel in a crime ridden neighbourhood and Ritz Carlton in a nice neighbourhood. The former may be free-but do you want to stay there with your family.

In the US, the latter can be used by people with insurance and poor/illegals who just walk into the emergency room and get treated for free. The middle class-they can come after your assets. But the poor/illegals are judgment proof-they have no assets. So there is a difference with the mandates.

Now I understand the rationale, if you are in a car accident, or have a heart attack, the last thing you need is to be tossed aside by the emergency room, because you have no proof of insurance-you might have left proof at home. So that is a big problem. But hospitals do run up a big tab and the rest of us pay for it.

However I read somewhere that India is giving free generic prescritpon drugs to all of its 1.2 billion citizens, don't know if the law passed yet.

Bottom line is that the 51% found that they can use the government as a means of extortion. For now, they think that all of their needs can be achieved by this and life will be better as a government serf. We shall see.

chanakya4773 says

and you still believe GOVT is not a problem and you are a free citizen.
this is the worst form of tyranny.

Where did anyone say that the US government wasn't one of the problems with US health care, one of many? No one said anything even close to that. Try to read more carefully. Everyone is saying that your free market idea doesn't work either. If it does then please show us where it exists. India sure isn't it.

Why is the government forcing you to do any of these things? You are free to not have health insurance, just pay the penalty, No health insurance then the subsidy doesn't matter to you. No health insurance no payment for er's for you. No health insurance no payment for litigation for you. You are free to travel to any free market hospital in the world for your care. You don't even need a doc, just use the internet. You have all the access you want to foreign doctors, just cross the border.

Why are you and john law always a matched set of comments together? Curious coincidence.

chanakya4773 says

My idea of having a free market health care system and govt run hospitals for the poor and needy will work.

WTF???? After ranting against government involvement in health care for 20 or 30 posts now you want government run hospitals? Did you log onto the wrong profile by accident?

So where does this utopian free market health care exist? Got an example? I'd love to see it. Since 93% of the hospital income in India comes from government or insurance I really don't think you can say it's a free market.

chanakya4773 says

Do you think a person living in utah will cross the border to get a doctors visit. please me more practical.

You have the option, if it's practical is a different issue. Tyranny is when the government closes the boarders so you can't leave and confiscates your paycheck to give to cigna.

chanakya4773 says

Having a charity or govt run hospital for the poor and needy atleast allows us to control the money we will be shelling out to the free loaders.
These hospitals will be with bare minimum facilities to at least not let people die on streets.

Today , the free loaders have free pass to the private sector hospital emergency rooms and they are creating havoc in the system. the better option is to remove the mandate from private sector to service them in emergency rooms and create a govt run hospital for emergency services.
these will be similar to the services we provide for homeless people.

ofcourse the hospitals will be shitty but that's what you get for free.

The total cost that we will be bearing will be far low because we won't be giving them top of the line emergency services for free at our expense which is what is happening now. instead we will be giving them bare minimum services and we will control how much to spend on it as well.

You are such a compassionate soul. How did you ever become so considerate of your fellow human beings? You talk so much about India that I guess it must be Gandhi's influence.

chanakya4773 says

Are you f** crazy. you are googling all over the place to get some crappy data. talk to someone who has lived in india and you will know how indian health care works. some useless and incomplete document from web on indian healthcare system is not enough to prove that there in no free market private health care system in india. .Its a fact that most middleclass people in india have access to fully private free market based health care system in india.majority of them are direct cash payments.ofcourse there are some shitty govt run hospitals to service the poor who are completely broke but no middleclass person will dare to go there and nobody does. The Govt does not mandate the private sector to service a person irrespective of their ability to pay.
if a person tries to go to a private hospital and demands to be treated without paying them, they will cut his balls off ;-)

So you espouse having healthcare run by charities (or government, depending on how the mood takes you) if you are poor, and there are a lot of poor in India, and in the same breath say how shitty that healthcare is. Let's just summarize your argument - if you've got the cash, you get the healthcare you oh-so-deserve. If you're poor, you can basically just fuck off and take your chances because, well, you're poor. Like I said, you're a compassionate soul.

chanakya4773 says

Its a human thing not to let people die. if you don't have that..there is a problem with you. that does not mean you allow people to use that excuse to game the system and create a huge burden. I would any day donate a small sum to help a homeless who is really desperate or help save a life. that does not mean i'll write a blank check to everyone of them ( which is what is happening now).

Thats why charity based hospitals fit the model very well because the free money that people get are based on people's compassion which serves only the really desperate for their desperate needs and thus automatically control costs. we are giving too many very expensive freebies in todays system.

Have you actually taken a look at the WHO's list of the best healthcare systems around the world and their related costs? I think you need to.

chanakya4773 says

If you are poor and you are asking somebody else to pay for you...you only get what the other person is willing to give you on compassionate grounds . whats so difficult to understand here. anything else would be called extortion. do you like to do extortion ?

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you. I suspect that would be nothing in your case. I tell you what, let's go back to the days of poor houses and the like whilst we are at it.

chanakya4773 says

If a homeless guy comes to you for help ..would you like to have him "demand" money or would you like to give him whatever you thing is right on compassionate grounds ?
i know when i give him few dollars that he will be able to eat only eat very inexpensive not so great restaurant versus a steak house....but thats what i am willing to give away for free. anything wrong with that?

How about having a society that actually tries to prevent homelessness rather than just having people like you thinking they're doing the very best for them by tossing them a couple of dollars when/if the mood ever takes you?

chanakya4773 says

Bigsby says

Let me guess, you're poor because that's the consequence of your past life and so you only deserve what I deem fit to hand out to you.

well then go earn it. why do you want other people's hard earned money.
do you think they got it for free

Because not everybody is as fortunate as you so obviously seem to be. Personally, I'd much prefer to live in a society that tries to take care of every citizen's medical needs rather than one that is based on your philosophy of 'fuck you, I've got mine.'

chanakya4773 says

Bigsby says

How about having a society that actually tries to prevent homelessness

The best one known to man today : free market enterprise. If there exists something better, its definitely is not known yet.

Complete and utter bullshit.

chanakya4773 says

you need to understand something here.
there is only fixed amount of health care resources available in US. if you take something from it and give it away free to somebody. somebody else is not getting it. its called rationing. rationing should be the last resort. The focus should be to grow the pie . in this case, healthcare resources pie. one way to grow the pie is to make every person contribute money to grow the pie. that why you cannot just give freebies.

You need to understand something. The US ranks 38th on the WHO's rankings of health systems whilst spending the highest amount per capita by a long way - $2500 more (according to the OECD) than the next highest spender. This isn't an issue of money or lack thereof. It's an issue of how the country has decided to spend its money on healthcare.

chanakya4773 says

There is nothing wrong with that concept. the approach is wrong though.
Given the high cost of healthcare, there is this huge outcry that you are venting. but you failed to find out why the costs are so high. before attempting to ration it, we should try to find a better way. the better way is to focus on reducing the cost so that its available to everybody.
rationing will only make all hospitals shitty.

giving govt mandated freebies creates lot a waste because there is lot of abuse since its free. that increases cost for everybody.

Yes, there are better ways. You could simply look at what the highest ranking healthcare systems have done. And guess what, none of them have done what you are arguing for. Amazing I know, but there you go.

chanakya4773 says

you can read my original post. lets talk once you read that. we all know its
broken but rationing is not going to fix it.

actually rationing of emergency services is already happening. how is that helping you ?

I've already read all your posts. I fundamentally disagree with what you are saying as you should quite clearly be able to understand. And it's laughable that you are complaining about rationing because your argument seems to be to leave the poorest in society to their chances. Charity hospitals for very basic care if you are lucky, seemingly.

chanakya4773 says

there is bigger problem here that just following what others have done.
even though other countries can brag all they want about their system, US medical field is the most advanced and is the innovation engine of the entire world. other people piggy back on our innovation.
Once you kill this system here , there will be bigger repercussions than you can imagine. sometimes the intentions are good but the results are not.The last thing you want is stagnation in medical field innovation and lose the opportunity to save thousands of lives across the globe. most countries have chosen the non-free market approach but it does not matter since US is the innovation engine anyway.

there should be every effort to keep most part of the health care system here money making industry so that people keep innovating.
once you take away the incentive to make money , innovation will die for sure.

Kill what? There's plenty of major medical innovation that comes from Europe, for example. Having comprehensive healthcare coverage isn't the death knell for medical advancement, though your plans for medical healthcare might well be the death knell for any semblance of a civilized society.

chanakya4773 says

you didn't answer on how to prevent homelessness for good...any ideas ?

It's obviously a highly complex issue, but an entirely free market has absolutely no interest in dealing with that kind of problem, and if you don't see that, then there's little point in discussing anything with you.

chanakya4773 says

I would also be interested to know why somebody ( who is already fully burdened) should be paying for your emergency room visits?
for every free emergency room visit that happens today , there is probably some already broke family paying for it.

Then perhaps you should try and understand a system such as the one the French have. Most people aren't that desperate to pick up a gun and kill a few taliban, but they understand the need for some of their dollars to go towards defense expenditure. Why can't their dollars also go towards universal healthcare? You do understand that most people wouldn't be making the choice to pay twice, and based on current US per capita expenditure, it would be highly likely that LESS of an individual's money would be going towards funding their healthcare than is the case now whilst simultaneously enabling universal coverage. That's a win-win in my book, but apparently it means something else to you.

chanakya4773 says

Bigsby says

Having comprehensive healthcare coverage isn't the death knell for medical advancement,

read this : http://www.forbes.com/2010/01/06/health-care-reform-congress-politics-opinions-contributors-whitman-raad.html

What's your point? That has nothing to do with the impact that universal healthcare might have on research. The UK has more nobel laureates per capita than the US as have a number of other countries with universal healthcare. Does that mean I can argue that universal healthcare actually advances scientific research... or could there possibly be other factors at play?

chanakya4773 says

Health care costs ...Too much GOVT is the problem.

I would argue that the problem is bad government rather than too much.

If we completely got government out of health care and let the transnational corporations run everything how they see fit, knowing that profits, not lives, are what motivates the executives of these corporations, do you honestly believe that health care prices will go down?

Don't just answer that question right away. Think about it. Think about what corporations, particularly large and powerful ones, actually do when unrestricted by law.

A very flawed analysis by the OP. No mention of high-tech medical toys, oops, I mean DEVICES, that are one of the main drivers of insane inflation of medical care costs.

That's good ol' capitalism, complete with patents that protect the inventor. How does government get in the way of that sort of private market activity? They don't, and it doesn't work. 46 million uninsured people will tell you that.

I also detect more than a sniff of class-based contempt for the less fortunate in the OP's analysis. Does your employer provide you with health care coverage? I hope so, as it's killing the rest of us barely making the monthly premiums with their double-digit yearly increases. That's good ol' capitalism as well, juice it to the captive consumer whenever possible.

No, you have backwards, we need to get the private market bloodsuckers OUT of the healthcare industry and get the administrative costs down from 15 -30 % to more like the Social Security Administration, which manages just fine with a 3% overhead.

chanakya4773 says

Are you f** crazy. you are googling all over the place to get some crappy data. talk to someone who has lived in india and you will know how indian health care works

Are you the person who has lived in India? If you are then you should have no trouble at all refuting my numbers. Sorry I don't do anecdotal. Please feel free to provide some official numbers that dispute my crappy data. Until then I will stand on my hand.

chanakya4773 says

yes , i was born and raised in India and i know the system in and out.

I know how much it costs for medical care in india. even normalizing it to US per capita income, the costs here are "ridiculous".
don't you all agree that the costs are just absolutely insane in US ?
does anybody have an answer why ? I have put four points which are possible reasons with different degrees of effect.

Well then you should have no trouble at all providing correct numbers since mine are incorrect, when can I expect to see them?

Yes the costs are ridiculous. I'm waiting to see your theoretical free market in action. India isn't anywhere close. It's cheap because it's so poor a large number of people simply don't have health care at all. Show me a comparable to the US health care system operating as a free market, I'll be glad to look.

The rest of the first world uses government public health care with better results and half the cost. So simply saying government is the problem doesn't make much sense. Corporate ownership of the political system of the US is the problem. Not just in health care either.

There are 3 very simple reasons why health care in the US is expensive. Fee for service, insurance billings for fee for service, and drug patents. If the US used capitation for general medicine and salary for specialists like everyone else then the costs would be the same as everyone else. That would also mean the enormous cost of insurance and insurance billings were eliminated. If drug companies weren't able to continually repatent existing medications, keeping generics off the market, then the cost for drugs would be a fraction of what it is now.

Government involvement magnifies these problems but is not the cause. If you actually bothered to read some of what was posted you would discover that health insurance and fee for service were common before insurance was tax deductable and well before medicare existed. You have your causation backwards. The problems were there, then government got involved and made it worse.

Your blood can boil as much as you want it's never going to change. Doing so would also mean the huge bribes, whoops sorry expressions of free speech, going to politicians from insurance companies, pharma, and the AMA would go away. Never, never ever going to happen. So everyone is just plain old screwed. I think I'll just continue to be an expat.

chanakya4773 says

Hi Bob,

I agree with some of your statements. But both you and me are not right on the free market concept since we both don't know "exactly" how it will work.

but we could definitely start with small steps in the right direction and fix things which we all agree are broken. getting as close as possible to the free market without messing it up is one such step. there is no perfect answer here.

So you have no basis for thinking a free market would work, you just want to give it a go. Why not give a go to a system that we do know works and that we also know supplies better results at less cost? How about that for an idea?

I noticed you tossed in that old chestnut of supply constraint. I take it that waiting a little while longer is unacceptable but having 50m lacking coverage isn't. Everything has constraints. It's how you manage them for the good of the whole. If you want to go the private route and get faster care, then you aren't prevented from doing that under the universal healthcare systems.

chanakya4773 says

Bigsby says

If you want to go the private route and get faster care, then you aren't prevented from doing that under the universal healthcare systems.

The current private route will still have all the issues i highlighted in my OP.

That's the private route in the US not in the other healthcare systems. And there's nothing wrong with the universal healthcare systems as demonstrated by the WHO report.

chanakya4773 says

Bigsby says

That's the private route in the US not in the other healthcare systems.

how do you fix the private route in US ?

looks like we are looking for bandages not solutions to the real problem.

Good grief. You minimize its role and influence by adopting an effective universal healthcare system, many of which have demonstrably better results than the current US system. That leaves a minimal role for private healthcare for those who wish to take that route. How that is implemented is unimportant because EVERYONE will still be able to get good healthcare.