patrick.net

Infant mortality per thousand live births is naturally lower in countries that have higher abortion rates! The congenital risks are killed off early before being born.

BTW, in the case of child birth, the US also has socialized medicine: the low income mothers are taken care of by Medicaid. That's why birth cost has been skyrocketting!

Now that Sweden is realizing that their healthcare and welfare system isn't financially sustainable, it's great to see them taking steps to revert back to more free market principles.

Singapore is a model that we should definitely look at where there's cost-sharing involved so that it forces more transparency as to what it costs the consumer, which will drive more competition like what we have in the LASIK market. On the flip side, it's still regulated and subsidized by the gov't for lower income individuals. I sure hope ACA takes us this direction.

debyne says

it's great to see them taking steps to revert back to more free market principles.

There is no "free" market in the U.S. healthcare system. Fuck man, there isn't even a "market" in any sense of the word. A market is a meeting place where buyers and sellers negotiate prices. When was the last time you negotiate a price at a hospital?

Let me tell you how reality works. You go to a hospital because you suddenly have a great pain you never had before. The administration clerk at the front desk immediately tells you to go to the emergency room. You don't get to enter any other queue; you have to go to the emergency room for service.

Of course, the emergency room is on the entire other side of the hospital and despite the hospital admin calling your case an emergency, you have to walk you ass half a mile or more while in dire pain.

Then when you get to the emergency room, the tech takes one look at you and asks if you ever had a kidney stone before? You say no and he says, "well, here's your first". You are then made to fill out five pages of forms that include your residency, your place of employment, and a bunch of other things that would only be of interest to debt collectors trying to track you down. You give them various forms of IDs that they copy, again so that collectors can track you down, not because any medical work needs these things. And then you have to sign various documents giving away your rights to sue for malpractice, etc.

If you don't sign all these documents and cooperate in every single way, you won't see a doctor. And this all happens while you are in constant agony.

Finally, when they have all the data to make sure their collectors can track your ass down and you have signed away all your rights, then they make you wait several hours because evidently your emergency -- and remember, you are only in the emergency room because the hospital admin sent you here -- is evidently not emergency enough to deal with for hours later.

When they finally get you into a room -- which they only do for the sake of billing for the room -- they leave you there for a few more hours. When a low-level doctor, typically a resident, finally does see you, he orders a MRI test even though the tech had already correctly diagnosed that you have a kidney stone. Remember, the hospital gets profit with every test, even when the hospital knows what the results will be already.

The doctor spends maybe a total of five minutes looking at the results of the MRI and examining you to conclude you have a kidney stone. The nurse then sticks a salt-water solution bag to a tube going into you veins. That's the treatment. Salt-water to the blood and wait while you pass the kidney stone on your own, something you could have done much more comfortably at home.

When the ordeal is over, the hospital bills you over $10,000 for the services they provided. The insurance company ends up paying only $1,000. Why the difference? To ass fuck anyone without insurance. And quite frankly, that's the only reason you and tens of millions of other people have insurance, so they don't get ass-fucked on the billing.

So tell me, debyne, where exactly is the free market in this system? Where do I get to see the prices of goods and services? When do I get to negotiate these prices? This isn't a free market. It's not even a market.

You want a free market? Get single payer. With single payer, the prices are known ahead of time. Individual health care providers can charge whatever-the-fuck-they-want for a given service, but they cannot charge different people different amounts for the service, nor can they hide the costs of the service until after the service has been rendered.

Single payer would make shopping for health care like going to a restaurant. You want a calzone? Luigi's calzone is $8.50. Frank's is $6.50. Maybe it's worth paying more for Luigi's, but that's your choice. You know the prices and you can ask others about the service. That's a market. Health care in our country is no market by any interpretation of the word, and the only way that health care can ever become a market, free or otherwise, is through single payer.

And for all those you think the Affordable Care Act sucks ass, myself included, either come up with a counterplan -- which I have done -- or shut the hell up. We're not sticking with the status quo because it sucked the sweat off a dead man's balls.

Interesting radio program that covers the Swedish health care system:

Klaus Bernpaintner - Hour 1 - A Swedish Lesson in Conformity & Control
http://www.redicecreations.com/radio/2013/10/RIR-131021.php

He says that Sweden gets by using implicit "death panels" in that for older patients with cancer, they simply put them on waiting lists until they die.

But really, is that any different from subjecting them to painful therapy until they die? From what I gather, old people with disease in the US are basically guinea pigs that are used to further research. Other countries don't have anywhere near our capacity for research so they just let them die.

In the end, the result is the same, except we might actually find a cure some day. Possibly?

Dan8267 says

There is no "free" market in the U.S. healthcare system. Fuck man, there isn't even a "market" in any sense of the word. A market is a meeting place where buyers and sellers negotiate prices. When was the last time you negotiate a price at a hospital?

Yes, the idea that the US has anything close to a "free market" health care system is complete fantasy.

A few years ago my spouse needed a procedure and when we tried to price it out we found that there was a place, an hour drive away, that would perform the procedure for $500, but it would be it would not be covered by insurance.

The other option was a nearby place through insurance. It was impossible to get anyone to tell us what our out of pocket cost would be for the procedure. We got the run around from everyone we contacted. The price was "confidential" -- but we would know when we got the bill -- and we were referred to someone else who may be able to tell us the price. After many hours on the phone we were referred back to the original person.

We ended up taking the risk at not knowing the price, and saving the drive time. Insurance was going to cover half, and even if the price was double the $500 we would still be ahead.

...out of pocket ended up being $1200...

Dan8267 says

So tell me, debyne, where exactly is the free market in this system? Where do I get to see the prices of goods and services? When do I get to negotiate these prices? This isn't a free market. It's not even a market.

You want a free market? Get single payer. With single payer, the prices are known ahead of time. Individual health care providers can charge whatever-the-fuck-they-want for a given service, but they cannot charge different people different amounts for the service, nor can they hide the costs of the service until after the service has been rendered.

Our system needs drastic reform, which is what I've said in multiple threads and offered suggestions of what solutions we need. I think Singapore seems like a good model to consider given they've created a market by requiring citizens to pay up to a deductible. That alone creates a market where providers have to compete on lower cost and quality. And, we absolutely must have the individual mandate for at a minimum catastrophic coverage. Anyone who doesn't believe that is delusional.

Regarding the payer side of the house, anything (gov't or private) that is a monopoly does NOT promote the elements of a free market...it does the exact opposite. That's why I'm glad we have antitrust laws...so we can keep a single power from setting prices themselves and screwing the consumer and not letting the market drive them, and so that entity doesn't become too slothful and non-innovative (like the govt). What motivation does the gov't have when they can just print or borrow more money? Keep the private sector actively involved but regulated.

John Bailo says

Interesting radio program that covers the Swedish health care system:

Klaus Bernpaintner - Hour 1 - A Swedish Lesson in Conformity & Control

http://www.redicecreations.com/radio/2013/10/RIR-131021.php

It's the exact same article and author as the mises article. Didn't you read the OP?

Why is it all the people advocating free market medicine can't ever come up with any working examples?

mell says

The problem is that most countries experience health-care inflation similar to the US and the systems eventually become unsustainable, independent of their system.

Examples?

bob2356 says

Why is it all the people advocating free market medicine can't ever come up with any working examples?

LASIK

bob2356 says

mell says

The problem is that most countries experience health-care inflation similar to the US and the systems eventually become unsustainable, independent of their system.

Examples?

France

mell says

But none of that invalidates the claim that Sweden is reaching its limits with its overall welfare and health-care system (if you look at taxes which in fairness also pay for a host of services for everyone rich or poor), no matter how you compare the US to it. Here is a balanced blog article about Sweden and some of its moves to allow more private competition:

http://fcw.com/blogs/lectern/2013/11/sweden-procurement-lessons.aspx

But that's impossible...how am I supposed to continue worshipping European healthcare if it has any sort of competition? The free market is evil and never works!

Interesting. I emailed the mises article to a friend working as a doctor in Sweden. I was surprised to get an almost immediate reply. He says that a) the article is bullshit pure and simple b) this guy Klaus Bernpaintner is actually pretty well known in Sweden as an anarchist (apparently he does a lot of letter to the editor stuff and writes for the anarchist web site) who's following is mostly among the neo nazi's and skinheads. The good news for Swedes is he's now living in the US.

debyne says

bob2356 says

Why is it all the people advocating free market medicine can't ever come up with any working examples?

LASIK

What country is LASIK, my atlas doesn't list it.

bob2356 says

debyne says

bob2356 says

Why is it all the people advocating free market medicine can't ever come up with any working examples?

LASIK

What country is LASIK, my atlas doesn't list it.

You said free market medicine, not country.

bob2356 says

Interesting. I emailed the mises article to a friend working as a doctor in Sweden. I was surprised to get an almost immediate reply. He says that a) the article is bullshit pure and simple b) this guy Klaus Bernpaintner is actually pretty well known in Sweden as an anarchist (apparently he does a lot of letter to the editor stuff and writes for the anarchist web site) who's following is mostly among the neo nazi's and skinheads. The good news for Swedes is he's now living in the US.

Uh huh

Cosmetic procedures?

debyne says

bob2356 says

mell says

The problem is that most countries experience health-care inflation similar to the US and the systems eventually become unsustainable, independent of their system.

Examples?

France

Do you have anything beyond the word France. like a good analysis why it's unsustainable? The recession hit hard in France causing a huge drop in revenues. Costs have been cut since the recession hit although there is still a deficit. With some more moderate reform the system will be fine.

Dan8267 says

There is no "free" market in the U.S. healthcare system. Fuck man, there isn't even a "market" in any sense of the word. A market is a meeting place where buyers and sellers negotiate prices. When was the last time you negotiate a price at a hospital?

Let me tell you how reality works.

Very well said!

I really think we could go a long way in improving our country's healthcare situation if we require all of the population to have high deductible plans with a Health Savings Account (subsidized for the poor)...this is similar to the Singapore model. This will naturally create a market because consumers will demand transparency from providers and you'll start to see more providers get away from a fee-for-service model...like Qliance does in Seattle where you just pay a monthly fee and have access whenever you want.

The pre-paid healthcare concept fosters abuse and overuse...leave it in the hands of the consumer to create a healthcare market and watch quality increase and prices drop.

bob2356 says

debyne says

bob2356 says

mell says

The problem is that most countries experience health-care inflation similar to the US and the systems eventually become unsustainable, independent of their system.

Examples?

France

Do you have anything beyond the word France. like a good analysis why it's unsustainable? The recession hit hard in France causing a huge drop in revenues. Costs have been cut since the recession hit although there is still a deficit. With some more moderate reform the system will be fine.

I posted an article in the healthcare section...go read it.

debyne says

You said free market medicine, not country.

A single elective procedure isn't exactly representative of the entire medical community. Consider the statement to be suitably modified to say a free market medical system.

bob2356 says

debyne says

You said free market medicine, not country.

A single elective procedure isn't exactly representative of the entire medical community. Consider the statement to be suitably modified to say a free market medical system.

Do you mean a pure, free market healthcare system, or do you mean a healthcare system with free market principles? Let me add by saying that a pure, free market healthcare system doesn't exist to my knowledge and I would never advocate it.

Singapore is the example I keep bringing up as a model we should seriously look at. It has elements of regulation and government, but also has very important elements of the free market.

debyne says

That's why I'm glad we have antitrust laws.

Anti-trust laws were murdered by Reagan. Yes, they still exist on the books, but they are not enforced. They are a joke. If anti-trust legislation were actually enforced, no bank could become too big to fail because that, by definition, is a violation of anti-trust laws. Such laws do not exist solely to keep competition, but also to
1. Ensure that no failure of a single or a few companies could bring down an industry or harm the economy as a whole.
2. Ensure that corporations do not have enough power to influence legislation or the running of government.

In other words, the status quo is very pro-trust.

debyne says

Regarding the payer side of the house, anything (gov't or private) that is a monopoly does NOT promote the elements of a free market.

Single payer is not in any way, shape, or form a monopoly. It is a centralized clearinghouse with transparent pricing. Single payer can literally be a god damn web service running on a couple of VMs in a cloud that has literally zero human interaction. It's fucking software.

Single payer DOES NOT:
- set prices
- force providers to provide specific services
- determine compensation
- take away choice from patients, doctors, or bunnies

Single payer DOES:
- handle the mechanics of the financial transactions
- provide a clear electronic paper trail
- allow for real-time and constant accounting and reporting including statistical reporting to the public
- streamline billing and collecting, thus reducing the cost of health care and the burden of administration from health care providers, particularly small businesses like individual practices
- ensure that prices are public and that no individual patient gets discriminatory pricing
- by doing so, enables a market to exist where none currently does
- as well as comparative shopping, thus reducing the cost of health care
- eliminates the primary need for "insurance", which is to prevent getting fucked on the bill. That purpose, by the way, is not even a function of insurance. Ironically, a person without insurance under single payer is far better off than a person with insurance but not under a single payer system. So great is the billing fraud.

There is no reform without single payer. There is no economic reason, even by hard-core capitalist porn standards, for not using single payer. Without single payer there is no possibility of a market. Without single payer, waste is rampant and accountability non-existent.

bob2356 says

mell says

The problem is that most countries experience health-care inflation similar to the US and the systems eventually become unsustainable, independent of their system.

Examples?

http://www.reforminghealthcare.eu/economist-report/challenges-facing-healthcare-systems/costs-and-financing

Cost is a general problem and the few countries who can manage costs successfully while providing/maintaining good quality care (e.g. Singapore ?) should definitely be looked closer at.

Dan8267 says

Single payer DOES NOT:

- set prices

- force providers to provide specific services

- determine compensation

- take away choice from patients, doctors, or bunnies

Of course a single payer can do all these things...that's how many of the socialized nations attempt to keep costs down. The payer has the money, and he who has the money makes the rules.

debyne says

Of course a single payer can do all these things...

Spoken like someone who doesn't know jack shit about what single payer is. Single payer isn't socialism.

Single payer is fucking PayPal for health care.

Read http://www.pnhp.org/facts/what-is-single-payer

Single-payer is a term used to describe a type of financing system.

It is not a means of taking over health care decisions.

John Bailo says

He says that Sweden gets by using implicit "death panels" in that for older patients with cancer, they simply put them on waiting lists until they die.

here, they put you on morphene to hospice you to death. whether you like it or not.

Dan8267 says

- set prices


- force providers to provide specific services


- determine compensation


- take away choice from patients, doctors, or bunnies

I love where you pull this article from. You're reading a website that's called "Physicians for a National Health Program"...think it's spun?

Better yet, here's an article from your same website called "The Pros and Cons of Single Payer Healthcare":
http://www.pnhp.org/news/2006/august/pros_and_cons_of_sin.php

I don't see any cons listed in this article at all LOL. You can't read something balanced on this website that's going to tell you the full truth...just half truths that you want to hear.

Look at single payer models around the world and what the pros and cons are, and don't read theoretical websites that spin fantasy.

debyne says

Due to a lack of profit motive, free services not only become bad but also very
expensive. One of the major banks (Swedbank) recently came out with a report
stating that the average earner pays about 70 percent tax of his income to the
government

That's not very nice - don't tell the truth when you're pretty sure it will hurt someone's feelings and expose a myth. We all know that free means free - oh, and if you like your healthcare insurance you can keep it - period.

Don't take away my unicorns and rainbows, the real world is too big and hard to deal with. The nerve of some people.

To the extent anything has gone systematicllay wrong in Swedish healthcare the last ten years, it is all caused by the wave of privatization generated by the conservative party that has been in power.

The same goes for the Swedish school system. Look it up.

Yeah, so Swedish healthcare was working just fine until the right wing loonies took over. That has caused some trouble that should now been reversed.

justme says

To the extent anything has gone systematicllay wrong in Swedish healthcare the last ten years, it is all caused by the wave of privatization generated by the conservative party that has been in power.

The same goes for the Swedish school system. Look it up.

Yeah, so Swedish healthcare was working just fine until the right wing loonies took over. That has caused some trouble that should now been reversed.

You've been blinded by performing too much Obamalingus.

mmmarvel says

That's not very nice - don't tell the truth when you're pretty sure it will hurt someone's feelings and expose a myth. We all know that free means free - oh, and if you like your healthcare insurance you can keep it - period.

Don't take away my unicorns and rainbows, the real world is too big and hard to deal with. The nerve of some people.

I know man. It's like trying to talk to a religious zealot who is just so brainwashed that you can't talk reason into them no matter how many facts you show them. They'll always come up with some unsubstantiated statement that just repeats their ideological platform like a broken record.

debyne says

I don't see any cons listed in this article at all LOL.

The con is that hospitals can't price rig or practice billing fraud anymore.

Dan8267 says

debyne says

I don't see any cons listed in this article at all LOL.

The con is that hospitals can't price rig or practice billing fraud anymore.

Those are cons? Boy, your website doesn't spin at all.

coriacci1 says

here, they put you on morphene to hospice you to death. whether you like it or not.

I call bullshit on that one.

No one is placed on "morphene" (it's morphine) and "hospice'd to death" whether they like it or not if they are able to say they don't want it. If the patient or family refuses hospice or there is no one to sign consents, the patient won't receive hospice.

Morphine (and its stronger counterpart medications) is a godsend when you are dying or are in pain. But people who are dying aren't just pumped full of medications. I had a patient (years ago) that preferred no medication. it was hard to watch, but it was his choice.

Hospice is a type of care that offers support at the end of ones life. Most of the time it works -unless the hospice is a crappy one, and there are some of those out there - the program doesn't hasten nor does it slow down the death process, but it makes people comfortable.

People on hospice can be a full code and even those with a DNR can choose to revoke it and go to the hospital for treatment.

Please speak about something of which you possess a little knowledge - comments like yours are dangerous. When a person is trying to find out about hospice, there are many unsolicited opinions that usually contain as much pertinent info as yours. I've seen people wait until their last few days to allow a hospice to provide care for them because of such stupidity.

By the way, hospices have been curtailed in their marketing practices, their practice of signing anyone on and billing the shit outta the government. Things have changed over the past 6 years.

elliemae says

I call bullshit on that one.

patient given morphene for “cancer pain” that was later found out to be constipation. 6months later patient asked for oxygyn for copd shortness of breath. was reffered to hospice. hospice nurses on 3 different occasions over 3 week period exclaimed " wow your lungs are really clear "!
3rd nurse discovers cause of “cancer pain” (constipation relieved, NO MORE PAIN!) Although he complained since he felt himself declining with all the morphene, patient encouraged to take as much morphene as he wanted for...sleeping, anxiety, shortness of breath, (liquid) cough (which he did not have before beginning hospice and “comfort” care.
of course elle you know what morphene does...causes constipation and decreases respiratory capacity. When asked for some other medication for cough the hospice answer was morphene is the best cough medicine. he drowned in his sleep 1 night later.

Sounds like a crappy hospice nurse.

Many medications cause constipation - and every hospice nurse, every visit, should ask when the last bowel movement was. If the pain is constipation, it should go away with a good bm. If it is due to a bowel obstruction and the patient is very end-stage, it's possible the only thing that can be done (short of surgery, which is out of the question) is to medicate for pain and allow the patient to die a more comfortable death.

A patient with COPD who is asking for oxygen might be surprised to find that oxygen is often not helpful. He can get all of the oxygen he wants, his body can't use it. Oxygen can actually be detrimental to a patient in late stages of COPD.

Morphine doesn't decrease respiratory capacity, it suppresses respirations. There is a difference.

So far as the patient "drowning" in his sleep one day later, not enough info. Morphine would not have caused the patient's lungs to fill with fluid, there was a disease process (as you mentioned).

I helped to open a small hospice 12 years ago in a very small town - the company provided hospice in several different sites and had the capacity to train its staff. But it did not do so, and after we opened the nurse overmedicated a patient (the doctors trust that nurses are reporting accurately and the rest of the team helps to paint a picture of the patient's condition). But I digress - she slapped a fentanyl patch on a patient who previously had only taken lortab sparingly. The patient was stoned as hell. The hospice did not provide any training or oversight to the nurse and she nearly killed a few people. Yes, they were terminal, but that doesn't mean you treat them as if they're gone already.

Like I said, you didn't provide clinical info - but it certainly doesn't sound like the patient received the best of care. However, from what you said, it sounds like his disease killed him, not the morphine. You don't "drown" in your own fluids from the administration of - or lack of administration of - morphine.