patrick.net

>>Believe me, the private sector is capable of fucking up healthcare all by itself. Big amen to that

Tenpoundbass: >>SO then just let the Government take over general medicine, and the specialists and elective medical doctors, could stay private. This is the usual governing principle of the US: Load the government down with the unprofitable stuff, and leave the profits to private industry.

justme says

>>Believe me, the private sector is capable of fucking up healthcare all by itself. Big amen to that

I would beleive that when the private sector had more control, they were doing a much better job at running things. When I was growing up seeing a doctor was never a problem. Also doctors could use their judgment and experience when it came to treating people. Now the entire industry is ran by insurance companies and the government. Although it may not be obvious when you see a doctor these days the chances are your treatment is almost solely based on what the insurance company and Medicare thinks they should cover vs the doctor. Also should be illegal for drug companies to bribe doctors with gifts to push their drugs and treatments. Call me selfish, but I do not think it is fair for me to have to lower my ability to get treated while having to pay for other peoples treatments at the same time. I think there are a lot of problems, but I think most of them are the result of doctors lack of power and not them having too much power. I feel that we as a society have already taken too much power away from the people who are treating us and have given that power uninvolved parties whose only interest in our treatment is the cost.

Some Guy says

d3 says

justme says

>>Believe me, the private sector is capable of fucking up healthcare all by itself. Big amen to that

I would however argue that when the private sector had more control, they were doing a let better job at running things. When I was growing up seeing a doctor was never a problem. Also doctors could use their judgment and experience when it came to treating people. Now the entire industry is ran by insurance companies and the government. Although it may not be obvious when you see a doctor these days the chances are your treatment is almost solely based on what the insurance company and Medicare thinks they should cover vs the doctor. Also should be illegal for drug companies to bribe doctors with gifts to push their drugs and treatments. Call me selfish, but I do not think it is fair for me to have to lower my ability to get treated while having to pay for other peoples treatments at the same time. I think there are a lot of problems, but I think most of them are the result of doctors lack of power and not them having too much power. I feel that we as a society have already taken too much power away from the people who are treating us and have given that power uninvolved parties whose only interest in our treatment is the cost.

Still don’t understand what you’re talking about. What do you mean, “When the private sector had more control”? The private sector has ABSOLUTE control over your health care. The government is not the one deciding which treatments get paid for and which don’t. Those decisions are made by PRIVATE insurance companies. You continue to conflate private insurance companies with Medicare. Either explain how the existence of Medicare causes the government to exert influence over private insurance companies, or shut up about it. Because it doesn’t. You are talking out of your ass. What has changed since you were growing up is not government control, but the increasing greed and penny pinching of insurance companies.

Ok, maybe I should have said doctors. They have almost no control. The government and the insurance companies over the last 15 years essentially took away there ability to make profit or choices regarding treatment. Are people too dumb to understand that when Medicare or the insurance companies treat you, the doctor currently to base a lot of their treatment on what Medicare and the insurance companies allow and not what may be medically in best interest in the patient. When most people see a doctor, his bill is essentially meaningless. No matter how much his services should be worth he will only be able to collect a set amount. Sometimes this works out ok most of the time it does not. The doctors to control their practice or make a profit has become so bad, most primary care doctors have quite the field. The US is now having to get doctors to come from overseas because most US doctors are no longer willing to deal with the system that we have allowed both the insurance companies and the government put in place. Read the articles I linked above. The problem is, this is not stuff that is known to the average person. Doctors have very little lobbying power as do the insurance giants, pharmaceutical ect.. Basically doctors are left begging for scraps when it comes to re-imbursements. People do not want to accept this fact because all they care about is having everything handed to them and only beleive what TV tell them too. The problem is people want cheap treatment not good treatment and by allowing the goverment to take over that is what I fear we will get.

Yes private insurance and government run programs are different, but they are both doing the same thing to ruin the system

Tenpoundbass, I don't have much quibble with most of what you said. My main point was that a split health care system where government hospitals does the easy stuff and private hospitals do the advanced and more profitable stuff is not a good split. If you think about, you can probably see a dozen reasons why this will not work well in practice. All doctors should do both trite stuff and more "advanced" stuff, but to some degree a division of labor amongst doctors will naturally occur, determined by the internal competition for specialist jobs and a status hierarchy within the profession, much like it is now.

d3, I can't help but think that you have a bit of a split personality on the whole medical costs thing. One one hand, you say doctors are begging for reimbursement scraps, but on the other hand they are somehow supposed to end up charging you less scraps if only they did not have to beg and could set the price themselves. I think the logic is not sound.

Unfortunately you either end up having low cost, but having to commit to a volume up front, or high cost print-on-demand. If you've had bad results with Cafepress, I've heard good things about Spreadshirt.

The following chart will give you a good indicator of why median prices will likely see a temporary rise as the correction continues: http://www.housingbubblebust.com/OFHEO/Major/NorCal.html It comes down to lag. The lower end and outlying markets like Stockton, Tracy, Vallejo, etc. have all corrected much faster. So, as per the chart, they are reaching stability. Now the mid to higher end is beginning its decline but with the low end transactions essentially oscillating around a stability level from this point forward, the mid and higher end homes will become the majority transactions. So from the standpoint of the median, the value of the median home price will increase as the mid to high end deline and the low end stays roughtly flat. At some point, we will reach a turnover point where the mid to high end will become the majority transactions and then the median will begin to fall again until all areas have reached trend. From there, the median will likely fluctuate for several years as final excesses are worked out. And from there, we will begin to slowly move up again, but at more normal fundamental rates.

I actually don't think most doctors should be completely in charge of it, especially when they get paid for procedures. I know way too many cancer patients used as lab rats that ran up million dollar medical bills, having procedures done that were unnecessary and dangerous that made their lives shorter and more painful... The entire medical field has been perverted by profit and greed.

Some Guy says

d3, yes I agree with what you’re saying now. Bureaucrats should not be deciding what medical treatment people need; doctors should be deciding that. I guess where we disagree is that I don’t believe just leaving it in the hands of private insurance companies is going to solve anything. I think they are the PROBLEM, not the solution.

I don't think we should leave it in the hands of private insurance companies either. Personally I think the doctor should decide what he is going to charge for his treatments. If he is trying to charge to much and the insurance company has a problem with that, they should take him out of their list of covered doctors. My gut tells me that unless a doctor is too good to need to accept insurance he will work with the insurance companies to come up with reasonable rates. These will lead to higher primary prices, but I believe at the same time it will lower emergency room costs because it will overtime increase the number of primary care doctors. Part of the current problem of having set prices used by Medicare and insurance companies is that it is not always equitable and unless both them and the government are will to accept that the cost of service is dependent on both physical location of service and quality of service they cannot be equitable. The way the system currently works though, I do not see the government as being willing to properly differentiate what the salary of a talented doctor in NYC vs a Novice in Las Cruses NM. Unless that can fairly happen you cannot have equity for doctors and there will be a shortage of talented primary care providers. My whole premise is that I fear we are slowly heading this way and that government involvement will most likely make the problem worse. Also I fear that if we over standardize medicine the US is going to lose out on their current ability for coming up with medical breakthroughs because doctors will be more likely become required to give specific treatments verses doing what they think will work best. Am I the only one who worries about handing my health choices over to the government or any other entity that does not have a strong medical background?

Tude says

I actually don’t think most doctors should be completely in charge of it, especially when they get paid for procedures. I know way too many cancer patients used as lab rats that ran up million dollar medical bills, having procedures done that were unnecessary and dangerous that made their lives shorter and more painful… The entire medical field has been perverted by profit and greed.

I think most of the greed comes from insurance companies and not the doctors. People on here seem to believe that all doctors are making a lot of money and are taking of us. I believe this is true in some medical fields, but in regards to family and non-specialized medicines we are taking advantage of the doctors

What's wrong wiith the Obama plan of having a government alternative insurer? Seems pretty good to me. Not dictating anything, just providing an alternative, and a guarantee you are eligible for it. If you like private insurance, you can buy it. Taxes may go up, but premiums go away. And taxes may not even have to go up if we can manage to reduce spending to other countries with good health care. We spend twice what they do for no better health.

Summing all my thoughts together: I believe the biggest problem with the industry is that primary care doctors leaving the field because the government and insurance companies have made it too unprofitable for doctors to want to continue their practice and to open new ones. Because of the shortage of primary care doctors in many cities you have to wait a few days to see a doctor. People who cannot or do not want to wait a few days to see a doctor are often left with having to admitted in to the emergency room which costs a lot more money. Simple procedures that a doctor would charge $200 are now costing $1000's of dollars because of all of the added administrative overhead created by an emergency room visit. By allowing the government to control medical care more people will probably switch from health using health insurance to government insurance. Unless the government can accept the fact that being a primary health care providers need to become more profitable for the doctors, even more doctors will leave the field. For this reason I do not see how overly socializing medicine will fix the system. Although I am far from an expert, I would rather see the following occur. Allowing primary healthcare providers to charge more money for there service so they could get the doctors needed to open more offices and for longer hours. This way if someone gets sick, they can see a doctor and not have to go to an emergency room. Also if a doctor worked hard to finish the top of his class at John Hopkins he should be able to make his hard work worth it by being able to get a greater compensation for his services. I think that is fair. Maybe insurance companies should categorize doctors based on their average rates and then force patients to pay a certain % of the extra cost if the patient opts to go to a more expensive practice for treatment. In regards to paying for people without coverage, it is currently being done in some fashion. If you are really sick the hospital will admit you and cover their loses by charging more money to the other patiants. This is where I think the government can step in.. For emergency room visits, I do not have an issue with the government subsidizing the cost based on your income. If you are uninsured then the government should step in to subsidize of the cost of emergency procedures and preventative care based upon your net income. We are already paying for this through higher medical bills for those who are covering the cost their bills. We would essentially be rolling the medical premiums we pay to cover uninsured people to our taxes. In the end we should be paying about the same overall but things would hopefully become more transparent and manageable because hospitals would no longer need to cover there loses by charging more money to people who have insurance. I know that I am way out of my league with this stuff and Maybe my idea crazy, but it is what I think would make more sense...

OO said the physical therapy rehab facility are always keeping the seniors for the max time Medicare allows. I have never seen one senior getting discharged after 3 days even though the injury is minor. There is so many Medicare abuses that this is not even funny.

Actually, that's not true. I work in a SNF and we regularly discharge patients when they're done with their therapy, whether thats a few days or a few months. The facility has to justify the amount of therapy provided to every patient and if the patient doesn't need the service, they go home. Are there abuses? Absolutely - I worked in a facility that was absolutely horrible and ended up leaving due to the abuses, but I reported it first. But there are facilities that are run ethically and morally. In fact, I'd say that more are ethical than not. Right now our healthcare system is run by for-profit companies whose job it is to keep costs down so that they can make money hand over fist - this includes denying procedures that, had they been done they would have prevented further surgeries. The govt helps to set prices, but private insurance companies do their own setting of prices too. Other countries have shown that the govt can get involved and it can be beneficial.

Hey, Nomo. Where ya been? And what's with interjecting reality into this conversation?

The main stream media is a waste on all fronts. All they do is copy and paste whatever the PR firms spit out. Ask yourself the last time you saw a news reporter who was educated on a subject well enough to even ask a single pertinant question. They are too stupid to even realize that these month to month improvements happen every summer. Then everyone will put their heads in the sand when the weather cools and people slow down on buying.

Just because I am not a fan of government running things does not imply I want insurance companies running things either. If I some how implied that, it was not my intent. I believe that neither the insurance company or the government should be in charge of treatment or be able to manipulate prices for their own benefit. Most of my dislike of the current system is based on the fact that by taking power away from doctors, patient care is now being determined by non-doctors whos only interest is in saving money and not lives. This is a problem with both private insurance and government controlled programs. I beleived that healthcare worked much better in the us before it was taken over by the insurance programs and other external entities. If any one is to be more regulated it should be the insurance companies. Currently they have a lot of lobbying power and have almost complete control over most of the primary care practices. A lot of doctors currently feal trapped. Also I beleive another problem with the current system is that we allow US citizens pay for almost all of the medical research. When drugs are introduced to the market most contries have price controls on drugs that US companies feal obligated to follow which has lead to much higher pricers for drugs purchased in the US. I feel research costs should be shared by all who use the drugs. If a country does not want it's people to pay the extra cost, we should not sell them the drugs. This however is an entirely different issue...

This is my first forum (and only, to date). I feel your pain on the arguing, there's an awful lot of polarized name calling (lib v conservative) and that sucks. But there are some nice people with stuff to say. And we're working on the nursing home forum - patrick has set it up so that anyone can post a comment, good or bad, uncensored about every nursing home in the country. We're posting articles and and grades, so that people can make informed decisions. We have a ways to go but it's coming along nicely. This, and old "friends" are why I stick around. But I do have an actual life too. :)

Here in Canada the media was wild crazy telling us all that we avoided the real estate drop. Now after sales and prices are down they are calling June record month and a "recovery". Wait a minute ... if we avoided the carnage what are we recovering from? June is the best month for real estate sales. June being up a few points from May is a totally meanlingless stat. The fact that its only up 2-3% shows the truth. Only a 2-3% increase in sales for the busiest month? Yikes! Yet Realtors are quick to run to the copy machines and hand out flyers to all stating "Real Estate up in JUNE!" Its up every June. Just like retail sales are up every December. What happened to news? Its just quacking ducks now parroting whatever trash they are handed. Of course you can trace every "news" outlet to the same few parent companies. Just who is buying anyway? The same people who already went into foreclosure? We will see more foreclosures and stupid loans hit the fan next year as the only people who think housing is a bargain right now are total idiots. Markinga product up 300% adn then taking 20% off is no bargain. These sideline morons who think its finally their chance will be the next round of writeoffs and bailout candidates. I stick to one rule - if the average income cannot afford the average house - then only one thing can happen - prices must go down. Of curse there are those who believe rich foriegners will buy us up. Those are people are also morons and obviously do not travel. America is not at all appealing to most other countries citizens anymore. We get the worst immigrants that other countries do not want. One walk down any street shows. America is a dumping ground without identity. Its over.

I am one of those who believe in the historic co-relation between household incomes and home prices. I have been watching with unconcealed glee as prices crashed and even managed to snag an REO in Texas in 2008. I now notice that Zestimates are starting to go up on ALL the properties that I have in my Zillow favorites. It would suggest to me that we have reached the bottom in housing! I am now scrambling to snag another property before the home prices start back up on their upward curve!!

mikey says

I think Sarah was being facetious with that VP comment. Everyone knows that the veep is second banana but that job doesn’t exactly have a bunch of appeal. Some swingers around here seem to consider her the gorilla their dreams and I’m sure they wouldn’t mind monkeying with her tail if the time was ripe. Well, at least this Chiquita isn’t on the Dole and doesn’t act like a fruit.

I wasn't talking about the "could somebody even tell me" thing, which seemed to be a joke -- I was talking about the "they're in charge of the US senate" comment. Tenpoundbass says

Those You Betcha’s and the word grasping as she reaffirms “in this “Great country of ours… Uh that is America” is a tell that she is soul searching by the seat of her pants for the next words to say, as she reads her audience

She doesn't pause that often or even say "uh" that much -- she just stumbles through sentences that a 12 year old could manage without sounding like a total buffoon. Beyond that, she's a creationist and believes that "the public" should "debate" science. Because, don'tcha know, if people don't believe something to be a fact, it isn't a fact!

How do I get some of those tits benefits at my job?

Some Guy says

I’m tired of it too, but you’re still nitpicking. The utopian concept of communism where the means of production is owned by the people doesn’t exist, and never has. There has never been a true communist country under that definition. So to nitpick about that distinction seems quite meaningless, wouldn’t you say?

No. Communism and socialism are simply not the same thing, or degrees of the same thing. Just because there has never been a (large) communist society does not mean that communism and socialism are the same thing, or that it's OK to equate them as being similar. Socialism has a lot more in common with capitalism than it does with communism, as both are systems assume benevolence on the part of those with "power", but inevitably lead to power hording and controlling the lives of individuals. Some Guy says

That’s nice, except I did no such thing. You read ALL of that into my post. All I did was type the word “communist” and everybody freaked out. Please, please, please, quote where I equated Keynesian economics with socialism, or said anything about failures of socialism.

Why do you assume that all of my comments were directed at you? Some Guy says

A government owned and operated health care system, with hospitals owned by the government and doctors as government employees is not “Keynesian economics” by the way. That is in fact socialism. That ASPECT of the government would be a socialist one. To say, “It’s not socialism because other things are not owned by the government” doesn’t cut it. You can have various socialist elements without it being necessary to say an entire society is socialist.

Of course -- though nobody is seriously considering that type of medical system. The most extreme proposals are for single payer, which is also not socialism. By reasons for "nitpicking", as you say, is that the distortion of this issue is astounding. Instead of having serious debate on the issue of how to fund health care, we keep seeing discussion about fully government owned and operated medical systems as though that was what people were going for (and automatically dismissing that policy by equating it with the failed socialist system of the USSR). That's why I say that people who are intelligent and actually understand the issues need to stop throwing around terms like "socialism" and "communism" (as well as "free market", for that matter) where they're inaccurate or just plain wrong. It's intellectual dishonestly. Do you want people to agree with something because they've been presented with the facts and made a rational decision, or do you want people to agree with something because it has been mischaracterized and presented as something with an inherent negative bias?

angrish says

ctually, understanding the math, as the market continues to contract, the median price will actually move UP, not down. Weird huh. The problem is the word “median”. If 10000 houses sold last year for 200K, the median is 200K. If one house this year sells for 220K, the median is 220k, a 10% rise in prices.

That's not how math works. The median is the point where half of all values are above and half are below. In your scenario, the median is still $200k. There are some systems of calculation that exclude duplicate values, but those are only for very specialized equations and certainly aren't used for house prices. You can't change a median by moving values at the edges. The point still holds for the most part, but please get the math right. A better example would be this: - In year 1, 1000 houses sell for $500k -- the upper end of the market has completely disappeared. Median == $500k. - In year 2, 1000 houses sell for $300k, and 1000 houses sell for $800k. Median == $550k For the people who are in the 'lower' tier of home buyers, it looks disheartening. House prices are up! But the reality is that, for them, house prices are actually down by over 40%. This is exactly what will start to happen as prices on high end homes start to fall and sales pick up.

Kevin, You may have misread angrish's post. My interpretation is: 2008 - 10000 houses sell for $200k, so 2008 median is $200k 2009 - 1 house sells for $220k, so 2009 median is $220k Newspapers then report median increase in 2009 over 2008 Your example is technically correct (since when two numbers bracket the median, you can take the average of the two numbers as the "median"), but is a better example of a mean than a median.

I, for one, am glad that Kevin takes the time to debunk some of the distortions and propaganda that is being thrown around to scare people away from healthcare reform. Thanks, Kevin.

I see lots an lots of cognitive dissonance in this thread. People cannot quite decide whether the villain is private enterprises, or government, or sometimes BOTH at the same time. What does that make such a person, some kind of nihilist or anarchist? I have a theory as to why this is occurring: People who normally were adamantly against government involvement in anything (having been bottle-fed anti-government propaganda since they were young enough to flick on a TV) now have seen lots of evidence (bubbles, financial crises, bailouts, losses, unemployment and general mayhem, ) that private enterprise and "free" markets have lots of imperfections. But at the same time, the just KNOW that regulation and government is ALWAYS evil and awful. So then where do they go? People are literally kicking left and right, and somehow trying to reconcile their world view with the facts "on the ground" to use another trite phrase. It would be amusing if it was not so sad. The solution to most problems of society is that BOTH government AND private enterprise/free markets must be regulated to keep them honest. If we could agree on that, we would at least have a starting point.

The people regulates the government through elections. That is at least the way it is supposed to work. Instead we have corporations regulating the government through monetary donations.

The semantics of semantics. Drfelle exclaimed: >> Semantics! A few weeks ago, Elliemae said (and it stuck in my head) >> Nah, they’re busy slinging names, blaming it on the libs and delving into semantics. At the time. I did not understand what she meant by the expression "delving into semantics." You could say, I did not understand the semantics (==meaning) of the expression. Now I think I do. But it bothers me. The implication is that "semantics", or understanding the meaning or definition of words and concepts, is somehow a contemptible game. Well, it only is if you make it so. I think we should not accuse someone of "semantics" when we are really accusing them of "playing a semantic *game*" of distorting the meaning of a concept. And please, no meta-semantic games about semantics now....

SomeGuy, Haha, don't you understand that you need to be a mind-reader, and the correct answer is either "Tuscan" or "Local". As in: You: Do you want to go for some Local? GF: Uh, which one? You: ???? Or alternatively, you could play some semantic games with her: You: Do you want to go for some local? GF: Excellent idea! You: Ok, let's go to the Mexican one down the street GF: ????

>> and spend less time posting on Patrick.net; maybe then you’ll be able to afford health coverage. Look who's talking. It's always the right-wingers who wants *everyone else* to get off their fat lazy asses. 1/2 :-)

Some Guy, >>So my question is: What else ya got? You're a relative newbie, so you just walked right into that one :-) :-) Do a search on "election system" right here on patrick.net for the answer(*) In short: The problem is that our dysfunctional 2-party duopoly system is caused by our equally dysfunctional election system, which in practise permits only 2 parties to win elections, and hence no free market in political representation. We need to regulate the elections system to get a properly functioning democratic process. (*) Actually, Patrick, it seems that the Google search does not find all older post, or am I mistaken?

>> *chuckle* Me too. That was a classic. It's not a solution unless drfelle says so,

Some Guy says

Teddybearneil says

I am one of those who believe in the historic co-relation between household incomes and home prices. I have been watching with unconcealed glee as prices crashed and even managed to snag an REO in Texas in 2008. I now notice that Zestimates are starting to go up on ALL the properties that I have in my Zillow favorites. It would suggest to me that we have reached the bottom in housing! I am now scrambling to snag another property before the home prices start back up on their upward curve!!

Oooh, Zestimates. Yeah, those are really accurate…

I mean I would love for the home prices to crash further so that I can snag another property for pennies on the dollar..but thanks to the re-flation policies of the Fed/Treasury, it appears that a combination of low interest rates, plenty of loans being originated with only 3% down payment, banks NOT foreclosing on properties and the existing inventory of foreclosed properties pretty much cleared out, I don't see how and when prices will come down further. A bottom with a bounce as another wag suggested, is a possibility, but I am not betting on it. I am definitely going to buy a home if it gives me a monthly positive cash flow by renting it out!!

Patrick, Here's an example of a search term not found: I did a search on "Duverger", and it came up empty. But here's a post that contains the word: http://patrick.net/?p=548#comment-622769 Am I doing something wrong here?

SomeGuy, yes, I was being sarcastic/humorous, partly at my own expense. Humor alert: I think I know your girlfriend, too Or could there be more than one of them? Still more humor: >>Hint: Your sentence should start with “The solution is…”, as opposed to “The problem is…” Are we suddenly playing the game show Jeopardy now, where you do not get points unless you formulate the answer as a question. Jeepers.

>> I have health care….that I pay for….that I don’t bitch about. And therefore, if someone else does not, it must be their own fault?

That's a lot of if-if-if qualifiers there, Doctor Nixon ...

justme says

Well, it only is if you make it so. I think we should not accuse someone of “semantics” when we are really accusing them of “playing a semantic *game*” of distorting the meaning of a concept.

That's exactly my point when I complain about use of terms like "socialism" and "communism". There is a MASSIVE difference between a single-payer "insurance" system and what you might get out of a "socialist" system. When you start throwing around these terms, you're distorting the actual discussion about what is best for our country by bringing fear to the table. If you tell Joe six pack that a single payer system is communism, he's going to automatically reject it, without actually investigating what is being proposed and how it would work. There have been numerous studies that show that people are open to just about anything if you phrase it a certain way. Politicians know this all too well, and people like Karl Rove have made their entire careers on influencing opinion through selective language. drfelle says

If they’re paying for cable TV and INTERNET, eating out, paying for a mortgage they can’t afford, wearing designer clothing, buying Plasma’s/Blu-Rays, having kids out of wed-lock, financing a car, etc, etc, Then YES!

So your basic argument is that it's OK to overpay for health care because there is still a lot to sacrifice? Perhaps we should all live like serfs so that we can afford to pay the insurance companies whatever they ask? That's not a solution. A "solution" means coming up with the best way to reduce the crushing cost of health care on society as a whole. Health care costs have been growing at a rate more than double the general cost of living. That is not sustainable.