Posts Tagged “healthcare”

Sometimes I think so.  It can’t be true though.  IQs are going up (Flynn Effect).  I do think people are uniformed, but certainly people have always been uninformed.  With the Internet providing more information that we can ever possibly wade though, and college attendance at an all time high, there is no excuse for being uniformed…moreso I believe that since all that information wasn’t even available in the past that people are actually more informed now that ever.

So…people are smarter and more informed than ever.  Why are they such idiots?

Hmm….well, maybe they are informed, but informed of the wrong information (which makes them seem dumb)?  That is a hard hypothesis for me to get my head around since if I were also misinformed then me commenting on other people’s misinformedness would be making the problem worse.

I know people are misinformed (including myself); however I know that; so not being an idiot might simply be knowing that you don’t know.  A healthy skepticism (even of yourself) is not exactly inspiring, but it is a useful bullshit detector.

I think people are apathetic.  They may be relatively well informed and intelligent; they just don’t give a fuck.  Republicans or Democrats?  Why does it matter since they both pander, lie, and misrepresent?  Fox or MSNBC?  Doesn’t matter.  They both spin. 

You just give up maybe.  After all, you still have to get out of bed in the morning…focus on what you can control.

Anyway, my bullshit detector is stuck permanently on, so here you go:

Health Care:

Lots of debate these days about this. 

Spin: “National Health Insurance will ration my care.  There will be long lines.  I’ll die on a government list waiting for my surgery.” 

Fact:  Yes.  Your health care will be rationed.  HOWEVER, IT IS ALREADY RATIONED….by money.  The rationing goes like this:  If you have money, you get care.  If you don’t have money, you don’t die on a government list waiting for treatment, you die at home unable to even see a doctor.

Why must health care be rationed?  You can’t provide unlimited use of something and expect that it won’t eventually consume all resources.  Everything is rationed in some way; most things are rationed by money (others by law, etc).

So does that mean you will not receive some services that you want, or if you do, then you may have to wait?  Yes.  That is what it means; however, bear in mind that this is ALREADY the case.  Public health care just changes the means of rationing.  Besides, as shown below with life expectancy, rationing doesn’t seem to change health outcomes.

Why not let money continue to ration?  I guess that is fine, except that our current course is unsustainable (costs too much), and what happens when you don’t have the money/lose your insurance (Medical bills prompt more than 60 percent of U.S. bankruptcies.)?  Are you willing to risk that?  US insurance is tied to jobs, and people change jobs a lot more than they used to…you will get caught in between at some point and find out that private health insurance is unaffordable (the same private insurance industry that says there is no need for reform). 

Spin:  We have the best health care in the world.

Fact:  People with money have the best health care money can buy.   On average we do not have the best health care in the world. 

In fact, we are 50th in the world in life expectancy.  Most/All the countries in front of us have some sort of government supported health care and so must also ration care in some form.  Despite that (or perhaps because of it), they are in better health than us.  Additionally, Cuba is 55th…with a life expectancy pretty much the same as ours (78 years).

Why is life expectancy an important metric?  Easy:  Shouldn’t all health care improve health?  Isn’t the ultimate reason for being healthy to stay alive?  You can argue about quality; however, quantity (life expectancy) is a good overall measure, and we are losing to other countries with socialized medicine.

Spin:  The Free Market will save us.  The answer to all economic questions is capitalism.

Fact:  I can’t even begin to tell you how fed up I am with the free market religion. 

Let’s talk about the free market incentives for the health care gatekeepers:  Insurance companies.  Ultimately, whether you get health care or not (at least in the US) is about whether or not you have insurance.  Try paying cash.  You’ll go bankrupt.  (The reason for this is beyond the scope of this article.)

Here is how the free market is supposed to work (I’m self-selecting an example that shows free market incentives in a positive light):  Mitsushiba (or any company) makes a TV.  It is the best TV, but it is expensive.  You don’t even really need a TV though; it is elective.  You can do without.  Still, Mitsushita is proud to offer an awesome TV at a good price, and they make a profit.  They make the profit by selling you what you want (the ability to watch TV) for a price you are willing to accept (after all, there are other TVs and in the end you didn’t HAVE to buy a TV at all). 

Now let’s examine the incentives of the health insurance industry:  HealthCon (or any company) sells health insurance.  It is expensive, and you HAVE to buy it (unlike a TV).  There are a few other alternatives (a handful of major players nationally), but their prices are all similar (expensive), so it doesn’t much matter which one you go with.  They make a profit as well, but not by providing you with the service you want (health care) in exchange for the money you provide.  They make a profit ONLY if they deny you the service you have paid for.  Let me repeat that:  Health insurance companies only make a profit if they don’t provide health care (the very thing they are supposed to be in business for).

In short, to argue that the free market can save health care is simply….misinformed.

Spin:  We need a limited public health option, if any.  Any public option that competes openly with the private health insurance industry will eventually lead to nationalized medicine.  (I’ve heard this poppycock many times as an argument against the public option.)

Fact:  Left unencumbered, the public option would indeed compete with private health insurance.  Why is that an issue?  Isn’t competition good?  The only scenario under which a public option competing with private health insurance would lead to nationalized medicine is if private health insurance couldn’t compete (ie.  people CHOOSE to go with the public option because it was cheaper or better). 

By arguing for a restricted public option, private insurers are basically saying “We couldn’t compete with an open public option.  It would drive us out of business.  We couldn’t make a profit.”  Really?  I thought anything government-run was inefficient and wasteful and private industry would always beat it.  I guess big business is all for competition, as long as it doesn’t compete with them.

Also, there is no competition presently.  Health insurance is an oligopoly…not much different in effect than an monopoly.

Spin:  Governments are inefficient.  They make a mess of any market they enter.  Private industry is superior.

Fact:  Let’s go one by one:  “Governments are inefficient.”  I agree they often are in practice, but that needn’t always be the case.  If you look at admin costs as a percentage of health care expenditures for other countries; theirs comes in below the US’s private industry number.  Also, it is a little two-faced for the health care industry to argue that governments are inefficent; private industry’s inefficiency (bulging costs) is how we got in this mess in the first place. 

“Government makes a mess of any market they enter”:  Again, no.  Think of the FLSA (Fair Labor Standards Act).  People (of any age) worked all day long in terrible conditions before the government stepped in to regulate.  Governments do make messes…..but so does private industry (think financial meltdown); again, it is two-faced to say governments mess up markets when the private industry also messes up markets even without government intervention…..which then requires large government bailouts on the taxpayer dollar.

“Private industry is superior”:  Taking my two examples above of  TVs and Health Insurance, Private industry is good at providing TVs (when that set of incentives is in place), but bad at providing healthcare (the incentives are wrong).

Spin:  Public health care costs too much.

Fact: Uhh…

health_care_costs

Public health care will cost too much?  Seriously, it ALREADY costs too much.  That’s why we’re having this conversation in the first place.  If that isn’t the pot calling the kettle black.

We already pay for it; we just don’t get anything out.  If you mean public health care as it is in European countries, then it will cost LESS than it currently does.  The reason we will never see that is that any system we put in place now will have to pander to the current system, so we’ll end up with some messy compromise. 

Alternative Energy:

Alternative energy is important.  Oil is not sustainable (nor are humans).  We must make changes; however, some I think aren’t so well thought out.

Spin:  Biofuels are the future!

Fact:  If you mean turning corn, grass, or basically anything organically grown into fuel….its a terrible idea.  Food prices will rise worldwide as that land is used to produce fuel instead of food.  Those billions of people worldwide who barely have enough to eat care far more about corn or rice than they do about whether we can drive our Priuses around using biofuels.  You can’t eat a Prius.  You can quote me on that.

Spin:  Batteries dude!  

Fact:  Batteries are not power, they store of power.  I’m not arguing against more efficient batteries; I’m just saying batteries are not a substitute for oil….they are a complement.  Oil produces electicity, which is stored in batteries. 

To that end, oil itself can be thought of as a battery.  It is storing power in the form of hydrocarbon bonds that we release to do work (eg. make energy, run cars, etc).

The difference is that nature, in the form of oil, has already gathered the energy, already stored it in a fairly stable form.  In the case of batteries, we still need to provide the energy as input. 

Again, batteries are not an alternative energy; they are an alternative store of energy.

Myth:  Solar energy is the future!  Nuclear power is the future!

Fact:  Solar energy is the future!  All life on earth is powered directly by the sun (plants) or indirectly by consuming things that are powered by the sun.  Nuclear energy is the future!  If all things on earth are powered by the sun…..what is the sun powered by?  Nuclear energy. 

Bottom Line, we should take note:  Nature has a way of pointing out the most efficient mechanisms for things (except the wheel….how did it not invent the wheel?).

The Cost of Doing Nothing:

Spin:  “It would’ve been worse if we had done nothing.”  “We must act now; the cost of doing nothing is too great.”

Fact:  I hear this all the time in the media, in politics, in business.  Is the cost of doing nothing greater than the cost of acting now?  The answer is easy:  Impossible to say.  Untenable.

We hear the cost of doing nothing argument currently about health care; we also heard it with the financial crisis.

People use the phrase as a way to promote expediency.  “We must act now…or else!”  Or else what?

The suggestion (or whatever we must act now on) may or may not have merit, but often it is simply impossible to prove what would’ve happened otherwise.  What was the true opportunity cost that decision?  We don’t know in most cases.  You can search for analogies in the real world to try and see, but it is easy to argue those away.

In the end, the “cost of doing nothing” argument is a complete waste of breath.  It doesn’t signify anything.  It is unsupportable and does not promote dialogue.  If you must do something then the merits stand on their own, not as an alternative to “or else”.

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It doesn’t get any plainer that this:

There will be a lot of political talk coming up about “changes” in healthcare…to deal with the cost, with the un-insured…about the mandate the election provided for change. I talked about the investment the healthcare industry has in maintaining the status quo here.

No matter what they say do not be fooled that some incremental change will make a difference.  US Healthcare costs are so far out of whack that only structural change will make a difference.

Also, understand what the chart is saying and think about what the end result of healthcare is supposed to be:  A longer life.  You can argue that quality is also important; however, quantity is a good surrogate, as all healthcare improvements should conceivably lengthen life some bit.  Obviously we fail.

The chart is saying:  We pay twice as much as everyone else, and are pretty much LAST in lifespan among developed first-world countries.  We pay the most and get the least.

The opponents of a change in healthcare will make two main points:

1)  The quality of care will be worse under nationalized healthcare:  Really?  Then how do all the countries ahead of us live longer and spend less?  They will say you will have less choice and wait in long lines to get care.  Maybe or maybe not, but that obviously isn’t affecting the life span in those countries ahead of us.  They may (or may not) stand in a line….but it isn’t shortening their life any.

2)  Nationalized care (or basically any change proposed) will cost too much:  Hard to argue with the chart….we are already paying too much.  I will make a comment on that, and it relates to income inequality:  Although I have no data to back this up, I bet the rich in the United States DO have the best healthcare in the world.  The issue is that so few can afford that kind of care.

What do I propose as far as a change (its easy to poke holes in the current system)?  Don’t know.  There is so much mis-information out there about WHY our current system costs so much that I’ve had trouble sorting that out.  I know alot is administation, but not all of it.  I know some of it is too few doctors/health care professionals.  I know some of it is litigation and using emergency room as last resort care.

I do know though that it can be done, because all the countries ahead of us are generally similar to the US in macro-economic conditions.  There is nothing unique about the US that is driving costs so high.

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