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apogee
climber
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Mar 25, 2010 - 02:14pm PT
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"Oh, what the hell was the McD worker doing starting a family earning $7 an hour!!"
He started his family back when he was making a decent wage as a real estate agent about 5 years ago. When everything crashed, the only job he could find was flipping burgers.
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tradmanclimbs
Ice climber
Pomfert VT
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Mar 25, 2010 - 02:24pm PT
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The level of care decision has been made within the US free market system as long as it has existed, driven solely by profit interests. end quote
I feel this is pretty much spot on and it is moraly wrong on so many levels.
I would like a system simeler to canada without all the hockey and funny language.. everyone I talk to from up there likes the level of care that they get and feels that the cost is acceptable.
The republican hype that extending the single payer medical coverage past medicare and all the goverment workers, legislators etc to the rest of us would turn us into Pinko commie faggots is just pathatic....
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nature
climber
Tucson, AZ
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Mar 25, 2010 - 02:27pm PT
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slippery slope.
you just turned 18. You work at McD's. You've just been diagnosed with a fatal illness unless you get expensive medical attention. In Fatty's world you die.
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tradmanclimbs
Ice climber
Pomfert VT
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Mar 25, 2010 - 02:40pm PT
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The worst thing about our system is that it is all about profit from peoples illness and misfourtune. Why is it that most of us would be offended if someone offered us money for pulling them out of a burning wreck yet many of us feel that they shouldn't recieve life saveing care for their burns unless they can pay for it?
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dktem
Trad climber
Temecula
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Mar 25, 2010 - 02:41pm PT
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I read Atlas Shrugged many years ago.
Every word of it (Ok, I skimmed the John Galt soliloquy...doesn't everyone?)
Overall, an interesting book, even if it is a bit tedious at times.
Some observations I made about the story:
 The characters fit neatly into two categories: Independent responsible types, or lazy scheming bureaucrats (the "looters")
The independent responsible types all seem to have almost superhuman powers (extreme intelligence, gifted business acumen, an extraordinary work ethic, sometimes even athletic skill...)
The looters are just ordinary people who always choose not to use even their limited skills toward productive purposes.
There are no children in the story at all. Every character is a childless adult.
There are no sick, or handicapped, or wounded veterans of wars. There are no elderly.
The central conflict in the story is, of course, between the heroes and the looters.
Ayn Rand is popular with many conservatives because they like to see the world that way. Of course they see themselves as the hard-working heroes carrying the world on their back (remember Joe the Plumber? - what did we eventually learn about him?)
And the details of caring for children, the unfortunate, the elderly? We just leave them out of the story because it would complicate the message.
Ayn Rand wrote comic books without pictures.
The world is not that simple.
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nature
climber
Tucson, AZ
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Mar 25, 2010 - 02:43pm PT
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nice job in dodging the context of my question/issue, fatty.
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Bob D'A
Trad climber
Boulder, CO
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Mar 25, 2010 - 02:53pm PT
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All the talk about caps and limits is all well in good until it happens to one of your children, spouse, family or close friends.
I when into debt to try and save my 13 year old Lab (dog)..it was the right thing to do. Like Tktem said...the world is not always black and white.
Very hard to put a price tag on someone or some thing and where the cutoff point should be.
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stevep
Boulder climber
Salt Lake, UT
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Mar 25, 2010 - 02:57pm PT
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So what about someone like Stephen Hawking? I'm sure he's run up a pretty high cost. Should we have let him go?
Or going back to our McD worker? What if one of his kids is genius level? Keeping his dad around and healthy and may mean the kid goes in the right direction rather than the wrong one.
If we can improve some of these other cost issues (tort reform, administrative expenses, and very expensive, marginal value, end of life treatement), then it's probably not an issue to give pretty good coverage to everyone.
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jstan
climber
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Mar 25, 2010 - 03:00pm PT
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A difficult question.
Jeff has proposed one algorithm. Let’s look at it. As a matter of speech let’s think of the public assistance as coming from Medicare.
Public expenditures on a person’s health and prolongation of life as being somehow proportional to the individual’s contributions to the public.
Well how to quantify their contribution? And should not the public’s expense be proportional really to the public’s expected contribution from the individual – in future. That’s what the public is buying.
As far as children are concerned we can just patch in the parent values. Another inheritance if you will. But not the parent’s net worth! The parent’s active income exclusive of passive income, bonus, and stock options. Strictly the direct income. And it might be the larger of the two parent incomes.
Now if we want to gauge instead future expectation of contribution we might make public assistance proportional to inception to date direct income per annum times the remaining working life till age 75 say. (People are increasingly going to be needing to work that long.) What are the effects?
1. young people will get an advantage because of long life expectancy
2. there will be an advantage to having appreciable income before having children
Where would we get this number for direct income? Well we could use one of the numbers off the 1040. Some affects of this.
1. another advantage for filing
2. another advantage for not tax dodging
3. it tends to make more expensive to the patient any extreme measures to prolong life for a year or two.
Admittedly this moves us back toward a practice of the plains Indians. When in a person’s judgment they became a burden they got up in the night and went out into the snow to die. But we are doing a thought experiment here. Shall we go on?
To make any of this work we would need a comprehensive list of fully costed out treatments. But more than that. If a treatment has very little chance of helping, the public should be proportionately less willing to fund it. In aggregate that sounds hard to implement but I think it would not be. We keep immense databases on the effectiveness of treatments. We would need to have a putative number for the cost of each to be applied nationwide as derated according to effectiveness. The structure for cost is already in place – Medicare’s costings that are used today nationwide. Effects of this:
1. Little public liability for ineffective treatments
A texan I know had this to say about W. “He needed both hands to find his a…hole.” I guess “pungent” is the word to describe this characterization. All of us are familiar with CEO’s who, except for their amazing ability to suck-up, are not worth the powder to blow them to hell. But put emotion to the side. We are dealing in aggregate here. We have to go with what we think might work.
Fairness will never be attained.
And what happens to a budding genius/whatever whose parent has no income? Well for that there might be non-profit organizations actively seeking out and evaluating young people The answer might lie in the above results being adjusted by some derating scheme.
I don’t have an answer. Andrew Carnegie or Edison would have pushed their way to success no matter what. But there are a lot of others with something to contribute who would not.
What about the drop out? There could be a panel of health care available independent of the person’s contributions. It would be lower.
Jeff’s suggestion has some basis in reality. In future we will no longer be able to have everything we would like. Can something like this work? Probably not.
But we need to start thinking.
Edit:
Bob:
When I said "we" I meant us, not a party or a Congress. There won't really be reform until "we" have worked through the alternatives, as is going on in this thread.
Despite the occasional bubble of gas, what it has been possible to do on ST has risen miles above what used to be the limit. I am beginning to be, a little, more encouraged.
Edit2:
Bad news.
With old age comes..........even more old age........
provided you are lucky.
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Bob D'A
Trad climber
Boulder, CO
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Mar 25, 2010 - 03:02pm PT
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JS wrote: But we need to start thinking.
Isn't that what the democrats are doing with health care reform? It's a start and far from any consensus what is perfect but it is a start.
We also needed to start acting and like it or not that is what the democrats did. Republicans have no interest in HCR.
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Crimpergirl
Sport climber
Boulder, Colorado!
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Mar 25, 2010 - 04:21pm PT
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Prices were calculated on victims in the 9/11 terrorist attack.
It's been a while since I looked, but it was, I believe, based on age, earning potential, marital status and number of kids I believe.Survivors of older folks got less. Survivors of folks earning more got more. Survivors of single victims got less. And survivors of victims with kids got more.
Not a productive=more pay out model, but a model nonetheless. I wonder if this is a starting point?? One thing is clear, this model was met with hideous resistance.
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Bob D'A
Trad climber
Boulder, CO
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Mar 25, 2010 - 04:27pm PT
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JS...I know what you meant but health care debate is nothing new...110 year old issue...what is new how we get our information and how we can communicate with each other. The internet is really cool if used in the proper way. Thanks for adding so much to these discussion. The old saying "with age comes wisdom".
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apogee
climber
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Mar 25, 2010 - 04:31pm PT
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After a week of racial slurs, homophobic namecalling, spitting and physical threats towards Dems, the Repugs have said 'enough is enough'....and are claiming that they have been threatened, too:
"House Minority Whip Eric Cantor blamed top Democrats for “fanning the flames” regarding threats to members of Congress — and says his office in Richmond was shot at earlier this week."
http://www.politico.com/news/stories/0310/35021.html
'The Party of No' is so short of ideas, they have to steal political strategies from the Dems. Anybody wanna bet that the 'shot' that Cantor heard was a backfiring car driving by his office?
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HighDesertDJ
Trad climber
Arid-zona
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Mar 25, 2010 - 05:04pm PT
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Jelazrain said - "I respectfully disagree, HDDJ. In California, malpractice rates are much lower than they were befre the imposition of MICRA limits, but that is only a small part of the problem. Most studies I've read cite the cost of "defensive medicine" (i.e., "unnecessary" tests and procedures) to be the single biggest reason for our high cost of medical care. This is a far bigger cause than, for instance, relying on the ER as one's primarly source of medical care."
Yes, defensive medicine is part of the problem but it's not the whole problem. The larger problem is that hospitals and doctors MAKE MONEY practicing defensive medicine. There is a very, very large body of evidence about this. If you take away the incentive to do the unnecessary tests you greatly reduce the number.
As an example: my grandmother went to the doctor and got a set of labs and a chest x-ray done. She was then referred to a specialist who ordered the exact same labs and x-ray done over again unnecessarily. He could have simply gotten the results from the other doctors office, but doctors often do not do this because the incentive is to do as many things yourself as you can. This happens over and over again in hospitals and doctors offices from coast to coast.
When Medicare wants to pay 3% less for a given procedure in a given year they have to cut the reimbursement by 5% because doctors will do a higher number of procedures to make up the difference. By cutting the reimbursement by 5% the number will settle at 3% due to the higher volume.
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dktem
Trad climber
Temecula
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Mar 25, 2010 - 05:22pm PT
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Former militiaman unapologetic for calls to vandalize offices over health care
http://www.washingtonpost.com/wp-dyn/content/article/2010/03/25/AR2010032501722_2.html?hpid=topnews&sid=ST2010032402500
"Vanderboegh said he once worked as a warehouse manager but now lives on government disability checks."
At least all the broken windows are good for the economy.
(I'm not serious about that one - it's nerdy economics inside joke.)
At one time I would dismiss this guy as a fringe case. Anymore, I'm not sure. If the Republicans don't start distancing themselves from these characters, the party is never going to regain credibility.
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jstan
climber
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Mar 25, 2010 - 05:36pm PT
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From the above link:
"Vanderboegh, who lives in the Birmingham suburb of Pinson, described himself as a "Christian libertarian" and said he has long been a gun rights advocate. He said he joined a clandestine militia group called the "Sons of Liberty" and later became a public leader of the First Alabama Cavalry, Constitutional Militia."
emphasis added
The Civil War is still here.
Wars have this characteristic.
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Douglas Rhiner
Mountain climber
Good question?!?!?!?!?
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Mar 25, 2010 - 05:43pm PT
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One thing that I believe has been over looked by many opponents to HCR is their own health protection, from their fellow human being.
What about highly communicable diseases that are treatable in early stages like TB?
Or diseases that are currently not in our vocabulary except for when used in conjunction with -immunization?
I for one am more than willing to pitch into a system to help people without the ability to purchase insurance so these diseases don't get out of control. I don't want to have to resort to paranoia-in-public for fear of contracting a highly communicable disease that could kill me or make my life hell both physically and monetarily - which invariably leads to mental health issues.
How many times have we heard prevention is the best form of heath care there is?
Werner is on to something when he criticizes the US is not a very healthy nation, mainly due to unhealthy lifestyle practices.
But this will be compounded if policies like Fattrad has suggested are implemented where everyone is on their own with little access to primary preventative care.
Having a healthy, vibrant public is in everyones best-self interest.
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Bob D'A
Trad climber
Boulder, CO
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Mar 25, 2010 - 06:04pm PT
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Douglas wrote: Having a healthy, vibrant public is in everyones best-self interest.
You would think so but that is not the case.
If we had healthy, educated populace a lot of politicians would be in deep sh#t.
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