Quote: Original post by Eelco
Yes, i think a well-functioning legal system accessible to all is fundamental to a free society. All countries i know of a significantly lacking in this regard. You pretty much need big money just to get heard in court. Thats bullshit, and it opens the door for all kinds of abuse.

I agree. A well functioning legal system and a possibility to enforce it are of paramount importance in contract based societies. I gather you are for a more minarchist model, or even night watchman state.

Quote: Original post by Eelco
There definitely is a power imbalance problem here, where it pertains to contracts and loopholes and playing the legal system. Some measures to counteract loopholes and conditions that people would simply not have agreed upon, had they been aware of them, seems like a good thing to me. As i said, if an insurer is to refuse care, the burden of proof for that should be on him. Hed better have that specified in bold, in a list of conditions not covered or somesuch. Vague interpretable claims need not apply.

The burden of proof would be difficult to enforce as there is a resource imbalance towards these companies (or corporations). As you write, modern societies are lacking in this respect, partly because economic power is real power someone will use for his own benefit. I think the problem runs even deeper and it has to do with more fundamental concepts pertaining to the formation of societies in the first place.

Quote: Original post by Eelco
To solve these problems by demanding insurers can not refuse new clients, or refuse payment for conditions not specified in the contract, is however the end of insurance in any meaningfull term of the word. If redistribution relative to the current status quo is the aim (and it is), there are ways to do it without making insurance effectively illegal. Set price controls on medical practicioners, and outline a minimum coverage plan that you will subsidize as a government. Now im not saying i am looking forward to the long term unintended consequences of that, but it seems like the least invasive way to redistribute.

Perhaps one fundamental issue here is that a society should protect its members, always. Be them poor, rich, sick, disabled, criminals or victims. In that case the individuals can decide to relocate their resources to a commonly managed pool. I figure you disagree with this part due to your chosen philosophy. That is, you disagree with the notion "a society" decides how to use some of your resources or that "the society" arrange itself a certain way that makes exercising your chosen way more difficult.

In anycase, as it seems to be currently, these insurance companies aren't competing on driving down costs or offering substantially better products to their customers (this one could make an interesting topic too). Would it be more pragmatic in short term to fix issues with some variant of the currently proposed public health care bill and improve the legal system after that? I mean to ask that do you believe that there would be short-term benefits for doing this? It may be, of course that long-term implications of the proposed bill are problematic.

One way of seeing public health care is that it'd level the playfield in the sense that it changes the power balance towards individual members of a society, making a need for better legal system less acute. Other issues are that someone could argue the state could be more cost efficient and drive down costs solely for being a bigger collective – leaving the society to form (that is, to collecet resources) (insurace) corporations to compete (or in general muster resources to produce benefits) with other means.

Quote: Original post by Naurava kulkuri

Quote: Original post by Stab-o-tron
Wow, according to this Stephen Hawking is dead.

Or that he would be dead if he lived in the UK. I glanced quickly over another article from the pages Shovel-Ready Health Care.

Quote: Oregon resident Barbara Wagner might beg to differ — as she begs to stay alive. Last year, the 64-year-old received news that her cancer, which had been in remission, had returned. Her only hope was a life-extending drug that her doctor prescribed for her.

The problem was that the drug cost $4,000 a month. The state-run Oregon Health Plan said no, that it was not cost-effective. Oregon's equivalent of a "death panel" sent her a letter saying it would cover drugs for a physician-assisted death. Those drugs would cost only $50 or so. Oregon could afford that.

"It was horrible," Wagner told ABCNews.com. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die.

"But we won't give you the medication to live."

So, the drug was too expensive to her and the state of Oregon and by this reasoning public health care is bad? Or are they, what it seems to be, to take the little offer of help and distort the message to mean they want her to die? It sure looks like that to me, which in that case is a deliberate lie.

<edit...
One could argue that if Wagner would not have been taxed out of her money, she could afford the life extending drug. Or more generally, the state took her money and spent it so she couldn't use it more productively to either collect more resources or to just save it to be used in incidents like this.

The point is that it doesnt matter a whole lot who rations the medical care, the visible or the invisible hand. People die, and the government isnt going to change that in any qualitative way.

Deciding life and death by the bureacratic wheel of fortune seems less attractive to me than deciding it as members of a free society.

Quote: Original post by Eelco

Quote: Original post by Naurava kulkuri

Quote: Original post by Stab-o-tron
Wow, according to this Stephen Hawking is dead.

Or that he would be dead if he lived in the UK. I glanced quickly over another article from the pages Shovel-Ready Health Care.

Quote: Oregon resident Barbara Wagner might beg to differ — as she begs to stay alive. Last year, the 64-year-old received news that her cancer, which had been in remission, had returned. Her only hope was a life-extending drug that her doctor prescribed for her.

The problem was that the drug cost $4,000 a month. The state-run Oregon Health Plan said no, that it was not cost-effective. Oregon's equivalent of a "death panel" sent her a letter saying it would cover drugs for a physician-assisted death. Those drugs would cost only $50 or so. Oregon could afford that.

"It was horrible," Wagner told ABCNews.com. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die.

"But we won't give you the medication to live."

So, the drug was too expensive to her and the state of Oregon and by this reasoning public health care is bad? Or are they, what it seems to be, to take the little offer of help and distort the message to mean they want her to die? It sure looks like that to me, which in that case is a deliberate lie.

<edit...
One could argue that if Wagner would not have been taxed out of her money, she could afford the life extending drug. Or more generally, the state took her money and spent it so she couldn't use it more productively to either collect more resources or to just save it to be used in incidents like this.

The point is that it doesnt matter a whole lot who rations the medical care, the visible or the invisible hand. People die, and the government isnt going to change that in any qualitative way.

Deciding life and death by the bureacratic wheel of fortune seems less attractive to me than deciding it as members of a free society.

Do you mean that without the state of Oregon and its health care council Wagner would have been able to decide this matter of life and death (perhaps choosing life) independently, as a free member of a society? Or do you refer to your thoughts in general?

Quote: Original post by Naurava kulkuri

Quote: Original post by Eelco
Yes, i think a well-functioning legal system accessible to all is fundamental to a free society. All countries i know of a significantly lacking in this regard. You pretty much need big money just to get heard in court. Thats bullshit, and it opens the door for all kinds of abuse.

I agree. A well functioning legal system and a possibility to enforce it are of paramount importance in contract based societies. I gather you are for a more minarchist model, or even night watchman state.

I am for a society without implicit social contracts.

Quote:

Quote: Original post by Eelco
There definitely is a power imbalance problem here, where it pertains to contracts and loopholes and playing the legal system. Some measures to counteract loopholes and conditions that people would simply not have agreed upon, had they been aware of them, seems like a good thing to me. As i said, if an insurer is to refuse care, the burden of proof for that should be on him. Hed better have that specified in bold, in a list of conditions not covered or somesuch. Vague interpretable claims need not apply.

The burden of proof would be difficult to enforce as there is a resource imbalance towards these companies (or corporations). As you write, modern societies are lacking in this respect, partly because economic power is real power someone will use for his own benefit. I think the problem runs even deeper and it has to do with more fundamental concepts pertaining to the formation of societies in the first place.

Yes, there are more fundamental issues that can be raised, but a tendency for courts to ruthelessly punish obscurantism in contracts would be a start.

Quote:

Quote: Original post by Eelco
To solve these problems by demanding insurers can not refuse new clients, or refuse payment for conditions not specified in the contract, is however the end of insurance in any meaningfull term of the word. If redistribution relative to the current status quo is the aim (and it is), there are ways to do it without making insurance effectively illegal. Set price controls on medical practicioners, and outline a minimum coverage plan that you will subsidize as a government. Now im not saying i am looking forward to the long term unintended consequences of that, but it seems like the least invasive way to redistribute.

Perhaps one fundamental issue here is that a society should protect its members, always. Be them poor, rich, sick, disabled, criminals or victims. In that case the individuals can decide to relocate their resources to a commonly managed pool. I figure you disagree with this part due to your chosen philosophy. That is, you disagree with the notion "a society" decides how to use some of your resources or that "the society" arrange itself a certain way that makes exercising your chosen way more difficult.

'the individuals can decide' is the crux of the matter. I dont mind joining a group of people where we as individuals agree on a common set of rules. I never explicitly joined a group of people though, and my 0.1% of the vote never got to decide anything at all.

Quote:
In anycase, as it seems to be currently, these insurance companies aren't competing on driving down costs or offering substantially better products to their customers (this one could make an interesting topic too). Would it be more pragmatic in short term to fix issues with some variant of the currently proposed public health care bill and improve the legal system after that? I mean to ask that do you believe that there would be short-term benefits for doing this? It may be, of course that long-term implications of the proposed bill are problematic.

'There is nothing so permanent as a temporary government program'

Welfare systems never get fundamentally revisited, unless the country is in a bloody revolution anyway. People will come to depend on the system, they will adjust their lives accordingly, and removing it will be impossible.

Quote:
One way of seeing public health care is that it'd level the playfield in the sense that it changes the power balance towards individual members of a society, making a need for better legal system less acute. Other issues are that someone could argue the state could be more cost efficient and drive down costs solely for being a bigger collective – leaving the society to form (that is, to collecet resources) (insurace) corporations to compete (or in general muster resources to produce benefits) with other means.

I am all for a public option that is both self-funding (that includes opportunity cost on invested capital), and does not use the powers of government in ways unavailable to private actors.

It wont happen though: noone truely believes the profit margins are the problem here. Such a program would be a complete disaster. The only benefit it can offer is rationing not based on contract and haggeling thereover, but by 'objective and independent assesment' of 'needs and benefits'. Ill pass, but whatever. For the rest, the only way it could be competitive is by direct subsidy (which would make private insurance, like private education, an affair for the elite), and by price fixing. Price fixing is a restriction on consesual interaction, and it will cause the strain between supply and demnd to increase further, and it will mean the end of drug research, but people wouldnt have to choose between buying a new laptop or going to the doctor, so i guess that makes it worth it.

I would love to have a 2500$ deductible or more, by the way, but the dutch government has decided in all its wisdom not to allow deductibles over 600. WTF?

Quote: Original post by Naurava kulkuri

Quote: Original post by Eelco
The point is that it doesnt matter a whole lot who rations the medical care, the visible or the invisible hand. People die, and the government isnt going to change that in any qualitative way.

Deciding life and death by the bureacratic wheel of fortune seems less attractive to me than deciding it as members of a free society.

Do you mean that without the state of Oregon and its health care council Wagner would have been able to decide this matter of life and death (perhaps choosing life) independently, as a free member of a society? Or do you refer to your thoughts in general?

If she would have shelled out a little money a month for private catastrophic healthcare, she would have gotten it, had her contract been honored.

That said, if i were over 65 and got remittent cancer, I wouldnt even regret it if i wasnt insured for it. Id party hard and die softly, and use the remaining cash for a more worthwhile cause than spending the rest of my 'life' in and out of hospitals.

Being insured against catastrophic events is great, but if you had half a million dollars in your pocket, were 75 and got cancer, would you use it to extend your life into a few extra years of torture, or would you give it to your grandchildren, or some charity? But if insurance covers it, why not take the pills, right?

The vast majority of costs are made near the end of life. Usually on largely pointless procedures. My perfect insurance contract would include age limits on procedures. No 100's of k cancer treatments for me when im over 70, but at least my insurance was a factor three cheaper than yours.

Quote: Original post by Eelco
[...]The vast majority of costs are made near the end of life[...]

So, there's some context established and I'm not really inclined to push those avanues of thought, but in the spirit of this thread I'd like to ask how do you feel, or propose, about the health care to those that aren't old like in your examples? For instance, like ten years old kids. Should their parents take responsibility of their insurance? If so, from where to take the money (assuming there are people who don't have anything to spare)? As there's a system already in place and wealth has been distributed in some fashion, it may not be easy to acquire the necessary money. I remember you have written somewhere in the effect you don't view health care a positive right, so I could try to derive your point of view from there, but it would be guessing.

Quote: Original post by Naurava kulkuri

Quote: Original post by Stab-o-tron
Wow, according to this Stephen Hawking is dead.

Or that he would be dead if he lived in the UK. I glanced quickly over another article from the pages Shovel-Ready Health Care.

Yeah... about that... he's from the UK and lived most his life there...

Quote: Original post by Stab-o-tron

Quote: Original post by Naurava kulkuri

Quote: Original post by Stab-o-tron
Wow, according to this Stephen Hawking is dead.

Or that he would be dead if he lived in the UK

That's my point, if Stephen Hawking would be dead if he lived in the UK, then Stephen Hawking must be dead.

Yep, dead as a doornail

To be even more explicit: Stephen Hawking lives in the UK. Stephen Hawking was born in the UK. Stephen Hawking is British. [smile]

Ah, I love the smell of morons in the morning.

Quote: Original post by Naurava kulkuri
So, the drug was too expensive to her and the state of Oregon and by this reasoning public health care is bad? Or are they, what it seems to be, to take the little offer of help and distort the message to mean they want her to die? It sure looks like that to me, which in that case is a deliberate lie.

It's absolutely a deliberate lie, and it plays to people's emotions and fears by carefully omitting plenty of contextual information such as the fact that both private health insurance corporations and several branches of government use the same metrics for determining the value of a life, and that placing a dollar amount on the value of a life is essential for budgeting and policy in domains as diverse as road safety (how much are we willing to spend on installing traffic lights at an intersection given its effect on the likelihood of accidents) and environmental protection.

Slate has an interesting article on the subject: Cost of Living: Sarah Palin is afraid Obamacare will put a price on human life. But we already do. Time has one from last year: The Value of a Human Life: $129,000. New York Times articles from 2008 (Like the dollar, value of American life has dropped) and 2007 (Putting a Price on the Priceless: One Life) as well as an additional Slate piece from 2003 (Is Your Life Worth $10 Million? Nope. But your grandson's will be.) should make it clear that this is neither new nor controversial. Activities that employ collective assets require policy determinations on cost-benefit even as they pertain to human lives.

Quote: Original post by Eelco
The point is that it doesnt matter a whole lot who rations the medical care, the visible or the invisible hand. People die, and the government isnt going to change that in any qualitative way.

Deciding life and death by the bureacratic wheel of fortune seems less attractive to me than deciding it as members of a free society.

Again, you're participating in the misrepresentation of the issue. Nobody "decides death" - not government, not private insurers, not "a free society." All that may be decided is to withhold expensive treatment that is not acceptably cost effective when it would be paid for out of a collective pot. Each of the parties mentioned above would have different criteria for cost effectiveness: for government, in this case actually synonymous with "a free society" since there is no effective way that a national population is going to vote on every critical medical case without electing or appointing delegates to that specific task, it would be years of quality life per dollar amount spent; for insurers it would be years of quality life per dollar amount spent plus impact on net profitability.

Quote: Original post by Naurava kulkuri

Quote: Original post by Eelco
[...]The vast majority of costs are made near the end of life[...]

So, there's some context established and I'm not really inclined to push those avanues of thought, but in the spirit of this thread I'd like to ask how do you feel, or propose, about the health care to those that aren't old like in your examples? For instance, like ten years old kids. Should their parents take responsibility of their insurance? If so, from where to take the money (assuming there are people who don't have anything to spare)? As there's a system already in place and wealth has been distributed in some fashion, it may not be easy to acquire the necessary money. I remember you have written somewhere in the effect you don't view health care a positive right, so I could try to derive your point of view from there, but it would be guessing.

Indeed I do not believe any positive right can be gotten except by unanimous consent.

As far as positive rights are concerned, how to justify the positive right to hunderds of thousands in medical costs, while hunders of millions of people are dying because of a lack of simple daily needs?

There is only one kind of socialism being practiced, and it is national socialism.

Quote: Original post by Naurava kulkuri
So, the drug was too expensive to her and the state of Oregon and by this reasoning public health care is bad? Or are they, what it seems to be, to take the little offer of help and distort the message to mean they want her to die? It sure looks like that to me, which in that case is a deliberate lie.

<edit...
One could argue that if Wagner would not have been taxed out of her money, she could afford the life extending drug. Or more generally, the state took her money and spent it so she couldn't use it more productively to either collect more resources or to just save it to be used in incidents like this.

A) Show me a person who pays $4000/mo in taxes and I'll show you a person who can easily afford to pay for the drug on their own. Get real. That's $50,000 of taxes a year, more than most people in this country even make.

B) You're making an awfully huge leap assuming that a private insurance company, who has a higher priority to its shareholders to make profit than it does to its customers to keep them alive, is going to pay for the drug. Hah, fat chance of that my friend. The insurance company is under no obligation to pay that. It's a liability to their profits now and will pull every dirty trick in the book to not pay for it.


Perhaps the real question ought to be, "Why does this drug cost $4000/mo?". I'm willing to bet it's due to supply and demand. It's probably a rare condition and therefore the "efficient" market decides it's not worth making that much of it because there aren't enough customers, so therefore the supply is low and the price skyrockets. Another case of profits taking precedence over humanity, no doubt.