Quote: Original post by Naurava kulkuri
And perhaps I was expanding this to more fundamental issues. I guess Eelco knows my position already and I see no real need to pursue social theories in this thread. What I'd like to know is an answer to my last question on insuring, say, children. That is, basing the answer to current situation, I'd like to know his option. Perhaps it was a bit long prelude to that question, but I felt there has been too much number throwing based on ideology and I'd like to know his take on that question based on his view of world. I haven't seen a definite answer yet, though. An idealogy piece and a note resources could be spent otherwise, but not an answer to the question.

I thought it was implicit in my post, but ill make it explicit: i do not consider myself obliged to make the world a better place than it would have been in my absence.

Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die. If the people who happen to have the same flag in their passport should be treated any differently, you tell me.

There isnt really anything the government does which i approve of, since i dont approve of implicitly assigned government in the first place. I mean, there is stuff it does that benefits me, but I dont consider that much of an argument for its legitimacy. Thats all very nice and nonconstructive, i know. I do have a constructive vision of the way people should relate, but this trollfest does not seem like a good way to get started on that.

Quote: Original post by Promit

Quote: Original post by Eelco
Throwing around big numbers is completely meaningless. PROFITS INCREASED 200%!!!11!!oneoneone.

Populist clowns.

These types of comments are going to get you in trouble -- HostileExpanse, you're treading awfully close to the line in spots too. Don't forget that the Lounge continues to be an extreme moderation zone, especially these threads. If your post doesn't have content for the discussion, don't post it.

From here down I'll start dealing out warnings or worse.

No content for the discussion? Displaying a relative number or an absolute number, when the converse is the one with the actual information content is dishonest rethoric aimed at stirring populist angst. It bears pointing out.

Ill try to do it more politely next time though.

The "death panels" are already here

Quote:
The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.

It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.

That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."
...

Quote: No content for the discussion? Displaying a relative number or an absolute number, when the converse is the one with the actual information content is dishonest rethoric aimed at stirring populist angst. It bears pointing out.

Is that even English? I'm running into severe parse errors trying to figure out what the hell you just said. Doesn't matter though, I suppose.

Quote: Original post by Eelco
Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die. If the people who happen to have the same flag in their passport should be treated any differently, you tell me.

Some people can't afford health insurance. Some people can, but then they get their treatments denied or their insurance terminated outright because they're too expensive and would drive the insurance company's profits down. Some people are sick enough that no insurance company will ever agree to insure them. Are you suggesting that the people who can't afford to pay out of pocket in these situations should suffer and/or die because they don't have money?

It gets better. Palin's "Death Panel" for the Elderly in Alaska

Quote:
But as the Anchorage Daily News reported this last July, the situation in the state's Medicare- and Medicaid-funded in-home elder care program became so bad that the federal government had to step in and force Alaska to make necessary improvements.

In one 2 1/2 year stretch, 227 adults already getting services died while waiting for a nurse to reassess their needs. Another 27 died waiting for their initial assessment, to see if they qualified for help.

The feds had been tipped off to the systemic problems by doctors and other health care providers, who found the state unresponsive when confronted with their incompetence. No other state faced comparable problems.

Suddenly I understand why the republicans are so against public health care: they're so incompetent that all their worst case scenarios would come true if they're the jokers running it!

This seems to be a standard tactic with them now.
Destroy financial regulations, watch financial sector destroy itself, claim that government intervention doesn't work because it didn't stop the destruction.
Destroy energy regulations, watch energy sector destroy itself, claim that government intervention doesn't work because it didn't stop the destruction.
Call the UN ineffective, intentionally veto anything the UN does to try to do anything useful, call it proof that the UN is ineffective.

Dear Republicans, intentionally destroying things to prove that the government can't be trusted is the single most counterproductive thing you could ever do. Keep up the good work.

/bonus: insert whargaarbl about states rights here.

Quote: Original post by Eelco

Quote: Original post by Naurava kulkuri
...What I'd like to know is an answer to my last question on insuring, say, children. That is, basing the answer to current situation, I'd like to know his option.

I thought it was implicit in my post, but ill make it explicit: i do not consider myself obliged to make the world a better place than it would have been in my absence.

Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die. If the people who happen to have the same flag in their passport should be treated any differently, you tell me.

Is your answer that, "sick children should be left to die, if they can't come up with the money (or a benefactor) to pay for medical services?"

Quote: Original post by Eelco
There isnt really anything the government does which i approve of, since i dont approve of implicitly assigned government in the first place.

And yet, for all your bluster... you still haven't relocated to Somalia, where there's all the absence of government that you could want.

Quote: Original post by Promit

Quote: No content for the discussion? Displaying a relative number or an absolute number, when the converse is the one with the actual information content is dishonest rethoric aimed at stirring populist angst. It bears pointing out.

Is that even English? I'm running into severe parse errors trying to figure out what the hell you just said. Doesn't matter though, I suppose.

So if ill use naughty words in complicated sentences, ill get awy with it? Sweet.

Quote:

Quote: Original post by Eelco
Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die. If the people who happen to have the same flag in their passport should be treated any differently, you tell me.

Some people can't afford health insurance. Some people can, but then they get their treatments denied or their insurance terminated outright because they're too expensive and would drive the insurance company's profits down.

We went over that exhaustively. People should get what they have agreed upon.

Termination of contracts is a subtle issue though. An insurance is not an insurance if it is at a variable rate, and an insurance is not an insurance if its obligations can be spread over an extended periods of time, yet it has the freedom to unilaterally violate your contract in the meanwhile.

Nobody has yet given examples of that systematically happening, but if it would, that would be bad indeed.

Medical insurance is essentially a contract for life. Dont expect to be able to quit one fixed-rate program and join another when you are 60. I wouldnt offer you such a deal, and noone but santaclaus would.

One may argue in how far this leaves room for any genuine market in health-insurance to begin with: a decent argument in favor of a single-payer system, which noone seems to have bothered to articulate in their profit-frenzy.

Getting the US federal government involved with it, is something I wouldnt wish on my worst enemy though. If america needs universal healthcare so badly, why do hardly any states enact it?

Quote: Some people are sick enough that no insurance company will ever agree to insure them. Are you suggesting that the people who can't afford to pay out of pocket in these situations should suffer and/or die because they don't have money?

Well, i wouldnt use the imperative sense. It doesnt matter what i think they should do: unless someone does what it takes to keep them alive, they will die, yes.

Quote: Original post by Eelco

Quote: Original post by Naurava kulkuri
And perhaps I was expanding this to more fundamental issues. I guess Eelco knows my position already and I see no real need to pursue social theories in this thread. What I'd like to know is an answer to my last question on insuring, say, children. That is, basing the answer to current situation, I'd like to know his option. Perhaps it was a bit long prelude to that question, but I felt there has been too much number throwing based on ideology and I'd like to know his take on that question based on his view of world. I haven't seen a definite answer yet, though. An idealogy piece and a note resources could be spent otherwise, but not an answer to the question.

I thought it was implicit in my post, but ill make it explicit: i do not consider myself obliged to make the world a better place than it would have been in my absence.

Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die.

So, you fully support leaving people out on their own to fend for their lives when things go wrong?

You fully support me shooting you in the back to steal your wallet so I can help pay for the drugs to keep myself or my child alive? After all, stealing stuff is harder when the owner is alive to object to it.

Quote: Original post by Eelco
We went over that exhaustively. People should get what they have agreed upon.

Termination of contracts is a subtle issue though. An insurance is not an insurance if it is at a variable rate, and an insurance is not an insurance if its obligations can be spread over an extended periods of time, yet it has the freedom to unilaterally violate your contract in the meanwhile.

Nobody has yet given examples of that systematically happening, but if it would, that would be bad indeed.

Medical insurance is essentially a contract for life. Dont expect to be able to quit one fixed-rate program and join another when you are 60. I wouldnt offer you such a deal, and noone but santaclaus would.

^^ Could not parse.

Quote: Original post by Eelco
One may argue in how far this leaves room for any genuine market in health-insurance to begin with: a decent argument in favor of a single-payer system, which noone seems to have bothered to articulate in their profit-frenzy.

People have elucidated MULTIPLE problems with US healthcare. You're the only one hung up on any "profit-frenzy" discussion, likely stemming from your inability to successfully deflect/downplay even just that problem.

It's was on page 1 that I raised the entirely different issue of conflict-of-interest in the concentrated industry. Almost ten pages ago, I covered numerous issues I see with the US system, of which only one was the possibility of profiteering.

Quote: Original post by HostileExpanse
Here's my take on the whole healthcare issue.


It's pretty clear that insurance is the key point to focus on with regards to improving the whole situation. Unfortunately, insurance has its own intrinsic faults, which make the market prone to catastrophic failure without intervention of some sort.

The bottom line problem that I see with healthcare is that company incentives are nowhere close to being aligned with the goals of consumers (or broader society).

I see the following as the goals which are likely needed:
A) eliminate excessive medical procedures
B) encourage medical procedures which significantly improve quality-of-life
C) promote healthier lifestyles
D) make healthcare affordable
E) determine a baseline cost for coverage
F) deal with end-of-life costs


SUGGESTIONS
===========
If I were modifying the US system, based on the above criteria, I'd probably do something like the following.
1) Create a Medicare-like insurance system which covers only preventative care as recommended by some consensus of doctors. Call it HealthyCare for the purposes of this post ... yeah, I suck at naming stuff.
2) Allow covered HealthyCare services to be subsidized 100% by taxpayer funding. Patients should have no premiums, copays, co-insurance, etc.
3) Extend coverage of HealthyCare to all US citizens.
4) Create a government program to facilitate the grouping of insurance beneficiaries into blocks ... much like what happens with the way employees are grouped together into blocks which their company gets coverage for. Subsidize the administrative costs.
5) Endorse "Patient Block Rating Systems," which pay underwriters to give their estimate of the healthcare costs for both individuals and also blocks of people over the next ... say, 8 years. This is a weak point of my proposal since it'd be a complex beast, and it also extends the privacy problems of the insurance system. Also, this service might need to be run by government(s), since private ratings agencies have been notorious to falling victim to conflict-of-interest issues.
6) Limit insurance underwriting to only the allowable information released through the Patient Ratings Services. This could include, for example, only: Patient rating [low risk, med risk, high risk, very high risk], patient zip code, patient gender, patient prostheses, mobility level, and a few other details I probably hadn't thought of.
7) Create a Medicare-like insurance plan which is available to citizens under 65 years of age, to compete with private insurers. The plan should be forced to pay all administrative costs through beneficiary premiums and government benefits which are readily available to all private insurance companies; in other words, it should be competing on a fairly level basis. We'll call this plan AmeriCare here.
8) I'd suggest modifying the payment structure of AmeriCare significantly from the strictly "fee-for-service" basis that regular Medicare uses; I suggest a novel variation from the dreaded capitation system used by HMOs. Specifically, this variation would seek partial refunds from the healthcare provider when they accept money for a patient that later dies within some number of years .. say, 4 years (unless the healthcare provider shows the death was not from illness). This would have the likely effect of needing to increase the average payouts to doctors (in order to compensate from some of the future refunds they'll need to consider). The amount of the refund would be dependent on the patient's rating from the aforementioned Patient Rating system. Riskier patients would prompt smaller refund percentages.
9) As the AmeriCare payment structure is novel, there may need to be incentives in order for people to try it out. It'd likely be a good idea to offer tax incentives to doctors who register as AmeriCare providers, and agree not to refuse any AmeriCare patients.
10) Establish a government program to subsidize interest charges, and to facilitate healthcare lending. People with copays or who incur medical expenses beyond their means during a period that they are insured should be eligible to receive low-interest 30-year loans. Perhaps, require that at least one person accepting responsibility for the loan be under the age of 50.
11) Make contributing to Health Savings Accounts mandatory by taxing earnings and placing that amount into the individual's account with the insurer of their choice.
12) Maintain the requirement for insurance companies to service only beneficiaries which claim residence in their state.


RATIONALE
==========
#1, #2, #3 ... the rationale for "HealthyCare" is simple. Subsidize basic preventative care. That's the cheapest form of care, and the investments here could do much to curtail more expensive medical problems later. At the very least, this eliminates the excuse that people can't afford the care.

#4, #5, #6 Helps maintain the integrity of the insurance system, while keeping cost increases small. Overall, these measures would reduce adverse selection, and should make private insurance significantly more accessible.

#7 ... a plan with open and public accountability should help establish a baseline

#8 ... a payment structure of this sort should simultaneously encourage both minimal unnecessary spending, while still encouraging the necessary medical procedures.

#9 ... the new payment structure comes with risks to the healthcare provider, so it may need a way to get itself established

#10 ... provides a safety net to make healthcare affordable for those who do suffer catastrophe.

#11 ... this would help people prepare for their own end-of-life care needs

#12 ... prevents the Federal gov't from encouraging a nearly needless "race to the bottom."


Admittedly, the above leaves unaddressed a few very large questions ... the possible need for a coverage mandate, malpractice insurance and guarantees of coverage for those without the financial means (although State Medicaid programs are available).

Anyways, let the flames begin :oP

Quote: Original post by Talroth

Quote: Original post by Eelco

Quote: Original post by Naurava kulkuri
And perhaps I was expanding this to more fundamental issues. I guess Eelco knows my position already and I see no real need to pursue social theories in this thread. What I'd like to know is an answer to my last question on insuring, say, children. That is, basing the answer to current situation, I'd like to know his option. Perhaps it was a bit long prelude to that question, but I felt there has been too much number throwing based on ideology and I'd like to know his take on that question based on his view of world. I haven't seen a definite answer yet, though. An idealogy piece and a note resources could be spent otherwise, but not an answer to the question.

I thought it was implicit in my post, but ill make it explicit: i do not consider myself obliged to make the world a better place than it would have been in my absence.

Either way, what happens to people, young or old, who can neither care for themselves, nor have anyone else caring for them, is that they die.

So, you fully support leaving people out on their own to fend for their lives when things go wrong?

Not more or less than you do.

Or maybe. Im not a national socialist, my charity is neither bound by national borders, nor forced at gunpoint.

Quote:
You fully support me shooting you in the back to steal your wallet so I can help pay for the drugs to keep myself or my child alive? After all, stealing stuff is harder when the owner is alive to object to it.

No. I do not condone anyone making the lives of others worse than it would have been in their absence.