From Healthcare to Wealthcare
There is no doubt that the healthcare system in the US could use some work. We spend way too much and the quality of the healthcare that many receive is not where it could or should be. We allocate too much of our healthcare spending in the last few months of a person’s life and not nearly enough on preventive care throughout our lives. We are not leveraging the power of technology enough to help treat diseases and other conditions early when the treatments are more effective. So I am all for modifications to our health care system that will allow for more innovation, more preventive and wellness care, and more engagement with the system.
What I am not for is a total and complete dismantling of the Affordable Care Act and a return to a time when many US citizens did not have a means to pay for the healthcare they need (ie insurance). The Congressional Budget Office predicts that the Republican plan that has been put forth will cause 15mm US citizens to lose their insurance in the near term and up to 24mm over the longer term (by 2026).
This would just take us back to the time when a large percentage of our population had no other option but to defer healthcare until they got really sick and then show up in hospital emergency rooms and stick the “system” (ie those with insurance) with the bill. This is not a good way to run our healthcare system. Sure it might enable the government to remove the mandate that everyone have insurance, which sticks in the craw of conservatives and libertarians, but the cost of doing so means less preventive care, less outpatient care, and more costly end of life care.
I believe citizens of the US should have healthcare insurance. If they can afford it, they should pay for it. If they can’t afford it, society should pay for it. But one way or another, everyone should have the ability to see a doctor regularly, get preventive care, find diseases early on and treat them, and not defer their medical needs until they become acute.
The Republican plan seems hastily drawn up, largely a political reaction to the Affordable Care Act, and a return to a time when the wealthy can afford healthcare and many others cannot. I would encourage the President, his team, and the Republican members of Congress to go back to the drawing board and come up with something that moves us forward, not takes us back.
Comments (Archived):
gotta get the insurance companies way out of this, the whole problem starts with this idea of needing insurance for any medical visit rather than just for emergencies.obamacare was going to collapse on its own anyway, all the insurance firms were pulling out. this was obviously going to happen from the get go which is a big part of why it was opposed by so many.of course all problems related to affordability of any kind ultimately go back to monetary policy, the mother of all macroeconomic problems.
“… obamacare was going to collapse on it own anyway”The reason that healthcare is so difficult in this country is that people read about one-liners like that on the news and latch onto them, and don’t bother trying to learn about the issue.Insurance for those with pre-existing conditions, bans on lifetime coverage caps, expanded medicare, preventative coverage, limits on non-medical related costs by insurers, contraceptive care, expanded medicaid – none of those things “collapse”. And as for the exchanges, the CBO itself is predicting improvements in the marketplace over the next decade.This mess will last until the majority of citizens place a priority on personally engaging with issues.
Maybe if we stopped paying the dummies to be dumb we wouldn’t have this problem. You can’t reward bad behavior by paying for the consequences. The republic was lost when enfranchisement was granted without the property requirement. Ironically it was Vermont that was the catalyst.
spot on. I don’t buy haircut insurance. Oil change insurance? Cmon people….$10k deductible should be the MINIMUM
Yes, because haircuts are exactly like my wife’s cancer treatments over the last year, or her insulin needs for the last 35 years (currently at $1200 a month retail). Both are completely optional things that nobody really needs.
did I say cancer was a non-emergency? cmon. We are talking about ordinary doctor visits and minor illnesses here.
You do realize that without ordinary doctor visits, most cancers kill you pretty quick, right?
IIRC, retail on a mammogram would be about $600 if it wasn’t mandated coverage by Obamacare, and extra $300 if you get the new high tech 3D scan. I’m guessing 50% of woman in the US would be really hard pressed to come up with $600 annually.
Free Markets require a couple of things to operate rationally, relatively equal info available to both sides of the transaction, and substitute goods that allow somebody to walk away from a bad deal. Patients don’t have equal info because they can’t read MRIs and debate the doctor about what it means. And insulin, and most other life saving drugs, don’t have a substitute good. The free market solution to healthcare is that people like my wife die if there is no way to make money keeping her alive. And the only way to make money keeping her alive is a regulated market that socializes the costs for people with chronic conditions like diabetes, Crohn’s, or whatever. The basic, day to day retail cost of my wife managing diabetes is $24,000 a year at retail, plus a $6000 insulin pump with a 5-year lifespan. Maybe 5% of the American population could cover that from cash reserves. So the other 95% just die because they can’t afford the free market retail cost of insulin?
Here’s why drug prices have increased 20-fold under the FDA while “safety” of approved drugs hasn’t budged. Hint: government makes it worse. http://www.econlib.org/libr…
andy, cancer, once you get it, is considered chronic, because we don’t know enough about it. We have no idea why cancer cells will lie dormant in the body for years, in some case for a decade, and then come back, raging worse than before. (and more than likely, you’re also probably untreatable) Once you get cancer, you’re basically uninsurable. High risk is also tetchy.
there are systemic forces that make it $1,200 month retail. if we remove those systemic forces, prices come down and capital available goes up.
$10k deductible should be the MINIMUMWell but people would say that if you don’t cover those haircut costs then people will not cut their hair (they won’t do preventive care in other words).So once again we are put in a position with paying for something so we don’t have to clean up the mess later on. Make sense?
People really that useless?
Total losers. First hand knowledge. Seriously.
You can cut your own hair. You can change your own oil. You can extract your own appendix?
The question is “why insure against routine costs”? Appendix removal is not routine. Well visits and a few sick visits is.
Everything’s a routine cost when aggregated across a population over time. That’s what an inclusive healthcare system is.
Ok so why not an inclusive housing system? Inclusive food system?
We already have that. Starvation is not common in the US, we have food stamps. We have plenty of homeless folks, but a good percentage of them have mental heath issues that prevent them from taking advantages of the services that are available. There may not be enough beds for all the homeless in a lot of places, but the programs to provide shelter are out there.
land (on which to build, to grow food) has been privatised. the human genome has not. it is a shared common ‘asset’.the foundational layer of the ‘health stack’ is the human genome. that’s you, that’s me, that’s everyone. the coming age of ‘big data’ analysis (genetics, disease, therapies, cures, prevention) will only work well when every human genetic profile is inside the data system. having millions of people on the outside of the system means a very incomplete data set, and for those on the inside it results in sub optimal health outcomes at scale over time. you must see that, surely?
Because insurance pays for those costs with pre-tax dollars and consumers pay for those costs with post-tax dollars (unless they have a FSA). Given the option between paying for an insurance plan that pays most or all of your medical costs with pre-tax dollars, or paying them directly with post-tax dollars, the first option is obviously superior.
Ok change that
At this point many plans do. Obamacare actually tried to shift employers towards that model with a “Cadillac healthcare plan” tax. The main problem is loss aversion: in a world where the employer is footing (most of) the bill for healthcare the employee is going to just demand the best plan possible and view being put on a high deductible plan as a wage cut. The rationale thing would be for employers to offer their employees higher wages in exchange for taking a higher deductible plan, but for some reason it often doesn’t work out that way.
$10k deductible should be the MINIMUMThere should be no mandates of any kind… people should be left to decide what risk they’re willing to accept for what cost.
Do you have a source for this claim that using insurance for routine medical expenses is the principal driver of unaffordable premiums and/or healthcare costs generally? I see this claim made all the time without evidence; meanwhile, much of the economic literature on insurance focuses on adverse selection and catastrophic events.
the source is an economic framework, which i’ll broadly refer to as true capitalism. the basic idea here is that the economy is like a biological system, and just like any biological system, possesses self-healing mechanisms. from this perspective, it is often more prudent to work with self-healing mechanisms than it is to ignore them or work against them. this is the same logic that suggests eating well and getting some moderate exercise is the best way to stay healthy — because exercise and good nutrition reinforce self-healing properties within the human biological system.likewise, mandating insurance has side effects like crippling regulation that hinder technological and business model innovation, as well as reducing the ability to solve problems through charity.this stuff is hard to prove because it is hard to build a control set and run a double blind test, but if we have a sound framework, decision making becomes much easier and clearer.
Right, so it’s an ideological claim masquerading as an empirical one.
sure. it cuts both ways though. what other claims are there? and are they empirical? some things are hard to measure empirically because there are too many variables to control for and not enough data (for now, at least).
You mean the Fed and fiat currency is bad? Who would have thought? It’s not like Murray Rothbard has ever written books on such understood topics…
gotta get the insurance companies way out of this, the whole problem starts with this idea of needing insurance for any medical visit rather than just for emergencies.Which starts with a society that essentially lives hand to mouth and paycheck to paycheck because they know the government will dig them out of any problem that they have. Same system that allows kids from poor families to get a free ride in college. At a certain point being poor gives you more than providing just a bit for yourself.
It’s clear that you have zero understanding of the root causes of poverty or how one lifts themselves up out of poverty. It’s also clear you lack the basic level of compassion found in most human beings. A lack of understanding and a lack of compassion. Talk about a winning combination.
There are plenty of people that are living hand to mouth that aren’t in the poverty that you seem to assume that I am referring to. You know people with corporate jobs that keep perhaps 6 months of savings in case they loose their jobs. Those people. Or max out their credit cards and then file for bankruptcy.”with a society” doesn’t refer to any particular group of people. It refers to the way many people of every race and color of skin think and act.
There’s mostly a single root cause of poverty: disintegration of the family unit. Now that we’re four generations in on a welfare culture you have people who grow up knowing nothing but free handouts. Mom is incentivized to procreate as much as possible because each mouth is another check from the taxpayer, and good luck finding Dad.We had no welfare in 1789 yet produced the greatest document in the history of man. Welfare is best left to private charity. Or do you not know how mob rule ends?
Systemic reform may be a non-starter, but is there another country whose health system you’d like the US to use as a model?
As someone whos lived in Canada for years, and now is in the US, it’s incredible frustrating to see Americans trying to make healthcare and capitialism go well together.It’s not going to happen.
It’s not actually a “market,” either.
I’m not a healhcare specialist, but im pretty sure you can choose not to get cancer.
Yeah… Go look at the cancer mortality rates for Canada and the US. Your healthcare system is a disaster. Most STATES in the US have more diagnostic equipment than the entire COUNTRY of Canada.
I just looked. You are wrong.
[CITATION NEEDED] Canada’s healthcare system is a joke. Thousands of people go south for critical treatment every year.What’s the current waiting time on a diagnostic MRI? (Hint: in the US, it’s about 30 minutes)
The plural of ancedote is not data. Cancer survival rates, which was your initial point, are not dramatically different between the US and Canada.
Again… [CITATION NEEDED]
As soon as you cite your statement that most states in the US have more diagnostic equipment than the entire country of Canada, and that is somehow casually related to a higher mortality rate for cancer in Canada, which is something else you failed to provide a citation on.
According to the CDC, the allegedly “horrible” US healthcare system has a 3% higher breast cancer survival rate than Canada and a 6% higher prostate cancer survival rate. Heck, in prostate cancer survival rates, the US is almost 15% ahead of the UK with it’s “awesome” socialized healthcare.
And your evidence that those discrepancies, which are also seen state to state in the US, have anything to do with the funding mechanisms for healthcare are……?The death rates for all cancers in the US by state range from 127 per 100K to 193 per 100K. Source: https://www.cdc.gov/cancer/…
That “awesome” UK system is being stalked by US healthcare corporations that want to pick off easy profits.
… and yet, the US somehow has none of these problems… Funny how that works…
Problems?
Only in the Emergency Room. Otherwise you have to schedule one when there is a slot open.
Yeah. Not if you have good insurance.
Lol. Sob.
I don’t have to be a building specialist but I’m pretty sure you can’t choose to have a storm destroy your house. That’s why there is and should be insurance. You buy insurance to protect yourself against low probability / high cost events like cancer or a tree falling through your roof. Insurance should not cover things like routine bloodwork, annual physicals and so on, and in doing so has made insurance incredibly inefficient.
depends on the cancer. and only to some degree. Lots of people can’t choose, either it is familial (unknown genetic cause), genetic, or sporadic (we have no idea what causes brain cancer, for example)
Bad day to come late to the party.Man, I miss @jlm on days like these. Could use some help bouncing the riff raff.
This Ryan plan is a disaster. Trump knew it would be, and let him step in front of the bus where he belongs.Now Rand Paul and Trump will come up with something much, much better and poor little Paul Ryan will be stuck doing his bicep curls in isolation.The GOP has earned their death by a thousand trumps.
Agreed! Trump is totally going to deliver on all his health care promises. If not this term, then next term. If not next term than it’s Obamas fault.
It IS Obama’s fault. His plan was designed to be unworkable and foster a government takeover of the entire healthcare system. I don’t know about you, but I don’t want .gov telling my doctor what treatment is and is not “medically necessary”.
It’s not gov telling your doctor what is medically necessary – it’s your insurance company.
Yes… and I have far more leeway getting a better insurance company than I do getting a better government. Welcome to the free market.
Except all of your insurance companies suck, which is why insurance prices have gone up more than Medicare since inception.The insurance companies are crony capitalists, not innovators.
Yeah… Funny how my insurance is still awesome, despite Obamacare. But again… The point is that when they CAN compete, they DO compete. Right now, there are unconstitutional laws preventing companies from selling insurance across state lines.
If you get it through work, it’s being subsidized by US taxpayers (tax deduction), so you don’t see how ridiculously expensive it is.
Yeah… You don’t know what the word “subsidized” means. The US government has the constitutional authority to spend money on three things, DoD, Interstate infrastructure, and Law Enforcement. Everything else if graft.Oh, and FYI, it’s not a tax “deduction”, it’s just non-taxable, like 100% of your income should be.
You can wish all you want, but that doesn’t mean it will ever come true.I wish we would never have had Jim Crow in this country. Would have saved the need for a lot of this spending now.
Yeah… Because clearly the downfall of the black community was Jim Crow and not the “War on Poverty”… HINT: The black community had a higher standard of living under Jim Crow than today. I wonder why that is? Could it be because the Demokkkrats just decided to switch tactics? (Take a look at the rate of out of wedlock births in 1960 and today.)
I agree, mass incarceration was a huge mistake. Fix it.
Yup… Time to expand the death penalty to cover all gang-related offenses.
You’re a free market guy, yet you voted for Trump? He promised healthcare for all and to badger private enterprise.
[CITATION NEEDED]
http://www.cnn.com/2017/01/…
Yeah… The Counterfeit News Network… What was Pravda or The Terrorist News Network (aka AJ) not available for comment?
Bullshit on standard of living. Just look at high school graduation rates since Jim Crow. Or how incomes went up the last two years.All of this would be a lot better had school desegregation orders and fair housing regulations been followed. Do some research.
Yeah… Because high school graduation rates totally mean something when 80% of inner city high school graduates are functionally illiterate.
https://www.bloomberg.com/v…
I don’t consider a far left propaganda site to be a credible source. Cite a primary source or sit down.
Hahahaha! Far left propaganda site. whooosh
Yeah… Bloomberg’s pet news rag is less credible than Breitbart.
“Everything should be made as simple as possible, but not simpler” – Albert EinsteinSo we should all stop with the simplistic right vs left, my perspective is sacrosanct, polemics and start seriously entertaining opinions from both right and left before declaring one or the other propaganda!Definitions:Education is the promotion of my perspective on reality.Propaganda is the promotion of others perspectives on reality.Operating without a personal check list of introspective window-of-doubt epistemologically techniques is dangerous for all of us !
ok, why is bloomberg a far left propaganda site?
Because of who owns it.
he’s a republican. plus they have a Chinese wall between business and editorial. Plus he almost never seems to actually run the damn business, it seems to run itself through its senior managers by now…
Bloomberg is a republican? Really? You expect anyone to take you seriously after that little gem? Bloomberg is about as far left as it gets… but I expect you believe that MSNBC and CNN are “conservative”…
He ran as a republican. https://en.wikipedia.org/wi…He’s also weirdly fiscally conservative about certain things. The switch sort of made sense.
Yeah… and he funds the largest Astro-turf anti-gun organization in the US… he’s a RINO.
Again not worth a response !But I can’t help myself :-)”Take a look at the rate of out of wedlock births in 1960 and today.”2017 vs 1960 Can you surface any other possible variables you might be conflating ?
You assume the variables you allude to are causes and not effects. The welfare state has done more to destroy the black family than generations of slavery.
I didn’t assume/allude to any variables let alone that they were cause/effect.I just asked you in a socratic manner whether you could surface any variables as an exercise in window-of-doubt introspection.
So “Public Education” = graft ?
Yes. It is not my job to pay to have your kids educated and therefore support my kids’ competition.
So in your world view the social and economic organizing principle for a successful society/country always pivots around “My Interests” never around “Our Interests”?Are you fully convinced that that perspective is singularly cost effective ?
It is for me. Life is a cutthroat business. It makes no sense to take money out of your pocket to support your competition.
YES!We all agree the free-market is a pivotally indispensable/powerful economic tool but an unquestioning blind commitment to that singular approach is still a form of ideological extremism.
I have yet to see a program which was run better by a government than when left to the hands of the free market. When you’re asking me to bet my life on something. I prefer to not hand more power to the same governments that murdered tens of millions of people in the 20th century alone.
Oh, FYI, my “ideological extremism” doesn’t tend to have people winding up in death camps the way socialism does.
Not a market if you aren’t paying for the services yourself. Insurers don’t work for you.
They actually are. That’s what legally binding contracts are all about.
+1 for good bicep curl diss on paul ryan
i think that is what i am asking for, at least i hope it is
Right on
Yes. Let’s start with a full repeal and deregulation of the health industry. Fun fact, a doctor spends almost 50% of his time filling out legally mandated paperwork rather than treating patients. You want to reduce healthcare costs? Make the FDA approval process rational and get the lawyers out of your doctor’s office.
It’s not paperwork, it’s electronic medical records. We need way better EMR technology, but docs need to realize that we are in the 21st century and computers will have to be used. Without data recording, there won’t be progress.
And the reason we don’t have an EMR record standard that works across all medical facilities is profit seeking medical records companies more interested in locking their customers into proprietary data formats than enabling frictionless information sharing. Electronic medical records should be open source.
Support Medal for EMR innovation: https://www.medal.com/
Get rid of HL7 and write something new and moder. HL7 is holding us back.
Given that electronic records can be hacked or grabbed by the government, I’m just fine with paper. Thanks.
Make the FDA approval process rational optionalFTFY
The US needs to add one word to the “Affordable Care” act: Universal.Still surprised that the US is perhaps the only developed country whose government doesn’t provide basic healthcare for their citizens, free of charge.Fuck profits on healthcare. Lives matter more. Stop dicking with half-ass solutions (and pardon my language).Here’s a list of countries providing free healthcare, some of them since 1912 (Norway) and 1938 (Japan). https://truecostblog.com/20…
You offer weak support. Sure, Japan and some European countries, among others, offer universal health care. How exactly is that working out for them? Japan’s economy is the equivalent of a junkie on a morphine drip that cannot survive without it. They are leveraged beyond the point of no return. The EU is crumbling as the Germans are the only adults and they end up shouldering the load for the rest of the countries to belong to the club. The EU as a whole has a non-dynamic economy and Let’s see how long Germany will tolerate those antics. Healthcare costs money. No such thing as a free lunch. Offering “free” things to people requires that the government take the funding from those who have it. Medicaid/Medicare already exist for those in our society that need assistance. Drug companies/hospitals have programs to offer assistance. Where in our constitution did our founding fathers include universal healthcare as a right?
You’re looking at it the wrong way. These stats are unrelated. Look at life expectancies. If the US has such a great system, the average life expectancies are not better than other places. Yes, taxpayers have to pay for it, of course. But it’s a good thing to pay for.
That metric, in isolation, is not right. I’d argue that no single metric can irrefutably claim superiority of a nation’s healthcare system. If I were to speculate on a single aspect, I would argue for access to the best medical care.Life expectancies are largely effected by diet, exercise, etc. It’s no surprise that the United States doesn’t top the list as our diets have gotten progressively worse with larger portions and added sweeteners over the years coupled with less physical activity as more and more jobs involve sitting all day long.This universal health care argument ends up coming down to an argument of socialism vs capitalism. Socialism has never been and will never be a good idea. It is the redistribution of wealth by the government – a la steal from the rich and give to the poor. Socialism is built on the foundation that outcomes should be equal which disincentivizes individuals to work hard. The “fair” way to look at things is equality as it relates to opportunities.
Medical insurance is not stealing from the wealthy to give to the poor. It is taking from the healthy to give to the sick, a social bargain that most people find acceptable. The socialism debate is moot in a country in which everyone is guaranteed emergency care, which the United States is.
I was not referring to insurance. My comments were directed at universal health care.Receiving emergency medical care is not the equivalent of having full health care provided, which is how I’d imagine universal health care to be characterized.
Nobody should be guaranteed anything. It is not my job to pay for your stuff. If you can’t afford healthcare, it’s not my problem or my financial responsibility.
Until we are ready to let people die in the ER or nursing home if they don’t have coverage, it is all of our problem and responsibility. The unreimbursed care shows up in our insurance premiums
I’m more than ready. Again… Not. My. Problem.
Hospitals should hire security guards to keep riffraff out. It would be cheaper than paying $200K for a welfare queen’s emergency surgery.
Or better yet, just take no action. Stabilize the patient, and do what you can to make them comfortable. I am not completely heartless, but in battlefield conditions, you don’t assign a corpsman to take care of the man who just got the lower half of his body ripped off by an IED. It’s not pretty, but even if you COULD save them, the scarcity of the resources means that other people who would have certainly lived, would instead die.
You could label me “heartless” but I’m acutely aware of the transgressions committed by our SCOTUS in constitutional creep. 75% of the federal budget goes to welfare, and as soon as you say “well, we will just stabilize the patient…” it blossoms into something larger. Case law almost aways defers to the broadest application, which is why we must refrain from heading down that path.
Agreed. The core of the problem is created by this mandate in the first place. If insurance costs were not artificially inflated by these mandates, then it would be the responsibility of the patient to have insurance.
I’d love to know how inexpensive healthcare would be if we got the government out of the way. Going off empirical data from drug studies & FDA collusion, I’d content at least a logarithmic decline
Are you a veteran ?
that means a bed and drugs to get them stable, and then figuring out where you are going to move them to which is expensive. It actually would be cheaper to get them insurance and preventive care.
You and I have very different definitions of “stable”. I can stabilize a gunshot wound with a $20 pressure bandage and possibly a $30 tourniquet.
lovely, but that doesn’t mean you don’t have to strip the bedsheets, sterilize the room the best you can.Besides, technically speaking, as a Marine, you don’t get him stabile, the next stage of Military care does, the Forward Surgical Teams, before they are shipped to hospitals (which you should know….). You’re literally just making said person barely transportable to be stabilized with a bandage and tourniquet.
Again semantics. The cost is nowhere near that of emergency surgery and can easily be covered by private charities. I’m not arguing against charity. Heck. Make it tax deductible for the hospital for all I care. That’s not the same thing as holding a gun to someone’s head and reaching into their wallet…. and yes, that means that sometimes you let people die. I consider that a far lesser transgression than pillaging the productivity of millions of people on a regular basis.As for me not getting them stable… again… we have very different definitions of stability. Do you know how long it takes to bleed out from a severed femoral artery?
Funny flashback !Seriously, that was my smart aleck comeback to every thing when I say a teen age kid 🙂
It does not work like that. When the person seated next to you on the train has tuberculosis, it becomes your problem. When your child’s school teacher can not come into work because her disabled daughter needs childcare that she can not afford, it becomes your problem. When your partner is denied insurance because they had cancer and lost their job, it becomes your problem. When your decorated veterans die of preventable conditions because they sacrificed a lucrative career to serve their country, it becomes your problem. When the boy with untreated mental health issues opens fire in the shopping center you happen to buying milk in, it becomes your problem.Until the day comes that you can afford to pay for the training of all the medical staff you interact with, fund the hospitals you visit, and pay for the full salaries of the doctors you consult, then you too are leeching the system like everyone else.
You do realize that the VA is a perfect example for why socialized healthcare DOESN’T work? Right?
Again I respectfully ask are you a veteran ?
he said he was previously
you do know the VA is underfunded? https://www.dav.org/learn-m…Even with the current budget, the VA is underfunded, which is why it is falling apart. Underfunding isn’t necessarily a good explanation of why socialized medicine wouldn’t be good, just why underfunding something is bad. Underfunding the VA without the actual healthcare system, but still having the same health benefits with the money go to private/public normal hospitals in a localized competitive market, and you’d still see a waitlist/problems (because, underfunded)
So where are you magically going to get the money to fully fund socialized healthcare when more than 50% of all spending already goes to handouts?
Then go live on your island of one.
No. Your move.
No rights without responsibilities.
You don’t understand the legal concept of rights then.
Well, if you are suggesting that “rights” include the right not to be taxed at all, or to use violence against democratically elected government that duly enacts a tax with which you disagree, then you don’t understand rights.
So by your logic Jews didn’t have a “right” to use force against a democratically elected government that duly ordered their extermination? Really?This is the reason why we live in a Constitutional Republic and not a Democracy. Mob rule is no way to run a country.
I’m sorry, I don’t have time to debate Russian trolls.
Ukrainian Cossack, actually. But please, keep pushing your delusions. It worked so well for you in 2016. I mean, clearly, you have a DNC controlled House and Senate with Hillary in the White House… Oh… Wait…
Don’t want you to have to work overtime or Putin will have to pay you extra.
You do realize that it’s like 2 AM in Russia? Right?Putin has more important things to do than watch you humiliate yourself.
People forget how Hitler was elected; irony is overwhelming. Democracy is a ethereal concept in Plato’s fantasy land; ochlocracy is the only term people should use.
And there we have it fully exposed !
I will laugh at the irony here, and note that the Khmelnytsky Uprising was also a huge pogrom. https://en.wikipedia.org/wi…(Nice Jewish girl whose family came from Ukraine-Russia-Lithuania on one side)
To be fair, in this case, most of them had it coming. That’s what happens when you live off the backs of people who actually do work. But please tell me all about how benevolent Eastern European jewery was during this period in history… I’d love to hear another far left fairy tale.
Your attitude is a great example of why my great grandfather had to kill a Cossack to come to the US. He was afraid for his life, due to rampant antisemitism at the turn of the last century.FYI, he was a republican once he came here, he really hated leftists, and had strong libertarian leanings.Yes, the Polish-Lithuanian nobility was awful, and yes a very small percentage of the Jewish population did act as tax collectors. Yes, the Polish-Lithuanian nobility should not have been awful missing landowners with way too high of a tax-rate. The vast majority of the Jewish population were not tax collectors (and in fact, still had to pay taxes themselves). The vast majority were things like brewers*, mill owners, small time crafts-people that you didn’t need to be in a guild for.*lots of brewing, evidence by way too many polish-ukrainian-russian-lithuanian liturgical tunes that ironically started out as russian drinking songs. Ah, history, and the funny ironies it creates.
Now here you go taking my comments about a specific incident and blowing it out of context. We’re talking about the SPECIFIC CAMPAIGN you described. Can you REALLY blame the peasants who were treated worse than actual slaves for lashing out at the people helping to perpetuate their slavery?
I find your presumptions about my attitude rather interesting. Given that my maternal grandmother is Jewish and my father is a Cossack.Interesting that you throw Cossacks under the anti-semite bus while probably living your life without ever having met one.
Your comment wasTo be fair, in this case, most of them had it coming. That’s what happens when you live off the backs of people who actually do work. But please tell me all about how benevolent Eastern European jewery was during this period in history… I’d love to hear another far left fairy tale.a)that comment is anti-semitic, no way around it. The TL:DR version is Jewish people deserved a pogrom, which is definitely antisemitic.b) as to throwing cossacks under the bus.No – I bated you because you are hyper-nationalist. You’re very proud of your military service, and you are very proud of your Cossack heritage, despite the fact that it caused problems and made you flee the Ukraine. You see the world as us vs them (or more extremely, me versus them) based on previous statements you’ve made. I made some on a probabilistic assumptions about people with hyper-nationalist tendencies about what you’d say and what you think.And it sort of reminded me of this film, made by the US Military in the wake of ww2https://youtu.be/23X14HS4gLkJust as an FYI:In fact, I actually do know people of Cossack and/or Russian background, though I do not know many people as hyper-nationalist as you are
That’s addorable. You’re in a hole and you just keep digging.1. The problems that caused me to “flee” Ukraine were caused by communists not Cossacks.2. You conflate a 17th century uprising with late 19th century pogroms. That’s an absurd level of intellectual dishonesty even for a leftist. 3. You just accused an ethnic Jew of anti-semitism.You’re done honey. Once you start shouting “racist” you have no actual argument to make.
No, he is suggesting that government has no authority to tax him to pay for others care. He makes no assertion that the Constitutional authority to tax, in order to pay for national defense, is illegal. He, I, you, have no responsibility to pay for others. His property is his, and he has no responsibilities as you are suggesting. Furthermore, his question to you is valid. If a “democratically elected government” is oppressive, then it doesn’t matter whether it was “democratically elected”. Stalin was democratically elected, as was Hitler. Are you asserting that no one had the Right to resist them??Semper fi
How oppressive? Because it taxes you? Or because you don’t like the use of the tax revenue?
No, because the government has no authority for what you support.Semper fi
Art. 1, Sec. 8 of Const. gives Congress power to provide for “general Welfare” and power to tax to pay for it. Broad powers. Supreme court cases agree.
You need to read about it. It has no such meaning as you describe, because it contributes NOTHING to the general welfare of those whose property is taken. If it meant what you describe, then there would be NOTHING that the central government cannot do, provided it says it is for the “general welfare”. The phrase has to do with the Powers ceded to the central government, and nothing more than that. But if you’re still confused, take a look at Constitution.org.Semper fi
Well, that’s just not true. The Supreme Court has decided many cases upholding government payments (welfare, Medicaid, etc.) under the “general welfare” clause. You may not agree. But, that is the law.
I am, not so sure they used the “General Welfare Clause”. Odd that you have failed to cite a single court case, though.
Name one of those cases, please.Semper fi
The “general welfare” that Congress may tax for are the articles listed in Article 1, Section 8. Nothing more. And Supreme Court cases don’t agree.
Nope. Read the cases. Beginning with Helvering v. Davis (1937).
“Indeed, in a free government almost all other rights would become worthless if the government possessed power over the private fortune of every citizen.” Chief Justice John Marshall
If you really believe that the richest country in the world shouldn’t provide its citizens with healthcare because it’s not your problem or financial responsibility then you ought to be very supportive of a mandate. Here was the initial (conservative) argument for the mandate.”If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services — even if that means more prudent citizens end up paying the tab.Many states now…require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Mandate all households to obtain adequate insurance.”
Your argument fails on two points.1. We may care for him, but it does not make it moral to hold a government gun to someone’s head and make them PAY for his treatment. Your argument would defend a mandatory self-purchased insurance mandate, not government funded insurance.2. Liability insurance protects the VICTIMS of your negligence. It does not protect YOU from YOUR negligence.
It must be hell to leave your house (or mother’s basement?) without traveling on a road that wasn’t financed by the government putting a gun to your head. How do you manage?
Yeah… There’s a reason why “muh’ roads” is a meme. Funny how I deployed to numerous countries without functional governments and they still managed to have roads.
1. Agree, this is an argument for a mandate.2. If someone crashes their car it doesn’t cost me anything so I don’t care from a financial perspective. If an uninsured person has a heart attack and is uninsured I pay for it in the form of higher premiums or hospital bills because we as a country have agreed to care for people whether they can pay or not (e.g. I’m hurt by their negligence in not having insurance). Unless you’re arguing that we shouldn’t stabilize people that can’t pay (I’m sure you’re not) then an insurance mandate is a requirement in a society that believes in personal responsibility.Conservatives rail against ‘freeloaders’ all the time. In economic terms there’s no greater freeloader than someone who runs up a $200k hospital bill that they have no chance of paying. A mandate that everyone has health insurance seems to me to be a perfect conservative principal.
I object to forced charity. That’s the core of my argument. Realistically speaking, part of the reason why the hospital bill is $200,000 is because the hospitals KNOW that SOMEONE will be forced to pay for it and thus have no incentive to reduce costs.I don’t agree with the “treat everyone regardless of economics” argument. While I can see the heartstrings being pulled, it is not a logical approach to distributing a scarce resource. I similarly don’t see massive government programs as the solution to the problem. (Look at the VA for an excellent example as to why.)Unfortunately, we do not live in a post-scarcity society. That means that, ultimately, human life DOES have a price tag. It makes no sense logical to spend a half million dollars treating a crack head who got knifed at his local drug den. There is no logical argument that you can make that would justify that expenditure as a net benefit to society.The way I see it, the best solution is to get government to stay completely out of it. Remove the legal requirement to do anything other than stabilize people who can’t pay and remove any impediment to companies competing for insurance customers. (A good example is the mandatory maternity and birth control coverage that I have to buy as a single middle aged man.) As was the case before health insurance was a thing, the free market and natural charitable giving will more than make up the shortfall in logical cases.My argument would rest solely around personal responsibility. It is YOUR job as a responsible adult to take care of yourself and your children. If you fail in that responsibility, it is inherently immoral to force that responsibility on others. That’s why I oppose any form of welfare. As the data shows us over the past few decades it simply DOES NOT benefit the people it’s supposed to. The welfare state has outright DESTROYED communities and forced GENERATIONS of people into perpetual poverty. Why? Because welfare makes poverty COMFORTABLE.
If you’re acknowledging that we should force the hospital to stabilize the patient then you are acknowledging that you and I must pay for that in some form. I know you don’t like it but that’s just a reality. It’s a fact. We are paying for that patient to be stabilized. Period.So you’ve now accepted the fact that society is going to pay for healthcare for those that can’t pay. Knowing this, from a practical perspective, wouldn’t a mandate on insurance be a step forward in making all of this more fair for those that are paying? All you’d be doing is lessening the pain for the people that have insurance. This is what confuses me. I really believe that the mandate is perfectly aligned with a conservative viewpoint.
I can understand the moral argument. I didn’t say I agreed with it. I can agree that a mandate is only necessary so long as you create the problem in the first place by forcing hospitals to treat people who can’t pay.
Private companies have to put a value on human life and buy insurance policies (think airlines) against them. There is a dollar amount we can put on anyone’s head.
No, because welfare buys votes. Since LBJ’s war on poverty we’ve spent like $60T on welfare and as a % of population the same number of people are classified as destitute. Don’t feed the animals.
Then, you just need to not use any of the assets or services that are provided for you by society as a whole.Like roads. Or sewers.
As I said elsewhere, “muh’ roads” is not an argument. I could go into debunking that old gem, but I’m sure your Google-fu is good enough to educate yourself.Let me give you the simple version.Everybody benefits from roads. Only people who can’t afford good healthcare benefit from socialized healthcare, everybody else gets stuck with their bill.
Wrong.I benefit from people everywhere being healthier, as my risk of disease lowers, dramatically.Immunizations paid for by the government have a direct benefit to me as an individual.Try again, 3 for a quarter.
Please tell me how you benefit from the government sending a half million dollars to stitch together a crackhead who go knifed at the local drug den.
crackhead doesn’t contract something that becomes an epidemic.Keep trying though.
Not an answer to my question. But keep trying.
You asked for a benefit, I gave you a valid benefit.Costs are another thing.
I asked you for a benefit from a specific example.
?Cholera.Happy?
My specific example smart one.
honestly need more clarification as to what it is that you want.
How do you benefit from the government spending half a million dollars patching up a crackhead who got shanked at the local drug den?
As opposed to letting them die in he streets?
Yes. We’ve discussed this. We’re talking about logic, not emotion.
That’s not a healthcare question, really.Why do we presume people innocent?Because wrongly convicting the innocent undermines the entire system more than wrongly freeing the quilts.Once you deem someone worthless, you put yourself in the position of judging the value of others, which is the first step to genocide.
Not really. We don’t presume anything. If the person can’t be bothered to buy insurance, then they run the risk that they run.
I don’t expect to change your mind on the obligation of the strong protecting the weak.However, from a system perspective ( and modern western democracies need more system thinkers in charges – China has lots of engineers in government leadership positions, for example ), the right call is to choose the core characteristics of the system and enact policies that create those outcomes.I have had European raised friends say they would trade off the top end return on their work for more security via government programs / support; Americans regularly vote against their economic interests to protect their free market ideals.Neither is wrong, just different core system characteristics.
I would clarify that the strong should protect the weak against OTHERS, not themselves.
actually, you gain other benefits, like if they lose weight, you get added benefits
I don’t have a car an travel very little why am I forces to subsidize people why travel a lot ?
You don’t. Roads benefit the nation as a whole. Without public roads you wouldn’t be able to live in a 21st century society.
“Roads benefit the nation as a whole.”And there’s your argument for better healthcare for ALL U.S. citizens. A healthy workforce improves our economy. “Healthy” means physically and mentally. Follow this notion to its logical outcomes and you arrive at a more “free” society. “Free” meaning able to enjoy “Life, Liberty, and the Pursuit of Happiness.” Substitute “healthcare for all” for “roads” in your statement and you COULD arrive at an epiphany. I invite you to give yourself time to think about that.
False. The people socialized healthcare supports are not part of the workforce. Strike 2.Fun fact, you do not have the right to hold a government gun to other people’s heads and take their stuff so that you can “pursue happiness”. That’s called communism and we know how that ended.
Ok, I stayed out of all of this as long as I could…but one minor point of disagreement and it happens right here: “The welfare state has outright DESTROYED communities and forced GENERATIONS of people into perpetual poverty. Why? Because welfare makes poverty COMFORTABLE.”You are completely correct that the welfare state has destroyed communities and forced people into poverty. But I disagree with the assertion that it is comfortable. It is humiliating, embarrassing, painful and degrading. The quality of the buildings are generally substandard. The pest problems from people who live in the “people’s” housing throwing dirty diapers on the floors of elevators or failing to keep themselves or their apartments clean are absolutely unbelievable. The lead paint, poor water quality scores and other failures of government run programs are all apparent.I did everything I could to convince my parent to get off Section 8 and start a business but she was always too worried about “losing her housing.” I wished we could lose it in a hurry and burn it down besides. As soon as I was able, I moved into the most expensive apartment complex I could find. I was lucky because I did not drive-still don’t know how-and therefore had no car payments/insurance/gas/maintenance to worry about. Practically every penny I had went to living there…with barely any furniture I might add. Because I was desperate to live where there were no roaches, no dirty diapers and no trash bags in the hallways.My point, if I am allowed one, is that not not everyone wants “free housing” or “free anything” for that matter and people take time to develop. Allowing them to die or become ill from environmental effects like poor water and lead paint before they have a chance to develop into what others may consider “worthwhile” seems like a society bent on shooting itself in the foot.
Let’s be honest, 90% of the discomfort you just described is self inflicted. I just visited family in the Ukraine this year and their rundown soviet era apartment complexes are in much better shape than the garbage you just described in “Section 8”. Perhaps there is a cultural issue caused by the welfare state as well?
“Discomfort?” &^%$” !!!!A leading cause of childhood asthma is cockroach detritus. A leading cause of childhood behavioral issues is lead in paint/water. Both of those things lead to long-term medical issues and I would wager to bet-I’m not in the mood to Google any fancy graphs-that long-term social disorder is also a side effect. Which as all you should know is very very $$$$$$$.I didn’t say it wasn’t self-inflicted. In fact, I was pretty clear that some of the people in the complex did not take care of themselves or the “people’s” (read: socialist ownership) property. My comment was aimed at the fact that you seemed to be implying that everybody in these types of schemes are living the life of riley. People really only care about what they themselves have actually earned and purchased which is why all of this nonsense about UBI is a VERY bad idea. We have tried this already and if the AA community is any guide at all, it will simply magnify personal failure to a completely uncontainable degree. The same can be said for public schools, public housing and public food. Remember “Gov’t Cheese?” Well, I do…and I also have family members who used to give away their 3 gallons of “free milk” because they couldn’t drink it all. But American farmers are going bust providing all this “free” stuff while at the same time trying to feed us all in the manner to which we have become accustomed.There is no such thing-at least not a wanted thing-as “free”. Last year, farmers, according to the WSJ, dumped 43 M gallons of drinkable-sellable-milk on the ground. A farmer in Michigan dumped 40K lbs of cherries due to all the regulatory crap surrounding food production/distribution. More government is never the answer. Drop it all and let the free market handle it. That stands for everything: roads, bridges, schools, housing, and yes, even milk and cherries.Just imagine for a moment how much smaller the Big G would be if the departments most affected by what I just proposed were to suddenly poof into thin air. NO Dept of Ed, NO IRS, NO AG, NO HUD, NO DOT. Do you think that anyone would drive on a road/bridge rated D- or worse if was owned by MacQuarie? No, sir…and those people who fell off I-35 a few years ago would probably welcome them with open arms because MQ doesn’t build bridges to nowhere…..
We can agree that more government is never the answer to fixing government created problems. That being said, crating a sense of community is going to take a lot of work for people who are used to not caring.
On a side note, good for you. As an immigrant I know exactly what you’re talking about when you describe pulling yourself out of that sort of garbage. I grew up in the Soviet Union where even if you had money, getting food on the table was not a trivial exercise (I won’t even talk about how hot running water got to be unreliable enough to be considered a luxury.) Compared to that, what you’re talking about sounds like either self-inflicted stupidity or just plain whining. (FYI lead paint is not so much of a problem unless you make a habit of literally chewing your walls.)
You’re always allowed point @ Fred’s bar.We only bully bullies here.
to be blunt, cancer can easily be $200k because of drug costs, plus surgery, plus radiation, before insurance negotiations. This doesn’t include experimental drugs, like immunotherapies, one of which just busted the over $500k mark by itself and comes with a refund if it fails.a 28 day supply of Lynparza, a PARP inhibitor is $3,348 according to drugs.com (breast, prostate, and ovarian cancer depending on the BRCA mutation on the tumor). PROLEUKIN, for metastatic renal cell carcinoma is 3,080.88 per injection (one dose). Memorial Sloan Kettering now has a drug policy and pricing outfithttps://www.mskcc.org/resea…(which put together this handy pdf https://www.mskcc.org/sites… ) because they take the hippocratic oath seriously.They’ve also decided that they will not prescribe Zaltrap because it isn’t any more effective than existing medications and has crazy costs, at $11,063/month. Then they wrote an editorial about it.http://www.nytimes.com/2012…Bad insurance and cancer will bankrupt patients. If you get cancer, unless you have excellent insurance with no cap, and you manage to keep it until you get medicare, you might possibly be very screwed if the ACA goes away.
Not my problem and not my financial responsibility. Like sucks. Get a helmet.
There is no helmet for cancer. You can live a healthy life and still get it.Very few people can save enough to early detect and surviveAre you ok with killing people?
I did two tours in Iraq. What do you think?It is not my job to spend my money for the benefit of other people.
So did friends of mine (they also did a couple in Afghanistan). Not all of them agree with you.
Well… it takes all kinds. But if you have a problem with killing people, ground combat positions in the military are a poor career choice.
They were ground combat and officers
Ah… That explains it. Officers very rarely get personally involved in combat. The overwhelming majority spend their entire careers pushing paperwork and passing canapés.
Oh, and one of my to-be-cousin-in-laws served in the Navy as a doctor and I think also did a lot of front line surgery (orthepedic!)
Law isn’t required to be moral. Nor is government. Where did you that idea from?There is actually a whole theory of law premised around the government gun idea (legal positivism) premised by John Austin. https://plato.stanford.edu/… (And I should note, this is a classical liberal view in the realm of John stuart mill and Jeremy Bentham. )
You see, we have this thing called the Constitution. It lays out exactly what the government is allowed to do. (and the sum total of what it is allowed to do) Nowhere in the Constitution is listed the authority to confiscate my property to give it to others. Pretty sure that there’s a specific prohibition on that point.
I could point out the constitution is the gun, and indeed, there are provisions in broad readings for the federal government to do just that vis a vis the interstate commerce clause alongside the amendment that allows for the federal income tax.You could opt out of the social contract that is the constitution as the gun, you know?
You do realize that the the ability to tax does not imply a repeal of the 5th amendment. Nowhere in the CotUS is the federal government granted the authority to create a welfare state of any form. The entirety of Social Security is grossly unconstitutional because once you pay out cash to individuals the taxes seized are no longer “taken for public use” but are instead redistributed. That, is an authority the federal government DOES NOT HAVE.
It’s not an either/or decision. US is a hybrid system. Lots of opportunities and incentives to succeed in all kinds of ways, including financially. Not always equal opportunities yet. But, backed by a social safety net that expresses our humanity and our commitment to community.
“Socialism has never been and will never be a good idea.”That is why every nation on the planet has implemented some socialist economic components even the USA.As the old cliche go “it takes to wings to fly”.Show me a nation-state system that needs no commonly financed/executed mechanisms. As the famous quote goes “we are all socialist now”. It is just a matter of clear intelligently dovetailed degrees.We are in an age of organic interdependencies. We don’t have the time to waste on 19th century left-vs-right polemic framing.Politics driven by social goals, functions, methods and stockholder integrated interdependency optimization is the order of the day.New technologies are imposing an inevitable degree of socialism by virtue of their ubiquitous unstoppable social/economic network-effect substrate.Pure socialism like pure capitalism is long dead a as viable ideology! Lets start applying imaginative network-effect solutions to our emerging organic interdependencies by ignoring the old ideological polemic labels.
You do realize that the life expectancy issue has far more to do with the obesity epidemic than with healthcare? Right?
Food quality is another big ball of wax that the US and even Canada need to fix for sure. And it contributes to higher healthcare costs.I think we can continue disagreeing on this, and that’s ok. Two different philosophies at stake. I believe that healthcare is a right. Others believe it’s a privilege.
Healthcare inherently cannot be a right. It is the product of the labor of others. Saying you have a “right” to the product of other’s labor is no different than saying I have a “right” to own people to go pick my cotton.
A right can be anything a society democratically decides to enforce for the common good.You of course are welcome to your own definition.
I go with the accepted definition that has been around since the enlightenment. Not SJW nonsense.
So why don’t the afflicted here just move there? I’d sacrifice a one-time payment of $5K per person to get them out of this country if it means our voter base would now declare welfare programs unconstitutional, as they were until FDR
The whole point of a blog like this is to have civilized debate. Why don’t you move somewhere else if welfare programs bother you so much?
This is a civilized debate; I’m discussing the downfall of our republic. Over/under on secession or civil war in the next 20 years?
The answer is that many countries have stricter immigration policies than the United States. For example, Australia (offers universal healthcare) has a multiyear waiting list to determine whether or not you are worthy of being allowed to come live in their country (read: are you a net taker or a net contributor). When the government offers costly “free” things, some of them realize that they must control immigration better.Medical tourism, on the other hand, is a real thing in which people go to foreign countries for certain procedures that are either less expensive or unavailable in their home countries (i.e. drug that isn’t FDA approved but it is available in Europe).
Unless you plan to make doctors, nurses, etc work for free, there is no such thing as “free” healthcare. Every country with “free” healthcare has worse patient outcomes for critical diseases than the US.It is not my job to pay to somebody else’s healthcare.
Not really. That shows you don’t understand how a universal system works. And I’ve already mentioned this a few times here. There are hundreds of doctors making over $1M/year in Ontario alone. Everybody bills as usual, but the rates are not extravagant, and there is a single payor.
Is that why people are running south to the US for healthcare and why the average wait times on diagnostic imaging are measured in weeks rather than hours?
I can get a no-wait-list MRI here in Vancouver BC Canada for $700-US if I feel it is crucial or any other diagnostic free-market service for that matter.That unlikely free-market MRI fallback need at $1000-CDN is a lot cheaper that paying ongoing American healthcare rates.I’m 67 and I or my wife have consumed our share of health services and surgeries over the years. We have never experienced any serious wait time for critical surgeries or any health critical service for that matter.I personally know only one person who has run south to Texas in hopes of more advanced treatment for a rare brain tumour and in the end the doctors in Texas told them they should return to Vancouver because it had the best expertise regarding the particular specialty required for their case.Other smaller poorer provinces may be worse off relative to wait list. Probably the biggest failing of the Canadian healthcare system is the fact that it is left to the provinces to administrate. A mistake the GOP seems interested in implementing in the US.The Canadian system is not perfect but most Canadians would be horrified to be force into an American style healthcare system.
I don’t pay $1000 for my health insurance in a year, it sounds like you’re getting very biased data.
How disingenuous can you be!It is not all about you. It is about the overall healthcare system. Sooner or later you will not have employer coverage and will in your own words become one of the medicare freeloader you seem too eager to disparage.Or maybe you will be forever young. I wish you luck with that 🙂
Or, more likely, given my family history, I’ll be dead long before it becomes a problem. (Given how many times I got shot at, I’m shocked I made it to 30.) There is such a thing as a retirement health plan. If you don’t budget for it, that’s hardly my problem.
Never concede a point !Cheers 🙂
No, they do that for expediency.Running is inaccurate, as well.American medical professionals are addicted to MRIs, likely because it is the best way to prevent getting sued. Prevalence of diagnostic apparatus and usage is more a function of the disastrous legal system.
You’re not 100% wrong. However, I have had three cases in my life where MRIs were critical diagnostic tools. Once, to plan the reconstructive surgery of my leg after I got home from Iraq and twice to make sure I wasn’t bleeding into my brain from head trauma. The absence of such tools is a serious problem.In my opinion, MRIs should be the diagnostic standard in any cranial trauma case. Even a mild concussion can cause serious issues that an MRI will detect almost 100% of the time.
Study medicine as well? or economics of medical systems?US Docs MRI everything as litigation prevention insurance. Major cost issue.I had a 2oz eye antibiotic Rx in California last week. $47.Drug margins – major cost issue.Guess which 2 major cost issues do not occur in Canada or the UK?Duh.
As a matter of fact, yes. My undergraduate degree is in bio-mechanical, mechanical, and aerospace engineering. (Fun fact to get from any one of those three to the other two is an extra semester.)I’m nor arguing that the costs are absurd. What we disagree on is the cost. I don’t think more government regulation is a solution to a problem created by excessive government regulation. As I said, I work in patent law. You’d be shocked how much of the cost of brining a new drug to market is regulatory compliance overhead.
No, I wouldn’t be surprised.Your standard starting point that you know things that no one else knows or considers is a major fault in your approach.
Here’s the diff between you and Larry Bird: he is so arrogant, he walks into the locker room of the first ever NBA 3 point contest and says, so everyone can hear. “Who is taking home the 2nd place money?” Then he goes out and wins.’not 100% wrong.”hint: rhymes w “Hoe, truck four/wealth’ but uses G, F & Y.Jackass.
Yeah… Stay classy bro. Stay classy. This is why I love debating leftists. It’s adorable when they start to spazz out like eight year olds.It’s even more adorable in person because you see them thinking that they can safely take a swing at an armed 210lb USMC veteran. …then lizard brain self-preservation kicks in.
Wrong again.One of us is in lizard brain mode, but its not me.You’re the one that pulled the ultra arrogant ‘you are not 100% wrong’ move out.I’ve schooled half baked jackasses here for the better part of a decade. You are in way over your head intellectually, pal.If you brain was working properly, you will recall I am a social liberal fiscal conservative. In the USofA, I’d be a Republican, no doubt.Nice lizard brain labelling though.FWIW – I’m 6’3″ 225 and I grew up in the bush of Northern Canada (hell, my old Man owned an M1 – in Canada – for kicks).Andy Swan is 6’9″ and God Knows What (he’s in shape though, I guarantee it). At least he carries the Libertarian banner with some logical consistency and intellectual rigour.He’s also not in an emotional state where he would not help an injured child that was not a direct relative (read your posts, pal, that’s what you said).Get some help.
Nice straw man there bro. I didn’t say I wouldn’t help. I said I wouldn’t hold a gun to SOMEONE ELSE’S head and FORCE them to help. BIG difference.Oh, and size doesn’t count for much. You’ve got almost a foot and barely 15 lbs on me. Betcha I know which one of us benches more.But please, tell me more about how a welfare state jives with your alleged “fiscal conservatism” when the US government spends more than 50% of its annual budget on entitlement programs.
Stay with your own game.You mentioned armed, said it was cute, blah blah blah.Keep pumping your own tires until you feel better about yourself. Just do it somewhere else.As for your distraction of a new line of argument, as a Trump Objectivist (not a popular position hereabouts), I think the current President is exactly what Bush 43 was not – someone with the experience to bring people in around him to properly allocate resources to operations. People beak that it is running government like a business….it is not.Its setting out strategic goals and funding them appropriately. He has a better shot at it than anyone in recent history, given his skills.
1. I have never had to resort to even drawing my firearm outside of uniform. I’ve never run into anyone quite THAT suicidal.2. We’re actually in broad agreement about Trump. That’s kind of shocking.But I would love to hear what you would allocate resources away from to pay for a larger welfare state. This should be good.
His plan is pretty clear:- take huge swathes of the federal government and eliminate them- reduce regulatory oversight and its enforcement cost at the federal level- shift burden to statesClassic Donald J Trump move: looks like he is winning, but he’s really just making somebody else lose.I don’t have the right answer, yet. When I do, I’ll run for office rather than run my mouth.
I feel really short next to andy. I’m not short
You kinda came out swinging there. You’re not a 100% wrong is a way of acknowledging you got some things right, and in some people’s not really ever going to admit not rightness, that’s concession of some level of respect.
JamesHRH:we are Knicks, NY Giants, Yankees, NY Rangers, Liberty supporters.We root against anything coming from Massachusetts. But Larry Bird was confident.Arrogance isn’t the right word for the event you described.
It will also overdetect in some number of cases(false positive), causing someone to have their head opened up unnecessarily, putting them at risk for unnecessary infections and prolonged hospital stays. (things that happen with complicated surgeries like opening up someone’s head to relieve no-existent intracranial pressure from a non-existent bleed inside one’s skull. You’ve broken the blood-brain barrier in open air, and even surgical wards are not 100% sterile)Statistics are annoying, but unnecessary surgery kills people as much as not getting necessary surgery
[CITATION NEEDED]
Incidence of positives in general for a head scan is 0.4%, mostly because people with migraines come in wanting head scans. False positives are usually measured on a per-type of scan, and there are apparently many types of scans for the many reasons people get their heads scanned.(american college of radiology guidance on head/brain scans, https://acsearch.acr.org/do… )I do know there is enough controversy over the sensitivity of MRI causing false positives in other use cases (acl, breast cancer screening), that it is a safe assumption that MRIs do have a reasonable false positive rate, and unless there is a reason to think you are undergoing blunt head trauma or you are having a lot of sudden severe headaches, you should probably skip the scanAs for death/complication rates, the government benchmarks it, and (or at least was) pushes for their use as part of the ACAhttps://www.qualityindicato…https://www.qualityindicato…(as they are tied to medicare billing rates closely, due to the way the ACA is written, which I read, screw up and kill people/make them sick, you don’t get paid.)
So… You’re not arguing to my point which is that MRIs are an invaluable tool for cranial trauma diagnostics. False positives due to over-use is not an argument. If you go into the hospital because you have a headache, you need to put your big boy pants on. The only time I’ve been in a hospital is severe trauma or infection.That’s the problem with liberals. You stub your toe and you call an ambulance expecting other people to pay for it.
I happen to get an MRI with contrast yearly because I am high risk for breast cancer due to my family history while also having dense breasts, and that is the current standard of care based on my age and medical history. I happen to also get it at a hospital annex because that’s where my doctor prescribes it. My doctor(who is also a researcher, I might add) and I have discussed it intensively because there is a significant false positive rate for one of MRI breast screens (which would lead to really painful, very scary, needle aspiration biospy), though the incident of false positives for repeated, annual screening (especially by a breast radiology specialist) is far lower, due to the ability to compare historical images. My political beliefs have absolute no relationship with my disliking, or liking of screening.My statements about statistics are generally factualI’m arguing that tools should be used as needed. Liberal, conservative, or nationalist, false-positive rates exist, alongside false negative rates. They are directly related to the sensitivity of the test. I can’t think of a test where the sensitivity and specificity aren’t related, and where there aren’t tradeoffs in sensitivity with a type 1 error rate (false positive) or specificity and a type 2 error rate, (false negative) be it medical or a probabilistic test for colors of gumballs in a machine.https://en.wikipedia.org/wi…
I can actually relate to that as my mother has the same problem. Given that she avoided MRIs for years and then was lucky enough to catch her breast cancer at stage zero (a fact for which I will be eternally grateful), I think she would have far preferred the occasional unnecessary biopsy to the radiation therapy she had to undergo. My grandmother (her mother) was not so lucky. We didn’t catch her cancer until stage two. Right now, ten years later, she’s in early stage four and almost certainly terminal given her other health problems.Bottom line, the occasional false positive in high risk cases is far preferable to missing something like a sub-dural hematoma or early stage breast cancer. In my case, I actually own six high contrast scans of my brain and can show you the effects of a cracked skull and severe concussion in nice before and after slides. FYI, because I have those scans, my particular false positive rate would be through the floor because doctors have almost a decade worth of baseline scans to compare to.
The citations are all over Cochrane.
So provide them rather than this non-argument.
pwrserge:now this explaination is sufficient in explaining your train of thought. Anyone that attempts to convince you on opposing your view would not be using common sense. Thank you for your service and please go get help.
You’re addorable.Now get in the helicopter.
I live near Detroit and I can tell you that the Canadians also come over to because the Canadian health doesn’t build redundant, under utilized equipment but rather contracts to send Canadians to use US facilities which actually saves us money too. Those damn Canadians being frugal and all give government a bad name.
For elective and non-urgent cases, waiting is OK. Urgent cases get done faster. I know that fact.
Unless your non-urgent case turns out to be more urgent after all. Stefan Molyneux would probably be dead from cancer if he didn’t go down to the US to get his throat looked at.
The minute you bring an individual anecdote into a population level health policy discussion you have lost every bit of credibility.
Not really, it’s called illustrating a point. Once you declare victory when none exists, you’ve already lost.
No, it is cherry picking data.The only relevant data in health care policy is statistically important sized cohorts.My uncle won the lottery does not carry over to everyone should buy a lottery ticket.
No, but if your uncle gets hit by a car, it is a data point showing that such a thing is possible… do you eon logic bro?In the US someone with his income would have exactly zero chance of not getting the necessary treatment. In Canada, that chance is not zero and is thus infinitely higher. That proves that the people who are actually worth anything do better in the US than in Canada.I don’t care about averages when you include barely sentient welfare rats in the equation.
There are hundreds of doctors making over $1M/year in Ontario alone. Then you can’t call it “free” healthcare.
no one ever does.
Except @wmoug:disqus who said there are a number of countries who offer “free” healthcare.
It’s a dumb gotcha issue – free to user does not mean free, it means universally available.
It’s free to citizens, but HC providers still need to get paid. The gov is like a single payer. Hospitals are given budgets to break even, and doctors charge according to codes, etc.
It’s free to citizensUnless the government raises its own capital to pay for said healthcare providers, it is very much not free.
It’s about budget allocations and priorities. as simple as that.
Thanks for taking a stand William.
I second that, @wmoug:disqus
When I was stationed in the UK I had several occasions to seek medical assistance from other than US Military sources. The level of care was what at the time I would have called “minimal”, as well as several decades behind what is common practice in our hospitals. Now, this was in the 1980’s, so it may be different now, but I suspect it is not. Socialized medicine inherently provides lower quality care and fewer options.
It is different now.
Socialized medicine is by its very nature stagnant, rarely improving, because while the people want better care they are rarely willing to put for the public funding to make it happen. So while I would love to believe your claim experience indicates it is unlikely. I know I can find this out for myself, but the following question is the point I am making. “How long is the average wait for a hip replacement in a non-private hospital right now, measured in years?”
You definitely have several misconceptions about this. Government funded is not the same as socialized health care. Your hip replacement data point is not really an indicator of anything. Check Canada’s or the UK systems.
You should have read my earlier post a bit more closely, I have actually been in the hospital in the UK, more than once. I know the conditions, I know the tools and techniques, and they are decades behind what is available here in the US.
“Every country with “free” healthcare has worse patient outcomes for critical diseases than the US.”Data please?
Google CDC cancer survival rates. There is not a single country in the world where the rates are better than the US across the board.
Granted that is true but you really cherry picked your source and the health variable you choose to compare but regardless most credible sources have very similar stats for 5-year cancer survival rates,———Breast___Colon____Lung ___Prostate____Child LeukemiaCanada—85.8—–62.8——17.3——-91.7————90.6USA——-88.6—–64.7——18.7——-97.2————87.7So given the fact that the stats are almost equal you are inflating the USA health outcome for this single cherry picked outcome.This very small 5 year cancer survival difference must be weighed against the significant financial impact it make on the average Canadian vs American patient and their surviving family members. Given a choice I and many others middle income people would probably choose a few months shorter survival against serious financial hardships for our striving families.Now let see you come up with a wider set of health outcome comparisons that favour the American system.U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries —>Forbeshttps://www.forbes.com/site…Now that does not make Canada look too good either as we come in 10th place just ahead of the USA in 11th place , call it a wash?Key differences:- Canada spends only 10.7% vs USA at 17.1% of GDP- everyone is covered in Canada no scrambling or coverage- Canadians have no financial stress or healthcare bankruptciesThese differences help put a secure financial footing under every individual and family as well as every small and large business in the country.
I’d say that a large portion of that is over-regulation and dependent on what you consider “healthcare spending”… As for “healthcare bankruptcies”… You’re talking about a “problem” that is both very rare and only exists because hospitals are forced to treat people who can’t afford to pay.
I’m not willing to research how rare healthcare bankruptcies are in the USA but many Americans end up in deep financial stress with high deductibles/co-pays that may be just short of bankruptcy.That possibility hang over nearly every American as nobody knows whether they will someday be unlucky enough to faced a very serious health issue.Even if you are right that health related bankruptcies are rare ??? it still hangs like a bad luck worry cloud over ones life.
Hardly. I have exactly zero chance of healthcare bankruptcy unless I manage to goof by the numbers for multiple years in a row. Believe it or not, I’m more worried about my next cup of coffee. The same can be said about all my relatives in the US and every one of my friends. Funny how my family OUTSIDE the US doesn’t have that level of financial security.
End of trolling me – Thanks for playing.I’d wish you good luck but I now realize you don’t need such trivial things 🙂
Are you Sean’s alt account? Because the tedious ad hominems and non-arguments are getting repetitive.
Trolling isn’t a name, its a verb.Immature dip-shit is an ad hominem, name calling example.
Accusing someone of trolling most certainly is attacking them and not their argument. The textbook definition of an ad hominem.
Wrong again.It is a description of a series of events by one party that implies that the other person is a troll.You are a fucking dipshit is an ad hominem.
Just keep digging, there’s gold in dem dere hills.
As you are fond of saying, #notanargument.But, also, #notalogicalresponse .I believe this bears repeating – wrong again.
Also not an answer – generalized question of financial bankruptcies answered by specifics of your situation.I get you are the center of your life and arguments, but you seem awful pugnacious when others fail to answer your points.How about a little accountability on your logic?
Also not an answer.
Good point on that one. Curious what it is for CHD.
Yeah…. I’d bet not that different once you normalize for relative obesity rates.America is fat, that’s not a problem with the healthcare system.
It’s true of 5-year cancer survival rates. http://www.ncpa.org/pub/ba596
Show us your sourceS for that claim !And no Breitbart does not count 🙂
WRONG. The United States is something like 17th in outcomes, and 1st in cost. Your credibility will increase when you admit you erred in your statement. Our discussions as a species will get better when we require people to state relevant facts when we have discussions.
Yeah… [CITATION NEEDED] Betcha that this study was not normalized in any way for the differing populations in the countries involved.
Every time someone says this, I ask the same questionWhy should I let you use drugs and clinical tests based off pieces of my body and my genome? (Note: I participate in trials, and will probably continue to do so, for a huge variety of reasons)Either we’re in this together or we’re not. You’re just as much of a datapoint as I am in the end
Because you were paid for your participation and waved all further rights when you did.
a)I actually didn’t wave all my rights, mostly because I do read the stuff I sign involving medicineb) If I get paid,(which isn’t necessarily true, so fun fact, people pay to be effectively in clinical trials and not know it, ha….) it’s a nominal courtesy fee. It also doesn’t cover the costs of data resales, cost to the company to recruit patients initially, or a whole lot of things that go into producing a drug.c) You talk a good game about Morals, but if I say Henrietta Lacks’s problems are still somewhat common, and definitely will become more so repealing chunks of the ACA,based on your previous response, what you are actually saying is you are ok with stealing (and in fact, letting someone else die) in order to survive longer yourself. That’s not ok. There is a reason why we created things like iRB. We want to move away from what happened to Henrietta, not go back.(She’s now a germ line of cells)
Yeah… You’re taking the argument to absurdity. A person isn’t measurably inconvenienced from providing a cell sample. But please, keep digging.
She didn’t provide it. The sample that became the HeLa cell line actually was just taken without her permission or knowledge during her treatment for cervical cancer, and then the dna was sequenced without her family’s permission or knowledge (and published) which means sections of her grandchildren’s dna was just stuck on the internet. (and then someone just felt like sticking up some of the family’s health records)Just to be specific about what you’re advocating. You’re ok with someone taking pieces of you and using it without your permission.
When I don’t even know they are missing? Sure. It doesn’t harm me in any reasonably describable way. A massive social welfar program, however, would take yet a larger portion of my income and provide me with inferior medical service to what I already have.
so it wouldn’t harm you if that sample was sequenced as part of medical research and the results were put publicly on the internet, including how the sample was obtained (aka pieces of your medical history)?
I don’t see the harm.
I hate to break this to you, but human life is not a scarce resource, quality healthcare is. It is much more important to make sure that the productive members of our society can purchase the best healthcare on the planet than it is to make sure that every worthless welfare leech has full dental coverage. Quite frankly, it is not the job of the US government to take care of you by holding a gun to my head and reaching into my wallet.
But they voted for some other people who decided to send armed men to your home to perform the financial extraction so that makes it OK.
viva la ochlocracy!
Its unAmerican, not in the literal, but the philosophical sense.Never gonna happen.
“BLAH BLAH OTHER DEVELOPED COUNTRIES BLAH BLAH”Let me stop you all right there. I know it’s easy to forget, but the United States is the home of almost every medical technology, procedure and pharma innovation of the past several decades.This is precisely because we have a for-profit motive in healthcare. Think about it— what other industry would you want attracting the best brains and biggest capital other than health care?So before we accept lectures from the moochers that spend the fortunes they save by not having to defend themselves properly on the innovations that the USA provides to the global market… how about a quick “THANK YOU.”
Thank you USA for having the best health care in the world.Now if only I could afford it.
15 years ago LASIK was $5k/eye and not pleasant. Today it’s a half day off work and $2k to have 20/20 vision. Profits drive innovation. High costs come down. Wealth is created…and yes… healthcare will not be equal in an innovative environment.
“Let them eat anecdotes!”The US spends signifigantly more on healthcare per capital and as a percentage of GDP than any other nation, and yet our health outcomes are worse than Switzerland, Sweden, UK, Australia, Germany, Netherlands, New Zealand, Norway, France, and Canada.So if we are optimizing for profits, then mission accomplised. If we are optimizing for health outcomes, then.. we.. we fucked up.
Why aren’t those countries contributing to healthcare innovations at the same rate (per capita) we are?
Because they value the net health outcome of their citizens?
Yes, they value equality of outcome above innovation. Let’s just say I’m glad they weren’t in charge 50 years ago. Or 100. Or 200…..or 5000.
Oh man. I totally forgot the US is the only country producing any innovation. I feel honored to be a citizen of the US, at the forefront of healthcare innovation. I know I have to suffer with lower healthcare outcomes, but I’m a patriot first.
Yeah… You suffer the health outcomes you can afford. It is not my job to pay for your healthcare. Triage is a thing. Deal with it.
Nobody with good healthcare coverage in America is “suffer the health outcomes (they) can afford”That is the whole point of insurance. When serious health problems arise the cost is spread over the larger pool of participants.The difference in America is that you refuse to consider the benefits of that pool including all citizens in the name of a free-market ideological extreme.Military security for all citizens = compromise with socialism GOOD!Disease/injury security for all citizens = compromise socialism BAD!
Yeah… #notanargument Not every government program is socialism.Again… There is not a single country with better healthcare outcomes for people worth the effort than the US. Basically, you’d be dragging the healthcare of people who are actually worth something down to the level of your average welfare queen. How’s that working out in the UK?
Not worth a response !
No, but I gave you one anyway. Still #notanargument
They are crushing all others in volume, especially in medicine.
This is fiction. The markets are tougher in Europe for sure because of the insurance controls, but there are a lot of innovative drugs companies there. Last I checked, Japan was innovating like crazy in medical research and therapies. How do webmeasure innovation (per capita)?
Blah, blah, blah laser eye surgery wasn’t invented in the USA blah blah blah…”The history of laser eye surgery dates back to 1896, when in Netherlands, Dr.Lendeer Jans Lans, an ophthalmology teacher, published a theoretical paper on the possibility of cuts made in the cornea to rectify corneal curvature and cure astigmatism.In 1930, Tsutomu Tsato, the Japanese opthalmologist, first practised refractive surgery on war pilots. He made incisions in the cornea radially, that corrected the vision by as much as 6 Diopters. However, his technique was rejected since it was reported to lead to fast corneal degeneration.In 1963 Jose Barraquerr, an ophthalmologist of Bogota, Columbia, developed the technique called “keratomileusis”, or in other words, corneal reshaping, which was capable of correcting both myopia and hypermetropia.”http://www.optilase.co.uk/w…
His point though wasn’t that lasik was developed here. The ‘we lead’ was part of another comment and I think that is mostly or grossly true. That said many things could be initiated elsewhere but perfected and/or popularized here. (Heart transplant may be an example of that).
What percentage of LASIK procedures are medically necessary? It was a luxury good for every single person I know that has had it. They didn’t need it, and they could live just fine without it. They just didn’t want to mess with contacts or glasses any longer, and they had the disposable income to have the procedure. A free market can exist there – not so much in the medically necessary space.
I agree with you. I wear contacts (which I pay for obviously) and have since college. But even contacts are not essential I’d just have to wear glasses.
chemo isn’t lasik
I’m afraid you’ve got this completely wrong Andy. These innovations exist primarily because of non-profit spending originating mainly in American academic institutions, and Federally funded medical research. Facts matter.
Pfizer alone spends almost a billion dollars a month on R&D.
The NIH alone spends more than $30 billion per year on medical research. Pfizer currently spends less than $8bn per year.
The United States healthcare PRIVATE sector invested more than any other sector, at $102.7 billion. That accounts for close to 65 percent of all R&D expenditure in 2015. Federal agencies invested a total of $35.9 billion, research institutions (including universities) invested more than $12.5 billion, foundations invested $4.7 billion and voluntary health associations, professional societies and local and state governments invested close to $3 billion.Facts matter Joe
Innovation comes from the R, not the &D. And that’s what public spending excels at. Without the federal and academic spending, fundamental research dies. The facts speak for themselves. GO read https://www.nih.gov/about-n… for a nice summary of this.
The R also speaks volumes: https://uploads.disquscdn.c…
That doesn’t prove any innovation necessarily, but it’s damned interesting, I must admit. I work in a field where private spending on “R&D” way outpaces the academic area and it’s a disaster. The field is flooded with shitty products that don’t do anything but market well, while the necessary and more permanent solutions based on real research remain unfinished because the private sector is awash in money and sucks up all the talent.
And $11 billion (2013) in marketing. #Freemarket, amiright?
Andy don’t distract from the real issue: everyone is entitled to a Bugatti. And a house. And a private jet. I feel triggered just thinking about not having any of these entitlements.
I don’t understand why this has to be either/or. We either get universal coverage that helps outcomes or we get innovation in healthcare.
where in my post did i use the words “other developed countries” and where did i suggest there should not be a for profit healthcare system?
I’m pretty sure Andy was just mock quoted the comments section.
No you did not !So is that to confirm you consider a”not be for profit (single payer) healthcare system”to be out side the realm of rational consideration for America ?
The American Health Care system is the best in the world, qualitatively….and its not even close…..for people who can access it.Can that history and quality mix with a method of covering everyone?Tough nut.
I was quoting the comments section not you Fred
Your tone reminds me of https://www.youtube.com/wat…In regards to R&D, the US does indeed lead the world in total $ spent, but not in % of GDP nor in $ per capita (https://en.wikipedia.org/wi….Why do you think profit and progress are antitheses? Profit is a great personal motivator, why do you think it should be our social one too? Why do individual Americans need to suffer so the investors of the medical technology companies can profit? Healthcare in our country is crony capitalism at its best.I’m at a loss how to reconcile the oft touted “equality of opportunity” credo of many on the right with their actual policies that distort the playing field and funnel profits to the already ensconced. Healthcare & education are the prime examples.
I’m not sure I could agree with that statement, unless you can back up your anecdotal remark with real data. Other countries contribute a lot to the state of medical research and advancement, not just the US. Here’s one data point against your claim: look at the list of Nobel winners in the fields of medicine, and you’ll see it’s a fairly global list, not US centric.https://en.wikipedia.org/wi…
Go to the medical campus in Houston.He doesn’t need anecdotes. America crushes all other countries on volume of medical innovation.I cannot count the # of CDN trained docs & nurses that I know that have headed south. Smarter they were, faster they went.
But is it because health care is expensive or because the US is rich at funding programs. The HC providers, insurers & profit makers aren’t the ones funding research.I am going to Houston soon actually, funny you mentioned 😉
from the moochers that spend the fortunes they save by not having to defend themselvesNot sure you were referring to defense spending or not but if you were this is correct.’Your little shit country’ is providing leadership, protection and resources and is not same as ours. Love them but an example of this is Israel using our defense shield. Sure it’s because of the oil that we need to protect in the end but it still costs us money to develop which they also benefit from. [1][1] My god can you imagine what would happen if the jewish state were somewhere where there wasn’t oil?
they’re pretty good at health innovation.
what other industry would you want attracting the best brains and biggest capital other than health care?Well actually we have a problem with that because we now have some of the most capable people in the world working for Facebook so they can mine more advertising dollars. Or for Uber because major cities had taxi medallions. Or Airbnb so millenials can have more vacation experiences. Certainly the ‘problems’ that some of these companies have ‘solved’ don’t rise to really big issues in life, right?
Andy – how do you know this? Are you looking at medical patents per person or spending or some other metric? Not a rhetorical question – where are you looking to support the claim that “United States is the home almost every medical technology, procedure and pharma innovation of the past several decades.”Being from Canada, I know of a bunch of cancer related treatments originating out of the University Medical R&D system. But this is just anecdotal evidence.Wonder if there are good studies/data on world wide medical innovation per some metric?Humbly…
I’m ASSuming based on R&D spend
Wonder if R&D spend is good proxy for medical advances? Could be. Could also be that the R&D spend is ineffective, inefficient or focused on viagra type advances.
Indeed. If we assume Pharma companies are targeting R&D dollars where it will produce the most return, curing chronic disease has to be a low priority. Treating diabetes is a multi-billion dollar business. That goes away if they cure it. They could charge $100K for the cure, and that is only 4 years revenue for treating diabetes and not curing it. When you factor in the R&D costs of finding a cure, it can’t be a priority. Diabetics can absolutely lead better lives today than was possible just 25 years ago, and for that I’m grateful. However our economic model rewards turning chronic disease into a lifetime gravy train, it doesn’t reward doing the work to cure it.
Here you go, that’s a good proxy: number of medical scientific papers.https://uploads.disquscdn.c…
Also has to do with educational system and size of the nation and doesn’t = innovation
We could compute the equivalent of an Erdős number perhaps:https://en.wikipedia.org/wi…To be assigned an Erdős number, someone must be a coauthor of a research paper with another person who has a finite Erdős number. Paul Erdős has an Erdős number of zero. Anybody else’s Erdős number is k + 1 where k is the lowest Erdős number of any coauthor.
OK- Humour me here ;-)Let us concede your assumption that high cost = innovation.Well America already spends 50% more GDP than most other countries so there you have your high cost innovation margins covered. That American innovation margin is in fact much higher than 50% when you factor in the millions who are not covered or not fully covered and all the financial-life fallout that dominos off that reality.Now, with that innovation margin already covered, you are ounce again free to stop conflating high margin healthcare/innovation with the separate issue of America’s world leading political/entrepreneurial innovation at delivering universally accessible healthcare via your superior free market obsession.The rest of the world is waiting with bated breath to follow that superior free market innovation as soon as it demonstrates its superior cost/benefit ratio !Waiting . . . Waiting . . . Waiting 🙂 🙂 🙂
Yeah… Go take a look at US regulation compliance costs and you’ll see where most of the money is going. It’s not the job of the US government to tell my doctor how to do his job. The federal government has no such authority enumerated in the CotUS.
Don’t forget academic research and government funding, both of which play large roles. It’s not just a “market”.
or patients. what if we had a bunch of new patients injected into the system who would be willing participants in research?
A friend commented earlier today that it’s like the Republicans threw out a crappy plan that they knew would fail to pass, so that they could claim to the base they tried, without actually accomplishing anything that might cost them votes.Not sure I buy it, but it is an interesting thought.
Trump got Ryan to do it because he knew he’d F it up and now we can have a Trumpian leadership in congress. Once Ryan is ousted, of course.
Trump made promises that are impossible to keep. Why did he say that he can cover everyone at lower cost?The biggest problem is the hospitals in this country are inefficient and overcharge for care. Insurance companies have been happy to not push them to become more efficient.Instead of browbeating Boeing or Carrier on Twitter, Trump would be much better off traveling the country and browbeating hospitals.
Here, here.
Thank you.
I love the notion of the CBO, and I think they are largely non-political. But they are not accurate, either, which means that we can’t really bring their arguments to bear on the healthcare dilemma, where they have been notoriously pitiful at predicting basic human behavior. They have consistently missed every single prediction in their analysis of the ACA. I wish we had something better to rely on.
If everyone would just follow the advice below, health quality would go up, and expenses would go way down. We’re not made to eat mozzarella sticks and sit at a desk all day. This will only get worse when the robots take over. It’s not an answer to the health insurance battle, but still, get moving people!http://sd.keepcalm-o-matic….
My biggest health issue in my adult life: a freak accident that happened when I was exercising.
I think you’re joking, right? Like “I went to a boxing match and a hockey game broke out” kinda funny?You went to the gym and realized somehow adulthood crept up on you?If you weren’t making a joke – and did get a serious injury…I’m sorry to hear that.
No, I’m not joking.
I hit “enter” on that last one before I completed the thought. No, I’m not joking, and thank you for your kind words. (And I’ve been a healthy person, thankfully, partly because of being vegetarian/vegan for much of my adult life, though now I’m more omnivorous. Also, runner, yoga practitioner, hiker, wearer of SPF50.)My point in bringing this up is that we can do everything “right” and still have something go very wrong. My oldest friend is a neuro-oncologist (sp?) and one of the bits of wisdom she shared in our circles decades ago was that we don’t get to choose what happens to us.This becomes more and more apparent and true as I gain age and experience. This is why health care is not actually a market.
I hear ya on all fronts. We can’t choose health, only do our best to avoid bad things. Hope your bad things are manageable. Salud!
If we boil down the specific issues and examples in these comments, it seems the core question being debated here is: “Do all Americans deserve access to healthcare, regardless of their ability to pay?” I’m curious to know, or a straight up or down vote, what say you? Yay, or Nay? As or me – Yay.
Yes.
Yes. But there will be rationing. It’s not a dirty word, it’s reality.
Nay. Healthcare is a good which requires resources and labor. To say people have a right to it is no different than saying they have a right to enslave a doctor, or at a minimum to enslave their neighbor to pay a doctor.
I assume then that you are opposed to all social services? And public schools?
Maybe you all can help me with a few questions about the state of healthcare in the US:1. Why is healthcare “insurance” a for-profit business?2. Why are drugs marketed on TV and how much is spent annually on drug marketing?3. Why aren’t lifestyle choices rewarded and penalized when determining insurance rates?4. Why is such a large portion of our healthcare expense spent on end-of-life care?5. 50 years ago Americans dealt with their lifestyle choices with pain and shorter lives, while now their insurance companies spend a lot of money on drugs to manage their pain and extend their lives. Are we better off?6. Why is it that in healthcare the end user has no incentive to compare the cost of products and services?
I don’t have the answers, but I like your questions.
1. Because insurance is a good to be bought and sold like healthcare itself.2. Because drugs are a good to be bought and sold. What each company spends annually on marketing is their decision and is not relevant.3. Because the legal environment the government has created around insurance prevents such approaches4. Seems like a self-answering question — it’s when the care is demanded5. People seem to think so6. Because the legal environment around health insurance has turned it into subsidized care and the idea of price shopping for care seems taboo to many people.
I remember this conversation from ’09 http://avc.com/2009/08/cons… and couldn’t agree more. It also sounds like what Mark Cuban is talking about recently – separating genetic/chronic disease coverage (diabetes, cancer, cystic fibrosis, neurofibromatosis etc.) from acute care (appendicitis, accident trauma, broken bones etc.)The Lasik example in the link, and cosmetic procedures do show that the market can work if consumers have price discovery. This discovery is basically non-existent in non-cosmetic healthcare beyond knowing what you will pay your doctor for a physical. Ask the office staff how much the blood work will cost and they have no idea. Worse, try to get an anesthesia cost estimate prior to surgery. Improving this will go a long way to controlling healthcare costs.
Lasik works because in most cases it’s a luxury good. If you can’t afford it you keep wearing your contacts or glasses. If you can’t afford medically necessary treatments your options are pain and suffering or maybe death. Its not even close to the same thing. There is no lesson in the Lasik market that applies to chronic diseases.
Agreed. I was making the point that separation of how we insure treatment of chronic disease should be different that acute health issues or cosmetic ones.
I actually took a shot at creating my own healthcare solution on my blog last week. http://odonnellweb.com/peli…
I read your post and we are thinking along the same lines – Socialize the excessive costs of chronic diseases or acute care, and let a regulated market function below the reinsurance levels.One of the problems with health insurance is people see it as wasted $ if they don’t get sick. No one wants to have a car accident or their house burn down, but they don’t begrudge paying to insure those possibilities. However, with health insurance people feel if they don’t get sick they feel it’s money wasted. Separating the chronic and capping has potential to remedy this. It’s a good conceptual start. Now let’s pair it with some cost transparency and let the market work.
I believe citizens of the US should have healthcare insurance. If they can afford it, they should pay for it. If they can’t afford it, society should pay for it. But one way or another, everyone should have the ability to see a doctor regularly, get preventive care, find diseases early on and treat them, and not defer their medical needs until they become acute.Part of the problem is that with every new advance in healthcare we end up with a situation whereby people have less reason to not take chances with their health. Because they know there will be some technology, pill or procedure that will allow them to clean up the mess that they create for themselves. Things that people do now are not the things they would do 200 years ago or if they were living on a desolate island without modern healthcare.We spend a great deal on end of life care because we can. And each little advance in medicine adds to that end of life cost. Unfortunate example but kids that would have died 50 years ago are kept alive today at all costs because we have the ability to do that. (Not a judgement, just stating a fact).My wife deals with patients all of the time at the hospital she works at and sees firsthand some of the losers and what they do to themselves. SAD! (This is not Lenox Hill with high end patient population obviously). You see many of the same people returning over and over again. You definitely see people who have made bad life choices. It’s not a matter of education or preventive care either. You’d be surprised at how many people don’t even come close to following medical advice.There are many other inefficiencies in healthcare that add up as well that are rarely discussed. For example I rent out some properties to physicians who open multiple offices in different geographic areas to compete with other doctors who are already in those areas providing adequate care. However this does not lower costs at all. The doctors don’t compete on price since people are not paying out of pocket it’s covered by insurance typically. So that money going in my pocket is in theory coming out of everyone else’s pocket.Fwiw hospitals do have a big motivation to kick out patients and lower costs. I have seen this first hand at least at the places that my wife has worked at. You get bonuses as a physician for that and it’s part of your pay package. They have a position at the hospital just to try and game as much as they can to pay for insured and uninsured patients. They do this for the same reason airlines nickel and dime on bags and other fees. Money was taken from another area so you have to make it up somehow.One thing the government could do is possibly a variation of what Apple did when it bought factories for it’s suppliers in China (or the machinery whatever). The government makes the investment in supplying the capital for the healthcare system and takes the risk out of having to keep diagnostic machines operating at a high price to spread the fixed costs. The cost of the machine and the risk factors factored into what the hospital must charge for what it does. Pay for all of that so the providers can just focus on labor costs. That’s an entire other story in terms of supply and demand which adds to cost. My wife makes a good living, all deserved, but no doubt she would earn less if there were more people who could do what she does and there probably are, right? The supply is constrained part of that is for valid reasons in medical education but not all of it.
great points fred, but the challenge becomes defining “afford it”. does that require a financial review? will there be brackets of acceptable expenses per income bracket (eg; % of gross / net income allowable to be dedicated to rent, food, auto, etc)? that’s a foundational challenge. – cory
In the developed world olympics, first place in costs and last place in relative outcomes. Whooo hoo! I love paying more for my prescription eye drops than my Canadian friends. Grandpa’s office was between Dr. Will and Charlie Mayo for the first years of his career. Medicine has lots of history with innovation and compassion together at the core. The quality of our healthcare debate needs improvement, period! We really are not solving anything. It is BS.
One item that deserves to be mentioned is the issue of our drug costs being in many cases way more than what is paid in other countries.While there are many reasons for this (maybe the quality is less who knows) one thing is for sure. If we stipulate that pharma companies must operate at a certain level of profitability to continue to develop drugs then they must earn a certain level of profit one way or the other. And if they are earning less by selling drugs cheaper overseas then it is the people in our country who are paying more for the same drugs to allow that to happen.Would seem to be obvious that there should be, let’s call it, ‘most favored nation’ [1] clause or law so that we don’t pay more for the same drugs that are sold in other countries for less.What this will end up doing is shifting part of our prescription drug costs to other countries and we will no longer be subsidizing their patient populations.Very clear to me why this doesn’t exist or won’t happen though. It’s almost certainly because the drug companies are lobbying against it and that they don’t see it as beneficial to them in some way.[1] https://en.wikipedia.org/wi…
Or we could just remove about 2/3 of FDA regulations that needlessly stifle innovation and development while skyrocketing the cost of compliance? Nah… That would be crazy talk. Why would we want to take authority from an unconstitutional and un-elected government bureaucracy and give it back to the free market.
Why can’t our gov’t, in tandem w/ leading healthcare providers, model a system that works? Two words….lobbyists and profit, as in billions of dollars for leading healthcare providers like United Health and others. There’s enough data at hand, plus fundamental MR can identify and model what costs/benefits are most acceptable to those doing the underwriting, the buying public.Pass (fed or state) legislation requiring that each healthcare provider deliver at least 1 “affordable” plan–w/ minimum coverage & max deductible requirements–with premiums capped at a % of the avg. cost of all plans marketed by that provider in that state. If that reduces or eliminates provider profitability on that singular plan(s), then too bad…it becomes the cost of doing biz in that state. No provider opt outs will be allowed, which only reduces choice and competition. Delivering a base plan–profitable or not–becomes a “mandated” provider requirement if an insurance company desires to do biz in any state. No more free pass to the bank.Our Congress continually operates in a vacuum, hellbent on repealing Obamacare to stroke their own partisan agendas, cowtowing to lobbyists, all without taking into account the legit needs of the people. The swamp is infested w/ snakes and reptiles, w/ no plug to pull in sight.
To quote a friend, the insurance companies are just *begging* to be nationalized.
One idea that I believe is generally supported by economists on both sides is to phase out the tax exemption for employer-sponsored healthcare, a quirk of history from WWII where the American government initiated a wage freeze. As a response, employers began offering subsidized healthcare to compete for employees. This really distorts our healthcare market. It is predicted that eliminating or limiting it would induce consumers to pay closer attention to healthcare costs.There seems to be a very deep anger among some conservatives that “freeloaders” at the bottom of the economic ladder are destroying our country, but really anyone who has “good” job with decent health insurance is getting a nice tax break, something that those with “bad” or no jobs don’t get. Eliminating this tax preference would increase government revenue and drive down healthcare costs in meaningful ways.
One point most are missing: Hospitals pick up the tab for the uninsured. Not private hospitals, but public ones. And all of us pay that cost.Insurance is at the heart of the problem, but so is Big Pharma. It doesn’t help that most medical practices can’t calculate what a procedure costs.For those that say Universal Healthcare is in’t a right, neither is driving or education. Education was set up so factories would have workers. Driving requires insurance, yet no one seemed plagued by that. Your house requires insurance (flood, home owners) but again no one seems to mind that (except flood).I think we should skip it all. Go straight to Medicare for ALL and repeal the laws that say we can’t negotiate with Big Pharma. However, that means most insurance companies would become useless. And they own most of the politicians so…
I don’t believe that anyone understands – or openly acknowledges – what you write here. Moreover, you’re nowhere near accurate or accusatory enough. Specifically:The law states that if a sick person shows up at a hospital, that person MUST be treated. Whether they have insurance or not, whether they have money or not, they *will* be treated or the hospital (and other such caregivers) will be sued. And they will lose, too, if the person can prove that the hospital intentionally gave them sub-standard care on this basis.Does everyone understand this? Does everyone understand that unless the Congress and POTUS have the brass to revoke that law – to, literally, let people die at the front door of a hospital because they don’t have healthcare – then we already de facto, have universal health care.This was brought up, time and again, during the initial Obamacare debates – but it was ignored, because it is inconvenient.Healthcare is ALREADY fully covered, at least for sick care. You can debate this as much as you’d like, but it is a fact. It is, in fact, the LAW.Where the author here is wrong is that Insurance companies don’t pay for it. Oh, they pay for a lot of it, but a lot of it is eaten by the hospital. This is the single largest reasons that hospitals go bankrupt. Are hospitals in affluent areas going bankrupt? No. Why? Because they have far less Charity Care to provide.And, remember, Obamacare doesn’t extend to illegal immigrants. Those people are still using charity care, and driving insurance costs up while simultaneously driving hospital revenues down.The solution is right in front of Congress, but it would require honesty, courage, and debate – which our brave Congress is generally averse to.Either let people die, or provide a basic level of coverage for all (means adjusted). Use a food-stamp type system for it, that would allow recipients to redeem these “health stamps” for private insurance, and mandate that the insurance must cover some level of basic care.And have the spine to openly admit “beyond this basic coverage, you’re on your own – if you can’t afford it, and don’t have private insurance, then you ain’t getting it.”Then demand that hospitals open their books and revise their rates down to account for the impact that this will have – fewer non-payers will translate to lower insurance rates for those who have it.And that’s how the overall cost falls. The basic coverage has limits, but it also does provide the cost saving basic preventive care.This would be hard work. When’s the last time you saw a congressman work hard, other than to get re-elected?
If they can afford [healthcare insurance], they should pay for it. If they can’t afford it, society should pay for it.Ignoring for a moment that health insurance ≠ health care, therein lies the rub. What constitutes “affordable” care? Who defines what is affordable? There is no universal definition, therefore if you leave it up to the government then you force a one-size-fits-all on everyone which leaves many unhappy.I find the cognitive dissonance laughble, especially from people in the tech space. There are countless choices when it comes to the products and services we use but many of those same people want to remove choice when it comes to healthcare and insurance.
From a Canadian perspective, free medical care is a disincentive for wellness care. Medical care is reactionary by philosophy and will never provide proper wellness care. There is a general misunderstanding that going to the doctor will help get you well – so just wait till you’re sick and let the MD’s deal with it. The branding of “Health Care System” is completely misleading and should be labelled as to what it is – “Sick Care System”.
Thank for saying this, Fred.One other point that is important is that, without health insurance, many families are just one medical emergency away from financial disaster. Before the ACA, medical debts were the leading cause of personal bankruptcy in this country. That should never be the case again.
Isn’t there a saying, “never time to do it right, always time to do it over.” What’s your rush, Mr. President? And while you’re at it, consider leading change to mandate that Congress be on the same medical system as everybody. Or move to get all of us on their coverage.
The argument for a mandate was initially from the conservative think tank, the Heritage Foundation. It was based on the notion of personal responsibility. Here was their thinking:”If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services — even if that means more prudent citizens end up paying the tab.Many states now…require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement…Mandate all households to obtain adequate insurance.”
CONTRIBUTORS:Is 400 comments close to the top five commented blog posts?
Thank you, Fred, for your post. Sorry it was hijacked.
More than that, people will die as a result. The whole thing is ridiculous- it’s also a security risk. YOu want epidemics to spread, stay alive, keep lots of people untreated.Every country that has universal coverage has better outcomes, and pays less for it. European pharmaceutical companies seem to still be profitable.Obamacare was the best possible thing to keep the vestiges of what people think of as for profit medicine, and insurance companies.But there is a better way, and the US is behind, because it pretends a horrible mix of the worst of Amish and highway robbers are a legitimate school of political thought and operations.Top tier tax cuts is not a multi tier multi subject policy plan. It’s stupid, irresponsible and in no way supported by any data, anywhere, to be helpful to the economy at current rates, even by the Laffer Curve.
It seems you’re forgetting that health insurance is not healthcare. Many were insured with Obamacare, but they still couldn’t get care because of high deductibles and other things like that. So, insurance is great when you have the money to pay your portion, but hurts the most vulnerable that can’t.
wow. oil calling :)btw- the toronto sick kids/tgh/ university hospitals complex pulls their weight in medical research too.
I am not saying other places don’t innovate, but the combination of the size of the American market, the free market health care system, makes the classic wealthy > upper middle class > everyone adoption cycle work in health care in the US, when it doesn’t anywhere else. Lasik is a great example, but so are hip replacements.Its gas that’s calling – Michele is now VP, Gas Ops for Enbridge. She’s the real deal 😉
but on hip and lasik, Canada medical services are at par with the US.
I am ignorant here, but don’t CDN doc put in Stryker hips (US) and use Lasik lasers (US)?
I agree 100%. I have been blissfully on vacation. But since this is one of the few times I agree with Fred on a political issue – it is worth noting.As a Trump voter and overall supporter – this is a major disappointment. They need to take their time and do things right.
CONTRIBUTORS:”We are not leveraging the power of technology enough to help treat diseases and other conditions early when the treatments are more effective. So I am all for modifications to our health care system that will allow for more innovation, more preventive and wellness care, and more engagement with the system.”The United States has a mixed economy (But at some periods in history it was close to a free market) and in the end businesses view profits foremost. The Altruistic views fall on deaf ears until the wealthy and well connected have a family member or love one that is affected.Fred’s progressive views are being expressed. Enjoy hearing the excuses of the Conservatives with the opposing views.
Yes I know. All the medical procedures that government doesn’t pay for seem to get cheaper and better quality by the day
Yeah… Do you know how long it took me to get MRIs when I needed them? Under an hour.
Two weeks isn’t bad at all. But that’s where you are. Where I am there are multiple providers with capacity. [1]But actually a little wait time isn’t that bad for many things. It cuts down on costs. Friction.Let’s take an example.Say you go to the doctor and he says ‘oh that hurts let’s do a mri’. Just go to the office next door and get it. Which is what happens when I need labs the lab is right in the office. Simple. Lubricated. As easy as buying eggs or bread when you are already in the market getting Salmon.Now let’s say there is a wait of ‘n’ weeks and a trip to another office and waiting, making appointment etc. During that time period many things will go away and people will not feel they need the diagnostic test. Or maybe they will just put up with the pain.[1] Several years ago I met with a doctor who operated an MRI center to discuss investment in opening up a new one. (Conclusion: Danger Will Robinson. [2] To much risk, hospitals can put you out of business when they decide to expand).[2] https://www.youtube.com/wat…
Yes… Except that there are things that taxes are supposed to fund. Per the CotUS those are limited to law enforcement, the DoD, and interstate infrastructure. Everything else is basically wealth redistribution by armed robbery.
Yes, as it should be. People who earn more money should have better access to healthcare than worthless welfare queens.
good for you, sport.Sport? What is he a dog?
No, I’m officially a Darwinist. It is not my job to increase the survival rates of genetic defectives.
No need to resort to name calling. Because you know it’s what he would do and one of the things that they don’t like about him.
OMG. (edit: and I don’t mean “OMG, Charlie.”)
Yeah… You need to try harder there’s a reason why I used survival rates rather than number of deaths. Canada is, in case you haven’t noticed, quite a bit smaller than the US.
“MY country?” I’m an American. And last time I checked Canadians weren’t communists. At least pay attention to who you are talking to. And by the way, this entire thread started with this by you.”Your healthcare system is a disaster. Most STATES in the US have more diagnostic equipment than the entire COUNTRY of Canada.”You haven’t substantiated any of that. At best, you’ve documented differences in outcomes, none of which you’ve provided a shred of evidence for being related at all to the healthcare systems of the respective counties. And if you actually want to substantiate your claim, and not just throw bullshit statements around in the Internet you also need to explain why we see the same variances between states and even within states in the US, where we are working under the same screwed up healthcare system.I’ll be eagerly awaiting your well researched and documented reply.
I’m not the one who is trying to change the system. Since you want to change the system, the burden of proof is on you to convince me that we need to do that. Otherwise, living in a free country, I can always exercise a 2nd amendment veto on any such attempt.
You are right. You are just leveling unfounded statements you can’t back up with data, so you start threatening violence instead.
Can you knock off the stupid threats of violence? Inappropriate anywhere, but especially in in this forum. 2d Amend. gives you limited right to own firearm, not to commit crime.
No, I point out that you have no authority to insert the government into my healthcare decisions. Any attempt to seize such authority will be met with an appropriate response. (Generally involving a free helicopter ride.)
I doubt it. Dogs have more compassion.
With the east coast weather you should have made some money the last few days.
You contradicted yourself in two sentences. First you said we need to get rid of insurance and in the next sentence suggest that people should be allowed to purchase supplemental insurance. Which is it?If someone’s motivated by a million dollar salary and not care of patients, we don’t want them in the system anyway.What a shortsighted, ridiculous statement. Wages are a reflection of supply and demand. A binding cap on wages will guarantee a shortage of supply (aka surgeons). Do you want fewer surgeons than we need?
You can’t be serious. Have you been a VA hospital. This would be Medicare for all. Who are you to dictate surgeons salaries? Why not cap VCs earnings?
ain’t that the truth my friend. always good to hear your opinions on these items.
i know
Here you go – universal care, with a $25K deductible, and a regulated insurance market to insure against the cost of the deductible.http://odonnellweb.com/peli…
and if it weeds out those that care more about the money than the care, then great.So they do what then? Work for facebook doing god’s work there?Where is the connection between someone who cares about money and not providing good care or being a good doctor? Where is the connection between someone not caring about money and being a good doctor?Many of these highly paid doctors are absolute machines with the stress that they are able to handle and the work output which they have. Compare life as a psychiatrist (low paid) or primary care (low paid) to some surgeons and what they do for the money they make. I couldn’t even touch it or come close. It’s not the life you have or the life that I have.Not caring about money doesn’t make you a good person and caring about money doesn’t make you a bad person as your 500k should be enough seems to imply.Ben & Jerry very caring people and not about money I guess. But they create product (high fat high sugar ice cream) that isn’t exactly a healthy food product or in any way good for you. Sure not their fault people abuse it and yes others sell ice cream. But Coke could say the same thing (and that is Buffets point often).
No, that’s what Canadian news told me about your healthcare system. Or did you miss how an immunocompromised cancer patient spend half a day waiting in the emergency room with possibly lethal complications a few weeks back?
Amoral actually. I don’t recognize your right to make me act in any particular way because of your fee fees.
60,000,000 dead Chinese peasants would disagree. But please, if you want to help them, go ahead. You are free to start up a charity clinic on your own dime.Those evil libertarians. They want to take over, quit tanking your money, and leave you alone. How horrible.
1. People’s “needs” are neither my problem, nor my financial responsibility.2. That case is hardly isolated. Your healthcare system is incapable of handling basic early 20th century triage.3. I have never had a wait longer than 10 minutes in an emergency room. But please, explain why Canadian cancer patient outcomes are actually WORSE than American ones if your system is so much better.
Yes. That’s why I’m a libertarian leaning conservative and not an anarcho-capitalist. Government has a function in society. Taking care of those too pathetic to care for themselves is not it.
Policy by anecdote. Smart.
Actually, it gives me the right to shoot tyrants in the face. That’s the whole point. There are no “limits” on the 2nd amendment. The idea that it has anything to do with hunting or self defense is absurd. It’s designed to be a sword of Damocles hanging above the head of any would be tyrant.
In this guy’s (imaginary) world, citizens have only rights, but no responsibilities. Not how the civilized world works.
You see, you’re under the delusion that the government protects your freedom. Despite dozens of examples to the contrary in just the past 100 years.
It’s called illustrating a point. I already showed that US cancer patient outcomes are better than Canadian ones.
I must have missed the part of the CotUS called the “Bill of Responsibilities”. Silly me. Please cite it.
I don’t recognize the authority that the court granted itself. What part of “shall not be infringed” implies limits to you?
Oh, FYI, your blog relies on overturned rulings for the core of its argument. It’s rather sad actually. It is perfectly legal to yell “fire” in a crowded theater. That ruling was overturned half a century ago.
Yeah. “Thinking”. I call it delusional sheepism. Government is the leading cause of death in human history after natural causes.
Maybe you need to understand that forced charity is inherently destructive.
Yeah… I have no respect for unconstitutional laws and have no legal or moral obligation to obey them. Keep trying. But please, cite the portion of the CotUS that grants the SCotUS the authority to limit the CotUS… That would seem counter-productive.
#Notanargument
Ah… and here we go… What, no quip reply? No snappy comeback?FYI Clinton is still not the president.
I have sufficient compassion not to hold a government gun to people’s heads to make them pay for my stuff. Funny how a refusal to be extorted is somehow a “lack of compassion”….
I got a mountain of email spam today, too.
“hate inspired”? Really? Not wanting to pay for other people’s stuff is now “hate”?Ok snowflake. This is why the left won’t win another national election for generations. It’s also why the overwhelming majority of young people identify as “conservative” or “libertarian”.
Kind of. Feds get discretions to build roads for postal service. Federal highways funds violates commerce clause as ruled in Gibbons
I would argue that federal highway funds would fall under the national defense mandate as a working interstate highway system is a critical strategic tool for national defense. They are poorly implemented, agreed, but they are not inherently unconstitutional.
Makes for a good discussion, and definitely something that would be enthusiastically debated by SCOTUS prior to 1937. The slippery slope here is that Congress might broaden “national defense” to include any number of things.
Spoken like a man that has studied Hitler, Polpot and Lenin
True, but the interstate highway network was constructed as a strategic asset. It’s hard to argue that it does not serve a critical role as a national defense tool.
Unfortunately demographics are trending very statist. The number of people in the workforce as a percentage of population has shrunk for over 30 years and the number of people forgoing tax payments will outnumber those of us who work in short order. Civil war/revolution is only a trend line away.
Facts, rather than feelings, are more informative in this conversation.Among Millennials, the youngest adult generation (today ages 18-35), 41% identify as independents, compared with 34% who identify as Democrats and just 22% who identify as Republicans. The share of Millennials who identify as independent is up eight points since 2008.On leaned party affiliation, however, Millennials have a strong Democratic orientation. By 57% to 36% more Millennial voters identify as Democrats or lean Democratic than identify as Republican or lean Republican. http://www.people-press.org…
Spoken as a man 3/4 of whose family was murdered by Stalin after getting kicked off their land.
You’d be surprised. There’s a reason why Trump won in an electoral landslide. “Statism” is not the problem. Unrestricted “statism” is. There will always be room in human society for nation states. The trick is keeping them on a tight leash.
I’ve long contended there’s a subset within the human population that can offer zero value in today’s market. It’s amazing how much money we’ve spent subsidizing patronage votes.
what makes someone genetically defective,EGhttp://rspb.royalsocietypub…Fecundity? Cancer? which is it? evolution is funny.
Most specifically statism
Yea people just need to read some dang books. This stuff is really not that complicated.
Not really. Its the same system Democrats have used to stay in power since the dawn of the republic. First they used their slaves to up their congressional representation. Then they used violence to remove said former slaves from the democratic process. Finally, when that failed, they made those former slaved dependent on their handouts and started importing more from the 3rd world. If American demographics in 2017 matched American demographics in 1917, the DNC wouldn’t be able to elect a dog catcher.
Not saying right or wrong as it relates to the issue, but something I’d like to see discussed instead of the routine blank check, rubber stamp doctrine of SCOTUS over the last 80 years
I’m more pessimistic than you. I don’t see a tightening of federal budgets or programs and can’t envision the welfare state contracting. Singularity is secession with either revolution or civil war. If only we’d followed the Constitution.
… and yet, I’m not the one who’s resorting to ad hominems and citing the most debunked argument on the internet.
Ah… The “tolerant” left. Lose an argument? Blame the “evil Russians”… Good luck with that. I’m going to enjoy watching the GOP pass constitutional amendments on party line votes.
I don’t lack empathy, I’m just not a juvenile shill who can’t separate his emotions from his decision making process. I also consider the full picture. Everything the government gives to anyone without them working for it is something someone else works for without getting. My empathy is reserved for the person who’s having a gun held to their head due to no fault of their own. For all the left’s alleged abhorrence of Eugenics, I find it ironic that they support the most dysgenic program in human history. (I say alleged, because they seem to have few problems with Margaret Sanger.)
Why should I care about people outside of my family and circle of friends? You have yet to make a logical argument as to why the government is logically justified in holding a gun to my head to pay for the medical treatment of a random crackhead.
… and yet, I’m the one who makes enough money to complain about it being taken from him via threat of government force… Funny how that works out… But please, keep slinging the delusional ad hominems… it makes your side of the argument all the more endearing.”I want the government to force people to give me their stuff at gun point and shoot people who don’t comply because I’m a “good person”. Anyone I disagree with is stupid and an inhuman monster.” ~SeanWhat’s your next plan? You going to set up special “re-education camps”… Fun fact bro, it’s a hard thing to make an armed man get into a cattle car. You might need to work on your cross-fit a bit more, you’re hardly in any shape to be forcing people like me to do anything we don’t particularly want to.
Ah… “Fake patriots”… Did you even deploy bro?But please, go contribute to the “world outside” and get the heck out of my country. I’ll make you a deal, you renounce your US citizenship and I will, no joke, buy you a one way ticket to a socialist paradise of your choice.
Why should I care about people outside of my family and circle of friends?Maybe because it is the only rational way to participate in a stable society :-)The trouble with the me-against-everyone strategy is there are so many more of them. Easier to be a cooperative social player than going the me-myself-and-I social defector route.Any way I’m a slow learner. It has taken me way too long to accept that you are just trolling for responses.
Not quite. I’m not the one throwing mindless ad hominems. I leave that to Sean.You do realize that not caring about other people is not the same thing as waiting for the next Purge to slit their throats? Right? It’s not a binary condition.
As a CDN, a Trump Objectivist and a classic social liberal / financial conservative, your ‘I have all the answers’ libertarianism BS reminds of being in college.If you don’t want to hold up your end of the deal with society, move to your own island and be awesome. You won’t be missed.Do you have a Law Degree? Have you studied constitutional law – please cite whatever texts that helped shape your views. I’ll wait.The CDN system is not great. No system is perfect. All are covered, no one is covered awesomely.I personally travel to the US to expedite things. I belong to a clinic here that would provides expedited service and longer appointments.Two tiered health is tough to balance – how do you keep an appearance of equity between private an public (best doctor gravitate to private, mostly for control of their working days).I have no idea if an unregulated insurance market will work. It is quite apparent that universal single payer is pretty much anti-American.I think that this approach has more likelihood of being accepted and effective in America, versus the ACA.I have no idea if @fredwilson:disqus is right when he says it is rushed. Paul Ryan has had a long time to put it together.Trump is not to be trifled with – he is serious as the cancers you so glibly and immaturely quote. I would give you 60/40 minimum odds that he gets healthcare improved. I will give you 40/60 odds that he covers the lowest 10-20% of Americans through a universal healthcare system (likely revamped Medicaid).History shows that a small # of people running a system that governs a very, very large number of people has a binary result pattern: the elites are enslaved by their own need for security or they are violently removed.The healthiest societies are the ones that have the most number of people with something to lose and a reliance on the greater society that provides or adds value to the things they do not want to lose (cars, property that is not nearby, rule of law, lots of cool stuff that requires compromises or trade offs)…..which keeps those societies from imploding on themselves.Libertarianism is the antithesis of that healthy society goal – no one has anything to lose that is outside of their own personal control and no one relies on anyone else.Libertarianism is bit like that guy that keeps telling you how awesome he is……..he’s mostly trying to convince himself.A person is judged by what they decide is meaningful in their lives. From your posts, your ‘rightness’ is about all that matters to you.That’s a small life.
JD focusing on patent law from Rutgers University. I studied constitutional law but do not practice it because it doesn’t bring in the money. (Patent law is an absurd cash cow by comparison.)I hate to break this to you, but the “lowest” 10-20% of Americans were covered by medicaid long before Obamacare. Even a total repeal of that bill will not change that. What Trump really needs to do is to remove pointless government regulation that’s acting like a leech on our healthcare system, then start rolling back “entitlements” across the board.The bottom line is that the American people are tired of working for a living to support people who vote for a living. The fact that there are families out there in which nobody has held down a job for three generations is an abomination.
Oh, you’re adorable. Was there supposed to be an argument somewhere in there or do you just get off on humiliating yourself on the internet? (FYI: posting naked selfies to facebook is far more time efficient)
Not an answer though.
Large numbers of social defectors who care little about working out social compromises with others is the seminal swamp from which violent purges emerge.
It really is though. It’s possible to live alongside a person without wanting them dead or particularly caring what happens to them. It’s actually the normal human condition. Virtue signaling to the contrary does not change that fact.
Yes… Which is why the left should quit provoking the people who have been stockpiling guns and ammo for the past eight years and perhaps look into leaving them alone?
comparing economies of scale.
Your now down to guns and ammo threats are you !
Hardly… I’m just pointing out that continuously provoking people who have you outmanned and out gunned is hardly an intelligent idea.
Patent law.Fucking hilarious.Speaking of leeches.
Hey if you don’t think patent protections are important, just go start learning Chinese right now.
There is boatloads of research that shows that it is not the normal human condition.You should get checked out for PTSD. I am as detached and intellectual a human as you can find……that’s not normal.Research shows that social exclusion and physical pain are sensed by the same area of the brain.
Again… Taking the condition to ridiculous extremes. Not caring about random people on the street doesn’t mean that you’re “socially excluded”. I have a close circle of friends. (most are fellow veterans)
You are pretty dense.Its fucking hilarious that someone who is Mr. Shoot You in the Head if you infringe my rights is a patent lawyer.#ironymuchOh, btw, my uncle & father practised criminal law, combined, for 85 years. They know the difference between blowing smoke and real bad people.Here’s the example: Uncle being interviewed on radio in ’70’s. He is one of 7 people in Canada allowed to carry a firearm (licensed). He also has a firearm bolted to the underside of his desk, in case he was attacked in his office. When asked about these protections by a CBC reporter, who clearly thought he was off his rocker, he said, “While, I have received threats that have been corroborated by the RCMP and they feel these steps are justified.’ Interviewer responds with ‘These people that call you, they scare, you?”No, …..its the ones who don’t call.’That’s what I think of your comments.
I’m pretty sure I didn’t threaten anyone today. That would be illegal. Then again, I actually know what the legal definition of a threat is. It’s one of those things you learn in law school.But then again, I live in a free country. We don’t have “hate speech” laws or “islamophobia” bans. We actually believe in this thing called “freedom of speech” you might have heard of it. Canada had it until fairly recently.Oh, and FYI, I can legally carry a firearm in every state of the union. There’s a fun federal law that covers me due to me being attached for a tour with the 4LEB.
my kid split his chin open when he was 4. Former ER nurse lived down the street. She sent me to the clinic downtown (not the nicest clinic in town) b/c ‘those cats sew up guys 18 times a night’.Eye surgeon friend says the best thing Canada could do is copy US specialized clinics for quality and cost of eye surgery. His complaint was that union mandated nurses get rotated….so, just when a team could keep up with him…they left.Economy of scale works everywhere, even in healthcare, I think.
Not what you said.You basically stated that you lack empathy. That’s not ‘normal’.And I am not a doc.
Armed man and cattle car comment implies threat of violence, with little room for misinterpretation. Especially in the constitutional law and libertarian context you are showering everyone with today.Do Marines regular waffle like this? I thought you were more Say What You Mean & Mean What You Say types?Don’t bring a knife to a debate gun fight.
No, it’s called discipline and having control of your emotions. The fact that this is considered “abnormal” says more about the sad state of our society than it does about me.
Wow… You really didn’t study law, dd you?I do say what I mean and do mean what I say. Which is why I am very careful about what I say.
not what you said.”It’s possible to live alongside a person without wanting them dead or particularly caring what happens to them. “I will accept your clarification and say that your mode is very militaristic. I give a shit about the neighbours – lived next to them for nearly 3 years, probably only talked to them for about 15 minutes total ,but they give off a good human vibe and I like them.I don’t think about them a lot, but I would feel bad if something baad happened to them. That’s normal.
Not today you’re not:- BSc (Logic)…but that can’t be a surprise by now- JD (Criminal Advocacy)….even gave you a BIG hint- MSc (Human Perception & Memory)Take the rest of the night off, come back with a fresh start and a little compassion tomorrow.All those loser freeloaders you talk about…..got shit starts in life and couldn’t pull themselves out of the tail spin.Good on you for taking care of yourself…..but someone with your discipline will be able to help others too, I bet.
Are you a Veteran ?
I take your point but you are kind of begging for ad hominem attacks to meet some kind of personal need are you not ?
I’m just not a juvenile shillBut you do account for a inordinate % of the comments here just saying 🙂
What do you think? I think the “5’10” 210lb USMC veteran” thing was a bit of a hint.
Able? Yes. Willing, not so much.
Well, given that I am a veteran, a military attitude is hardly surprising.
I am happy to bet you will come around on that front.
And I am thankful for your service.As a CDN, I am embarrassed that we are shirking our fiscal duty re: NATO. So, I make a point of thanking US Armed Forces personnel for keeping our bacon out of the pan.
Nice straw man. I wasn’t talking about milllenials. Oh. And Hillary still lost snowflake.
Yes let’s argue semantics and not the point… that will surely be productive.