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Thursday, May 8, 2014

Why we needed--and need--Obamacare

One headline tells it all:

We spend more--far more--on health care than any other nation but get the worst health care results and mortality rates of any of the industrialized nations.

And people don't think we needed some fixes?

And we're not done there, either. How's this little beauty from none other than The Washington Post?

The U.S. ranks 26th for life expectancy, right behind Slovenia

Slovenia, for God's sake.

And people want to contend we have a health care system that doesn't need any intervention? Any fixes?


Sevesteen said...

Big government, tying health insurance to employment and big health insurance corporations ruined American health the solution is to keep health insurance tied to employment, keep penalizing those who get their own insurance apart from their employer...but also penalize them if they don't get their own insurance from the very people who caused the problem in the first place. Makes even less sense than fixing crime by disarming victims.

Instead of more force, why don't we try more freedom occasionally? Big government solutions are almost always hand in hand with big corporate business, and almost always detrimental to people.

Mo Rage said...

"Big government...ruined American health care"?

In no way.

It was government stepping aside and letting business do whatever they wished, most especially with prices and pricing, that got us to the point where we have, hands down, the most expensive health care system in the world. It's also the number one reason for bankruptcy in the country.

And this isn't "big government", either. Yes, we had to step in with something and yes, certainly, it's government that has to do it but who or what else would be able to step in and force especially health insurance companies not to gouge us any further?

People who say we either shouldn't do anything or, as in your case, that we should try "more freedom" for business and unregulated Capitalism stun me. It's been unfettered, foolish, trusting Capitalism that got us into the nightmare we're in.

Sevesteen said...

The laws and regulations on health insurance, written by the insurance companies that prevent actual competition. Governments decide where and when hospitals can be built, what patients they must accept, what services they must provide, which services they must provide for free, who they can hire, what drugs they can prescribe for which conditions, what services health insurance must cover...Mandatory insurance coverage for minor mental health means churches get to charge insurance companies for faith-based counseling, on a sliding scale based on the maximum the insurance company will pay. Different tax status for self-purchased coverage means that insurance companies only have to please employers, and we aren't their actual customers.

Off the top of my head, and I'm sure there's more. That's totally unregulated?

We haven't had unfettered capitalism with health care at least since at least the 1930's, probably before. We've had rent-seeking crony capitalism, corporations writing rules, lobbying government to adopt those rules for the benefit of corporations.

Mo Rage said...

Again, here, with you, as in so many conversations I have with people from or in the Right Wing or Libertarians or Republicans, you're putting more in what I said than what I wrote. You're putting words in my mouth.

I never once wrote "totally unregulated."

I said and still contend that there is FAR too little regulation of health care and that is PRECISELY what has gotten us the most expensive health care system in the world, factually, and the health care system with the worst health care outcomes and mortality rates of the top 26 industrialized nations.

First, we agree--"The laws and regulations on health insurance..." have been and are "...written by the insurance companies..." That's one mre thing we get for allowing "campaign contributions" for and to our legislators.

Government decides where and when hospitals are built so--hello?--they don't build FAR MORE beds than the society needs and so, overloading the system with costs that have to come out of--again, hello?--your and my pockets.

Governments decide what services they have to provide for free so there's a basic, minimum level of humanitarian aid and service and it's not entirely consumed with only profit and profits. Health care needs to be about health care and humans, first, and profits, last, instead of the system we have now.

They only decide who they can hire to say they can't discriminate. I thought that should be a good thing and one we decided long ago.

You don't want government requiring hospitals and doctors and businesses preventing over-prescribing or incorrectly prescribing of medicines? That's what government is trying to do there, when you complain about this government regulation. There are countless stories of doctors, hospitals and pharmaceuticals either wrongly prescribing or too widely prescribing and so, unnecessarily, of drugs.

Again, we have hands down the most expensive health care system in the world and with the worst outcomes. With those as givens, as facts---and they are facts, statistically---I'd contend we have, without doubt, the worst health care system in the world and certainly the most heartless.

It has the most profits, certainly, but it is the least humane of any other health care system in the world, arguably.

Sevesteen said...

Who says that an "extra" hospital should be paid for out of our pockets? Hello? That's part of the problem, that hospitals are a hybrid tax-funded charity business. We don't get bailouts of grocery stores when they build too many, and food is even more important than health care.

You think some federal bureaucrat is better at deciding what drugs you should be allowed to take than you in consultation with your doctor? You say you're against the war on drugs, but what does that really mean--reduce enforcement, but keep them illegal, allow some with a doctor's permission? When I say it, I mean that I want drugs to be legal for adults, that if you want to over-use drugs, you shouldn't need permission from anyone as long as you aren't driving or similarly risking others. And if you are in chronic pain, your doctor should be able to give enough drugs to help without risking his license.

Government does decide who can work there--you have to be licensed to be a doctor, pharmacist, nurse or even a nurse's aid. Most of a pharmacist's job could be done with a computer program, there are very few compounding pharmacists anymore. I'd rather my doctor be licensed, but I should have the choice. I also think there's likely better and cheaper ways of doing most health care, and a lot of medical licensing protects the income of providers at least as much as it benefits patients. (I'm not saying they don't deserve the income...but again, choice) Look at what eyeglasses cost online vs what they cost at a physical optician's--Where I get mine online is $7 per pair plus $5 per order shipping for basic, complete prescription glasses. Mine cost more because I get the high-end $20 frames and almost all the options on the lenses...but still hundreds less than the nearest equivalent highly regulated local optician.

There will always be mistajkes. Regulation won't stop mistakes.

Imagine if deregulating health care had the same results as deregulating telephones--better, cheaper and more convienient...with the old version still available for people who prefer it. I think that's possible and likely.

Mo Rage said...

So many things to react to.

So much you have wrong.

What are you talking about that "hospitals are a hybrid tax-funded charity business"? Non-profit hospitals, mostly because of the Catholic hospitals of the past, get some support, sure, but most hospitals are for-profit and don't get tax deductions. And if they do, they're not as widespread as, for one best example, the tax deductions "Big Oil" gets and they're one of the most profitable industries in the world.

Yes, I do happen to think that some federal bureaucrat should be responsible for seeing to it that doctors--and pharmaceuticals--don't over-prescribe medicines in order to line their own pockets. How you can defend that, I've no idea but there you are. Also, the whole thing about "some federal bureaucrat" isn't remotely accurate in the description of this situation but it helps the emotional argument for it, if the person you're discussing it with lets you get away with it.

I'm against the war on drugs. Allow me to make this clear. It should be already but here you go. Marijuana shouldn't be the unnecessarily illegal drug it is. We should make it not illegal (legalize it), tax it and see to its logical, intelligent distribution. Colorado is clearly, clearly making headways in all this. They're leading the nation and profiting for it in the meantime. Surely you agree to that.

And now you're against licensing doctors.

Really, your view of government of any and all types being ugly, wrong and negative is stunning. How do you think we run a nation of 325 million people without it? I just don't get it. I just don't get you. I don't have the remotest idea how you think this world, let alone this nation, could exist and function if we don't have government.

Is our government broken?


Does it need fixing?

Again, absolutely.

And how to fix it?

Get the money--the big money of the wealthy and corporations--out of our election system and so, out of our government. Then we can have government back for the people and the entire nation and not just for those same wealthy and corporations.

If you had your way, the greedy and wealthy and corporations would have their way with us.

"Imagine if deregulating health care had the same results as deregulating telephones" you say.

I can. I can imagine that and I have. It doesn't take a lot to do.

We'd have the even more expensive health care system on the planet than we already do.

You mention that "there's likely better and cheaper ways of doing most health care,"

There are.

It's called universal health care.

And most all other nations on the planet already practice it.

But you'll ignore or disallow that.

Sevesteen said...

A quick Google found this as the first useful result:

Based on that, most hospitals are private, nonprofit, with about as many for profit as government owned. I don't know what government benefits the nonprofits get. The government owned ones should have some controls to make sure they don't overbuild. Look up Edward Hospital (where I was born) and Governor Blagojevich--corruption in the certificate of need was the beginning of the investigation that put the governor in jail.

So you're for ending the war on pot--what about other drugs? Making pot legal, but not legalizing heroin, cocaine, Viagra or Abilify isn't about freedom, it's still paternalistic "we know what's best for you". Doctors shouldn't have a financial incentive in prescribing drugs. Most often they don't--you don't buy from them. Things like undisclosed kickbacks from drug companies should be regulated--but otherwise the government should butt out.

There's no way real competition would make a worse or MORE expensive system, in either telephone service or health care. The problems come with partial deregulation, where there is neither real competition nor price controls, where the ability of customers to comparison shop is restrained.

Like health care is now.

There are a lot of nutrients that are both necessary and poisonous depending on the dose--you can sicken or die from either too much or too little. Government is the same way--Some government is essential, too much is crippling. We're far closer to too much than not enough.

Mo Rage said...

How could anyone argue for legalizing cocaine or heroin?

Doctors shoul absolutely not have a financial incentive in prescribing drugs, certainly. And how do you make sure that doesn't happen without government? Again, someone has to set the rules. And that would be government. Not huge government, not government for government's sake but government, for sure. It's the only way.

Things like undisclosed kickbacks from drug companies shouldn't just be regulated but made illegal.

More competition in health care? Who are you kidding? Hospitals, what with all their costs, etc., go into an area and they own their area, for all practical purposes. There's only one game in town and that's where you go and they set the prices and they set their own rules. That is one of the many reasons we've, here in the good ol' USA, ended up with--once more--the most expensive, punishing, bankrupting health care systems in the world, hands down and many times over. Virtually all other nations in the world know there is no way we should tie health and life and feeling good to profits or you end up with the nightmare like we have.

We're just stupid.

England has such a great system, whatever its flaws, that they actually celebrated theirs in their Olympics.

There's no way we could or would do anything remotely like that. We're sick and our health care system is sick.

And it's killing us. Literally.

Sevesteen said...

Would you use heroin or cocaine if it were legal? I wouldn't. I don't believe usage rates would go up significantly if at all, overdoses would go down if strength was consistent, health problems due to contaminated or adulterated drugs and contaminated or shared needles would go down. (and restricting needles is extraordinarily stupid) It is likely that drugs would be harder for children to get--I knew exactly where to buy pot by 6th grade in a small town middle class school, it was a lot easier to get than beer or liquor since the sellers didn't have a license to worry about. Current illegal drug use funds cartels, violent criminals, terrorists and has ruined much of Mexico and South America, not to mention the civil rights we all have lost to fight this stupid war on all drugs. Doctors cannot give dying cancer patients enough drugs to make their last days as comfortable as practical.

Legal drugs for adults including heroin or cocaine would mitigate most of this damage done to NON ABUSERS and shift the remaining harm back to users where it belongs. Employers should remain free to require drug free employees--workplace drug testing does more to curtail drug use than criminal penalties.

And it's not OK to lock up a huge percentage of poor black men for pot, but it is for other drugs?

Are you really completely free if you can't even decide what goes into your own body? This is actually my core argument--I am against regulating "for your own good", regulating should only stop you from harming others. Plus it's pretty arrogant to say "I know better than you what risks you should be able to take for the fun you want to have". Where's the line--Motorcycles, promiscuous sex, cigarettes?

Legalizing pot is a good start, but it isn't nearly enough. And to be clear, I don't want any of it for me,the currently legal drugs are sufficient for my desires.

But no, let's stick with the drugs that rich white men like, and don't compete with the established corporate interests. (Like E-cigarettes--looks like cigarettes and e-cigarettes existing before 2007 will be grandfathered, new ones subjected to expensive and stringent review--despite all evidence that e-cigarettes are far safer than traditional)

Undisclosed kickbacks for doctors should be illegal, I didn't say that well.

Hospitals are bigger than they should be because of regulatory burdens. Instead of the 3 or 7 small hospitals an area should have, there's likely one big one, mostly due to regulations. Instead of encouraging a monopoly with regulation, we should set the regulations up to discourage it, and instead of offering "free insurance" in a monopolistic system, maybe something closer to "health care stamps" to the poor, similar to food stamps. Maybe the bigger your market share the less your government reimbursement rate. Competition almost always works to reduce cost and increase quality, monopolies almost always the opposite--regardless of "for profit" or pseudo-charity. And established monopolies fight against deregulation with deceptive propaganda and lobbying for protective regulations. Zipcar in New York, (taxi companies fight it) AirBNB in lots of places (hotels fight it)

I would agree that a mix of artificially limited competition and for-profit should not be allowed, let alone mandated...but that's exactly what Obamacare is.