Why people are afraid of universal health care

[Loren Pechtel]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

 

[Loren Pechtel]

We have two ( at least) public options already: Medicare and Medicaid. There is an enormous issue with both of these: The pay for services is inadequate which has resulted in providers limiting the number of Medicaid patients they serve because reimbursements fall short of cost of service. Medicare is approaching the same issue with the providers limiting the number of Medicare patients they accept. In my area, more and more health care systems are declining patients with Medicare Advantage plans.

Which is exactly the problem. Fix them (and the military healthcare) then talk about UHC.

My concern with UHC is that politicians campaign on saving money/tax dollars and patients and providers suffer. I know it works in other countries. I do not know why we are so fucked up that it is a huge issue here.

Yup--it's not like it removes financial factors. It just replaces the insurance companies with the voters.

 

[laughing dog]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

 

[Loren Pechtel]

In my area, more and more health care systems are declining patients with Medicare Advantage plans.

Could you post a link or two on that? Isn't happening around me. I've never encountered it or heard of anyone else encountering it.

Okay, I did a bit of googling. It seems 1% of non-pediatricians do not participate in Medicare.

You see a pediatrician? Medicare would not cover any such visit.

I don't think it's completely impossible. Child actor, works 10 years, fully disabled, two years later I think they go on Medicare. I see no reason it would be completely impossible to have that happen before 18.

 

[Loren Pechtel]

The drawbacks I observe are that a lot of providers limit the number of their Medicaid ( low income) patients and increasingly, Medicare patients because Medicare and Medicaid pay so poorly, often not covering the actual cost of treatment.

Medicaid is often very low, but it can be done. Most successful Medicaid plans have very tight controls on what procedures a patient is allowed to get, when they can get them, what they have to try first, etc. They almost always require an assigned primary care doctor who you have to see prior to any treatments by any other provider (except emergency), and they require referrals from that PCP for all other services. They're very tightly managed, which places very strict limits on how much excess a provider can bill for. It's not actually the cost per service that's limiting for providers, it's not being able to send everyone for every possible sort of exam. It's being required to do an xray when the initial diagnosis is a broken bone, and not being allowed to send that patient for a CT scan or an MRI instead.

I'm thinking of something I saw from a doctor explaining his costs. Tennessee?? a series of well-baby visits. The state paid a hair less than the actual cost of the vaccinations that were part of said visits. Or the local doc who explained in the newspaper why he wouldn't see certain patients, making them go out of state instead. He would get something like $1,000 for it--but it cost $250/hr to run his office and counting all visits actually doing the procedure would take more than a day of his time.

 

[Elixir]

What principle of economics do you know of that says "These people matter; those people don't."?

Trumponomics.

 

[Loren Pechtel]

I don't think the way our system has evolved was nefarious; it's just been repeatedly pushed and tweaked and duct-taped in an endless effort to fix something that was wrong with it, by too many chefs, most of whom didn't know what the consequences of their messing with it would be. Good intentions, meet road to hell.

Exactly. It's what happens when you keep trying to patch over fundamental flaws.

 

[Loren Pechtel]

... Whether to keep the private model around for those it serves and add on an additional mechanism to care for the poor, or to kill off the private model and make all its users switch to the new mechanism, is a question for economists who know something about the unique challenges of health care, not a question for moral philosophers preaching abstract formulas that would apply equally to feeding or curing people. ... Moral philosophy is all too often just a lame excuse for not doing a cost/benefit analysis.

Cost/benefit analysis helps to illustrate the tradeoffs inherent in any decision, along with quantifying the costs and benefits. But it cannot ultimately answer a question about social policy unless it is combined with moral judgments.

For example, suppose some CBA on switching to a UHC saves 1000 lives per year at a cost of net cost ( excluding an explicit value on a life) of $ 6 billion per year. Depending on the value of a life, the CBA could be positive or negative. That’s where values and morals come to play.

I don't disagree. IIRC some economist did a calculation, based on observed tradeoffs, that the U.S. government valued a citizen's life at $6,000,000, the Japanese government valued a citizen's life at $60,000, and the Vietnamese government valued a citizen's life at $600. Which way we want our governments to go on that is a moral judgment, not one an economist has special expertise on. But the moral judgment we need is a raw one, a consultation with our intuitive moral senses, not any sort of reasoning from abstract moral premises. Arguments like "Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalized, but a misfortune the cost of which should be shared by the community." tell us jack squat about whether saving a thousand lives is worth six billion dollars.

It's actually good that the government does this. It should explicitly be defined to use as a basis for making safety decisions. All too often politics gets in the way of sane risk assessments.

 

[Loren Pechtel]

Well… we have the raw numbers from COVID.
While enduring an estimated one million “excess deaths” we (Trump) ran up a 7 trillion $ debt. So with inflation, the number has to be around $7m/citizen.
If I knew I was worth that much I’d have sold out long ago!

There are no lives saved here to be making the comparison.

 

[Loren Pechtel]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

No--the Republicans crippled the FAA to the point that they allowed Boeing to do their own inspections because the FAA wasn't able to.

 

[laughing dog]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

No--the Republicans crippled the FAA to the point that they allowed Boeing to do their own inspections because the FAA wasn't able to.

But the FAA was an independent regulator.

The obvious point that eludes you is that an effective overseer is necessary for accountable, not its affliation.

 

[bilby]

Why would anyone assume that a YHC would not have some form of outside rsgulation?

Who? It's the government setting the standard of care. It's the government providing the care. That's a fox guarding the henhouse.

That's no less absurd than saying of any system "It's humans setting the standard of care. It's humans providing the care. That's a fox guarding the henhouse".

"The government" is not a monolithic entity. It is a society in its own right, and is divided into competing departments and divisions.

Would you suggest that an officer from the airforce could not fairly referee an army vs navy football game, on the basis that it's all "The Military"?

No wonder American politics is so fucked up; The people can't seem to grasp that they don't live in a dictatorship. Shit, even one of the two candidates for this year's presidential election can't seem to grasp that the US government is not the power apparatus by which the President rules as an autocrat.

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Boeing can't self regulate because it's primary motive is profit, and it is accountable to the Boeing board for both profitability and regulatory actions. Internal regulators are under the control of the same board of directors who want corners to be cut.

The GAO has no such motive; It's job is to audit government departments, and it won't cut them any slack 'because they are government too'. The Comptroller General has no motive to let other federal agencies get away with anything; The GAO is as independent as it is possible for any regulator to be.

Government auditors have as much separation from those they regulate as can reasonably be accomplished. Your belief that they are not separate because they both have the label "government" is a failure to grasp how governments work.

 

[Bomb#20]

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

The FAA, independent? Riiight. The FAA reports to the transportation committee. You mentioned screwing...

When Members of Congress Sleep With Lobbyists

Is that frowned upon?

nymag.com

 

[Bomb#20]

Whether to keep the private model around for those it serves and add on an additional mechanism to care for the poor, or to kill off the private model and make all its users switch to the new mechanism, is a question for economists who know something about the unique challenges of health care, not a question for moral philosophers preaching abstract formulas that would apply equally to feeding or curing people.

Morality should be included in all economic discussions. By pure economic standards, we would just kill all prisoners who get a life sentence. Incurable disease? Kill the patient. Disabled child requiring lifetime care? Kill the child. Slavery? Sure!

Show your work. You appear to have made those inferences by neglecting the interests of the prisoners, patient, disabled child, and slaves. Calculating the benefit to your ingroup and disregarding the cost to your outgroup does not qualify as "pure economic standards".

Why not

I can't even.

What principle of economics do you know of that says "These people matter; those people don't."?

That's easy. The one that doesn't include morality.

"Increasing a factor of production by one unit, while holding all other production factors constant, will at some point return a lower unit of output per incremental unit of input." That one doesn't include morality. Not seeing where it says "These people matter; those people don't."

Morality involves asking why the slave tries to escape and why the master deserves to keep the slave.

Certainly. I wasn't raising any objection to using morality, just answering your question about how it's possible not to.

Your original point was that morality should not be included in the cost/benefit analysis.

No. My original point was that a popular internet meme somebody posted was a dumb argument. I wouldn't even have bothered except six people "Liked" it. But it's a discussion forum, so inevitably a bunch of posters made up other things for me to have meant and excoriated me for them.

Are you backing away from that now? Because it sure looks like you are.

Do you often back away from things you didn't say? Where did you see me say morality should not be included in the cost/benefit analysis? Morality and moral philosophy are not the same thing. See post #214.

Not commenting on the merits of the NHS model for health care delivery, just pointing out that moral philosophy is an utterly garbage way to decide how to solve the hard technical problems of economics.

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics. Whether a master deserves to keep a slave is not a hard technical problem of economics.

 

[bilby]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

 

[Elixir]

Well… we have the raw numbers from COVID.
While enduring an estimated one million “excess deaths” we (Trump) ran up a 7 trillion $ debt. So with inflation, the number has to be around $7m/citizen.
If I knew I was worth that much I’d have sold out long ago!

There are no lives saved here to be making the comparison.

WTF are you comparing/talking about?

 

[laughing dog]

No. The problem comes with any organization that self-regulates. Look what has happened recently with Boeing--the FAA was permitting them to do a lot of their own inspections. Oops. You need as much of a separation as can reasonably be accomplished.

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

The FAA, independent? Riiight. The FAA reports to the transportation committee. You mentioned screwing...

When Members of Congress Sleep With Lobbyists

Is that frowned upon?

nymag.com

Is your point is there is no such thing as a truly independent regulator, so LO’s objection to UHC is based on a chimera? Then we agree.

 

[Bomb#20]

Let me get this straight. The FAA -an independent regulator - screwing up is your reason for wanting an independent regulator.

It appears you are letting the perfect get in the way of the good.

The FAA, independent? Riiight. The FAA reports to the transportation committee. You mentioned screwing...

When Members of Congress Sleep With Lobbyists

Is that frowned upon?

nymag.com

Is your point is there is no such thing as a truly independent regulator, so LO’s objection to UHC is based on a chimera? Then we agree.

I couldn't say if there is such a thing as a truly independent regulator; my point was rather that if there is such a thing the FAA isn't it. Regulatory capture is an eternal problem, but it comes in a spectrum, and trading sex for industry-favoring regulation is kind of on the egregious end of it. If a truly independent regulator really is a chimera, that doesn't strike me as a good reason not to strive to get regulation to move along the spectrum toward the independent end. I think that was LP's point, and I see some merit in it. "Regulators are all going to be captured anyway so let's just design the capture in from the get-go and treat it as a feature, not a bug." seems unnecessarily defeatist to me. Moving along the spectrum toward the independent end is of course swimming against the current, but if a regulatory agency turns out to be unreformable the government always has the option of creating a brand new regulatory agency to replace it. That's probably easier than creating a brand new industry for the government to operate itself.

 

[Bomb#20]

Whether to have an NHS or a mixed public/private medical system is a hard technical problem of economics.

Is it?

Which is cheaper, or more efficient, I can see as a hard technical problem of economics.

Whether to make cost, or efficiency, or something else - popularity amongst patients, for example; Or effectiveness in reaching those least able to provide for their own care - that is a problem of moral philosophy.

Hmm. It's a problem of morality. A person might for example take the view that what patients prefer matters and what those paying for it prefer doesn't matter, based on gut moral intuition. But I'm not seeing how moral philosophy is any use here. How would you put together an argument for prioritizing cost, or efficiency, or something else? What reason would anyone hearing your argument have for regarding your abstract moral premises as more certain than his own gut feelings?

And in any event, if we decide cost and efficiency don't matter and what we want is for the system to be popular amongst patients, forecasting whether a proposed system will be popular with patients is a hard technical problem of economics. You can't just postulate the system of your dreams and expect it to necessarily work out in practice the way you envision. Patient experience will depend on myriad decisions by doctors, nurses, researchers, manufacturers and so forth, and all those people's decisions will depend on the incentives the system gives them. Economics is pretty much just the science of incentive.

 

[ZiprHead]

Do you often back away from things you didn't say? Where did you see me say morality should not be included in the cost/benefit analysis? Morality and moral philosophy are not the same thing. See post #214.

Whether to keep the private model around for those it serves and add on an additional mechanism to care for the poor, or to kill off the private model and make all its users switch to the new mechanism, is a question for economists who know something about the unique challenges of health care, not a question for moral philosophers preaching abstract formulas that would apply equally to feeding or curing people.