Why is medicine expensive?

[Stalins Organ]

I don't think there is a common understanding as to what constitutes "decent" health care.

For those dying or with rellies about to die it is everything that is necessary to keep them alive regardless of cost.

For insurance companies it is whatever their tables tell them the premiums are worth.

For those administering fixed budgets it is whatever gets them the least opprobrium from those who don't get what it takes to save their lives!

For politicians it is whatever gets them re-elected.

[Dietrich]

Anyone else here think that decent health care is a human right in a civilized society?

Yes, that group called 'the World'*.

* exception: USA

Since when do ruthlessly money-grubbing conservatives pols and pundits (who would rather that tens of millions of their fellow countrymen fail to get decent health care than that the government taxes them any more than it already does) speak for all Americans?

For those dying or with rellies about to die it is everything that is necessary to keep them alive regardless of cost.

Except when those dying have already decided that they want to be "do not resuscitate".

[abneo3sierra]

Anyone else here think that decent health care is a human right in a civilized society?

I do think decent healthcare being AVAILABLE is a human right..I strongly question whether government is actually who I would turn to for said "decent healthcare" as they pretty well muck up everything they touch..see AMTRAK train system, US Postal system, VA medical system for veterans, etc.

I do NOT think politicians, long ago, and far away removed from the real world citizens they supposedly are elected to serve, are more capable of handling health care choices than are doctors who have endured countless long days and years in medical school, residency, etc.

So, while I see the same objective as you do, I disagree on the path to that objective, is all.

[Stalins Organ]

Except when those dying have already decided that they want to be "do not resuscitate".

Even then take hem out of the hospice as they are on the decline and see what reaction your get.

[JonS]

Since when do ruthlessly money-grubbing conservatives pols and pundits (who would rather that tens of millions of their fellow countrymen fail to get decent health care than that the government taxes them any more than it already does) speak for all Americans?

Fair point, which I had expected to come up. My response would be something along the lines of "since you started voting them into power, and consuming their product (be it tangible goods or media and opinion)."

[Magpie_Oz]

Fair point, which I had expected to come up. My response would be something along the lines of "since you started voting them into power, and consuming their product (be it tangible goods or media and opinion)."

"People deserve the government they get, and they deserve to get it good and hard."

~ Timothy Moultrie

"In democracy you get the goverment you deserve. Alternately you deserve the government you got."

~Josef Heller

Everything said and done, at the end of the day, we get the government we deserve and deserve the government we get.

~ P. Ramakrishnan

"A people deserve the government they permit."

~attributed to the pseudonym "General R. Never,"

"In Russia, it is a common saying that every people deserve the government they choose."

~Vladimir Viardo

"In a democracy you get the government you deserve and you deserve the government you get."

~Duane W. Compton

"We have to let these turkeys know that we are not going to play games and go sideways and backwards. America deserves better. They say that you deserve the government you get. "

~ Eldridge Cleaver

"We deserve the government that we get. That's an old adage and it's really true."

~Patricia Boyd, executive director of the Minnesota Christian Coalition

[dieseltaylor]

You may then say that when these people opined the pithy saying politics was less managed.

In the last mid-term elections we saw the evolution of a new form of campaign funding that avoided the disclosure requirements of the Federal Election campaign Law (FECA). The new approach was masterminded by Karl Rove and former Republican Party leaders through American Crossroads GPS. They created a non-profit organization under 501©(4) of the Internal Revenue Code -- organizations that are not supposed to be primarily involved in elections -- and used it to raise tens of millions in secret donations. In total, nearly $150 million was spent by these ©(4) groups leaving voters in the dark as to the personal interests of the donors. We can expect that to more than double in 2012 if existing laws are not enforced. Indeed Rove has announced his group alone intends to raise $120 million for 2012.

http://www.alternet.org/news/150864/unlimited_secret_money_is_drowning_democratic_elections

SO do you think it is possible that business groups are prepared to pay for a Government more favourable to them. And it just may include medical groups. I think it is fairly common that those who spend most get elected in the US [a few exceptions].

What is going on in Wisconsin with recall votes is actually very encouraging as it shows that though you can hornswoggle an electorate there is a means to kickback.

Not all countries are as fortunate. Are democracies able to take difficult decisions - or should I say politicians in power. Is the structure wrong ? Should Civil Service think tanks come forward with the ideas and then the Party skin is not so much in the game.

I thought I would look at what I consider well-governed countries - though both are small - Switzerland and Singapore. All is not roses in either. Switzerland has some supporters though whether the US providers could be trusted, and the population make up allows it to work must be moot, Interestingly this came from a 2009 Singaporean article:

The danger of people being medically uninsured is a very serious one. Business Week, in a recent issue, highlighted the plight of thousands of Americans with little or no medical insurance who are being squeezed by financial companies who had taken over their debt from the medical providers.

.

"As doctors and hospitals turn to GE, Citi and smaller rivals to finance patient care, the sick pay much more," said the article. "Hospitals are transferring patient accounts to banks and finance firms that impose interest rates as high as 27 per cent."

.

This is a picture of the United States today. We may face the same situation if something is not done to address the way Singaporeans, particularly the baby boomers, finance their medical cost.

Might explain some of the US cost problems.

I think my chief solution is to educate the public that there has to be limits on what a Health Service can do.

[abneo3sierra]

I think that quite a fair argument can be made for this, but also for the hundreds of millions spent by labor unions to support Democrat Party candidates..the Democrats were ready to make some rulings on this particular item,when they realized they would have to forfeit the donations of labor unions, they basically backed off..my point is, it goes both ways..and even worse, in this direction, because the labor unions spend money to support anyone with a 'D' by their name, regardless of the wishes of those whose money they are taking, to pay for said donations.

Still, it is wandering way off topic here and into the realm of politics I think.

[gunnergoz]

I do think decent healthcare being AVAILABLE is a human right..I strongly question whether government is actually who I would turn to for said "decent healthcare" as they pretty well muck up everything they touch..see AMTRAK train system, US Postal system, VA medical system for veterans, etc.

I do NOT think politicians, long ago, and far away removed from the real world citizens they supposedly are elected to serve, are more capable of handling health care choices than are doctors who have endured countless long days and years in medical school, residency, etc.

So, while I see the same objective as you do, I disagree on the path to that objective, is all.

I don't see government as the big bad boogeyman that you apparently do, and that says something since I've been around a while and I by all rights should hold a grudge, since that same government tried to deport me when I was 5, separating me from my parents in the process. Regardless, I accept that bureaucracies are only as good as the political leadership that heads them, and some are better at what they do than others. In other words, I have faith in the government, or at least in my ability to influence it towards improvement.

What I find more a more horrifying prospect is the idea that some insurance company bean counter will determine whether or not I or my loved ones will get some medical procedure, based upon his/her calculation of how that will affect insurance company profits and the CEO's annual bonus. You see, I own no insurance company stock, attend no board or stockholder meetings, and thus have ZIP opportunity to have my complaints heard. With a government run healthcare system, I at least have (in the end) my vote, and other tools as well, to influence how it comes to be operated.

In other words, I am VESTED in my government, and it in me. A medical insurance company, on the other hand, is NOT VESTED in me or my health: it is interested only in its profits...and it profits most when it serves me when I do not need it, and ignores me or rejects me when I need it most.

And I don't find most government services appallingly inefficient, as you seem to do. Actually, they were doing pretty well until deregulation and underfunding made the whole government services setup (federal, state and local) start to wobble and wheeze for lack of revenue with which to operate.

Finally, one more thing: for over 25 years I was a bureaucrat myself, in local county government, and I know for a fact that my co-workers and I worked long, hard hours to serve the taxpayers that were our clients and ultimate bosses. I know that simply being a civil service employee does not make one a money-grubbing, lazy leech, as the right likes to depict them now. I have a modest pension (which I paid into) and NO MEDICAL until Medicare kicks in, so in that respect I'm no better off than most retirees from business and industry.

This whole argument that government is the ultimate evil and should not be involved in public medical care is hooey; unfettered, unrestrained greed is what is the problem and that is what is presently running the medical insurance industry.

[abneo3sierra]

Well..I do not see the government as "bad"..however, myself having also been around enough, usually at the sharp end of the decisions that are made, I see them mostly as incompetent. The VA medical system is a joke, the postal service loses money yearly, Amtrak train service can never manage to turn a profit, despite actually being a fairly popular method of transportation for many people. 90% of the decision making portion of the federal government, give or take a little, is composed of lawyers...who are great at writing laws, decent at interpreting those laws, but horrible at anything else..not the same as seeing them as "boogeymen"..just more a joke.

[Stalins Organ]

What transport system in the USA doesn't get govt funding?

[dieseltaylor]

Good angle, good reply gunner. I wish I had thought of it.

Both presidential candidates have put forward proposals for curtailing waste in the U.S. health care system. Behind these claims are estimates that various medical procedures are used inappropriately as much as one third of the time in the United States. The director of the Congressional Budget Office, Peter Orszag, stated in August 2008 that “a variety of credible evidence suggests that health care contains the largest inefficiencies in our economy. As much as $700 billion a year in health care services are delivered in the United States that do not improve health outcomes.”1 Reports abound of needless or low-benefit procedures, some performed for fear of litigation, some out of venality, some demanded by importunate patients, and some representing the mindless repetition of established routine: “That's the way we do things here.” As is often noted, other countries spend less per person than we do and achieve equal or superior outcomes. That a first-class health system can be run for less than the United States spends — or a better system for what we actually spend — is undeniable. But what, really, do we mean by waste? Do we have the means to curtail it? How fast can savings be realized?

From an excellent article here - with some suggestions:

http://www.nejm.org/doi/full/10.1056/NEJMp0807204

[dieseltaylor]

What transport system in the USA doesn't get govt funding?

SO are you implying that all those roads are not directly funded by drivers! Thats atrocious. Only those that use certain roads should pay for them.

: )

[Bigduke6]

Blaming politicians is a cop out. Politicians are people and they behave as the people that influence them allow.

The problem is multi-faced: average citizens as a group are poorly-educated and indeed frequently willfully ignorant, average citizens are trained from an early age that political engagement and involvement is not cool, average citizens in their average lives are too busy with day-to-day problems to commit time to pressuring politicians, the constitutional setup doesn't give average citizens that many tools to influence politicians, the constitutional setup favors accumulation wealth and so wealthy citizens and proximately the companies that generate the wealth, the constitutional setup favors government policy that caters not to intelligent citizens, but stupid ignorant ones.

Can this be overcome? I would say the answer is emphatically yes. If you take the examples of poor governmental management that ab3s (sorry for abbreviation) submits - AMTRAK, postal system, and VA system, then to me this is just a matter of critical civic mass.

By this I mean, that if enough of the general population cared enough to use the service, write Congressmen, watch media reports praising rail, attract show business types to riding the train, etc. then certainly you could pressure the government into committing resources and changing laws so that AMTRAK would serve the population properly. But as it stands too many Americans prefer riding in a car and accepting pollution and traffic to working to force their elected government to fix the national rail system.

Ditto Postal system and VA medical benefits. If the general population decided either of these issues was a hot button issue, and voted its representatives in based on their position on these issues, you'd see change almost immediately. All it would take would be a decision by a strong majority of the population that other government programs must be sacrificed, so that the VA system is properly financed and properly run.

But as it stands the apparently feels it is sufficient to accept things the way they are and just complain among themselves.

It is not possible to say everything run by the government is poorly-run. Consider:

- NASA's moon shot program

- The Manhattan project

- World War Two mobilization

- The US military 1990 - 2005 or so

- Eisenhower's national highway program

- The NSA right up through now

If that list seems overly military and not sufficiently supporting the needs of the average American, then all I can say is maybe Eisenhower was on to something when he warned about the dangers of letting the military-industrial dictate government priorities.

I do think decent healthcare being AVAILABLE is a human right..I strongly question whether government is actually who I would turn to for said "decent healthcare" as they pretty well muck up everything they touch..see AMTRAK train system, US Postal system, VA medical system for veterans, etc.

I do NOT think politicians, long ago, and far away removed from the real world citizens they supposedly are elected to serve, are more capable of handling health care choices than are doctors who have endured countless long days and years in medical school, residency, etc.

So, while I see the same objective as you do, I disagree on the path to that objective, is all.

[gunnergoz]

As far as blaming politicians goes, I place the real blame on one facet of our society that has brought more problems to us than any other - the way we fund elections. Our system has become corrupted by its massive appetite for campaign funding for virtually any and every election, at every level. We have allowed the dollar tail to wag the political dog. Elected officials are increasingly beholden to those who will fund their campaigns, be they interest groups, corporations or wealthy individuals with deep pockets. As a result, most legislation is warped by the demands of these influence groups. This has gotten to the point where we now have courts stacked in accordance to these same alignments, due to elected officials picking judges based not on legal expertise, but upon likely ways of voting on selected issues. Judges no longer recluse themselves when they have a direct interest in the vote's outcome. It has all become one big influence peddling game.

The end loser is the voter. While his/her vote is essential to the elected official, the amount of money spent on campaigns and the amount of propaganda vs fact being thrown around makes it very hard for voters to discern what is truth from what is spin. In the end, you have a situation where those who shout loudest, get heard.

The only solution in my mind is major campaign funding reform, which would serve to separate the political candidate from the funding sources; in other words, campaign funds anonymity. They would probably have to be pooled in some system and shared out equally to all candidates. Self-funded candidates would basically be out in this system, so that no one had the advantage of more funds than the other candidates. And obviously, no candidate would be beholden to any one source of funding, other than the pool. No corporation or lobby could come up to them and say, "Hey, remember us, it's time to vote our way since we paid your way."

No one is perfect, least of all those inclined to run for public office, but this is the only way I see to get elected officials who might, just might, think about what they are doing in terms of what is best for their constituents and not simply in terms of what is best for those who paid for their campaigns.

[Magpie_Oz]

Yes it always seems like such a joke that we place budget caps on Formula 1 and Rugby to ensure a fair competition, but not on that race which matters most.

[abneo3sierra]

I would not say the same thing regarding use of government funds, vs government actually in control of..

The military is one of the few things, government was mandated to control, in our constitution, and a fine job generally, mostly because the people controlling it on a day to day basis are usually not politicians, but rather people who have been trained for it. Most things "military" have been done well, until "politicians" actually become involved..then, we run low on logistics for budgetary reasons, run over on deployment because of budgetary reasons also, as they do not provide enough manpower, to do the many things they need us to do..etc. So the common thread,just like it will be with the government involvement in the medical field, is that once politicians are involved, and dealing with budgetary issues, overall quality will decrease, in anything the politicians touch. This would be the case, unless they allowed people who actually KNOW the subject, to be involved more in the money discussions..where right now, barely a bill can be debated,for anything,without every politician involved, adding in so much "pork"spending that the original issue many times ends up being the LEAST, as far as money being budgeted. Want a defense bill for xxxx? ok..but lets also add in this politician's pet project in his district, this one's in this state...and by the end, the original project being voted on, is buried with many things that have no part in the discussion even. This happens everytime, as you can see by just a few hours of CSPAN coverage lol.

[Bigduke6]

I disagree the military is doing a fine job. I agree lots of people in uniform are trying hard. I would point out that they are paid to.

But if after 10 years and 3 trillion dollars the military can't win the war, state clearly what strategy and resources are needed to win the war, or admit publicly that there are no strategies or resources available sufficient to win the war, then that looks to me like a government organization without direction or much moral integrity, and running on autopilot as it hemorrages the treasury.

Under the circumstances, I would fault a politician far more for approving a military funding bill because the military says it's necessary, than for attaching riders to the funding bill which have actual benefit to the people who elected him to office. At least in the latter case he's trying to deliver something to the citizens. Hand the money over to the military and it's just gone, as far as his electorate is concerned.

[costard]

Also worth noting that the military hierarchy is selected for capability and proven performance. Or at least most of it - at the highest levels it becomes dependent on political relationships. This could explain the problems it faces.

[abneo3sierra]

I think that the strategy is determined (unfortunately in the opinion of some of us hahaha) by the executive branch of government(read, the president primarily) the lack of strategy says much more about the failures of the current and past administration, than it says about the military. As for stating what resources are needed, the military has stated this, to both of said administrations, and was given perhaps 70% of what was stated as "needed" under then President Bush, and closer to 40% of what was requested under President Obama..if I recall correctly you are a reporter...so to view it this way..you are assigned a job to do in a specific city..a major story breaking, shall I say...the city is far away from where you are, however, so you tell your boss that you need some money to pay for your expenses..say, the flight ticket, probably food since you will be eating at those great restaurants in that city lol :-) etc. Your boss thinks it over, and tells you, no, we cannot fly you there, here is some spending money though, and some carrying money to hitch a ride there. Now..you may still get there, depending upon how much you have to hold up the thumb,yes, you can get lucky and somebody may give you the ride, but in all likelihood, you will be A) later than if you had received the plane ticket you asked for, and Might miss the story all together, while en route. Is this your fault as the reporter? Or your cheap editor's fault, for skimming here and there on expenses? Now, to make it a better example, imagine how you would feel if the reason for not getting what you need to do your job, is because the editor decided his family needed a vacation, so he took your transportation money to fly his family to Spain for the holiday. After all, they are his "constituents" and he is responsible for taking care of them, more than you.

Also, you said you would fault the politician for approving a spending bill which the military says is necessary, in the paragraph immediately following faulting the military for not saying what resources are necessary. :-)

I disagree the military is doing a fine job. I agree lots of people in uniform are trying hard. I would point out that they are paid to.

But if after 10 years and 3 trillion dollars the military can't win the war, state clearly what strategy and resources are needed to win the war, or admit publicly that there are no strategies or resources available sufficient to win the war, then that looks to me like a government organization without direction or much moral integrity, and running on autopilot as it hemorrages the treasury.

Under the circumstances, I would fault a politician far more for approving a military funding bill because the military says it's necessary, than for attaching riders to the funding bill which have actual benefit to the people who elected him to office. At least in the latter case he's trying to deliver something to the citizens. Hand the money over to the military and it's just gone, as far as his electorate is concerned.

[JonS]

Blaming politicians is a cop out. Politicians are people and they behave as the people that influence them allow.

QFT

(padding)

[Stalins Organ]

SO are you implying that all those roads are not directly funded by drivers! Thats atrocious. Only those that use certain roads should pay for them.

: )

I was reading a remark made by the head of Amtrak a few years ago to John McCain who suggested removing Amtrak's subsidies - teh head suggested that it would be fine as long as it also involved removing the subsidies to the regional airlines that fly around McCains home state of Arizona.

apparently Mr McCain pulled his head in at that point.....

According to that section of wiki -

Highways, airports, and air traffic control all require large government expenditures to build and operate, coming from the Highway Trust Fund and Aviation Trust Fund paid for by user fees, highway fuel and road taxes, and, in the case of the General Fund, by people who own cars and do not

-http://en.wikipedia.org/wiki/Amtrak#The_21st_Century

Not sure exactly what those are, so my originalquestion - which parts of the transport system are not taxpayer supported?

[abneo3sierra]

Stalins Organist..

I am fairly certain that all parts of the transport system are taxpayer supported, as well they should be..my break from that is the difference between using money to help fund something, vs taking over the management of whatever it is. Roads do not count, because they are not a service, but rather in a different category. A better example for mine would be the AMTRAK system mentioned, where not only are they federally funded, they are run by the government in the same way as the Postal Service, and the VA medical service..very very poorly, especially when looked at in a side-by-side comparison with private industries that do the same things, better.

[Bigduke6]

And Amtrak and the Post Office are working with 100 per cent resources?

That journalism example is pretty interesting. And it's real world too, like most reporters for me there is never enough money in the organization for all the cool stuff I want to do, so there's always conflict between the editors and us reporters all of whom want to do cool stuff. It's not so much the editors are cheap, as there is practically no limit to the amount of money you can invest in a reporter going out on assignment. See above, resources are always limited.

For instance, if you take the transportation example, put me in a hired car and that's one level of coverage, put me on foot that's another, and put me in a helicopter that's yet another. The question is, how much resources to you want to commit to help out the field guy to do his job?

One thing is for sure, I am not the guy to judge how the organization should support me. In the first place I don't know all the other stories and reporters competing for resources, and in the second place it's in my personal interest to make the best case I can for as much resources as possible, always. No secret about that.

But once the resources are distributed, I have to get on with the job and not whine about how if only I had more resources I'd be doing the job "right".

I certainly never say "Well, I'm doing my job badly because you guys aren't giving me enough money, so leave me alone." That one will get laughed right out of court. Sure, it can happen (very rarely) that editors will demand the impossible. My responsibility at that point is to educate them and failing that to quit and go into advertising or construction work or start a skyrocketing career at MacDonald's.

The US military has absorbed something like 3 trillion dollars over the last decade and is failing to get the result the society wants. If the society complains, then basically the answer is either "Wait a bit and things will get better" or "You civilians aren't giving us enough resources."

Resources are limited and things are not getting better. Nowhere, not in the constitution nor anywhere else, is it written the military must have unlimited resources and if they don't get it then it's okay to lose wars, or participate in losing wars and pretend the wars are going OK.

Look at history and Westmorland and Van Fleet - are they known now as generals who weren't given enough resources? Or as generals who pretended they were winning when in fact the Vietnamese were winning? Because one thing is for sure, no matter how many times Westy and Dutchman Fleet said the war was going great and Vietnamization was just a terrific program, and look it up, they said it over and over and over - the Communist Vietnamese won.

Where are the military professionals today? By this I mean the senior NCOs and officers who as professionals have an obligation to stand up and say: "As professionals and citizens we will not mislead you: the task you civilians have set us is impossible given the resources you are giving us."

Sure, plenty of lower-grade enlisted and junior officers are just quitting, they're voting with their feet.

But the professionals, the backbone of the military, the ones who keep telling us they've dedicated their lives to protecting the nation? It sure seems to me like they prefer accepting paychecks and not rocking the boat, than looking unpleasant reality in the face and taking the next logical step, which is refusing to go along with policies that are harming the nation.

I think that the strategy is determined (unfortunately in the opinion of some of us hahaha) by the executive branch of government(read, the president primarily) the lack of strategy says much more about the failures of the current and past administration, than it says about the military. As for stating what resources are needed, the military has stated this, to both of said administrations, and was given perhaps 70% of what was stated as "needed" under then President Bush, and closer to 40% of what was requested under President Obama..if I recall correctly you are a reporter...so to view it this way..you are assigned a job to do in a specific city..a major story breaking, shall I say...the city is far away from where you are, however, so you tell your boss that you need some money to pay for your expenses..say, the flight ticket, probably food since you will be eating at those great restaurants in that city lol :-) etc. Your boss thinks it over, and tells you, no, we cannot fly you there, here is some spending money though, and some carrying money to hitch a ride there. Now..you may still get there, depending upon how much you have to hold up the thumb,yes, you can get lucky and somebody may give you the ride, but in all likelihood, you will be A) later than if you had received the plane ticket you asked for, and Might miss the story all together, while en route. Is this your fault as the reporter? Or your cheap editor's fault, for skimming here and there on expenses? Now, to make it a better example, imagine how you would feel if the reason for not getting what you need to do your job, is because the editor decided his family needed a vacation, so he took your transportation money to fly his family to Spain for the holiday. After all, they are his "constituents" and he is responsible for taking care of them, more than you.

Also, you said you would fault the politician for approving a spending bill which the military says is necessary, in the paragraph immediately following faulting the military for not saying what resources are necessary. :-)

[abneo3sierra]

Actually it is a fairly common topic of discussion..most are torn between what they see as their duty and oath, and what they see as their moral obligations,along with the hope that maybe they can help better from "inside" than from "outside"..certainly it is not the paycheck lol, which is not enough for what we do...certainly at my grade, and probably well above me as well.