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Yeah, I mean I can understand the philosophical place that one could come from that would make one skeptical of government-run anything. But every other indust

by jbooth 16y ago

Yeah, I mean I can understand the philosophical place that one could come from that would make one skeptical of government-run anything. But every other industrial nation beats the crap out of us both in results and in results per $$, while spending far less money. This isn't a theoretical argument -- we could just copy one of those systems wholesale and get way better results than we're getting. At one point does the engineering principle of "if it works, it works" kick in? If you saw a better technique for doing something at your business, and didn't do it because "i don't like to see problems solved in that fashion, regardless of what the metrics tell me", you'd be an idiot, right?

yummyfajitas 16y ago
But every other industrial nation beats the crap out of us both in results and in results per $$... What results? Please be specific. In particular, if you want to compare health outcomes, please make sure you controlling for factors like demographics, lifestyle, pollution, food quality, etc. Also, how do you propose to pay US doctors the same salaries paid to doctors in poorer countries? Some numbers: the top 5% of income earners in Canada earn 40% less than the top 5% of the US. Are you proposing to knock doctors a few rungs down the income ladder? http://www.statcan.gc.ca/pub/75-001-x/2007109/article/4096885-eng.htm http://www.statcan.gc.ca/pub/75-001-x/2007109/article/409688...
- maxxxxx 16y ago
  I think reducing doctors' salaries is a good idea.
- jbooth 16y ago
  A) Call it even for health outcomes if you'd like, we could argue the numbers regarding demographics, lifestyle and all that until the cows come home, but health in Canada/UK/France/Japan definitely isn't materially worse. So for the sake of argument let's just call it even, except we're spending several times as much. (we actually spend more gov't money on healthcare per capita than many companies with socialized medicine, in addition to private sector spending -- that's how broken our system is). B) Regarding doctors wages, I'm not really talking about "poorer" countries unless you'd call western europe, canada, japan "poorer". If they make significantly less in those countries than here.. sure, fine. Given that we don't offer cheap schooling like those countries there might be a limit to how low we can go, though. C) Top 5% of income != doctors, necessarily. And the money we're wasting, a tiny percentage of that is going into doctors' pockets. Most of it is just plain pissed away, and a lot goes to insurance company profits. Doctor salaries are pretty far down on that list, so I don't think I was proposing drastically lowering their salaries, no.
  - yummyfajitas 16y ago
    Ok, fine. So we are in agreement that health outcomes are roughly even. Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. (And keep in mind, this was a good year for them. They all raised prices significantly in anticipation of Obamacare.) http://biz.yahoo.com/p/sum_qpmd.html http://biz.yahoo.com/p/sum_qpmd.html You simply won't get much money by soaking insurance companies. The main thing you need to do to reduce spending is to get people to consume less medicine. That was the conclusion of another (very good) series of articles on the same blog - we spend more on health care because we consume more (in particular, outpatient care). http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
    - anamax 16y ago
      > Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. And, their total profit plus executive salaries is a small fraction of the amount of admitted Medicare fraud. I mention medicare because it's supposedly more efficient, but that's based solely comparing their cost to cut a check to the "overhead" of private health insurance companies. Note that folks who have disputes with medicare are less likely to win than folks who have disputes with private health insurance companies.
      - yummyfajitas 16y ago
        And, their total profit plus executive salaries is a small fraction of the amount of admitted Medicare fraud. Do you have a citation for this? It doesn't sound implausible, but a citation would be nice.
        anamax 16y ago
        I remember, but can't find, AG Holder saying that the number is between $120 and $150B. http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpayers-60-billion-year/story?id=10126555 http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpaye... says that the govt admits to $60B/year in medicare fraud. http://issa.house.gov/index.php?option=com_content&task=view&id=271&Itemid=92 http://issa.house.gov/index.php?option=com_content&task=... says that the number is closer to $150B . Meanwhile, the govt recovered $4B in 2010. http://www.publicbroadcasting.net/kwgs/news.newsmain/article/0/0/1764514/US/U.S..charges.111.in.largest.Medicare.fraud.crackdown http://www.publicbroadcasting.net/kwgs/news.newsmain/article... . IIRC, the total profit by private healthcare companies was less than $10B in 2009 and the executive salaries total was under $1B. You've said that the 2010 numbers are somewhat better.
CWuestefeld 16y ago
If we have to have this discussion again... we could just copy one of those systems wholesale Maybe. But when you do out the demographics, there are plenty of reasons to think that things here are not quite the same. With different sorts of problems, the same solution isn't guaranteed to work. If you saw a better technique for doing something at your business, and didn't do it because "i don't like to see problems solved in that fashion, regardless of what the metrics tell me", you'd be an idiot, right? Maybe. But maybe you're constrained because of what the Board of Directors will allow you to do. By analogy, the Constitution simply doesn't allow the federal government to do many of the things that your solution would require. Even if they're great ideas, it's simply not allowed. So you should be concentrating on changing the Constitutional restrictions that prevent those solutions, rather than getting the Courts to throw out ever larger chunks of the only thing that protects us from tyranny.
deleted 16y ago
[deleted]

by jbooth 16y ago

yummyfajitas 16y ago

But every other industrial nation beats the crap out of us both in results and in results per $$... What results? Please be specific. In particular, if you want to compare health outcomes, please make sure you controlling for factors like demographics, lifestyle, pollution, food quality, etc. Also, how do you propose to pay US doctors the same salaries paid to doctors in poorer countries? Some numbers: the top 5% of income earners in Canada earn 40% less than the top 5% of the US. Are you proposing to knock doctors a few rungs down the income ladder? http://www.statcan.gc.ca/pub/75-001-x/2007109/article/4096885-eng.htm http://www.statcan.gc.ca/pub/75-001-x/2007109/article/409688...

maxxxxx 16y ago
I think reducing doctors' salaries is a good idea.
jbooth 16y ago
A) Call it even for health outcomes if you'd like, we could argue the numbers regarding demographics, lifestyle and all that until the cows come home, but health in Canada/UK/France/Japan definitely isn't materially worse. So for the sake of argument let's just call it even, except we're spending several times as much. (we actually spend more gov't money on healthcare per capita than many companies with socialized medicine, in addition to private sector spending -- that's how broken our system is). B) Regarding doctors wages, I'm not really talking about "poorer" countries unless you'd call western europe, canada, japan "poorer". If they make significantly less in those countries than here.. sure, fine. Given that we don't offer cheap schooling like those countries there might be a limit to how low we can go, though. C) Top 5% of income != doctors, necessarily. And the money we're wasting, a tiny percentage of that is going into doctors' pockets. Most of it is just plain pissed away, and a lot goes to insurance company profits. Doctor salaries are pretty far down on that list, so I don't think I was proposing drastically lowering their salaries, no.
- yummyfajitas 16y ago
  Ok, fine. So we are in agreement that health outcomes are roughly even. Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. (And keep in mind, this was a good year for them. They all raised prices significantly in anticipation of Obamacare.) http://biz.yahoo.com/p/sum_qpmd.html http://biz.yahoo.com/p/sum_qpmd.html You simply won't get much money by soaking insurance companies. The main thing you need to do to reduce spending is to get people to consume less medicine. That was the conclusion of another (very good) series of articles on the same blog - we spend more on health care because we consume more (in particular, outpatient care). http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
  - anamax 16y ago
    > Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. And, their total profit plus executive salaries is a small fraction of the amount of admitted Medicare fraud. I mention medicare because it's supposedly more efficient, but that's based solely comparing their cost to cut a check to the "overhead" of private health insurance companies. Note that folks who have disputes with medicare are less likely to win than folks who have disputes with private health insurance companies.
    - yummyfajitas 16y ago
      And, their total profit plus executive salaries is a small fraction of the amount of admitted Medicare fraud. Do you have a citation for this? It doesn't sound implausible, but a citation would be nice.
      - anamax 16y ago
        I remember, but can't find, AG Holder saying that the number is between $120 and $150B. http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpayers-60-billion-year/story?id=10126555 http://abcnews.go.com/Nightline/medicare-fraud-costs-taxpaye... says that the govt admits to $60B/year in medicare fraud. http://issa.house.gov/index.php?option=com_content&task=view&id=271&Itemid=92 http://issa.house.gov/index.php?option=com_content&task=... says that the number is closer to $150B . Meanwhile, the govt recovered $4B in 2010. http://www.publicbroadcasting.net/kwgs/news.newsmain/article/0/0/1764514/US/U.S..charges.111.in.largest.Medicare.fraud.crackdown http://www.publicbroadcasting.net/kwgs/news.newsmain/article... . IIRC, the total profit by private healthcare companies was less than $10B in 2009 and the executive salaries total was under $1B. You've said that the 2010 numbers are somewhat better.

CWuestefeld 16y ago

If we have to have this discussion again... we could just copy one of those systems wholesale Maybe. But when you do out the demographics, there are plenty of reasons to think that things here are not quite the same. With different sorts of problems, the same solution isn't guaranteed to work. If you saw a better technique for doing something at your business, and didn't do it because "i don't like to see problems solved in that fashion, regardless of what the metrics tell me", you'd be an idiot, right? Maybe. But maybe you're constrained because of what the Board of Directors will allow you to do. By analogy, the Constitution simply doesn't allow the federal government to do many of the things that your solution would require. Even if they're great ideas, it's simply not allowed. So you should be concentrating on changing the Constitutional restrictions that prevent those solutions, rather than getting the Courts to throw out ever larger chunks of the only thing that protects us from tyranny.

deleted 16y ago

[deleted]