5 ms·

To the young brilliant minds

68 points by galactus 16y ago

RyanMcGreal 16y ago
It doesn't matter how often I come across it or from which direction: I'm just flabbergasted that the USA doesn't have universal health care.
- pragmatic 16y ago
  I think it's been an issue, but not that big of an issue (in voter's minds) until recently. Many of the voting blocks are already covered. Low income people have medicaid, seniors have medicare. Many people working a full time job have employer sponsored health plans. Health insurance costs are rising. It's harder to find a cheap plan. Pre-existing conditions really screw you as far as decent coverage. I'm not sure what the answer is at this point. The US is almost broke, we might not have a choice. http://esr.ibiblio.org/?p=3035 http://esr.ibiblio.org/?p=3035
  - aaronblohowiak 16y ago
    Military spending.
  - jbooth 16y ago
    Yeah, and it's brilliant, because the gov't is on the hook for poor people and old people, aka unprofitable insurance subjects, while the private industry scoops up profits on the rest. And before some conservative comes in telling me that insurance profits aren't that high as a % of revenue, % profits on a pass-thru payment system are not the same thing as % profits on actually building something. I saw a statistic (can't place it now and don't feel like googling, so grain of salt) that we actually have comparable government spending per capita on healthcare to some western european countries, and that's just for medicare/medicaid, without even covering everyone. No generic drugs + byzantine public/private payment systems + highest-risk populations = lots of money.
    - yummyfajitas 16y ago
      % profits on a pass-thru payment system are not the same thing as % profits on actually building something. Could you explain this claim?
      - jbooth 16y ago
        In one sentence, IMO of course, passing something through should be much cheaper than actually building something or adding value unless you're bilking people. In another sentence, insurance companies don't administer care, they just move money around. Compare to the overhead as a % of revenue for the social security administration, for example. They're a simpler passthru so it's not a completely fair comparison but insurance is closer to SS than it is to manufacturing.
        barry-cotter 16y ago
        passing something through should be much cheaper than actually building something or adding value unless you're bilking people. The amount someone gets paid for doing something depends on how much value they capture, not how much they add. In most cases where all parties contract freely, you can't capture more than you add, but anyway _Value added and paid are often wildly out of whack_ "Bilked" is a moral judgement. If you're saying you think insurance is unjustly fair then since that's a fact about you not about insurance, sure it can be true. But it's like "profiteering", a moral/political statement, with no economic content.
        jbooth 16y ago
        Adam Smith would differ with you, in the ideal case. Value capture and rent seeking aren't how capitalism are supposed to work. Heck, if that was the best capitalism could do, I'd be inclined to try communism.
- reader5000 16y ago
  Basic racial politics. Welfare queens and all that jazz.
- rdtsc 16y ago
  Agreed. Even the ex-"Evil Empire" managed to provide decent basic health care for its citizens. Yeah, they couldn't graft a human ear onto a mouse (http://en.wikipedia.org/wiki/Vacanti_mouse http://en.wikipedia.org/wiki/Vacanti_mouse), but at least when I broke my arm or busted my teeth on a bike they never asked my mom how she is going to pay for it, or some insurance company did have to decide to only replace 2 out of 4 of my teeth, because the other 2 would be considered "cosmetic surgergy" or "experimental procedure".
- rick888 16y ago
  I'm flabbergasted that Europeans won't admit that it's a failing system. Both France and Sweden need to scale back their systems because it's just not efficient or cost effective. I know it's just anecdotal evidence, but everyone I know from Canada that has had to get any major surgery has come over to the US. The reason? the waiting list is too long (in the years). Most universal health care advocates will deny this, but I just can't ignore it when I've seen it happen so many times. I would rather have a system with no insurance companies that we paid for ourselves. This way, Doctors would be forced to charge affordable rates.
  - galactus 16y ago
    > Both France and Sweden need to scale back their systems > because it's just not efficient or cost effective. What? Both countries have amazingly cost effective health care systems!
    - m_myers 16y ago
      And now that both sides have made mutually contradictory and equally unsupported statements, I believe the first round is a draw. Galactus will have the honors in the second round. Proceed, gentlemen.
      - arethuza 16y ago
        It's fairly easy to find supporting information for the galactus view e.g.: http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php
        jbooth 16y ago
        And frankly, it should be common knowledge that western europe has better/equivalent outcomes at less than half of our cost (very round figures to sidestep the nitpicking), meaning, at minimum, they're getting at least twice the value per cost that we are, and that's rounding every number in the direction that's unfavorable to europe. I could argue that let's just copy the system within europe that works best and we can go for 3x. Unfortunately, doing things that have been empirically borne out to work doesn't seem to be on the agenda these days.
- mtviewdave 16y ago
  I'm curious: you are aware that a universal health care law passed in the U.S. last year, right? Its goal was to make this statement no longer true in the U.S.: >If you have the wrong medical profile, you could be simply uninsurable. That’s how a free market works. by January 1, 2014. Given that health insurance systems similar to the one the Affordable Care Act sets up do provide universal insurance in other countries, it seems that the ACA has a good chance of doing what it's promised to (though I'm sure it will require tweaks and adjustments in the years to come). But regardless, a conversation about health care in the U.S. that doesn't even mention the ACA seems to be rather pointless.
- spenrose 16y ago
  The reason is race: http://www.kff.org/healthreform/upload/7871.pdf http://www.kff.org/healthreform/upload/7871.pdf and many others. Search for "Truman health care reform". As in many other democracies, America's right wing party is a coalition of the military, established business, the religiously observant, and what you might call resentful rural folks (who unlike the other factions exist in enough numbers to make an electoral difference). But uniquely among rich democracies, apartheid is a living memory here and still a core political differentiator. That means that anytime established business opposing something, they can get traction by implying that it's a plot to help "them". Those who mocked the grandfather who demanded that his Congressman "keep your government hands off my Medicare" for ignorance miss the point. He meant "keep Obama's black hands off my Medicare."
scotth 16y ago
To the brilliant young Americans.
yummyfajitas 16y ago
Health care is expensive, limited, and must be rationed. Not everyone can have as much as they want. There simply is not enough to go around. In the US, this rationing process is done by price, and by insurance companies. In other countries, this is done by govt bureaucrats. No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them. I don't know why the author can't believe it has come to this in the US. Does he feel that the laws of scarcity should not apply, simply by virtue of American Exceptionalism?
- stellar678 16y ago
  It's really not so black and white: 1. The laws of scarcity don't dictate how a scarce resource is distributed. I guess the argument is all about what the most effective means are to distribute this resource. 2. Anyhow, commercial enterprises have strong incentives to produce artificial scarcity. The "laws" of scarcity don't have to apply here.
  - rick888 16y ago
    The "laws" of scarcity don't have to apply here. The laws don't necessarily apply to digital goods, because we can make infinite copies. However, Space, time, hospitals, and doctors are limited...so these laws apply.
    - stellar678 16y ago
      Sure, but they're also not 100% efficiently utilized. Far from it. And the argument is that profit motive in health care may actually drive "efficiency of utilization" the opposite direction. When one person is staying at home with chest pain, afraid of the ER bill, while another person shows up with a soar throat and a headache because they have health insurance, well...that's pretty clearly misdirected utilization of the scarce resources.
- rdtsc 16y ago
  > No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them. Don't agree. If access is free then a lot of preventative care can be done in order to not have to conduct expensive critical and emergency procedures. People in this country don't go to the doctor because they may or may not end up owing sums of money ranging from $0 to many hundreds of thousands, depending on the combination of provider, doctor, insurance policy, state and federal laws. So people just stay away. Until they have a heart attack, or cancer is in the terminal stages then they are rushed to emergency and then guess what happens -- a very expensive procedure probably needs to be perfomed. So not very surprising that health care is expensive. But let's take from another point of view. You say it is expensive. But how come Scandinavian and many European countries manage do provide it? Could it be that we just spend everything on defense (well...I personally called it offense but let's keep it official here) -- more than all the countries in the world combined? Do our doctors and medical supplies companies charge insane prices? I don't know the answer, but I know it has been done in other countries, and it is currently better than here. So it seems like it is possible.
johngalt 16y ago
Taking everything this article says at 100% face value: 1. You will get expensively sick when you get old 2. Insurance carrier will try to kick you out and not pay for hospital stays. If getting old and having $500k operations are certain for everyone, then wouldn't a better bet be for everyone to save their money? If all of this is a certainty why have the insurance as the middle man? Save your own money, and then don't deny yourself coverage. More realistically, what alternatives exist? There is nothing that changes the cost of the expensive operation. A single payer NHS doesn't change the amount of money operations cost.
- dbfclark 16y ago
  A single payer NHS actually does change the overall cost of healthcare: the UK pays about half as much per person as the US does for its healthcare system as a whole with no noticeable difference in measured effects. The reason is simply market forces: people import drugs to the US from Canada because the power of single payer there changes what pharmaceutical companies can charge Canadians for drugs. The UK pays less for drugs, doctors, the whole shebang. Operations are cheaper in the UK and Canada (not to mention the rest of the world, which is more extreme in general), period. The takehome point is simple: pretending that consumers must be price-takers for any good as vital as healthcare entitles producers to arbitrary profit. I hope not to spend all my savings on healthcare and my best hope is to get some kind of market power, be that from an insurance company or the government.
  - johngalt 16y ago
    I don't believe adding more layers of bureaucracy between me and the person/company providing my care will ever result in better treatment net. Countries that do use the Walmart approach to healthcare are piggybacking on innovations that wouldn't happen otherwise. Pfizer may not fund a new drug if every government in the world thinks it should sell at 10% above costs. Additionaly there are other regional differences in pricing between the US/UK. A better comparsion would be the performance of the federal health programs we have now. What kind of treatment are patients at the VA hospitals getting?
wyclif 16y ago
Anyone who bills himself as "the father of blogging" really ought to figure out how to make their blog available under high load.
- sudont 16y ago
  I think this might be a mirror:http://scriptingecho.wordpress.com/2011/04/11/to-the-young-brilliant-minds/ http://scriptingecho.wordpress.com/2011/04/11/to-the-young-b...
  - galactus 16y ago
    There is also: http://s3.scripting.com/stories/2011/04/11/toTheYoungBrilliantMinds.html http://s3.scripting.com/stories/2011/04/11/toTheYoungBrillia...
j_baker 16y ago
Thank God. I thought this would be another condescending post about how kids these days think they know everything and just need to learn how to listen to their elders because they know everything.

68 points by galactus 16y ago

It doesn't matter how often I come across it or from which direction: I'm just flabbergasted that the USA doesn't have universal health care.

pragmatic 16y ago
I think it's been an issue, but not that big of an issue (in voter's minds) until recently. Many of the voting blocks are already covered. Low income people have medicaid, seniors have medicare. Many people working a full time job have employer sponsored health plans. Health insurance costs are rising. It's harder to find a cheap plan. Pre-existing conditions really screw you as far as decent coverage. I'm not sure what the answer is at this point. The US is almost broke, we might not have a choice. http://esr.ibiblio.org/?p=3035 http://esr.ibiblio.org/?p=3035
- aaronblohowiak 16y ago
  Military spending.
- jbooth 16y ago
  Yeah, and it's brilliant, because the gov't is on the hook for poor people and old people, aka unprofitable insurance subjects, while the private industry scoops up profits on the rest. And before some conservative comes in telling me that insurance profits aren't that high as a % of revenue, % profits on a pass-thru payment system are not the same thing as % profits on actually building something. I saw a statistic (can't place it now and don't feel like googling, so grain of salt) that we actually have comparable government spending per capita on healthcare to some western european countries, and that's just for medicare/medicaid, without even covering everyone. No generic drugs + byzantine public/private payment systems + highest-risk populations = lots of money.
  - yummyfajitas 16y ago
    % profits on a pass-thru payment system are not the same thing as % profits on actually building something. Could you explain this claim?
    - jbooth 16y ago
      In one sentence, IMO of course, passing something through should be much cheaper than actually building something or adding value unless you're bilking people. In another sentence, insurance companies don't administer care, they just move money around. Compare to the overhead as a % of revenue for the social security administration, for example. They're a simpler passthru so it's not a completely fair comparison but insurance is closer to SS than it is to manufacturing.
      - barry-cotter 16y ago
        passing something through should be much cheaper than actually building something or adding value unless you're bilking people. The amount someone gets paid for doing something depends on how much value they capture, not how much they add. In most cases where all parties contract freely, you can't capture more than you add, but anyway _Value added and paid are often wildly out of whack_ "Bilked" is a moral judgement. If you're saying you think insurance is unjustly fair then since that's a fact about you not about insurance, sure it can be true. But it's like "profiteering", a moral/political statement, with no economic content.
        jbooth 16y ago
        Adam Smith would differ with you, in the ideal case. Value capture and rent seeking aren't how capitalism are supposed to work. Heck, if that was the best capitalism could do, I'd be inclined to try communism.
reader5000 16y ago
Basic racial politics. Welfare queens and all that jazz.
rdtsc 16y ago
Agreed. Even the ex-"Evil Empire" managed to provide decent basic health care for its citizens. Yeah, they couldn't graft a human ear onto a mouse (http://en.wikipedia.org/wiki/Vacanti_mouse http://en.wikipedia.org/wiki/Vacanti_mouse), but at least when I broke my arm or busted my teeth on a bike they never asked my mom how she is going to pay for it, or some insurance company did have to decide to only replace 2 out of 4 of my teeth, because the other 2 would be considered "cosmetic surgergy" or "experimental procedure".
rick888 16y ago
I'm flabbergasted that Europeans won't admit that it's a failing system. Both France and Sweden need to scale back their systems because it's just not efficient or cost effective. I know it's just anecdotal evidence, but everyone I know from Canada that has had to get any major surgery has come over to the US. The reason? the waiting list is too long (in the years). Most universal health care advocates will deny this, but I just can't ignore it when I've seen it happen so many times. I would rather have a system with no insurance companies that we paid for ourselves. This way, Doctors would be forced to charge affordable rates.
- galactus 16y ago
  > Both France and Sweden need to scale back their systems > because it's just not efficient or cost effective. What? Both countries have amazingly cost effective health care systems!
  - m_myers 16y ago
    And now that both sides have made mutually contradictory and equally unsupported statements, I believe the first round is a draw. Galactus will have the honors in the second round. Proceed, gentlemen.
    - arethuza 16y ago
      It's fairly easy to find supporting information for the galactus view e.g.: http://ucatlas.ucsc.edu/spend.php http://ucatlas.ucsc.edu/spend.php
      - jbooth 16y ago
        And frankly, it should be common knowledge that western europe has better/equivalent outcomes at less than half of our cost (very round figures to sidestep the nitpicking), meaning, at minimum, they're getting at least twice the value per cost that we are, and that's rounding every number in the direction that's unfavorable to europe. I could argue that let's just copy the system within europe that works best and we can go for 3x. Unfortunately, doing things that have been empirically borne out to work doesn't seem to be on the agenda these days.
mtviewdave 16y ago
I'm curious: you are aware that a universal health care law passed in the U.S. last year, right? Its goal was to make this statement no longer true in the U.S.: >If you have the wrong medical profile, you could be simply uninsurable. That’s how a free market works. by January 1, 2014. Given that health insurance systems similar to the one the Affordable Care Act sets up do provide universal insurance in other countries, it seems that the ACA has a good chance of doing what it's promised to (though I'm sure it will require tweaks and adjustments in the years to come). But regardless, a conversation about health care in the U.S. that doesn't even mention the ACA seems to be rather pointless.
spenrose 16y ago
The reason is race: http://www.kff.org/healthreform/upload/7871.pdf http://www.kff.org/healthreform/upload/7871.pdf and many others. Search for "Truman health care reform". As in many other democracies, America's right wing party is a coalition of the military, established business, the religiously observant, and what you might call resentful rural folks (who unlike the other factions exist in enough numbers to make an electoral difference). But uniquely among rich democracies, apartheid is a living memory here and still a core political differentiator. That means that anytime established business opposing something, they can get traction by implying that it's a plot to help "them". Those who mocked the grandfather who demanded that his Congressman "keep your government hands off my Medicare" for ignorance miss the point. He meant "keep Obama's black hands off my Medicare."

scotth 16y ago

To the brilliant young Americans.

yummyfajitas 16y ago

Health care is expensive, limited, and must be rationed. Not everyone can have as much as they want. There simply is not enough to go around. In the US, this rationing process is done by price, and by insurance companies. In other countries, this is done by govt bureaucrats. No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them. I don't know why the author can't believe it has come to this in the US. Does he feel that the laws of scarcity should not apply, simply by virtue of American Exceptionalism?

stellar678 16y ago
It's really not so black and white: 1. The laws of scarcity don't dictate how a scarce resource is distributed. I guess the argument is all about what the most effective means are to distribute this resource. 2. Anyhow, commercial enterprises have strong incentives to produce artificial scarcity. The "laws" of scarcity don't have to apply here.
- rick888 16y ago
  The "laws" of scarcity don't have to apply here. The laws don't necessarily apply to digital goods, because we can make infinite copies. However, Space, time, hospitals, and doctors are limited...so these laws apply.
  - stellar678 16y ago
    Sure, but they're also not 100% efficiently utilized. Far from it. And the argument is that profit motive in health care may actually drive "efficiency of utilization" the opposite direction. When one person is staying at home with chest pain, afraid of the ER bill, while another person shows up with a soar throat and a headache because they have health insurance, well...that's pretty clearly misdirected utilization of the scarce resources.
rdtsc 16y ago
> No rationing system can change this fundamental fact: some people will die because we don't have the resources to save them. Don't agree. If access is free then a lot of preventative care can be done in order to not have to conduct expensive critical and emergency procedures. People in this country don't go to the doctor because they may or may not end up owing sums of money ranging from $0 to many hundreds of thousands, depending on the combination of provider, doctor, insurance policy, state and federal laws. So people just stay away. Until they have a heart attack, or cancer is in the terminal stages then they are rushed to emergency and then guess what happens -- a very expensive procedure probably needs to be perfomed. So not very surprising that health care is expensive. But let's take from another point of view. You say it is expensive. But how come Scandinavian and many European countries manage do provide it? Could it be that we just spend everything on defense (well...I personally called it offense but let's keep it official here) -- more than all the countries in the world combined? Do our doctors and medical supplies companies charge insane prices? I don't know the answer, but I know it has been done in other countries, and it is currently better than here. So it seems like it is possible.

johngalt 16y ago

Taking everything this article says at 100% face value: 1. You will get expensively sick when you get old 2. Insurance carrier will try to kick you out and not pay for hospital stays. If getting old and having $500k operations are certain for everyone, then wouldn't a better bet be for everyone to save their money? If all of this is a certainty why have the insurance as the middle man? Save your own money, and then don't deny yourself coverage. More realistically, what alternatives exist? There is nothing that changes the cost of the expensive operation. A single payer NHS doesn't change the amount of money operations cost.

dbfclark 16y ago
A single payer NHS actually does change the overall cost of healthcare: the UK pays about half as much per person as the US does for its healthcare system as a whole with no noticeable difference in measured effects. The reason is simply market forces: people import drugs to the US from Canada because the power of single payer there changes what pharmaceutical companies can charge Canadians for drugs. The UK pays less for drugs, doctors, the whole shebang. Operations are cheaper in the UK and Canada (not to mention the rest of the world, which is more extreme in general), period. The takehome point is simple: pretending that consumers must be price-takers for any good as vital as healthcare entitles producers to arbitrary profit. I hope not to spend all my savings on healthcare and my best hope is to get some kind of market power, be that from an insurance company or the government.
- johngalt 16y ago
  I don't believe adding more layers of bureaucracy between me and the person/company providing my care will ever result in better treatment net. Countries that do use the Walmart approach to healthcare are piggybacking on innovations that wouldn't happen otherwise. Pfizer may not fund a new drug if every government in the world thinks it should sell at 10% above costs. Additionaly there are other regional differences in pricing between the US/UK. A better comparsion would be the performance of the federal health programs we have now. What kind of treatment are patients at the VA hospitals getting?

wyclif 16y ago

Anyone who bills himself as "the father of blogging" really ought to figure out how to make their blog available under high load.

sudont 16y ago
I think this might be a mirror:http://scriptingecho.wordpress.com/2011/04/11/to-the-young-brilliant-minds/ http://scriptingecho.wordpress.com/2011/04/11/to-the-young-b...
- galactus 16y ago
  There is also: http://s3.scripting.com/stories/2011/04/11/toTheYoungBrilliantMinds.html http://s3.scripting.com/stories/2011/04/11/toTheYoungBrillia...

j_baker 16y ago

Thank God. I thought this would be another condescending post about how kids these days think they know everything and just need to learn how to listen to their elders because they know everything.