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> Other countries have had such success with this model that it's becoming very difficult to argue that it's inherently flawed ... The British NHS discovered t

> Other countries have had such success with this model that it's becoming very difficult to argue that it's inherently flawed ... The British NHS discovered that by not feeding hospitalized patients they could realize tremendous savings in food, shortened length of hospital stay, followup costs, etc. > half the price per person Health care spending will dramatically increase under Obamacare. Americans spend a lot on health care as a lifestyle choice. Obamacare is nothing more than an attempt to recreate the housing bubble using health care.

tocomment 13y ago
That sounds interesting. Can you explain more about the bubble angle?
- Daniel_Newby 13y ago
  Government officials find something popular, promise unlimited amounts of it to get votes, then create a program to deliver it with total disregard for economic consequences. Last decade they bought votes with easy mortgages. After all, even an idiot could see that home ownership was a sound investment. They won two or three rounds of elections with mortgage policy. This decade it is health care for all! Even an idiot can see that health care for everyone is a sound investment. Just look at these scary charts of runaway growth of medical costs. And the votes roll in. In reality, most health care consists of vaccines, blood pressure pills, diabetes pills, and the occassional antibiotics. That gives most of the benefits and costs almost nothing. Most of the costs come from ludicrous end-of-life procedures on old people, most of the rest comes from ludicrous $500k courses of treatments for this like multiple sclerosis and stage 29 recurrent cancer. These are lifestyle choices for well-off people who would rather pay a doctor than leave an inheritance. Trying to extend this lifestyle to every waitress will destroy the economy. It's no different than last decade's plan to put every hairdresser in a $700k mansion.
  - deleted 13y ago
    [deleted]
  - mjn 13y ago
    As far as "ludicrous end-of-life-procedures for old people", I agree Americans spend far too much on those, but the bulk of that is people who are 65 or older, which is outside PPACA's purview, since they are already covered by Medicare [1]. If you want to argue for Medicare to reform how it treats end-of-life coverage, I'd support that, but anyone who argues that Medicare should spend less on end-of-life heroics runs into hysterics about "death panels" refusing to pay for an extra 10 days of granny's life support. PPACA is trying to fix a fairly different problem, the under-65 segment, where end-of-life treatment is a much smaller proportion of costs. [1] About 80% of Americans who died in 1997 were covered by Medicare at the time of death: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/
    - tocomment 13y ago
      To eliminate the problem of end of life heroics would it be possible to add something to Medicare like you get x dollars you can leave to your family if you forgo the heroics. Where x is day 10% of the cost of the heroics? Then people have an incentive to save money but death panels aren't needed. Of course this is assuming the heroics rarely work.
phaemon 13y ago
> The British NHS discovered that by not feeding hospitalized patients they could realize tremendous savings in food, shortened length of hospital stay, followup costs, etc. That's a lie. Try checking your facts next time: http://fullfact.org/factchecks/nhs_malnutrition_death-28806 http://fullfact.org/factchecks/nhs_malnutrition_death-28806 Oh, and by the way, the NHS costs us less than US public healthcare costs. Meanwhile, I can get zero deduction, all additions, money for any nights spent in an NHS hospital, private health insurance for $150 a month. How much does yours cost?
- Daniel_Newby 13y ago
  The story was covered extensively by bloggers over 5 years ago, and appeared in the press periodically since. Basically, the local NHS trusts fired a lot of hospital staff to save money. They replaced them with service contractors. So instead of a trained nurse feeding helpless patients, a gormless food deliverer drops a tray off at the patient and leaves. On paper they are still being fed, but in reality patients were starving during the trickiest few hours of recovery. But look at the costs drop! Similar cost cutting was done for the building caretakers and similar staff. On paper everything is the same just more efficient, but in reality the floors are not getting cleaned, nobody is bringing round tea for the surgeon in the middle of a 12 hour procedure. But look at the costs go down! Look at the readmission rate drop!
  - phaemon 13y ago
    Well, yeah, except that the starving patients bit never actually happened. That's the bit you're missing. I know that they had some problems with some NHS trusts as they went more "efficient private sector", mainly with cleanliness, but this was not pervasive throughout the NHS and suggesting it was commonplace is a flat out lie.
    - Daniel_Newby 13y ago
      Once again, I am not talking about the recent media fight about arguably-cooked statistics. I'm talking about reports from a variety of sources starting in about 2007, including nurses and doctors. If it was a disinformation campaign, it was curiously extensive for not having been used in a media campaign of the day.
j2d3 13y ago
Any references to support any of your claims?
JPKab 13y ago
I see from your linkedIn profile you are a defense contractor in Oklahoma. As is typical of defense contractors I encounter, you yourself make your money from a large, taxpayer supported industry while criticizing other nation's taxpayer supported industries that actually fucking do something, instead of supporting a standing army that is 5 times bigger than it needs to be. I have nothing against defense contractors, but I do hate ones that have hypocritical small government, conservative political views. Please feel free to put your money where your mouth is and go work in a free market industry. The taxpayers pay your company, and therefore your salary and health insurance.
- Daniel_Newby 13y ago
  You appear to be reading rather a lot between the lines. I am not, and nothing in my comment suggested, that government involvement in health care is inherently bad. Nor was there any mention of conservatism, small government, etc. I merely pointed out that nationwide programs tend to go horribly wrong. Obamacare in particular failed before it was introduced since American health care is already cheap, and any good ideas it might have incorporated were destroyed by its secret process of creation and lack of feedback. Incidentally, defense workers are ideally positioned as experts on national health care schemes. We have seen exactly how large one-size-fits-all programs almost always destroy themselves.
  - JPKab 13y ago
    American healthcare is already cheap? Compared to what industrialized nation? Every metric out there shows this to be wrong. Instead of talking the abstract "healthcare", instead talk about the cost of individual procedures. http://www.economist.com/blogs/democracyinamerica/2013/07/high-cost-health-care-0 http://www.economist.com/blogs/democracyinamerica/2013/07/hi... Regarding "one-size fits all programs destroying themselves", please explain to me how Obamacare is a one size fits all scheme? It's a conservative policy, designed by the Heritage Foundation think-tank on K Street in DC. (I have a buddy who works at the Heritage Foundation. They all loved Obamacare when Romney was implementing it, and were disappointed that it was only for a single state at the time. Suddenly when President Blackenstein was implementing it, it became evil and socialist. Frankly, Obamacare isn't the best solution. I would have much preferred a national, single payer system coupled with private providers, like the system in Canada. You know, the one that has vastly higher approval ratings among its patients than the one in the US. But no, the Republicans scared the old people into thinking they would lose their free, socialist medical care if people under 65 got in on the action, so we got stuck with insurance subsidies.

tocomment 13y ago

That sounds interesting. Can you explain more about the bubble angle?

Daniel_Newby 13y ago
Government officials find something popular, promise unlimited amounts of it to get votes, then create a program to deliver it with total disregard for economic consequences. Last decade they bought votes with easy mortgages. After all, even an idiot could see that home ownership was a sound investment. They won two or three rounds of elections with mortgage policy. This decade it is health care for all! Even an idiot can see that health care for everyone is a sound investment. Just look at these scary charts of runaway growth of medical costs. And the votes roll in. In reality, most health care consists of vaccines, blood pressure pills, diabetes pills, and the occassional antibiotics. That gives most of the benefits and costs almost nothing. Most of the costs come from ludicrous end-of-life procedures on old people, most of the rest comes from ludicrous $500k courses of treatments for this like multiple sclerosis and stage 29 recurrent cancer. These are lifestyle choices for well-off people who would rather pay a doctor than leave an inheritance. Trying to extend this lifestyle to every waitress will destroy the economy. It's no different than last decade's plan to put every hairdresser in a $700k mansion.
- deleted 13y ago
  [deleted]
- mjn 13y ago
  As far as "ludicrous end-of-life-procedures for old people", I agree Americans spend far too much on those, but the bulk of that is people who are 65 or older, which is outside PPACA's purview, since they are already covered by Medicare [1]. If you want to argue for Medicare to reform how it treats end-of-life coverage, I'd support that, but anyone who argues that Medicare should spend less on end-of-life heroics runs into hysterics about "death panels" refusing to pay for an extra 10 days of granny's life support. PPACA is trying to fix a fairly different problem, the under-65 segment, where end-of-life treatment is a much smaller proportion of costs. [1] About 80% of Americans who died in 1997 were covered by Medicare at the time of death: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282187/
  - tocomment 13y ago
    To eliminate the problem of end of life heroics would it be possible to add something to Medicare like you get x dollars you can leave to your family if you forgo the heroics. Where x is day 10% of the cost of the heroics? Then people have an incentive to save money but death panels aren't needed. Of course this is assuming the heroics rarely work.

phaemon 13y ago

> The British NHS discovered that by not feeding hospitalized patients they could realize tremendous savings in food, shortened length of hospital stay, followup costs, etc. That's a lie. Try checking your facts next time: http://fullfact.org/factchecks/nhs_malnutrition_death-28806 http://fullfact.org/factchecks/nhs_malnutrition_death-28806 Oh, and by the way, the NHS costs us less than US public healthcare costs. Meanwhile, I can get zero deduction, all additions, money for any nights spent in an NHS hospital, private health insurance for $150 a month. How much does yours cost?

Daniel_Newby 13y ago
The story was covered extensively by bloggers over 5 years ago, and appeared in the press periodically since. Basically, the local NHS trusts fired a lot of hospital staff to save money. They replaced them with service contractors. So instead of a trained nurse feeding helpless patients, a gormless food deliverer drops a tray off at the patient and leaves. On paper they are still being fed, but in reality patients were starving during the trickiest few hours of recovery. But look at the costs drop! Similar cost cutting was done for the building caretakers and similar staff. On paper everything is the same just more efficient, but in reality the floors are not getting cleaned, nobody is bringing round tea for the surgeon in the middle of a 12 hour procedure. But look at the costs go down! Look at the readmission rate drop!
- phaemon 13y ago
  Well, yeah, except that the starving patients bit never actually happened. That's the bit you're missing. I know that they had some problems with some NHS trusts as they went more "efficient private sector", mainly with cleanliness, but this was not pervasive throughout the NHS and suggesting it was commonplace is a flat out lie.
  - Daniel_Newby 13y ago
    Once again, I am not talking about the recent media fight about arguably-cooked statistics. I'm talking about reports from a variety of sources starting in about 2007, including nurses and doctors. If it was a disinformation campaign, it was curiously extensive for not having been used in a media campaign of the day.

j2d3 13y ago

Any references to support any of your claims?

JPKab 13y ago

I see from your linkedIn profile you are a defense contractor in Oklahoma. As is typical of defense contractors I encounter, you yourself make your money from a large, taxpayer supported industry while criticizing other nation's taxpayer supported industries that actually fucking do something, instead of supporting a standing army that is 5 times bigger than it needs to be. I have nothing against defense contractors, but I do hate ones that have hypocritical small government, conservative political views. Please feel free to put your money where your mouth is and go work in a free market industry. The taxpayers pay your company, and therefore your salary and health insurance.

Daniel_Newby 13y ago
You appear to be reading rather a lot between the lines. I am not, and nothing in my comment suggested, that government involvement in health care is inherently bad. Nor was there any mention of conservatism, small government, etc. I merely pointed out that nationwide programs tend to go horribly wrong. Obamacare in particular failed before it was introduced since American health care is already cheap, and any good ideas it might have incorporated were destroyed by its secret process of creation and lack of feedback. Incidentally, defense workers are ideally positioned as experts on national health care schemes. We have seen exactly how large one-size-fits-all programs almost always destroy themselves.
- JPKab 13y ago
  American healthcare is already cheap? Compared to what industrialized nation? Every metric out there shows this to be wrong. Instead of talking the abstract "healthcare", instead talk about the cost of individual procedures. http://www.economist.com/blogs/democracyinamerica/2013/07/high-cost-health-care-0 http://www.economist.com/blogs/democracyinamerica/2013/07/hi... Regarding "one-size fits all programs destroying themselves", please explain to me how Obamacare is a one size fits all scheme? It's a conservative policy, designed by the Heritage Foundation think-tank on K Street in DC. (I have a buddy who works at the Heritage Foundation. They all loved Obamacare when Romney was implementing it, and were disappointed that it was only for a single state at the time. Suddenly when President Blackenstein was implementing it, it became evil and socialist. Frankly, Obamacare isn't the best solution. I would have much preferred a national, single payer system coupled with private providers, like the system in Canada. You know, the one that has vastly higher approval ratings among its patients than the one in the US. But no, the Republicans scared the old people into thinking they would lose their free, socialist medical care if people under 65 got in on the action, so we got stuck with insurance subsidies.