Health Care, or Dolly's Epistle to the Fallopians
...and that takes us back to one of the original issues: there is no accountability. What Tom Daschle calls "comparative effectiveness" has a much simpler name, oversight. The field of medicine is self-policing, a strategy which is inherently flawed. And the field of health insurance is also almost unregulated -- abuse is inevitable. Is it any surprise that the AMA, Big Pharma and everyone else fought bitterly against the Patients Bill of Rights? The one thing that terrifies them all is....accountability.
Christianity, as explained by…”The Incredibles"
So you're trying to persuade us that WE are the ones who are delusional? I admire your chutzpah.
As you yourself noted, it is your team which refuses to to its homework. Undoubtedly because you know what you will find.
Christianity, as explained by…”The Incredibles"
In the immortal words of Heinlein, one man's theology is another man's belly laugh.
If two religions want to compete for adherents, I don't suppose we can stop them. But when they kill half a million in Sudan, that's where I start to lose my sense of humor. Half a million dead for a philosophical belief based on a whole bagful of delusions.
Health Care, or Dolly's Epistle to the Fallopians
Why our current health care system is broken
Cost: America’s health care “system” ' chaos is a better word for it ' costs more than that of any other country, both per head ($7400 per person in 2007) and as a percentage of GDP. Costs are rising much faster than wages or inflation. It is killing American families: family premiums have doubled in a decade, and half of US bankruptcies involve medical bills. Taxpayers pay not only for themselves but also another $15 billion for the uninsured; also, like Europe and Japan, American taxpayers will soon be paying for a gigantic elderly population. It is also crushing the states with unfunded federal mandates such as emergency services and Medicaid. The need to seek profits for corporate shareholders is driving costs up even further.
Inefficiency: Even Kaiser Permanente chief George Halvorson admitted that the current system is inefficient and wasteful to the point of being dangerous. Tons and tons of waste. The administrative costs in the US are way above the rest of the industrialized world at 24 percent of the total health care bill. The free market impels doctors to provide unnecessary services, HMO’s give them a guaranteed market regardless of how poorly they perform, and they set rates above market value in an oligopolistic manner, particularly among specialists. As a result our system sucks at life expectancy, infant mortality, quality, efficiency, access, safety, equity and wait times.
Incomplete coverage: America is the only wealthy industrialized nation that doesn’t provide universal health care. Our uninsured come to 40-50 million, and the current recession will add 2 million unemployed to the list. Fewer employers offer coverage. And that’s before we get to the under-insured, struggling with their finances because of medical bills; they skip health care, skip prescriptions, and then things just go south from there.
The Obama health care plan
Obama says he will introduce a universal health care plan by the end of his first term, if not sooner. The existing private plans will be supplemented by a Medicare-like government option. Everyone is covered, and premiums don’t vary based on health status. Parents must cover their children, but no adults will be required to buy insurance. Some estimates say it will cost 120-160 billion a year, but the money saved should blow that number away: he aims to bring premiums down $2500 for the typical family, if you also add in all cost reductions including Medicare and Medicaid. An Emory University study backed up Obama’s proposal and his numbers.
Right now we pay more for lousy care: the Obama plan will reverse that, and it will help businesses with their costs and induce more hiring; the automakers in particular really want it. Coverage will improve: the new plan will cover those who are uncovered, help the under-insured, and encourage preventive medicine which benefits everyone who has skin in the game. It cuts out the middleman (the insurer) in many cases and cuts paperwork, both of which save tons of money; it also makes doctors compete for patients, bringing costs down in a way HMO’s can’t.
The start-up costs will be pricey, just when the cupboard is bare; we need to let people know that the costs will come down once it’s set up, and remind people that even though taxes may go up, other costs will go down. Since many people like their current care, the changes should be kept as transparent as possible. Also, consumers do need to know more in general, to make good decisions not only about lifestyle but also health care itself. We must ensure that health care professionals are well paid so they stay in the game. We must beware of clashes between doctor-patient privacy and government oversight, or the Republicans will go nuts.
Much thought must be given to the drug companies, on both prices and patents. Because there are no governmental price controls, prices are so high that people are shopping abroad to save money, and some call for letting the HHS negotiate prices. Others argue for removing patent protection for drugs, to get generics out there. The trick is not to push so hard that it impairs innovation.
Other universal coverage systems are paid for by a combination of taxation and direct payments to the doctor or patient; sometimes employees and employers must kick in some money. Some systems mix federal and local systems, something Romney would support. Many have the private insurance option for extra coverage on cosmetic procedures, private rooms, quicker service, etc. The tricky part comes when, in addition to mixing the methods by which the bills get paid you also mix the types of plans: when you have both private and public plans you can run into “adverse selection”, wherein the private sector tries to maximize the bottom line by dumping the unhealthy, creating a market imbalance between public and private. The Europeans use a risk compensation pool to equalize the risk between plans. The plan with your healthy people pays into the pool, the plan which collects the more unhealthy people takes the money out. In this way, funds compete on price and there is no advantage to eliminate people with higher risks because they are compensated from the pool. Funds are, in theory, not allowed to pick and choose their policyholders or deny coverage. If anything is guaranteed to cause the insurers to go bananas, it would be the comp pool idea.
Ireland got burned on this issue. They up a compensation pool but then removed it; foreign insurers swooped in and grabbed the healthy customers, who were no longer kicking into the pool. Then the pool came back.
The easy fixes to our health care system
Even Newt Gingrich, no socialist, said "there is more than enough money in the system. We just are not spending it well." There are many ways to improve efficiency. Tom Daschle has endorsed the concept of comparative effectiveness, analyzing what works and what it costs, and using data to spot gaps such as the UCMA Medical Center which charges almost twice as much for similar care as other facilities. Streamlining paperwork and putting more online with good software could cut $250-300 billion a year in admin costs.
A key element will be health care strategies: coordinating care, researching the best treatments, rewarding performance, encouraging prevention strategies, managing chronic illnesses better, and rejecting the inclination of American patients to ask for expensive but unproven innovations. The MRI machine isn’t the answer to every diagnostic question!
Another key element: how doctors are paid. If there is no incentive to keep a patient out of the hospital, he’s going to the hospital. Lots of pricey tests too. Not long ago, Starbucks had a wave of back problems; their insurer, Aetna, incentivized therapy instead, and soon a lot of guys were going back to work with no MRI’s and no drugs.
Preventive care helps, up to a point. We could accomplish a great deal by taxing alcohol, tobacco and trans-fat into extinction, tackling obesity, cholesterol and heart and artery disease, and focusing on diabetes. But remember that if you prolong lives that way, you just have more old sick people at the other end. It’s still a worthwhile effort, though ' perhaps 450 billion a year even without the taxes.
The arguments of the opponents of universal health care
Oh my God, it’s socialism, anything tax-funded is armed robbery, it will turn out just like Stalin’s planned-economy disasters of the 1930s, the free market must rule! ...Sorry, the free market has had its chance, it failed miserably. And all this screeching about socialism is silly: the Europeans are doing it the public-sector way and are beating our numbers by 2 to 1.
Oh my God, Big Brother is coming! The Big Bad Government will apply so much oversight that they will destroy doctor-patient privacy (crap), they will decide whether my doctor will be allowed to do what he thinks best (HMO’s do that but Obama won’t), and they won’t let people opt out of the system and buy what they want (crap ' Obama will let you keep your current plan).
Oh my God, the horrors that will ensue ' the system will be overused and abused, quality will go down, care will be rationed, people will die! ...Crap.
Oh my God, it’s such a huge change! ...Crap. Everybody who likes their current coverage can keep it. And about half our current coverage already comes from federal and local taxes and subsidies anyway; government already insures more than a quarter of us already.
Oh my God, it’s not perfect, there might still be some unequal access! ....And? So what? We must stick with a terrible system because the alternative isn’t perfect?
Oh my God, they’re getting rid of a perfectly adequate system that its customers like! ....The problem is that 40-50 million are NOT customers, and even more are uninsured. And it’s not adequate, either. It’s incredibly inefficient.
Oh my God, the current free-market system is actually inefficient because of excessive government regulation, and a government-run plan must, of necessity, be more inefficient that a free-market plan!...Why? What’s the difference between a government bureaucrat and an insurance bureaucrat? And who says the market is always more efficient than government? Government can carry a document across the country for half a buck ' can FedEx do that? Some anti-reform people claim that excessive regulation stopped doctors from making house calls, which is also crap ' the UK has them more than we do.
Oh my God, costs will skyrocket!....Crap. Again, Europe uses systems like the Obama plan and they pay half what we do in health costs, because they don’t have corrupt insurers stealing half the money.
Oh my God, as soon as government gets involved, all innovation on drugs, treatments and technology will stop, of course?....Crap. Why would innovation stop? It’s still a free market, and good products and services will still sell.
Oh my God, look at the examples in Medicare, England and Canada!...Crap. Opponents of reform constantly stack the deck by picking on the most unpopular systems and ignoring all the others. Even then they have to make stuff up ' British patients allegedly denied life-saving dialysis, Medicare spending about 100 million on products ordered by dead doctors...crap. The facts are: All these foreign countries who use and enjoy universal health care are democracies: if their government-run systems sucked, the voters would make heads roll on election day. Canadians, to cite one example, are quite satisfied with their coverage. And in fact a recent survey tested sick adults in six nations and found that it was the Americans who had trouble getting a same-day or next-day appointment 47 percent of the time, worse than all but one country.
Separation of Marriage and State
Marriage isn't just about children. If you are married in the eyes of the state, you have many rights in many areas, which gay couples don't have.
Such as insurance coverage, Medicaid, compensation for service-related deaths, survivor benefits, continuation of health care for surviving spouses, organ donor issues, next-of-kin status, and medical and funeral decisions.
...and parental rights, access to school records, child support and custody, adoption, and foster care.
...and financial issues such as income tax filing status and deductions, tax-free property transfers, Social Security and veteran’s pensions and disability, disabled vets tax exemptions, bankruptcy, alimony, shared property, prenuptial agreements, wills and inheritance, condominium laws, homestead laws, water rights, and spousal assets as a factor in determining need for government aid (VA benefits, housing, educational loans, farm price supports).
...and family-only services, name changes, domestic violence laws, spousal privilege for criminal witnesses, relocation benefits for military families, prison and hospital visitation, and conflict-of-interest rules.
Sanctioning gay marriage would make it EASIER to hold gay parents accountable, which you say you want.
Nobody is arguing in favor of getting rid of all laws, or marrying pets, or sanctioning public sexual solicitation, which is what Craig was arrested for because it's illegal for both straights and gays. Stop moving the goalposts. And stop trying to mix up the gay issue and the abortion issue -- they are unrelated.
Unanimity on the court: good or bad?
All philosophies DO need to be represented. And that is even more complex than you think.
We need social liberals and social conservatives.
We need strict constructionists and activists.
We need both supporters of stare decisis and those who don't care so much.
We need friends of labor and friends of business.
We need friends of government and friends of the individual.
You get even one of these out of whack, then suddenly the court is cranking goofy decisions in some area or another.
That's why you can't have some fucking bonehead president picking a guy like Clarence Thomas just to fill the "black guy" chair. All Thomas has done for 17 years is rubber-stamp whatever Scalia does.
green party=politics for hippies
Not to be a wet blanket, but....focus on the policies, not the people...?
If this was thousands of white people being murdered in Denmark, our troops would have been there in half a minute.
Look at all the incredibly difficult things we have to do now -- the banking bailout, the auto industry, health care, energy....Comparatively speaking, Darfur is easy. The minute we show up and demonstrate that we're serious, the Sudanese government will be falling all over themselves to fix the problem the right way.
And this is another reason that Iraq was handled stupidly -- Bush allowed it to escalate into a gigantic undertaking because of an appalling lack of foresight and planning. If our military wasn't needlessly overstretched in Iraq, these other conflicts would be a cinch to resolve.
Unanimity on the court: good or bad?
This idea is one hundred percent bad. All philosophies need to be represented on the court.
You might as well argue in favor of unanimity in the House of Representatives.
If I, God forbid, was president, and some calamity forced the appointment of nine new justices, I would still pick a mix of liberal, moderate and conservative. The Court, like the president himself, must represent all the people, not just half.
When the nation is deeply divided on a particular question, we can't always expect the Court to give us direction.
What would help is if the Republicans would stop picking hardliners. Roberts, Alito, Scalia, Thomas are way, way to the right. Kennedy, Souter, Breyer, Stevens and even Ginsberg are moderates -- if the rightwing loons can't reach a compromise with THEM, it's their fault.
Jack says spam is the closest to human flavor. Um, how does he know that? If we're going to follow that logic, the answer is absurdly simple. Kill two birds with one stone, pardon the expression, by sanctioning the eating of Republicans. Lolly with fava beans, Shawn in a chasseur sauce, problem solved! Of course eating Republican protein might drag down the old IQ, but you gotta take the bad with the good.
Just a modest proposal.
The credo in Texas is "Beef, it's what's for dinner". In Texas, they would propose eating vegetarians, the final irony. No vegans, though; too stringy and tough. You'd have to dice them and slow cook them, in the style of Bourgignon or Coq au Vin.
Well, Clarice, you will let me know when the lambs stop screaming...?