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The Human Cost of Health Care Reform

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This week the Congressional Budget Office projected enormous cost increases under the current congressional plan for national health care. It was promoted as saving taxpayers money, but the CBO estimates a cost over $1 trillion and it is likely to raise the tax burden for many Americans to close to 60% of their already dwindling incomes, as government bureaucrats balloon the cost of what is already the most expensive health care system in the world. The devastating financial impact of ObamaCare for the nation and every citizen is now overwhelmingly clear. But just in case you still harbor any illusions about how disastrous current proposals for national health care would be, I thought it was time to revisit the other cost — the cost in human suffering and loss of life under socialized medicine.

A key element of the cynically misnamed Affordable Health Choices Act, which is the plan currently being rushed through congress to meet deadlines and criteria set by President Obama, is rationing health care using Comparative Effectiveness Research (CER) methodology where government bureaucrats would set up schedules by which treatment would be allocated based on statistics and cost to benefit ratios rather than the interests and needs of the specific patient. Decisions on care would be matters of policy based on group effectiveness rather than on a case by case basis and doctors would have to abide by these decisions without regard to the welfare of the patient.

The impact of rationing in other nations where it has been introduced as part of the national health care system has been horrendous. It attempts to reduce the financial cost of the system by a trade-off which increases the cost in lives lost and individual suffering. Two nations with many similarities to the United States which have resorted to rationing health care are Great Britain and Canada. In both nations the human cost has been high and the results are easily quantified.

The failure of rationing comes down to two basic problems — denial of treatment and very long wait times. Both of these can result in suffering and death for patients, especially those with critical and chronic conditions which are treated easily and routinely in the United States today, but which often result in death in Great Britain and Canada.

One telling scenario of denial of care comes with cardiac patients. In the United States if you come into a hospital with an arterial blockage you are usually scheduled for an angioplasty or a bypass in a matter of days, because that is the best way to achieve a long-term solution to the problem. In Canada and Britain the common response is dictated by a shortage of surgeons and facilities, so you are given beta blockers to try to keep your heart functioning and sent away. If you're lucky you'll survive the months that it takes to get you scheduled for surgery or maybe come into the hospital in the middle of an actual heart attack when your chances of surviving the surgery are lower but they may actually operate. Or even better, if you live in Canada they may slap on a heart monitor and have an ambulance drive you to the US for treatment as they do with hundreds of cardiac patients every year. The sad reality is that many who are denied immediate surgical treatment for heart problems just die.

In the US a coronary patient is four times as likely to receive surgical treatment as in Britain. In the US only 5% of Americans are made to wait more than four months for surgery. In Canada 27% wait four months or more and in Britain 36% wait four months or more. While the base rate of coronary disease in the US is higher than in other countries because of diet and lifestyle, the rate of survival for those diagnosed with coronary problems is much higher than in other countries because patients get the best and most appropriate treatment more quickly.

The same pattern holds true with cancer. Overall Britons and Europeans in general die at a higher rate from all forms of cancer than US citizens and the difference is dramatic in cases where early detection and treatment are important. For example, women with breast cancer in Britain have a 46% death rate as opposed to 25% in the US. Men with prostate cancer in Britain have a 57% mortality rate while in the US only 19% die and the death rate is declining rapidly because of early detection. It's the same with colon cancer. In Europe as a whole there is only a 8% survival rate, in Britain there's a 40% survival rate and in the US there's a 60% survival rate. With cancer of the esophagus only 7% survive while in the US 12% survive, although it's still one of the most deadly forms of cancer. Both long- and short-term recovery and survival rates for all forms of cancer are also significantly higher for US patients. Rationed care has limited diagnostic facilities like MRI machines and has created long wait times for specialist doctors. In fact, 40% of cancer patients in Britain never get to see a cancer specialist at all, and the National Health bureaucrats have denied basic tests like pap smears and ruled out powerful chemotherapy medicines as too expensive, all of which has cost lives. With diseases like cancer where early detection and treatment are vital,  resource rationing means a lot more dead patients.

The human cost of delay of care caused by rationing is particularly significant. One key element of this is the wait time to see a specialist who can provide the best treatment for specific ailments. In the US 74% of patients get to see a specialist within four weeks. In Canada only 40% get seen that quickly and in Britain only 42%. In many cases these delays can cost lives, but the cost of suffering has to be considered as well. In both Canada and Britain the wait times are even longer for conditions which are not life threatening, but can be very painful and seriously reduce quality of life. In Britain a hip or knee replacement can take more than five months and in Canada it can take as long as eight months. That's a very long time when pain is literally crippling.

An unsurprising irony is that as our congress looks at health care reform, activists in Canada, Britain, and a number of other countries are also looking at health care reform. The difference is that they are trying to figure out ways to introduce more choice and more market elements and reduce rationing at the same time we are plunging headlong into the same mistakes which they made a generation ago and which they now realize have left them with unacceptable failures in their systems with thousands of preventable deaths every year and millions stuck on waiting lists for essential treatment.

This is how bad it can get with government-run, single-payer systems, which may have a cost in lives and suffering, but do at least bring down the cost of health care. Imagine how much worse it could be with a combination of government bureaucracy and rationing and the high prices of private insurance and you have some idea of what ObamaCare will be like. It is likely to have all the flaws of socialized medicine while preserving most of the shortcomings of our current private insurance system, because the thousand-page bill which congress was considering is largely authored by lobbyists for the health care, pharmaceutical and insurance industries. It's like yet another bailout for these industries at a high cost in life, suffering and taxation to the American people.

Even the far left agrees that the health care plan currently being rammed through congress serves the interests of big insurance, medical and pharmaceutical companies while doing more harm than good to the average citizen. It rations and reduces the quality of medical care. It massively increases costs and forces small businesses and individuals to purchase insurance plans at inflated prices which they cannot afford or pay substantial penalties which they also can't afford. It passes many of these costs on to the public in huge tax increases. It doesn't solve the key problem of inflated insurance and health care costs and is projected to still leave 20 million people uninsured.

This may be the most monumental legislative disaster ever given serious consideration in the notoriously profligate halls of congress. This plan is not what the American people have in mind when they think of health care reform. It ignores their needs and sets their interests aside to pander to statist radicals and big business. The American people deserve better.

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About Dave Nalle

  • Jordan Richardson

    Yep, we’re droppin’ like flies up here. God help us all.

  • http://www.republicofdave.com Dave Nalle

    And Jordan, the welfare you Canadians enjoy as a group is pretty meaningless to the individuals who suffer and wait and die because of healthcare rationing.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I think you’re making good points about rationing healthcare. The problem is, it already exists under the present system. So why do you suppose the problem will become exacerbated once the universal healthcare comes into effect – to cover the presently uninsured. How will their situation become worse? Or for that matter, how will the situation of those who are presently insured become worse than it already is? I believe the kind of connection you’re pressing for remains to be substantiated.

  • Clavos

    …how will the situation of those who are presently insured become worse than it already is?

    If you add 50 million more patients to the pool and simultaneously institute significant cost control measures, from whence will you get your reductions?

    Bliffle and a few others claim that the government-run system will be more efficient in terms of overhead, as demonstrated by the allegedly low Medicare overhead, but several of us have demonstrated that this is simply not so; on a per patient basis, Medicare is in fact less efficient than the private insurance system — surprise, surprise.

    Nope, rationing will increase, not decrease.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I’m presuming that those already insured will hold on to their premium insurance plans. And if so, their healthcare wouldn’t be jeopardized by the influx.

  • Clavos

    Except that those premium health plans will be unable to compete with the free government insurance, which will also impose much lower fees for service than they (the insurance companies) can afford to pay (the government insurance doesn’t have to be profitable), so they will inevitably disappear.

    And most middle class folks, particularly those working for small firms (the majority) don’t have premium plans to resort to; they will see a significant decline, because Obamacare also proposes putting a significant tax on those who don’t buy into the government plan.

    Because for the lower fees for services, don’t be surprised to see a lot of foreign doctors practicing in US hospitals in short order, either.

  • Clavos

    “Because of

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Again, I’m supposing that those who are aware of the dangers of rationing will maintain their premium policy for that very reason. And those who don’t, well … they were already in the cold somewhat. So yes, some dilution in quality will occur, but not to those who can afford to pay.

  • Clavos

    No, As I explained in #8, with the so-called “public option” the time will come (and in very short order) that there will be no other option than the government one, except for those rich enough to pay all fees out of their own pockets, and even they will be thinned by the degree to which they are sick. Some chronic patients’ medical bills exceed $500K a year for years on end.

    The majority of the US population will see a decrease in the quality and availability of their medical care under the “plan” currently being ramrodded through the congress.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    What you’re saying, the present proposal will eliminate private insurance if not now then in the near future. That remains to be seen.

  • Bliffle

    Everything that Clavos and Nalle say about the Public Option is guesswork. for example:

    “…with the so-called “public option” the time will come (and in very short order) that there will be no other option than the government one, except for those rich enough to pay all fees out of their own pockets,…”

    Says who? How can you draw that conclusion? looks to me like you’re just guessing.

  • Bliffle

    The USA medical system is not only overpriced, it is downright dangerous:

    death by Medicine

    “ABSTRACT
    A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.1 Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.2, 2a The number of unnecessary medical and surgical procedures performed annually is 7.5 million.3 The number of people exposed to unnecessary hospitalization annually is 8.9 million.4  The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.”

  • http://www.republicofdave.com Dave Nalle

    Everything that Clavos and Nalle say about the Public Option is guesswork. for example:

    Bliffle, I didn’t say a single word about the public option in this article, actually. Part of the deal is that CERs will be used increasingly by private insurers in an attempt to cut costs. When they should be cutting costs by reducing overhead and unreasonable expenses they will be instead be cutting costs by rationing and limiting care.

    As for the private insurers gradually dying out under this system, I don’t see it. They are effectively being subsidized with draconian mandatory insurance rules, and their service will still be better than whatever public option there is, so they will keep being propped up by the state.

    Dave

  • Bliffle

    But profits of insurance companies go up at the same time the med business becomes more deadly:

    Medical loss ratios

    “Health plans make more, spend less in 2005

    By Jonathan G. Bethely
    American Medical News
    March 6, 2006

    If physicians needed any more indication of tightening reimbursement, how about this – not only did profits for the biggest health plans go up last year, but those plans also continued to cut the percentage of revenue they spend on care.

    The medical-cost ratio – also called the medical-loss ratio or medical-care ratio – is the key number for health plans in terms of their level of profitability. That ratio, simply, is the percentage of dollars the companies spend on health care.

    Whereas 10 years ago many plans had medical-cost ratios in the high 80s or 90s, now the highest percentage among large, publicly traded health insurers is Health Net, at 83.9%. Aetna, which had a medical-cost ratio well into the 90s when CEO John Rowe, MD, took over in 2000, recorded a ratio of 76.9% in 2005, Dr. Rowe’s final full year before his retirement. That was the lowest medical-cost ratio for the nation’s largest publicly traded plans.

    Medical-loss ratios for 2005 (Source: Company 10-K, year-end filings with the Securities and Exchange Commission):

    76.9% – Aetna
    82.3% – Cigna
    83.9% – Health Net
    83.2% – Humana
    78.6% – UnitedHealth Group
    80.6% – WellPoint

    Source

    Comment: By Don McCanne, M.D.

    Clearly, one-fifth of health insurance premium dollars are not being spent on health care, but are consumed by the insurers. What does not show up in these numbers is the cost of the administrative burden that these insurers place on the health care delivery system. The billing and insurance related functions for physicians and hospitals burn up another 12 percent or so of the premium dollar (Kahn et al, Health Affairs, Nov/Dec 2005). Add these together, and that is about one-third of the premium dollar.

    We are very concerned about the continued escalation of health care costs. New technology and pharmaceuticals are adding to the spending on physicians, hospitals, laboratories and other health care services. We fret about these expenditures within the two-thirds of the insurance premium that actually makes it down to the health care system, yet we are ignoring the one-third that is wasted on administrative services that provide no health benefit for the patient.

    We are enriching this industry for providing coverage for the healthy workforce and their young, healthy families, and for covering the healthy sub-sector of the individual insurance market. We taxpayers are footing the bill for the population subgroups with greater health care needs.

    We certainly are not receiving much value from the insurers – letting them have the easy stuff at a very high cost. Wouldn’t it be more logical to target their waste, rather than slowing spending growth by making health care unaffordable for those who do have needs?

    Why do we keep hearing that eliminating this industry isn’t feasible? You would think that anyone with a modicum of business sense would believe that keeping them in charge is no longer feasible.”

    Please take note of the comment by Don McCanne, M.D., above.

  • http://www.republicofdave.com Dave Nalle

    Bliffle, we’ve been over this subject before, and it is completely separate from the issues raised in this article. You’re essentially spamming here and attempting to distract from the real issues with this irrelevant canard about relative administrative/overhead costs.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    He’s not spamming insofar as your claims are concerned. It is guesswork.

  • Clavos

    I linked to this article in another thread about three weeks ago.

    It incontrovertibly refutes the administrative cost myth that says that Medicare’s administrative costs are far below those of the private insurers.

  • Lumpy

    Are administrative costs even an issue when comparedwith all of the other problems in this bill? Seems like a red herring.

    I have reasonably good health insurance already. What worriese isthe damage to individuals and small businesses forced to buy insurance they can’t afford.

  • http://handyfilm.blogspot.com handyguy

    The NY Times today ran a very useful table outlining the plans that have passed through committee.

    Read it. It disproves some of the silliness passing for argument around here. And describing these plans as entirely written by lobbyists for the insurance and healthcare industry is laughable.

    Dave’s ridiculously alarmist rhetoric adds nothing useful at all to the discussion.

    The main reason we spend so much more on health care than nearly all other countries is not the superiority of the care. It’s that we pay for each test and examination separately. This incentivizes doctors to order more tests.

    Caricaturing the attempt to differentiate between beneficial and wasteful tests and treatments as ‘rationing’ that will kill patients comes pretty close to being immoral. Oversimplify much?

    There are certainly flaws in the current bills, which will not be the final bills. Constructive discussion rather than dumb ‘sky is falling’ articles might possibly get us somewhere.

    The fact that Dave thinks the public plan option is basically irrelevant, while Clavos and congressional Republicans decry it as the end of private insurance, shows that this discussion is far from clear cut, on either side.

    And the president did vow today to reject any plan that adds to the federal deficit.

    It will be interesting to watch this play out.

  • Clavos

    It is a red herring, Lumpy; one that’s constantly brought up by supporters of UHC.

    They say that Medicare’s low overhead (which they claim is lower than that of private insurers), is proof that a government-run UHC plan will be cheaper than, and actually save money over, the present system.

    The article points out that, on a per patient basis (the only way to make a comparison, in light of the huge difference in the number of patients covered by Medicare vs those covered by private insurers), Medicare’s admin costs are actually considerably higher than the private sector’s.

    And your reasonably good insurance is in danger of suffering the fate of the dodo if the UHC with “public option” (Obamacare) is what we wind up with.

  • Clavos

    And the president did vow today to reject any plan that adds to the federal deficit.

    Oh good, we’re not going to have UHC after all!

  • Lumpy

    Obama’s ability to ignore budgetary reality is astounding. In lesser men such delusion would end in a padded cell.

  • http://handyfilm.blogspot.com handyguy

    BC’s rightist commenters’ ability to crack wise yet say nothing is not exactly astounding.

    It does, however, induce much eye-rolling in anyone more interested in having an actual back-and-forth discussion, as opposed to lobbing ideological caricatures, cliches, and unproven/outdated ideas back and forth.

  • Glenn Contrarian

    Dave –

    I can go point-by-point with your references and refute them – and you’ve seen me do so.

    So to make a long story short, the error of your article – some of which is based on articles which themselves do not give a solid reference for their claims – is obviated by the fact that we’re thirtieth on the list of countries by life expectancy, that the only two other countries without UHC on that list are third-world countries Jordan and Bosnia (28th and 29th, respectively), and our government spends significantly more per capita than ANY of the top twenty-seven countries on the list…ALL of which have UHC in one form or another.

    Yes, you’ve seen me post this many times…and I will continue to post it because it is true and it obviates the errors (and some outright lies) by the HMO’s and Big Pharma who are spending $1.4M a DAY in lobbying Congress to protect their cash cow.

  • Clavos

    Quite.

    Your own trenchant, cogent arguments in favor of UHC certainly have us all dazzled.

    Well, one assumes they will, when you present them.

  • Clavos

    Glenn,

    You should look up the definition of obviate.

  • Glenn Contrarian

    Dave –

    to back up what I said, here’s a little something from one of your references:

    “In Canada, the wealthy and powerful have significantly greater access to medical specialists than do the less well-connected poor. High-profile patients enjoy more frequent services, shorter waiting times, and greater choice of specialists. Moreover, non-elderly, white, low-income Canadians are 22 percent more likely to be in poor health than their U.S. counterparts.”

    Not only does this claim have NOTHING in the way of references to back it up, it is proven false by the disparity in our respective life expectancies.

  • http://www.republicofdave.com Dave Nalle

    I can go point-by-point with your references and refute them – and you’ve seen me do so.

    I’ve seen you engage in the same sort of diversions and misdirections Bliffle has used here while avoiding the actual points.

    So to make a long story short, the error of your article – some of which is based on articles which themselves do not give a solid reference for their claims

    And most of which give references to government studies or studies from international groups like the OECD. All of this stuff is established fact and comes from reputable sources. None of it is made up. Most of the data originates in data reported by the same national health services which I’m criticising.

    – is obviated by the fact that we’re thirtieth on the list of countries by life expectancy,

    Another of the same old red herrings. Life expectancy in the aggregate has no relationship to the care which individuals receive and is a product of other factors like diet and lifestyle as we’ve already discussed at length.

    that the only two other countries without UHC on that list are third-world countries Jordan and Bosnia (28th and 29th, respectively), and our government spends significantly more per capita than ANY of the top twenty-seven countries on the list…ALL of which have UHC in one form or another.

    None of which changes the data referenced in this article. Do you dispute that the US has lower rates of death from all forms of cancer and heart disease than Canada and Britain? Do you dispute that patients in the US have substantially lower wait times for treatment and to see specialists?

    No. You can’t, because these are facts.

    I never argued that US healthcare was not overpriced and inefficient. That’s a separate issue. What you and Obama and the entire left seem not to get is that bringing down healthcare costs at the cost of loss of life and loss of quality of life is an unacceptable tradeoff.

    I believe we can bring those costs down by other methods without resorting to the draconian methods currently being considered, but that’s for another article.

    Yes, you’ve seen me post this many times…and I will continue to post it

    And you will continue to duck the actual discussion and resort to introducing irrelevancies because you cannot address the actual issues.

    because it is true and it obviates the errors (and some outright lies) by the HMO’s and Big Pharma who are spending $1.4M a DAY in lobbying Congress to protect their cash cow.

    Which I actually discuss at some length in this article. They have bought off congress and the administration and the current bill being considered is their dream come true. But don’t address the fact that your political idols have sold out or anything.

    Dave

  • Bliffle

    Clavos takes a lesson from Colin Powell:

    “…incontrovertibly refutes…”

    Sure. Just like the “incontrovertible evidence” that Saddam had WMD.

  • http://www.republicofdave.com Dave Nalle

    Regarding #27. A lot of these sources are articles in traditional print media where sources are not generally linked to as we can do here in the blogosphere. 10 years ago the veracity of articles in the WSJ or National Review — where the Goodman article you object to comes from — would not have been questioned, so I’d say you’re just setting new standards to serve your position.

    But if you look into Goodman’s work and sources you’ll find that ultimately you can trace his data back through other articles to legit sources. In this case to a WSJ article which draws on studies by the OECD and Lancet. And if you go looking for the actual studies the data is there, so please stop trying to weasel out of the argument here by these weak ass methods.

    Dave

  • Bliffle

    Clavos’ citation to the RealClearPolitics article (where that rightist pub cites the rightist Heritage Foundation, thus creating an echo effect), promotes an interesting idea: that we should look at the cost PER CLIENT rather than the cost PER DOLLAR of premiums.

    But regardless of whether one accepts that idea or not, the author stumbles when he says:

    “So, … moving tens of millions of Americans into a government run health care option won’t generate any costs savings through lower administrative costs. Just the opposite.”

    Because the millions of non-medicare clients that get folded into the public option are not, in fact, as old as existing medicare clients upon which the RCP calculations were based, and thus they have less required care (by the articles own premise). Thus, they will not carry the same burden.

    It’s a logical inconsistency. Not just contrary, but contradictory (in the Socratic Square sense).

    I still don’t see why one should embrace the RCP idea, why it would be more appropriate to consider cost per client than cost per premium dollar. Except, of course, that it facilitates the authors point (through the logical inconsistency), but then it reduces to a mere debating trick.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Dave,

    Coming back to point #3, still unresolved and the key point of your article: the purported relationship between increase in rationing healthcare and the present plan in effect.

    As I’ve argued, rationing already exists. And it’s necessarily a function of money along (i.e., how much one can afford to pay) but other factors as well – e.g., one’s age and or willingness to prolong life, perceptions, etc. And you yourself have stated in one of your comments that UHC doesn’t necessarily mean that all private insurers will be driven out of business.

    So you haven’t argued for the purported relationship/connection, only asserted it. Indeed, you allowed others to try to answer these questions rather than tackle them head on.

    So again, unless the implementation of UHC will inevitably result in the demise of all private insurers and there’ll be only one government plan of the same low quality everyone would be required to join – both quite hypothetical at this point – your argument against UHC on the grounds of increased rationing doesn’t stand. Thus far, it’s a bogus argument and an alarmist one at that.

    So the questions remains:

    (1) How would adding the presently uninsured to the already great masses of people who are subject of healthcare rationing worsen the position of that group, I repeat, in any SIGNIFICANT way?

    (2) How would the position of those already enrolled in premium insurance plans worsen by whatever the impact on the group specified in #1?

    If anything, your argument ought to be more in the spirit of highlighting the need for public education – on behalf of obtaining a higher grade of insurance, whether public or private, rather than the lowest grade available. So conceived, the argument you’re proposing would be logical – as a warning against the dangers of healthcare rationing. But you didn’t do that. So as it stands, it’s just another example of scare tactics against UHC.

  • Clavos

    In my comment #6, I pointed out that those who work in small businesses, which are the majority of working Americans, will most be hurt by the proposal put forth by the Democrats, because of the tax to be imposed on small business owners who do not (because they cannot afford to) provide paid health insurance to employees.

    Here’s an editorial from The Miami Herald which explains the details well. Some excerpts:

    The bill unveiled by House Democrats last week is a sweeping, 1,000-page blueprint containing scores of provisions that will change the way we pay for medicines and medical treatment. Some have more merit than others.

    The proposal to impose a penalty of 8 percent of payroll on all but the smallest businesses is particularly onerous and unworkable…

    According to the Small Business Administration, the nation’s 6 million small employers represent 99.7 percent of the total number of businesses that provide jobs, and 50.2 percent of private-sector employment. Small businesses create about 70 percent of new jobs…According to SBA figures, 89 percent have fewer than 20 employees, and 98 percent fewer than 100.

    The bill’s ”pay or play” option offers owners with payrolls exceeding $400,000 two unpalatable choices: Either pay the 8 percent penalty, or pay part of the premium for all full-time employees.

    For many, this is a lose-lose proposition. A survey by the National Federation of Independent Business (NFIB) found that 20 percent of its respondents would simply shut down if they were faced with this choice. They couldn’t afford it. One out of four said they would replace full-time workers with part-time workers in order to avoid having to pay anything.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Bliffle does raise a valid point concerning the flawed logic of the RCP article Clavos links in #17: namely, that “because the millions of non-medicare clients that get folded into the public option are not, in fact, as old as existing medicare clients upon which the RCP calculations were based, and thus they have less required care (by the articles own premise). Thus, they will not carry the same burden.”

    There’s another fatal flaw in the aforementioned article, and it concerns the major assumption. I quote:

    “But here’s the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a ‘miracle’ is really just a statistical sleight of hand.”

    First off, the assertion that the elderly are “in need of greater levels of medical care” (then the rest of the population) is a misleading one and can be represented in two ways: (a) as measuring the actual need versus (b) the actual amount spent on the elderly (under the Medicare program). One could thus well argue that the “higher levels” don’t necessarily reflect “the need” but rather the fact that since Medicare is available, and it’s “free,” the elderly will make use of it over and above their level of need – not to mention the motivation of the medical establishment to keep on providing the benefits (so that great volume could compensate somewhat by lower compensation rates). Which does represent an indictment of the system – on those very grounds – but that’s not the intended point of the author of the RCP article.

    Consequently, there can be a reasonable dispute as to whether the elderly actually REQUIRE/NEED a greater level of medical care than other population groups (as opposed to the actual burden they pose to the system).

    Hence the statistic cited by the RCP article as an unexpressed, hidden consequent – namely, that private healthcare administrative costs are therefore lower than they appear to be.

    But here’s the question which the RCP article purposely obfuscates while ringing with what looks like razor-sharp logic:

    Since the private insurance business caters (by its own assumption) to population groups which, by definition, require less medical care than the elderly (and is less therefore prone to abuses in obtaining unnecessary care from the subscribers if only because it’s not free), shouldn’t it follow that the lower per capita administrative costs of the program should also translate into lower administrative costs in terms of the overall percentages? The very fact that it doesn’t is puzzling, to say the least. The author doesn’t say.

    So the argument presented by the RCP article is muddled or double-edged. Why should an average patient who requires LESS medical care, not more, present a greater burden to the private system (in terms of non-administrative costs) than one who does?

    Can anyone explain this paradox?

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I have no argument with your criticism of the small business aspect of the plan – by all means the most objectionable part of the plan. Whatever limits that are being imposes, the House or the Senate version, are ridiculous. So I’m not addressing the dire economic consequences that are bound to follow – only the internal logic of Dave’s argument.

  • Bliffle

    Roger brings up a good point about rationing and old people:

    “…As I’ve argued, rationing already exists. And it’s necessarily a function of money along (i.e., how much one can afford to pay) but other factors as well – e.g., one’s age…”

    I’m glad to see you young folk finally recognizing that you owe it to us old folk to provide especially good care in our old age. After all we’ve done for you young whippersnappers!

    Take me, for example. I’m plenty old and I’ve done plenty for the young folks (spreading sunshine wherever I go) so I deserve plenty extra medical care now.

    Glad to see our contributions recognized. Finally!

  • Clavos

    Bliffle,

    Geezer care IS a major concern. So is care of chronically ill, dependent patients like my wife.

    Though not yet a geezer, I’m no spring chicken. As such, it is precisely the likelihood that geezers (and the invalids) will be among the most likely to be rationed that has me fighting against the proposals currently on the table, as opposed to reforming the insurance, pharma, and tort industries instead of the medical industry, which, if done properly, would result in real improvement to the whole system and real improvement for the population as a whole.

  • Clavos

    Oh, and BTW bliffle. RCP is a news aggregator, not a “rightist pub.” As such, it publishes essays from both sides of the aisle, rarely taking a stance of its own.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    What’s the point, Clavos, of trying to prolong the lives of those who are chronically ill? Is there any quality of life we can sensibly address?

  • Clavos

    Wow, you’re a cold fish, Roger.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Not at all, Cindy. Just being realistic. Life has got to be productive to have any meaning. I’m not saying anything here that I don’t apply to myself.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Sorry, I thought Cindy made the remark.

  • Clavos

    I disagree, Roger, but in any case, that’s a decision for the patient and his/her family and doctor, not the government or any other entity.

    However, one of the scariest aspects of the govt. running health care is the likelihood of a faceless bureaucrat with your attitude making such decisions.

    What’s next? Eugenics?

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    You’re not going to find me among the ranks of those who would endorse this solution. I can’t make these decisions on behalf of others. But unless the medical science will advance to the point that old age can be enjoyed with relatively speaking little pain and suffering, I’m willing to bet that some such program you’re suggesting will become more and more prominent in future societies. Not eugenics but definitely assisted suicide.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    And isn’t the concept of healthcare rationing, logical in many respects if only in conjunction with the notion of triage, already a step, however gradual, in the general direction>

  • http://www.facebook.com/tolstoyscat Cindy

    Roger,

    Triage is meant for disasters and other specific conditions of scarcity. I don’t see it as a move in a direction any more than water rationing in a drought is a move in a direction. These actions are designed for a certain contingency. Capitalism maintains a situation of scarcity where there is none. It one reason why it’s evil. We’re talking about life and death–if there is no real scarcity, the manufacture of it for economics points to bad economic plans.

    We are human beings and capable of designing a system where we don’t create artificial conditions of scarcity and then justify letting people suffer and die from them.

    There need be no health care rationing. That is the only acceptable attitude because it is the only one that will lead to care for all. Anyone who is able to imagine something else being acceptable, I have to ask why. You’re holding back progress. We aren’t merely talking economics, what needs to change is consciousness.

    I object to your idea that life has to be ‘productive’ as a condition where you (or anyone else, outside the individual person) defines what ‘productive’ means. For me, hearing the voice of those I love, whilst not being able to do anything else, might be ‘productive’ enough.

    Also, if you were truly being realistic you would be taking reality into account rather than applying only what you personally think. To do so you’d have to get the opinions and experience of people who either are living with a severely ill, incapacitated person or those who themselves fit that description.

    The gross error and oppressive decisions that can be created by the human propensity to generalization based on one’s own viewpoint is one of the reasons any kind of authority will never work.

    Look at what is happening just in this discussion. One person is making assessments that would affect the conditions of whether someone should live or die, for a whole nation of individuals, based on limited perspective and presumption. Yes an exercise for you; but yet exactly how it is done in reality.

    This is one of the many reasons why representative govt and authority does not and cannot work.

  • http://www.republicofdave.com Dave Nalle

    Cindy, I would argue that you have no basis to be commenting here at all, because under your political philosophy there would be NO health care system at all, and people would die when they were about 45.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Cindy, read my #44. And I don’t mean to influence how people feel about their loved ones. These are my standards and I think they’re reasonable. Life as such has no value unless … you fill in the blanks. That others would want to hang on to it no matter what, it’s their business and it’s not for me to say they’re wrong.

  • Clavos

    Also, if you were truly being realistic you would be taking reality into account rather than applying only what you personally think. To do so you’d have to get the opinions and experience of people who either are living with a severely ill, incapacitated person or those who themselves fit that description.

    And I am living with (and care giving) a severely ill, incapacitated person who wants to continue living, but who, in Roger’s schema, would not be allowed to.

    Which is why I objected to Roger’s comment and why I object to rationing.

    It’s very personal.

  • http://handyfilm.blogspot.com handyguy

    A couple of thoughts – I’ll divide them into separate posts:

    [1] We all expect someone else to pay for our health care. We expect it to be so expensive that either the government or a private insurer will pick up the tab.

    It’s only fair that the entity picking up the tab should come up with rules regarding what gets paid for and how much is paid.

    So rationing is already going on right now, every day, mostly by private insurers. The question is what kind of rationing is fair: an insurance company that refuses to cover a ‘pre-existing condition’ is rationing care, with gross unfairness.

    MRI’s and CT scans and other massively expensive tests and treatments are approved by the thousand every day for some. They are denied for others.

    Many experts believe they are vastly overused and often do not improve health. Trying to come up with a rational set of rules for approving/not approving these tests, based on their effectiveness, makes a lot of sense to me. It’s the only sure way to get the costs down.

  • http://handyfilm.blogspot.com handyguy

    [2] The small-business part of the discussion is, like many issues, being simplistically caricatured by many commenters on here.

    The bills that have passed through House and Senate committees so far say this:

    Businesses with 25 or more employees [Senate] or $250,000 or more in payroll [House] are required to pay 60-70% of premiums for their employees’ health care, or face a penalty: either $750 per full time employee [Senate], or a sliding scale payroll tax [House], 8% if the payroll is $400,000 or more.

    Will this really drive small businesses out of business? The smallest businesses will still be exempt. Offering health coverage is already a way to draw more qualified, desirable employees.

    And what would be your alternative suggestion for the employees of these firms? Just hang ‘em out to dry?

  • http://handyfilm.blogspot.com handyguy

    [3] The real ‘secret’ to financing UHC is taxing employer-provided benefits. This is opposed by labor unions, making it a difficult position for Dems. Don’t be surprised if Obama nudges them in this direction, which may draw some GOP support.

  • http://www.republicofdave.com Dave Nalle

    Coming back to point #3, still unresolved and the key point of your article: the purported relationship between increase in rationing healthcare and the present plan in effect.

    I thought Clavos addressed #3 rather well, but I’ll add my two cents. There are only two ways of expanding health care coverage when resources are finite. You can spend more to create more resources or you can ration the health care provided. This is true under a capitalist model or under a government model or under any kind of hybrid system. Either citizens will be taxed enormously or somewhere the system is going to limit the services they receive.

    As I’ve argued, rationing already exists. And it’s necessarily a function of money along (i.e., how much one can afford to pay) but other factors as well – e.g., one’s age and or willingness to prolong life, perceptions, etc. And you yourself have stated in one of your comments that UHC doesn’t necessarily mean that all private insurers will be driven out of business.

    Yes, rationing does exist. It will continue to exist. But the point of the article is that in every instance where the management is put in the hands of government the result is an increase in rationing and a reduction in service. On the other hand, in a free market (see my new article) there is a motivation for health care providers and insurers to make an effort to provide better service and less rationing of service which does not exist in a government run system.

    So again, unless the implementation of UHC will inevitably result in the demise of all private insurers and there’ll be only one government plan of the same low quality everyone would be required to join – both quite hypothetical at this point – your argument against UHC on the grounds of increased rationing doesn’t stand. Thus far, it’s a bogus argument and an alarmist one at that.

    It’s a valid argument even if there remains a private system, because as we have seen with Medicare and Medicaid the private system will adjust its practices to match those of the public sector competitor. What’s more, government regulations will impose further rationing on private insurers as they become more closely merged into government management of the entire system.

    What is going to be created is a government managed system in which insurers participate as agents of government policy. It’s the worst of both worlds, with companies wringing profits out of consumers while government bureaucrats limit their care.

    Even worse, it’s a system which people will be forced to join by draconian regulations which penalize them for not joining a government approved plan.

    (1) How would adding the presently uninsured to the already great masses of people who are subject of healthcare rationing worsen the position of that group, I repeat, in any SIGNIFICANT way?

    Obviously what it does is add to the overall cost of the system. That cost can then be made up in only one of two ways, either by massively raising taxes or by reducing and rationing services to everyone. This is obvious.

    (2) How would the position of those already enrolled in premium insurance plans worsen by whatever the impact on the group specified in #1?

    Because there will be less and less competition or motivation for insurers to offer competitive plans or attractive services. As government mandates become the standard service will be lowered to the mandated level for everyone.

    I feel like you and others here don’t really understand what is in this healthcare bill. I suggest that you take the time to read it or at least parts of it. I can point you to some of the problem areas. Look at sections 881, 1802, 4376, 9511 for some of the obvious problem areas, like penalizing the uninsured and rationing methodology. There’s more, but you’ll see what a mess the bill is if you try to read it.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    It’s not a Roger schema, Clavos, and I said it’s a decision every person must make. But it is unrealistic to expect a continuation of a fruitful and productive life while the process of aging, and of sickness and disease that come with it, marches on while our medical sciences are not yet in the position to stop it. In short, I do accept certain natural limits to productive and fruitful life, and I’m willing to live with it. Whether others do so or not, again, it’s for them to decide. Life for the sake of just living ain’t worth it.

  • Clavos

    handy writes:

    Many experts believe they are vastly overused and often do not improve health. Trying to come up with a rational set of rules for approving/not approving these tests, based on their effectiveness, makes a lot of sense to me. It’s the only sure way to get the costs down.

    The most sure way to reduce the number of tasts is not by means of restrictive rules, because that will inevitably result in lives being lost because of overzealous application of the rules.

    The far more certain way to cut down the overuse of tests is massive tort reform.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    “Businesses with 25 or more employees [Senate] or $250,000 or more in payroll [House] are required to pay 60-70% of premiums for their employees’ health care, or face a penalty: either $750 per full time employee [Senate], or a sliding scale payroll tax [House], 8% if the payroll is $400,000 or more.”

    Handy. You’re either being unrealistic or have no conception of small business. These limits are ridiculously low to be penalized. Neither the number of employees nor the annual payroll expense come even close to what the limits ought to be: they will go under because of the added burden. None will make it.

  • http://handyfilm.blogspot.com handyguy

    Roger, what makes you so certain of this? And while you may think congress is stupid, are they stupid enough to deliberately drive businesses under? They’d be digging their own political graves, at the very least.

    Obviously some smart people disagree with you about these ‘inevitable’ consequences.

    Back up your assertions with facts. And/or suggest an alternative.

  • http://handyfilm.blogspot.com handyguy

    I assume the coverage mandated for small businesses will be tax-deductible, just as current health insurance costs are now for most businesses.

    If this tax deduction is reduced or removed, as some have suggested as a means to pay for coverage, that would be something else to consider in determining the effect on small businesses.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I used to run one for over twenty years, Handy. 3/4 to a million in gross sales and 25-30 employees will barely make it. And mine was labor-intensive. The only way I made it I was paying most every one under the table.

    And no, politicians have no idea about the struggles that small business go through in order to make it. Being in Washington, D.C. is no qualification.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    The only way it would possibly work is through tax-credits. The government would have to share at least half of the burden. You can’t squeeze blood out of a turnip.

  • http://handyfilm.blogspot.com handyguy

    The far more certain way to cut down the overuse of tests is massive tort reform.

    Or maybe both malpractice-suit limitations and an attempt to find out what’s really effective and what’s not?

    At least one article I read indicated that Obama may use tort reform to get a few more Republicans on board.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I think a major tort-reform should be an integral part of the plan.

  • http://handyfilm.blogspot.com handyguy

    There are at least 3 mutually exclusive and contradictory viewpoints being promoted, and the proponents of all three are just sure that they are 100% correct and the others are totally fucked. [The argument is not unlike global warming in this respect.]

    [1] The Dave/Libertarian take: the bills being considered were written by insurance lobbyists and will pipe billions into these businesses. We are all doomed.

    [2] The Clavos/Congressional Republitard take:
    The public plan option in the legislation is a Trojan Horse method to destroy the private insurance industry and effect a government takeover. We are all doomed.

    [3] The Obama/House Democrats/Paul Krugman take:
    Without the public option, all health care reform is doomed to failure. The plan will keep private insurers honest. We will all be happily insured if there is a public option — yay!

    There is actually a 4th subgroup arguing for a private insurance co-op instead of a government plan. Intended as a compromise, it doesn’t seem to satisfy any of the other groups.

    Take #1, Dave’s stance in this overheated article, sounds like conspiracy theory gloom and doom nonsense to me.

    But at any rate the 3 [or 4] viewpoints are almost completely incompatible. How do we decide who’s right?

  • Clavos

    In order to keep my comments on the same plane as yours, handy, I guess I’ll have to start referring to Democrats as Democraps.

  • http://www.facebook.com/tolstoyscat Cindy

    47 – Dave,

    You really do test a person’s ability to maintain respect for you on any level. You understand anarchism does not preclude systems for anything. I don’t have to tell you that. You’re just trying to sway others with your bluffs. Don’t pretend to be dumb as well as blind.

  • Bliffle

    Clavos makes an interesting suggestion:

    “However, one of the scariest aspects of the govt. running health care is the likelihood of a faceless bureaucrat with your attitude making such decisions.”

    Is that worse than a faceless insurance company bureaucrat with that attitude making such decisions, as it is now?

  • Bliffle

    Then Roger chimes in with some more weird ideas:

    “But unless the medical science will advance to the point that old age can be enjoyed with relatively speaking little pain and suffering,…”

    Hey, wait a minute! Just because I need to drop a couple tabs of Ibuprofen in the morning and rub some peanut oil into my sore knees doesn’t mean that I’m ready for the glue factory!

    “… I’m willing to bet that some such program you’re suggesting will become more and more prominent in future societies. Not eugenics but definitely assisted suicide.”

    That’s the problem with you young people, always thinking about suicide

  • http://www.republicofdave.com Dave Nalle

    So the argument presented by the RCP article is muddled or double-edged. Why should an average patient who requires LESS medical care, not more, present a greater burden to the private system (in terms of non-administrative costs) than one who does?

    I actually think this makes sense. A moderately sick person who requires long term care will end up costing more than a very sick person who will be dead soon and no longer cost anything. Better to spend money on someone who will either be cured or die very quickly than on someone who won’t die and just keeps on living and costing money. Makes sense.

    [1] The Dave/Libertarian take: the bills being considered were written by insurance lobbyists and will pipe billions into these businesses. We are all doomed.

    I actually only mentioned this briefly in my article and it was certainly not the main thrust of the article. It’s a valid criticism of the current bill, but my primary concern is the mistaken focus on government control and cost cutting which will lead to rationing which has not worked well in other countries.

    Dave

  • http://www.republicofdave.com Dave Nalle

    Sorry, Cindy. I found #46 to be idiotic and offensive and not deserving of a serious response so I provided a response of equivalent quality.

    Dave

  • Clavos

    bliffle asks:

    Is that worse than a faceless insurance company bureaucrat with that attitude making such decisions, as it is now?

    Yes, because:

    1. The insurance guy(gal) is not a bureaucrat, he/she is an employee, with accountability.

    2. The insurance employee’s job isn’t a sinecure; applying enough pressure can either a) get a change in ruling, or b) get him fired.

    3. I can change insurance companies.

    4. You can sue an insurance company, you can’t sue the government.

    The old aphorism is “You can’t fight City Hall,” not “You can’t fight Humana.” I’ve already had a number of successes fighting Humana to get rulings reversed.

  • Bliffle

    “Tort Reform” looks like a Red Herring to me.

    How much money is involved?

    Or is Tort Reform just a distraction to delay and defeat health reform?

  • http://www.republicofdave.com Dave Nalle

    The problem with tort reform is that although it seems attractive, those lawsuits are still the most effective check on abuse within the medical profession, the pharmaceutical industry and the insurance industry. I’d like to see some tweaking to reduce things like the ridiculousness of class action suits and maybe trim down purely punitive awards, but we still need to keep the legal tort system viable.

    Dave

  • hsr0601

    A new ‘incomplete’ analysis by congressional budget experts of emerging House legislation said it would increase deficits by $239 billion over a decade.
    CBO does not score any savings from prevention / wellness and the rest, even if Prevention / wellness is an actual and essential part of the savings.

    Besides, the Times in a July 7 editorial argued “As much as 30 percent of all health-care spending in this country?some $700 billion a year?may be wasted on tests and treatments that do not improve the health of the recipients,” .

    And I think the others such as increased productivity, potential stem cell effect, decreased mental stress, and massive job creation considered, the reform might be within reach.
    The report of stem cell research turned around the stock markets world-wide, and then what if the reform package clears the Congress ?

  • Clavos

    “Tort Reform” looks like a Red Herring to me.

    How much money is involved?

    Irrelevant, bliffle. Docs order all those unnecessary tests because of the threat of being sued.

    It’s a CYA exercise, “just in case.”

    And if it’s such a red herring, why are the premiums for high risk specialties so astronomical? OB/GYNs are disappearing almost as quickly as snail darters — oh wait, snail darters, unlike OB/GYNs, are protected.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    #67 apparently takes it personally. I don’t have their medical file. Perhaps we can fix that and throw in a diabetes for good measure. Or perhaps a dementia as well. With a little bit of luck, we’ll have them howling for mercy and climbing the walls. Will that suit you, or do I need to pile some more? You tell me when to stop. Oh yes, and I forgot the Alzheimer’s. The more, the merrier.

  • Bliffle

    Clavos is RIGHT!

    “#38 – Clavos

    Oh, and BTW bliffle. RCP is a news aggregator, not a “rightist pub.” As such, it publishes essays from both sides of the aisle, rarely taking a stance of its own.”

    Sorry about that. I must have been thinking of something else. I just spent a couple hours reading interesting articles on RCP , originating from other sources.

  • Bliffle

    …but at the same time, I read

    David Broders article on healthcare

    … and found this suggested reading at the bottom:

    Related Articles

    July 9, 2009
    Getting Cold Feet Over Big Government – Michael Barone

    July 10, 2009
    Why Waste $1.5 Trillion Only to Get Worse Health Care? – Rick Scott

    July 13, 2009
    The Consequences of Big Government – Robert Samuelson

    July 9, 2009
    Legislature Should Fix What It Broke – Debra Saunders

    July 19, 2009
    Record Deficits Could Sink Obama’s Presidency – Victor Davis Hanson

    Maybe that’s why I recall RCP as being rightist.

  • Bliffle

    …and then, while reading another article I found the righthand marginal links:

    Most Watched

    * GOP Rips President On Stimulus In “Obama vs Obama” Ad
    * Pelosi On Health Care: We Have The “Support Of The American People”
    * Ron Paul: Obama Will “Destroy the Dollar”
    * Taliban Video Shows Captive US Soldier

    Latest From
    AC 360

    O’Reilly Factor
    Face the Nation
    Fox & Friends
    Fox News Sunday
    Glenn Beck
    Hannity
    Hardball
    Larry King
    Meet the Press
    Morning Joe
    No Bias. No Bull
    Countdown
    On the Record
    Rachel Maddow
    Situation Room
    Special Report
    This Week

    Which tilts hard to one side.

    Maybe I remembered RCP from previous experiences as a “stealth’ wingnut site.

  • http://www.facebook.com/tolstoyscat Cindy

    69 -Dave,

    You find the idea that every human life is precious and each person should have the right to decide to live offensive?

    I’m not very shocked. As I have pointed out, you are more of a soulless animal than a real human. Your ideology is, in fact, based on the behavior of animals and not humans.

  • http://www.facebook.com/tolstoyscat Cindy

    Maybe not even social animals, come to think of it, but animals that are not social.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Cindy, even animals have “soul.” De Animaby Aristotle – on the nature of living things, animated. We call them brutes but they’re more social than some humans.

  • http://www.facebook.com/tolstoyscat Cindy

    I don’t know exactly what a soul is, but you get a big agreement from me there, Roger.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I knew I would, Cindy. Just give me the right to decide when to live and when to die. That’s also part of the deal.

  • http://www.facebook.com/tolstoyscat Cindy

    Here is how I see it Roger. As far as I am concerned, all sound minded people have a right to take their own lives without my interference.

    Depressed and mentally ill people need help from others, much like a child needs a parent.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    We agree, then. It’s an existential decision.

  • Bliffle

    Clearly, the human is a social animal. If we weren’t then we would kill infants and the human race would disappear. But we are not AS social as some insects. There are some species that abandon their young (especially aquatic creatures) to fend for themselves and sometimes even eat their young. But even those species seldom kill their own kind as adults.

    Humans, like most animals, try to find a balance between Competition and Cooperation. It is to our discredit that we seem unable to do that. Witness the constant wars and revolutions and insurrections that seek to impose one extreme or the other and then, in turn, reverse things.

    And we consider ourselves superior beings!

  • Bliffle

    About RCP: I concluded that it’s a rightist ‘honeypot’, with headline articles appealing to everyone, then with suggested links that point predominantly to their rightist favorites, with token leftists (notice how Rachel Maddow stands out in the list: the exception that proves the rule).

    Read, but be wary.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Goes along with the idea of health rationing, although the idea of MDs as “civil servants” is not to be pooh-poohed. MDs shouldn’t be thinking about getting stinking rich for having chosen their profession: it is supposed to be a vocation, no less so than teaching. A labor of love.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Demonstrates the duplicity of “the political class,” Democrats and Republicans alike.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    You’re right. It is skewed, Bliffle, in spite of Clavos’s protestations. A new website, relatively speaking. It’s presumed forte, billed by many, was a fairly accurate polling during the election season – on par with Zagby’s or Rassumussen’s.

  • zedd

    My brilliant post from yesterday didn’t show up.

    It was a masterpiece!

    Paraphrase:

    Dave, Let go. No need to pretend to be pontificating the complexities of the issue. You hate giving. You are suspicious of most people and think they have some sort of angle. Sounds like a personal problem. However, on this topic, your angst(or whatever personal issue you are toting around) can’t be accommodated any longer. You don’t have a choice. To be human, you have to help other humans who are ill or dying. You just do.

    The only thing that is left for discussion is what the best way to go about this.

    Come up with some solutions instead of waisting time on these ridiculous stalling mechanisms. It’s inevitable so quit dragging your feet and be about a real solution AND perhaps represent your party in a more positive light.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    All your posts are brilliant, Zedd. You just don’t realize it because you’re incapable of anything less. So how’s that for a compliment?

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    #86,

    Correct, except for the few incorrigible posters on BC – and I shan’t name names. They know who they are!

  • Clavos

    Clearly, the human is a social animal. If we weren’t then we would kill infants

    More BS from the bliff.

    Sine prehistory, many cultures have done just that, and the Chinese continue to do so (albeit unofficially) even today.

  • http://www.Affiliate-Marketing-Guy.com Christopher Rose

    Clavos, it would be nice to see you escape the well of cynicism and negativity that appears to have become your comfort zone and make some positive suggestions rather than merely debunking others…

  • Bliffle

    Not just the Chinese, either:

    Kanani

    “After all, we’ve known for decades about the murder of wives no longer wanted, the murder or abandonment of unwanted baby girls, the selling of young girls into slavery, trafficking into prostitution, rape, the withholding of education, sweatsKhanday School Girls With New Uniforms, Pakistan. Images From Central Asia Institute. hop conditions, forced marriages, & female castration. These realities unsettle all women, and yet when we bring them up we risk being relegated to the status of left wing moonbat, a veritable Birkenstock-shod, skirt-wearing radical.”

    So? Are you in favor of it?

  • http://twitter.com/tolstoyscat Cindy

    “These realities unsettle all women…”

    Yes, they do, but they also unsettle the most advanced men of the species, equally…

    …and yet when we bring them up we risk being relegated to the status of left wing moonbat, a veritable Birkenstock-shod, skirt-wearing radical.”

    …The ones who don’t care much if their more ape-brained (read evolutionarily laggard) contemporaries would try to emasculate them by calling them ‘girls’.

    They understand, on whatever personal level, and despite the culture’s violent force to crush their spirit, that men who identify as ‘not women’ are lacking in depth and self-value and are actually quite insecure and needy creatures.

    I prefer confident* males.

    (*not to be confused with invulnerable)

  • Clavos

    Clavos, it would be nice to see you escape the well of cynicism and negativity that appears to have become your comfort zone and make some positive suggestions rather than merely debunking others…

    But I wouldn’t have as much fun…

  • Clavos

    So? Are you in favor of it?

    Where did I say, or even imply that?

    I simply pointed out that your Pollyanna-ish view of the human race is out of touch with the reality that a significant portion of the human population throughout the ages has always been evil, and probably always will be.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    We’re all vulnerable, Cindy – that’s what you’re saying of course.

    Is “evil” an offspring of ignorance, Clavos – just a bit? And if not, we must conclude then that a significant portion of the human population is defective.

  • Bliffle

    To advance, we must learn to accomodate, to empathize, to be able to set common goals and join in reaching them.

    Societies that kill their own kind become poor and marginalized.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    This is a cute story. We need more people like that.

  • Clavos

    Though I don’t agree with the author’s advocacy, I’m linking

  • Clavos

    Here’s the link to my late-term aborted comment #103.

    It’s in today’s edition of Salon, and is a good analysis of the various health care schemes that have been proposed.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Looks like a well-balanced article, shows all the flaws of the proposal on the table. Everything that emanates out of Washington these days is half-baked, a matter of political expediency. No way to run a country.

  • Bliffle

    Everything that emanates from Washington is written by lobbyists. They write the laws, and they write the news.

  • http://handyfilm.blogspot.com handyguy

    All the talk, from people as varied as Bliffle and Nalle, about lobbyists writing legislation seems a little off to me. A good article in today’s NY Times provides a partial answer:

    Lobbies Adopt Tone of Accord With President

    Some right-wingers are apparently disappointed with corporate lobbyists for ‘cozying up to’ the White House, and some on the left are uncomfortable with the White House ‘cozying up to’ corporate lobbyists, for banking and health care particularly.

    But I would interpret this as a strong indicator that Obama really is not as anti-business as some have portrayed him, and that his administration is looking for solutions that are not strictly partisan/ideological.

    And lobbyists who in the past have adamantly opposed regulation are instead hoping to shape laws that are seen as inevitable [like new financial regulation and health care reform and cap-and-trade].

    This is a lot different from ‘lobbyists writing legislation.’

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    I’m glad you entertain such high hopes, Handy. I’d like to believe that money and power are no longer anything but a strenuous connection. Somehow, I can’t!

  • Clavos

    “strenuous” or “tenuous,” Roger?

  • http://www.republicofdave.com Dave Nalle

    Dave, Let go. No need to pretend to be pontificating the complexities of the issue. You hate giving.

    This would explain the many hours of charity work I do every month. Meals on Wheels, Lions Club, local community center. I guess I volunteer at these places so I can oppress and exploit the old, the blind and the poor respectively.

    You are suspicious of most people and think they have some sort of angle. Sounds like a personal problem.

    Sounds like a realistic view of human nature.

    However, on this topic, your angst(or whatever personal issue you are toting around) can’t be accommodated any longer. You don’t have a choice. To be human, you have to help other humans who are ill or dying. You just do.

    That’s my goal here. To stop a political agenda which will cause more death and suffering for more people.

    The only thing that is left for discussion is what the best way to go about this.

    Which I have done at length in another article.

    Come up with some solutions instead of waisting time on these ridiculous stalling mechanisms. It’s inevitable so quit dragging your feet and be about a real solution AND perhaps represent your party in a more positive light.

    It’s not inevitable that we are going to enslave the nation and reduce the quality of healthcare. I’m fighting for the welfare of the people. I’m sorry that you’ve given up.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Actually, I meant something like “unseverable.” So perhaps the term used was rather unfortunate.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    A well-balanced, down to earth article.

  • Bliffle

    Clavos:

    “So? Are you in favor of it?

    Where did I say, or even imply that?”

    Which confirms my point, that as people advance from desperation, superstition and poverty into better circumstances, they do more to support and nurture fellow humans.

    Isn’t that EXACTLY the point that we make when we excoriate the heathens for their lack of “Human Rights” consciousness? We all do it, left and right alike. The leftists are famous for it, and now even rightists like George Bush are fond of invidious comparisons with our antagonists in China, Iran, etc.

  • Broke Bloke

    Yoo hoo. Obama? Unemployment? Anyone? Unemployment please. Health insurance is great and all but…yeah.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Yes, unemployment remains the greatest problem. The stimulus package thus far has proved the greatest disappointment. One just doesn’t see the effects of it on any level – nothing of the sort that FDR’s NRA was responsible for. Other than rescuing businesses “too big to fail,” it’s total effect thus far – especially in the area of unemployment – is zilch.

  • Ryan

    All the fear mongering, you people must live in constant fear! Makes me glad I’m Canadian. For all of you wondering, my health care is just fine. If your sick, you can go to the ER, and you leave with no bill! My mother beat bone cancer after her amputation, and paid nothing for her treatment. The worst thing about it is that for something minor like a broken bone or a bad flu, you may have to wait a few hours. But unlike the 18000 or so that die in the US every year, if your life is threatened, in Canada you get the care you need. Also, we spend about 9.5 percent of our GDP on health care, whereas the USA spends 15.4 (and rising) so really, who’s making the mistakes? People in the US have got to start realizing when someone is opposing something simply for political gain, or simply because their party told them to!!

    Let me put it this way: In our country, if some politician proposed getting rid of universal health care, he’d be finished. End of story.