FB: Minnesota Intercollegiate Athletic Conference

[Ralph Turner]

Without the de facto floor to costs in health care that Medicare has provided and the subsidies that exist in the system, prices would actually achieve a market-based value.

I know an orthopedist who uses the most expensive artificial joints, regardless if the patient's lifestyle demands that specification.  Put an artificial hip that can run a marathon in an 80-year grandma at three times the cost of the one that will let grandma walk around her apartment?  If grandma were determining a value to the hip replacement, we would have some marketplace discipline as to what she valued with her health care purchase.

My 88-year old mother-in-law is an educated healthcare consumer.  She doesn't value the extra $10000 in "medically indicated Medicare expenditures" that her doctors recommended to her last year.  It would not have made $10000 value difference to her, but would have cost taxpayers that much anyway.

Regina Herzlinger is one of my favorite authors on healthcare.  Anything that she writes is excellent.

The real issue in the healthcare debate is that everyone else in the country is benefiting from the traditional doctor-patient relationship.  Intruding into that relationship is now the HMO, the hospital, the labor union, the employer who buys the healthcare, the healthcare economist, the legislator, the pharmaceutical company, the durable medical equipment supplier, etc.  Everyone of those intruders have their strategies and the data as to how to profit off that doctor-patient equation.  The governmental focus now is "health of populations", not "health of patients".

And, as a physician, when the principle source of income is the "single-payer system", it is no longer the patient who is buying my services.  My check comes from the government.

[Mr. Ypsi]

I'm disappointed in the responses (except, as usual, from Ralph - I'll get back to you later).  OzJohnnie, you are usually quite reasonable, so I am disappointed that you refuted points I never made.  I never said a market-based person was not 'serious'; I made the (clearly true) point that such arguments are so much out of the mainstream of voters that no party advocates them.  You will not find any mainstream party in GB or Canada advocating dismantling their medical system (I don't know the politics of Australia).  I am sure that opponents of the healthcare in Canada exist; that I have never met any does not mean they don't exist, but I assume they are not a majority!  That you assume CEOs of insurance companies are better qualified to 'run' heathcare than elected officials blows my mind.  I'd prefer that neither 'runs' healthcare, but I'd kinda prefer people I can vote for or against pay for it than guys I didn't vote for and who have a vested interest AGAINST paying for it.

And to all: I never said the ONLY reason for outrageous drug prices is executive greed, but it doesn't much help!   Getting a drug to market is horrendously expensive (though eased quite a bit by GOVERNMENT financed research at universities, as well as other quite generous subsidies), but the bottom-line profit is still greater than for nearly any other industry.  We don't need to pass the hat for those poor pharmas quite yet.

And OxyBob, saw your post just before I posted.  Partly correct, but I'll respond later.

[Ralph Turner]

...
Wal-Mart's new "$4 drugs" has done more to save my patients their own money than anything else that I have seen in my 30 years of being a physician.  That is one tangible marketplace force for good in health care.  Wal-Mart did it, not your government.
...

One practical example for you to use...

Wal-Mart and Kroger in my area have a formulary (a whole specific list) of $4 drugs.  Please go to one of those pharmacies and get the brochure of drugs that are on those "$4 lists".

At your next visit, when your physician suggests a prescription, please discuss with him/her whether one of those $4 drugs is an acceptable option for the value that you want.  If the $80 drug is of that much more value to you, then the market has priced it correctly for you.   

[snoop dawg]

How about them Pens?

[Mr. Ypsi]

And, as a physician, when the principle source of income is the "single-payer system", it is no longer the patient who is buying my services.  My check comes from the government.

Ralph, what I cannot understand is how this differs from "my check comes from Blue Cross" (or whomever).  Obviously, I want a system where I (the patient) has ultimate control of medical decisions (with the advice of my physician, of course!), but do I want the payment decision to come from my fellow citizens or from unelected insurance executives who skim many tens (hundreds?) of billions of dollars off the top for themselves and their shareholders?  Unless one is totally cynical about democracy, it seems an easy choice to me.

[Superfoot Wallace]

In which circuit do most of the pharmaceutical manufacturers, particularly the R&D steeped, reside?

Would venture to say the Seventh. 

Strangely there have been movements to eliminate the rule against perpetuities in two states.  One, Alaska is in a circuit dominated by an energy crunch and BOT's that span the Canadian border.  Oddly, or maybe not so, Alaska represents the United State's largest indigenous oil.  The other, Illinois, is the seat of the Seventh Circuit.

Don't know how universal healthcare will deal with federalism issues.  Will it be a collective pot with state to state administration as with Social Security and in the periphery to a lesser extent Medicare?

Some of the R & D issues have collectively eluded executive orders, particularly 1988, for the business of doing business with populations as opposed to patients.

Had an uncle in Scotland, where they have socialized medicine, who passed in the same manner as Mr. Ypsi's friend's father.  This of course is all according to my stepfather, who is an ardent socialist, albeit one that believes in profit.

On the other side of the coin of your earlier opinions, there are good things about healthcare in my homestate of Indiana.  There are caps on medical malpractice suits, easing the doctor's insurance burden.  And there is a required, doctor composed board review of all medical malpractice cases.  While this board review is not determinative it does streamline some of the expert witness issues and provides solid evidence.  These savings, most probably in addition to some of the local flavor R & D issues have generated access to solid healthcare for the working poor in Indiana.

Again, the question will eventually boil down to state's rights, and not so sure those populations when the RAP becomes muddled are present day populations.  At least the big government of administrative agencies that handcuffed President Carter in their nascence have experience, track record and precendent to move forward.  Really think this all is an inevitability, and personally am more in tune with it's rule of law versus rule by law consequences.

Anyhow, am uninsured and need a hernia surgery so can play some semipro foosbah this summer.  Anybody want to front me six me grand?

signed,
Zhivago

[tmerton]

Yes!!!

[Kilted Rat]

Have you ever wondered why no serious political party in Canada or Great Britain (the other countries I feel competent to comment on) has ever proposed moving to a U.S. form of healthcare?  (Answer: because they would no longer be considered 'serious' political parties.)

So measures proposed in Canada and Great Britain are the measuring stick for legitimate policies? Then clearly our national beverage should be tea, our national past-times should be hockey and cricket, our national animal the moose, and our head of state should be born into the position rather than elected.

Thank God, I was getting sick of all these presidential election campaigns and that damn baseball and their 162 game season.

Additionally, if things proposed in official government offices are to be considered stellar ideas, then lets build more bridges to nowhere and outlaw booze!

There are many reasons why so many docs from Canada and many other countries are trying to get licensed to practice in America; among which are freedom to think on their own and practice medicine as they were trained, the money, and the ability to work as much or as little as they wish and be reimbursed as such. In Canada a doc gets paid the same if he sees 5 patients a day or 35. Which end do you think most trend towards? Do you think it's a good idea to reward inefficiency and poor production?

Insurance companies reap tens (hundreds?) of billions off the top on health care.  I realize you have deep concerns about 'the government' running anything (so do I!), but the ultimate bosses stand election every 2, 4, or 6 years.  Are you SO cynical about democracy that you would prefer the decisions of insurance company executives over the decisions of elected officials?

Am I happy about insurance companies collecting money from patients then telling the patients what they can and cannot have covered without any input from the patients doctor? Of course not.

Of all people an obvious democrat such as yourself should surely have some issues with the "ultimate bosses" having full power to make decisions after that last 8 years. In fact I would wager money you or a member of your family has a bumper sticker proclaiming such sentiments.

I'd rather have doctors and the patients themselves make their own healthcare decisions. Amazing concept; letting the experts in the field make decisions. Doctors don't try to go into courtrooms and dictate how the proceedings should be run, yet lawyers feel ok with and even obligated to do the reverse.

The VA gets a very bad rap (SOME of it deserved), but their drug costs (as the only federal agency allowed to bargain) are VASTLY lower than anyone elses.  Would it be such a bad thing if ALL of us could get lower prices?  (We're paying well over $100 a month WITH good coverage; I shudder to even think what it would be without insurance.)

Would it be a bad thing if all of us could get lower prices? Of course not. Would it a bad thing if we all paid lower prices? Absolutely.

The reason we have so many great medicines in this country is because we pay a lot of money to those who make great meds. It's called capitalism. You make a great product, you get to profit from your work. If you take away the motivation to make advances in health care, you lose those advances in healthcare.

The easiest way to get something done is to reward those who do it well.

I saw the Michael Moore movie.  This was visually observable when he went to the various countries, but he never mentioned it (for obvious reasons).

Michael Moore looks like what would happen in Rosie O'Donnell and Chewbaca had a lovechild and the lovechild lived under powerlines and ate glue daily.

This is a grateful American Johnnie ready to take the heat also.
In 1999 I had a whole 10 day wait to get my first screening colonoscopy. 4 days later I had colon resection to remove cancer. It got caught in time so I needed no chemo or/and radiation. I'm told the average wait for colonoscopy screening in countries with socialized medicine is 12 - 18 months. Nobody can tell me I'd have had a better prognosis even if my wait would have been 6 months.
KR is better qualified to weigh in on that.
Grateful & Thankful 

I don't know enough to make a qualified statement on wait times for screening procedures in other countries, but I do know that the longer you wait on any kind of cancer, especially Colon, the worse the prognosis.



57,
Glad to see the american healthcare system isn't failing everyone.





Welcome back TDT!

+k to all to celebrate your return and -k to you as is the custom.

[OzJohnnie]

Thanks for the reasonableness complement, Ypsi, and I return it.  I appreciate that people are working hard to to not descend in vapid name calling.

What I refuted were the methods of your argument, if not always the specific argument itself, since if the method is flawed thus too is the point.  I'll do a couple more here to show what I mean:

* Appeal to consensus: "such arguments are so much out of the mainstream".  I doubt I need to list examples of mainstream opinions, while being strong and unified, were horribly and sometimes tragically wrong.  The point here being, just because everyone else is doing it doesn't make it a good idea.  Granted it doesn't make it a bad idea either, so at best this argument is agnostic to the value of the point you are trying to make.  At worst it is an effort to shout down contrary positions and prevent them from being voiced.

* Accusation of minority:  Similar to the argument above, but from the other direction.  Claiming opponents are 'not in the majority' aims to dismiss an argument as irrelevant due to it's unpopularity.  Again, I doubt I need to list situations where one man stood strong against the current in support of an unpopular but correct position.  Again, at best agnostic.  At worst, an effort to intimidate the contrarian into silence.

So, I trust you didn't intend to use these lines of argument with base intent, but they have been used so address them I must.  My responses are intended to separate the rhetorical wheat from the chaff, so to speak.

Now, onto the wheat:

That you assume CEOs of insurance companies are better qualified to 'run' heathcare than elected officials blows my mind.  I'd prefer that neither 'runs' healthcare, but I'd kinda prefer people I can vote for or against pay for it than guys I didn't vote for and who have a vested interest AGAINST paying for it.

That you would believe a politician or, in what would in actuality be the case, an unnamed faceless bureaucrat in an unidentified Washington concrete bunker would be better at running a business than a trained and experienced CEO blows my mind.  I challenge you to name one government institution that runs better (with more responsive services at a lower cost) than the private sector equivalents.  FEMA?  The Post Office? PBS?  You will not be able to do it.  So how can you trust something as complicated and vital as health care to be the miracle exception?

(As an aside, the focusing on insurance company CEO's despite all the other actors in the health care stew is an 'appeal to other' argument.  An attempt to demonize a small group as being the evil cause of a larger vat of problems.  The implication being that addressing - or getting rid of - this small group will fix everything.  Again, I doubt it takes much thought to create a list of examples.)

And to all: I never said the ONLY reason for outrageous drug prices is executive greed, but it doesn't much help!   Getting a drug to market is horrendously expensive (though eased quite a bit by GOVERNMENT financed research at universities, as well as other quite generous subsidies), but the bottom-line profit is still greater than for nearly any other industry.  We don't need to pass the hat for those poor pharmas quite yet.

My particular industry is also quite profitable.  In fact the company I work for has profit margins of 40% while maintaining growth rates of 20% - 25% annually.  This year we could break $18 billion in revenue.  Target for government management or an example of competitive excellence?  Where exactly do you put the threshold to justify government ownership?

Sorry, retagent.  It didn't take me long to break that promise, did it?

[Ralph Turner]

And, as a physician, when the principle source of income is the "single-payer system", it is no longer the patient who is buying my services.  My check comes from the government.

Ralph, what I cannot understand is how this differs from "my check comes from Blue Cross" (or whomever).  Obviously, I want a system where I (the patient) has ultimate control of medical decisions (with the advice of my physician, of course!), but do I want the payment decision to come from my fellow citizens or from unelected insurance it may executives who skim many tens (hundreds?) of billions of dollars off the top for themselves and their shareholders?  Unless one is totally cynical about democracy, it seems an easy choice to me.

I want that system, too, and no one on the campaign trail is offering that system.  My check comes from Blue Shield, but the patient is the one who has come to my practice.  (I choose not to take some insurance plans because compliance with their billing protocols is too onerous.)  If 5, 10, 45 million patients who have not purchased health insurance premiums now flood the system with no economic checks and balances to the system, then the "law of unintended consequences" will occur, and I think that I outlined some of them very clearly.

The best system for the patient is the one in which the patient is in complete control of the payments, and John Goodman's system at www.ncpa.org is the closest one that I have seen to getting everyone else out of the doctor-patient relation.

Your health care account should be your tax-free/tax-neutral money.  You should be allowed to do with that money whatever you wish, even long-term care.  At your death, it may be given to whomever you wish.

As for Medicare now, there are numerous services for which Medicare will not pay.  The patient can buy them, but Hillary's plans and Obama's to a degree take that control into a bureaucracy.  As for what happens under Hillary's or Obama's plan, those health care conglomerates will now compete for cost-plus federal contracts to administer the federal plans, and I have to jump thru the hoops to give the government the information that they deem necessary to provide quality data to Congress.  Blue Shield has the infrastructure to manage that data collection.  They already do it on many Medicare systems now.

The emphasis on "healthcare of populations" is permeating all decisions.  The number of quasi-mandated healthcare protocols that are foisted on me are numerous, each with a nice margin to the hospitals and durable medical companies.  Failure to do so puts me at risk for malpractice litigation, with increased expense to the system.

[OzJohnnie]

I would like to quickly and genuinely complement Ypsi on gamely trying what I counted as full on 5 1/2 on 1 argument.  It usually seems like it's the other way around when I get into these things - refreshing change for me.


Ralph, you had me at "tax-free"...

Your health care account should be your tax-free/tax-neutral money.  You should be allowed to do with that money whatever you wish, even long-term care.  At your death, it may be given to whomever you wish.

[Ralph Turner]

Interesting quote from today's WSJ...

Industry PACs may not give directly to his campaign, but employees of industries may do so, and many of his contributors have come from executives and their spouses. For example, Mr. Obama leads all candidates in donations from the pharmaceutical industry and commercial banks, among other industries. According to the Center for Responsive Politics, which tracks fundraising in elections, Mr. Obama has received $528,765 from people in the pharmaceutical industry and $1,380,108 from commercial banks. He comes in second to Mrs. Clinton in donations from lawyers with $13,690,170, just over a million shy of her total.

[snoop dawg]

Lord Stanley ....here we come

Final
Ottawa 
Pittsburgh 
1 2 3   
0 0 0   
2 0 2   
T
0
4

Fleury, Pens shut down Sens in opener
Box Score | Shot Chart | Photos | Conversation
W »  Fleury (26 SV)L »  Gerber (31 SV)G. Roberts 2 (2), P. Sykora (1), E. Malkin (1)PIT »

Penalty to Gary Roberts 10 minutes for Misconduct(opposing player not identified)
EASTERN CONFERENCE QUARTERFINALS: PENGUINS LEAD 1-0

[Mr. Ypsi]

Oz and Ralph,

Thank you for your courteous and thoughtful replies.  I should have gone to bed hours ago, and will try to reply tomorrow when I am more awake!

[janesvilleflash]

Was that a sonic boom? It could have been, the way this discussion has zoomed OVER MY HEAD.