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sometimes we have to tell the dying "no"
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| outrider 2005-07-21, 8:55 am |
| Drug costs count: Sometimes we have to tell the dying "no"
By ANDRE PICARD
Thursday, July 21, 2005 Page A13
They are heart-wrenching tales: The young mother struck down in her
prime by breast cancer, and cruelly denied a miracle drug; the
brilliant lawyer diagnosed with colon cancer but unable to access the
medicine deemed his best hope for survival.
The bad guys in these stories are vile bureaucrats and their heartless
political bosses, who deny cancer patients access to breakthrough drugs
to save a few lousy bucks. If only it were so simple.
The reality: Drug costs (particularly cancer drugs) are skyrocketing,
and the benefits of new drugs are often marginal. Despite the
pharmaceutical company bumph -- and what patients themselves
desperately want to believe -- miracles are few and far between, and
cures are even more elusive.
As such, deciding which drugs will be used, and which will be covered
by public health and drug plans, is a difficult proposition. It
requires asking questions for which there are no easy answers:
Should patients be guaranteed access to drugs regardless of cost?
Should physicians consider a drug's cost when prescribing it?
At what point is a drug deemed inadequate, or too expensive?
Of course, if your child, your mother, your spouse is suffering, is
dying, money is no object. No one can fathom the notion that treating
their loved one is "not worth it," no matter how fleeting the hope.
But we cannot allow ourselves to make important public-policy decisions
based on pity, or raw emotion. Nor can publicly funded drug plans (or
private ones, for that matter) allow themselves to automatically
reimburse or subsidize every new drug. Determining if and when drugs
should be covered must be done in a dispassionate, rational manner.
In the emotion-free world of health economics, scientists base their
recommendations on the cost of extending a person's life by one year.
This measure is called a QALY, or quality-adjusted life year.
It is generally accepted that an intervention -- be it a drug, surgery
or prevention program -- with a cost per QALY of less than $50,000 is
deemed cost-effective.
Yet, determining the cost per QALY is rarely straightforward. Clinical
trials to determine the effectiveness of drugs are done in ideal
situations, with specific groups of patients. Real world results are
hardly ever as good.
And what is a good result, anyhow? Take the colon-cancer drug Avastin.
In clinical trials, it extended life by an average of five months -- to
20.3 months from 15.6 months. Is that good enough? At $55,000 a year,
is it worth the cost? Or could we get more bang for our health-care
dollars by spending that money on screening for colorectal cancer, or
on health promotion campaigns?
Doctors hate the idea that a committee of pharmaco-economists could
influence their prescribing decisions. But rhetoric about independence
and "putting patients first" should not obscure the need for checks and
balances.
There is currently no incentive for a physician not to prescribe
liberally -- and plenty of inducements from pharmaceutical reps
encouraging them to do so.
Drug companies are in the business of selling hope -- sometimes at
exorbitant prices.
When Taxol was introduced in the market in 1992, the $4,000 annual cost
was considered outrageous. Now we have Herceptin (breast cancer) at
$50,000, and Erbitux, another colon-cancer drug, at $100,000. Can the
$1-million prescription drug be far away?
When governments create mechanisms to determine if 'miracle' drugs are
living up to their promise, and whether they are a worthwhile
investment -- such as the formulary committees that exists in each
province and the Common Drug Review -- they are not being cruel and
obstructionist. On the contrary, they are being responsible
administrators.
If there is a shortcoming in our current approach, however, it is a
lack of transparency, a failure to explain how decisions are made and
why specific drugs are not covered.
Patients and their families deserve explanations, prompt decisions and
consistent judgments.
The bottom line is that health dollars are not unlimited. We already
spend $16-billion a year on prescription drugs. Sometimes we have to
say "no."
Our inflated expectations and overpoliticization of health-care
administration make that difficult, doubly so when the media give
blanket coverage to sad stories, often without the necessary context --
in particular, a hard look at the real costs and benefits of drugs
touted as miracles.
Paying too much for drugs, and paying for drugs that provide only a
marginal benefit, serves no one.
It may be politically expedient but will have painful long-term
consequences for all of us, diverting precious health dollars from more
cost-effective initiatives.
fairuse
http://www.theglobeandmail.com/serv...RD21/Health/Idx
| |
| Kurt Ullman 2005-07-21, 8:55 am |
| In article <1121945916.653074.111690@g49g2000cwa.googlegroups.com>,
"outrider" <outrider@despammed.com> wrote:
>Drug costs count: Sometimes we have to tell the dying "no"
>
>By ANDRE PICARD
>
>Thursday, July 21, 2005 Page A13
>
>
>They are heart-wrenching tales: The young mother struck down in her
>prime by breast cancer, and cruelly denied a miracle drug; the
>brilliant lawyer diagnosed with colon cancer but unable to access the
>medicine deemed his best hope for survival.
>
>The bad guys in these stories are vile bureaucrats and their heartless
>political bosses, who deny cancer patients access to breakthrough drugs
>to save a few lousy bucks. If only it were so simple.
>
>The reality: Drug costs (particularly cancer drugs) are skyrocketing,
>and the benefits of new drugs are often marginal. Despite the
>pharmaceutical company bumph -- and what patients themselves
>desperately want to believe -- miracles are few and far between, and
>cures are even more elusive.
>
<cheap rhetorical shot> Much copyright infringed stuff
snipped.</cheap rhetorical shot>
Actually this story pretty much frames the problem with the
debate on health care in the US. Unlike Canada, Great Britain and
most other countries with universal coverage, we have not yet been
able to wrestle to the ground what constitutes 'universal' coverage.
Do we or do we not transplant every long-term alcoholic with liver
disease? Do we let nature take its course if someone
can't/won't/don't follow medication requirements for HIV drugs? Do
we chemo everyone over 75?
This would indicate that we expect do everything for
everybody.
--
"No nation would be so dumb as to say that we all want to go one point,
we just don't know how to get there. What we are finding is some want to go to
San Diego, some to Seattle. We are ashamed to admit this so we
pretend we all want to go to San Francisco."
Uwe Reinhardt on the health care debate.
| |
| outrider 2005-07-21, 8:55 am |
|
Kurt Ullman wrote:
> In article <1121945916.653074.111690@g49g2000cwa.googlegroups.com>,
> "outrider" <outrider@despammed.com> wrote:
> <cheap rhetorical shot> Much copyright infringed stuff
> snipped.</cheap rhetorical shot>
>
> Actually this story pretty much frames the problem with the
> debate on health care in the US. Unlike Canada, Great Britain and
> most other countries with universal coverage, we have not yet been
> able to wrestle to the ground what constitutes 'universal' coverage.
> Do we or do we not transplant every long-term alcoholic with liver
> disease? Do we let nature take its course if someone
> can't/won't/don't follow medication requirements for HIV drugs? Do
> we chemo everyone over 75?
> This would indicate that we expect do everything for
> everybody.
Andre is hittin' it. Doncha think?
But your argument really doens't hold water. What about the guy (or
gal) who sits at the computer too long, and follows that with several
more hours watching television. Are we going to continue pay for their
self-induced cardiovascular disease?
See....?
>
> --
> "No nation would be so dumb as to say that we all want to go one point,
> we just don't know how to get there. What we are finding is some want to go to
> San Diego, some to Seattle. We are ashamed to admit this so we
> pretend we all want to go to San Francisco."
> Uwe Reinhardt on the health care debate.
| |
| Mr-Natural-Health 2005-07-21, 11:51 am |
|
outrider wrote:
> Are we going to continue pay for their
> self-induced cardiovascular disease?
How about breast cancer? Is that self-induced? It does have lifestyle
factors.
| |
| Kurt Ullman 2005-07-21, 11:51 am |
| In article <1121954686.645142.30470@g44g2000cwa.googlegroups.com>,
"Mr-Natural-Health" <johngohde@naturalhealthperspective.com> wrote:
>
>
>outrider wrote:
>
>
>How about breast cancer? Is that self-induced? It does have lifestyle
>factors.
>
All good questions. With no US answers as of yet.
--
"No nation would be so dumb as to say that we all want to go one point,
we just don't know how to get there. What we are finding is some want to go to
San Diego, some to Seattle. We are ashamed to admit this so we
pretend we all want to go to San Francisco."
Uwe Reinhardt on the health care debate.
| |
| outrider 2005-07-21, 11:51 am |
| Well there ya go. Shootin' holes all over Ullman's theorizing.
zee
| |
| bae@cs.toronto.no-uce.edu 2005-07-21, 5:52 pm |
| In article <6sMDe.6151$dU3.5395@newsread2.news.pas.earthlink.net>,
Kurt Ullman <kurtullman@yahoo.com> wrote:
>
> Actually this story pretty much frames the problem with the
>debate on health care in the US. Unlike Canada, Great Britain and
>most other countries with universal coverage, we have not yet been
>able to wrestle to the ground what constitutes 'universal' coverage.
>Do we or do we not transplant every long-term alcoholic with liver
>disease? Do we let nature take its course if someone
>can't/won't/don't follow medication requirements for HIV drugs? Do
>we chemo everyone over 75?
> This would indicate that we expect do everything for
>everybody.
There are always cases of limited resources. You can't transplant a
liver into everyone who needs one because there aren't enough livers
available, but how do you decide who gets the organ? Is it the person
who can pay for it, or the one who can get the most years of useful
life out of it? So there are already criteria, but they are different
for different methods of funding and managing health care. Is it worse
to turn down a wealthy 75-year-old for a heart transplant, or to turn
down a 30-year-old parent of a young family who's just getting by
financially?
By what criteria do you decide to do dangerous surgery, or another
round of chemotherapy? Is it mainly by the likelihood that the patient
will survive it and benefit from it, or does whether they can pay for it
come into play? Compared to the US, Canadians with serious illnesses
live about the same length of time, but at much lower cost. Physicians
here are more likely to switch earlier to palliative care, focusing on
quality of life, than to go for kill-or-cure efforts when the kill to
cure ratio gets too high. ("Cure" here is figurative -- in such cases
it's usually just greater palliation involved.)
I recall a letter to the editor here some years ago. An elderly man
was refused heart surgery because his chances of surviving it were only
about 5%. His family pooled all their resources, went into debt, and
sent him to a famous US hospital for the surgery. He had the good luck
to survive, and his son wrote to the paper about the injustice of the
system not providing the surgery here in Ontario.
I thought about it and wondered how long after the surgery the elderly
man survived, and how the family would have felt if their substantial
financial sacrifice had resulted in the far more likely event that the
man died on the table, depriving him of even the few months of life he
might have had without the surgery. I can't guess if the family's
guilt would have been greater in that case than if they had done
nothing and let nature take its course. I certainly don't think they'd
have written the same letter to the editor if the man had died in
surgery.
One might also wonder what fraction of the elderly man's remaining life
was spent in pain and disability recovering from the massive trauma of
open heart surgery, and if he regretted it, both for himself and for
the effects on his children.
At any rate, there aren't any easy answers, and while it may make
decisions easier in a superficial way for the main criteria of how to
treat to be what the patient can pay for, it must be hard on the
physicians. When doctors return to Canada after working in the US for
a while, this is one of the issues that affected their decision to
return the most. (The other is quality of life in US vs Canadian
cities.)
There are a number of large-scale advantages to universal access to
medical care. It's in the government's interest here for the
population to be healthy (and paying taxes), so prevention and early
detection of disease are encouraged and funded. Doctors here don't have
to hire office staff just to deal with insurance, nor do they have to
waste time hassling with insurance companies over whether treatment
will or won't be funded. Data for the entire population of a province
is accumulated centrally where it can be analysed for geographical
trends and effectiveness of various treatment options. Global
optimizations become possible -- encouraging and funding flu shots for
the entire population reduces pressure on emergency rooms and demand
for hospital beds in flu season because the elderly, who often become
very seriously ill with flu and often don't respond effectively to
immunizations, are surrounded by immunized people who can't transmit
the virus to them.
Note that a universal insurance scheme is vastly less expensive to
manage than a private insurance company. About 30 years ago, Ontario
collected premiums from employers and individuals. They decided to
switch to a system of funding from a tax on employers and from general
revenues, at immense savings in clerical and data processing expense:
they closed down their entire data processing complex in Belleville.
Now, they only deal with doctors and other providers and with employers
instead of 10 million insured people individually or by family. Note
that OHIP is not a business so it doesn't have to recompense shareholders
or make a profit. It doesn't have to spend on selling or advertising
or dunning letters or market research or actuarial decisions on who it
will or won't cover, nor negotiating with doctors on whether individual
patients are covered for various treatments.
Another point -- malpractice suits are notoriously more common in the
US and malpractice insurance is one of a doctor's major expenses, which
further inflates the cost of medical care in the US. I wonder how much
the drive to sue is fueled by the feeling of injustice that despite
great financial sacrifice, there was a bad outcome? Or the belief that
had there been more money, there would have been better treatment?
| |
| David James Polewka 2005-07-21, 5:52 pm |
| kurtullman@yahoo.com (Kurt Ullman) wrote:
>Do we or do we not transplant every long-term alcoholic with liver
>disease? Do we let nature take its course if someone
>can't/won't/don't follow medication requirements for HIV drugs? Do
>we chemo everyone over 75?
We need to stop making influenza vaccines!
> This would indicate that we expect do everything for
>everybody.
=========================
"Endeavor to persevere"
=========================
| |
| Sbharris[atsign]ix.netcom.com 2005-07-21, 10:53 pm |
| bae@cs.toronto.no-uce.edu wrote:
Some stuff which gives me a serious headache because I agree with some
and not with some and don't know what to think about the rest....
> There are a number of large-scale advantages to universal access to
> medical care. It's in the government's interest here for the
> population to be healthy (and paying taxes), so prevention and early
> detection of disease are encouraged and funded. Doctors here don't have
> to hire office staff just to deal with insurance, nor do they have to
> waste time hassling with insurance companies over whether treatment
> will or won't be funded. Data for the entire population of a province
> is accumulated centrally where it can be analysed for geographical
> trends and effectiveness of various treatment options. Global
> optimizations become possible -- encouraging and funding flu shots for
> the entire population reduces pressure on emergency rooms and demand
> for hospital beds in flu season because the elderly, who often become
> very seriously ill with flu and often don't respond effectively to
> immunizations, are surrounded by immunized people who can't transmit
> the virus to them.
COMMENT:
Absolutely. Preventive care is where government health programs really
shine. People don't belong to even the best HMOs for long enough for
even them to care about it THAT much. But most of your citizens in a
country are with you from cradle to grave.
Perhaps if we're going to experiment with "universal health care
coverage" (aka socialized medicine) we should start with SOMETHING. So
how about (at first) just the preventive stuff? Which would be... odd.
Your vaccines and health checks, cancer screening of all kinds, blood
pressure pills and all diabetes preventive care and meds, would all be
totally taxpayer funded-- no co-pay. Ditto for all drug dependence and
smoking treatment programs. But not your pain pills or trauma care or
anything else you'd pay for anyway, when ill. The rule is universal
coverage for things you have no incentive to do, but maintainance. For
the other things, you'd still have to arrange for insurance. Teeth
cleaning and filling would be paid for, but you get a severe financial
going-over before the government paid for treatment of root abscess or
tooth pulling or the kinds of things that happen if you DON'T take care
of your teeth. Almost the complete opposite of what we do now. I'm not
saying let patients with acute problems suffer. But do make them pay
for non-preventive stuff if they have any extra money at all.
The government would also handle data collection and some other things
which suffer badly now, because of scale problems.
We don't do enough experimentation in social programs. We should do a
pilot program of this type in some state, and see what happens to
health endpoints. Do we save total medicaid and medicare money? My bet
is yes.
COMMENT:
> Note that a universal insurance scheme is vastly less expensive to
> manage than a private insurance company. About 30 years ago, Ontario
> collected premiums from employers and individuals. They decided to
> switch to a system of funding from a tax on employers and from general
> revenues, at immense savings in clerical and data processing expense:
> they closed down their entire data processing complex in Belleville.
> Now, they only deal with doctors and other providers and with employers
> instead of 10 million insured people individually or by family. Note
> that OHIP is not a business so it doesn't have to recompense shareholders
> or make a profit. It doesn't have to spend on selling or advertising
> or dunning letters or market research or actuarial decisions on who it
> will or won't cover, nor negotiating with doctors on whether individual
> patients are covered for various treatments.
COMMENT:
Sorry, but there's a big flaw in this argument. Advertising is data
processing, and it's not useless, despite what commies think. Not only
that, but competition is the mechanism by which waste and fat are
flensed from any enterprise. Remove competition, and you get
parasitical crud which cannot be removed by any other mechanism, and
pretty soon that stuff outweighs everything else.
Profits are merely pieces of information about what things are working
efficiently. The free market beats command economies for one reason
only: money and profit are the best markers for efficiency in
large-scale enterprises which have ever been invented. Other methods
may work for small groups like families or small communities where
everybody knows everybody else. But for larger groups where strangers
have to work together, it is prices and trade-efficiency which tell you
about waste and screwing-up.
>Note that OHIP is not a business so it doesn't have to recompense shareholders or make a profit.<
And therefore is fiscally accountable to people who aren't nearly as
interested in the results as are stockholders. Again, profits are
INFORMATION ABOUT EFFICIENCY. Your average taxpayer doesn't know nearly
as much about your government health program as your average
stockholder does about the company whose shares he owns. All of this
shows up in accountablity. If you don't give people a reason to think,
they won't. Prices in a store when you go to buy something, are (again)
almost PURE information. Remove them, and you get chaos.
> [OHIP] doesn't have to spend on selling or advertising
> or dunning letters or market research or actuarial decisions on who it
> will or won't cover, nor negotiating with doctors on whether individual
> patients are covered for various treatments.
COMMENT: In place of dunning letters, it decides services have been
stolen and sends the cops. But you don't count the police and the
prisons as part of your "payment enforcement system" even though that's
exactly what they are. Shifting business finanacial expenses from
credit/loan/debt collection to cops and jails doesn't make them go
away. It just makes them look like you're not paying for them. But of
course you are.
Besides, these decisions have to be made one way or the other. You
think actuarial research doesn't have to be done at some point? Market
decisions merely are merely "political decisions" if you remove the
money incentive, but the information processing still must be done (and
it won't be done as well). So what if you don't negotiate with doctors
or patients about who will be covered for various treatments? Fine, but
what makes you think somebody doesn't have to negotiate with *somebody
else* to decide these matters? You want these negotiations to be with
the people living with the disease and the effects of it, or some
politician a thousand miles away who knows nothing about it? Which will
give you the best and most informed decisions?
Explain to me please why a national auto manufacturing association,
with assignments for which citizens should be able to drive which cars,
shouldn't be more efficient than a bunch but individual manufactures
wasting money on advertising, and in wasteful individual negotiations
with each prospective buyer! What a nightmare of waste! And yet
there's so much difference between the needs of each individual, can
you imagine how it would have to be handled if you had to do it
centrally? And yet you propose to do it for an industry even more
complex. Tell me the flaw in my thinking.
> Another point -- malpractice suits are notoriously more common in the
> US and malpractice insurance is one of a doctor's major expenses, which
> further inflates the cost of medical care in the US. I wonder how much
> the drive to sue is fueled by the feeling of injustice that despite
> great financial sacrifice, there was a bad outcome? Or the belief that
> had there been more money, there would have been better treatment?
COMMENT:
Suing the government is always harder. But this is not always a good
argument for making the government responsible for any given
enterprise. Be it making cars OR delivering medical care.
SBH
| |
| outrider 2005-07-21, 10:53 pm |
|
Sbharris[atsign]ix.netcom.com wrote:
> bae@cs.toronto.no-uce.edu wrote:
>
> Some stuff which gives me a serious headache because I agree with some
> and not with some and don't know what to think about the rest....
>
>
>
> COMMENT:
>
> Absolutely. Preventive care is where government health programs really
> shine. People don't belong to even the best HMOs for long enough for
> even them to care about it THAT much. But most of your citizens in a
> country are with you from cradle to grave.
>
> Perhaps if we're going to experiment with "universal health care
> coverage" (aka socialized medicine) we should start with SOMETHING. So
> how about (at first) just the preventive stuff? Which would be... odd.
> Your vaccines and health checks, cancer screening of all kinds, blood
> pressure pills and all diabetes preventive care and meds, would all be
> totally taxpayer funded-- no co-pay. Ditto for all drug dependence and
> smoking treatment programs. But not your pain pills or trauma care or
> anything else you'd pay for anyway, when ill. The rule is universal
> coverage for things you have no incentive to do, but maintainance. For
> the other things, you'd still have to arrange for insurance. Teeth
> cleaning and filling would be paid for, but you get a severe financial
> going-over before the government paid for treatment of root abscess or
> tooth pulling or the kinds of things that happen if you DON'T take care
> of your teeth. Almost the complete opposite of what we do now. I'm not
> saying let patients with acute problems suffer. But do make them pay
> for non-preventive stuff if they have any extra money at all.
>
> The government would also handle data collection and some other things
> which suffer badly now, because of scale problems.
>
> We don't do enough experimentation in social programs. We should do a
> pilot program of this type in some state, and see what happens to
> health endpoints. Do we save total medicaid and medicare money? My bet
> is yes.
>
>
> COMMENT:
>
>
>
> COMMENT:
>
> Sorry, but there's a big flaw in this argument. Advertising is data
> processing, and it's not useless, despite what commies think. Not only
> that, but competition is the mechanism by which waste and fat are
> flensed from any enterprise. Remove competition, and you get
> parasitical crud which cannot be removed by any other mechanism, and
> pretty soon that stuff outweighs everything else.
>
> Profits are merely pieces of information about what things are working
> efficiently. The free market beats command economies for one reason
> only: money and profit are the best markers for efficiency in
> large-scale enterprises which have ever been invented. Other methods
> may work for small groups like families or small communities where
> everybody knows everybody else. But for larger groups where strangers
> have to work together, it is prices and trade-efficiency which tell you
> about waste and screwing-up.
>
>
> And therefore is fiscally accountable to people who aren't nearly as
> interested in the results as are stockholders. Again, profits are
> INFORMATION ABOUT EFFICIENCY. Your average taxpayer doesn't know nearly
> as much about your government health program as your average
> stockholder does about the company whose shares he owns. All of this
> shows up in accountablity. If you don't give people a reason to think,
> they won't. Prices in a store when you go to buy something, are (again)
> almost PURE information. Remove them, and you get chaos.
>
>
> COMMENT: In place of dunning letters, it decides services have been
> stolen and sends the cops. But you don't count the police and the
> prisons as part of your "payment enforcement system" even though that's
> exactly what they are. Shifting business finanacial expenses from
> credit/loan/debt collection to cops and jails doesn't make them go
> away. It just makes them look like you're not paying for them. But of
> course you are.
>
> Besides, these decisions have to be made one way or the other. You
> think actuarial research doesn't have to be done at some point? Market
> decisions merely are merely "political decisions" if you remove the
> money incentive, but the information processing still must be done (and
> it won't be done as well). So what if you don't negotiate with doctors
> or patients about who will be covered for various treatments? Fine, but
> what makes you think somebody doesn't have to negotiate with *somebody
> else* to decide these matters? You want these negotiations to be with
> the people living with the disease and the effects of it, or some
> politician a thousand miles away who knows nothing about it? Which will
> give you the best and most informed decisions?
>
> Explain to me please why a national auto manufacturing association,
> with assignments for which citizens should be able to drive which cars,
> shouldn't be more efficient than a bunch but individual manufactures
> wasting money on advertising, and in wasteful individual negotiations
> with each prospective buyer! What a nightmare of waste! And yet
> there's so much difference between the needs of each individual, can
> you imagine how it would have to be handled if you had to do it
> centrally? And yet you propose to do it for an industry even more
> complex. Tell me the flaw in my thinking.
>
>
>
> COMMENT:
>
> Suing the government is always harder. But this is not always a good
> argument for making the government responsible for any given
> enterprise. Be it making cars OR delivering medical care.
>
> SBH
Tell me the flaw in my thinking Steve invites. Here you are then:
"... competition is the mechanism by which waste and fat are
flensed from any enterprise. Remove competition, and you get
parasitical crud which cannot be removed by any other mechanism, and
pretty soon that stuff outweighs everything else.
Profits are merely pieces of information about what things are working
efficiently. The free market beats command economies for one reason
only: money and profit are the best markers for efficiency in
large-scale enterprises which have ever been invented. Other methods
may work for small groups like families or small communities where
everybody knows everybody else. But for larger groups where strangers
have to work together, it is prices and trade-efficiency which tell you
about waste and screwing-up."
Statins make multiple millions upon millions for shareholders every
year. Drugs shilled for a disease that doesn't exist. To do no-one
knows what. Profit. They make a lot of profit; while creating injured
living unproductive limping lives, sliding into dying from the drug and
the drug induced diseases. This is an example of profits being pieces
of information about what things are working efficiently.
| |
| Happy Dog 2005-07-22, 8:59 am |
| "outrider" <outrider@despammed.com> wrote in message news:
> Tell me the flaw in my thinking Steve invites. Here you are then:
>
> "... competition is the mechanism by which waste and fat are
> flensed from any enterprise. Remove competition, and you get
> parasitical crud which cannot be removed by any other mechanism, and
> pretty soon that stuff outweighs everything else.
>
> Profits are merely pieces of information about what things are working
> efficiently. The free market beats command economies for one reason
> only: money and profit are the best markers for efficiency in
> large-scale enterprises which have ever been invented. Other methods
> may work for small groups like families or small communities where
> everybody knows everybody else. But for larger groups where strangers
> have to work together, it is prices and trade-efficiency which tell you
> about waste and screwing-up."
Correct and internally consistent. I welcome your dissention. But it will
never come.
>
>
> Statins make multiple millions upon millions for shareholders every
> year. Drugs shilled for a disease that doesn't exist. To do no-one
> knows what. Profit. They make a lot of profit; while creating injured
> living unproductive limping lives, sliding into dying from the drug and
> the drug induced diseases. This is an example of profits being pieces
> of information about what things are working efficiently.
If you can prove that statins are sold under the auspices of a conspiracy,
then you have something. But, you won't. Fortunately, you can officially
avail yourself of plenty of money liberated from taxpayers and feel proud to
have defended legalized larceny. You have no friends here. I'd recommend a
sock-puppet to pump you up.
moo
| |
| george conklin 2005-07-22, 8:59 am |
|
"outrider" <outrider@despammed.com> wrote in message
news:1121945916.653074.111690@g49g2000cwa.googlegroups.com...
>
> The reality: Drug costs (particularly cancer drugs) are skyrocketing,
> and the benefits of new drugs are often marginal. Despite the
> pharmaceutical company bumph -- and what patients themselves
> desperately want to believe -- miracles are few and far between, and
> cures are even more elusive.
>
In many cancers, a 2 month difference in life expectancy is considered
optimal.
| |
| george conklin 2005-07-22, 8:59 am |
|
"Mr-Natural-Health" <johngohde@naturalhealthperspective.com> wrote in
message news:1121954686.645142.30470@g44g2000cwa.googlegroups.com...
>
>
> outrider wrote:
>
>
> How about breast cancer? Is that self-induced? It does have lifestyle
> factors.
>
They used to say that about TB. They said that TB victims were
melancholy. I guess they were. Once the real cause of disease is found,
no one pays any attention to fake lifestyle charges.
| |
| george conklin 2005-07-22, 8:59 am |
|
<bae@cs.toronto.no-uce.edu> wrote in message
news:2005Jul21.124423.9295@jarvis.cs.toronto.edu...
>
> There are always cases of limited resources. You can't transplant a
> liver into everyone who needs one because there aren't enough livers
> available, but how do you decide who gets the organ? Is it the person
> who can pay for it, or the one who can get the most years of useful
> life out of it? So there are already criteria, but they are different
> for different methods of funding and managing health care. Is it worse
> to turn down a wealthy 75-year-old for a heart transplant, or to turn
> down a 30-year-old parent of a young family who's just getting by
> financially?
>
> By what criteria do you decide to do dangerous surgery, or another
> round of chemotherapy? Is it mainly by the likelihood that the patient
> will survive it and benefit from it, or does whether they can pay for it
> come into play? Compared to the US, Canadians with serious illnesses
> live about the same length of time, but at much lower cost.
That really bothers the American medial/industrial complex because they
want to criticize Canada because they hate anyone knowing that spending
twice as much gets you nothing in terms of life expetancy.
| |
| george conklin 2005-07-22, 8:59 am |
|
"Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in message
news:1121998024.637073.139850@z14g2000cwz.googlegroups.com...
>
> Perhaps if we're going to experiment with "universal health care
> coverage" (aka socialized medicine) we should start with SOMETHING. So
> how about (at first) just the preventive stuff?
Preventive stuff costs MORE.
| |
| Sbharris[atsign]ix.netcom.com 2005-07-24, 1:00 am |
|
george conklin wrote:
> "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in message
> news:1121998024.637073.139850@z14g2000cwz.googlegroups.com...
>
>
>
> Preventive stuff costs MORE.
COMMENT:
That depends. I very much doubt that polio vaccine costs more than
dealing with polio.
SBH
| |
| Sbharris[atsign]ix.netcom.com 2005-07-24, 1:00 am |
|
Happy Dog wrote:
> "outrider" <outrider@despammed.com> wrote in message news:
>
> If you can prove that statins are sold under the auspices of a conspiracy,
> then you have something. But, you won't. Fortunately, you can officially
> avail yourself of plenty of money liberated from taxpayers and feel proud to
> have defended legalized larceny. You have no friends here. I'd recommend a
> sock-puppet to pump you up.
>
> moo
COMMENT:
Christ. This reminds me of the AIDS deniers, who vasilated between the
idea that HIV doesn't exist, or else that it does, but is harmless and
AIDS, as an infectious disease doesn't "exist" (rather, it's just a
giant phara conspiracy fronted by shills). This went on for quite
awhile and provided quite a lot of sparks back during the days when the
anti-HIV drugs weren't much good.
About 1995 the protease inhibitors arrived and high active
antiretroviral cocktails began to be possible. The HIV-infected HIV
skeptics who had low lymphocyte counts were then faced with a grim
choice: take the drugs and admit they were wrong, or else die. Some of
them chose to die. The rest of them now take the drugs and have shut
up. The only people we really have left in the debate are the people
who never had HIV to begin with, or else are among the small and lucky
group who actually can live wtih HIV without much viral reproduction or
immunosuppression, even without the drugs (10 to 15%).
These last group of people cause hell of course, because some of them
are narcisists. THey figure if the HIV doesn't harm THEM, why then, it
can't be harming *anybody.* Because their own experience trumps that of
the WHOLE world. Hey, I don't wear MY seatbelt and *I've* never been
hurt! And therefore the entire world MUST BE engaged in a VAST
conspiracy to make everybody with their diagnosis do something none of
them would really benefit from doing. It's sort of like those 85
year-old 3-pack-a-day smokers you find now and again, puffing away and
cackling about the stupid health nuts.
People who happen to win at slots sometimes think the light of God
shines directly upon them. It's infantile, but some people never quite
grow up.
SBH
| |
| Sbharris[atsign]ix.netcom.com 2005-07-24, 1:00 am |
|
george conklin wrote:
> In many cancers, a 2 month difference in life expectancy is considered
> optimal.
Oh, bullshit, George.
SBH
| |
| bae@cs.toronto.no-uce.edu 2005-07-24, 1:00 am |
| In article <1121998024.637073.139850@z14g2000cwz.googlegroups.com>,
Sbharris[atsign]ix.netcom.com <sbharris@ix.netcom.com> wrote:
>bae@cs.toronto.no-uce.edu wrote:
>
>Some stuff which gives me a serious headache because I agree with some
>and not with some and don't know what to think about the rest....
I know what you mean. This happens to me too. The only thing I can
suggest is to keep thinking until you decide which of the third class
belongs in the first or second. Or else, just ignore stuff on usenet
that makes your head hurt.
>
>COMMENT:
>
>Absolutely. Preventive care is where government health programs really
>shine. People don't belong to even the best HMOs for long enough for
>even them to care about it THAT much. But most of your citizens in a
>country are with you from cradle to grave.
>
>Perhaps if we're going to experiment with "universal health care
>coverage" (aka socialized medicine) we should start with SOMETHING. So
>how about (at first) just the preventive stuff? Which would be... odd.
>Your vaccines and health checks, cancer screening of all kinds, blood
>pressure pills and all diabetes preventive care and meds, would all be
>totally taxpayer funded-- no co-pay. Ditto for all drug dependence and
>smoking treatment programs. But not your pain pills or trauma care or
>anything else you'd pay for anyway, when ill. The rule is universal
>coverage for things you have no incentive to do, but maintainance. For
>the other things, you'd still have to arrange for insurance. Teeth
>cleaning and filling would be paid for, but you get a severe financial
>going-over before the government paid for treatment of root abscess or
>tooth pulling or the kinds of things that happen if you DON'T take care
>of your teeth. Almost the complete opposite of what we do now. I'm not
>saying let patients with acute problems suffer. But do make them pay
>for non-preventive stuff if they have any extra money at all.
>
>The government would also handle data collection and some other things
>which suffer badly now, because of scale problems.
>
>We don't do enough experimentation in social programs. We should do a
>pilot program of this type in some state, and see what happens to
>health endpoints. Do we save total medicaid and medicare money? My bet
>is yes.
I don't have enough knowledge of your system to comment on the feasibility
of your ideas.
>
>
>COMMENT:
>
>Sorry, but there's a big flaw in this argument. Advertising is data
>processing, and it's not useless, despite what commies think. Not only
>that, but competition is the mechanism by which waste and fat are
>flensed from any enterprise. Remove competition, and you get
>parasitical crud which cannot be removed by any other mechanism, and
>pretty soon that stuff outweighs everything else.
>
>Profits are merely pieces of information about what things are working
>efficiently. The free market beats command economies for one reason
>only: money and profit are the best markers for efficiency in
>large-scale enterprises which have ever been invented. Other methods
>may work for small groups like families or small communities where
>everybody knows everybody else. But for larger groups where strangers
>have to work together, it is prices and trade-efficiency which tell you
>about waste and screwing-up.
I'm not a "commie" and I don't think advertising or profits or
competition or most of the other components of a capitalist economic
system are intrinsically bad. However, I don't think that every area
of human endeavor works best under laissez faire capitalism.
Right now, my property taxes pay for the municipal fire department.
They do a good job, and I am quite willing that my taxes support them.
Suppose instead there were a dozen competing fire departments that I
could choose from to put out fires on my property. Each one would have
to spend on advertising and sales, collecting fees from its customers,
dispatchers and enough staff and equipment to handle fires in every
area of the city even though its competitors have eleven times the
equipment and staff there already. If I see flames shooting from my
neighbour's roof, who do I call? If a house covered by company A is
adjacent to houses covered by company B, C...L, who gets called? Who
prevents the flames from reaching the nearby houses? Who gets to use
the fire hydrant for its hoses? Maybe each company will have to have
its own system of water mains and hydrants.
What's more, since everybody will want a fire department to protect
them, but major fires are actually quite rare, the best way for a fire
department to be profitable is to charge low fees, and provide poor
service. This is how property and auto insurance already works -- an
insurance company that charges low premiums can do so because it
rejects many claims. I learned this by working with insurance brokers
for a good many years. Several well-known and very successful
insurance companies are noted for this. It's not dishonest or unethical
-- it's just an example of getting what you pay for.
Note that my fire department does advertise, as does OHIP. The fire
department advertises to recommend smoke detectors, that people check
their homes for fire hazards and figure out escape routes, etc. OHIP
advertises to recommend flu shots, assistance in stopping smoking,
screening for cervical cancer, diabetes, hypertension, etc, breast
feeding, folic acid for women who want to become pregnant and a variety
of other periodic campaigns.
shareholders or make a profit.<[vbcol=seagreen]
>
>And therefore is fiscally accountable to people who aren't nearly as
>interested in the results as are stockholders. Again, profits are
>INFORMATION ABOUT EFFICIENCY. Your average taxpayer doesn't know nearly
>as much about your government health program as your average
>stockholder does about the company whose shares he owns. All of this
>shows up in accountablity. If you don't give people a reason to think,
>they won't. Prices in a store when you go to buy something, are (again)
>almost PURE information. Remove them, and you get chaos.
Well, it depends on what your goals are. If you are a for-profit
corporation, your chief goal is to make profits for your shareholders.
That's capitalism, and I am not objecting to it.
If your goal to is provide good health care to all members of society,
independent of their ability to pay, it helps a lot not to have to make
short term profits for shareholders, or have to budget a great deal of
money to acquire customers and receive and process their premiums and
keep track of who's paid up and who's entitled to what and all the
overhead involved in running a for-profit corporation. Just as my
local fire department doesn't have to spend resources on competing with
other fire departments, or pleasing shareholders whose interest is in
how much money their investment can provide them independent of how
they conduct their business.
Efficiency is good, but you can only evaluate efficiency relative to
your goals. A health insurance company may be very efficient and
profitable if it can avoid insuring high risk people and disallow many
claims. It can offer low premiums, and attract many customers who will
be very happy until, possibly after many years, they find out just how
much good the company will do them when they run up substantial bills
or develop a condition that puts them in a high risk group. The
company is quite legitimately in business to make money, and it is
doing so efficiently. It's not in business to provide lifelong health
care to the whole population independent of ability to pay, and it
doesn't do so.
>
>COMMENT: In place of dunning letters, it decides services have been
>stolen and sends the cops. But you don't count the police and the
>prisons as part of your "payment enforcement system" even though that's
>exactly what they are. Shifting business finanacial expenses from
>credit/loan/debt collection to cops and jails doesn't make them go
>away. It just makes them look like you're not paying for them. But of
>course you are.
Well, since the services are covered for everybody the only people who
can steal services are non-residents of Ontario. It's true they are
hard to catch. When there got to be too many people sneaking in from
the US to steal services, OHIP went to photo-ID cards from the previous
plain plastic ones, which apparently helped a lot. No giant penological
expenses involved.
Doctors do occasionally get caught committing fraud, but I don't think
you'd regard it as okay to defraud OHIP but not a private insurance
company, would you?
>Besides, these decisions have to be made one way or the other. You
>think actuarial research doesn't have to be done at some point? Market
>decisions merely are merely "political decisions" if you remove the
>money incentive, but the information processing still must be done (and
>it won't be done as well). So what if you don't negotiate with doctors
>or patients about who will be covered for various treatments? Fine, but
>what makes you think somebody doesn't have to negotiate with *somebody
>else* to decide these matters? You want these negotiations to be with
>the people living with the disease and the effects of it, or some
>politician a thousand miles away who knows nothing about it? Which will
>give you the best and most informed decisions?
My point is that both the doctors and the insurance companies in the US
spend a lot of time and money hassling about innumerable individual cases
about coverage. AFAIK, it's common for a doctor in private or small
group practice to have to hire a specialist clerk just to deal with all
the insurance paperwork, and US doctors in this newsgroup often mention
how much they dislike wasting time arguing on the phone with low level
clerical workers at insurance comapnies. A single payer makes a huge
difference in the amount of resources that need to be spent on getting
paid for services rendered, and this applies to every place services are
rendered, including hospitals. Resources not spent on data processing
can be spent on patient care, or not acquired out of anybody's pocket in
in the first place.
I'm not a doctor, although I have worked with doctors. As I understand
it, doctors are given rather flexible guidelines on what is and isn't
covered for whom. E.g. a family physician can consult a guideline on
whether blood lipids should be screened for routinely in a patient. I've
seen such a list, and IIRC the criteria included age, sex, family history,
some specific risk factors and medical conditions, and the last one was
"if the patient is particularly concerned". I think these guidelines may
be on the Ontario Ministry of Health web page, if you want details.
Of course, not all procedures are covered, or not for all cases. Some
years ago they decided to stop covering IVF, first for women over 40,
for whom the success rate was very low at the time, and later entirely.
Women who want this procedure can purchase it at a private clinic.
Similarly, plastic surgery may or may not be covered -- if it's to repair
injury from trauma or disease, it usually is. If you want other
procedures, you pay for them yourself.
>Explain to me please why a national auto manufacturing association,
>with assignments for which citizens should be able to drive which cars,
>shouldn't be more efficient than a bunch but individual manufactures
>wasting money on advertising, and in wasteful individual negotiations
>with each prospective buyer! What a nightmare of waste! And yet
>there's so much difference between the needs of each individual, can
>you imagine how it would have to be handled if you had to do it
>centrally? And yet you propose to do it for an industry even more
>complex. Tell me the flaw in my thinking.
I'd say the flaw in your thinking is the standard rhetorical fallacy of
False Analogy. How's that? This reminds me of the standup comic joke
about the greedy girlfriend: "She wanted me to buy her something really
expensive that she didn't need, so I booked her in for chemotherapy."
>
>COMMENT:
>
>Suing the government is always harder. But this is not always a good
>argument for making the government responsible for any given
>enterprise. Be it making cars OR delivering medical care.
Doctors here don't work for the government, they work for hospitals,
clinics, partnerships, individual practices etc. They just bill one
insurer instead of many. If my doctor cuts off the wrong leg, I sue
him, not the government.
My point is that if I go bankrupt unsuccessfully trying to save my loved
one's life, I'm more likely to feel the need to blame someone and recover
something than if I had only the emotional trauma of dealing with it.
Left after the funeral broke and in debt, I'm more likely to believe
that the doctors just soaked me and let my loved one die. I'll want
revenge and compensation. I'm not saying this is reasonable -- quite
the contrary -- but it seems like many people might react this way.
Fear of malpractice suits and cost of malpractice insurance here don't
seem to be the crushing burdens they are for many doctors in the US.
They don't drive doctors out of certain specialties or absorb a
substantial fraction of their professional income. I'm speculating
above why this may be the case.
I'm not saying that the system here in Ontario, or in any other province,
or in any of the developed countries of the world other than the US is
ideal and problem free. They all have problems. But the evidence is
that people here seldom get into serious financial straits due to medical
costs, they can obtain medical care without worrying whether they can pay
for it, their life expectancy both in general and after acquiring a
serious disease is comparable or better than that in the US, health care
costs much less per capita than in the US, people don't feel that they
are taxed excessively for this service, and they feel the treatment they
receive is adequate and of good quality. Not everybody is satisfied,
everyone sees some problems, but most people feel reasonably well done by.
| |
| outrider 2005-07-24, 1:00 am |
| Are you saying the situation with statins and cardiovascular disease is
analagous to the situation with AIDS drugs and AIDS?
So ... then, you're ok with putting people on AIDS drugs to prevent
AIDS are you?
Zee
Sbharris[atsign]ix.netcom.com wrote:
> Happy Dog wrote:
>
>
>
> COMMENT:
>
> Christ. This reminds me of the AIDS deniers, who vasilated between the
> idea that HIV doesn't exist, or else that it does, but is harmless and
> AIDS, as an infectious disease doesn't "exist" (rather, it's just a
> giant phara conspiracy fronted by shills). This went on for quite
> awhile and provided quite a lot of sparks back during the days when the
> anti-HIV drugs weren't much good.
>
> About 1995 the protease inhibitors arrived and high active
> antiretroviral cocktails began to be possible. The HIV-infected HIV
> skeptics who had low lymphocyte counts were then faced with a grim
> choice: take the drugs and admit they were wrong, or else die. Some of
> them chose to die. The rest of them now take the drugs and have shut
> up. The only people we really have left in the debate are the people
> who never had HIV to begin with, or else are among the small and lucky
> group who actually can live wtih HIV without much viral reproduction or
> immunosuppression, even without the drugs (10 to 15%).
>
> These last group of people cause hell of course, because some of them
> are narcisists. THey figure if the HIV doesn't harm THEM, why then, it
> can't be harming *anybody.* Because their own experience trumps that of
> the WHOLE world. Hey, I don't wear MY seatbelt and *I've* never been
> hurt! And therefore the entire world MUST BE engaged in a VAST
> conspiracy to make everybody with their diagnosis do something none of
> them would really benefit from doing. It's sort of like those 85
> year-old 3-pack-a-day smokers you find now and again, puffing away and
> cackling about the stupid health nuts.
>
> People who happen to win at slots sometimes think the light of God
> shines directly upon them. It's infantile, but some people never quite
> grow up.
>
> SBH
| |
| Happy Dog 2005-07-24, 1:00 am |
| "outrider" <outrider@despammed.com> wrote in message
> Are you saying the situation with statins and cardiovascular disease is
> analagous to the situation with AIDS drugs and AIDS?
>
> So ... then, you're ok with putting people on AIDS drugs to prevent
> AIDS are you?
Only an idiot would interpret it that way. The comments are in direct
response to the following claim made by said idiot:
"Statins make multiple millions upon millions for shareholders every
year. Drugs shilled for a disease that doesn't exist. To do no-one
knows what."
Fair use.
moo
>
> Zee
>
>
> Sbharris[atsign]ix.netcom.com wrote:
>
| |
| Brucebo 2005-07-25, 6:59 pm |
|
bae@cs.toronto.no-uce.edu wrote:
> In article <1121998024.637073.139850@z14g2000cwz.googlegroups.com>,
> Sbharris[atsign]ix.netcom.com <sbharris@ix.netcom.com> wrote:
>
> I know what you mean. This happens to me too. The only thing I can
> suggest is to keep thinking until you decide which of the third class
> belongs in the first or second. Or else, just ignore stuff on usenet
> that makes your head hurt.
Ditto!
Let's give a slightly different scenario/example: worldnetdaily.com.
At first reading this site seems like a fairly interesing, alternative
media conservative site, and it does often offer usefull news not seen
in the MSM, but on further reading you see they are pro-creation,
anti-evolution, jesus, jesus, jesus, etc.
The absolute BOTTOM of the socially acceptable ladder in this country
is the "freethinking" RIGHT. By this I mean the rightwing atheists.
If you're one of these you're a "hater" or a "fascist" or a ... You're
not even given the benefit of "having good intentions" that the
leftwing atheists are given.
| |
| Sbharris[atsign]ix.netcom.com 2005-07-26, 11:09 pm |
|
bae@cs.toronto.no-uce.edu wrote:
>Sorry, but there's a big flaw in this argument. Advertising is data
>processing, and it's not useless, despite what commies think. Not only
>that, but competition is the mechanism by which waste and fat are
>flensed from any enterprise. Remove competition, and you get
>parasitical crud which cannot be removed by any other mechanism, and
>pretty soon that stuff outweighs everything else.
>Profits are merely pieces of information about what things are working
>efficiently. The free market beats command economies for one reason
>only: money and profit are the best markers for efficiency in
>large-scale enterprises which have ever been invented. Other methods
>may work for small groups like families or small communities where
>everybody knows everybody else. But for larger groups where strangers
>have to work together, it is prices and trade-efficiency which tell you
>about waste and screwing-up.
>I'm not a "commie" and I don't think advertising or profits or
>competition or most of the other components of a capitalist economic
>system are intrinsically bad. However, I don't think that every area
>of human endeavor works best under laissez faire capitalism.
>Right now, my property taxes pay for the municipal fire department.
>They do a good job, and I am quite willing that my taxes support them.
>Suppose instead there were a dozen competing fire departments that I
>could choose from to put out fires on my property. Each one would have
>to spend on advertising and sales, collecting fees from its customers,
>dispatchers and enough staff and equipment to handle fires in every
>area of the city even though its competitors have eleven times the
>equipment and staff there already. If I see flames shooting from my
>neighbour's roof, who do I call? If a house covered by company A is
>adjacent to houses covered by company B, C...L, who gets called? Who
>prevents the flames from reaching the nearby houses? Who gets to use
>the fire hydrant for its hoses? Maybe each company will have to have
>its own system of water mains and hydrants.
COMMENT:
Or maybe they'll all cooperate to get end-user stuff to you, as would
water and sewage departments. It can be done, you know. People used to
laugh at the idea of competing power companies, but Lubbock, Texas
actually has two--- complete with two sets of (in many places
duplicate) powerlines. If you want to change from one company to the
other, there's a check to see that your bills are paid up, and then
somebody comes over to run a tap from your place to the other
distribution system.
These don't NEED to be duplicated, if everybody goes in on the end-use
distribution, as happened no long ago with telephone companies. We
removed the "natural monopoly" created by the fact that one company had
built all the phone line infrastructure, and simply let anybody use it.
That wasn't very fair, but there are ways of encouraging companies to
do the end stuff by promising them license right for a certain period
of time (but not forever) if they install it. That's happening with
cable, and will likely be the mechanism for getting fiberoptic into
every home. You don't think ONE company OR the government will own that
system, do you? And yet, probably every home will have only incoming
fiber line. More would we ridiculous, considering the capacity. So
fiber-optics is like plumbing, but monopoly or government control are
not necessary.
The analogy of the fire department is not a good one, because when one
house goes it takes neighboring ones with it, so it's essentially a
community problem by the very physical basis of it, somewhat like air
pollution. Since one house-owner's risk is everybody's, and can't be
parceled out or divided (with one guy wanting to pay for more
protection from fire and another guy next wanting less), it seems that
a general democratic consensus for a single level of protection for any
unit of physically contiguous structures must be reached. Many aspects
of police protection are the same, since burglars and vandals are
somewhat like fires (if you don't want to pay your police much to watch
YOUR property, it affects MY property next door in somewhat the same
way as if you scrimp on your fire production). But there are few things
in life that actually run that way, and medical care isn't one of them.
If somebody's getting mugged, it's hard to tell in the time you have
what private police protection service you call for him. But it's much
easier to tell about his medical coverage. Nor do his bad medical
decisions affect other people in the same way they would if he scrimped
on fire or garbage removal.
That being said, if the community as a whole decides it absolutely
cannot stand for uninsured lying in the gutter until they die, then
some kind of community decision has to be made on minimal care for the
uninsured. My problem is that invariably gets used as a back door
invasion of privacy, since the community invariably decides that if it
pays the bills, it should have some say in the risks the person takes
to generate them. Which goes back to every aspect of life style (think
of seatbelt laws and you get the idea).
>What's more, since everybody will want a fire department to protect
them, but major fires are actually quite rare, the best way for a fire
department to be profitable is to charge low fees, and provide poor
service. This is how property and auto insurance already works -- an
insurance company that charges low premiums can do so because it
rejects many claims. I learned this by working with insurance brokers
for a good many years. Several well-known and very successful
insurance companies are noted for this. It's not dishonest or unethical
-- it's just an example of getting what you pay for.<
COMMENT:
Indeed, but I covered that. It's FINE for people to want to pay less
and accept that they then get less. And except in the case of some
really bleed-over things like fire, it can be done in just that way.
>Note that OHIP is not a business so it doesn't have to recompense
shareholders or make a profit.<
>And therefore is fiscally accountable to people who aren't nearly as
>interested in the results as are stockholders. Again, profits are
>INFORMATION ABOUT EFFICIENCY. Your average taxpayer doesn't know nearly
>as much about your government health program as your average
>stockholder does about the company whose shares he owns. All of this
>shows up in accountablity. If you don't give people a reason to think,
>they won't. Prices in a store when you go to buy something, are (again)
>almost PURE information. Remove them, and you get chaos.
>Well, it depends on what your goals are. If you are a for-profit
corporation, your chief goal is to make profits for your shareholders.
That's capitalism, and I am not objecting to it. <
COMMENT:
Yes, that's your goal. But along the way, it also allows you to be
maximally efficient at delivering a given service for a price. You city
as a whole probably WOULD benefit if it could contact (as a unit) with
competing fire departments, because it would find out in that case that
a lot of fire service money gets wasted now.
>If your goal to is provide good health care to all members of society,
independent of their ability to pay, it helps a lot not to have to make
short term profits for shareholders, or have to budget a great deal of
money to acquire customers and receive and process their premiums and
keep track of who's paid up and who's entitled to what and all the
overhead involved in running a for-profit corporation. Just as my
local fire department doesn't have to spend resources on competing with
other fire departments, or pleasing shareholders whose interest is in
how much money their investment can provide them independent of how
they conduct their business.<
No, wrong, wrong, wrong. As well say If your goal to is provide good
nutrition to all members of society, independent of their ability to
pay, it helps a lot not to have to make short term profits for grocers
or food distributors, or have to budget a great deal of money to
acquire customers of farmers and receive and process their bids for
next years crops and meat and keep track of who's paid what and who's
entitled to what, and all the
overhead involved in running a for-profit corporation, which any modern
farm certainly is, and which most food distributors and outlet are
also. Let's just socialize all that. Look at all the duplication and
the guessing with the porkbelly futures and so on. For godsake, just
grow the food for people who need it, okay?
>Just as my local fire department doesn't have to spend resources on competing with other fire departments, or pleasing shareholders whose interest is in
how much money their investment can provide them independent of how
they conduct their business.<
COMMENT:
Just as my local grocery store (farm, restaurant, whatever) doesn't
have to spend resources on competing with other stores (farms,
restaurant, whatever) or pleasing shareholders whose interest is in how
much money their investment can provide them independent of how they
conduct their business.
Right. Let's just eliminate the profit angle, and feed everybody for
less, by cutting out all that investment and competition between grain
in the field, and the hamburger on the table.
>Efficiency is good, but you can only evaluate efficiency relative to
your goals. A health insurance company may be very efficient and
profitable if it can avoid insuring high risk people and disallow many
claims. It can offer low premiums, and attract many customers who will
be very happy until, possibly after many years, they find out just how
much good the company will do them when they run up substantial bills
or develop a condition that puts them in a high risk group. The
company is quite legitimately in business to make money, and it is
doing so efficiently. It's not in business to provide lifelong health
care to the whole population independent of ability to pay, and it
doesn't do so.<
COMMENT:
No, but again, you're not making a very good argument as to why Canada
shouldn't have an entire separate socialized government farming and
food processing facility for the purpose of feeding those who don't
have enough money for food. And thence also to housing and whatever.
What's special about medical care? Medical insurance is NOT like fire
insurance or police insurance. It's rather more like auto insurance
(do you have AAA up there?). If some people are too poor to afford
auto insurance and you decide they need it anyway, the solution isn't
to have the government go into, or take over, the auto insurance
industry, anymore than you can justify the government taking over the
entire food industry because some people can't pay enough to eat well.
>Explain to me please why a national auto manufacturing association,
>with assignments for which citizens should be able to drive which cars,
>shouldn't be more efficient than a bunch but individual manufactures
>wasting money on advertising, and in wasteful individual negotiations
>with each prospective buyer! What a nightmare of waste! And yet
>there's so much difference between the needs of each individual, can
>you imagine how it would have to be handled if you had to do it
>centrally? And yet you propose to do it for an industry even more
>complex. Tell me the flaw in my thinking.
>I'd say the flaw in your thinking is the standard rhetorical fallacy of
False Analogy. How's that?<
COMMENT:
It's glib and not good enough, is what. You have to explain what makes
it a false analogy, and what it is about medical care which makes it so
inherently different from producing food or cars or any other good or
service which is inherently personal (not like fire or police
protection), that the ordinary laws of market efficiency do not apply
to it. It ISN'T that some people can't afford it, because (as noted)
some people can't afford food or housing or clothes and almost any good
or service you can think of that is for sale on the free market.
Government solves THAT problem by simply providing people with some
credit, as for food stamps (actually we have a plastic Electronic
Benefits Transfer = EBT card, which now does the same thing), and not
worrying that use of the EBT card at a grocery store thereby helps pay
for grocery store advertising, or farm-vs-farm livestock competition,
etc.
>Suing the government is always harder. But this is not always a good
>argument for making the government responsible for any given
>enterprise. Be it making cars OR delivering medical care.
>Doctors here don't work for the government, they work for hospitals,
clinics, partnerships, individual practices etc. They just bill one
insurer instead of many. If my doctor cuts off the wrong leg, I sue
him, not the government. <
COMMENT:
Yes, but cutting off the wrong leg is not what doctors get sued for in
the US. It's not what we do that's found wrong, it's generally what we
FAIL to do. The most common lawsuit is failure to find cancer soon
enough. Followed by suits related to damaged babies (presumably related
to failure to do C-sections soon enough, I suppose). Canada gets
around that by setting the standard for what doctors are supposed to be
doing. You can sue the doctor for not doing it, but he has the perfect
defense: he didn't do it because the government wouldn't pay him to,
and that's the end of it. What the doc "should" be doing is what the
government covers. Very simple.
In the US it is made all very complicated by multiple sets of standards
for what the insurers will and won't pay for. I admit that this could
be greatly simplified, but it's not clear to me that total government
takeover is needed. For heavensake if government has solved this
problem for government food stamps, it can do a lot of it for medicine.
If you try to use EBT card to buy a fastfood like a hamburger, or
cigarettes or beer, or non-food items, the computerized system goods
"GLEEP" and won't let you do it. In a similar way, the way government
takes care of medical care for poor people in one of my states is it
simply enrolls them in one of a couple of competing HMOs, and gives
them an HMO card. What they get for that, is then clear from the HMO
rules. And it's harder for them to sue about what they don't get, in
very much the same way it is in Canada. BUT people who can pay more
don't have to use the system, and doctors don't have to, either, unless
they want to work for one of those particular HMOs.
>I'm not saying that the system here in Ontario, or in any other province,
or in any of the developed countries of the world other than the US is
ideal and problem free. They all have problems. But the evidence is
that people here seldom get into serious financial straits due to
medical
costs, they can obtain medical care without worrying whether they can
pay
for it, their life expectancy both in general and after acquiring a
serious disease is comparable or better than that in the US, health
care
costs much less per capita than in the US, people don't feel that they
are taxed excessively for this service, and they feel the treatment
they
receive is adequate and of good quality<
COMMENT:
Yes, and I've speculated on some of the reasons for that. Without
question we waste a lot of health care dollars in the US by having no
co-pay (so the customer doesn't assist in the monitoring), but at the
same time not having the government ration expensive and fairly
worthless technology, either. So we get the worst of both worlds, being
taxed for somebody ELSE'S luxury medical scan or angiogram. The other
problem is that Canada really does ride the US coattails in terms of
research and medical technology development, and that's like having to
be the front windbreak biker in a racetrack bike race ALL the time. It
gets to be very old, after a while. And it always makes #2 look better
than he really is.
There's also a completely different attitude toward medical care in the
US-- one which I can only characterize as "technology and money and
complaining can get you anything." In Canada it's more of a Roman
Catholic or Episcopal attitude, which is you do what you can, and ask
politely, and after that, you accept what you get. The opposite
attitude is associated with, well, let's just say non-Catholics.
SBH
| |
| bae@cs.toronto.no-uce.edu 2005-07-26, 11:09 pm |
| In article <1122419807.519986.325780@g49g2000cwa.googlegroups.com>,
Sbharris[atsign]ix.netcom.com <sbharris@ix.netcom.com> wrote:
>
>bae@cs.toronto.no-uce.edu wrote:
Steve, your posting software is not distinguishing who wrote what properly.
What I wrote and you wrote are indistinguishable. If you indicate who
wrote what by means that don't show up in plain ascii text, you're
going to continue to confuse people. Please, do me, at least, the favor
of using standard quoting to make things clear. I'm sure your favorite
posting software will do this for you readily.
At any rate, sci.med isn't a good venue for discussing issues of political
economy, that isn't my favorite area of discussion, and I don't feel a
strong need to either persuade or be persuaded by you. Perhaps other
people in talk.politics.medicine, which I don't read, would like to continue.
As for comparing supplying medical care to supplying food, it's not the
best analogy either. Also note that US farmers are so heavily subsidized
by the US federal government that many make most of their income from
subsidies.
I don't think you are familiar with how universal medical care is managed
in the many jurisdictions of the world that provide it. You make a lot
of incorrect assumptions, often combining the worst problems of several
different systems, and attack these straw men. I also think it's wrong
to assume that every country should do things the same way, or that there's
only one right way to do anything. It's very common among Americans to
believe that their way is the only correct one, and it creates a lot of
bad feeling towards the US in other parts of the world.
This is pretty much my bottom line:
>or in any of the developed countries of the world other than the US is
>ideal and problem free. They all have problems. But the evidence is
>that people here seldom get into serious financial straits due to medical
>costs, they can obtain medical care without worrying whether they can pay
>for it, their life expectancy both in general and after acquiring a
>serious disease is comparable or better than that in the US, health care
>costs much less per capita than in the US, people don't feel that they
>are taxed excessively for this service, and they feel the treatment
>they receive is adequate and of good quality<
>
>COMMENT:
>Yes, and I've speculated on some of the reasons for that. Without
>question we waste a lot of health care dollars in the US by having no
>co-pay (so the customer doesn't assist in the monitoring), but at the
>same time not having the government ration expensive and fairly
>worthless technology, either. So we get the worst of both worlds, being
>taxed for somebody ELSE'S luxury medical scan or angiogram.
Well, we like our system, so why do you think it's so horrible and wrong
and we are stupid not to go to a system like the US?
>The other
>problem is that Canada really does ride the US coattails in terms of
>research and medical technology development, and that's like having to
>be the front windbreak biker in a racetrack bike race ALL the time. It
>gets to be very old, after a while. And it always makes #2 look better
>than he really is.
I don't think this issue is relevant to how medical care for individuals
is funded, but I'll address it anyway. I won't address where funding
for medical and scientific research should come from. Presently a great
deal of it comes from governments, and there can be serious conflict
of interest problems when it comes from for-profit corporations.
Both countries benefit from research done in Europe, Japan and elsewhere.
Canada has only a tenth the population of the US, so if funding were equal
on a per capita basis, it would result in technology transfer from the US
to Canada anyway.
There's also the question of how research grant money is used. As I
understand it, in the US, a substantial fraction of a scientist's grant
goes to overhead and is claimed by his institution before he ever sees
it. Granting agencies take this into account when determining the
amount of the grant -- if they want the researcher to have $x to work
with, they'll give him $2x or whatever is needed to cover the
overhead. In Canada, researchers don't pay overhead from their grants
to the institutions at which they work. The institutions (universities,
research institutes, etc) are funded separately. So comparing money
spent on research in the two countries is not at all straightforward.
Also, money spent on a problem isn't a good measure of the quality or
quantity of solutions you get. There are quite a few good scientists
in Canada, and they are doing good work in both pure and applied
research, both locally and in collaboration with scientists in the US
and elsewhere. When I read the technical literature in the several
fields I'm interested in, I see numerous papers with authors and
co-authors who are not at US institutions. I observe that a lot of
high tech medical equipment comes from European and Japanese
companies, and European pharmaceutical companies develop a lot of drugs.
The US isn't the one and only "front windbreak rider" in every field.
>There's also a completely different attitude toward medical care in
>the US-- one which I can only characterize as "technology and money
>and complaining can get you anything." In Canada it's more of a Roman
>Catholic or Episcopal attitude, which is you do what you can, and ask
>politely, and after that, you accept what you get. The opposite
>attitude is associated with, well, let's just say non-Catholics.
Steve, you've never lived in Canada, you don't know much about the
country, its history, its economy, its religions, its political and
social systems, or how its great diversity of people view the problems
of life. Don't you think you may be jumping to conclusions? If you're
generalizing from the few identifiably Canadian posters to this
newsgroup, you should realize that they're not likely to be a
representative sample.
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