Enjoy Health Care As a Regulated Utility

President Barack Obama is pushing for health care reform by October. One of his main proposals is the creation of a "public option insurance plan" to keep private insurers "honest." By "honest" Obama means that private insurers would have to compete with the public health plan by keeping their prices as low as the government's plan. So how would the feds keep their prices lo

w? By imposing price controls, explains the New York Times:

To help control costs, the administration indicated support on Tuesday for a proposal to strengthen a federal panel that recommends how much Medicare should pay doctors, hospitals, nursing homes and other health care providers.

Senator John D. Rockefeller IV, Democrat of West Virginia, recently introduced a bill that would expand the role of the panel, the Medicare Payment Advisory Commission, and give its recommendations the force of law. Senators said Mr. Obama and his aides had expressed general support for such a change, which would establish the panel as an independent rate-setting body in the executive branch.

This would basically turn medical care into a regulated utility. In other words, private insurers would have to compete with a government agency that could tell doctors, hospitals, and drug companies how much they are going to get paid, period.

How have price controls worked out in other areas of the economy? Not too well, at least with regard to electrical utilities. As one research report found:

…monopoly regulation appears to have stifled productivity and long-term innovation in the U.S. electric utility sector.

You can be sure that price control regulation will do exactly the same thing to health care innovation and productivity. And for those of you who live in the blessed era of (some) telecommunications deregulation, take a little walk down memory lane to see what it was like to live under the tyranny of the original AT&T with this (not too inaccurate) Lily Tomlin spoof. 

Comments

[Steven]

Americans need to accept hopeless diagnosis like the Europeans do.

[Ron Bailey]

Steven: Great insight. This is exactly what bioethicist Daniel Callahan recommended in his book, False Hopes. I quote from my review. Read it and weep.

Not surprisingly, Callahan finds much to admire in European systems of socialized medicine. "Those countries began... with low expectations and a relatively ineffective medicine," he explains. "For Europeans, almost any level of health care was initially acceptable, whereas for Americans practically nothing that can be mentioned is ever quite adequate." He notes that "in Europe most allocation and rationing decisions have historically been made by politicians and experts working together in private, without much public knowledge, much less participation. This makes life considerably simpler for everybody." He approvingly observes that European medicine "has remained for the most part heavily paternalistic and authoritarian."

But even the Europeans, Callahan sadly notes, have been contaminated by "the quest for perfect health." His nostalgia is palpable. "If we had exactly and only the same range of technologies as were available twenty or thirty years ago, there would be no problem in equitably allocating resources," he writes. "We could readily afford that level of medicine and health care." (It would be even cheaper, of course, if we returned to using rattles and beads as remedies.)

[swillfredo pareto]

One of his main proposals is the creation of a "public option insurance plan" to keep private insurers "honest."

Given that RBRVS has helped Medicare screw up private insurance more than everything else combined, this proposal has winner written all over it.

[Warty]

"If we had exactly and only the same range of technologies as were available twenty or thirty years ago, there would be no problem in equitably allocating resources," he writes. "We could readily afford that level of medicine and health care."

Sounds good. You first.

[Episiarch]

This makes life considerably simpler for everybody.

And shorter. People like this are monsters. So very inhuman.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[SugarFree]

As my arm was being twisted and bent in physical therapy this morning, a thought occurred:

If you think that pain is under-medicated in this country now, wait until the DEA is watching pharmacists count out every Vicodin. All scripts run through the government if it's the single payer. Under full-on socialized medicine, the pills will be doled out directly by the government.

And if you don't think pain is under-medicated in this country, I've got a pipe that would like to have a word with your coccyx.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[creech]

No, private insurers would not have to keep their prices as low. They could charge more for better service, more flexibility, etc.
(Just as many carriers charge more than the U.S.Post Office.) So the next step would be for the government to prohibit anyone from paying providers more than the government pays.
Economic fascism.

[John]

Callahan is a serious monster. He definitely confirms the need for a hell.

[Episiarch]

wait until the DEA is watching pharmacists count out every Vicodin

Dude, they're trying to do that already. Why do you think it's so hard to get a simple hydrocodone script? The doctors are terrified of the DEA, even if it's unlikely that they'd be targeted. So they err on the side of caution, which means more pain for their patients. The DEA is a sadistic organization in more ways than one.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[DBN]

Can we stop talking about the Europeans as if they have a single system of healthcare?

[Monster]

Leave me out of this! He isn't like me

PS you are all childish, anti intellectual, and deserve ad hom attacks

[R C Dean]

This round of health care reform will

(a) squeeze down payments to health care providers.

(b) increase costs for providers through mandates and compliance burdens.

(c) transition more people from private insurance to welfare/government insurance (which pays less than the cost of providing care).

(d) force some hospitals into receivership - look for the creation of a "resolution trust" for hospitals, with direct federal ownership and operation as the outcome.

(e) dry up the pool of physicians.

[JW]

I so hope that I'm dead by the time this country finally and irrevocably spirals down the Euro-style drain in the shitter.

If I'm not, I'd say it won't be too long of a wait under the new regime.

[kinnath]

Either the economy rations services (i.e., poor people buy fewer services or lower cost services than rich people) or the government rations services (directly or indirectly through reimbursement schedules to providers).

That's it, there are only two choices.

[Spoonman]

That Callahan guy....Jesus Christ.

[JW]

(f) reduce the amount of R&D money available for new treatments and drugs.

(g) create a new and wholly uncaring health civil servant. "Empty your own goddamn colostomy bag!"

(h) introduce a whole host of procedures that won't be "permitted," such as "elective" and semi-cosmetic procedures and creating a black market for such.

[JW]

Should we start calling this the War on Sick People?

It sounds like it's going to be just as caring and effective as the War on Drugs has been.

[DBN]

(e) dry up the pool of physicians.

Unlikely. The rest is probably accurate. JW is pretty much all wrong, though.

[P Brooks]

Senator John D. Rockefeller IV, Democrat of West Virginia, recently introduced a bill that would expand the role of the panel, the Medicare Payment Advisory Commission, and give its recommendations the force of law. Senators said Mr. Obama and his aides had expressed general support for such a change, which would establish the panel as an independent rate-setting body in the executive branch.

This appears to me to be an impeachable offense. The Senator is attempting to transfer the Constitutionally mandated power of the Legislature to the Executive.

I'll be here (holding my breath), awaiting the news of Rockefeller's removal from office.

[Fluffy]

Kinnath is correct that those are the only two choices.

But, since majority political opinion in our country is simultaneously committed to the two propositions:

1. "Access to health care should not be limited based on ability to pay"

and

2. "Rationing health care is not an option,"

- the state has no choice but to engage in misdirection. The health care system will be made as complicated as possible, with multiple advisory boards and layers of bureaucratic review, all designed to allow state-directed rationing to take place while allowing mass confusion and obfuscation to assist and support the official denial that any rationing is taking place.

[Xeones]

Ok, serious question: is Barack Obama retarded, or is he just fucking with us? Nobody in the world really thinks this a good idea... right?

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[Tacos mmm...]

That Callahan guy....Jesus Christ.

He's right, though. Health care cost increases for the last century have been primarily due to the increasing technical sophistication of medical care. At some point, we'll reach a ceiling as to either what to government will pay (rationing! horrors!) or what the market will support (rationing! horrors!).

We're already pretty much nearing the latter right now.

[SugarFree]

is Barack Obama retarded, or is he just fucking with us?

Both.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[kinnath]

Nobody in the world really thinks this a good idea... right?

There are many otherwise bright people that really believe the government can make things happen by simply establishing a new rule.

I often remark to these people that the government could save a boatload of money by simply making it illegal for "it" to snow on the roads. They never make the connection back to whatever they were talking about when I interjected . . . .

[Ron Bailey]

Taoos mmmm: You may be right that we're near what the market would support by way of expensive new techs, but how can one know for sure since there is so little competition between providers and technologies in the system already?

[JW]

DBN--Care to put your predictive powers where your mouth is?

I would wager that no matter how ridiculous sounding a speculative guess is now, it will sound prophetic within a few years.

You clearly have faith, I mean that literally, in our masters serving us over political considerations and political expediency.

[Hambone]

"...monopoly regulation appears to have stifled productivity and long-term innovation in the U.S. electric utility sector."

[citation needed]

[JW]

(i) introduce legal or civil consequences for individuals engaging in "unhealthy" practices, as these behaviors unfairly burden taxpayers. "Unhealthy" being defined as whatever the incumbent political class decides what that is, in addition to whatever the previous administration determined.

[Hambone]

" The doctors are terrified of the DEA"

America! What a country!

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[Invisible Finger]

is Barack Obama retarded, or is he just fucking with us?

Both.

[Episiarch]

JW, is the gem in your hand blinking red, or is it black?

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[Invisible Finger]

(e) dry up the pool of physicians.

Depends on how you define "physician".

[P Brooks]

Congress should pass a law making it illegal to get sick.

Monstrous or not, at some point you have to recognize the difference between "health care" and "prolonging suffering". If doctors, hospitals and pharma companies want to establish a system by which they can provide and finance experimental treatment, I am one hundred per cent in favor of allowing them to do so. But diverting large sums of money which could be used to provide basic care to lots of people to the maintenance of one patient is wrong.

[SugarFree]

Invisible Finger,

Dude, that stings.

SugarFree | June 3, 2009, 12:07pm | #
is Barack Obama retarded, or is he just fucking with us?

Both.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[JW]

JW, is the gem in your hand blinking red, or is it black?

I always figured you for a sandman.

Now, if you'll excuse me, I have to go run around with a mostly naked Jenny Agutter.

[Warty]

is Barack Obama retarded, or is he just fucking with us?

Both.

[SugarFree]

OH, COME ON!

[Xeones]

I think you're right, Warty.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[Episiarch]

(guns JW down)

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[JW]

is Barack Obama retarded, or is he just fucking with us?

Yes.

[Marc]

Won't someone please think of the sick children?

[R C Dean]

(e) dry up the pool of physicians.

Unlikely.

Current physicians are increasingly unhappy with their lot. Their complaints are directed 100% at (a) bureacratized, assembly line medicine, and (b) decreasing margins/compensation. Both of these will increase in coming years, leading to more current physicians leaving the field. Most would not recommend doctoring as a career choice to young 'uns.

The same factors are making the practice of medicine a less and less popular choice for potential new doctors.

There are already shortages of primary care doctors in a lot of places.

So, yeah, absent a drastic dumbing down of what it takes to be a doctor, we will see increasing shortages.

[Xeones]

Won't someone please think of the sick children?

Barack Obama won't.

[John]

"He's right, though. Health care cost increases for the last century have been primarily due to the increasing technical sophistication of medical care. At some point, we'll reach a ceiling as to either what to government will pay (rationing! horrors!) or what the market will support (rationing! horrors!)."

Even by the worst estimates health care costs will peak at about 26% of GNP. If we were Venezuala or Zimbabwe that would be a problem. But we are not. When you are really rich you can afford to pay a lot for healthcare. Further, we are on the brink of some serious improvements in life expectancy. Given the potential of modern medicine, I don't think a 1/4 of our income is a bad deal. of course Obama is doing everything he can to turn this country into Zimbabwe. So maybe you are right, we don't have the money.

[B. Obama]

is Barack Obama retarded, or is he just fucking with us?

as Americans, we reject the false choice between my retardation and my fucking with you. We can and we must and we will accept both.

[Seward]

R.C. Dean,

There are already shortages of primary care doctors in a lot of places.

That largely has to do with how the government (directly and indirectly) reimburses doctors.

[Sumguy]

If any of you folks suspect you may need health care in the future, you'd better start sucking up to you local pols. If you want to know how BarryCare will work, just call some of your friends in Barry's home area of Chicago/central Illinois. They'll tell you what (or who) you need to do in order to get anything done in any portion of the economy the pols control. Of course, if you live in certain other areas of the country, like New York, Boston, Philly, etc., you already know how.

[Program Officer for Department]

"Fish, and plankton. And sea greens, and protein from the sea. It's all here, ready. Fresh as harvest day. Fish and sea greens, plankton and protein from the sea. And then it stopped coming. And they came instead. So I store them here. I'm ready. And you're ready. It's my job. To freeze you. Protein, plankton... "

[R C Dean]

That largely has to do with how the government (directly and indirectly) reimburses doctors.

Precisely my point. As the government pays for more and more care (as it will), and grinds down what it pays (as it will), then the shortages will increase.

Our future: Rationing by wait list. Well, for the little people, anyway.

[Seward]

"Program Officer...",

"My birds! My birds!"

[Pro Libertate]

I just bought some behind-the-counter Sudafed at Wal-Mart, after presenting my ID and signing an affidavit swearing to something or other. When I got home, the medication got lost somehow, probably inadvertently tossed out by my meddling kids.

So, do I risk going into some database by buying some more, or do I just suffer through this bout of allergies without adequate medication?

Somehow, this is the type of scenario I envision in our highly regulated future.

[JW]

ProL--Go back in, but this time act all twitchy, hyped up and paranoid.

[JB]

"...compete with a government agency that could tell doctors, hospitals, and drug companies how much they are going to get paid, period."

About time they started getting serious. The top amount a healthcare worker should be paid is $30,000 a year. Doctors, nurses, and administrators can sacrifice for the greater good. Let's see how well that works out.

[MayorOmalleySuxs]

(i) Create a host of new unionized health workers that by paying due to the union will in effect be paying kickback money to the Democratic Party. If one could see through all the bullshit, this might be the primary reason the Democrats are so hot to see a national health system for it certainly is not "for the children," "po' people" or anyone not politically well conected.

(j) Increase research spending on diseases that disproportionally affect politically favored groups (women and breast cancer, gays and AIDS) at the expense of research on diseases that disproportionally affect non-favored groups (men and prostrate cancer, those of northern European descent and cystic fibrosis).

(k) Dry up or at least slow the fund raising ability of disease specific research organizations. The "rich" and the "middle-class" won't have as much money left after taxes to be generous with and an attitude of, "Why should I give? Health care is the government's problem" will develop and prevail.

[MayorOmalleySuxs]

I just bought some behind-the-counter Sudafed...
...through this bout of allergies without adequate medication?

Pro L - Recommend you try the generic version of Claritin. Keeps my hayfever in check and don't have to sign anything to get it.

[John]

is Barack Obama retarded, or is he just fucking with us?

He said today that the US is one of the world's largest Muslim countries (we are 38th by absolute population size). He is most definitely retarded.

[MayorOmalleySuxs]

Depends on how you define "physician".

Isn't this the way the old Soviet Union used to do it? I remember reading (sory can find a citation) that the Soviets used the term "doctor" a bit more generously and many that the Soviets called Doctor would have only been qualified to be nurses in the US.

[alan]

Omen: The Retool

Damien runs into the kitchen, pulls at the bottom of his mother's skirt for attention.

Damien: Mommy, mommy, mommy!

Mum: Yes, Dear.

Damien: You know what I want to be when i grow up?

Mum: A doctor?

Damien: Nooooo.

Mum: A fireman.

Damien: No. I want to be a bioethicist.

Damien's mother screams, pulls out a butcher knife and stabs herself to prevent any more of her foul DNA from being born.

Damien: I'm afraid we lack the resources to do anything about that.

[Pro Libertate]

John,

He's including the secret Islamic terrorist cell network. That bumps us up to the top ten.

[Ron Bailey]

Hambone:

[citation needed]

Why not click on the link I provided in the post? Just a thought.

[John]

I forgot about that Pro.

Alan,

That is classic. That is a scene out of Peter Singer's childhood isn't it?

[Dr. Kenneth Noisewater]

If the public insurance option is going to be such a shitty deal for those that choose it, won't people steer clear of it and stick with their private insurance?

[MayorOmalleySuxs]

The top amount a healthcare worker should be paid is $30,000 a year. Doctors, nurses, and [low & middle] administrators can sacrifice for the greater good.

And they'll have no trouble hiring Senior adminsitrators at $300k pa, like Michelle Obama, to keep the Doctors, nurses, and [low & middle] administrators in line.

[JW]

And they'll have no trouble hiring Senior adminsitrators at $300k pa, like Michelle Obama...

Those $540 sneakers aren't going to pay for themselves you know!

Actually, now that I think about it more, they are. Silly me.

[Isaac Bartram]

Depends on how you define "physician".

Isn't this the way the old Soviet Union used to do it? I remember reading (sory can find a citation) that the Soviets used the term "doctor" a bit more generously and many that the Soviets called Doctor would have only been qualified to be nurses in the US.

In the old Soviet Union doctors were predominantly women and were quite low paid. And their skill level was somewhere a little higher that of a nurse practitioner.

Surgeons, on the other hand, were mostly men and were quite well paid - many multiples of what doctors got.

I spite of this (or possibly because they were ignorant of the actual facts) commsymps in the west would frequently point to the number of women "doctors" in Russia as evidence of greater gender equality.

As far as I know this is still the way it is in Russia and the former Sooviet republics.

[Pro Libertate]

John,

Also, my sources tell me that the Mexican government will soon reveal to the world that Mexico has adopted Sharia and has converted en masse to Islam. That goes for all those illegals in the U.S. as well. Obama is aware of that, because it is part of the North American Union conspiracy, as envisioned by Colonel Sanders.

[DBN]

Current physicians are increasingly unhappy with their lot. Their complaints are directed 100% at (a) bureacratized, assembly line medicine, and (b) decreasing margins/compensation. Both of these will increase in coming years, leading to more current physicians leaving the field. Most would not recommend doctoring as a career choice to young 'uns.

I know, RC. I am a current physician. But students entering medical school are bright eyed, bushy-tailed 22 year olds dreaming of having a career both altruistic and presitgious. For them, the difficulties of medical practice are either unknown or unrelatably abstract. By the time they realize how nightmarishly difficult the system can be, they're so far in debt that they have to work, and so old by the time they've finished paying off their debt that it's too late to train for anything else.

That's a pessimistic take on the situation for certain, but there's an element of truth to it. Medical school applications are as high as they've ever been - almsot 560,000 for 18,000 slots in 2008, the highest they've ever been, and up by more than 150,000 in the past four years. Whatever difficulties are currently present in the medical system, they're not leaking down to the level of the medical school yet.

And in any case, if by some reverse miracle, the supply of domestic physicians should run dry, will just continue to import them. There are always countries where physicians will be paid less than in the United States.

So, yeah, absent a drastic dumbing down of what it takes to be a doctor, we will see increasing shortages.

Looking at the numbers, I simply see no evidence that this will be the case for a long time.

http://www.aamc.org/data/facts/

Precisely my point. As the government pays for more and more care (as it will), and grinds down what it pays (as it will), then the shortages will increase.

The government doesn't just under-reimburse primary care - so does private insurance. And even if you were to pay out of pocket, the cost for a primary care visit would be substantially less than for a specialist. There are innate stratifications in physician pay, just as in law.

[TrickyVic]

"""I just bought some behind-the-counter Sudafed at Wal-Mart, after presenting my ID and signing an affidavit swearing to something or other. When I got home, the medication got lost somehow, probably inadvertently tossed out by my meddling kids.

So, do I risk going into some database by buying some more, or do I just suffer through this bout of allergies without adequate medication?""

I was ranting about that process not long ago on H&R. What a crock of shit. It's part of the Methanphedmine Act of 2005. That's when the GOP owned two of the three branches of government.

"""He's including the secret Islamic terrorist cell network. That bumps us up to the top ten."""

Maybe the no-fly list? I hear that will count for another million.

[kinnath]

So, do I risk going into some database by buying some more, or do I just suffer through this bout of allergies without adequate medication?

If you live in Iowa, the police will come and arrest you, no joke.

Sudafed PE is available over the counter and is not covered by the fucking psuedofed law here in Iowa -- I think it phenylepherin instead of psuedoephederin (who knows how their spelled).

The new PE version work as well or better as the original formula, costs the same amount, and my doctor assures me you can make speed out of it just like you can the original -- so much for our dipshit legislators having a clue.

As noted above, if you have allergies both Claritin and Zyrtec (as well as generics) are not available over the counter and work very well.

[TrickyVic]

"""And they'll have no trouble hiring Senior adminsitrators at $300k pa, like Michelle Obama,"""

Isn't that par for corporations? She must have been good at what she did, if not, they would have paid her millions.

[TrickyVic]

"""The new PE version work as well or better as the original formula, costs the same amount, and my doctor assures me you can make speed out of it just like you can the original"""

Na, it's crap. The new shit doesn't work worth a damn when I have a serious cold. I had to break down and get the behind the counter stuff for real relief.

[Hambone]

"Why not click on the link I provided in the post? Just a thought."

I did. It's just one poorly conducted / written study. And I think it's assertions are crock.

[Spoonman]

Kinnath means "now available", not "not". (Not meaning to be a pedant, just being clear.) If you're like me, Claritin and Alavert (they're the same thing) don't do a thing for you, but Zyrtec works great.

[kinnath]

In the old Soviet Union doctors were predominantly women and were quite low paid. And their skill level was somewhere a little higher that of a nurse practitioner.

Surgeons, on the other hand, were mostly men and were quite well paid - many multiples of what doctors got.

I spite of this (or possibly because they were ignorant of the actual facts) commsymps in the west would frequently point to the number of women "doctors" in Russia as evidence of greater gender equality.

I travelled to Moscow about 20 times in the mid to late 90's. Observation 1) Women are still second rate citizens (way behind the US in that regard). Observation 2) Doctors are way low on the totem pole in terms of respectable work. Combining 1) and 2) most doctors (except for specialist and administrators) are women because no self-respecting man would take the job.

[TrickyVic]

"""The government doesn't just under-reimburse primary care - so does private insurance."""

Correct, and providers over-bill knowing they will only get the contracted rate. An EOB of mine showed my PCP charged my insurance $355 for a regular visit. My insurance paid him 139.51.

[Atanarjuat]

Personal anecdote time. My parents started their own business, a walk-in primary care clinic. They only take private insurance or cash. The amount the government reimburses is not enough for them to stay in business. They don't have many kind words for Obama's health care plans.

Regarding a shortage of doctors, they can't find enough doctors to keep the place open seven days a week anymore (this is in a relatively small town of 150,000 however).

[kinnath]

Kinnath means "now available", not "not". (Not meaning to be a pedant, just being clear.)

Oops.

If you're like me, Claritin and Alavert (they're the same thing) don't do a thing for you, but Zyrtec works great.

Claritin works well for some things that make me stuffy. Zyrtec work well for other things. After 2 decades of suffering severe symptoms, I now take a clartin (24 hour pill) in the morning and a Zyrtec (24 hour pill) at bed time. I have never felt better in my life.

[DrSteve]

If the public insurance option is going to be such a shitty deal for those that choose it, won't people steer clear of it and stick with their private insurance?

(1) 150 million Americans (at least) have employer-provided coverage, meaning they would at least be principally affected by the decisions of others;
(2) It'll be subsidized, silly.

[MayorOmalleySuxs]

She must have been good at what she did...

Married well?

[Isaac Bartram]

kinnath, 2:00pm

I suspect that the communist sympathizers i referred to had either never actually been to the USSR or they were counting on their listeners being ignorant of these facts.

As for, "Observation 1) Women are still second rate citizens (way behind the US in that regard)."

I have found this to be true of many places in the world, including some to which American liberals point to let us all know how bad things are in the USA. This is not true of womens' right but other things as well.

[kinnath]

I have found this to be true of many places in the world, including some to which American liberals point to let us all know how bad things are in the USA.

An engineering buddy tells a European counterpart a standard joke:

Heaven is a British policeman, a German mechanic, a French lover, an Italian cook and it's organized by the Swiss.

Hell is a German policeman, a French mechanic, a Swiss lover, a British cook and it's organized by the Italians.

The European counterpart replies:

Heaven is an American paycheck -- Hell is an American wife . . . .

[brotherben]

Mmmmmmmmm, Lily Tomlin...

[prolefeed]

This would basically turn medical care into a regulated utility. In other words, private insurers would have to compete with a government agency that could tell doctors, hospitals, and drug companies how much they are going to get paid, period.

And all the competent physicians are gonna be flocking to work for a government-run agency when they have the option of working for other employers, or setting up a private practice ...

/sarcasm

[Geotpf]

"Atanarjuat | June 3, 2009, 2:03pm | #

Personal anecdote time. My parents started their own business, a walk-in primary care clinic. They only take private insurance or cash. The amount the government reimburses is not enough for them to stay in business. They don't have many kind words for Obama's health care plans.

Regarding a shortage of doctors, they can't find enough doctors to keep the place open seven days a week anymore (this is in a relatively small town of 150,000 however)."

There is not a shortage of doctors. There is a shortage of doctors who will work at the price your parents are willing to pay to remain profitable. If they were running a charity (or a government entity) with a near unlimited expense account, I'll bet they could find a doctor willing to work for a high wage.

The government could subsidize the salaries of doctors who are willing to move to places like your parents' small town...

That is, your argument in favor of the current system could easily be used to attack said system.

[prolefeed]

Isn't this the way the old Soviet Union used to do it? I remember reading (sory can find a citation) that the Soviets used the term "doctor" a bit more generously and many that the Soviets called Doctor would have only been qualified to be nurses in the US.

That's the way Hawaii does it. Fucking chiropractors are legally defined as "physicians".

[Episiarch]

Pedant time: Claritin and Zyrtec are antihistamines; they stop allergic reactions and dry up sinuses. Pseudephedrine (Sudafed) is a decongestant; it breaks up stuffed sinuses and gets them draining. These two types of products do opposite things and are not for the same purpose.

That is your pharmaceutical lesson for today.

[R C Dean]

Why not click on the link I provided in the post? Just a thought.

That's asking an awful lot, Ron.

If the public insurance option is going to be such a shitty deal for those that choose it, won't people steer clear of it and stick with their private insurance?

ObamaCare is setting up a massive migration out of private insurance.

As experience has shown, with a public insurance alternative for their employees, some companies will stop offering coverage as a benefit.

Insurance benefits provided by an employer will become taxable, making this a less attractive alternative.

As the private insurance pool shrinks, premiums will go up, driving more people out of the pool and into the state plan. At some point, you get into a death spiral.

[Michael Ejercito]

Can we stop talking about the Europeans as if they have a single system of healthcare?

I have heard and read that the health care systems in Singapore and Germany are excellent.

Of course, the success of government-run health care depends on the political culture. Los Angeles County would not run a health care system as well as Singapore does.

[R C Dean]

There is not a shortage of doctors. There is a shortage of doctors who will work at the price your parents are willing to pay to remain profitable.

Technically true. However, addressing the shortage by raising the price paid for physician services runs directly contrary to the Master Plan for health care.

[Dr. Kenneth Noisewater]

(1) 150 million Americans (at least) have employer-provided coverage, meaning they would at least be principally affected by the decisions of others;

I don't understand what you're trying to imply here. Can you please clarify? If the gov't plan is shitty, why would any of those 150 million leave their employer-provided private plan?

(2) It'll be subsidized, silly.

What if (1) the gov't plan must operate using funds obtained solely from premiums; and, (2) any subsidies were in the form of a need-based voucher and the recipient could spend it on the govt plan or private plan premiums?

[Atanarjuat]

There is a shortage of doctors who will work at the price your parents are willing to pay to remain profitable.

Agreed, if they offered a higher salary they could probably find someone. Of course finding just anyone doesn't help. The last few people they hired didn't work out; a cokehead, an incompetent newbie, and an ex-military doc who oddly couldn't function outside of a bureaucracy.

That is, your argument in favor of the current system could easily be used to attack said system.

I wasn't arguing in favor of the current system, I was just trying to point out, anecdotally, that the doctors I know hate dealing with the government system.

[MayorOmalleySuxs]

I have heard and read that the health care systems in Singapore and Germany are excellent.

I lived in the UK for 15 years and can assure you that excellent is not a word used to describe the British health care system.

If one was to read British newspapers, the perennial subjects are complaints about health care and schools.

[bookworm]

"I have heard and read that the health care systems in Singapore and Germany are excellent."

The average physician makes only $56,455 in Germany. Considering that American doctors on average make $300,000 a year, if their salaries were to fall to that level, how many would stay in the field? It would not take us long before we had a serious shortage of doctors.

Between 1999 and 2005, the US was responsible for 71% of the sales of new pharmaceuticals. Germany in comparison, was responsible for only 4% of the sales of new pharmaceuticals. If Germany has such a good healthcare system, why do they produce so few new pharmaceuticals and if the US has such a lousy healthcare system, why do we produce so many new pharmaceuticals? Will we continue to produce so many new pharmaceuticals once we go under Obamacare?

[MayorOmalleySuxs]

Will we continue to produce so many new pharmaceuticals once we go under Obamacare?

No

[Dr. Kenneth Noisewater]

As experience has shown, with a public insurance alternative for their employees, some companies will stop offering coverage as a benefit.

Can you quantify "some" and provide evidence that this "some" is enough to kick off the death spiral?

Insurance benefits provided by an employer will become taxable

That has yet to be determined.

As the private insurance pool shrinks, premiums will go up, driving more people out of the pool and into the state plan. At some point, you get into a death spiral.

In other words, there won't be enough people who find the value of a private plan compelling enough to sustain a large enough risk pool for the private plan. Correct? Shouldn't you have a bit more confidence in the ability of the private plans to meet the needs of their customers to avoid them fleeing to the gov't plan?

If the dystopia of the gov't plan comes about, what's to stop people from creating a private plan that meets customers needs better than the public plan and luring customers back to their private plan?

[robc]

If the dystopia of the gov't plan comes about, what's to stop people from creating a private plan that meets customers needs better than the public plan and luring customers back to their private plan?

price. Private health care is available in Britain, the the rich buy it.

If the government subsidizes health care (and they will), many people will use it, just like they do subsidized education*. You are already paying for it with taxes, might as well take advantage of it.

*whether it will be like colleges (partly subsidized, but still with costs) or high schools (free!!!) doesnt matter. Its a matter of degree.

[insert standard libertarian disclaimer here] If we are going to have some government plan, I would prefer the auto insurance model. Make health insurance manditory. But, states would have to make bare bones plans legal. Like with collision, require everyone to buy a high-deductible catastrophic policy. Anthing beyond that is up to the individual.

[Enough About Palin]

With all the talk about Sonia Sotomayor's celebrated capacity for empathy and what it might mean for the law, I'm surprised that more attention has not focused on her 2001 ruling in Bartlett v. New York State Board of Law Examiners. The case held that a woman was entitled to double the normal amount of time on the bar exam - to become a licensed attorney in the state of New York - because she wasn't able to read very well. Or, as Judge Sotomayor put it, she was "substantially limited in the major life activity of reading when compared to most people by her slow reading rate and by the fatigue caused by her lack of automaticity."

The plaintiff in the case had graduated (barely) with a GPA of 2.32 from Vermont Law School, where she had received substantial accommodations for her professed learning disability. After this, she took and failed the New York bar exam three times. Apparently not believing that the fourth time would be the charm, she decided to sue under the Americans with Disabilities Act, alleging that the state Board of Law Examiners had "discriminated against her . . . by failing to provide her with reasonable accommodations" as required by the law.

Now you might think that, since reading ability is an important part of practicing law, and the bar exam is designed to ensure minimal competence among lawyers, papering over a test-taker's lack of reading ability would somewhat defeat the purpose. It would seem clear to most people that, in the language of the ADA, compromising the standards of the test regarding a basic legal skill would not qualify as a "reasonable accommodation." But that would be a decidedly unempathetic point of view. Such an attitude is in fact "invidious," according to Sotomayor's opinion.

At the end of the day, Sotomayor wrote, "plaintiff has convinced me that she needs extra time on tests in order for her true abilities and knowledge to be assessed." A lawyer's "true abilities," of course, are measured by what she is able to achieve when a judge orders that she be given twice the allotted time to complete a legal task. On the basis of this understanding, Sotomayor proceeded to award the plaintiff $7,500 in damages, and mandated that she be allowed four days to take the bar exam instead of the usual two. Thus buoyed by a gust of judicial empathy, the intrepid plaintiff took the test a fourth and final time. And failed it once again.

[phalkor]

I sure as hell wouldn't pay to put myself through medical school for $56,455 a year. I can't imagine anyone else would either.

[SugarFree]

Enough About Palin,

That is a wonderful story.

Of course, she could have also ruled that everyone that took the test with her didn't get to pass the bar either.

[Enough About Palin]

In United States v. Santa, Judge Sotomayor ruled that when police search a suspect based on a mistaken belief that there is a valid arrest warrant out on him, evidence found during the search should not be suppressed.

[phalkor]

^^That test-taking sotry better be fake.

it's the sort of story that get me geared up for some of the ultra-violence

[Enough About Palin]

"Of course, she could have also ruled that everyone that took the test with her didn't get to pass the bar either."

I think I accidently cross-posted here. Sorry.

[phalkor]

In United States v. Santa, Judge Sotomayor ruled that when police search a suspect based on a mistaken belief that there is a valid arrest warrant out on him, evidence found during the search should not be suppressed.

That one I know is real. It's very very hard to defend someone with a serious child porn collection though. I can see why it went the way it did.

[Enough About Palin]

But yes, phalkor, the story is true:

http://caselaw.lp.findlaw.com/cgi-bin/getcase.pl?court=2nd&navby=docket&no=979162v2

[SugarFree]

I think I accidently cross-posted here. Sorry.

I didn't even notice. All threads eventually become about Sotomayor nowadays. 🙂

[John]

"Of course, she could have also ruled that everyone that took the test with her didn't get to pass the bar either."

Good thing she didn't think of that. Too bad Sotomayer wasn't a judge when I was in high school. I could have sued for being cut from the varsity basketball team. They should have made accomadations for my significant limitations in the major life activities of dribling and shooting.

Cases like the one Palin points out need to be beaten like dead horses. Most people don't know the kind of nonsense people like Sotomayer actually want.

[J sub D]

Barack Obama is not retarded. He's an arrogant twit who having never run a goddam thing in his life is certain he can run everythig.

P.S. Any replies to this comment will most likely consist of ad homs, as libertarians concede my points and show their childish, anti-intellectual nature.

[Enough About Palin]

Read it here:

http://lw.bna.com/lw/19980929/979162.htm

[MayorOmalleySuxs]

...for $56,455 a year

I'd like to know where that figure came from - it seems low even by socialized medicine standards. If $56k is an accurate figure, is that figure actually what they take home a year? Are there other ways they are paid? Housing allowances or some other way of compensation?

[John]

"Barack Obama is not retarded. He's an arrogant twit who having never run a goddam thing in his life is certain he can run everythig."

That pretty much describes it. And when he fails it will everyone's fault but his.

[alan]

That is classic. That is a scene out of Peter Singer's childhood isn't it?

It certainly is. Those memories were weighing so heavily on Singer's conscience, he had them transferred to a chimpanzee who now spends his days drooling, sitting in his own poop and growing his nails to obscene lengths. To which, Pete's only reply was, 'he seems fine to me.'

[bookworm]

"I'd like to know where that figure came from - it seems low even by socialized medicine standards. If $56k is an accurate figure, is that figure actually what they take home a year? Are there other ways they are paid? Housing allowances or some other way of compensation?"

My source is Sally Pipe's "The Top Ten Myths of American Health Care". Her source is "Germany's Poor Doctors," 2004 analysis by the National Economic Research Associates as cited in Der Spiegel. http://www,souegek,de/img/0,1020,575805,00.jpg

[bookworm]

"I'd like to know where that figure came from - it seems low even by socialized medicine standards. If $56k is an accurate figure, is that figure actually what they take home a year? Are there other ways they are paid? Housing allowances or some other way of compensation?"

It's really on a par with other doctors' salaries in countries with socialized medicine. The average rate in France is $55,000.

[alan]

Good thing she didn't think of that. Too bad Sotomayer wasn't a judge when I was in high school. I could have sued for being cut from the varsity basketball team.

I was cut from my college baseball team, something I share with my best friend who was a pitcher for the University of Texas, and he was cut for being too short.

I've moved on with various interest and professions I have mentioned before, my friend works in B-movie crews like Cabin Fever 2 though he hopes to direct someday, and you moved on to law. Apparently in Sotomayor's opinion we should have stuck it out and sued our way to the top instead of finding other things that we are good at.

[D.A. Ridgely]

And for those of you who live in the blessed era of (some) telecommunications deregulation, take a little walk down memory lane to see what it was like to live under the tyranny of the original AT&T with this (not too inaccurate) Lily Tomlin spoof.

I detect an in-joke here!

I am, in any case, eternally grateful to Tomlin for the line, "No matter how cynical you get, it's never enough."

[lc]

""I'd like to know where that figure came from - it seems low even by socialized medicine standards. If $56k is an accurate figure, is that figure actually what they take home a year? Are there other ways they are paid? Housing allowances or some other way of compensation?"

It's really on a par with other doctors' salaries in countries with socialized medicine. The average rate in France is $55,000."

Don't worry. Once we cut salaries to "Comparatively Effective" national doctor salaries, and we see a huge exodus of doctors out of the system.

We will just draft all the doctor's.

Problem solved.

[John]

"I was cut from my college baseball team, something I share with my best friend who was a pitcher for the University of Texas, and he was cut for being too short.

I've moved on with various interest and professions I have mentioned before, my friend works in B-movie crews like Cabin Fever 2 though he hopes to direct someday, and you moved on to law. Apparently in Sotomayor's opinion we should have stuck it out and sued our way to the top instead of finding other things that we are good at."

Never thought of it that way. But you are right. It has to be hell trying to do something you suck at your whole life.

[Fluffy]

If the dystopia of the gov't plan comes about, what's to stop people from creating a private plan that meets customers needs better than the public plan and luring customers back to their private plan?

Actually, I think that private plans will remain attractive and large numbers of people will use them.

Unless those private plans are substantially burdened with mandates regarding who they must accept and what coverage they must provide and which providers they must work with.

Which I expect would certainly happen.

Personally, I think it will be fairly simple for private individuals to remain outside the plan, but probably not so simple for providers over time. If there is substantial resistance by providers to participating in the public option, or if substantial numbers of providers withdraw from the public option, I expect that we will see escalating punishments directed at those providers. The licensing of health care professionals will almost certainly be misused as a means to this end, as will federal manipulation of the medical education system, and probably the tax code. All while the fiction that the public option is "voluntary" is maintained.

[T]

It has to be hell trying to do something you suck at your whole life.

Nah, just learn to enjoy doing it poorly. Kind of like sex. You may suck at it, but as long as you're happy with your performance, who else matters?

[John]

"Personally, I think it will be fairly simple for private individuals to remain outside the plan, but probably not so simple for providers over time. If there is substantial resistance by providers to participating in the public option, or if substantial numbers of providers withdraw from the public option, I expect that we will see escalating punishments directed at those providers. The licensing of health care professionals will almost certainly be misused as a means to this end, as will federal manipulation of the medical education system, and probably the tax code. All while the fiction that the public option is "voluntary" is maintained."

I suspect that is right. The equivillent of going after hoarders under a price control plan. There will always be private doctors and hospitals. The big people would never be stuck in a government system. I suspect what will happen is it will be similiar to private schools. People will pay taxes to support the crappy public option and then mortgage themselves to the hilt to go to a competant private provider.