I am both an economist (three year M.A., Univ. of Chicago, 1968, in economics PhD program) and a lawyer (J.D., Univ. of Chicago, 1971). I had a Woodrow Wilson National Fellowship in economics and the good fortune to study at Chicago under seven Nobel Laureates in economics (received before or... More
The Health Care Reform Agenda (Revised Version) 241 comments
Mar 26, 2010 3:00 AM
While many have strong feelings for or against the initial health care reform legislation, few Americans understand the economic issues involved. Popularization of the economics of health care has been neglected. This is one reason reform has been so difficult.
1. Why health care reform is necessary.
Before passage of the New Health Care bill, we were the only developed nation without a national health care program. Yet, we spend 16% of GDP on health care. That is almost 1/6 of our entire economy, as measured by GDP. It is as large as our housing sector. Yet little is written here or elsewhere for the public to understand the issues and economics involved with the sector. Housing, on the other hand, gets lots of ink.
However, according to recent polls, only 5% of Americans believe that the health care system we had was workable or working. This can in part be seen from the Congressional Budget Office's (CBO) projections for the old health care system. In the absence of the changes in federal law, that is, the heath care reform just passed:
1. Total spending on health care would rise from 16 percent of gross domestic product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082.
2. Federal spending on Medicare (net of beneficiaries’ premiums) and Medicaid would rise from 4 percent of GDP in 2007 to 7 percent in 2025, 12 percent in 2050, and 19 percent in 2082.
Between 2000 and 2005, insurance industry administrative overhead – including both administrative expenses and industry profits – increased 12% per year. Premiums have skyrocketed, increasing over 87% over the past six years. What is going on in health care is America's dirty little secret. Those raking in the money and their friends don't want the word to get out or any reform to pass -- just say "no" has been their position. The problem is they have over reached and the present situation is obviously not a viable prospect and most seem to understand that intuitively, except those wanting to maintain the status quo and the profits it affords.
2. The health care problems we face.
The problem is optimal effective reform is not possible until people understand specifically how the markets in this area are in fact distorting resource allocations, at the most basic level, theory aside as I have learned. Consequently, most people’s proposals for reform or change are (1) non-existent or (2) incoherently all over the place. There is little understanding or agreement. Some even urge the old system that 95% of Americans correctly recognize is malfunctioning!
Among the public and politicians there has been too little practical understanding of the problems in the markets involved and even less useful thinking about how to fix them by what has to be government intervention to produce the kinds of results obtained in other areas of the economy by free markets that work, i.e., good resource allocations and cost effective pricing.
The reason the Republicans lost here is (1) they are apologists for and sometimes enablers of excessively high prices in the relevant markets; (2) many don’t understand the problems of markets in this area. (3) they made no systematic and sensible alternative proposal for reform, especially reform that included protecting those not receiving adequate medical care, and (4) by just saying “no,” to any reform proposal they cast their lot with the old health care system that 95% of Americans recognize was not working. This was not the best way to go.
The problems the old health care system faces are clear, although few wanted to admit them and even fewer understand them as an interactive package. They are:
1. Excessive oligopolistic pricing of health care and malpractice insurance by insurance companies ineffectively regulated by the states, but which are exempt from the antitrust laws and which are relative few in number because they have eliminated their competitors (There have been over 400 health care mergers in the last 10 years and just two companies dominate a full third of the national market.);
2. Some patients being treated for free creating a cross subsidization in their favor on hospital charges and doctors fees and against those who are insured or pay for their own treatment;
3. Excessive prices for doctors’ services (a) due to AMA restricting number of doctors by restricting number and size of medical schools*, and (b) due to excessive charges for malpractice insurance for reasons cited in (1) above, causing (c) too much expensive, defensive medicine being practiced by doctors which is not cost effective, and (d) due also to an excessive paperwork load on doctors that cuts into to their treatment time and compensation.
4. Lack of systemic incentives to practice preventive medicine;
5. Drug companies engaged in fraud (e.g., Pfizer, repeatedly), oligopolistic over-pricing and other misdeeds and abuses; and
6. Inadequate economies of scale in the treatment of patients, including underutilized facilities, due to so many being excluded from the medical care treatment system because of (1) and (3) above.
3. The health care reforms at hand.
The question has been how and where to have the government intervene, but it is now with a new wrinkle: as a matter of public social policy, it has been determined that “everyone” is to be covered by health insurance for medical care. No one is to be left uncared for. This is a quantum leap because, under the old system, over 45 million Americans—including over 8 million children—lack health insurance and 80% of the uninsured are in working families. A good part of that omission however was due to the failings of the markets involved.
In other words, we have two proposals at hand, (1) intervene to correct the markets’ misallocations in the area, and (2) try to expand and extend medical care to everyone by extending insurance coverage for all. The two goals are very much related and interactive, given the problems in the relevant markets.
The needs of the system to emulate free markets are simple but not that easy to implement because of seriously entrenched economic interests that profit from the status quo. That is part of the reason issues have been confused and opposition has been so strong to the changes coming.
In a nutshell, the reforms needed are:
1. Insurance premiums for both health care and malpractice have to drop to more competitive levels, which will be easier if more people are insured, malpractice claims are reduced, doctors cut back on practicing defensive medicine and the government aggressively applies the antitrust laws and laws of unfair competition and establishes an insurance exchange to force competition and make it easier to shop for insurance based on rates and coverage;
2. Doctors salaries need to drop, medical schools be expanded, more tuition help needs to be available in exchange for service time, and doctors need to stop practicing so much defensive medicine and be more cost effective; Medicare compensations are already starting to be dropped by 20% to force the issue because it will take time for the number of doctors to change;
3. Malpractice suits need to be screened when they are filed to eliminate “strike suits” and frivolous or bogus claims so they are not an expensive and silly burden on the system;
4. People need to be able to buy their drugs worldwide at the cheapest prices; the antitrust laws and laws of unfair competition need to be more aggressively enforce against the pharmaceutical companies, with the term of patent protection individually tailored to actual R&D cost amortization and a reasonable profit for each drug and the drug companies need to get their oligopolistic prices down;
5. Outlaw drug companies from fraud, unfair competitive practices such as blocking or buying off generic drugs that would otherwise be available to consumers at much reduced cost and finally also allow cooperative drug purchases by groups at lower negotiated prices;
6. Have health care policies encourage wellness check-ups and promote preventive medicine similar to Kaiser Permanente because it is cheaper in the long run; and
7. Everyone needs to be insured and pay as much of their own way as they can, with taxes levied to make up the difference for those less fortunate financially, which taxes will be less than they otherwise would be because (a) premiums will be lower because (b) doctors will charge less, (c) hospital charges will be lower (no more cross subsidization), (d) the cost of medicines will be less, and (d) much greater economies of scale will be possible with more people insured.
This is a tall order, given where we are, but where we are is not a position in which we can remain. The system is interactive and if properly handled can be made to work, but expect continued fighting from those getting unfair oligopolistic profits from the status quo. They very much want to hang on to their ill gotten gains. Too, for the apologists out there who want us to stay put, it is important for them to know what is wrong with the system for they are apologizing. This is the basic, not so hidden agenda for health care reform at this point. _______ footnote *
(Doctors per 1000 population
3.40 per 1000 people Germany 3.40 per 1000 people Austria 3.37 per 1000 people France 3.90 per 1000 people Belgium 3.82 per 1000 people Israel 3.60 per 1000 people Switzerland 3.20 per 1000 people Spain 4.20 per 1000 people Italy 4.50 per 1000 people Russia 4.40 per 1000 people Greece vs. 2.30 per 1,000 people USA, on par here with 2.25 per 1000 people Slovenia
In “free” markets, it is simply supply and demand: fewer doctors => higher doctors' salaries that in turn means higher medical bills => higher insurance premiums => fewer people can then afford health insurance => fewer people insured => more people uninsured and without medical care.
Canada and the United Kingdom have 2.1 and 2.2 per 1000 respectively, for similar reasons, but both have national health care systems that cover everything for everybody (instead of the seriously malfunctioning “free” markets we have in the U.S.A.) and that are much, much more efficient at delivering medical treatment than ours because of massively less bureaucracy, overhead, red tape, hassle and paperwork.
If we wanted similar results to what they have, we could adopt either of their systems or some hybrid of the two. The core problem is entrenched financial interests have been making a ton of money off our “system” as it is and they don’t want any change. That is much more the problem than what changes should we seek. Because of the opposition to change, Obama has chosen the path of least resistance, politically, which is probably not optimal and will be much more time consuming to fully implement. America has a mean-spirited greed problem and it is not just limited to the medical area either. We are awash in too many "no's," lies, misinformation and the blocking of accurate information.)
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umm... the republicans did not lose. The libs secured the repubs victory this winter, along with the next presidency. this health care bill that just past is only a power grab - there is no real reform here, whatsoever.
@Loverboy. Read the article again. This is just the start. It is an interactive system you obviously don't understand. That is why I tried to spell it out. Truth is, vested interests don't want to hear it and neither do their apologists. They like the money right where it is just fine.
If the Democrats don't sell out to being bought off on financial reform, if health care reform continues and if employment comes down steadily, the "just say no" party will clearly lose. Much depends on the last point -- but then what would, or have Republicans done about unemployment -- nada, zero, zip and they have blocked some efforts to help with it. The "just say no" party is a prescription for being stalled in place and nobody wants that.
Well, Kimball, me as a republican would have the government just friggin STOP - then guys like me would feel better about growing our business. as usual, your view is really too macro to be of any benefit.
i did read your article, and i understand where you are coming from better than you think i do - i just happen to disagree, thats all.
you say nobody wants our county to be "stalled",and i agree. however, it will be very interesting what happens this fall and the next presidential election - my current opinion is that most of us feel better only because the DEMS are screwing themselves so bad!
as i have posted before - i paid over 320k last year in med benes, and i bet that goes up by... God knows how much. Mark my words, the healthcare reform that just passed will either be eliminated by this time next year, or it will be so watered down you wont even recognize it - liberals are getting thier moment in the sun rigth now, but they will be forced back into the caves for another decade after this power grab debaucle.
Two big points to make here. First is that America needs to join the league of developed nations: they all provide health care to their populations, it's a given. If a government can't take care of it's people, what's the point? Germany, Japan, Canada, France, Sweden...or how about Costa Rica and the next tier countries. They all do it, and the fact that America doesn't, that 10% of American children are in poverty (and 20% are without health care) is disgusting and embarrassing. And it was truly disgusting to see hordes of people protesting the fact that the less well-off were going to get some health security for once in their lives. What is the mentality of someone who takes to the streets to protest something like that? Second point: single payer needs to get back ON the table. Go to any doctor's office in the US: there is one doctor out front and at least three ladies in the back trying to figure out whom to bill for how much, with filing cabintes to the ceiling. It's ridiculous. In Holland they had a similar insurance company system before their health care reform: their solution was typically pragmatic. They kept the insurers in place, but mandated that they each had to offer a minimum standardized package of coverage, and capped the amount they could charge for that. So the insurers were incented to take cost out; and to improve service as a way to differentiate themselves. They are also allowed to sell better coverage for more money etc etc. I live in Australia and they have single payer. I go for treatment, there is one standardized list of reimbursement amounts, the doctor submits the claim online, the money hits their account within a few days. Try doing that without single payer: never happen.
Yet everyone of the nations you mention have a higher mortality rate relative to the US in virtually every possible area of medicine including Australia. I have many colleagues we do business with down under. Their not at all happy with your system of medicine. One was recently flown here to the US to see a cancer specialist at Sloane Kettering since there was no comprable expertise in Australia.
American's mortality rate is dropping fast. Too, Canadians and Brits, with their national health care systems, live several years longer than we do on average and the gap is expanding. We are awash in lies about national health care systems. Too, we are getting less medical care, with much more hassle and at outrageous prices, and anybody who dares to say that gets muzzled or not published. Those profiting exorbitantly from the status quo are screaming "no" to any change and drowning us in lies and deceit.
Sorry, mate, the reason your Australian colleagues are "disappointed" with their health care is that it's not as good as it was 20 years ago, when Australia was widely viewed to have the best health care system in the world. John Howard took a cue from Bush and worked to make it more like the Americam model, privatise etc.(luckily he didn't succeed entirely). But the only way to compare, is to compare. I have extensive real-world experience with both and I can tell you the level of care is very comparable and the costs and administrative experience are much better in Australia. I screwed up my finger in the garden this weekend; this morning I will call my doctor; he will ask what time today is convenient for me to see him; I will get simple treatment for a reasonable price with no paperwork; if any drugs are required they will also be cheap; I will be offered generic drugs as an option; and he will call me later this week to ask how I'm doing. Compare that to the same experience in America.
Mortality rates are not dropping quickly at all !!!. Trying checking with the Actuarial Society. 50% of all Americans live to 85 years old. 25% of Men in the US live to 92 and 25% of women now live to 94. That is the longest statiscal live expectancy we have ever seen. The only place where our Life expectancy data is ever reflected to be lower is in studies like the World Health Organzation. However they failed to mention that the data complied was based on different criteria. So when they counted Averages, they left out the fact that in the study many nations for example didn't count in their data simple things like infant mortality. As though that wouldd not have an impact. When all data is compiled and non healthcare related mortality is looked at eliminating things like murder or car accidents, the USA has by far and away the longest life expetancy. This is expressly why we are seeing an elination of Defined Benefit plans and a move toward Defined Contribution plans. The cost to a company is the same up front. But the Growth in life expectancy has made it imposible to project hoe solvent a DB plan will be. Take is from CFP. First rule of Financial planning is plan to about age 95. If your clients are over 65, we plan to closer to 100 now. Still Curious Kimball...Do you support Price Controls at the Federal level on Attorney Compensation ???
Interestingly enough my colleague, a non us citizen was treated instantly at Sloane Kettering. Yet our system is supposedly so Exclusionary. The reality is that in all systems of Socialized medicine the treatment is fine as long as you have nothing serious. yet everytime their is a real serious issue they are transported to the USA just as the Canadian Premier was recently for Heart surgery. Their is an entire industy in this country of companies whose business it is to help immport patients to the USA for treatments not available elswhere. How many such industries exist down under ??? The problem with this entire debate is that those in favor of the Gov't control over Socializing the system proceed from the perspective that Healthcare is a Right. But in a Free Society you can not have a right to the fruits of someone else's Labor. Because the moment you do, the Counter party has just lost his rights. Healthcare isn't grown on tree's. It must be provided. And those providing the service have rights as well. We've lost touch with that concept in this country to a large degree. Hence Medical Enrollement is down. Dr's discourage their children from particpating in the field. The profit is being removed and so are the brightest minds. Although I have many business Colleagues in Australia, I admit I haven't been their. However I have been to Europe. My wive lived their many years. I have seen that system first hand. I would never let my children be treated for any serious illness. It's and absolute nightmare. Have we forgotten a few years ago when the French had a rash of deaths in Hospitals due to Heat Stroke because during the Summer a massive number of Doctors just took off on vacation at the same time. Why shouldn't they, They're Civil servants. They've got no reason to expect to be held accountable. My guess is the reason for a push toward the privatization in Australia had a lot to do with why they have been moving in the same direction in Europe. Because their Entitlement programs are bankrupting the nations. It is simply unaffordable as are programs here in the US. And if you have ever lived in the USA and been to DMV, the Post office, the local public school superindents office or the Social Security office you can see exactly what type of service the Gov't provides. They're not only bankrupt, but they have no interest in helping you in the least. Then again why should they, they're all tenured.
As I have shown, you cannot believe much this apologist says. See the inter-country mortality misrepresentations he made above which I have shown to be false. I will look into some more of it later, but am now out at a remote Tongan island where I have virtually no Wi-Fi.
I believe he was saying his Autralian counterparts offer a different sentiment. I have heard largely the same from them. And as a physician I can tell you that you better not walk in my office with any form of Gov't insurance. That'll do you as much good as confederate dollars.
More or less yes...If their happy then that suits me fine. But I don't want their system pushed on us. These's types will are not much differnent then the Michael Moore's of the world. They'll have you believe that people brave shark invested waters on hand made make shift life rafts to land on the shores of the USA from cuba, because they have such a wonderful system there. They just try to disguise the same agenda through a better academic backround then moore. But the end result is the same. A system that is good for everyone except for them. And Like my Brother in-laws I'll assume that means you to no longer accept medicare either Dr.
FAVORJ, in your March 28 comment at 7.57PM you raise an interesting point about Canadians seeking medical treatment in the US which I will try to address briefly below.
Doesn’t the fact that Premier Danny Williams of Newfoundland (the ‘Prime Minister’ to whom you refer) recently went to Florida to have heart valve surgery suggest that the quality of care available in Canada is generally inferior? I would respond that the travel issue is more complex than that question suggests.
Canadians do travel to the US, India, Malaysia and other destinations for medical treatment in some cases. A significant part to this travel is to the US and much of it is the result of Canadian health authorities sending patients to US facilities, and paying for the services there. This is a cost saving measure for these authorities as it forestalls the need to enhance occasional peak or rarely used specialist capacity locally. Canadian residents, like many US residents, also as individuals at their own cost travel abroad (as Premier Williams recently did) for medical treatment for a variety of valid reasons and this is not necessarily a basis for claiming that health care is intrinsically or generally better in such other places. Premier Williams went to a private hospital in Florida, for example, because that hospital is a world leader in less invasive heart valve surgery techniques. Premier Williams could have received timely and effective surgery at any one of many locations in Canada but chose to undergo surgery in the unique manner available at the particular Florida hospital and recuperate at his vacation condo near by. Likewise numerous US citizens travel to Edmonton in Alberta for eye surgery or to Spain or Italy for stem cell related treatments because of the advanced techniques available in each of these niche situations.
Even where it is not one of these niche situations, many US and Canadian residents travel to India, Malaysia or other countries for surgery or treatment at their own expense because they have reason to believe they will receive quality service, sooner and at lower cost than would be the case back in their home countries. We do not conclude from this that the Indian and Malaysian health care systems, for example, are generally superior to those available in North America.
Counterpoints 1. The differential in what we spend as a percentage of GDP is largely related to the fact that healthcare is actually more accessible in the US versus other nations. I was scheduled for an MRI on my knee last year. The day before the procedure the pain disappeared. That didn’t stop me from getting it done anyway just to be sure. That is the not the norm in nations with national healthcare. You can’t just get an MRI in England. Not unless you’re one of the members of Parliament. This must be why 70% of people in England buy private insurance and won’t have anything to do with the Gov’t run care. 2. Medicare spending is precisely the problem. 65% of all of medicare costs are currently administrative. Classic example of an inefficient beaurocracy. Yet the new bill requires that private insurers are mandated that no more then 20% of Premiums collected can be used for administrative costs. Yet they must deal with even a larger web of beaurocratic rules that must be muddled through. Meaning premiums will immediately go up faster than they had before. In addition, and by no means a surprise that my company two days after this reform was signed announced that the impact of the loss of a tax deduction(sometimes called Loopholes) to the company on employees whom are retired will cost them enough money that all retires whom where previously receiving benefits will now pay 40% more of the Premium cost. 3. Restriction of medical schools is a ridiculous point. Medical School enrollment is at an all time low. Doctors today for the most part would never recommend their own children follow in their footsteps. They can barely get people to attend these days. The last thing in the world they are doing is restricting participation. 4. Most Americans due realize the system is problematic. Yet the same polls show that the vast majority of Americans are happy with THEIR coverage. Much of this is due to media perception of all the” 45 million uninsured Americans”. Which is a MYTH. When people are informed that about 10 million are illegally here in the USA,(Fleeing the very Socialized systems that the Author seems to be praising) and the remaining portion are largely often people switching employers and covered for three months under COBRA until the new coverage kicks in. Or just have chosen not to buy insurance even when their employers offer it. (Lord knows I have seen many of these at work). And lastly there are those whom are not offered it through and employer or are self employed yet make more than enough to purchase insurance and just have chosen not too. Then you see the real opinion of the Public. And that is why there is such large public opposition to this bill. Generally speaking, most American believe in personal accountability and would prefer to clean up their own back yard. If they can help their neighbor they will. But they don’t want the Gov’t mandating that we provide the same level of care to a crack addict as a hardworking American. I work out 6 times a week and try to eat right. Why shouldn’t I get preferential treatment to someone who chooses to eat Burger King six times a week. 5. Oligopolistic Pricing could largely be addressed by allowing insurance companies to do business across state lines. The total # of companies operating in the Health Insurance industry nationwide is over 1500. Yet you would never know it with the current restrictions in place. These rules of preventing cross state contracts are reducing competition and protecting just a few. 6. Lack of systemic incentives to practice preventive medicine ??? Preventive medicine does surely makes logical sense from the stand point of your personal health. However every study shows it has no long term impact on reducing cost. On the contrary it actually marginally increases the cost. 7. Drug companies engaged in fraud. This is even more ridiculous for a # of reasons. But one example is this. The current regulations the FDA places on a medications expiration date is far more strict in the USA then elsewhere in the world. And the companies are even more strict in some cases due to the litigious society we live in. A cousin of mine is responsible for global shipping of a major drug company. When a medication is created it goes into a suspension chamber. When there isn’t enough short term demand for the current supply of a drug it is often expired. Yet foreign nations, including European nations sign legal disclaimers to have drugs shipped into their country and discounted prices knowing full well that medication may have passed expiration and lost anywhere from 25-50% of its medicinal qualities. Then pass this off as a cost savings of Socialized medicine. Furthermore, foolish Americans then buy them back on the internet not knowing their expired and believe they have some great discount. The point here is the Gov’t is the corrupted entity, not the Drug Companies. They don’t hide the medicinal breakdown. They require before shipping that these Gov’t bodies sign these waivers stating their knowledge of this. As a matter of fact if you truly are indigent, most major drug companies have programs to provide the drugs for free. It’s good PR for them. 8. The Dr Compensation is the best one of all. This is specifically why Medical enrollment is down. A typical Dr nets about $30.00 in an office visit before taxes. As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner. So I pose this question to the Author. Since he feels that all citizens should be covered by the force of Gov’t with no regard to the rights of Dr’s. Then let’s address this point. Isn’t it also vital that all Americans receive due process as a citizen of the USA. Aren’t all Americans entitled to adequate legal representation. Yet that is not always the case. Shouldn’t we then offer all citizens a Nationally subsidized form of legal assistance at the Federal level. And since being an Attorney is now a far more profitable venture than a Doctor, it seems to me that we ought to have national mandates on what an Attorney can charge. Surely Congress can be trusted with this responsibility, can’t they ??? After all, it just doesn’t seem fair to me that there are Americans out there not getting the proper representation while there are attorneys who have made enough money that they have the luxury of sailing around the world in a boat that cost more than the average American’s house.
No sooner do I mention the lies, misinformation and deceit involved from the opposition to health care reform then I run into a major damn lie and deceit from a FlavorJ (real name not disclosed) here who writes:
“Yet every one of the nations you mention have a higher mortality rate relative to the US . . . “
This is absolutely false. Virtually the reverse is true. From the CIA World Fact Book for 2008, here are the rank numbers by country on deaths per 1000 per year (lower is better):
rank from top Germany 56 Austria 72 France 89 Belgium 64 Israel 145 Switzerland 90 Spain 73 Italy 59 Russia 22 Greece 63 Slovenia 60 vs. USA 99
As you can see and verify for yourself the USA has A HIGHER MORTALITY RATE than every other country I originally listed except Israel which is too much and too often at war.
This is an immediate and concrete example of the lies and falsehoods being propagated by those opposed to health care reform.
Once again you show yourself to be statistically inept. Surely you can do better than a quick Wikapedia search. Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die "in their sleep," in a car accident or of some medical ailment before an ambulance ever arrives. Murder or possibly even suicide. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic. How many deaths are related to Plane crashes, crime or Hurricane Katrina. For Example infant mortality appears to be a good measure of a health care system. First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also satisfies the second criteria of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world. This can be seen by constructing a table using the data on infant mortality utilized in the report from the Physicians for a National Health Program. Such a study shows that on infant mortality, the U.S. ranks below all nations save New Zealand. But infant mortality tells us a lot less about a healthcare system than you would think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age." While the U.S. follows that definition, many other nations do not. For Ex in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living." This excludes many of the most vulnerable infants from Switzerland's infant mortality measure. And We Shall see how quickly you’ll attend Switzerland should you get diagnosed with a rare Cancer. My Money says you’ll be on the first plane to NY to Sloane Kettering or Houston TX to MD Anderson. As for my reasons for remaining nameless, When you work for a global Financial Organization you are often forbidden from speaking to the media or making public commentary not specifically approved by the company. Do to the highly contentious political environment most prefer to remain on the sidelines and don’t even allow employees to make political contributions without first disclosing to the company. So although my work is confined to Personal/Corporate Financial Planning, I shall be forced to remain anonymous unless I go back into Private Practice. Which is unlikely in the current regulatory environment. Once again Kimball, Why do you avoid the question for your readers. Considering that the wealthy can afford the best of legal representation and the poor, underprivileged youth’s from the South Bronx can only afford legal aid which is often less qualified and places them at a disadvantage, DO YOU OR DO YOU NOT SUPPORT FEDERAL MANDATES ON RESTRICTING ATTORNEYS FEE’S TO PROPERLY BALANCE THE SYSTEM AND PROVIDE FOR EQUITABLE DISTRIBUTION OF SUCH A VITAL PART OF OUR JUSTICE SYSTEM ??? Why Should I not have access to an attorney who’s qualifications allow him to charge…say $250 an hour. Far more than Most medical practitioners receive. Doesn’t the young man from the Bronx with a hotdog stand deserve the same representation in his potential infringement case. Shouldn’t the Federal Gov’t level the playing field of availability by controlling attorney’s fee’s. This may as well be a Rhetorical question…Because we both know that your left wing hypocritical ideology won’t allow you to apply the same standards to your wealth creation as you intend to impose on the sheep.
That Exactly right. This man tries to quote a political body over an acutarial society of mathmaticians. I believe you just exposed him as the liar. As we say in the old neighborhood, Kimball Corson, You just got smoked
As has been said many times, Statistics...Statistics and Damn Lies. If you choose to cherry pick broad based #'s without looking at internal data, it's easier to paint the picture you want. At the end of the day the Actuarial data shows clearly that 50% of all Americans live now to at least age 85. If you reach 65, the odds of going past 90 is now greater than 75%. This is very much a serious concern for pension funds including Social Security. This was one of many problems GM had. They often paid people in retirement longer than they actually worked for the company. Mark my words. In the not so distant future you will start to see even public employees transitioned to Defined Contribution plans in larger #'s for exactly this reason. For those of you reading that are concerned about loosing a pension fund.. fear not. Every American can take a Qualified plan and choose to Annuitize it themselves at retirement. Depending on the individual case that may or may not make sense. It's actually safer then a company backed plan anyway. In NY if you annuitize 500k or less the state backs it anyway. In a company plan you'll receive up to 60% from the PBGC if the plan goes insolvent. And I Stress "up to" The guarantee is typically more like 40% with the Govt's upsurd formula's. Plus Insurance companies have a much more secure way to project solvency. Corporate Pensions use both Actuarial Life expectancy (that the Author claims doesn't exist ) along with interest rates and other key data such as the # of employee's participating. However a company can project benefits with 300k employees. But possibly through loosing market share in their industry they may for example downsize. That has an impact on the ability to fund current an future retiree's. With an insurance company they use what is called a large # of homogeneous units. Essentially people in a simliar situation. They sell an equal amount of immediate Annuity business against Life insurance policies. Since there are only two potential outcomes, either more people die or less people die than projected. This balances the client base so the solvency of an insurance companies annuities business is protected as is the Life insurance business. Even a poorly run entity like AIG had a very healthy insurance division. In most cases the NAIC steps up first in the event of an unforeseable act. Then in NY the 500k guarantee steps up. Before using these products clearly check with your financial planner as they may or not be suitable for you. And oviously look at the state insurance commissioners office for what if any guarantee limits there are.
Seriously, your comments are quite insightful. I actually had been considering exactly that possiblity of annuitized some of my keough money upon retirement, which might be a bit earlier than originally planned after reading some of this new legislation and what I expect coming down the road. As I assume you know doctors don't have any cushy pensions. And no I don't accept Medicare anymore. You just can't make enough anymore to make it worth your while. I hate to do that to seniors. But there is thirty thousand pages of medicare legislation. You call for preapproval and they tell you it's not needed. Then you submit a bill and they say it had to be preapproved. You go back to them with the name of who you spoke to after they reject a claim and they tell you that you received incorrect information. But too bad. They're not paying anyway. This very common and just not worth the headache anymore. To say there unhelpful is an understatement. They just simply don't care. I think motor vehicle is actually easier to work with. They are much worse to deal with than most private insurance companies. They pay pennies when they do pay, and your lucky to break even.
Understood. Speak to your Financial Planner. Try to restrict yourself to those whom are fee only. Tend to be much more unbiased. Notice Mr. Corson doesn't address the wholes in his statistical analysis. The truth is there are many such inconsistencies across all nations in how and what criteria they use to address average life expectancy data. The Swiss example is just one. And certainly doesn't address the question of restricting his compensation as he wishes to see the Dr's medicare comp cut by 20%. So I will leave you with a couple of quotes from two of our founders as we await Mr. Corson's next article of pontification
Government is not reason; it is not eloquence; it is force. Like fire, it is a dangerous servant and a fearful master. – George Washington
They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety. – Benjamin Franklin
Data did not come from Wikapedia search. Read comment again. Came from CIA Worldwide Handbook for 2008. Deaths per 1000 per year is standard definition of morality rate. To use other data is to diviate and most likely preclude comparability. To talk about infant mortality now as you suggest is to change the subject. By the way USA is 29th there, not exactly a wonderful showning in that quarter either.
You think the US health system is wonderful, but 95% of Americans, each with their own experience, disagree with you.
I just did address what you call the wholes (sic) in my analysis which you claim to have pointed out. You are wrong across the board. (I am a bit slow because I am in the outer ilands of Tonga and WiFi is difficult.)
95% Disagree. Please site your source. It seems to me that is a ridiculous statement. If only 5% of Americans are disatisfied then Nobody in congress would have had to been bribed to pass legislation.
FlavoJ. You start off on comparative national mortality rates with a misstatement on comparative rates and then when you are snared there your try to slip slide away into a belabored discussion on incomparable life expectancy analyses and other sundry matters that have nothing to do with deaths per 1000 per year, that is, the standard definition of a mortality rate.
I will get the source on the 95%. I had it once, but cannot pull it up instanty. Congress is bought off by the insurance and drug companies who like the status quo.
I've got news for you Kimball...150k isn't alot of money anymore. I pay 13k a year in property taxes alone. And I live in a Middle class neighborhood on LI. And I didn't have 6 years of Residency to do after medical school working 24 hour shifts. And although I take on a lot of liability...It's nothing compared to the responsibility and Liability of a Dr. You missed the point entirely. Why go to all the trouble of becoming a Dr. when you could make far more with less education...As you chose to do.
It is not a mistatement at all. As I demonstrated many times already...Mortality rates on not dropping...It's my business to know that...Since I do regular work with Actuaries on specifically this subject. Apparently it is you that has been snared as you had NO idea that Mortality rates on not measured based on Universal Criteria around the world. I read these studies regulary. And It's by no means and obcure study. If you had ever been involved in the creation of a defined benefit plan you'd know that. More importantly the proof is in the results. If life expectancy was declining in this country then clearly it would be more cost effective for the EVIL GREEDY corporations to utilize Defined Benefit plans and contribute less towards an employee's retirement. Yet the opposite is true...Hence the push toward defined contribution plans. Maybe we should just place you in charge of Social Security. They'd run out of money even faster. Or even better let's put you in charge of the Dept of Labor's division that regulates ERISA. You can create a formula for benefits testing that will collapes all QP's
The impact on US labour mobility deserves greater attention.
During WW II tax incentives were enacted in the US that strongly encouraged employers to provide health care, sick leave and retirement plans and the like as benefits to employees and from this the current employment based health insurance model arose. Large corporations such as those dominating the steel, automotive and defense industries in particular attracted and retained employees in completion with small and middle sized employers by offering such plans. Such industry leaders were mass employers and collective bargaining extended these benefit packages to their unionized employees. Management extended similar benefit packages to many of their white collar employees. Insurance companies developed innovative schemes to facilitate such corporate programs and allow at least some of the middle and smaller corporations to also offer comprehensive benefit packages to at least some of their longer term employees. As a result, the pattern in the US was that employer based programs played a large if not dominant role in the provision of health insurance with private insurance schemes for individuals outside the employment context filling some of the remaining void. Government health insurance plans played a subsidiary role filling some but by no means all of the remaining gaps in health insurance coverage. Note that in this paragraph ‘void’ refers to both lack and inadequacy of coverage.
In contrast to the US employment based health insurance model, in most other advanced countries the government took a lead role in providing comprehensive health and security benefits to all citizens and residents with employers and private insurers playing a smaller augmenting role.
The effect on labour mobility in the US is complex but, arguably, it is not too much of a simplification to state that: (a) many employees in smaller and middle sized companies have inferior or no health insurance coverage, (b) many of the insurance company plans (whether offered to persons based on employment with a particular employer or by some group plan that was not employment based) are applicable only to persons resident within a particular geographic area, and (c) the scope of and eligibility for coverage in many industries decreased significantly as the traditional large employers downsized or faced increased competition from rivals that did not provide similar coverage with the cumulative effect over the 70 years after WW II that a large number of persons who have no health insurance coverage as employees, inferior coverage or coverage that is personally very costly are very willing to move to other employers who offer equal or better (in terms of cost or quality) coverage while another large number of employees are unwilling to leave their current employer of area of residence for fear of losing coverage. The choice of young persons entering the labour market is similarly skewed by concerns about health insurance eligibility and the cost of adequate coverage depending on their place of residence or employment. Thus mobility is enhanced for some segments of the work force (but for reasons that are arguably not enviable) while for other segments mobility is impaired. The point is that the effect of health insurance availability on labour mobility is not rational in terms of the needs of employers and employees generally.
The challenge from the labour mobility perspective is therefore whether, and if so how, the US wishes to maximize the opportunity of all individuals to acquire adequate health insurance coverage at reasonable cost (i.e. on essentially the same terms) without regard to who employs these individuals or where those individuals reside. Most other advanced countries do this by basing health insurance on national citizenship or residence.
Citizenship, bob, should be the test. It allows for maximum labor mobility, excludes illegal immigrants and keys I think on the contral condition for acceptabilty into the system.
FlavorJ gets entirely too much wrong to be proceeding in good faith here. He should not be listened to. I have flatly proved him false on the US comparative mortality rates and do so below on the rest here as well.
“1. The differential in what we spend as a percentage of GDP is largely related to the fact that healthcare is actually more accessible in the US versus other nations.”
The differential by which we spend more on health care is due to its excessively high prices and therefore more limited quantities of health insurance, drugs and medical services we receive in the face of relatively inelastic demands. That is what it means here to have oligopolistic pricing and output regarding health insurance, drugs and medical services. Economics 101. In fact, insurance, drugs and medical treatment are less available to the population in the US than elsewhere for that reason and profits in those areas are larger than they should be. You have it precisely backwards and do not understand the economics involved.
2. "70% of people in England buy private insurance and won’t have anything to do with the Gov’t run care."
This is pure nonsense and a bald face lie. The correct figure on private insurance in the UK is 8% and it is as a supplement. Here is the date from en.wikipedia.org/wiki/... “The UK’s National Health Service (seekingalpha.com/symbo...) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8) are met directly from general taxation. The NHS provides the majority of health care in the UK. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services.”
3. “65% of all of Medicare costs are currently administrative.”
This is patently absurd. Not even close. The Congressional Budget Office (seekingalpha.com/symbo...) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans. The CBO study suggests that even in the context of basic insurance reforms, such as guaranteed issue and renewability, private plans’ administrative costs are higher than the administrative costs of public insurance.
4. “Restriction of medical schools is a ridiculous point. Medical School enrollment is at an all time low.”
This is flatly incorrect and false on both counts. The AMA has in fact restricted new and expanded medical schools and it has done so for years. That is why we have so few doctors per 1000 people compared to other developed nations, as I have shown. It is not coincidental. So few doctors per 1000 people and their high salaries is one reason medical costs are so high in the U.S., given our “free market” health care system.
Now the AMA is allowing expanded enrollment and the current AMA figures in the US for medical school enrollment are:
And this is with (a) the recession and (b) the lack of general tuition and other costs help available. It is not at all a question of not being able to interest students in becoming doctors because of doctors’ salaries. That enrollment is falling is a bald faced lie. Enrollment has been monotonically increasing.
5. “Most Americans do realize the system is problematic. Yet the same polls show that the vast majority of Americans are happy with THEIR coverage.”
This is also wrong. Americans are not at all happy with their insurance coverage. The practices recounted in Moore’s SICKO are far too prevalent. Americans are irate about it. Indeed, 95% do not believe our health care system FlavorJ likes so is working or workable. Americans are happy with their medical treatment if and when they can get it, but so are people of other nations happy with their own medical treatment on average and they don’t have to hassle with insurance companies like we do.
6. ‘The 45 million without insurance is just a myth.’ Many are illegal immigrants or COBRA transfers.
FALSE. The 45 million uninsured Americans includes eight million children and only US citizens, not illegal immigrants. COBRA transfers are included as insured parties and so are also not counted. Most of those without insurance now, feel they cannot afford it except for the super wealthy who self insure.
7. “Oligopolistic pricing could largely be addressed by allowing insurance companies to do business across state lines.”
Except for Kaiser Permanente which is repeatedly blocked as a threat, most insurance companies can and do cross state lines without a problem. All you have to do is qualify in the states where you want to do business. Most insurers do that without difficulty. Two health care insurers that operate nationally account for 1/3 of all health insurance written. Oligopoly pricing is the problem. We are being gouged right and left and at all levels.
8. “Preventive medicine does surely makes logical sense from the stand point of your personal health. However every study shows it has no long term impact on reducing cost. On the contrary it actually marginally increases the cost.”
This is false. According to the CBO, researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness. However, experts have also concluded that a large fraction of preventive care adds to spending but should be deemed “cost-effective,” meaning that it provides clinical benefits that justify those added costs: Roughly 60 percent of the preventive services examined in the review cited above have additional costs that many in the health care community consider to be reasonable relative to their clinical benefits.
9. “Drug companies engaged in fraud. This is even more ridiculous for a # of reasons. But one example is this. The current regulations the FDA places on a medications expiration date is far more strict in the USA then elsewhere in the world. And the companies are even more strict in some cases due to the litigious society we live in.”
Pfizer has been fined three times in the last ten years for activities amounting to fraud. They just keep doing it. The major drug companies cheat on the rules all the time. They buy off companies that manufacture generic drugs. They slander products other than their own (“out of date;” “weak;” “dangerous”). They engage in serious oligopolistic pricing and much unfair competition. A big crackdown is needed. But it is for their other stuff that drug companies have paid a total of $1.6 billion since 2001 to settle lawsuits brought by whistle-blowers that accused them of marketing fraud and overbilling Medicare and Medicaid, according to a report released recently. More big fines are coming. The drug companies just pay the fines and go on cheating. They are invenerate cheaters because the fines are too low. See, www.uow.edu.au///~bmartin/dissent/do...
10. “The Dr Compensation is the best one of all. A typical Dr nets about $30.00 in an office visit before taxes. As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner.”
Your comment is absurd and outrageously misleading. Here are the actual data:
"The American Medical Association' annual physician income survey shows that, an average, doctors are making close to $200,000 a year." Too, here is average compensation by primary specialties.
Total compensation of Physicians by Specialty; 2002
Anesthesiology $306,964 Surgery, general $255,438 Obstetrics/Gynecology $233,061 Internal medicine $155,530 Pediatrics/Adolescent medicine $152,690 Psychiatry $163,144 Family Practice $150,267
Much, much falsehood and many lies here by FlavorJ.
I have a question about medical compensation in private practice: What asset and income positions are not reflected in reported compensation? There is a persistant claim that statistics such as those reported above do not include dividends and profits from closely held practices and partnerships (ie, stock ownership benefits from the practice), but only salary, benefits (and not all of those), and any new/granted ownership shares.
Most small Private Practice firms are S Corps. Everything flows through to the personal return in that case. There is no stock granted, options or deferred comp. Some larger practice's are set up as a partnerships. Typically little is paid as a dividend in my experience. That has a lot to do with benefits testing under ERISA. If you declare income as a dividend rather than salary you cannot calculate it into DB/PSP/SEP contibutions. That just increases your tax liability short term and makes it less practical. The benefit is seen upon sale of the practice or their relavant portion whether partnership or sole owner as an S corp. the problem is in a personal service business you are the business. So you can' t just walk away. They're is usually a period in which you are retained before seperation of service to keep the business and the patients of the practice intact. With heathcare this is always harder to do, because the Dr's reputation goes along way. Just buying his practice doesn't confer on you his experience. It's much easier in larger practice's where you may see all the drs in the practice as part of a team based approach.
1. That is absolutely false. Healthcare is anything but inaccessible in the USA. In the Year 2007 the British health minister admitted that one in eight British patients still wait for more than a year for treatment. You neglected to mention that Britain has had to import more than 20,000 physicians in the last three years—chiefly from Middle Eastern and Asian countries—because so few of the British want to enter or stay in the profession after sixty years of experience with the NHS. In the year 2003 13,000 citizens in France died of heat prostration and dehydration during a heat wave in the summer of 2003, when most French physicians were on summer vacation and did not show up in emergency rooms. This would never be tolerated in the United States. Example… I play amateur baseball player for fun since my early 20’s. This has has an impact on my knee’s overtime. There isn’t a year that goes by where I don’t have an MRI anymore for a strain or in some cases a tear. Citizens in Europe do not get annual MRI’s. I have so many that I am more concerned about the impact of the MRI itself than I am the Knee problems. Access is not the problem. We’ll maybe now it will be. But this is why it contributes so much to GDP.
2. Point about British citizens is hardly a lie. There are different levels of coverage. It has also become common place for British citizens waiting for free surgery and cancer treatment fly to India to pay for it. More disturbing is that more than one third of physicians employed by the National Health Service in Britain buy private insurance. Curiously you make no mention of National Rationing bodies that exist in Britain ??? the same body that recently denied Breast cancer medication to women in need.
3. Medicare, administrative cost includes not only reported costs but a proportional allocation of all overhead costs for functions where people spend time on Medicare but are not allocated to Medicare by the government. Medicare unreported costs include parts of salaries for legislators, staff and others working on Medicare, building costs, marketing costs, collection of premiums and taxes, accounting including auditing and fraud issues, etc. These are currently included in the Federal Budget in various areas such as legislative, judicial, and Health and Human Services, but are not specifically earmarked to Medicare. Clearly you don’t address all aspects of cost in your rebuttal. Private market administrative costs do include acquisition costs over and above commissions, such as underwriting and advertising.
4. Medical Enrollment has seen are dramatic decrease in this country among OUR citizens. Try checking the Demographics. There is massive # of new students coming to the States because of greater economic opportunity that doesn’t exist in foreign countries. And may not exist here much longer. I live a stone’s throw from a teaching hospital like Stony Brook University. Virtually all residents are foreigners. Also largely because most Dr’s do not encourage their own children to enter the field. According to Association of American Medical Colleges The average physician's net income, adjusted for inflation, declined 7% between 1995 and 2003, according to the Center for Studying Health System Change. In order to enter the most lucrative specialties, like radiology, ophthalmology, anesthesiology, and dermatology, doctors must continue with their training into their 30s. That means they can't start chipping away at their debt…let alone make money…until a time by which their counterparts in law or business are usually prospering. And here is Kimball Corson trying to cut their compensation further.
5. June 26th of 2009 the Washington Times released a report on the status of Heath care in America. Only 44% where happy with the National status. But when polled about THEIR OWN personal Coverage…93 percent were satisfied; 95 percent of those who suffered chronic illness were satisfied with their health care. That’s an impressive #. Rasmussen… the most successful and consistently accurate pollster had different but similar #’s. While 93 percent of the insured say that they are "satisfied" or "very satisfied" with their own health care, Curiously…70 percent of the uninsured who indicated their level of satisfaction said the same thing.
6. Anyone who reports that there are more than 46 million uninsured is greatly exaggerating since the Census Bureau puts the number of uninsured at 45,657,000 people. Nearly 10 million, 9.7 of the 45.7 million uninsured are “not a citizen.” That makes every media claim of uninsured Americans higher than 35.9 million is wrong. More than 17 million of the uninsured make at least $50,000 per year (the median household income of $50,233) – 8.4 million make $50,000 to $74,999 per year and 9.1 million make $75,000 or higher. Two economists working at the National Bureau of Economic Research concluded that 25 to 75 percent of those who do not purchase health insurance coverage “could afford to do so.” An Urban Institute study found that 25 percent of the uninsured already qualify for government health insurance programs. The Congressional Budget Office says that 45 percent of the uninsured will be insured within four months. “CBO Director Douglas Holtz-Eakin also said that the frequent claim of 40+ million Americans lacking insurance is an “incomplete and potentially misleading picture of the uninsured population.”
7. Point. From the statement I will assume you have never attempted to even register with a State regulatory body to sell Insurance across state lines. I have to do that for Interstate clients. It is quite the task…And it is the STATE whom makes this quite problematic. Another example of your lack of experience in the field of providing a Financial services.
8. Point 8 is not in dispute. I am not against preventive medicine. My point was is it not really a cost savings. It doesn’t mean it should not be practiced.
9. Drug Companies engaged in Fraud is a myth. The cost to manufacture a drug is astronomical. Virtually every company in every major industry is routinely fines for something because the medical Industry along with many other industry’s is a web of regulation that is impossible to maneuver. Case in Point…Boston Scientific recently was forced to suspend the sale of one of their cardiac defibrillator. There was absolutely nothing wrong with the product…yet a minor regulatory filing has forced them to halt sales and cost the company millions. Pfizer for example as most drug companies do, literally gives away medications close to a couple 100 million each year to the truly indigent. My estimate is they give away a much larger percentage of their profits than you do as a percentage of your AGI. For those of you who know someone in need…Feel free to contact them directly as Mr Corson would never provide such data, I shall link to it. ….www.pfizerhelpfulanswe...
10. Without even realizing it you just made my point. As I Said….” As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner.” Your own data reflects a “Family Practice $150,267” According to MTA New York A New york city bus driver max pay is $29 per hour. With overtime they cap at 87k. With total benefits pension…Deferred Comp…Health Coverage for life…they earn in excess of $200k.
11. lastly…YOU HAVE NOT ADDRESSED MORTALITY RATES….Because as I have clearly explained to the literate…The criteria that goes into determining mortality rates is not UNIVERSAL. Therefore the CIA fact book can only use the stats that each nation reports with no standard around the methods. The case in point about infant Mortality illustrates there are vast differences in whom is excluded from the data. Many studies have been done applying the same standards and as expected the US ranks at the top. When further eliminating those whom have not had contact with the healthcare field the statistics reflect even better for the USA. ( Although it is a bit harder to quantify whom has or has not come in contact with the healthcare system) Michael Tanner has done Numerous studies to this effect and testified before congress specifically in reference to this issue. Using your logic Kimball…I run 100 yards and you run 50 yards…The fact that you finished first would make you clearly the faster runner. Thank god no organization has placed you in charge of a pension fund. Using your methodology we would have no need for PBGC.
Once again you have failed to address the question of Federally mandated cost controls on attorneys in light of the outrageous profits in the legal field…with disproportionate services rendered to the wealthy.
Folks this is a classic example of Academic experience without real world practical experience. Kimball seems to think doing business across state lines is so simple. Lets assume you choose to sell Health, Life or even annuities. Just the Company registering is not enough. If you have 2000 agents representing these products then each has to be registered in each state. And most states do not allow for out of state registrations to be transferred with out sitting for that states requirement. NY accepts NOBODY. Actually NY is the one that is most likely to get honored out of state. So if your a small insurer you need and agency office in every state to compete. Not always cost effective oviously. So you can conduct business via Call centers out of state. But then each agent needs to take a seperate exam per state since few honor each others requirements. Each state has seperate continuing education requirements mandated along with filing fee and registrations fees. Keep in mind these test are not on par with the CFA, CPA or CFP exam. Frankly I wouldn't even call them difficult. But this is time consuming, cost inefficient, and not practical. Not to mention the time invested in an employee whom may shortly leave the firm or the industry. Ofcourse Kimball would have you believe this is all the companies doing. In reality it's the state mandates that obstucting the competiton. and yes...A few larger companies that can afford this expense benefit and monopolize the field. So once again Gov't manadates punish those they wish to protect.
FJ says: "I will assume you have never attempted to even register with a State regulatory body to sell Insurance across state lines. I have to do that for Interstate clients. It is quite the task…And it is the STATE whom makes this quite problematic. Another example of your lack of experience in the field of providing a Financial services."
Not so. On two occasions I worked with another lawyer to get foreign (out of state) insurers qualified and registered to do business in Arizona. It was not a particularly difficult task, but it was some years back. The ensuing regulation by the Department of Insurance was nominal at best, but the antitrust exemption so obtained for both companies was wonderful.
It's the not isurer a you overlooked. It's each individual agent with a seperate registration which is typically non transferable. As I said. 2000 agents are 2000, exams, 2000, 40 hour courses before you sit for the exam. ( P&C is serperate from Health Life and Variable annuities), registration filings and CE due typically semi annually. So I guess that means you had nothing to do with registering there agents and have no clue how cost inneficient that is.
Funny...But seriously, this debate reminds me of the Rodney Dangerfield comedy from the 80's when he went to college. Kimball is the Textbook College Professor buried in Macro Details with no practical experience of how to actually run a business. But I am quite certain he knows how to file a lawsuit against one though.
Are the money grubbers those who "left economics and the PhD program after finshing the course work and core prelims and contrary to the wishes and advice of Milton Friedman, because having good grades out of a top law school had much more remunerative prospects then than being an economist." Curious you didn't spend your career as a legal aid attorney or possibly employed with exclusively with a Gov't agency for the greater good.
What I know is how to meet payroll, Run a small business as well work for multinational financial firms Largely doing planning today small business owners, many of which are Dr's trying to work their way through the web of legislation that attorneys like you create.
Kimball, you observe near the beginning of your Instapost that only 5% of Americans believe their health care system is working satisfactorily. By contrast, Rokjok777 has described why he is satisfied with the Australian system and I as a Canadian can say the same for Canada’s system. By coincidence, ‘The National Post’, a conservatively oriented national circulation newspaper in Canada, published the following article
on March 29th reporting a Canada wide poll probing attitudes concerning various aspects of our system. These findings were essentially supportive of the current standard of coverage and service.
I don't dispute that most Americans believe that the system is in trouble. I dispute the reasons. Once again. When asked about THEIR individual situation there is an entirely different response. If istand in the Street and screaming and calling you a racist then most believe believe you're a racist. Rassmussen is hardly Left Leaning and the most accurate pollster out there. His result were not that much different. "68% of American voters have health-insurance coverage they rate good or excellent." That was Aug 7th 2009. Most Americans are in favor of change but not what we have gotten. 5% of americans don't organize 100,000's to march around the country as we have seen. Most people are far more concerned about th budget deficit that we face with a federal balance sheet in which 2/3's can be accounted for in entitlment programs. I pose a question to you being from Canada. This is not belligerent just and honest Question. I have heard repeatedly from colleagues and friend who live under a Socialzed system that care is fine for the simple routine procedures. But when you need urgent treatment or you are dealing with complex or time sensitive care that is where the problem is. Considering I believe it was Newfoundland and Labrador Premier Danny Williams was the one whom recently flew to the state for Heart Surgery, How do you rationlize this ??? I actually never heard what his response was. I am not even sure he if he ever made one.
Most delevoped nations with national heath care programs like their programs although some urge some minor changes. Such programs work too well in too many developed nations for the US naysayers to be believeable about them, with their dire predictions of collapse and terminal programs. The only terminal case is the system we have had. What is believeable about such naysayers, is their earstwhile desire to proteect their pursues and ill-gotten gains.
On Danny Williams of Newfoundland, please see my response to one of your earlier comments.
On you statement “when you need urgent treatment or you are dealing with complex or time sensitive care that is where the problem is” respecting Canadian universal health care government plans, my experience and that of my friends is that urgent and complex matters are generally handled in a timely and satisfactory manner. It is a myth to suggest that Canada lacks a full array of specialists and technology to address complex medical situations. Two observations should be made, however.
First, Canadian health authorities do not rush to adopt expensive new technology and pharmacology before their utility is established. They also do not encourage giving patients batteries of tests where a sound basis for diagnosing patient condition and prognosis would not be materially advanced by such tests. The statistics for patient outcomes in Canada are generally as good and for many matters better than corresponding outcome stats for the US which, arguably, indicates that this conservative approach generally does not prejudice patient outcomes. It is not only tight budgets that prompt this conservative approach. Concern over radiation exposure from over use of Cat Scans, for example, is the primary reason that this technology, very useful in specific situations, is generally confined to such situations. Also in Canada litigation concerns have not trumped medical utility as a basis for ordering tests.
Second, one potential weakness area under our single payer universal health care system is service to the patient with a condition that is chronic but not life threatening or threatening to cause material deterioration in the health and wellbeing of the patient if a remedial operation or further tests are delayed. In setting priorities by the allocation of funds to local health authorities and the distribution of funds for services by these authorities, the funding for services in this area can be short changed and waiting periods for these services grow in consequence. Much of the complaining one hears about our system arises from these delays. They are frustrating for those involved and some patients suffer unnecessary and sometimes serious deterioration in their quality of life attributable to such delays. Arguably this is essentially a funding issue – the downside flowing from the fact that Canadian healthcare costs are in total about 70% on a per capita basis to those in the US.
I suffered with a Chronic Illness ( Ulcerative Colitis ) for years & when I was just 20 years old I was forced to have my entire colon removed. I was operated on when it became necessary at the Cleveland Clinic in their old Ft Lauderdale hospital. about 15 years ago. Having been in that situation I am not interested in making a sacrifice to a system that will ever risk me waiting that long. As far as outcomes in Canada go I admit I have no first hand experience. However in britiain, I have experienced seeing this up close. Case in point.
February 2005 issue of The Spectator, a British magazine, James Bartholomew details the downside of Britain's universal healthcare system.
Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States
If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent
On the availability of equipment, explains Bartholomew, Britain has only half as many CT scanners per million people as the United States, and half as many MRI scanners. With lithotripsy units for treating kidney stones, the United States has more than seven times the availability per million of population than Britain.
An audit by the World Health Organization, for instance, found that over half of Britain's x-ray machines were past their recommended safe time limit, and more than half the machines in anesthesiology required replacing. "Even the majority of operating tables were over 20 years old --- double their life span," reports Bartholomew.
In Relation to Canada...He wrote...Quote "As a footnote on Canada, the average wait for a simple MRI is three months. In Manitoba, the median wait for neurosurgery is 15.2 months. For chemotherapy in Saskatchewan, patients can expect to be in line for 10 weeks. At last report, 10,000 breast cancer patients who waited an average of two months for post-operation radiation treatments have filed a class action lawsuit against Quebec's hospitals."
For me...sorry, If this is the standard...It's unacceptable. I'll let you be the judge since you live there.
The topic of life expectancy in the US as compared to that in other countries has been raised. Clearly several factors are relevant besides the availability and quality of health care from place to place. That said, the availability and quality of health care are clearly significant in this context.
I thought a comparison of life expectancy by Canadian Province with the US State contiguous with that Province might be of interest in this context. The following two web links will allow the reader to prepare rough comparisons for the 2004/5 window in time.
Too often when considering new ways of dealing with an issue we become prisoners of (a) existing models that apply to somewhat different issues, and (b) the terminology that best makes sense in relation to those existing models and the other issues they address. Unfortunately the debate about the delivery and funding of health care services in a nation state (or a state within a federation) has been especially burdened by this problem in the way we conceive issues. Thus, for example, when we talk of ‘insurance’ schemes in relation to national or state health care availability, the mind naturally turns to the term life insurance or to the fire insurance model and this, arguably, clouds our thinking. A more apt analogy in the national health care context might be made to unemployment insurance but even this only begs the question because the ‘risk pool’ for national health coverage is unlike any other insurance scheme.
My thought is that the starting point in any discussion of coverage for national health care is universality within the national community. (This is not to say that valid arguments can not be made that various segments of the national community should t be excluded from some or all elements of coverage; only that the starting point for debate would naturally be general inclusion for any and all persons without exclusion for any medical condition). However, universal coverage is not a concept that is easily made compatible with insurance concepts.
What happens when we try to create a national health care program on a term life insurance model? Under such a model it becomes one of the functions of the insurer’s administrators (whether the insurer is a private or public sector body is not really at issue) to exclude coverage or disallow claims and it becomes one of the temptations of persons seeking coverage or making claims to delay joining a plan while they don’t need its services, misrepresent their pre-conditions and fug their claims. In other words, because the model doesn’t fit the need, people on all sides game the system.
It is perfectly legitimate to argue that national schemes for near universal health care coverage are poor public policy (This isn’t what I would argue but that isn’t the point here). It is, however, a poorly framed debate if arguments centre around whether some facet of coverage reflects good insurance policy as reflected in the way term life insurance plans are administered. The real questions are two: (a) how best to ensure that the health services needs of all people are appropriately met in a way that makes services readily assessable to all and affordable to both the individual and society, and (b) what, if any, is the role of government.
The questions you pose are the two that FlavorJ and his side kick most wish to ignore. Ditto, the naysayers. Absent coherent alternative proposals that stand some chace or working, passing and covering all, all of this here is just flack in an attempt to protect the unsustainable status quo.
Sidekick is not the case at all. I am just a medical practitioner who is also and investor enjoying this debate. I will say that flavorj makes points that are quite true. Dealing with private insurance is far simpler than any government program.That's not to say private insurers are not in any way difficult. But truthfully medicare is impossible. So in my case I no longer accept medicare and have never accepted medicaid. You can make all the statements you wish about us "helping people" However you fail to realize we do loose money on these patients. You often wait anywhere from 6-18 months to get paid if you get paid. And when you do, it's nominal. You have little recourse even when they make a mistake. You can't run a business this way. We have employees with salaries, benefits, office space to pay for. We have electric bills and office supplies that must be paid. These resources will not wait to be paid. I can't tell the electric company to wait untl Medicare sends me a check. With an aging population, the market place of people that have private insurance is getting smaller when compared to medicare patients. Those demo's are only going to get worse in the future. And I have no faith in the gov't to do any better than they are now. And no I would not tell my children to enter this industry. There is too much time, education, stress and liability. The reward is not there. I would like my children to be succesful and sadly the medical field is not and will not be the place anymore. With reference to life expectancy I have seen some similiar data. And I can guarantee you that mortality rates are not dropping fast. You truthfully don't need to study statistics to see this. With the naked eye americans can see all around them people today that are in their late 80's and 90's. I see many patients in this age bracket. If you really think about, twenty years ago a 65 year old was an old man. That's really not true anymore. I would say that is now the prime of your life.
I would like to believe that, at almost 70, I am at the prime of my life, but I know better. I used to be able to hit a softball further than anyone I ever met and throw a football accurately for almost 75 yards. Now, I huff and puff going up 300 meters of a mild hillside slope. I have climbed Popocatepital (18,000 feet plus) in Mexico, and Cotopaxti (19,000 feet plus) and Pichincha (15,200 feet plus) in Ecuador and several lesser mountains elsewhere, but I could no longer do that or indeed, come close to it. At one point in my youth, I daily swam two miles a day with a coach. No more. I also regularly rode big powerful and hot horses I owned on 100 mile endurance trail rides (flat out fastest between start and finish). No more. I am a shadow of my former self, in terms of my physical capability, and even to some significant extent in terms of my appearance. I wish.
You are however traveling the world apparently at almost 70. That's impressive compared to the life of a typical 70 years old 20-25 years ago. Your personal travels however don't address what is actually happens in my practice specfically in the case of how medicare cripples me. And no we don't call it pro bono when we don't get paid for out work. But'll we'll soon call it slavery. As more and more doctors accept the opt out option of programs like medicare, eventually the feds will mandate we accept these programs regardless if we get paid. We'll be forced to provide services for free. Unlike an attorney who may just choose to not take a case. This is exactly why I do not wish to see my children enter the field. And the standards to attend top medical schools will decline and become more inclusionary. But who do you want operating on you when your life is at stake ? The nicest physician with a great bed side manner or the most talented ?
I agree that the life of many doctors under Medicare is not what it should be. Too much slippage with medical codes, to fast a drop in payment rates, too much delay in payment, too much interference in the doctor patient relationship, too much interference with proper treatment, too high malpractice premiums, etc. etc. These problems need fixing. No real argument from me here.
You may not have difficulty in dealing with private insurers, but many times the owners of those policies do. You like the situation; often, they don't. Many states, even Arizona, have gone so far as to authorize bad faith claims against insurance companies who fail to carry their end of the bargain, stall, try to cheat the insured or otherwise act in bad faith. The need for such laws speaks volumes about how insurers behave and why those insured don not like them.
Well thought out statement I would say. In terms of the Mortality rate I would be careful with Wikapedia since almost anyone can modify that data and it has often been found to have a # of mistakes. The main point of my argument is that many mortality studies particularly the one issued by the WHO is greatly flawed because it doesn't use universal criteria. Each nation can report based on different standards. I personally believe much of that is political. The united states accounts for virtually everyone in their modeling. If you use the Swiss Model and eliminate a enormous # of Infant mortalities than you have removed fatalities that are in some cases only days old from your "Average". There are a # of holes in this data. As I said earlier there are too many to go into. And anyone in the Pension industry can tell you they're largest challenge is that people are living too long. However Michael Tanner has done some great work in this area. With regard to the role of Gov't. I believe it should be little. And I believe our constituiton in this country backs that premise. As a candian your founding documents may have been written differently. But the Premise that our founding fathers based this nation on was Economic & religious Freedom. Nobody is guaranteed success. Only Opportunity. The moment you assume you have the "right" to the fruits of someone else's labor, you then must examine what rights are left for the one providing such services. This is why no such rights exist in the constitution or the 27 amendements. Any Dr in private practice in this country knows it's worse dealing with Medicare and more so Medicaid. They have transitioned cost to the Private market in large #'s. There is not a gov't agency in this country that is run well at the Federal level. Their budgets are out of control. Incompetence is everywhere. We've all seen the stories of the pentagon spending $100.00 for a $5 hammer. The more dangerous question for us as Americans is what else can I be forced to buy...Or pay for on behalf of someone else regardless of how irresponsible they are Once the precedent is set. Americans are for the most part quite a charitable nation. But by the force of Gov't you empower Gov't not people. To me a much larger concern is There is a great degree of naivete among the people that gov't when intrusted with such power will operate in your best interest and make better decisions than you will. That has never been true throughout history. Nobody in this country wants anyone to go without the necessary care. But Gov't run institutions have never produced a better outcome. I personally am fairly well off now. But I grew up in some of the poorest area's of NYC. I've been in places like Lincoln hospital in the Bronx. Even in the worst hospitals in America...Nobody is denied care. There is no truth in this. The system is quite accessible. There are inefficiencies. For me failure was never an option. Most of the young people I grew up with that never went anywhere had what I call "Victim syndrome". They had been bred to believe they can't achieve something. It must be provided. And politicians love a society of dependent people. The larger the Gov't gets...the more the defeatest mentality sets in. We see this everyday in NY...as it is a melting pot of people from different cultures. We see people come from third world nations with nothing in their pockets. And a few years later they own a Grocery store in midtown. Then we have those raised in entitlement society like what we are rapidly becoming...and You have 3-4 generations of Poverty. I know people with Down Syndrome that hold down a job, receive benefits and live in their own Apartment. It can be done if the will is there. And The Gov't doesn't have to provide it for you. As for basic changes and what the Gov't can due. I think the tax code need not be punitive but provide more incentive for those to provide for their own coverage independent of an employer. But that should not be paid for by your neighbor unless they so choose to. As far as the Author goes... My problem is the simple hypocracy...He would never apply the same standards to his trade as he would to a Dr. And over the years I have seen this too many times in the field of Financial Planning. This may not be you...but the vast majority of Left leaning people have earned the term "Limousine Liberal" And they are consistently the last ones to give money to a charity in any sunstantial amount..Pay back to the Treasury the tax breaks they claim to not deserve. It's always somebody else's money. When I worked for a competitor I held a lower position but I would commonly see the assets of Celebrity's and Politicians. It was sickening how hypocritcal they are. But this has always been the way of the Central Planners.
"All Animals are Equal...except for some Animals...which are more equal than others"
I can understand problems with comparability regarding mortality rates as well as I can understand such problems regarding reported life expectancy rates. Where there is an urge to "tell it with a slant" we all suffer in ignorance. The question is always by how much?
FlavorJ asks me, DO YOU OR DO YOU NOT SUPPORT FEDERAL MANDATES ON RESTRICTING ATTORNEYS FEE’S TO PROPERLY BALANCE THE SYSTEM AND PROVIDE FOR EQUITABLE DISTRIBUTION OF SUCH A VITAL PART OF OUR JUSTICE SYSTEM ???
My answer is no. Here is why. The medical and legal systems are different. The ABA has never restricted the number of law schools, which have proliferated hugely, to artificially depressed the number of lawyers in practice to drive up their salaries which, on average, are much lower than in the medical profession, neither have state bar exams. Second, everyone has a right to counsel in felony criminal cases even if they cannot pay. We have a public defender system and where one is not available, a lawyer is appointed from the practicing bar. Too, incompetent legal representation here is grounds for reversal on appeal in such criminal matters. Third, very much pro bono work is done in the U.S by lawyers everywhere, usually on smaller cases. Fourth, civil cases that are worthwhile are taken on a contingent fee basis all the time in a large proportion of all civil cases; no recovery means no payment. The medical system never charges based on treatment outcome. They charge, often for ineffective treatment, if you were going to recover on your own anyway. There are no drug or insurance oligopolies to deal with in law. Courts do a reasonable good job. Very few with bona fide and worthwhile claims go without counsel. Malpractice assures minimal competency or a recovery if it is not provided. The legal system, even with its broader range of talents among lawyers, does much, much better than the medical system of doctors, drug companies and insurance companies so that, while there are some significant inequities, there are no real grounds for federal intervention in law.
The US medical system works well and fine, but only if you are wealthy enough to self insure or have a Cadillac or better yet a Maserati insurance policy, and you drop in from the top with mega bucks to spend on care. Many people are cut out of the medical system almost totally and that is not the case in law.
I should add, in response to an earlier and unrelated comment, my experience with the Arizona DMV, the Post office, the local public (charter) schools (with five children) and the local Social Security office has been uniformly excellent. Government services are not bad because they are provided by government. Did you ever call a U S private business and been told your business was important to the company and then been placed on hold interminably? I have, many times. The private sector fails frequently. You just cannot be ideologically biased about these matters as you are.
Dr's don't regularly do Pro Bono Work ??? The entire Medicare system has become pro bono work !!! Have you ever heard of Operation Smile. My Brother in-law did work for them for years. I supposed that was just the industry providing limited access. Your accusations are baseless. Your improved services at the DMV in AZ may be a result of the fact that you live a relatively small Gov't low tax state compared to us here in NY. Here when you go to DMV....You take the day off of work. It's at least 3-4 hours. The Post Office is Bankrupt and can't even deliver overnight anyore. They contract out UPS to fly the packages for them because they can't afford to run effectively. If you haven't heard...Soon no more mail on Saturdays. Don't waste your time justifying the legal sytem... When my father left the landscaping business, and became a NY city court officer, I spent many a night wathcing criminal court arraignments in Kew Gardens Queens. The Legal aid is a joke. Cause for a mistrial ??? You know damn well the way the system is supposed to work and the way it does are two different things. The joke around night court was the policy here is "Refer and Deny" Judges where routinely bribed and Legal aid couldn't litigate their way out of a paper bag. The system was so corrupted the Borough President commitied suicide after getting caught up in a parking meter scam with members of the court. I distinctly remember watching a young attorney by the name of Greg Meeks routinely get humiliated by Justice Glass for his incompetence in court. Not too many mistrials where declared my friend. Sadly Meeks now is in Congress as ranking member of the Finance commitee. The first time I saw him on TV I almost fell out of my chair. Don't get me wrong...Nice Guy to me when I was young kid hanging around the Courthouse. But he could screw up a cup of coffee. And yes we've all had business experiences in the Private sector. And we then Likely go elsewhere. Sadly I can't register my car anywhere else. Caddillac Plans ??? Blockbuster video offers employees a "Caddillac Plan" Last Time I checked you don't need an MBA to work there.
As for what real reform should look like I would say as follows.
Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation)
Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles.
Elimnate Medicare altogether for all those not currently enrolled or more than 10 years from enrollment. To be replaced by a system that is market based yet still regulated. Inurance companies shall compete for a larger marketplace.
Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.
Tax incentives to Purchase Private insurance should be both individually based along with employer based.
Place some Constraints around the FDA. The FDA has kept some unsafe or ineffective drugs off the market. At What Cost ??? The FDA adds billions to the development cost and price of new drugs. The FDA delays the availability of new drugs for years. The FDA prohibits the use of new drugs that treat conditions for which other drugs are available, regardless of how much better they might work for some patients. The FDA withholds new drugs—even those that passed initial safety tests—from terminally ill patients, in the name of preserving safety. When one of these patients wins access to the drugs by going to court, the FDA, apparently in a relentless effort to protect the health of the dead, appeals the ruling until the patient dies, at which time the appeal is of course dismissed. The FDA and Congress allow the drug approval process to be politicized to protect the interests of firms with political pull or to serve the anti-corporate political agenda of those who would rather see Americans die than allow any investors or businesses to make money developing new medications. The FDA constitutes a roadblock to new developments in anti-aging drugs by refusing to consider any science that would extend healthy lifespans—because "aging is not a disease." The FDA states that it lacks the resources to ensure human drug safety but requests more resources to review veterinary medicine. The FDA now publishes lists of drugs it approved but the safety of which it questions—leaving physicians in the lurch and creating a potential jackpot for litigation.
By definition, legal pro bono work is work you understand up front that you will not be paid for, not work you do expecting some payment that then does not get made.
One of the studies that Kimball calls Obscure is linked to below. I would challege some things in it...However Tanner does a great job of addressing political bias in the study of healtcare globally as well as life expectancy His work has been an excellent resource for some if us who do work in the Pension business. For those of you who are truly objective and not interested in attacking corporate America as kimball does as some evil entity, then read it with an open mind. There is additional data available from the actuarial society. You'll need some time. It's 50 pages and it's in PDF format. www.cato.org/pubs/pas/...
I will read the Cato piece and also respond to your reform proposals when I get a chance. I have to go into the main city and also to help someone here find a good lawyer in the states and get that lawyer orientated to their problem. Out of pocket for a bit.
P.S. We do not call not being paid what we want or customarily charge pro bono work in the legal profession. Too, courts in most areas are not as bad as the state courts in NYC and Chicago. I tried cases all over the country, mostly in federal courts, for notable and not so notable clients and found the courts uniformly good, some excellent, including in the Southern District of New York.
I have tried to get the 50 page piece, but I do not have (a) the bandwidth or (b) the connection time to succeed. I will have to wait to get back to Neiafu to get it. I am out in the islands.
FlavorJ. Now you quipple with the mortality rates reporting systems for various countries but earlier you had no problem declaring that mortality rates were better in the US than in the countries for which I reported doctors per 1000 of population. Now, of course, me thinks thy doth protesteth too much, when I use standard data to absolutely refute your claim but you offer no better data to establish your proposition. I have a problem with that as a method of argument. Changing the subject to longevity concerns only compounds the problem I have with your position.
Jumping even further afield, you argue "But the Premise that our founding fathers based this nation on was Economic & religious Freedom. Nobody is guaranteed success. Only Opportunity. The moment you assume you have the "right" to the fruits of someone else's labor, you then must examine what rights are left for the one providing such services."
The health care legislation and agenda goes not guarantee anyone financial success. Too, since the passage of the Constitutional amendment allowing an income tax and a progressive one at that as construed, the "fruits," as you call them, of someone elses labors can in fact go to someone else in significant measure, especially where those fruits are ill-gotten or misbegotten gains from oligopolistic or defrauded markets. But actually the looting has been going in the opposite direction: from the middle class and some poor to the rich and wealthy.
In fact,the situation is so bad that the income distritution in America has become skewed hugely against the middle class and some what the poor by the rich using and abusing government and its systems of doing business to loot America and the middle class of income, taking their "fruits and earnings." The current distribution of income is 23% to the bottom 59% and 6% to the top 1/10 of 1%. The wealth distribution is also not the Pareto optimal of 80% with the top 20%, but is now variously estimated to be 88% to 93% with the top 10% to 8%. The "fruits" of their own labors, my ass. They don't pay their big campaign contritutions and their lobbyists mega bucks for nothing.
The problem is rendering our country's economy dysfunctional because of the associated drop in the average propensity to consume consumer goods and services which drops aggregate demand and GDP relatively and raises the demand for financial assest on world secondary markets simply causing them to bubble up. We have the DOW almost at 11,000 with a real unemployment figure of 17%, to show you how out of whack the system is.
Or perhaps by earn and fruits you mean the mega salaries paid, like those to Wall Street bankers who dropped their companies in the toilet of insolvency slated for bankruptcy, only to be bailed out so their salaries could be continued. The pentagon spending $100 bucks for a $5 hammer is simply one of a million ways income is tranfered from the middle and lower classes to the rich who own the selling companies. Think of it as a $5 hammer sold for $5 with a gift to the rich company owners of $95 from the pockets of middle class tax payers. More "earned fruits. "Give me a break.
In the context of a discussion around Health care, which I believe this discussion is about I stand by my statement about average life expectancy as well as longevity in better in US. As shown earlier in earlier posts
( Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent )
If you would like to examine other causes of mortality ancillary to health care that is a discussion for another time.
I believe the founders would have quite a few problems with the punitive tax code we have developed today. And the problem with the legislation is plentiful. No it doesn’t guarantee anything…Yet. But as the president has said more than once, this is a stepping stone to single payer system. First off this legislation compels you to buy a private product under penalty of fine via the Gov’t if you don’t. Hopefully the Supreme Court will here this case and overturn it. We shall see. As far as rights to someone else’s labor…For Ex. I have the right to Keep and Bare arms. But such a right does not provide me with the expectation that the Gov’t must provide me with a firearm, nor does a private manufacturer. Nor am I required to purchase such and item. I have only the right to do so should I wish, and I am required to acquire this via my own resources.
Your point about the Court system in NY and Chicago being more dysfunctional than other places is well taken. I’ll than assume that you agree the larger the beauracracy (Major Cities), the less efficient. Interesting concept. I’ll agree hence my opposition to Gov’t run Healthcare.
You will never hear me justify the TARP bailouts. I believe these companies have every right to fail as they do to succeed. However you really out to take a much closer look at the Gov’t mandates and political pressure that where also handed down on many of these companies. Just look at some of the actions of Andrew Cuomo, or soon to be Gov a HUD Secretary.
You need to seriously do away with this concept of Equitable Wealth Distribution. The fact is that wealth distribution is more a function of effort and not nearly as much as conspiracy. If there is a conspiracy it’s the Federal elites insulating themselves. My life story and many others are proof that success can be achieved regardless of where you come from. I have no issue with lobbying. We all have a right to campaign for positions that we see to be fair. It’s up to the Politician to provide representation of the people. Dow 11k is irrelevant. You know full well markets have always been irrational in the short term. There may be numerous reasons for the dow at 11k. Possibly the dollar carry trade yet to unwind. Time will tell. Possibly we’ll look back in a few years and see the market got it right and we had stronger recovery than expected. I say not likely as the Keynesian will be wrong again and QE will fail miserably. We will fail period until we have a tax code that incents Capital Expenditures.
The reason the Gov’t gets away with the $100 hammer is the Government is empowered…Not the People.
Lastly one thing you seem to be missing in much of your writing is a serious problem among the lower income and the middle class. I consider myself among the middle class. In my house I have 3 TV’s ( One HD) 4 phones with two lines, 2 cars, 2 DVD players and 3 VCR’s. As demonstrated in earlier posts. There are a large # of uninsured that can afford to be insured but choose not to be. Where are they’re priorities when it comes to personal spending. I am somewhat guilty of this as well which is clearly evident. My grandparents where working class, and in there day they had a radio. They had ONE radio. This is the problem with the entitlement society. This reminds me of a story my brother in-law told me when he was still working in the ER. He had just finished hours of surgery putting a young boys face back together after a terrible car accident. When he went to the waiting area after surgery, he explained the situation to the father. He also provided him with some prescriptions the young boy would need going forward. The father looked at my brother in-law and quite combatively said, I can’t afford that !!! He then proceeded to take out his “Blackberry” to make a call to a family member I’ll presume. See if you can figure out what is wrong with that scenario.
I am quite curious to hear your take on the Tanner policy analysis. My guess is you’ll find some other way to assail American industry.
All policy changes are irrelevant if we don’t eventually institute term limits in the future. One term…6 years for all member of congress and the president. No future federal appts once you have served in congress. Nor can you run for another branch of congress.
There is some Debate as to whether this book was ever even written. But the words clearly ring true.
In the year 1801 Sir Alex Faser Tytler a jurist and history professor wrote this in the " Decline and Fall of the Athenian Republic "
. . a democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largess from the public treasury. From that time on, the majority always votes for the candidates promising the most benefits from the public treasury, with the result that democracy always collapses over loose fiscal policy, always followed by a dictatorship."
Sir Alex Faser Tytler (1742-1813), Professor Universal History, Edinburgh University,
Democracy is not sinking our ship; it is more the wealthy abusing government. The middle and lower classes haven't figured out Sir Alex's notion yet. They are too worried about family values, gays, abortion, religion, blacks and terrorists.
FJ writes, "this legislation compels you to buy a private product under penalty of fine via the Gov’t if you don’t." This was thought to be the easiest way into reform because it throws new business to the insurance industry before it hammers them on their rates and margins. 87% premium hikes over 6 years and 12% annual profit+admin cost increases are simply out of line. The theory was we have to work with the private insurance industry and clean it up. I do not think that was the best model for reform, but it was the easiest to implement politically.
The Cato piece was very informative. I have to admit that I have read to some extent that there are differentials in outcome related to specific fields of treatment. However, I had no idea there was such vast differences. The outcome in cancer survival rate certainly shows in which country the larger majority of people are being forced to suffer. That is clearly not the US. However, the one nation which was not mentioned in the study was Australia. Since it was subject to this debate I'd be curious to see some of his work in a side by side comparison.
sorry, i know of no specific comparisons he has done side by side with australia. i would imagine you could email that question to him directly at cato. most interesting to me is the statistics based on outcome are provided directly by the very national health systems of these countries themselves. that was my point about the average life expectancy being the highest. when focusing specifically on healthcare outcomes in virtually every major category we rank at the top. i personally think that as with anything you cannot expect a perfect system without flaw. but at the end of the day we may have to accept the fact that even in a more free market based system we may be able to cover more people, but it may not be possible to ever cover all without having the negative impact on the system he chronicles in other nations. For me, I am not willing to burn the farm down to save it. Sadly that is likely to be exactly what happens. Not a collapse but a slow decay, much like we have seen in this country in the area of work ethic. I'd like to think the generation younger than I would have a more driven to achieve success outlook. But I doubt it. My wife and I commented this winter as we were bombarded with one of the worst winters this year. Not one young kid came to knock on my door and offer to shovel my driveway for a few dollars. when I was young we couldn't wait for the snow. We'd fight over who worked which side of the street. I guess today there all home playing with their Nintendo wii.
This other SA article will interest you and the other commenters. It deals with the question of how people deal with their medical needs during an economic downturn in various countries. It also asks an important question about the long term impact of cutting back on basic health care needs.
bob, after publishing over 100 consecutive articles of mine, I submitted my next to last one originally entitled The Economics of Health Care and Seeking Alpha rejected it. I revised it to be less political, as they had characterized it, but they rejected it again. Then I submitted this article on The Economics of Health Care Reform and it too was rejected. I revised it and it was rejected again. I don't think Seeking Alpha wants to hear further from me, especially after I told them I though the earliest rejections were politically inspired.
I will look at what you suggest, but think the special case of a recession should be an after thought at best on how stuff in this area works during normal times. The area gets almost no press coverage worth a damn and public misunderstanding is rife. It is too bad.
Kimball, having observed how some SA articles written by others that appear to be devoted solely to slaging some political figure or exhorting the merits of some political position, it is easy to understand the frustration you are now experiencing in the face of resistance to the publication of your most recent material. Hopefully you can take some comfort from the fact that an Instablog by you like this one can attract more comment and, presumably, a larger readership than many of the SA articles written by others.
Whether one agrees with you or not on some point from time to time, we all know that all material you write is well crafted and thought provoking; something that cannot be said of all SA articles by others. Keep it up.
I´ll sit back for a while and enjoy my setting here, but probably will get back to writing some in a bit, but I have to get caught up on the stock market as well. I am leavin money on the table all the time being out of dependable internet range and my correspondence is also way behind.
You are probably right, bob. People to not have to agree with me. The preferred target is to get people thinking about the subject, doing some research on their own, contributing usefully to the ensuing converation and making adjustments in their own thinking (mine included) as they feel they should. It should be a learning experience for all.
Sorry for being out of pocket. I have been helping someone with a problem and am in a remote area with very spotty to non-existent Wi-Fi. Here is an expansion on my previous response to FlavoJ regarding how government is being used to loot America. He contents I "need to seriously do away with this concept of Equitable Wealth Distribution. The fact is that wealth distribution is more a function of effort and not nearly as much as conspiracy." I disagree, believing income and wealth distribution have too little to do with effort of the right kind and to much to do, not with a conspiracy, but with working a racket I describe below. Except for the middle and lower classes, earned income is a joke of the richer classes.
To be sure, we do have too much public debt. Much of it is left over from Bush, who squandered a $4.6 trillion dollar surplus from the Clinton years and ran up more than a trillion dollar deficit, with his tax cuts for the rich and his big wars, leaving us with a recession after the good economics times of Clinton. Then some more public debt was generated from bailing out the ill-behaving big banks during the recession and then even more from stimulating the economy. As Kenneth Rogoff at Harvard, one of the very best economists we have, argues, coun
tries with higher public debt ratios run a greater risk of (a) financial crises, (b) political instability, and (c) slower economic growth. I believe he is correct on all three points. We could attack our debt very well for starters by simply cutting the hugely bloated defense budget, among others, that feeds the rich from middle income tax dollars.
Let me explain. Chopping this bloated defense budget and other bloated government budgets is the key. Those budgets are simply being used to transfer money from the middle class tax payers to the rich. Here is how, on defense for example. Item X (e.g., a screwdriver, a toilet seat, a yard of nylon webbing) cost $y to manufacture and is then sold, very often on unbid and poorly or unaudited contracts, to the US government for $5y. $4y is -- in this fashion -- transferred from taxpayers (most of whom are middle class) to the manufacturer, usually owned by the rich, who ultimately get the $4y. Say, $0.50y is a reasonable profit. Then $3.50y is a gift from the middle class taxpayers to the rich via government. This happens on virtually everything all the time.
With just the defense budget alone at $663 billion a year, you can see the scope of the problem. It is a huge income transfer from the middle class, who pay the bulk of the taxes, to the rich. Only a relatively small portion of the defense budget is actually used for the wars in Iraq and Afghanistan.
Too, this has been going on for years and Bush expanded it hugely by “outsourcing” much of the work and business government did in all areas to private independent contractors who are the intermediaries for the rich. Government has been gutted.
That is the kicker. This problem is rife throughout government which has contracted out almost everything it used to do, down to and including Army motor pool maintenance in combat zones. The government has now made itself, mostly implemented during the Bush era, into the massive medium for looting of the middle class by the rich. The middle class gets too little back from their taxes. This is only one of many ways it is done, but even here it is done on such a massive scale throughout government that the looted sums are astronomical each year.
A partial solution to the problem would be to cut the defense budget of $663 billion in half to $330 billion, install serious auditing and mega fines for overcharging, pay for health care with $90 billion and then reduce the public debt with $240 billion. This is a great way to go here. Health care is funded. The rich are stopped from looting on defense. Our public debt is reduced. And our country’s actual defenses can remain strong without the looting.
However, the wealthy with their lobbyists and as campaign contributors don't want this and they have bought off Congress to protect their racket, not only in the defense area, but in every area where government has contracted out the business it used to perform to outside contractors. This is the racket of the wealthy to use government to get middle income tax dollars and induce deficit spending.
In a nutshell, America is being looted right and left, big time. 23% of all income now goes to the bottom 59%, 77%, to the top 41% and 6% to the top 1/10 of 1%. The super wealthy, those with incomes averaging $453 million a year, pay taxes at a marginal rate of 17%, a lower rate than most middle class tax payers. Too, it is now estimated that about 9% of Americans own about 91% of all wealth, where the Pareto optimal is 20% owning 80% of all wealth. These are the worst these distributions have been in American history.
Things are so badly skewed that less income is spent on consumer goods and services, lowering aggregate demand and GDP, because the rich spend a lesser percentage of their income on consumer goods and services than the middle class and poor, and spend more on buying financial assets in secondary financial markets, creating financial bubbles and instability.
Remember this now when you hear a political candidate for office use the defense “code words” to the basic effect --
'I am for a strong defense and want the very best for our boys in uniform who give their lives to protect our country.'
Either he is incredibly naïve, trying to sound good and doesn’t deserve to be elected or, more likely, he is basically saying “don’t touch the damn defense budget. It is transferring mega bucks to my wealthy friends who have put me into office with their campaign contributions and they expect a return on their money. If they don’t get it, I won’t be (re)elected, which (is) will be my basic goal while in office.”
This is cynicism of the very worst sort or unacceptable naivety in the extreme, each a ground for disqualification from public office. If an elected politician receives money from a rich man in say Ecuador, it is called a bride and if caught, both can go to jail. In the US, it is called a campaign contribution and the US Supreme Court goes out of its way to expand and protect it as -- of all things -- free speech under the First Amendment.
Meanwhile, what is happening is the middle and some of the lower class are getting clobbered, the income and wealth distributions are being badly skewed in favor of the rich and the economy, via impaired aggregate demand, is being undermined and strongly sabotaged.
The core problem is that most people do not understand this, especially those in the red states who regularly vote for Republicans and against their own purse and financial well-being all the time, because they are too much intentionally distracted by senior Republicans, at Karl Rove’s urging, onto relatively spurious issues and topics such as family values, gays, abortion, religion, the flag and the merits of Mom and apple pie. The red staters and middle class Republicans have been taken in hook, line and sinker.
The irony in your comments is that Clinton was more of a Conservative than Bush on Fiscal Policy. Cutting more taxes than he raised. Cutting Capital gains for the wealthy not the Poor who make no capital investments. As expected Revenues went up as rates went down. Then we had Welfare Reform and so on. The Same was true for JFK and Reagan. As Clinton's Sr Political Advisor Dick Morris has said many times...He would brag behind closed doors about continuing Reagans policies. I am intellectually honest enough to admit that although I believed he was weak on foreign and social policy...He was hardly a big gov't liberal. Yet Bush 43 claimed to be a conservative and was quite the opposite when it came to spending. The Military was peanuts compared to the entitlment spending he gave us. Prescription Drug plans...No Child Left behind that centralized education in washington. It went on and on...Not one Spending veto in 6 years. His father was another County Club Republican in many ways...Luxury taxes...Another failed half ass idea that cost more than it generated. I will take it from your lack of a response that you either never read the Tanner piece or just choose not to debate it on it's merits.
bob, an additional thought. Tying revenue acquistition for health care reform to employers may have an impact on labor mobility as well. Funding from general revenues might be a better way to go. Certainly there are some other countries that think so.
FlavorJ. I am having serious internet problems and have not yet been able to download the Tanner piece yet, but also I now lack time to read it just now, being immersed the the problems of some friends. It took me an hour to upload this small note.
Clinton was clearly more responsible fiscally than Bush who was a disaster for most but a superhero for the wealthy after giving them tax cuts and farming governement operations out on private contract to their companies. GAO can't keep up, especially when it is deliberately understaffed and underfunded. Bush was a disaster. Clinton simply got chewed on by Monica. Compare which of the two got how much press for what and you can realize how daft we are.
1. “Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation)”
I could live with this on all except drug companies in fraud and willful wrongdoing cases. The drug companies now have a track record of considerable bad faith, especially Pfizer
2. “Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles. “
First part is O.K. but tax deduction is not enough incentive for the poor and lower half of the middle class. Some scaling down subsidy is going to be needed if we want everyone covered with medical care.
3.“Eliminate Medicare altogether for all those not currently enrolled or more than 10 years from enrollment. To be replaced by a system that is market based yet still regulated. Insurance companies shall compete for a larger marketplace.”
Cannot agree here. Medicare does reasonably well, except to the extent government is now using it to put the squeeze on high doctors salaries and medical costs. The core problem for any system, with a public component, to care for the elderly is how far should we go to keep the very old living? The insurance companies -- with high administrative overhead, officer compensation and profits – cannot be well depended upon. They are oligopolistic and don’t want to reform their ways. Too few are left nationally and they are not well behaved, although they are facing a bind now that so many young and health are cancelling their policies because of the high premiums. We need a publicly overseen system of pooling risk and taking advantage of the law of large numbers but that also addresses the core question of how far do we go to keep the old alive.
4.”Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.”
Don’t know enough about what we had or how this might work. No comment.
5. “Tax incentives to Purchase Private insurance should be both individually based along with employer based.”
I understand what is being said here but I am more back at the beginning wondering whether anything we publicly fund should be done through employers as opposed to through the general tax system. Why load up businessmen with more paperwork? Then again, I am not sure tax incentives would work for those below the middle, middle income classes.
6. “Place some Constraints around the FDA.”
Some big reform is needed.
7.”The FDA has kept some unsafe or ineffective drugs off the market. At What Cost ???”
I am sure this is a fair question.
8.”The FDA adds billions to the development cost and price of new drugs. The FDA delays the availability of new drugs for years. The FDA prohibits the use of new drugs that treat conditions for which other drugs are available, regardless of how much better they might work for some patients. The FDA withholds new drugs—even those that passed initial safety tests—from terminally ill patients, in the name of preserving safety. When one of these patients wins access to the drugs by going to court, the FDA, apparently in a relentless effort to protect the health of the dead, appeals the ruling until the patient dies, at which time the appeal is of course dismissed. The FDA and Congress allow the drug approval process to be politicized to protect the interests of firms with political pull or to serve the anti-corporate political agenda of those who would rather see Americans die than allow any investors or businesses to make money developing new medications. The FDA constitutes a roadblock to new developments in anti-aging drugs by refusing to consider any science that would extend healthy lifespans—because "aging is not a disease." The FDA states that it lacks the resources to ensure human drug safety but requests more resources to review veterinary medicine. The FDA now publishes lists of drugs it approved but the safety of which it questions—leaving physicians in the lurch and creating a potential jackpot for litigation.”
I agree with this horror list and have heard about most but not all of these items. Clearly something needs to be done that is reasonable and sensible. The FDA is out of control and so are the drug companies. Who is inducing bad behavior by whom seems to be mixed. We clearly need something better.
In terms of past public charities...Both faith based and non faith based they're were once numerous. As a Practicing catholic I can tell you of many stories I have heard from parishoners whom in the 40's & 50's when in need of medical care had these services ultimately paid for by the church. They're were also many non faith based organizations that did the same. I don't know if you have heard but it was released in the media hear yesterday that cardialogist are now rescheduling procedures that were generally done on an out patient basis now as hospital stays for those covered under medicare since they have been hit with another 20% paycut. This is because the reimursment rates with an overnight stay is apparently more likely to actually turn a profit. Yet it cost the system as a whole even more money. Once again the law of unintended consequences at work. The goal of reducing cost resulted in precisely the opposite impact. Have you read the cato policy analysis. Quite clear from you writing's you are no libertarian...Neither am I someone whom identifies as a true libertarian but more a Conservative. But I find Tanners work to be largely fact based and little in the way of political bias.
Charity is not really enough to matter. It comes to about $259 billion a year or about $1 per person in America. It's really peanuts in the grand scheme of things.
God is over rated. He never fixes things. He doesn't show up to take charge when he should and he has far too many really kookie followers. Some would even say he is undependable; unreliable too. I'd put my money on Santa Claus first. At least he shows up from time to time, even if it is in department stores.
As I wrote in a recent article, entitled "Rightwing Republicaism as Religion," "Nietzsche would, I suppose, view this broad state of affairs as the final death throes of religion in America, as a sort of dummied down, reactionary and fundamentalistic backlash to an ill-understood postmodernism."
It's been a year since I read Tanners report but I recall no such reference to Godless Life's. As a matter of opinion I would not say most liberals are godless since the vast majority of the world is faith based either through spirituality or some form of an organized religion. The "Godless" usually exist more in Gov't. As the more you move towards Central planning the more faith becomes a threat. Gov't must be viewed as the ulimate authority. This was clearly recognized by our founders and they understood the concept of unalienable rights. The basis of our founding documents resides in the fact that your freedoms are not to be and cannot be taken from you by Gov't, because Gov't didn't give them to you. God did. I can always tell a Marxist from a true Atheist. Someone whom is simply atheist/agnostic looks at the words " In God we Trust" in a court room and see's this as just an irrelevant statement having no impact on their lives. It may as well say " In Chair We Trust " It means nothing and bothers them not. I know many conservatives whom are strict constuctionist and yet are still atheist's. They respect the concept rather than an actual God. A Marxist is someone whom is offended by faith. As Religion of any sort is a threat to the ultimate power of Gov't which in turn should decide what is best for society. Not individual freedoms. Hence our founders having lived under tyranny placed great importance not only in economic freedoms, but religious freedom as well.
Don't be concerned if Seeking Alpha doesn't accept any more of your articles. Perhaps the Daily Worker would have you as a regular columist. Plus there is alway room on the Daily Kos or The Huffington Post.
On matters of religion, you are talking to a Seth Speaks-Nietzschean. I emphatically do not believe in the elements of the Nicene Creed any more than I believe the Koran saying that Mohammed physically ascended up to heaven on a white horse from the Temple wall. I believe much harm and too little good has been and is being done in the name of religion and I refuse to base my life on what I consider myths and fables.
Religion mixed with politics I find particularly odious. No one will ever persuade me of the truth of anything by their declaration that God arranged it or said it was so.
It is not that I do not believe in a supreme consciousness. It is just that I cannot believe in one so stupid as to intervene in our silly affairs or listen to anything we have to say.
" Religious distress is at the same time the expression of real distress and the protest against real distress. Religion is the sigh of the oppressed creature, the heart of a heartless world, just as it is the spirit of a spiritless situation. It is the opium of the people. The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions. " Karl Marx, Critique of Hegel’s Philosophy of Right
This is not core Marxism which is a social-economic analysis. This is Marx addressing by way of critque a point of Hegel's philosophy on what is morally right. To both, I prefer Nietzsche's Beyond Good and Evil.
I do know what I believe and with considerable precision. I have spent years developing my own mix and extensions of views and never accepted what someone would hand me lock stock and barrel, although many have tried from Catholics to Buddhists. I reject all that is fantastic, supernatural or does not conform to the scientifically feasible, presently or likely in the future. I refuse to carry the luggage of the ages or associate with any church institution like Catholicism which lives on the defensive and is forever apologizing for one bit or errant foolishness or the other in the past. I just think there is incredible nonsense tied up with conventional religion.
I don't really care what your faith is...I could be wrong, But I think you have utter contempt for those with faith and look down upon them as beneath you as a true elite socialist. But maybe I just misread you.
Many are anti-religious who do not really have clue one about Marx. Any who disbelieve in myths and fables as factual truths qualify. There is no two way connection here to Marx.
Marxist are typically Atheist...I know few who are not. They are often afraid to admit it, deny there lack of faith. But they go hand in hand. And as a matter of faith goes...I won't speak for all faiths...But in christianity most christians do not believe that God routinely interferes with out lives. Quite the opposite. We are of the believe that God / A supreme intelligence provides us with free will, hence the story of Adam and Eve. The history of the world shows many conflicts over religious conflicts. But the history prior to faith was even more violent. Religion just provides stucture to spiritual faith. Whether you choose to eat meat on friday is a matter of commitment to a faith rather than an actual sin in my view. Much like military basic training. Making your bed doesn't make you better under fire in combat...But it instills a structure and a discipline. If you're truly just spiritual as you imply that must often come into conflict with your faith in an all powerful Centralized Gov't as you advocate so often in your writings that will somehow change it's ways as we will see empowered politicians behave in altruistic ways on behalf of the people. Truthfully..I could care less where your faith is. You can worry about that when and if you meet your maker. I am more interested in what type of propaganda you will have to spew in relation to the Tanner Report. If you still have limited access to it I will highlight some points below which you can feel free to thumb through on your own time. At the end of the day...More people die outside the US healthcare system than inside the system. Results just don't back your proposed solutions.
" For example, SiCKO cites a 2000 World Health Organization study that ranks the U.S. health care system 37th in the world, “slightly better than Slovenia. This study bases its conclusions on such highly subjective measures as “fairness” and criteria that are not strictly related to a country’s health care system, such as “tobacco control.” For example, the WHO report penalizes the United States for not having a sufficiently progressive tax system, not providing all citizens with health insurance, and having a general paucity of social welfare programs. Indeed, much of the poor performance of the United States is due to its ranking of 54th in the category of fairness. The United States is actually penalized for adopting Health Savings Accounts and because, according to the WHO, patients pay too much out of pocket.19 Such judgments clearly reflect a particular political point of view, rather than a neutral measure of health care quality. Notably, the WHO report ranks the United States number ONE in the world in responsiveness to patients’ needs in choice of provider, dignity, autonomy, timely care, and confidentiality.
When you compare the outcomes for specific diseases, the United States clearly outperforms the rest of the world. Whether the disease is cancer, pneumonia, heart disease, or AIDS, the chances of a patient surviving are far higher in the United States than in other countries. For example, according to a study published in the British medical journal The Lancet, the United States is at the top of the charts when it comes to surviving cancer. Among men, roughly 62.9 percent of those diagnosed with cancer survive for at least five years. The news is even better for women: the five year-survival rate is 66.3 percent, or two-thirds. The countries with the next best results are Iceland for men (61.8 percent) and Sweden for women (60.3 percent). Most countries with national health care fare far worse. For example, in Italy, 59.7 percent of men and 49.8 percent of women survive five years. In Spain, just 59 percent of men and 49.5 percent of women do. And in Great Britain, a dismal 44.8 percent of men and only a slightly better 52.7 percent of women live for five years after diagnosis.
Similarly, infant mortality, a common measure in cross-country comparisons, is highly problematic. In the United States, very low birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low birthweight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low birth-weight infants are not included when infant mortality is calculated. In addition, many countries use abortion to eliminate problem pregnancies. For example, Michael Moore cites low infant mortality rates in Cuba, yet that country has one of the world’s highest abortion rates, meaning that many babies with health problems that could lead to early deaths are never brought to term. "
What an incredible mix of religion and confused social/economic policy analysis. Too, your fight is with Moore here, much less than with me. You think the medical world is wonderful as it is before implemented reform; I don't. That is the heart of our dispute. You are largely an apologist for the status quo pre reform. I am not. You argue defensively, as though you were arguing to defend Catholicism, which you impliedly do. For me, it is too big a jumble of mixed and confused ideas to bother and try to cope with. I mean one minute it is God, the next Marx, the next life expectancies and the next free markets.
It's not surprising you would find it hard to follow. I don't defend my faith. Why would I. I don't feel it's under attack in this particular debate. My reference to Charitable delivery of services whether religious or not is based in their abilty to deliver compassion that the gov't does not as they had been more free to do in the past. I argue only for less gov't as I have yet to see a Gov't ageny deliver a service efficiently, or cost effectively, let alone anywhere near where they projected their cost to be. Take you pick on an ageny. Post office, Dept of Ed, Dept of interior, Depy of Defense. Ever see one come in under budget ???
On Tanner’s Article Tanner mistakenly believes that because Americans spend so much on health care that Americans are receiving a large quantity of health care at rather low prices. That is wrong. Americans spend so much on health care because doctors’ fees are higher than they should be because the number of doctors is too low because their number has been historically restricted, health care and malpractice insurance premiums are too high and rising because of high profits and overhead and because drug prices are too high. That is why Americans spend so much on health care and more than other developed nations.
Tanner believes national health care systems abroad -- which people in those countries like much better by the way -- are not good because they ration health care, but does not seem to understand that the American system before the health care reforms passed and coming, ration health care with oligopolistic pricing and restricted output far worse. In fact, oligopolistic pricing of doctors’ fees, insurance premiums and drugs necessarily requires serious restrictions on output. Tanner misses the boat here on his basic point. Too, he blows off and finds great fault with foreign national health care systems which people who use them really like because such systems are more efficient, do not entail oligopolistic pricing and therefore spend less as a percentage of GPD and per capita.
Tanner’s core statement that “Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control” is incorrect or seriously misleading. I believe the opposite can be shown to be true. Countries that have moved toward the American model and markets developed some of the same problems we have and have been unhappy with the results, e.g., Australia. Tanner’s implicit suggestion that other developed nations are unhappy with their health care systems and are moving toward what we have is wrong. There is no failure riddling those systems due to “failure of centralized command and control [requiring] the benefits of increasing consumer incentives and choice.”
Tanner’s belief in free and unfettered markets in the health care area ignores the mess we have with such markets and also the substantial work of the Nobel Laureate economist, Kenneth Arrow, in the area which has long been accepted by the American economic community, making Tanner’s core position untenable. Tanner talks too much of healthy competition in markets too much suffering from oligopolies and ignores Arrow’s accepted teachings that free markets cannot work in these areas for his reasons I have explained in an article Seeking Alpha rejected.
Tanner rags on about the supposedly better quality of American health care but concedes the facts that “The Institute of Medicine estimates that some 44,000–90,000 annual deaths are due to medical errors, while a study in The New England Journal of Medicine suggests that only a little more than half of American hospital patients receive the clinical standard of care. Similarly, a RAND Corporation study found serious gaps in the quality of care received by American children.” One way oligopolistic markets excessively ration health care is to reduce the quality and therefore their costs of what little output they do provide.
The thrust of Tanner’s article goes on to wage war and quibble over the national health care systems of foreign developed nations, too largely ignoring the facts that the people in those countries basically like their health care systems unlike Americans who basically dislike their health care system, which should come as no surprise for the reasons I have indicated. Tanner really does not understand the economics of health care very well and he certainly does not understand Kenneth Arrow’s work. He appears to me to be a market ideolog writing for the Cato Institute which has a market bias in virtually every regard, even where markets cannot or do not work effectively or both.
The theory that any market will work just fine if sprinkled liberally with competition is nonsense. An example here is the US. Stock market, which is quite free, but can get things quite wrong for long periods of time before it adjusts dramatically. The same is true of the U.S. housing market. Markets are no better than the judgment of people who participate in them. There is much free market nonsense and foolishness among conservatives. They buy the ideology of the perfectly competitive model but do not well understand how markets can and do fail or get things wrong a great deal of the time in reality even with nearly perfect competition, as in the stock and other financial markets.
And you're not an idealog in your views I presume. The fact that particpants in foreign systems like their coverage is pointless. As I have demonstrated earlier, most americans when polled about "their personal coverage" are quite happy as well. The perception is more about the overall system is where they are more critical. This is clearly evident as the media does an excellent job of influencing public opinion. Rassmussen has shown this in every major poll. And most Americans don't want a system that mimic's Britain, Canada or any other system currently in existence. Perhaps people in these nations are happy because most haven't fallen ill and needed access the way they may one day. But when they due what happens then. What does it say about the Candian system that 1 out of 3 physicians sends a patient to the US for treatment each year. And what happens when the US mimics these systems. Where will they send them ??? Nobody disputes that there are errors or flaws in our system. But the fact is that even in these socialized system's cost are still out of control. If you haven't been paying attention the PIIGS are in serious trouble right now. As is Britain. This is primarily due to massive uncontrolable entitlments. His point is that rising cost are not an American Phenomenon. For all of your talk about the American system restricting access to medical schools, We have more qualified Dr's per patient then most of these nations. And the WHO (which has quite the Socialist bias) still ranks us # 1 in Accessiblity. These nations are lacking in technology and accessibity. Nobody has ever claimed that free markets are without flaws. They're will always be mistakes and acts of fraud. That is true in all markets. But free markets are self correcting when they are allowed to work. Self correcting does not mean perfect. Only Marxist believe in the Utopian Society on earth. And on the cost side, Medicare and Medicaid entitlement programs are unsustainable at the current pace. And that's based on the stats they report around expenses. As I explained in earlier posts medicare has all kinds of costs that do not reflect in the medicare budget but in other aspects of Federal Expenditures. A little bookeeping game that private insurers can't play. The end result, at the end of the day is whether you like it or not...The USA for all it's flaws has the #1 ranking in results of outcomes in every major area of treatment. So for all the inequity you see in our system. No matter how fair Britain or Canada may seem...More people DIE in healthcare related matters. A fact you choose to ignore. That is because you along with academics like Kenneth Arrow are more concerned with your perception of social justice and distributive efficiency rather than what the actual real world results are and have historically been. This again is the difference between theory and practicality. You proceed from the false assumption that in order for me to gain something, someone else must loose something.
The U.S. mortality ratio for breast cancer is 25%, In Canada and Australia it is 28%, in Germany it is 31%, in France it is 35%, and in New Zealand and the United Kingdom it is 46%. For prostate cancer, the U.S. mortality ratio is 19%. In Canada it is 25%, in New Zealand it is 30%, in Australia it is 35%, in Germany it is 44%, in France it is 49%, and in the United Kingdom it is 57%.
FAVORJ displays little understanding of the public health care systems in Canada or, for that matter, those in place in Western Europe and elsewhere. This is evidenced by the errors in detail he makes and his tendency to lump all foreign universal coverage systems together as though they were all cut from the same cloth. It is, however, pointless to begin matching with him sources with sources and details in an attempt to reach some consensus over what are the valid sources and details that should be relied upon.
The point that should be made, however, is that efficient, effective and affordable universal medical coverage can be achieved by legislative restructuring of the non-government health insurance industry; the Netherlands and Switzerland have both been quite successful in that regard as have other countries. While I as a Canadian can state that, after more than sixty years Canadian experience with Province based (with Federal co-funding and Federal/Provincial standards framework consensus), single payer systems work well for us and have exhibited many health service delivery and cost savings and control features. That each advanced country has developed its own unique response to the sound universal coverage at affordable cost challenge and the US will likely also evolve its own unique response.
The key is not to simply search for abstract reasons, unverified factoids and unwarranted stereotypes of foreign experiences to paper over and justify the status quo. In this respect, a better general understanding of the programs in the Netherlands and Switzerland might suggest approached forward for those who reject the government single payer systems and there are many other models from which to draw ideas. It is simply a shame, when there are so many alternative ways to address these issues, that the life expectancy of the average US citizen is about two years less than the Canadian average and that so many in the US face financial hardship to finance needed health care for themselves or other family members or basic health care is denied for financial reasons.
Errors in detaill ??? Be Specific...My lumping of systems is only in the context of results. None produce better than the USA. Bob, It sounds as though you have little understanding of the American Healthcare system. And having come from the poorest communities in the USA, (which I'll assume you have only seen in the movies) I was never denied health care treatment, even when I was one of the uninsured. This is a myth. Long before Obamacare it has been ILLEGAL to deny treatment to anyone in the USA for financial reasons. Walk into any hospital and it clearly says so in the lobby. My brother-inlaw has performed numerous operations on people at the University of Maryland Hospital that had absoultely no ablity to pay him. We don't have waiting lists. You walk into the hospital and get treated if you're truly ill. If you are indigent the hospital takes the write down. The drug companies will provide the meds for free if you have no resource. It's little more than a few forms to fill out. If you have the resources to pay, you can and should pay for services you receive. I have been to Western Europe and my wife lived there many years. Having lived under both she will tell you herself their system is a disaster. Some worse than others, but all less accesible than the USA. For the WHO to say the same thing is quite telling. These are hardly unverifiable factoids and realtively easy to verify. The fact is whether you or Kimball like it or not, the outcomes are better here in the USA. I have already demonstrated how inconsistent the Life expectancy ratio's are. So I will challenge you to site your own source. Show me in what area of specific illness or disease that Canada for example has a longer life expectancy. See if you can find even three. Cancer...Heart Disease... AIDS...Take your pick and site your source. So which system is more equitable the one that covers more with more fatalities ??? Hardly. As I have said before and I will say again. All forms of Gov't run/sponsered care are great when you have a sinus infection and want an antibiotic. When you have testicular cancer and the tumor is encroaching on your vascular system, you'll find yourself at Sloane Kettering. Aside from results related to illness neither you nor Kimball address the fact that the medical price index correlated quite closely with CPI data prior to Medicare. Then the Gov't slowly crowded out the competition to the point that we have already socialized half the country and made 50% of the market inaccessible to private insurers. Under these programs the prices went up, not down. We had no such issue before the Gov't invovled itself. Since the Medicare act of 1965 the deviation between CPI and MPI began. The HMO act of 1973 made it worse. The Gov't underpayment of hospital care exploded in 1989 making it far more expensive. Every act of the Gov't has worsened the problem. British physician Max Gammon articulated this problem very well in his "Theory of bureaucratic displacement" I have yet in all my life met anyone who said they we're going to canada or Europe to get treatment unavaible here in the USA. That's not to say it's never happened. But hardly the norm. Living 3 1/2 years in the Naples Florida area, it was common to meet Candians on vacation there. There feedback was almost exclusively the opposite of your view. If your happy that's great. But so are most Americans. Our system is far from perfect. But Gov't is the obstacle, not the solution.
favorj, you are quite right. As a physician, I did my residency in minnesota at mayo clinic. we frequently received patients from canada since they were a close neighbor. some came to avoid waiting and receiving an essential death sentence. but the real issue was the incompentence. i have respect for all who choose to be a caregiver in once sense or another. but often patients were just given advice that was factually incorrect. they were simply not equipped or well trained enough to diagnoss address and treat more serious carcinoma/sarcoma but bob is correct. we have started down the road to socialization of one form or another. as i stated earlier. for me this means simply an early retirement. i feel bad for the younger generation. a rapidly advancing field will likely come to a screaching hault just as we are on the verge of making many important discoveries. favorj, remeber this. you live in a country where nearly half of the working population pays no income tax whatsoever. they will always vote for what they can get for free as long as they don't have to be the one to provide it.
Thanks Doc...But I partially stand corrected. If memory serves me correct from my board exams years ago, one of the automatic qualifiers for SS disability / medicare regardless of age was end stage renal failure. So this is virtually exclusively covered by Gov't insurance. If I remember correctly, as expected outcomes are not nearly as good when compared to other forms of illness measured globally.
I have no problem with the fact that you believe the health care system you currently enjoy is the best in the world and the objective of my comments to Kimball’s Instablog article are not intended to convert anyone to the particular form of universal health care provision I enjoy here on the west coast of Canada. My intent is simply to engage in the sharing of information, on the one hand, and, on the other, to respond to mistaken information, as I see it, expressed in relation to the system of health care available to people where I live.
You begin your most recent comment addressed to me by pointing out that all persons in the US, regardless of their ability to pay, are entitled to emergency treatment at any hospital. This is so in Canada as well. Additionally, legal residents and citizens of Canada are entitled to needed medical services in non-emergency circumstances including subsequently an emergency and these services are not restricted to those being provided at a hospital. You also mention that many doctors provide medical services as a charity to persons unable to pay or to fully pay the usual cost for these services. In Canada doctors and other medical services providers receive their normal fee for services to any legal resident or citizen of Canada. In British Columbia medications provided while admitted to hospital are generally free but prescription medications are generally paid for by the user and often covered by supplemental insurance coverage purchased by the user. The price of drugs is however generally lower than in the US because of bulk purchasing arrangements and the user can claim the cost as an income tax deduction.
Turning to the efficacy of treatment, I think we can both agree that those preparing statistics are faced with many methodological and information collection problems in trying to prepare statistics that compare outcomes from one country to another and that there is the added problem of those striving for a particular outcome slicing and dicing data to serve their needs. It follows that you can point to one study of outcomes and I could point to others but we are unlikely to find a valid way to reconcile differences between studies, reach a consensus or become any the wiser through the exercise. I will, however, refer you to the following website published by your own CIA where the life expectancy of the average Canadian is estimated to be 82.23 years as of 2009 while that of the average American is estimated to be 78.11 as of 2009, a difference exceeding 3 years. I also give a Statscan website showing life expectance estimates Province by Province as of 2005 for your interest.
I fully appreciate that life expectancy reflects several factors besides the availability and quality of health and medical services available but, accepting that limitation, the difference strongly suggests that Canadians are not badly served.
At the conclusion of my March 30 – 7:59 PM comment I acknowledge the weak link in the Canadian system, potential delays for those waiting for treatment of stable conditions and note that this would decrease if health care spending (private and public) in Canada, which is currently less than 70% per person of the corresponding US amount were increased.
My March 30 – 2:25 PM comment deals with your comment about Canadians travelling to the US for treatment and Americans coming to Canada for treatment.
When the model of Canadian universal single payer medical services was developed in Saskatchewan in the 1960s (the driving force behind that development was then Premier Douglas, grandfather of Kiefer Sutherland - the star of TV’s ‘24’ – who would have thought!), the intent was to preserve the doctor/patient relationship, avoid the bureaucratic features and two tiered nature of the UK system, extend essential quality service to all people, prevent for profit medical facilities involvement and control cost escalation over time (i.e. maintain the established form of medical practice but extent this services to everyone with the bills going to the plan rather than the patient and the cost being covered by the taxpayer). On the bureaucratic angle, the administrative costs and staff needs are reduced for doctors because they don’t face the need to deal with a multitude of insurers and doctors receive payment for all patients without undue delay. Our system is not perfect either but it has sufficient coherence that informed public debates about its improvement are possible.
Again..To each his own. My concern as both a US/and Global citizen is that the majority of developement of new treatments and advancements are developed here in the USA. Stifiling the private sector will only hurt this development. What many outsiders overlook is that Americans by in large want more free market based solutions. That is why this country is bordering on a puiblic revolt. Most Americans don't want reform in the form of greater Gov't. But it is true they want reform.
FJ: I flatly disagree with each and every one of your following statements: "And you're not an idealog in your views I presume. The fact that particpants in foreign systems like their coverage is pointless. As I have demonstrated earlier, most americans when polled about "their personal coverage" are quite happy as well."
You misunderstand: Arrow and I are economists. As such we are concerned with how, how well and why markets function as they do, issues most others ignore because they are not trained to address such matters well. Just as you you largely first ignore such issues and then disparge those who are trained to and do focus on those issues. Unless you enter the central ring knowledgeably, your jumbled comments on these issues and myriad other issues at once are probably best ignored.
You are having a conversation with yourself. I never ever said anything about an equitable distribution of anything. You are confused. For that reason, this is no longer a useful conversation. It is like trying to individually catch all number 7 birdshot pellets from a fired shotgun at 25 yards. It is crazy.
Americans don't know what they are talking about when they refer to free markets. They do not understand them, especially in the health care area, but they know that "free" sounds good. It is just ideology, second or third hand, speaking. Reform is imperative, because the status quo is not viable. We should have had a great national political discussion about what reforms were best and why, but the rightwing ideologs, the "just say no" dunderheads, as well as what was most politically feasible governed because reasonable discourse was not possible. It was impossible to even get the basic facts on the table before those trying were shouted down. This is a bad era for Americans and I largely attribute it to the self righteous religious right coming out of the closet and joining the Republican Party and largely destroying it. There was a day when the party was dominated by middle class sensible businessmen who were not only knowledgeable and capable of learning but who also had a practical bent and knew how to engage in discourse and communicate. No longer.
Like our educational system, political discourse has been badly dummied down to the point where it no longer serves.
Whether it is illegal or not to deny medical treatment by a hospital, patients in need of care are routinely and daily rejected by private hospitals nationwide, and sometimes if in ambulances are shipped upon arrival to private hospitals to county or other hospitals, sometimes even dying in route. Hospitals deny medical treatment all the time, sometimes going so far as to close their emergency rooms to make such denial that much easier.
I believe you last article if I remember correctly was based in the concept of "Redistributing Wealth". Maybe I misread the title. Don't hide what you believe. Healtcare reform as it was written and the eventual goal of single payer is another form of Redistribution of wealth. Someone who pays not income taxes receiving a healthcare benefit paid for by someone who does pay income taxes.
You critique the Right wing as if you have ever listened to anything they said. You are the guy that blasts Rush Limbaugh, Mark levin and the Priest buy have not likely ever listened to their show or sat down and discussed the idealogy of faith and politics with a priest or a member of the Catholic league.. None propose the status quo. All on the " Right have proposed some form of reform. Just not what you want to see. They just don't want or trust more Gov't interference or involvement in their lives. As expected you assume the american people just aren't as smart as you Kimball. They're smart enough to know when congress passes a law that they are exempted from they know it's Gov't that's screwing them. And they are alot smarter than your pretentious personality gives them credit for.
Give me a break...Trained to do what. As if all Econimist hold your views. Where would Milton Friedman side in this argument ??? You're an attorney who's never worked a day in your life employed as an economist. I have more education/ experience in the world of finance and economics than than you my friend. MBA in Finance / MS in quantitative finance from Hofstra, CFP, ChFC, CLU, FINRA licensed 7,9,10,63, 65. NY, FL, NY & CT health life and VA contract licensed along with 13 years of financial planning experience for individual and small/ mid sized business owners designing business plans. ( including plans that actually cover the area's of group healthcare policies) Having a degree does not make you an expert Kimball. You need actual experience.
I agree, but am calling them what others do for identificational purposes, especially those profiting from the status quo. The markets are not free in fact because of those who have some pricing control, directly or indirectly, over them for whatever and various reasons. In the markets for medical services, free markets won't work for the reasons Arrow has identified and explained.
The distinction you try to draw between theory and practice is one rejected by most economists for the reasons Freidman provided: If the theory is not predictive of what actually happens, then it is deficient and incomplete. It should be repaired. That it does not mirror what lay people believe it should or adopt assumptions acceptable to them is wholly irrelevant. Consistent predictive accuracy is the measure of any theory. Practice has little to do with it and often too little to do with predictive accuracy. There is a whole literature on these points beginning with Friedman, you obviously have not looked at or thought about.
Do you think economists study nothing? Or that everything they know is already known by any competent M.D? (or MBA?) How arrogant. By the way, an MBA typically covers marketing, finance, accounting, production and like topics and is not at all a substitute for higher level economic training as you seem to think. Practical experience often counts for too little as well. Until Arrow came along and explained the relevant medical markets, no one -- even those with a great deal of experience in them --- had managed to understand what he did from afar with his training and thought. Now his views are accepted among economists and most higher up in the medical community. Even the head of the AMA has now come out in support of the need for major reform.
I have written on the problem at hand. Most economists will not speak up on the economics of health care or the economics of health care reform. They do not want the retaliation, the vocational insecurity that can ensue, or the flack like I have gotten. Most, after Arrow, have remained largely silent. Michael Tanner, for example is not a trained economist, but he is sheltered as an ideolog of like mind by the Cato Institute. He is a right wing ideolog who writes for the National Review, wants Social Security demolished, and is basically a politico who joined the Cato institute from the Georgia Public Policy Foundation and a position as the legislative director for the American Legislative Exchange Council.
You write: "Where would Milton Friedman side in this argument ??? You're an attorney who's never worked a day in your life employed as an economist." Friedman agreed with Arrow! As for not working ever as an economist, I consulted frequently as such on cases where I was paid to but did not appear as a counsel of record. I also lectured on how to use economists in cases calling for them as experts. Also, I worked during the summers as an economist for the three years I was in graduate school. Moreover, as I explain above practical experience is too often worth too little in understanding the true economics and economic theories involved. You obviously did not learn that in your MD, MBA and MS programs. Top universities are not at the top for nothing.
You should address the substantive arguments, not attack me ad homonym.
Your arguiments have been previously attacked based on results in great quantitiy. As your article instructed that US should mimic the British and Candian systems, which have outcomes related to treatment of illness far worse than the USA. The result is all that matters. Room for improvement yes....Implement your idea's and more people die. I have read Friedman, but admit I have not met nor spoken to him. However here is a quote of his on the topic of Healthcare from 2001. Doen't sound as though he would have sided with you.
“Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own.” Consumers spending their own money holds costs down in every other sector of the economy: Consumers obsess about prices; providers fight to earn their business. Trying to duplicate this process through a government board of experts is pointless."
sorry kimball, but practical experience is worth more than you give it credit for. none of us would permit invasive surgery to be performed by a doctor who had only studied it in a text book and never actually performed in an operating room. consequently the medical school is often less important than were you completed your residency. that is where the real education begins. this is true in all fields. i would not hire company to construct a home for me if they only studied constuction yet never actually built a home. and i most certainly would not hire a professor of law to represent me in a murder trial had he never actually tried a case before.
" I'd rather entrust the government of the United States to the first 400 people listed in the Boston telephone directory than to the faculty of Harvard University. "
Doc, may I also suggest to you a good read. Try Liberty and Tyranny by Levin. It was a #1 best seller on NY times list for 3 months. The book reads in some ways like a legal analysis. But was generally well written He is an abbrasive personality in person...but his views are very much spot on in my opinion with few exceptions. To be intellectually honest. You should always read the material of the other side before your dismiss. Although I think Franken is a nut, I read his book anyway. Also have read some of the works of Chomsky...another one the left holds out as a hero to often. But I view it almost as understanding the mind of your opponents.
Redistributing wealth to Pareto optimality of 20% owning 80% of the wealth is certainly not an equitable distribution of wealth which would require everyone to share the wealth equally.
Americans are happy with the medical treatment they receive when they receive it, but they are not at all happy with the health care system. You are confusing the two issues. In fact only 5% of Americans think the health care system we had before reform was working or could work, as I explained in my article.
TNAFFLER, an MD writes: " . . . we frequently received patients from Canada since they were a close neighbor. some came to avoid waiting and receiving an essential death sentence. but the real issue was the incompetence."
I do not believe this is at all accurate. Most from Canada come for more esoteric or equipment intensive diagnoses or treatments that are being paid for by the Canadian government because they are more available in the U.S., and Canada has elected to proceed this way rather than incur the addition equipment or R&D over head expense in Canada. This is not incompetence, it is intelligent. It helps avoid expensive duplication; it spreads the overhead and it promotes efficiency. Nothing stupid about any of that, so the disparagement of Canadian physicians is most inappropriate here.
TNAFFLER. That may seem more true in medicine than economics. Practical experience is not the important point. Knowledge or know how when needed in the situation and for the purpose at hand is. Arrow, as an economist, had no practical experience in medical treatment administration or delivery unlike any practitioner or administrator, but he scooped them all in explaining the problems of the markets in their areas. Different things are studied in different ways. Medicine is a lot of hands on, as you imply. Economics is not. It is much more about structural market analyses, information distribution, risk types and issues, product definitions, substitutibility issues, income effects, surpluses, welfare analysis (different than what it implies), competitive issues, incentives and the like. Practical experience in making those determinations does matter for an economist, but it usually occurs by way of specialized studies, not by being on call for 24 hours to handle what arises.
Spoken like the good diehard Yalie he was. (He was the author of God and Man at Yale.) No opportunity to take a poke at Harvard is ever bypassed by a Yalie. Football and skulling are virtual blood sports between the two institutions. The comment is a just a slam at Harvard, nothing more.
Interestingly enough, Harvard is above the spitting and more secure in its position, except when it comes to football and skulling.
I think what he was trying to explain to you was the incompetence comes from a lack of experience with having little exposure these advancements. You cannot master what you have little access to. It was not a slander on the intelligence of the candian dr's. And when we adopt the candian system in the USA to cut cost...who will then develop the equipment intensive diagnoses or treatments. Or will the advancements come to a slowdown ???
The denial of treatment to any large degree is a myth. This is few and far between. And a fantasy conjured up institute more gov't control. The Gov't as usual, causes the problem and then determines they must fix it by involving themselves further. on the whole we still have the most accessible system in the world.
I think not...It was a bit more than that. And he was quite critical of Academia. Buckley was a staunch and practical conservative and would likely find your views comical.
And you failed to site a source other than your article. But i don't challenge the fact that americans find the system unacceptable. But the reform they got was not what the country wanted as it is not reform. And most don't want Socialized medicine of any sort
You do Realize that Pareto is not universally accepted as correct don't you. What believes to be optimal is simply what he believed. That doesn't make it correct because you agree. And the concept of indivdual liberty and private property rights which are bedrocks of our foundation as a country come into conflict with ideas.
I know that, but it is a starting point for discussion. The rich want a bigger share than Pareto optimum; the middle and lower classes want a bigger share too. Although I have not done it and don't know who has if anyone, I believe economic optima can be derived for both wealth and income using the standard of an economy which operates best. Clearly there has to be some capital concentration for good control and innovation, but at the same time we do not want bloated secondary financial markets and too low an average propensity to consume, aggregate demand and GDP. There is probably a range of good serviceabilty for both. I do know we are out of those ranges now.
I would agree with that for the medical field. No MRI, no experience using an MRI. Thinking about it, it does make some sense for countries to specialize to a degree in different type of more esoteric or advanced treatments and for other countries to ship their patients there as necessary. It amortizes cost better, assures capacity utilization better, allows more timely equipment upgrades and the like. I have a $5 million dollar world wide health insurance policy that will evacuate me to the nearest country with competent capability for treating what ails me. All countries, cities and towns should not have an MRI, for example. There is an economics involved here.
I have listen to Rush and others rant. Their's is not a considered discourse in my view. It is more an agitating political discourse designed to solicit agreeement at an emotional level.
When markets do not run correctly or indeed fail, you can reasonably expect the government to step in, permanently or temporarily, to one extent or the other. Banking, investment houses (now banks), housing, etc. are but recent examples.
Americans already have socialized medicine. The self payers and insured subsidized those treated who cannot pay, as the billings to the self insured and insured reflect.
Also, a 2008 survey of over 2000 doctors selected at random published in the Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.
America's health care industry has spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms proposed by Obama and others. There are six registered health care lobbyists for every member of Congress. The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Finance Committee that drafted Senate health care legislation is Senator Max Baucus (D-MT). A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT) in 2009.
This shows us clearly who doesn't want health care reform. Surprised? Not one bit.
A single degree is a bit unfair. I had a math and econ double major as an undergrad; there is one. Three plus years of graduate study in econ, with Ph.D prelims completed for an MA, the hardest way possible. There is another. And then I took a law and economics sequence in law school under Richard Posner, Ronald Coase (a Nobel Laureate), Gary Becker (another Nobel Laureate) and others in law school. All total, it was about 7 to 8 years of the study of economics in a formal academic setting with the best of teachers – hardly “a degree.” You minimize and desparage. Too, the type of training and experience you have had certainly does not make you competent in economics -- as an investment or business counselor, perhaps, but certainly not in economics. If you believe otherwise, then you surely don't understand what is entailed by the study of economics.
They're are 17 Phd's in the field of economics on my investment management team at the moment whom I work closely with on portfolio management. Most are additionally CFA's. None agree with your positions. Actually your commentary has been used for morning meeting coffee discussion. You've been quite entertaining. And economics can be understood by the local candy store owner without a degree. Whether he reads a study, or writes a thesis is irrelavant. he makes decisions everyday that effect his business on a microeconomic level. even the uneducated can understand a theory indirectly without actually having studied it. They may not know the difference between Keynes or supply side economics....At least not in terms of language. But they do in their own language.
Even if you believe that Pareto is correct, which I do not...What evidence do you have that the Gov't could ever effectively influence this through policy. Even when Gov't is able to create effective policy, it doesn't stay that way. Eventually it is perverted into an enormous beurocratic nightmare. Markets left to there own are not perfect, but far more efficienct than gov't. No policy maker is immune from coruption. And no federal agency as ever show itself to effciently complete it's task with all to often disaterous unintended consequences.
Federal Gov't did little to step in during the 1920-1921 and the decline was more severe and the recovery was more swift. Gov't just prolongs the inevitable in these situations and likely worsens them
Friedman always rejected being called Dr. The irony here is that as a protégé of his, much of my economic analysis reflects his own economic teachings. Our two big points of disagreement were (a) can free and competitive markets get things wrong medium term and (a) should markets be regulated to prevent abuse in and to them? Friedman thought that by mid term, markets would correct without specifying why or how necessarily within that time framework. On regulation, he felt those regulating would always become the captives of the regulated. Otherwise, with extended discussion, we could agree on most things within the framework of the analysis then at hand.
FJ. It is not that simple. Studies by George Stigler show Friedman was correct in regard to regulation for abuse in and to American markets; however, other studies have shown that is not true in Canadian and Scandinavian markets. Americans and Italians are shown to try and manipulate their regulators much more. The other countries are more accepting and law abiding.
On markets gettin it wrong, some studies are showing that I am correct. Markets can get things wrong for longer terms, according to those studies. The housing market bubble up spanned from about 2003-2004 until recently, when it collapsed, creating the recession.
So what if a market get's something wrong for a long period of time. It is the nature of markets to have positive and negative cycles. And the Govt's job is not to constantly intervene as they always make things worse. The housing bubble is a classical example. Glad you mention it. CRA pressured banks and still does to make loans to uncreditworthy people. Fannie & Freddie created demand for marketplace that wouldn't otherwise exist without gov't interference. These are not necessarily markets getting things wrong for long periods. These are Gov't induced economic dislocations. As I said once before as a conservative I am very critical of Bush in this area. Although he had little to do with monetary policy...He made weak attempts to reform these agencies and caved when ever his adm received pushback. And he was the one that announced that every American should own a home. No...Those that can pay for a home should own one. And the gov't should not influence this. But they did. And look at the results. Do you think banks would have been so quick to loan money to the unqualified if the loan was kept on their books. They didn't care because the Gov't was there to buy up the supply.
FJ writes, “So what if a market get's something wrong for a long period of time. It is the nature of markets to have positive and negative cycles.”
This is precisely my point and why I think Chicagoans and free market aficionados are wrong in thinking that markets cannot get it wrong except in the short term. Are we to believe that underlying or more intrinsic valuations are fluctuating as wildly over the market cycles and equally in magnitude? I seriously doubt it. Markets often overreact on the upside of the cycle with overly high prices and then overreact again on the downside of the cycle with unduly low prices. (Also, I have an article showing how excessive trend trading renders markets less capable to determine accurate valuations.) Ironically, Friedman saw this under dampened oscillation effect in other contexts (e.g., impact of money supply changes) but not in regard to markets and denied free markets would get wrong results for periods longer than the short run. In fact, I think he got it partially backwards in a way. The only way the efficient market hypothesis makes any sense to me is that the free market gets, for all time periods, exactly the results dictated by the buyer and sellers then participating in those markets. However, those buyers and sellers can easily be wrong or be mistaken by misjudgments, lack of information, wrong information and a million and one other reasons. There is no necessary magic to a free market. They do not always get valuations correctly. This is the argument the banks have used to get exemption from the FASB rule requiring assets be marked to market.
When markets that are important screw up for whatever reason over longer terms it is like a red carpet being rolled out for government intervention. Sometimes the government does better upon intervention; sometimes it does worse, often depending on the time frame. The bust in the housing market and also in the mortgage loan market substantially tied to it were clearly market screw ups fueled by unregulated greed fed by the misincentive of large upfront fees and much mistaken risk allocation and mismanagement and also by the effects of earlier government interventions seriously distorting incentives and market signals. Those markets then got it wrong big time, especially with help from the Federal Reserve. I don’t disagree with your analysis here. In housing, earlier government interventions over the years had caused a substantial misallocation of excessive resources into the housing market from other markets, making the later crash that much worse. American government too much earlier intervenes in markets, not to insure a lack of abuse in and to those markets by regulation, but to otherwise misallocate resources in regard to those markets, often according to whim and what government then thinks is “right” at the time. However, even without intervention, the stock market also screwed up big time both around May of 2009. True or intrinsic values did not swing so wildly. Too, good and bad stocks alike get dragged along collectively in such wild aggregate market swings, clearly and also indicating market failure.
It is just very hard to be dogmatic or ideological about various “free” and free markets and their virtues. They have to be evaluated case by case. Markets screw up and so does government, both in various ways. Neither is any better than the judgments of the people then participating in or affecting them.
There is much dogmatism and ideological nonsense in this area, probably because collectively and over longer terms larger numbers of free markets do allocate resources more broadly better than government , which is why general, centralized government planning does not work well.
Too many do not understand markets well, even in broad terms.
Funny loverboy...that's nice of you, since something tells me Kimball is not one to say an "our father" before he rests his head on the pillow at night.
No our fathers here. No 23rd Pslam either when I am in a physical jam, sailing the high and turbulent seas. I am too busy handling the situation. However, more broadly, I observe that rightwing Republicanism is fast becoming a religion where facts are used and abused "to do the Lord's work."
For too many, being a Republican has become an emotional, qua religious experience in the sense that facts don’t matter, only right wing Republican positions do. Facts are displaced by “beliefs” and true facts which conflict with such “beliefs” are quickly rationalized or deflected away, or more often just ignored. This is a painful process for reasonable and logical people to watch, regardless of their political persuasion.
The mental “belief” process applied by these people is the same as that adopted by religionists regarding the anti or supernatural aspects of their various religious beliefs systems, e.g., Islam: Mohammed physically ascended to Heaven on his white horse from the Temple wall or Christianity: Jesus physically ascended to Heaven after his resurrection from being dead. People who believe these things actually happened simply will not listen to any suggestion that they are physically impossible or may be the result of hallucinations. Again, facts in these cases simply do not matter. Emotional “beliefs” that are too largely independent of the facts, control. This is what it means to be a “religious nut” in politics these days.
Beliefs too much supplant facts in both religion and right wing Republican politics. Fair minded inquiry and sensible analysis are foreclosed or much worse, simply feigned for the sake of appearing sensible. Feigning sensibility and earnest inquiry on the facts is simply a temporary recloseting of religionist sentiment for the sake of appearing sensible among “normal” people. In fact, one could well argue that what separates a “belief” from a fact is that “beliefs” are held onto regardless, virtually as a matter of faith, whereas factual inquiry looks fair and open mindedly to the circumstances, what occurs and what is being done, said and will most likely occur. Factual inquiry is amenable to open discourse and the free exchange of ideas. This is not the case regarding belief systems.
Regrettably, the right wing religionist “nuts” have now become too much the dominate public voice of the Republican Party. The thinking, moderate Republicans have become a silenced minority driven into a corner by threats that the campaign contributions to them from the wealthy -- who are profiting immensely from the status quo --- and the support from the RNC will be withheld if they speak out in opposition to or vote against the new religion. It is a regrettable state of affairs. Too, the Tea Bagger crowd mentality infuses too much here. Crowds are not a good vehicle for thinking and careful analysis; they are a means of disseminating misinformation by repetition and rallying people to believe in it.
For example, those who are “believers” and love Fox News, should read the book Lies, Liars and the Lies They Tell by Al Franken and his Harvard research staff. However, because right wing Republicanism is too much a religion, I am sure nothing said here or in that book will matter to the religious “nuts” in the slightest, as it would to sensible, neutral-minded people not of that belief system. Hard and unequivocal proof of repeated bald faced sequential lying by O’Reilly and many others on the Network will not matter to them because they are working at an emotional, religious level grounded in “beliefs” and not at a neutral brain level dealing with facts. Again, the true facts don’t matter. They are to be lied past. Only right wing Republican “beliefs” are important. So it goes with rightwing nuts.
My observation is that serious, systematic lying across a broad range of issues was never the problem it is now in American politics until the fundamentalistic religionists emerged from the closet at the initial aegis of Jerry Falwell and then became a dominate part of the Republican party. Many such religionists have long held the view that lying is a means that is justified by the ends where it is God’s work that is being done, and a great deal of lying is now implicitly being justified under that silent rationale because, as I explain, right wing Republicanism now has developed the characteristics of a religious belief system.
It is truly a lamentable state of affairs for sensible, informed discourse of which we have had too little lately and for the fate of American politics. This is a truly a bad time to be living in America compared to other periods of American history, in very large part for this reason and what it has caused to happen with American political discourse and government. Nietzsche would, I suppose, view this broad state of affairs as the final death throes of religion in America, as a sort of dummied down, reactionary and fundamentalistic backlash to an ill-understood postmodernism.
I have read Frankens book a couple of years ago. He was easily debunked by numerous sources . Dave Pierre of newsbusters for example created a specific website to address a # of factually incorrect statements. Some of which is where substantial, some minor. Someone as one dimensional as you would not likely fact check it on your own, nor listen to someone who did. Since you mention it, the link is below. www.frankenlies.com/tr...
Franken is little more than a political hack that found enough votes in the trunk of a car at the last minute to ensure his election. And he is border line certifiable. Maybe next you’d like to read us a quote from “rules for radicals.” Who is the more emotional ??? The Christian Conservative or the Socialist trying to create a Utopian society. Your comments above show you to be little more than a pretentious bigot who holds those of devout religious faith in utter contempt as they are clearly beneath your intellectual capacity and cognitive ability. Perhaps my earlier statement is incorrect. Maybe Christianity is under attack in this debate. Your characterization of the “Tea Baggers” is a classical example. As you have not likely ever been to a tea party rally. If you had you’d know that this is hardly a religious crowd. The majority are not even republicans as Rassmussen & Gallup have recently pointed out in polling. An enormous number of them are/where obama voters. Many are socially liberal and fiscally conservative. They are honest hard working Americans whom are genuinely and legitimately concerned about out of control Gov’t spending and fiscal deficits. When you return to AZ, ask your local patrolmen who was stationed at a rally. See what he has to say about the behavior and conduct of “Tea baggers” at these events. Then ask a patrolmen about the conduct and number of arrests and vandalism at the Anti Bush protests or the Code Pink rallies. The way individuals like yourself, the media, and some scared members of congress attempt to characterize them is despicable. These emotional protesting Tea baggers are the types that founded our great nation. And if you knew even a little about the history of the nation of your origin, you’d know there is little difference in the political discourse today vs the past. Try reading some of the statements made in newpapers following the Lincoln-Douglas debate. Or even some of the comments made by both JFK and Nixon about each other on the campaign trail. Whether right or wrong, political discourse of this sort has been more the norm than the rarity. Citizens like yourself from the Baby Boomer generation have proven yourselves to be the complete antithesis of the greatest generation, and possibly done irreparable damage to the social and fiscal fabric of this country with your “Great Society” entitlements. You have shown yourself to be little more than a fraud. And hopefully SeekingAlpha’s rejections of your more recent articles of pontification will prompt you to redeploy your propaganda back to where it belongs…The Daily Kos, Huffington post or maybe even the Daily worker. This way you can continue you to marinate your ideas in a more friendly culture of victimhood & defeatism.
FJ. argues "Your comments above show you to be little more than a pretentious bigot who holds those of devout religious faith in utter contempt as they are clearly beneath your intellectual capacity and cognitive ability."
These are strong, resentful and ad homenym words, but that is not how I would put it. That is how FJ puts it.
I would put it thus:
Those of any religion who rely on the unverifiable, supernatural or, worse, the anti-natural as tenants of belief for what they accept as factually true are extremely suspect as to their mental processes in my mind. Take Christianity and the Nicene Creed for example. Acceptance of that creed as true REQUIRES you accept as true the following factual assertions:
1. God made everything
(Is there a God? a personal God? a supreme creator? a supreme consciousness? Did it create everything? As far as reason and the absence of faith might permit us to go here is to say that what we know about the universe implies a supreme consciousness knowledgeable about the extended laws of physics and of all matter of every form in the universe. The underlying structure and the principles governing it seem not to be random, happenstantial, or self-feeding incrementalism. What we know of the big bang implies as much. We are even getting a handle on the big bang process --> energy = mass x speed of light, squared and the relationship to convert mass into energy, or mass = energy/speed of light, squared, to convert energy into mass)
2. He came down from heaven to save us
(This multiple factual conjecture is purely faith based. Is there a He or a She? Did he "come down?" From "heaven?" Was it to "save" us? I frankly deny any of this actually occurred.)
3. He caused Mary, a virgin, to become pregnant,
(This factual conjecture is total nonsense -- a zero probability event-- and purely faith based.)
4. Mary gave birth to Jesus who was God, too,
(This factual conjecture is total nonsense too and purely faith based.)
5. Jesus was killed on the cross,
(There is some, but very little independent evidence that this is true.)
6. Three days later Jesus arose from the dead,
(If he was truly dead, this factual conjecture is nonsense and purely faith based.)
7. Jesus physically ascended into heaven,
(This factual conjecture is pure nonsense and can only be faith based.)
8. Jesus will come back down from heaven to judge us,
(This conjecture is also nonsense and purely faith based.)
9. We believe in the church which adopts this creed,
(This is tantamount to saying the believer accepts as factually true the factual absurdities identified above.)
10. We believe in baptism for the remission of sins,
(This is simply a statement of conjecture, not the truth or falsity of what is said.)
11. We believe in the resurrection of the dead, and
(This is a statement of belief in what is factually, demonstrable nonsense.)
12. We believe in life hereafter in the world to come.
(How do we know there is an afterlife as a matter of fact? Only on supposition and faith.)
I submit it is most reasonable to question the thought processes of those who believe in the Nicene Creed for the reasons I have indicated here. The thought processes of “believers” are very suspect and different than "normal," in my view. They tolerate entirely too much factual nonsense for my taste. Implicit in those thought processes and that tolerance, too, is a capacity to make things up and say as fact what believers wish or want to be true. That is what I mean by they tolerate too much factual nonsense, I think.
Conceding that Jesus was an intelligent and inspired Jewish mystic should not induce or inspire anyone reasonable to contend he was God, someone supernatural or that he was born of a virgin. In fact, Jesus and his teachings have been almost totally marginalized by Pauline Christology, especially within the Catholic Church. Any man would do as well as long as he was born of a virgin, was God himself, was killed dead and then arose physically from the dead and physically ascended into “heaven.” For a further example of marginalization, Jesus taught us to always pray alone, a mandate that is flatly ignored by members of virtually all Christian churches, especially the Catholic Church.
Worse, if in truth Jesus was God and understood and knew all, why would he cry out from upon the cross, "My God, My God, Why hast thou forsaken me?" How do we explain this, assuming it is true? One significant likehood is this situation is wholly consistent with the view that Jesus, as a Jewish mystic, had become delusional, especially in regard to what he knew and understood, and in his belief and claim that he was God, which claim the scriptures confirm he repeatedly made.
Saul's or St. Paul's contribution to the mythology was to up the ante. For eons, sacrifices had been made by those of Judeo religious disposition. Usually, animals of varying expense were the sacrifices to God in that tradition. Abraham's almost sacrifice of his son, Isaac, and human sacrifice in other then unknown cultures raised the stakes. Paul's idea was to make Jesus, a man, into God so that in sacrificing him, we would be sacrificing God himself or if you will, his "Son" in his likeness. (This is why the Father, Son distinction is needed -- killing God would not do for the mythology.)
But the point is you cannot get a higher level of sacrifice than that. The ante was raised to the ceiling. This was the ultimate sacrifice in the spirit of Abraham, but a much greater one still. The weak and needful believers in myth, who wanted a truly miraculous (i.e., zero probability events) religion, loved and bought it. It was an escape from reason and disorganized daily life which they found to be too disconcerting and oppressive. The myths of all religions are invariably tailored to meet human and social needs, some better than others. Early Christian services were held in the various homes of different believers and were led by women.
Regardless, the core issue, as Nietzsche contends, is the following: intelligent people who are intellectually honest with themselves and know what we now do about the natural world, philosophy, the sciences and especially the sociology and anthropology of the creation of myths and fables of various cultures and peoples to address personal and social needs, can no longer believe in the nonsensical, mythical conjectures of fact which are required to accept and believe in Christianity, Islam and other myth and fable based belief systems. As Nietzsche also explained, it is Christianity's dedication to truth and honesty that is also its ultimate downfall, as this explanation reveals.
This is why it is called "Faith" And not all Christians acceptance of faith means they take every biblical story literally. Different denominations of christianity accept theology in more literal terms than others. This does not represent a cognitive impairment. As Faith is not about what can be proven. It's about faith. The fact that a person attends mass, has faith in a higher power, edorses christian value's, and is a "Tea Bagger", does not mean they take ever biblical story or prophecy literally. Many recognize that many biblical stories where taken directly from babylonian mythology. If you attended a mass of most any denomination you'd know there is great diversity of opinion in congregations. And we christians don't blindly follow the advice of theologians. Most Catholics for example support the notion that a Priest should be permitted to be married, yet the vatican disagrees. The same as you have likely voted for a candidate and yet not agreed with all his positons. That did not necessarily preclude you from associating with his cause or supporting the greater effort. You just choose to lump the “Christian Right” together all as sheep because they don't agree with your idealogy, which makes them intellectually inferior to you. Steven Hawing himself has not ruled out the possibility of God in his book, A brief history of time. But since when do you care of actual facts or what can be proven. As with the original purpose of this debate. Every resource available shows the USA has the highest rates of success in the treatment of virtually every major illness...Cancer...Heart disease...AIDS. You name it and we've had more success. Yet all you can quote is a CIA fact book that accounts for multiple other ancillary causes for mortality. You can't debate the results on their merits because there is no proof to the contrary. Yet you still endorse your idealistic views that we need to mimic a system with results that are less successful. Sounds as though you are the one who does not follow the scientific method. You choose the outcome first that you wish to see, and then selected a philosophy that would support it regardless of what the results show. That is Intellectually Dishonest.
favorj, he doesn't dispute the results of the treatment of specific disease because it's not open for debate. results are typically but not exclusively better. there are a few area's of treatment where we lag as a country. but as a whole we do have better outcomes. incidently you wrote in earlier posts about the true cost of medicare not being reported in the medicare budget. i have not seen a specific study. but i can tell you it makes all the sense in the world. any doctor having to deal with both public and private insurance knows that medicare is far more beaurocratic and unresponsive to deal with. and yes they are twice as more likely to reject a claim. there are studies that show this and in my experience i would say that is understating it. if you told me they were three times more likely i wouldn't be taken aback. amazingly they are still riddled with major losses due to fraud even with all they don't pay. you'd think with all there rejections and refusal to pay they'd be a highly profitable asset to the federal balance sheet. but as you have stated earlier. gov't incompetence is the standard. they really can't get a single thing to run well. there is no circumstance in which i could envision ever participating again.
FJ writes, "This is why it is called "Faith" And not all Christians acceptance of faith means they take every biblical story literally. Different denominations of christianity accept theology in more literal terms than others. This does not represent a cognitive impairment. As Faith is not about what can be proven. It's about faith."
This is our core difference. If some Christians do not believe in the historical truth and accuracy of the elements or events of the Nicene creed, then what are they left with visa vi a Christian religion? This is my point. If a person believes the truth of those events occuring, I submit it has to be on faith -- that is, the factual conjectures must rest on no reasonable or credible basis. If they don't so believe, then the problem and the religion evaporates. If they do so believe, then I am concerned about that fictionalizing thought process spreading, especially into the political arena.
Now, I agree that many selectively believe, including Catholics, but by what criteria can they sensibly do so except by credibility and reasonableness? Their selections, however made, may or may not logically destroy their religious system, but too many do not both to think it through and decide that question. I submit that is a problem in thought. To be sure, Christian belief has become seriously fragmented across a wide range of people and churches, but do they consider the coherency of what they contend is in fact left of their religion? I believe, largely not.
As you point out and Hawking suggests, none of this negates the existence of a supreme consciousness or being, but when cleaning viewed from a Nietzschean perspective, it does raise serious questions about the nature of our relationship, if any, to that consciousness, if you will.
Debunked of myth and fable, it may well be that our lot is to try to understand that consciousness a la Newton, who is said to have proclaimed on his grandest discoveries, "God I think thine thoughts after thee." To be sure, to understand our universe and ourselves certainly seems to be a major thrust of civilization, but what more is involved? There is little to provide answers without reaching back into our discredited mythical systems which too largely grew out of our own needs. This is a major quandry of postmodernism.
Perhaps the best route to understanding the supreme consciousness, at least in my mind, is to better know and understand the what and how creation came to be and what it is all about. That certainly is the thrust of science and the best of world civilization. A great physicist has suggested that is the only way life can rise above the level of a farce to at least become a tragedy.
Since you end with a comment on medicine and my views, I will as well. The problem in American is less the quality of the treatment that is provided, than it is that too little access to treatment is afforded to so many. But this is no surprise because oligopolies -- and I have identified several involved-- necessarily charge too much as a means of rationing to correspond to their restricted outputs.
You next argue as to my views, "Yet you still endorse your idealistic views that we need to mimic a system with results that are less successful. Sounds as though you are the one who does not follow the scientific method. You choose the outcome first that you wish to see, and then selected a philosophy that would support it regardless of what the results show. That is Intellectually Dishonest."
Not so, my views are primarily limited to the following:
1. The American health care system is not sustainable,
2. Citizens of other developed nations with national healthcare systems basically like their health care systems and are not about to abandon them,
3. Americans do not like their health care system (as opposed to their treatment, when it is received),
4. So called “free markets” have failed and become troubled, dysfunctional oligopolies in the American health care system; and
5. Major reform of the American system is therefore imperative.
I do not go so far as to suggest the broad reforms to be implemented are the best, the optimal or perhaps any more than the most politically expedient. I have focused on the problems here more and in my article have simply identified what problems have to be solved and what the most direct solutions are. I have not been able to garner agreement even on that. I dare not suggest global solutions or reforms as opposed to how to fix the immediate problems of the present system.
Kimball, think of the perspective of faith in the minds of many christians as playing the telephone game. I for one believe in Christ. That does not mean that every interpertation of his existince was reported accurately for 2000 years. My faith in christ does not mean I assume he may for example not have been encarnated in many forms. So therefore I do not rule out all other faiths. the deviation in the minds of the faithful from the church itself comes in many forms. Most respect the fact that the church was created by man...not god. So not all the church says is an will be accurate. that doesn't preclude me from having faith in christ. The church for example does not support the death penalty and I do. You group people of faith together and imply they have a cognitive impairment. I take my daughter to mass for example because for the most part it reinforces the values I believe. Religion for many of us provides structure around spirituality. You can believe in Christ and the general values of the church without taking every story of bibilical prophecy literally. Shall we stop telling children the story of the boy who cried wolf if the story turns out to be made up.
To FJ On Franken, you are badly confused. The website to which you refer us is one where there are multiple attempts -- some more successful that others -- to catch Franken in misstatements or lies IN REGARD TO HIS FIRST BOOK, THE TRUTH.
Accepting that he needed some help for his second book, Lies, Liars and the Lies They Tell, Franken got staff support from a group at Harvard. It was solely to the second book that I referred. There is no debunking of the second book on the website to which you refer us although you have to go to each entry or challenge to determine that because, like you, the website's author tries to blur the two together with his main headings.
Your ad homonym slur was overly broad and badly in error. See, you simply wished it to be so, and then said it.
I don't believe I read his second book I will admit. However the book I had read was filled with so many mistatements that where so clearly plitically motivated, He is hard to take serious. That along with his upseen outbursts make him little more than a laughing stock,
FJ. writes: "Citizens like yourself from the Baby Boomer generation have proven yourselves to be the complete antithesis of the greatest generation, and possibly done irreparable damage to the social and fiscal fabric of this country with your “Great Society” entitlements. You have shown yourself to be little more than a fraud. And hopefully Seeking Alpha’s rejections of your more recent articles of pontification will prompt you to redeploy your propaganda back to where it belongs…The Daily Kos, Huffington post or maybe even the Daily worker. This way you can continue you to marinate your ideas in a more friendly culture of victimhood & defeatism."
Pure ad homonym vitriol.
It is one sure way to tell that your arguments are getting through and you are prevailing. As the old legal maxim has it, when you lose on the facts, attack on the law; but if you lose on the law, too, then attack opposing counsel personally.
Call it what you want. Your generation largely put entitlments on steroids. And you are a supporter of many of these entitlements. And you have passed the bill on to my Children and your grandchildren.
If the middle and lower classes are getting so many entitlements, how come the income and wealth distributions in America are skewing so strongly and rapidly toward the rich, giving us the worse distributions we have had in American history. (See research on same in economics department of Columbia University.) You are just a part of the smoke screen.
I support social security and medicare for those that have paid into those programs over their working life times. I also support unemployment benefits for those thrown out of their jobs by the recession. Beyond that, I do not support any so called "entitlements." Again, you are just blowing smoke.
These are two different issues. The Rich are not receiving anymore in entitlments because there is a maximum # of dollars paid on SS benefits. So if more than 2/3 of out federal budget is entitlements then whom does it go to. I personally believe the seperation in wealth is do to the entitlment society. When have created a society in which a large portion of our population believes the Gov't should do damn near everything for them, The Gov't must deal with obesity for example. Not the people that choose to eat garbage all day as if they didn't know better. And we need a gov't program for this. This has done great damage to the work ethic in this country. My Grandfather came to this country with less than $5 in his pocket. He built as sucessful business and lost it all during the depression. Than rebuilt it all over a period of many years. He never once accepted a dime in payments of Gov't aid. To him it would have been embarrasing. My father declared bankruptcy when I was a child. At that time it was over $300 or so. When he got back on his feet he paid back everything he owed regardless of the fact that he was not required to. When I asked him as a kid why he would do that, the answer was "because I borrowed it" Sounds so simple. But no longer the ethic of this country. Most people agree that people should receive a benefit that paid in should we actually keep the system as is. However Social Security is as insolvent as medicare. But that's not how it works. For example you can receive Social Security benefits based on credits for payments made into a foreign tax system. So we have people that come into this country, have paid next to nothing into our programs and then collect. You may not like it. Well...Hopefully you won't. But this is what happens when you put Gov't in charge of anything substantial. This is clearly done by design as most politiians love it when the masses are dependent on the system. It empowers them. Incidently...there is virtually no difference between the SS trust fund and the way bernie madoff ran his portfolio. Both take funds from group A and pass it along to Group B. There is no real investment that takes place other than buying treasuries which must then be paid for by those whom the benefits are paid to. Both are ponzi schemes. When the demographics fail...the system fails. At least Madoff attempted to hide it. For all of your talk about Pareto and how wealth is distributed, there is little mention to the fact that 75% of all Federal Income taxes are now paid for by 10% of the population. And nearly half of all Americans pay no income tax. Some people actually pay no taxes and get a refund check in the mail when they file. They call that a tax cut now. It's really just more welfare. Yet virtually everyone collects a benefit. That is unfair. Such a small # should not be forced to carry everyone on their back. As I have said before. The "Super Rich" where not necessarily born that way. They work damn hard to get there and it's nobody's business what they make. There are many "Super Rich" that come from nothing.
Sorry Folks this is the link for the second Franken book where he was actually debunked even further as a fraud. They're where even more factually incorrect statements in that one. As it turns out I was wrong it was hi second book I read. Not the first. It has beem some time and I read alot so I aplogize for the incorrect statement. But I specifically remember the chapter in which he slanders Barry Goldwater with baseless acusations. But here he was caught in even more fraudlent statements. Considering he had help from harvard that is pitful. I only read excerpts from the first book. But I am sure Kimball will have exuses for all the Researchers as well as franken. Since he wishes Franken was an honest man. So he just simply wished it to be so, and then said it. Maybe Franken and theresearchers we're all ill at the time they we're writing this book and didn't receive the necessary national healthcare they wer're entitled to. So clearly it's not they're fault they made so many substantial errors.They must have been medically distracted. It's the fault of society.
You're a toubled man kimball if this is a person you take seriously. And we are all in trouble now that he is actually a senator.
The new cite does address the right book. Some of the points raised there are legitimate, some are strained and some are pure deflection from the point raised to some alternative point. Considering how much Franken addressed in the second book, the critique is not particularly persuasive overall, not on par with the first effort on the first book. Too, the critique does not really come to grips with Franken's key points, issues and central conclusions, for what they are worth.
I do not mean to take Franken's side totally in this back and forth particularly and I do not share his political philosophy and certainly not his political style. Too, my perspective and focus is different. My contention is that for years the extreme right Republicans of a religious nature, once emerged from the closet, have been too ready and able to lie and say what they believe best serves their and their Lord's political and other interests for the reasons and explanations I have already provided. That is more my concern.
In the politican arena, in large part because of the situation I have described, I believe that we are awash in much foolishness and stupidity. The quality of discourse is hampered and very poor. Here is an example of me speaking out against that very thing by a religious nut this very evening, elsewhere:
"What ???? "the Obama administration's despicable sellout of America's security, of our allies and of our economy," "the insanity of the Obama administration," "this administration’s treacherous abandonment of America’s own national security interests," “Obama can coddle every Marxist and every terrorist across the globe.” – Give me a break!
This is outrageous, hyperbolic and stupid political discourse of the lowest and worst sort. Any politician should be ashamed to be associated with this obvious fool. You can disagree with Obama civilly, but this kind of talk is pure religious "nut” extremism and grossly irresponsible."
I think some of our closest allies in Israel would disagree with you here as well. Obama is the most unpopular president in the history of our country with Israel. And my friends over in the 82nd aren't particulary happy about there NEW recent rules of engagement either. I suggest you have a conversation with some officers in the NYPD anti terror task force my freind. We are in some trouble. And there hands have been tied even further than before. He would have fit in nicely at the Munich Accords. But that is a topic for another day. The point was you ought to stick to trying to convince people that Friedman agreed with your position on healthcare. Even though that would be a false. At least you'd be quoting someone whom isn't certifiable like Franken and attempting to use classic Alinsky tactics by intentionally misleading his readers. Too many false statements for the author and 14 harvard researchers to just be mistaken. And clearly deliberate. No...Wait...It's the Evil Christians That are Liars...Give me a Break. More Slander. Oreilly...Limbaugh... Levin...All on the right are liars. You never mention a specfic lie or site when and where it was said. Probably because you have never actually read their any of their books. You speak in generalities. Your borderline Alinsky yourself.
FJ suggests Obama is the most unpopular president in the history of our country with Israel. That may well be. He is certainly the least taken in by the Jewish Lobby which hawks and tries to censor American papers, including the N.Y.Times, for anything contra the State of Israel and tries to squelch anything they don't like that is published anywhere. It is a regular gestapo.
Obama is simply tired of US presidents and politicians being pushed around by the Jewish Lobby. For more on these Jewish activities see www.lrb.co.uk/v28/n06/.... The authors there provide a more balanced view that the zionist Jewish community cannot stand and in fact tried to surpress from publication. Israel, which engages in spying on America, does not serve America's best interest, while America has served Israel's best interest too well, causing us to lose good will in other non-Arab parts of the world. I have lived in Arab countries and have observed the situation first hand. There is too much bad Jewish behavior in the Middle East.
Next, you are too well terrorized by Bin Lauden and his ilk. There is a threat, to be sure, but we need not act like cowards about it and tremble so. It is unbecoming. Reasonable steps -- some in compromise of our Fourth Amendment rights -- are being taken. The Director of Homeland Security, Janet Napolitano, is a long time friend and former law partner of mine and I have a good sense of what in fact is being done.
Beyond that all we have from you is simply more and more ad homenym slurrs of me personally that I simply won't and don't have the time to respond to. If you tried your style of argument in a debate setting or a courtroom, you would be quickly banned. You are a classic example of what I have written about as rightwing Republicanism as Religion in the political arena, although you are a bit better informed than most and less overtly religious, but all the topical reactions are there.
P.S. Again on another issue you are badly confused. I never said Friedman agreed with my position on health care. In fact, I have not even stated my position on what reform of the health care system I think is or would have been best! I said Friedman agreed with Arrow's analysis of why markets cannot function properly in the area. Further, all I did was write what I thought had to be done, within the framework of Obama's legislative system, in order for it to stand any chance of working reasonably well. The legislation doesn't do too much. For that, I am villified ad nausium. You should try thinking about the issues and reading more carefully and widely, instead of throwing rocks and stones at me personally. It reflects badly on you.
Your entire article does nothing but make suggestions on what do with our heathcare system. You suggest a hybrid of Britain and Canada. Read your own material. You said " If we wanted similar results to what they have, we could adopt either of their systems or some hybrid of the two."
Anti semitism as well. At least you don't discriminate against some faiths. You apparently hate all equally. Anyone who has been to Israel... As I have... knows what a fantasy world Kimball lives in. This is the only true democracy in the region. And a country that has gone to create lengths to make constant attempts to achieve peace. And our president he has completely alienated them.
Is this the same Janet Napolitano that cut off funding to the virtual fence on out border. Then anounced to our law enforcement agencies that we need to be more cautious of the threat of our own soldiers returning home from combat. But in the meantime we no longer use the words Radical Islamic terrorist. She has become the laughing stock of our law enforcement around the nation. And the president is the laughing stock of the people that defend us in the theatre of combat. Doesn't surprise me you would associate with her. It's a shame we didn't have men like you at the chosin reservoir. They marines could have surely used a man with your attitude in the fox hole.
favorj you are correct. kimball apparently is a bigot. i am a jewish american. i have lived in israel for a brief time in my youth. i also visit family often in israel. not only does kimball not take serious the threat of these maniacs. he also is clearly discredited here. the israelis have made great and often grave sacrifices for peace. hamas wants nothing of the sort. they make no secret of their intent. nor does the mad man of iran. there is no negotioating with these groups. we have tried. they are very clear about their goal. they wish to wipe israel out. only american media pretends this is not the case. strangely hamas and hezbollah do not. they are quite proud of their postions. and they receive too much sympathy from surrounding governments. secondly, as a physician the notion that physician in the us support universal care is ridiculous. there are some at the university level that do until they go into private practice. then they have to deal with reimbursement problems. us dr's are few in numbers that support this or the current healthcare legislation. most people don't even know this. the current legislation allows for the federal gov to actually draft drs. even after they are retired in the even of an emergency. yet they decide what they consider to be an emergency. perhaps a shortage of drs will be an emergency after they run us out of the industry.
Agree accept for the part about the drafting of Dr's. There was some ridiculous language in the House version of HR 3200 back in Oct that attempted something like that. However I am almost positive it was stricken from the bill that passed. At least I hope so. There is enough disturbing elements to the bill that actually passed where ammendments had to be made to remove key elements. Scary the stuff these nuts write that had to be removed. 7 billion dollars for building Jungle gyms Employer mandates on providing time off for breast feeding. It gets worse. Almost as bad as the stimulus bill that spent 2.5 million on a program to educate prostitutes in china on how to drink responsibly on the job. This stuff would actually be hysterical if it wasn't our money.
Of course, true to form, any non-Jew who says anything contra the U.S. Jewish lobby, Zionist activities anywhere or Israel in any fashion is automatically anti-semitic (which term technically includes most Arabs too, as semitics as well) and bigoted too boot. Proof of another, but different variety of ideolog, also connected with a religious habit of mind.
The religious right has long supported Israel and Zionism because, according to the New Testament, just before the rapture, all Jews will see the error of their ways, convert to Christianity and will levitate and ascend with the Christians straight up into Heaven to sit on a cloud with God. I have heard Falwell and Robertson says so many times along with other nutty televangilists.
Those of us not of a religious habit of mind, of course, think the whole business is arch foolishness, even if it does guide peoples sentiments and behavior.
Again, all is a big part of the mind set I have been talking about as religious. Religion is a disaster for clear and unfettered thought.
Having said what I said, I do agree that hamas and hezbollah do in fact want to wipe Israel off the map and repopulate the area soely with Arabs. Our U. S. policy is to support Isreal and prevent that. I do not at all disagree with that policy, but do disagree with much Israeli policy and practice which antagonizes and hurts adjacent Arab populations and fans the flames.
Israel needs to be careful in the US, especially with its high pressure lobbying and hassleing of the press, not to more antagonize its supporters here, including the U.S. government. That should be only common sense, but the religious disposition among some Jews truly worries and scares me. The hard liners are a problem. We need to get the Middle East mess settled and resolve in the next few generations. Ironically, there are some Arab Jewish towns where the two populations live well and happily together with little friction and much cooperation and coordination.
Newsflash...Falwell and Robertson don't represent the conservative movement. Not by along shot. Most conservatives are more likely to identify with a Mark Levin. And the Conservatives...Not Religious right suport Israel because they use a form of democracy that grants individual liberty, more consistent with american values. It has nothing to do with Biblical scripture.
Hamas and Hezbollah are the values of many of these Gov'ts. They do not respond to olive branches. Only power. That has been the way of things since much longer than you and I. If we want to resolve the issue we need a president whom is not afraid to express support for the youth of Iran when they march in the street against tyranny. They are looking for support from the USA. But when a Honduran president decides to sieze power and order the miltary to overthrow the Gov't he is quick to condem them for throwing out a totalitarian dictator as they should. His instincts are all wrong. The Israelis know full well what they have to do to survive. And they will like deal with the problem before the end of the year.
You are in bed with these guys as members of the same party and as I argue, at a more subliminal level you argue like they do, albiet more articulately and religiously more covert, and take many of the same positions they do.
At one level, you are right. Arabs do strongly respond to power and do not always respond to an olive branch. However, they also respond to being needlessly antagonized and treated badly. Unfortunately, that makes them be all the more only responsive to power. It is a bad situation. Expanding settlements in to areas that under some settlement proposals would go to the Arabs likewise just adds fuel to the fire and leads Arabs to believe Israel is only about one big land grab. Again, it is bad policy and practice and also fans the flames. Israel is not at all being considered in its actions, and Israel is pissing off more nations than just the Arab nations by its bad behavior.
I am not knowledgeable about the Honduran situation and do not addrress it, but am unwilling here to condemn Obama across the board. I think he is correct on Israel. A bit of tough love is needed. It is Israel too that only understands power.
The article starts from the position that the health care legislation has passed and is going to be around. It then addresses what further or included reforms are needed to make the new system work because the old one was not viable. The system passed was not the best, but it was all that could be passed and it just barely made it at that. My focus was how to get something workable.
Also, I do not favor or disfavor Janet Napolitano actions. She is a friend of many years that is all. We had a common very liberal legal mentor (John Frank, the lawyer who did the Miranda case in the US Supreme Court), she became a good Democrat under him and I was deemed politically incorrigible because I always called each issue as I saw it and would not go along with any party platform, even in broadest outline, as you guys do. I was deemed insufficiently loyal, politically.
As to your rationale on why we should support Israel, aside, I assume, from our early pledge with the British, why is it any of our damn business whether Arabs abandon their Islamic theoracy and adopt democracy or not? Again, your position is covert religiousness disguised as being pro democracy. It is none of our damned business! Those of religious disposition always want to mind other people's business. It is an key identifier.
FJ you misunderstand me in saying "You suggest a hybrid of Britain and Canada. Read your own material. You said " If we wanted similar results to what they have, we could adopt either of their systems or some hybrid of the two." That is not me recommending any system. It is me saying if we want something similar we could adopt one or the other or something in between. That is not me advocating anything there. I have never put my thoughts on the table about what system we should have because what Obama went after was about all that could be gotten and that is what we have to work with now.
That’s an excellent question. Many Liberals believe we do not have a right to impose a democracy. Essentially Freedom isn’t for everyone. Fortunately for the survivors of Nazi Germany...That wa not out postion then. At least not after FDR was able to motivate the population after Pearl Harbor to do what was eventually inevitable. First off I believe as we saw from the students of Iran as they protested against tyranny that this is a myth. It is the religious clerics of these nations that suppress these people and try to convince the world that democracy has no place in the middle east. But this always comes mainly from those in power. Not the population. At least not anymore. So then the Question is should the united states be the one to impose democracy. As a matter of record I do not wish to see the USA act as the police dept for the world. And I much prefer to see us focus more on securing our own borders first. But the aspect which conflicts me is this. These radicals cannot be just ignored. Because as the Doc said. It is there intent to destroy Israel. But beyond that the leaders of Islamic fundamentalism believe that it is there job to impose Islam on the world. They interpret Islamic law this way. They also make no secret of this. Our media doesn’t always wish to report it this way. But if you listen to their speeches, their intent is clear. So that places us in a state of self defense. I don’t believe we can force democracy on a nation. But we can encourage it. And we can protect it where it already exists. In Israel. If I truly believed that the leaders of the Arab world and many of the organizations they support where content to impose their theocracy only on their people, and confine it to their nation. I would say we could disagree and say it is a sad situation. And not one American life would be worth the effort to change their culture. But that is not the case. They will not be contained through talk alone. And only the Neville Chamberlin ‘s of the world believe this. And much history is misreported. To these radicals, they are still fighting the crusades. I have actually heard some on the far left in the media almost justify the actions of Radical Islam in the name of revenge for the crusades. Most people do not know that the Crusades where a result of Muslim invasions into Christian territories as far back as the 7th century beginning with the first arab conquest of Palestine and the slaughter of countless Christians and the eventual fall of the byzantine empire under attack by Turkish muslim’s. You may think this is archaic. I know I do. But to them it is there mission. The importance of the history here is that it may not have been the right tactic to attempt a counter conversion as defense for 7th century Christians. But both then and now…The problem will not just go away. It will be dealt with directly or history will repeat itself. And i don't are what Napolitano is telling you. I have many friends in the NYPD Anti terror task force. You greatly underestimate there ability. They are quite patient. These people will sit on a builing not for days or months. But years. Harlem NY is now invested with Mosque's that are recruiting and training them. The Police can do little until they see an overt act. And the A.Q. Khan network had lamenated color brochures of nuclear technologies they where trying to sell before they where broken up. As the Task force tells us all the time. It's not an if anymore...It's a when and how bad. They only have let just one slip through the cracks.
I thought I posted this, but I guess it did not get through.
A 2008 survey of over 2000 doctors selected at random published in the Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.
Because what we had was not viable, some reform was imperative. I do not argue that the reform we got was the best. It was more likely the most expedient, give the opposition involved. The problem now is how to make what we have work. That requires the further changes and reforms I have written about in my article. The relevant markets are a mess. Premiums are shooting up at 67% per year in the insurance area, profits and overhead for insurers are increasing at a 12 rate per year, the Drug oligopoly and FDA system are a mess and we seriously need more doctors per 1000 population. All of this needs to be straightened out or the reform will not work any better than what we had that couldn't either.
Since what we had was no longer viable, some reform was imperative. The reform we got probably not not the most optimal, but we have it and the issues addressed in my article were largely targeted on what more is needed to make it work. The legislation alone is insufficient to give us something workable. The changes I suggested in addition are needed. The markets involved are not functioning as they should. Premiums are skyrocketing, Insurers' overheads and profits are too high. Ect., etc, as I explained.
America's health care industry has spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms proposed by Obama and others. There are six registered health care lobbyists for every member of Congress. The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Finance Committee that drafted Senate health care legislation is Senator Max Baucus (D-MT). A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT) in 2009.
This shows us rather clearly where the real opposition to health care reform is coming from. Basically, those with oligopolistic profits are putting their money where their mouth is. Doctors, interesting enough, seem more concerned about more prospective patients getting good medical care, even if the reforms ding their compensations a bit. However, foreign doctors in developed nations are not exactly paid at poverty levels for the most part.
This is a fanatasy. Was the Study US doctors. Or Doctors from around the world. Every poll done of US physicians shows that Dr's in this country in massive majorities oppose universal care. The few that do support it do not exist in private practice.
The fantasy, of which religionists have many, is all yours.
See, Google results: Search Results: US doctors support universal health care
31 Mar 2008 ... WASHINGTON, March 31 (Reuters) - More than half of US doctors now favor switching to a national health care plan and fewer than a third ... reuters.com/article/la... - Cached -
Physicians for a National Health Program Physicians for a National Health Program is a non-profit research and ... and health professionals who support single-payer national health insurance. ... The U.S. spends twice as much as other industrialized nations on health care, ... We endorse a fundamental change in America's health care - the creation of a ... pnhp.org/
22 Mar 2010 ... Health care costs will continue to skyrocket, as the experience with ... U.S. physicians support government action to establish national health insurance. ... Physicians for a National Health Program (pnhp.org) is an ... pnhp.org/.../pro-singl... - Cached
Support for national health insurance among U.S. physicians: a ... by RT Ackermann - 2003 - Cited by 14 - Related articles Support for national health insurance among U.S. physicians: a national survey. ... of U.S. physicians toward the financing of national health care. ... ncbi.nlm.nih.gov/pubme...
Physicians' Beliefs and U.S. Health Care Reform — A National ... by U Coverage - Related articles 14 Sep 2009 ... Physicians' Beliefs and U.S. Health Care Reform — A National Survey ... that he needed physicians' support on health care reform and offered ... healthcarereform.nejm.org
Small Samplng. More recent data shows IBD poll. 45% of Doctors consider retiring if Obamacare passed. Although I doubt the younger ones would be able to. You idealogy is in the way. There are hundreds of polls that state the opposite. Take your own polls readers. Ask your local physician what he thinks and you'll get the message. Just like your quoting of the AMA. They barely have any representation of the profession. The latest #'s show about 17% of Dr's are even members. And they've lost even more support since supporting obamacare.
count me amongst the retiree's. but i have been around long enough to do it. it us true that the younger doctors are likely just expressing disatisfaction. they are too in debt to just leave the field. it's really the newer doctors that will be the problem. as i said before, i would never have advised my kids to go into medicince. i saw much of this coming years ago. we'll continue to have to import and also lower the standards for medical school admission. all of my peers feel the same. my personal prediction is you will likely see an eventual single payer or public option. not that i support it. but government always grows. many doctors whom are the most qualified will offer a form of concierge type service for those who can afford it. this will actually create a greater disaprity in services between quality of care for the wealthy and the poor. and i can tell you with absolute certainty as i have worked with doctors in the field my entire life. they do not support what the president has done. the only support exist at the university level. many of them are excellent doctors. but at some point they go into private practice and must deal with medicare billing and a whole host of other issues. then there view tends to change. it's easy to think with this idealologic view of insuring everyone without the quality of care suffering. but it's just not real. this dicussion reminds me of when my son was a young child and we discussed current events. he once told me when he learned about crimes like murder. he aked me why don't we just make it illegal to kill someone. kids are so innocent. this is similiar. this is just a fantasy. there is no way to make doctors civil servants without the quality of care suffering. another major issue to consider is that if you do want to institute universal coverage, be prepared to pay for the education cost of med school for the doctors on the back of the tax payer. thats how many socialized systems work. you can't expect civil servants to take on such debt. especially with such reduced compensation as they will likely see. ofcourse the antitrust rules would likely then have to change for the medical community. i suppose we could then go on strike as they physicians in france have done many times. i wonder how well that would go over in the usa. i tend to think a garbage strike would be tolerated much better than a physician strike.
Doc, take the civil service slot for your own good. You can put your feet up on a desk for a few more years and collect a pension. NOT. Drudge linked to a story the mainstream has yet to report on. Maybe they won't at all. Not that this should be a surprise though. They funded one hospital with Stimulus money and then closed it down before completion with the healtcare bill. These nuts in congress would likely file for divorce at the alter. Drudge has so many hits he crash the site.
Health Law Bans New Doctor-Owned Hospitals, Blocks Expansion of Existing Ones Monday, April 12, 2010 By Fred Lucas, Staff Writer
The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds, says a group that advocates physician involvement in every aspect of health care delivery.
Physician-owned hospitals are advertised as less bureaucratic and more focused on doctor-patient decision making. However, larger corporate hospitals say doctor-owned facilities discriminate in favor of high-income patients and refer business to themselves.
The new health care rules single out such hospitals, making new physician-owned projects ineligible to receive payments for Medicare and Medicaid patients.
Existing doctor-owned hospitals will be grandfathered in to get government funds for patients but must seek permission from the Department of Health and Human Services to expand.
To get the department’s permission, a doctor-owned hospital must be in a county where population growth is 150 percent of the population growth of the state in the last five years; inpatient admissions must be equal to all hospitals located in the county; the bed-occupancy rate must not be greater than the state average, and the hospital must be located in a state where hospital bed capacity is less than the national average.
The rules fall under Title VI, Section 6001 of the Patient Protection and Affordable Care Act. The provision is titled “Physician Ownership and Other Transparency – Limitations on Medicare Exceptions to the Prohibition on Certain Physician Referral for Hospitals.”
More than 60 doctor-owned hospitals across the country that were in the development stage will be canceled, said Molly Sandvig, executive director of Physician Hospitals of America (PHA).
“That’s a lot of access to communities that will be denied,” Sandvig told CNSNews.com. “The existing hospitals are greatly affected. They can’t grow. They can’t add beds. They can’t add rooms. Basically, it stifles their ability to change and meet market needs. This is really an unfortunate thing as well, because we are talking about some of the best hospitals in the country.”
The organization says physician-owned hospitals have higher patient satisfaction, greater control over medical decisions for patients and doctor, better quality care and lower costs. Further, physician-owned hospitals have an average 4-1 patient-to-nurse ratio, compared to the national average of 8-1 for general hospitals.
Further, these 260 doctor-owned hospitals in 38 states provide 55,000 jobs, $2.4 billion in payroll and pay $509 million in federal taxes, according to the PHA.
In one ironic aspect, President Barack Obama’s two largest legislative achievements clashed. The Hammond Community Hospital in North Hammond, Ind., got $7 million in bond money from the federal stimulus act in 2009. It will likely be scrapped because of the new rules on physician-owned hospitals, according to the Post-Tribune newspaper in Merrillville, Ind.
Doctor-owned hospitals have long been a target of the American Hospital Association, which represents corporate-owned hospitals as well as non-profit hospitals.
An AHA study from 2008 says that physician-owned hospitals “lessen patient access to emergency and trauma care;” “damage the financial health of full-service hospitals and lead to cutbacks in service;” “are not more efficient than full service community hospitals;” “use physician-owners to steer patients;” “cherry pick the most profitable patients;” and “provide limited or no emergency services.”
One AHA fact sheet asserts that physician-owned orthopedic and surgical hospitals costs are 20-30 percent higher than average hospitals. Further, these hospitals lead to higher profits just for doctors, the AHA asserts.
“We don’t cherry pick patients, period, end of story. We take patients based on their need for care, not on their ability to pay,” Sandvig said. “It [the health care reform] puts control outside the hand of physicians and patients and into bureaucrats’ hands really.
The Association of American Physicians and Surgeons (AAPS) is one of many organizations suing to have the law declared unconstitutional on the grounds that the federal government cannot compel someone to buy a product.
While the provision on physician hospitals is not part of the lawsuit, it will affect it, said Dr. Jane Orient, AAPS executive director.
“If the law is declared unconstitutional, then the prohibition is part of the bill,” Orient told CNSNews.com. “There are vested interests in getting rid of physician-owned hospitals because they do a better job and are more affordable.”
The provision in the legislation and efforts opposing these hospitals can be simply explained from Sandvig’s view.
“It’s anti-competitive. I think it’s pretty clear,” Sandvig said. “We’re a model that makes sense that’s affecting innovation. We’re trying to do something better than it has been done. Anytime you do that, there’s going to be a clash between the existing and the new. Unfortunately, it’s a real David and Goliath battle.”
FJ argues that more recent data shows 45% of Doctors consider retiring if Obamacare passed. If this is sayings 45% will retire, and, to be sure that is the implicit suggestion, I do not believe it is close to accurate for a heart beat.
Doctors are going to have to be increased in number to around 3 to 4 per 1000 population instead of 2.2 we have now and they are going to get hammered on their artificially high current compensations because of the collapsing oligopoly in the supply of doctors, but, as I have shown, medical school enrollments are up and in a generation or so we will get there and doctors can go back to treating patients instead of worrying so much about their investments and managing their money.
The goal of this part of the legislation is to stop having hospitals run as doctors' coops. There is an economc literature on this point. Too, some doctors are forming speciality hospitals that attempt to scoop the cream of the practice away from other hospitals in selected high income specialities and leave those other hospitals with the freebes and more problematic cases. Again, this is doctors worrying about their investments instead of patients. These doctors are the ones that need to quit.
You guys are proving yourselves to be defenders through and through of the oligopolies in health care, with their attending pricing and output problems. Sorry, but I refuse to go there. You guys are too much sorry apologists for the status quo ante, which was really, like Christainty and Islam, a collection of indefensible and unsustainable positions.
At another level, doctor behavior in this quarter is just another reason, nationalized heath care is necessary, especially in the face of bald faced right wing lies like, 'We don't cheery pick patients period.' Denial, lies and apologetics is all we ever get from the right wing. It is enough to drive sane moderates out of the Republic Party.
Flooding the market with doctors will break up your earswhile desire for oligopolistic pricing and treatment. You are fighting a loosing battle eventually vis. many doctors whom are the most qualified will offer a form of concierge type service for those who can afford it. An oligopoly within an ologoply. Also, you do not have to drop med school admission standards. All that is needed is to increase the number of seats available in med schools hugely and qualified applicants can be found. As Harvard and other top schools argue, many, many more than are admitted to those universities are capable of doing excellent work there; they just cannot gain admission because the seats are limited. The scream of quality is always the cry of the oligopolist.
If we are going to have a nationalized health care system, tuition and other help is going to have to be made available to medical students with a subsequent reasonable service requirement of some kind to follow as a form of pay back, perhaps practicing in Timbucktoo for a while.
As far as Israel goes. You call it settlements…They call it their capital. As far as I am concerned they have made enough sacrifice’s. It’s time that they get tough. For your own edification, I thought Fallwell was a clown. And I am hardly in bed with what where his ideals. I could give you many ways in which I and many conservatives broke ranks with him. Robertson I have no issue with in general. But he is hardly a leader in the conservative movement. He is frankly irrelevant in many ways. Just not a real influence. Especially in the Tea Party movement. As I explained to you before. And you’d know this if you actually went to one. The entire movement is based primarily on Fiscal concerns. And in addition the view that our congress no longer abides by its constitutional constraints. Especially the 10th amendment, as I personally think this bill violates it. But we’ll leave that to the Constitutional challenges from the states and some other foundations. Whether the Supreme court takes this on or not remains to be seen. It’s not like it’s the first time congress has overstepped their bounds and gotten away with it. Yes most people attending TEA Party rally’s are probably Christians. But most Americans are Christians of some denomination. So that doesn’t tell us much. And I agree. I seriously doubt that many Dr’s will retire. I think the Doc is correct. Young Doctors carry to much debt to just walk away now. They where probably just expressing their outrage. Point being was they do not support this. That’s why your quoting the AMA is so irrelevant. There is so little participation from Dr’s in these organizations. But among the older Dr’s, the general consensus among my clients, which is I would guess to be maybe 20% of my client base. They have had it. They are all planning an early exit. The opening of seats is a myth. If you look at the medical enrollments, there are huge #’s of foreigners as I stated in earlier posts. If it was so restrictive to attend medical school we wouldn’t already be importing students. Stony Brook University is one of the largest teaching hospitals in the NY are and you’re lucky if you can find an American resident in there. They may be qualified. I won’t generalize. But it was quite frustrating in my hospital stay when I can’t communicate with the Dr. I prefer not to have an interpreter while receiving my diagnosis. If you think that quality won’t suffer like the Doc says, well time will tell. But you can call them what you want. Greedy… money grubbing… All I know is when I had to have my digestive system rebuilt via ileoanal osmosis, I wanted the brightest and most talented Dr’s at the Cleveland Clinic. Not the most altruistic ones. Bed side manner isn’t that important when you’re bleeding to death internally. And like it or not…Money attracts talent. Just like you left the field and study of economics for as you put it “much more remunerative prospects “ in the field of law. That’s what makes your ideas so impractical. You didn’t devote your life works to the Peace Corps did you. What makes you think Highly educated, skilled talented people won’t seek more “remunerative prospects” as well. Then again as President Obama said …They routinely take out tonsils when they could just write a script. Yeah sure. There is a real epidemic of this. A good part of the reason why so many foreign Dr’s come here is the economic opportunity relative to the rest of the world. As least for now. All that has happened at the end of the day with the example of the article I posted is that the government has stepped in between and willing supplier of a service and a willing purchaser of a service and said no. Yet they claim they will not intervene in Dr / patient relationships. They already have. What’s more comical is the Gov’t incompetence one again on display at they fund a hospital with stimulus money and then defund it with the Healthcare bill. This is more of what we can expect from Gov’t. Quite well coordinated they are.
P.S. If you think the ideala of conservatives like my self are driving out the “ Moderates” from the Republican party. THEN GOOD. That’s the point. The Lindsey Grahams & Arlene “The Spectacle“ Specter’s are the reason I reregistered as a Conservative several years ago. If they’d all get out then maybe I could reregister as a Republican again. No more Big Gov’t Republicans. If they don’t leave maybe a time will come for a real third party. Let us not forget…The Whig party is no more. There was a time when the Republican party was the third party. Thanks again Mr. Lincoln.
FJ, we don't disagree on much here. Medical school seats are expanding but not too rapidly because it cannot be done too rapidly without a real quality compromise. It is moving in the right direction however. Many foreign students do their residencies here and then elect to stay and not go back home, at least not for a good while. However, I agree that they should be fluent in English. An interpreter is rediculous.
We pick up many good students in all fields from abroad. At places like Harvard, Chicago, Columbia, etc. a very large proportion of the graduate students, even in my day, were and are foreign and Jewish. They gain admission because they are most qualified.
Some of the older doctors are clearly more focused on their money than their practices. I have represented many partnership factions in groups of waring doctors and my observation is too many would sell their mothers for a buck. They can really get nasty and vindictive and from a lawyer's point of view, need much collaring so they do not get into squabbles that damage their overall legal position. They are no fun to represent. I represented one guy who was such a turkey and so good at intinidating people I suggested a Dale Carnegie course and a year working on an indian reservation after he got board certified in invasive radiology and the market had turned down. With his new manner and credentials when the market turned up he got a positon as chairman of the radiology department at a major university research hospital and was hauling down the big bucks. A year later he sent me a bonus almost as large as my original fee. He was a handful.
I agree that Falwell and Robertson are not heavy hitters in the Republican Party but they dragged an awful lot of loonies out of the closet and into the politican current and induced more closeted religionists already in the political current into more full religious bloom, complete with Bible quoting, something not a few Senators enjoy.
I haven't attended a tea party. Crowds are not to my liking. Even in college, while I came to oppose the Vietnam war, I never participated in a rally or joined a crowd, although I would watch them. Just not my cup of tea. Recessions are not the time to complain about deficit spending, although tea partiers don't know that. It is during boom times when we should be accumulating surpluses that we should all very loudly protest deficit spending, not during recessions. We get this backwards all the time.
I agree talented or multitalented people usually try to do the best they can financially and it should be so. We want people doing their best. The system does better that way.But absolute income is not always the best incentive, I have observed. Relative income among peers seems much more important within a broad range. However, money does matter for sure.
Constitutional jurisprudence has become too much of a joke in recent years, since the Supreme Court put Bush in office using an Equal Protection argument it had consistently rejected for almost 100 years and has consistently rejected since. Fourth Amendment rights have been dumped in the toilet because we are terrorized and the majority on the Court will do what it wants and then try rather ineptly to rationalize it after the fact in constitutional speak. These are bad days for constitutional jurispurdence and the Court is too much politicized on both sides. We have no true constitutional scholars on the Court.
When you chose people for the Court based on their political positions, you tend to get political hacks, not truly serious and capable judges. I have often said I could go to America's ten largest cities and in each choose two neutral, non-political and very competent courts of nine justices each, all of which from each city would be better than what we have had for many decades. The craftsmenship and decisions of the Court are too often very poor.
Government is too big, especially inasmuch as we have contracted out much of the business of govenment to private companies who usually don't have to bid or suffer serious audits and especially after government employees have not been commensuately reduced afterwards. Congress is out of control and so is the bureacracy, but there is no one that can do much about it. Obama leaned on some lobbyests and the howl was unbelieveably loud. Anyone who bucks the money making system is simply dead meat and government goes on its way undisturbed.
We do disagree that new settlements in the outlying areas are not capital, but provocations that peace can never be attained because "land for peace" will be out the window and Israel will have nothing to put on the table that the Arabs want. It is stupid too because it is just a question of time until terrorists get some dirty suit case bombs and start making a polluted mess out of Israel. Israel is not being at all smart here and it is the arch conservative orthodox Israeli Jews that are pressing for the settlements because 'God gave them the land,' just as the Islamic Arabs believe 'Allah gave them the land.' Dumb, Dumber and Dumbest. Religious twits at base, blocking on both sides. Even Sharon got smarter than that. Too bad his health took him out of commission. Israel is getting the ever shorter end of the stick here due to its own foolish policies.
I would not get near either party because I am an independent and manage to offend everyone and skewer everyone's favorite idea or scheme, sometimes even my own with after thoughts.
Israel has done nothing but sacrifice land from the golan heights, sinai peninsula, to the the west bank. Israel allows palestinians to work in israel if they do so in peace. each sacrifice has been rewarded with missiles aimed at the jews. you can not negotiate with a people who do not believe you have a right to exist. and president obama is accelarating what i believe is most likely an inevitable war by making it clear he does not view israel as the unshakeable ally in the region they have always been and vice versa. the more he capitulates, the more he projects weakness. he asks the same of the israeli people and that can not be done. if they project the same weakness there will be nothing left of the israeli people. i fear that this is about to explode into a major war that will engulf the entire region.
The Health Care Reform Agenda (Revised Version) 241 comments
_______
footnote *
(Doctors per 1000 population
3.40 per 1000 people Austria
3.37 per 1000 people France
3.90 per 1000 people Belgium
3.82 per 1000 people Israel
3.60 per 1000 people Switzerland
3.20 per 1000 people Spain
4.20 per 1000 people Italy
4.50 per 1000 people Russia
4.40 per 1000 people Greece
vs.
2.30 per 1,000 people USA, on par here with
2.25 per 1000 people Slovenia
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If the Democrats don't sell out to being bought off on financial reform, if health care reform continues and if employment comes down steadily, the "just say no" party will clearly lose. Much depends on the last point -- but then what would, or have Republicans done about unemployment -- nada, zero, zip and they have blocked some efforts to help with it. The "just say no" party is a prescription for being stalled in place and nobody wants that.
i did read your article, and i understand where you are coming from better than you think i do - i just happen to disagree, thats all.
you say nobody wants our county to be "stalled",and i agree. however, it will be very interesting what happens this fall and the next presidential election - my current opinion is that most of us feel better only because the DEMS are screwing themselves so bad!
as i have posted before - i paid over 320k last year in med benes, and i bet that goes up by... God knows how much. Mark my words, the healthcare reform that just passed will either be eliminated by this time next year, or it will be so watered down you wont even recognize it - liberals are getting thier moment in the sun rigth now, but they will be forced back into the caves for another decade after this power grab debaucle.
Two big points to make here. First is that America needs to join the league of developed nations: they all provide health care to their populations, it's a given. If a government can't take care of it's people, what's the point? Germany, Japan, Canada, France, Sweden...or how about Costa Rica and the next tier countries. They all do it, and the fact that America doesn't, that 10% of American children are in poverty (and 20% are without health care) is disgusting and embarrassing. And it was truly disgusting to see hordes of people protesting the fact that the less well-off were going to get some health security for once in their lives. What is the mentality of someone who takes to the streets to protest something like that?
Second point: single payer needs to get back ON the table. Go to any doctor's office in the US: there is one doctor out front and at least three ladies in the back trying to figure out whom to bill for how much, with filing cabintes to the ceiling. It's ridiculous. In Holland they had a similar insurance company system before their health care reform: their solution was typically pragmatic. They kept the insurers in place, but mandated that they each had to offer a minimum standardized package of coverage, and capped the amount they could charge for that. So the insurers were incented to take cost out; and to improve service as a way to differentiate themselves. They are also allowed to sell better coverage for more money etc etc.
I live in Australia and they have single payer. I go for treatment, there is one standardized list of reimbursement amounts, the doctor submits the claim online, the money hits their account within a few days. Try doing that without single payer: never happen.
Doesn’t the fact that Premier Danny Williams of Newfoundland (the ‘Prime Minister’ to whom you refer) recently went to Florida to have heart valve surgery suggest that the quality of care available in Canada is generally inferior? I would respond that the travel issue is more complex than that question suggests.
Canadians do travel to the US, India, Malaysia and other destinations for medical treatment in some cases. A significant part to this travel is to the US and much of it is the result of Canadian health authorities sending patients to US facilities, and paying for the services there. This is a cost saving measure for these authorities as it forestalls the need to enhance occasional peak or rarely used specialist capacity locally. Canadian residents, like many US residents, also as individuals at their own cost travel abroad (as Premier Williams recently did) for medical treatment for a variety of valid reasons and this is not necessarily a basis for claiming that health care is intrinsically or generally better in such other places. Premier Williams went to a private hospital in Florida, for example, because that hospital is a world leader in less invasive heart valve surgery techniques. Premier Williams could have received timely and effective surgery at any one of many locations in Canada but chose to undergo surgery in the unique manner available at the particular Florida hospital and recuperate at his vacation condo near by. Likewise numerous US citizens travel to Edmonton in Alberta for eye surgery or to Spain or Italy for stem cell related treatments because of the advanced techniques available in each of these niche situations.
Even where it is not one of these niche situations, many US and Canadian residents travel to India, Malaysia or other countries for surgery or treatment at their own expense because they have reason to believe they will receive quality service, sooner and at lower cost than would be the case back in their home countries. We do not conclude from this that the Indian and Malaysian health care systems, for example, are generally superior to those available in North America.
1. The differential in what we spend as a percentage of GDP is largely related to the fact that healthcare is actually more accessible in the US versus other nations. I was scheduled for an MRI on my knee last year. The day before the procedure the pain disappeared. That didn’t stop me from getting it done anyway just to be sure. That is the not the norm in nations with national healthcare. You can’t just get an MRI in England. Not unless you’re one of the members of Parliament. This must be why 70% of people in England buy private insurance and won’t have anything to do with the Gov’t run care.
2. Medicare spending is precisely the problem. 65% of all of medicare costs are currently administrative. Classic example of an inefficient beaurocracy. Yet the new bill requires that private insurers are mandated that no more then 20% of Premiums collected can be used for administrative costs. Yet they must deal with even a larger web of beaurocratic rules that must be muddled through. Meaning premiums will immediately go up faster than they had before. In addition, and by no means a surprise that my company two days after this reform was signed announced that the impact of the loss of a tax deduction(sometimes called Loopholes) to the company on employees whom are retired will cost them enough money that all retires whom where previously receiving benefits will now pay 40% more of the Premium cost.
3. Restriction of medical schools is a ridiculous point. Medical School enrollment is at an all time low. Doctors today for the most part would never recommend their own children follow in their footsteps. They can barely get people to attend these days. The last thing in the world they are doing is restricting participation.
4. Most Americans due realize the system is problematic. Yet the same polls show that the vast majority of Americans are happy with THEIR coverage. Much of this is due to media perception of all the” 45 million uninsured Americans”. Which is a MYTH. When people are informed that about 10 million are illegally here in the USA,(Fleeing the very Socialized systems that the Author seems to be praising) and the remaining portion are largely often people switching employers and covered for three months under COBRA until the new coverage kicks in. Or just have chosen not to buy insurance even when their employers offer it. (Lord knows I have seen many of these at work). And lastly there are those whom are not offered it through and employer or are self employed yet make more than enough to purchase insurance and just have chosen not too. Then you see the real opinion of the Public. And that is why there is such large public opposition to this bill. Generally speaking, most American believe in personal accountability and would prefer to clean up their own back yard. If they can help their neighbor they will. But they don’t want the Gov’t mandating that we provide the same level of care to a crack addict as a hardworking American. I work out 6 times a week and try to eat right. Why shouldn’t I get preferential treatment to someone who chooses to eat Burger King six times a week.
5. Oligopolistic Pricing could largely be addressed by allowing insurance companies to do business across state lines. The total # of companies operating in the Health Insurance industry nationwide is over 1500. Yet you would never know it with the current restrictions in place. These rules of preventing cross state contracts are reducing competition and protecting just a few.
6. Lack of systemic incentives to practice preventive medicine ??? Preventive medicine does surely makes logical sense from the stand point of your personal health. However every study shows it has no long term impact on reducing cost. On the contrary it actually marginally increases the cost.
7. Drug companies engaged in fraud. This is even more ridiculous for a # of reasons. But one example is this. The current regulations the FDA places on a medications expiration date is far more strict in the USA then elsewhere in the world. And the companies are even more strict in some cases due to the litigious society we live in. A cousin of mine is responsible for global shipping of a major drug company. When a medication is created it goes into a suspension chamber. When there isn’t enough short term demand for the current supply of a drug it is often expired. Yet foreign nations, including European nations sign legal disclaimers to have drugs shipped into their country and discounted prices knowing full well that medication may have passed expiration and lost anywhere from 25-50% of its medicinal qualities. Then pass this off as a cost savings of Socialized medicine. Furthermore, foolish Americans then buy them back on the internet not knowing their expired and believe they have some great discount. The point here is the Gov’t is the corrupted entity, not the Drug Companies. They don’t hide the medicinal breakdown. They require before shipping that these Gov’t bodies sign these waivers stating their knowledge of this. As a matter of fact if you truly are indigent, most major drug companies have programs to provide the drugs for free. It’s good PR for them.
8. The Dr Compensation is the best one of all. This is specifically why Medical enrollment is down. A typical Dr nets about $30.00 in an office visit before taxes. As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner. So I pose this question to the Author. Since he feels that all citizens should be covered by the force of Gov’t with no regard to the rights of Dr’s. Then let’s address this point. Isn’t it also vital that all Americans receive due process as a citizen of the USA. Aren’t all Americans entitled to adequate legal representation. Yet that is not always the case. Shouldn’t we then offer all citizens a Nationally subsidized form of legal assistance at the Federal level. And since being an Attorney is now a far more profitable venture than a Doctor, it seems to me that we ought to have national mandates on what an Attorney can charge. Surely Congress can be trusted with this responsibility, can’t they ??? After all, it just doesn’t seem fair to me that there are Americans out there not getting the proper representation while there are attorneys who have made enough money that they have the luxury of sailing around the world in a boat that cost more than the average American’s house.
“Yet every one of the nations you mention have a higher mortality rate relative to the US . . . “
This is absolutely false. Virtually the reverse is true. From the CIA World Fact Book for 2008, here are the rank numbers by country on deaths per 1000 per year (lower is better):
rank from top
Germany 56
Austria 72
France 89
Belgium 64
Israel 145
Switzerland 90
Spain 73
Italy 59
Russia 22
Greece 63
Slovenia 60
vs.
USA 99
As you can see and verify for yourself the USA has A HIGHER MORTALITY RATE than every other country I originally listed except Israel which is too much and too often at war.
This is an immediate and concrete example of the lies and falsehoods being propagated by those opposed to health care reform.
For Example infant mortality appears to be a good measure of a health care system. First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also satisfies the second criteria of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world. This can be seen by constructing a table using the data on infant mortality utilized in the report from the Physicians for a National Health Program. Such a study shows that on infant mortality, the U.S. ranks below all nations save New Zealand.
But infant mortality tells us a lot less about a healthcare system than you would think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age." While the U.S. follows that definition, many other nations do not. For Ex in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living." This excludes many of the most vulnerable infants from Switzerland's infant mortality measure.
And We Shall see how quickly you’ll attend Switzerland should you get diagnosed with a rare Cancer. My Money says you’ll be on the first plane to NY to Sloane Kettering or Houston TX to MD Anderson.
As for my reasons for remaining nameless, When you work for a global Financial Organization you are often forbidden from speaking to the media or making public commentary not specifically approved by the company. Do to the highly contentious political environment most prefer to remain on the sidelines and don’t even allow employees to make political contributions without first disclosing to the company. So although my work is confined to Personal/Corporate Financial Planning, I shall be forced to remain anonymous unless I go back into Private Practice. Which is unlikely in the current regulatory environment.
Once again Kimball, Why do you avoid the question for your readers. Considering that the wealthy can afford the best of legal representation and the poor, underprivileged youth’s from the South Bronx can only afford legal aid which is often less qualified and places them at a disadvantage, DO YOU OR DO YOU NOT SUPPORT FEDERAL MANDATES ON RESTRICTING ATTORNEYS FEE’S TO PROPERLY BALANCE THE SYSTEM AND PROVIDE FOR EQUITABLE DISTRIBUTION OF SUCH A VITAL PART OF OUR JUSTICE SYSTEM ??? Why Should I not have access to an attorney who’s qualifications allow him to charge…say $250 an hour. Far more than Most medical practitioners receive. Doesn’t the young man from the Bronx with a hotdog stand deserve the same representation in his potential infringement case. Shouldn’t the Federal Gov’t level the playing field of availability by controlling attorney’s fee’s. This may as well be a Rhetorical question…Because we both know that your left wing hypocritical ideology won’t allow you to apply the same standards to your wealth creation as you intend to impose on the sheep.
Government is not reason; it is not eloquence; it is force. Like fire, it is a dangerous servant and a fearful master. – George Washington
They that can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety. – Benjamin Franklin
You think the US health system is wonderful, but 95% of Americans, each with their own experience, disagree with you.
The impact on US labour mobility deserves greater attention.
During WW II tax incentives were enacted in the US that strongly encouraged employers to provide health care, sick leave and retirement plans and the like as benefits to employees and from this the current employment based health insurance model arose. Large corporations such as those dominating the steel, automotive and defense industries in particular attracted and retained employees in completion with small and middle sized employers by offering such plans. Such industry leaders were mass employers and collective bargaining extended these benefit packages to their unionized employees. Management extended similar benefit packages to many of their white collar employees. Insurance companies developed innovative schemes to facilitate such corporate programs and allow at least some of the middle and smaller corporations to also offer comprehensive benefit packages to at least some of their longer term employees. As a result, the pattern in the US was that employer based programs played a large if not dominant role in the provision of health insurance with private insurance schemes for individuals outside the employment context filling some of the remaining void. Government health insurance plans played a subsidiary role filling some but by no means all of the remaining gaps in health insurance coverage. Note that in this paragraph ‘void’ refers to both lack and inadequacy of coverage.
In contrast to the US employment based health insurance model, in most other advanced countries the government took a lead role in providing comprehensive health and security benefits to all citizens and residents with employers and private insurers playing a smaller augmenting role.
The effect on labour mobility in the US is complex but, arguably, it is not too much of a simplification to state that:
(a) many employees in smaller and middle sized companies have inferior or no health insurance coverage,
(b) many of the insurance company plans (whether offered to persons based on employment with a particular employer or by some group plan that was not employment based) are applicable only to persons resident within a particular geographic area, and
(c) the scope of and eligibility for coverage in many industries decreased significantly as the traditional large employers downsized or faced increased competition from rivals that did not provide similar coverage
with the cumulative effect over the 70 years after WW II that a large number of persons who have no health insurance coverage as employees, inferior coverage or coverage that is personally very costly are very willing to move to other employers who offer equal or better (in terms of cost or quality) coverage while another large number of employees are unwilling to leave their current employer of area of residence for fear of losing coverage. The choice of young persons entering the labour market is similarly skewed by concerns about health insurance eligibility and the cost of adequate coverage depending on their place of residence or employment. Thus mobility is enhanced for some segments of the work force (but for reasons that are arguably not enviable) while for other segments mobility is impaired. The point is that the effect of health insurance availability on labour mobility is not rational in terms of the needs of employers and employees generally.
The challenge from the labour mobility perspective is therefore whether, and if so how, the US wishes to maximize the opportunity of all individuals to acquire adequate health insurance coverage at reasonable cost (i.e. on essentially the same terms) without regard to who employs these individuals or where those individuals reside. Most other advanced countries do this by basing health insurance on national citizenship or residence.
“1. The differential in what we spend as a percentage of GDP is largely related to the fact that healthcare is actually more accessible in the US versus other nations.”
The differential by which we spend more on health care is due to its excessively high prices and therefore more limited quantities of health insurance, drugs and medical services we receive in the face of relatively inelastic demands. That is what it means here to have oligopolistic pricing and output regarding health insurance, drugs and medical services. Economics 101. In fact, insurance, drugs and medical treatment are less available to the population in the US than elsewhere for that reason and profits in those areas are larger than they should be. You have it precisely backwards and do not understand the economics involved.
2. "70% of people in England buy private insurance and won’t have anything to do with the Gov’t run care."
This is pure nonsense and a bald face lie. The correct figure on private insurance in the UK is 8% and it is as a supplement. Here is the date from en.wikipedia.org/wiki/... “The UK’s National Health Service (seekingalpha.com/symbo...) is a publicly funded healthcare system that provides coverage to everyone normally resident in the UK. It is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged at the patient level and (c) costs are not pre-paid from a pool. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill-health. The costs of running the NHS (est. £104 billion in 2007-8) are met directly from general taxation. The NHS provides the majority of health care in the UK. Private health care has continued parallel to the NHS, paid for largely by private insurance, but it is used by less than 8% of the population, and generally as a top-up to NHS services.”
3. “65% of all of Medicare costs are currently administrative.”
This is patently absurd. Not even close. The Congressional Budget Office (seekingalpha.com/symbo...) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans. The CBO study suggests that even in the context of basic insurance reforms, such as guaranteed issue and renewability, private plans’ administrative costs are higher than the administrative costs of public insurance.
4. “Restriction of medical schools is a ridiculous point. Medical School enrollment is at an all time low.”
This is flatly incorrect and false on both counts. The AMA has in fact restricted new and expanded medical schools and it has done so for years. That is why we have so few doctors per 1000 people compared to other developed nations, as I have shown. It is not coincidental. So few doctors per 1000 people and their high salaries is one reason medical costs are so high in the U.S., given our “free market” health care system.
Now the AMA is allowing expanded enrollment and the current AMA figures in the US for medical school enrollment are:
2002 2004 2005 2006 2007 2008 2009
69,930 70,313 71,028 72,000 73,115 74,524 77,722
And this is with (a) the recession and (b) the lack of general tuition and other costs help available. It is not at all a question of not being able to interest students in becoming doctors because of doctors’ salaries. That enrollment is falling is a bald faced lie. Enrollment has been monotonically increasing.
5. “Most Americans do realize the system is problematic. Yet the same polls show that the vast majority of Americans are happy with THEIR coverage.”
This is also wrong. Americans are not at all happy with their insurance coverage. The practices recounted in Moore’s SICKO are far too prevalent. Americans are irate about it. Indeed, 95% do not believe our health care system FlavorJ likes so is working or workable. Americans are happy with their medical treatment if and when they can get it, but so are people of other nations happy with their own medical treatment on average and they don’t have to hassle with insurance companies like we do.
6. ‘The 45 million without insurance is just a myth.’ Many are illegal immigrants or COBRA transfers.
FALSE. The 45 million uninsured Americans includes eight million children and only US citizens, not illegal immigrants. COBRA transfers are included as insured parties and so are also not counted. Most of those without insurance now, feel they cannot afford it except for the super wealthy who self insure.
7. “Oligopolistic pricing could largely be addressed by allowing insurance companies to do business across state lines.”
Except for Kaiser Permanente which is repeatedly blocked as a threat, most insurance companies can and do cross state lines without a problem. All you have to do is qualify in the states where you want to do business. Most insurers do that without difficulty. Two health care insurers that operate nationally account for 1/3 of all health insurance written. Oligopoly pricing is the problem. We are being gouged right and left and at all levels.
8. “Preventive medicine does surely makes logical sense from the stand point of your personal health. However every study shows it has no long term impact on reducing cost. On the contrary it actually marginally increases the cost.”
This is false. According to the CBO, researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness. However, experts have also concluded that a large fraction of preventive care adds to spending but should be deemed “cost-effective,” meaning that it provides clinical benefits that justify those added costs: Roughly 60 percent of the preventive services examined in the review cited above have additional costs that many in the health care community consider to be reasonable relative to their clinical benefits.
9. “Drug companies engaged in fraud. This is even more ridiculous for a # of reasons. But one example is this. The current regulations the FDA places on a medications expiration date is far more strict in the USA then elsewhere in the world. And the companies are even more strict in some cases due to the litigious society we live in.”
Pfizer has been fined three times in the last ten years for activities amounting to fraud. They just keep doing it. The major drug companies cheat on the rules all the time. They buy off companies that manufacture generic drugs. They slander products other than their own (“out of date;” “weak;” “dangerous”). They engage in serious oligopolistic pricing and much unfair competition. A big crackdown is needed. But it is for their other stuff that drug companies have paid a total of $1.6 billion since 2001 to settle lawsuits brought by whistle-blowers that accused them of marketing fraud and overbilling Medicare and Medicaid, according to a report released recently. More big fines are coming. The drug companies just pay the fines and go on cheating. They are invenerate cheaters because the fines are too low. See, www.uow.edu.au///~bmartin/dissent/do...
10. “The Dr Compensation is the best one of all. A typical Dr nets about $30.00 in an office visit before taxes. As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner.”
Your comment is absurd and outrageously misleading. Here are the actual data:
"The American Medical Association' annual physician income survey shows that, an average, doctors are making close to $200,000 a year." Too, here is average compensation by primary specialties.
Total compensation of Physicians by Specialty; 2002
Anesthesiology $306,964
Surgery, general $255,438
Obstetrics/Gynecology $233,061
Internal medicine $155,530
Pediatrics/Adolescent medicine $152,690
Psychiatry $163,144
Family Practice $150,267
Much, much falsehood and many lies here by FlavorJ.
2. Point about British citizens is hardly a lie. There are different levels of coverage. It has also become common place for British citizens waiting for free surgery and cancer treatment fly to India to pay for it. More disturbing is that more than one third of physicians employed by the National Health Service in Britain buy private insurance. Curiously you make no mention of National Rationing bodies that exist in Britain ??? the same body that recently denied Breast cancer medication to women in need.
3. Medicare, administrative cost includes not only reported costs but a proportional allocation of all overhead costs for functions where people spend time on Medicare but are not allocated to Medicare by the government. Medicare unreported costs include parts of salaries for legislators, staff and others working on Medicare, building costs, marketing costs, collection of premiums and taxes, accounting including auditing and fraud issues, etc. These are currently included in the Federal Budget in various areas such as legislative, judicial, and Health and Human Services, but are not specifically earmarked to Medicare. Clearly you don’t address all aspects of cost in your rebuttal. Private market administrative costs do include acquisition costs over and above commissions, such as underwriting and advertising.
4. Medical Enrollment has seen are dramatic decrease in this country among OUR citizens. Try checking the Demographics. There is massive # of new students coming to the States because of greater economic opportunity that doesn’t exist in foreign countries. And may not exist here much longer. I live a stone’s throw from a teaching hospital like Stony Brook University. Virtually all residents are foreigners. Also largely because most Dr’s do not encourage their own children to enter the field. According to Association of American Medical Colleges The average physician's net income, adjusted for inflation, declined 7% between 1995 and 2003, according to the Center for Studying Health System Change. In order to enter the most lucrative specialties, like radiology, ophthalmology, anesthesiology, and dermatology, doctors must continue with their training into their 30s. That means they can't start chipping away at their debt…let alone make money…until a time by which their counterparts in law or business are usually prospering. And here is Kimball Corson trying to cut their compensation further.
5. June 26th of 2009 the Washington Times released a report on the status of Heath care in America. Only 44% where happy with the National status. But when polled about THEIR OWN personal Coverage…93 percent were satisfied; 95 percent of those who suffered chronic illness were satisfied with their health care. That’s an impressive #. Rasmussen… the most successful and consistently accurate pollster had different but similar #’s. While 93 percent of the insured say that they are "satisfied" or "very satisfied" with their own health care, Curiously…70 percent of the uninsured who indicated their level of satisfaction said the same thing.
6. Anyone who reports that there are more than 46 million uninsured is greatly exaggerating since the Census Bureau puts the number of uninsured at 45,657,000 people. Nearly 10 million, 9.7 of the 45.7 million uninsured are “not a citizen.” That makes every media claim of uninsured Americans higher than 35.9 million is wrong. More than 17 million of the uninsured make at least $50,000 per year (the median household income of $50,233) – 8.4 million make $50,000 to $74,999 per year and 9.1 million make $75,000 or higher. Two economists working at the National Bureau of Economic Research concluded that 25 to 75 percent of those who do not purchase health insurance coverage “could afford to do so.” An Urban Institute study found that 25 percent of the uninsured already qualify for government health insurance programs. The Congressional Budget Office says that 45 percent of the uninsured will be insured within four months. “CBO Director Douglas Holtz-Eakin also said that the frequent claim of 40+ million Americans lacking insurance is an “incomplete and potentially misleading picture of the uninsured population.”
7. Point. From the statement I will assume you have never attempted to even register with a State regulatory body to sell Insurance across state lines. I have to do that for Interstate clients. It is quite the task…And it is the STATE whom makes this quite problematic. Another example of your lack of experience in the field of providing a Financial services.
8. Point 8 is not in dispute. I am not against preventive medicine. My point was is it not really a cost savings. It doesn’t mean it should not be practiced.
9. Drug Companies engaged in Fraud is a myth. The cost to manufacture a drug is astronomical. Virtually every company in every major industry is routinely fines for something because the medical Industry along with many other industry’s is a web of regulation that is impossible to maneuver. Case in Point…Boston Scientific recently was forced to suspend the sale of one of their cardiac defibrillator. There was absolutely nothing wrong with the product…yet a minor regulatory filing has forced them to halt sales and cost the company millions. Pfizer for example as most drug companies do, literally gives away medications close to a couple 100 million each year to the truly indigent. My estimate is they give away a much larger percentage of their profits than you do as a percentage of your AGI. For those of you who know someone in need…Feel free to contact them directly as Mr Corson would never provide such data, I shall link to it.
….www.pfizerhelpfulanswe...
10. Without even realizing it you just made my point. As I Said….” As it stands now, a NYC bus driver makes more money in salary and benefits then the average general practitioner.” Your own data reflects a “Family Practice $150,267” According to MTA New York A New york city bus driver max pay is $29 per hour. With overtime they cap at 87k. With total benefits pension…Deferred Comp…Health Coverage for life…they earn in excess of $200k.
11. lastly…YOU HAVE NOT ADDRESSED MORTALITY RATES….Because as I have clearly explained to the literate…The criteria that goes into determining mortality rates is not UNIVERSAL. Therefore the CIA fact book can only use the stats that each nation reports with no standard around the methods. The case in point about infant Mortality illustrates there are vast differences in whom is excluded from the data. Many studies have been done applying the same standards and as expected the US ranks at the top. When further eliminating those whom have not had contact with the healthcare field the statistics reflect even better for the USA. ( Although it is a bit harder to quantify whom has or has not come in contact with the healthcare system) Michael Tanner has done Numerous studies to this effect and testified before congress specifically in reference to this issue. Using your logic Kimball…I run 100 yards and you run 50 yards…The fact that you finished first would make you clearly the faster runner. Thank god no organization has placed you in charge of a pension fund. Using your methodology we would have no need for PBGC.
Once again you have failed to address the question of Federally mandated cost controls on attorneys in light of the outrageous profits in the legal field…with disproportionate services rendered to the wealthy.
Not so. On two occasions I worked with another lawyer to get foreign (out of state) insurers qualified and registered to do business in Arizona. It was not a particularly difficult task, but it was some years back. The ensuing regulation by the Department of Insurance was nominal at best, but the antitrust exemption so obtained for both companies was wonderful.
www.nationalpost.com/n...
on March 29th reporting a Canada wide poll probing attitudes concerning various aspects of our system. These findings were essentially supportive of the current standard of coverage and service.
On Danny Williams of Newfoundland, please see my response to one of your earlier comments.
On you statement “when you need urgent treatment or you are dealing with complex or time sensitive care that is where the problem is” respecting Canadian universal health care government plans, my experience and that of my friends is that urgent and complex matters are generally handled in a timely and satisfactory manner. It is a myth to suggest that Canada lacks a full array of specialists and technology to address complex medical situations. Two observations should be made, however.
First, Canadian health authorities do not rush to adopt expensive new technology and pharmacology before their utility is established. They also do not encourage giving patients batteries of tests where a sound basis for diagnosing patient condition and prognosis would not be materially advanced by such tests. The statistics for patient outcomes in Canada are generally as good and for many matters better than corresponding outcome stats for the US which, arguably, indicates that this conservative approach generally does not prejudice patient outcomes. It is not only tight budgets that prompt this conservative approach. Concern over radiation exposure from over use of Cat Scans, for example, is the primary reason that this technology, very useful in specific situations, is generally confined to such situations. Also in Canada litigation concerns have not trumped medical utility as a basis for ordering tests.
Second, one potential weakness area under our single payer universal health care system is service to the patient with a condition that is chronic but not life threatening or threatening to cause material deterioration in the health and wellbeing of the patient if a remedial operation or further tests are delayed. In setting priorities by the allocation of funds to local health authorities and the distribution of funds for services by these authorities, the funding for services in this area can be short changed and waiting periods for these services grow in consequence. Much of the complaining one hears about our system arises from these delays. They are frustrating for those involved and some patients suffer unnecessary and sometimes serious deterioration in their quality of life attributable to such delays. Arguably this is essentially a funding issue – the downside flowing from the fact that Canadian healthcare costs are in total about 70% on a per capita basis to those in the US.
February 2005 issue of The Spectator, a British magazine, James Bartholomew details the downside of Britain's universal healthcare system.
Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States
If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent
On the availability of equipment, explains Bartholomew, Britain has only half as many CT scanners per million people as the United States, and half as many MRI scanners. With lithotripsy units for treating kidney stones, the United States has more than seven times the availability per million of population than Britain.
An audit by the World Health Organization, for instance, found that over half of Britain's x-ray machines were past their recommended safe time limit, and more than half the machines in anesthesiology required replacing. "Even the majority of operating tables were over 20 years old --- double their life span," reports Bartholomew.
In Relation to Canada...He wrote...Quote
"As a footnote on Canada, the average wait for a simple MRI is three months. In Manitoba, the median wait for neurosurgery is 15.2 months. For chemotherapy in Saskatchewan, patients can expect to be in line for 10 weeks. At last report, 10,000 breast cancer patients who waited an average of two months for post-operation radiation treatments have filed a class action lawsuit against Quebec's hospitals."
For me...sorry, If this is the standard...It's unacceptable. I'll let you be the judge since you live there.
I thought a comparison of life expectancy by Canadian Province with the US State contiguous with that Province might be of interest in this context. The following two web links will allow the reader to prepare rough comparisons for the 2004/5 window in time.
commons.wikimedia.org/...
www.statcan.gc.ca/pub/...
(a) existing models that apply to somewhat different issues, and
(b) the terminology that best makes sense in relation to those existing models and the other issues they address.
Unfortunately the debate about the delivery and funding of health care services in a nation state (or a state within a federation) has been especially burdened by this problem in the way we conceive issues. Thus, for example, when we talk of ‘insurance’ schemes in relation to national or state health care availability, the mind naturally turns to the term life insurance or to the fire insurance model and this, arguably, clouds our thinking. A more apt analogy in the national health care context might be made to unemployment insurance but even this only begs the question because the ‘risk pool’ for national health coverage is unlike any other insurance scheme.
My thought is that the starting point in any discussion of coverage for national health care is universality within the national community. (This is not to say that valid arguments can not be made that various segments of the national community should t be excluded from some or all elements of coverage; only that the starting point for debate would naturally be general inclusion for any and all persons without exclusion for any medical condition). However, universal coverage is not a concept that is easily made compatible with insurance concepts.
What happens when we try to create a national health care program on a term life insurance model? Under such a model it becomes one of the functions of the insurer’s administrators (whether the insurer is a private or public sector body is not really at issue) to exclude coverage or disallow claims and it becomes one of the temptations of persons seeking coverage or making claims to delay joining a plan while they don’t need its services, misrepresent their pre-conditions and fug their claims. In other words, because the model doesn’t fit the need, people on all sides game the system.
It is perfectly legitimate to argue that national schemes for near universal health care coverage are poor public policy (This isn’t what I would argue but that isn’t the point here). It is, however, a poorly framed debate if arguments centre around whether some facet of coverage reflects good insurance policy as reflected in the way term life insurance plans are administered. The real questions are two:
(a) how best to ensure that the health services needs of all people are appropriately met in a way that makes services readily assessable to all and affordable to both the individual and society, and
(b) what, if any, is the role of government.
Talent, of course.
"All Animals are Equal...except for some Animals...which are more equal than others"
My answer is no. Here is why. The medical and legal systems are different. The ABA has never restricted the number of law schools, which have proliferated hugely, to artificially depressed the number of lawyers in practice to drive up their salaries which, on average, are much lower than in the medical profession, neither have state bar exams. Second, everyone has a right to counsel in felony criminal cases even if they cannot pay. We have a public defender system and where one is not available, a lawyer is appointed from the practicing bar. Too, incompetent legal representation here is grounds for reversal on appeal in such criminal matters. Third, very much pro bono work is done in the U.S by lawyers everywhere, usually on smaller cases. Fourth, civil cases that are worthwhile are taken on a contingent fee basis all the time in a large proportion of all civil cases; no recovery means no payment. The medical system never charges based on treatment outcome. They charge, often for ineffective treatment, if you were going to recover on your own anyway. There are no drug or insurance oligopolies to deal with in law. Courts do a reasonable good job. Very few with bona fide and worthwhile claims go without counsel. Malpractice assures minimal competency or a recovery if it is not provided. The legal system, even with its broader range of talents among lawyers, does much, much better than the medical system of doctors, drug companies and insurance companies so that, while there are some significant inequities, there are no real grounds for federal intervention in law.
The US medical system works well and fine, but only if you are wealthy enough to self insure or have a Cadillac or better yet a Maserati insurance policy, and you drop in from the top with mega bucks to spend on care. Many people are cut out of the medical system almost totally and that is not the case in law.
I should add, in response to an earlier and unrelated comment, my experience with the Arizona DMV, the Post office, the local public (charter) schools (with five children) and the local Social Security office has been uniformly excellent. Government services are not bad because they are provided by government. Did you ever call a U S private business and been told your business was important to the company and then been placed on hold interminably? I have, many times. The private sector fails frequently. You just cannot be ideologically biased about these matters as you are.
As for what real reform should look like I would say as follows.
Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation)
Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles.
Elimnate Medicare altogether for all those not currently enrolled or more than 10 years from enrollment. To be replaced by a system that is market based yet still regulated. Inurance companies shall compete for a larger marketplace.
Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.
Tax incentives to Purchase Private insurance should be both individually based along with employer based.
Place some Constraints around the FDA.
The FDA has kept some unsafe or ineffective drugs off the market.
At What Cost ???
The FDA adds billions to the development cost and price of new drugs.
The FDA delays the availability of new drugs for years.
The FDA prohibits the use of new drugs that treat conditions for which other drugs are available, regardless of how much better they might work for some patients.
The FDA withholds new drugs—even those that passed initial safety tests—from terminally ill patients, in the name of preserving safety. When one of these patients wins access to the drugs by going to court, the FDA, apparently in a relentless effort to protect the health of the dead, appeals the ruling until the patient dies, at which time the appeal is of course dismissed.
The FDA and Congress allow the drug approval process to be politicized to protect the interests of firms with political pull or to serve the anti-corporate political agenda of those who would rather see Americans die than allow any investors or businesses to make money developing new medications.
The FDA constitutes a roadblock to new developments in anti-aging drugs by refusing to consider any science that would extend healthy lifespans—because "aging is not a disease."
The FDA states that it lacks the resources to ensure human drug safety but requests more resources to review veterinary medicine.
The FDA now publishes lists of drugs it approved but the safety of which it questions—leaving physicians in the lurch and creating a potential jackpot for litigation.
www.cato.org/pubs/pas/...
P.S. We do not call not being paid what we want or customarily charge pro bono work in the legal profession. Too, courts in most areas are not as bad as the state courts in NYC and Chicago. I tried cases all over the country, mostly in federal courts, for notable and not so notable clients and found the courts uniformly good, some excellent, including in the Southern District of New York.
Jumping even further afield, you argue "But the Premise that our founding fathers based this nation on was Economic & religious Freedom. Nobody is guaranteed success. Only Opportunity. The moment you assume you have the "right" to the fruits of someone else's labor, you then must examine what rights are left for the one providing such services."
The health care legislation and agenda goes not guarantee anyone financial success. Too, since the passage of the Constitutional amendment allowing an income tax and a progressive one at that as construed, the "fruits," as you call them, of someone elses labors can in fact go to someone else in significant measure, especially where those fruits are ill-gotten or misbegotten gains from oligopolistic or defrauded markets. But actually the looting has been going in the opposite direction: from the middle class and some poor to the rich and wealthy.
In fact,the situation is so bad that the income distritution in America has become skewed hugely against the middle class and some what the poor by the rich using and abusing government and its systems of doing business to loot America and the middle class of income, taking their "fruits and earnings." The current distribution of income is 23% to the bottom 59% and 6% to the top 1/10 of 1%. The wealth distribution is also not the Pareto optimal of 80% with the top 20%, but is now variously estimated to be 88% to 93% with the top 10% to 8%. The "fruits" of their own labors, my ass. They don't pay their big campaign contritutions and their lobbyists mega bucks for nothing.
The problem is rendering our country's economy dysfunctional because of the associated drop in the average propensity to consume consumer goods and services which drops aggregate demand and GDP relatively and raises the demand for financial assest on world secondary markets simply causing them to bubble up. We have the DOW almost at 11,000 with a real unemployment figure of 17%, to show you how out of whack the system is.
Or perhaps by earn and fruits you mean the mega salaries paid, like those to Wall Street bankers who dropped their companies in the toilet of insolvency slated for bankruptcy, only to be bailed out so their salaries could be continued. The pentagon spending $100 bucks for a $5 hammer is simply one of a million ways income is tranfered from the middle and lower classes to the rich who own the selling companies. Think of it as a $5 hammer sold for $5 with a gift to the rich company owners of $95 from the pockets of middle class tax payers. More "earned fruits. "Give me a break.
( Among women with breast cancer, for example, there's a 46 percent chance of dying from it in Britain, versus a 25 percent chance in the United States. If you're a man diagnosed with prostate cancer, you have a 57 percent chance of it killing you in Britain. In the United States, the chance of dying drops to 19 percent )
If you would like to examine other causes of mortality ancillary to health care that is a discussion for another time.
I believe the founders would have quite a few problems with the punitive tax code we have developed today. And the problem with the legislation is plentiful. No it doesn’t guarantee anything…Yet. But as the president has said more than once, this is a stepping stone to single payer system. First off this legislation compels you to buy a private product under penalty of fine via the Gov’t if you don’t. Hopefully the Supreme Court will here this case and overturn it. We shall see. As far as rights to someone else’s labor…For Ex. I have the right to Keep and Bare arms. But such a right does not provide me with the expectation that the Gov’t must provide me with a firearm, nor does a private manufacturer. Nor am I required to purchase such and item. I have only the right to do so should I wish, and I am required to acquire this via my own resources.
Your point about the Court system in NY and Chicago being more dysfunctional than other places is well taken. I’ll than assume that you agree the larger the beauracracy (Major Cities), the less efficient. Interesting concept. I’ll agree hence my opposition to Gov’t run Healthcare.
You will never hear me justify the TARP bailouts. I believe these companies have every right to fail as they do to succeed. However you really out to take a much closer look at the Gov’t mandates and political pressure that where also handed down on many of these companies. Just look at some of the actions of Andrew Cuomo, or soon to be Gov a HUD Secretary.
You need to seriously do away with this concept of Equitable Wealth Distribution. The fact is that wealth distribution is more a function of effort and not nearly as much as conspiracy. If there is a conspiracy it’s the Federal elites insulating themselves. My life story and many others are proof that success can be achieved regardless of where you come from. I have no issue with lobbying. We all have a right to campaign for positions that we see to be fair. It’s up to the Politician to provide representation of the people. Dow 11k is irrelevant. You know full well markets have always been irrational in the short term. There may be numerous reasons for the dow at 11k. Possibly the dollar carry trade yet to unwind. Time will tell. Possibly we’ll look back in a few years and see the market got it right and we had stronger recovery than expected. I say not likely as the Keynesian will be wrong again and QE will fail miserably. We will fail period until we have a tax code that incents Capital Expenditures.
The reason the Gov’t gets away with the $100 hammer is the Government is empowered…Not the People.
Lastly one thing you seem to be missing in much of your writing is a serious problem among the lower income and the middle class. I consider myself among the middle class. In my house I have 3 TV’s ( One HD) 4 phones with two lines, 2 cars, 2 DVD players and 3 VCR’s. As demonstrated in earlier posts. There are a large # of uninsured that can afford to be insured but choose not to be. Where are they’re priorities when it comes to personal spending. I am somewhat guilty of this as well which is clearly evident. My grandparents where working class, and in there day they had a radio. They had ONE radio. This is the problem with the entitlement society. This reminds me of a story my brother in-law told me when he was still working in the ER. He had just finished hours of surgery putting a young boys face back together after a terrible car accident. When he went to the waiting area after surgery, he explained the situation to the father. He also provided him with some prescriptions the young boy would need going forward. The father looked at my brother in-law and quite combatively said, I can’t afford that !!! He then proceeded to take out his “Blackberry” to make a call to a family member I’ll presume. See if you can figure out what is wrong with that scenario.
I am quite curious to hear your take on the Tanner policy analysis. My guess is you’ll find some other way to assail American industry.
All policy changes are irrelevant if we don’t eventually institute term limits in the future. One term…6 years for all member of congress and the president. No future federal appts once you have served in congress. Nor can you run for another branch of congress.
There is some Debate as to whether this book was ever even written. But the words clearly ring true.
In the year 1801 Sir Alex Faser Tytler a jurist and history professor wrote this in the " Decline and Fall of the Athenian Republic "
. . a democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largess from the public treasury. From that time on, the majority always votes for the candidates promising the most benefits from the public treasury, with the result that democracy always collapses over loose fiscal policy, always followed by a dictatorship."
Sir Alex Faser Tytler (1742-1813), Professor Universal History, Edinburgh University,
This other SA article will interest you and the other commenters. It deals with the question of how people deal with their medical needs during an economic downturn in various countries. It also asks an important question about the long term impact of cutting back on basic health care needs.
seekingalpha.com/artic...
I will look at what you suggest, but think the special case of a recession should be an after thought at best on how stuff in this area works during normal times. The area gets almost no press coverage worth a damn and public misunderstanding is rife. It is too bad.
Whether one agrees with you or not on some point from time to time, we all know that all material you write is well crafted and thought provoking; something that cannot be said of all SA articles by others. Keep it up.
Bob
To be sure, we do have too much public debt. Much of it is left over from Bush, who squandered a $4.6 trillion dollar surplus from the Clinton years and ran up more than a trillion dollar deficit, with his tax cuts for the rich and his big wars, leaving us with a recession after the good economics times of Clinton. Then some more public debt was generated from bailing out the ill-behaving big banks during the recession and then even more from stimulating the economy. As Kenneth Rogoff at Harvard, one of the very best economists we have, argues, coun
tries with higher public debt ratios run a greater risk of (a) financial crises, (b) political instability, and (c) slower economic growth. I believe he is correct on all three points. We could attack our debt very well for starters by simply cutting the hugely bloated defense budget, among others, that feeds the rich from middle income tax dollars.
Let me explain. Chopping this bloated defense budget and other bloated government budgets is the key. Those budgets are simply being used to transfer money from the middle class tax payers to the rich. Here is how, on defense for example. Item X (e.g., a screwdriver, a toilet seat, a yard of nylon webbing) cost $y to manufacture and is then sold, very often on unbid and poorly or unaudited contracts, to the US government for $5y. $4y is -- in this fashion -- transferred from taxpayers (most of whom are middle class) to the manufacturer, usually owned by the rich, who ultimately get the $4y. Say, $0.50y is a reasonable profit. Then $3.50y is a gift from the middle class taxpayers to the rich via government. This happens on virtually everything all the time.
With just the defense budget alone at $663 billion a year, you can see the scope of the problem. It is a huge income transfer from the middle class, who pay the bulk of the taxes, to the rich. Only a relatively small portion of the defense budget is actually used for the wars in Iraq and Afghanistan.
Too, this has been going on for years and Bush expanded it hugely by “outsourcing” much of the work and business government did in all areas to private independent contractors who are the intermediaries for the rich. Government has been gutted.
That is the kicker. This problem is rife throughout government which has contracted out almost everything it used to do, down to and including Army motor pool maintenance in combat zones. The government has now made itself, mostly implemented during the Bush era, into the massive medium for looting of the middle class by the rich. The middle class gets too little back from their taxes. This is only one of many ways it is done, but even here it is done on such a massive scale throughout government that the looted sums are astronomical each year.
A partial solution to the problem would be to cut the defense budget of $663 billion in half to $330 billion, install serious auditing and mega fines for overcharging, pay for health care with $90 billion and then reduce the public debt with $240 billion. This is a great way to go here. Health care is funded. The rich are stopped from looting on defense. Our public debt is reduced. And our country’s actual defenses can remain strong without the looting.
However, the wealthy with their lobbyists and as campaign contributors don't want this and they have bought off Congress to protect their racket, not only in the defense area, but in every area where government has contracted out the business it used to perform to outside contractors. This is the racket of the wealthy to use government to get middle income tax dollars and induce deficit spending.
In a nutshell, America is being looted right and left, big time. 23% of all income now goes to the bottom 59%, 77%, to the top 41% and 6% to the top 1/10 of 1%. The super wealthy, those with incomes averaging $453 million a year, pay taxes at a marginal rate of 17%, a lower rate than most middle class tax payers. Too, it is now estimated that about 9% of Americans own about 91% of all wealth, where the Pareto optimal is 20% owning 80% of all wealth. These are the worst these distributions have been in American history.
Things are so badly skewed that less income is spent on consumer goods and services, lowering aggregate demand and GDP, because the rich spend a lesser percentage of their income on consumer goods and services than the middle class and poor, and spend more on buying financial assets in secondary financial markets, creating financial bubbles and instability.
Remember this now when you hear a political candidate for office use the defense “code words” to the basic effect --
'I am for a strong defense and want the very best for our boys in uniform who give their lives to protect our country.'
Either he is incredibly naïve, trying to sound good and doesn’t deserve to be elected or, more likely, he is basically saying “don’t touch the damn defense budget. It is transferring mega bucks to my wealthy friends who have put me into office with their campaign contributions and they expect a return on their money. If they don’t get it, I won’t be (re)elected, which (is) will be my basic goal while in office.”
This is cynicism of the very worst sort or unacceptable naivety in the extreme, each a ground for disqualification from public office. If an elected politician receives money from a rich man in say Ecuador, it is called a bride and if caught, both can go to jail. In the US, it is called a campaign contribution and the US Supreme Court goes out of its way to expand and protect it as -- of all things -- free speech under the First Amendment.
Meanwhile, what is happening is the middle and some of the lower class are getting clobbered, the income and wealth distributions are being badly skewed in favor of the rich and the economy, via impaired aggregate demand, is being undermined and strongly sabotaged.
The core problem is that most people do not understand this, especially those in the red states who regularly vote for Republicans and against their own purse and financial well-being all the time, because they are too much intentionally distracted by senior Republicans, at Karl Rove’s urging, onto relatively spurious issues and topics such as family values, gays, abortion, religion, the flag and the merits of Mom and apple pie. The red staters and middle class Republicans have been taken in hook, line and sinker.
Are we daft or what?
FlavorJ. I am having serious internet problems and have not yet been able to download the Tanner piece yet, but also I now lack time to read it just now, being immersed the the problems of some friends. It took me an hour to upload this small note.
1. “Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation)”
I could live with this on all except drug companies in fraud and willful wrongdoing cases. The drug companies now have a track record of considerable bad faith, especially Pfizer
2. “Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles. “
First part is O.K. but tax deduction is not enough incentive for the poor and lower half of the middle class. Some scaling down subsidy is going to be needed if we want everyone covered with medical care.
3.“Eliminate Medicare altogether for all those not currently enrolled or more than 10 years from enrollment. To be replaced by a system that is market based yet still regulated. Insurance companies shall compete for a larger marketplace.”
Cannot agree here. Medicare does reasonably well, except to the extent government is now using it to put the squeeze on high doctors salaries and medical costs. The core problem for any system, with a public component, to care for the elderly is how far should we go to keep the very old living? The insurance companies -- with high administrative overhead, officer compensation and profits – cannot be well depended upon. They are oligopolistic and don’t want to reform their ways. Too few are left nationally and they are not well behaved, although they are facing a bind now that so many young and health are cancelling their policies because of the high premiums. We need a publicly overseen system of pooling risk and taking advantage of the law of large numbers but that also addresses the core question of how far do we go to keep the old alive.
4.”Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.”
Don’t know enough about what we had or how this might work. No comment.
5. “Tax incentives to Purchase Private insurance should be both individually based along with employer based.”
I understand what is being said here but I am more back at the beginning wondering whether anything we publicly fund should be done through employers as opposed to through the general tax system. Why load up businessmen with more paperwork? Then again, I am not sure tax incentives would work for those below the middle, middle income classes.
6. “Place some Constraints around the FDA.”
Some big reform is needed.
7.”The FDA has kept some unsafe or ineffective drugs off the market.
At What Cost ???”
I am sure this is a fair question.
8.”The FDA adds billions to the development cost and price of new drugs.
The FDA delays the availability of new drugs for years.
The FDA prohibits the use of new drugs that treat conditions for which other drugs are available, regardless of how much better they might work for some patients.
The FDA withholds new drugs—even those that passed initial safety tests—from terminally ill patients, in the name of preserving safety. When one of these patients wins access to the drugs by going to court, the FDA, apparently in a relentless effort to protect the health of the dead, appeals the ruling until the patient dies, at which time the appeal is of course dismissed.
The FDA and Congress allow the drug approval process to be politicized to protect the interests of firms with political pull or to serve the anti-corporate political agenda of those who would rather see Americans die than allow any investors or businesses to make money developing new medications.
The FDA constitutes a roadblock to new developments in anti-aging drugs by refusing to consider any science that would extend healthy lifespans—because "aging is not a disease."
The FDA states that it lacks the resources to ensure human drug safety but requests more resources to review veterinary medicine.
The FDA now publishes lists of drugs it approved but the safety of which it questions—leaving physicians in the lurch and creating a potential jackpot for litigation.”
I agree with this horror list and have heard about most but not all of these items. Clearly something needs to be done that is reasonable and sensible. The FDA is out of control and so are the drug companies. Who is inducing bad behavior by whom seems to be mixed. We clearly need something better.
As I wrote in a recent article, entitled "Rightwing Republicaism as Religion," "Nietzsche would, I suppose, view this broad state of affairs as the final death throes of religion in America, as a sort of dummied down, reactionary and fundamentalistic backlash to an ill-understood postmodernism."
Don't be concerned if Seeking Alpha doesn't accept any more of your articles. Perhaps the Daily Worker would have you as a regular columist. Plus there is alway room on the Daily Kos or The Huffington Post.
Religion mixed with politics I find particularly odious. No one will ever persuade me of the truth of anything by their declaration that God arranged it or said it was so.
It is not that I do not believe in a supreme consciousness. It is just that I cannot believe in one so stupid as to intervene in our silly affairs or listen to anything we have to say.
" Religious distress is at the same time the expression of real distress and the protest against real distress. Religion is the sigh of the oppressed creature, the heart of a heartless world, just as it is the spirit of a spiritless situation. It is the opium of the people. The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions. "
Karl Marx, Critique of Hegel’s Philosophy of Right
" For example, SiCKO cites a 2000 World
Health Organization study that ranks the U.S.
health care system 37th in the world, “slightly
better than Slovenia. This study bases its conclusions on such
highly subjective measures as “fairness” and
criteria that are not strictly related to a country’s
health care system, such as “tobacco control.”
For example, the WHO report penalizes
the United States for not having a sufficiently
progressive tax system, not providing all citizens
with health insurance, and having a general
paucity of social welfare programs. Indeed,
much of the poor performance of the United States is due to its ranking of 54th in the category
of fairness. The United States is actually
penalized for adopting Health Savings
Accounts and because, according to the WHO,
patients pay too much out of pocket.19 Such
judgments clearly reflect a particular political
point of view, rather than a neutral measure of
health care quality. Notably, the WHO report
ranks the United States number ONE in the
world in responsiveness to patients’ needs in
choice of provider, dignity, autonomy, timely
care, and confidentiality.
When you compare the outcomes for specific
diseases, the United States clearly outperforms
the rest of the world. Whether the disease
is cancer, pneumonia, heart disease, or
AIDS, the chances of a patient surviving are far
higher in the United States than in other countries.
For example, according to a study published
in the British medical journal The Lancet,
the United States is at the top of the charts
when it comes to surviving cancer. Among
men, roughly 62.9 percent of those diagnosed
with cancer survive for at least five years. The
news is even better for women: the five year-survival
rate is 66.3 percent, or two-thirds. The
countries with the next best results are Iceland
for men (61.8 percent) and Sweden for women
(60.3 percent). Most countries with national
health care fare far worse. For example, in Italy,
59.7 percent of men and 49.8 percent of
women survive five years. In Spain, just 59 percent
of men and 49.5 percent of women do.
And in Great Britain, a dismal 44.8 percent of
men and only a slightly better 52.7 percent of
women live for five years after diagnosis.
Similarly, infant mortality, a common measure
in cross-country comparisons, is highly
problematic. In the United States, very low
birth-weight infants have a much greater
chance of being brought to term with the latest
medical technologies. Some of those low birthweight
babies die soon after birth, which
boosts our infant mortality rate, but in many
other Western countries, those high-risk, low
birth-weight infants are not included when
infant mortality is calculated. In addition,
many countries use abortion to eliminate
problem pregnancies. For example, Michael
Moore cites low infant mortality rates in Cuba,
yet that country has one of the world’s highest
abortion rates, meaning that many babies with
health problems that could lead to early deaths
are never brought to term. "
Tanner mistakenly believes that because Americans spend so much on health care that Americans are receiving a large quantity of health care at rather low prices. That is wrong. Americans spend so much on health care because doctors’ fees are higher than they should be because the number of doctors is too low because their number has been historically restricted, health care and malpractice insurance premiums are too high and rising because of high profits and overhead and because drug prices are too high. That is why Americans spend so much on health care and more than other developed nations.
Tanner believes national health care systems abroad -- which people in those countries like much better by the way -- are not good because they ration health care, but does not seem to understand that the American system before the health care reforms passed and coming, ration health care with oligopolistic pricing and restricted output far worse. In fact, oligopolistic pricing of doctors’ fees, insurance premiums and drugs necessarily requires serious restrictions on output. Tanner misses the boat here on his basic point. Too, he blows off and finds great fault with foreign national health care systems which people who use them really like because such systems are more efficient, do not entail oligopolistic pricing and therefore spend less as a percentage of GPD and per capita.
Tanner’s core statement that “Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control” is incorrect or seriously misleading. I believe the opposite can be shown to be true. Countries that have moved toward the American model and markets developed some of the same problems we have and have been unhappy with the results, e.g., Australia. Tanner’s implicit suggestion that other developed nations are unhappy with their health care systems and are moving toward what we have is wrong. There is no failure riddling those systems due to “failure of centralized command and control [requiring] the benefits of increasing consumer incentives and choice.”
Tanner’s belief in free and unfettered markets in the health care area ignores the mess we have with such markets and also the substantial work of the Nobel Laureate economist, Kenneth Arrow, in the area which has long been accepted by the American economic community, making Tanner’s core position untenable. Tanner talks too much of healthy competition in markets too much suffering from oligopolies and ignores Arrow’s accepted teachings that free markets cannot work in these areas for his reasons I have explained in an article Seeking Alpha rejected.
Tanner rags on about the supposedly better quality of American health care but concedes the facts that “The Institute of Medicine estimates that some 44,000–90,000 annual deaths are due to medical errors, while a study in The New England Journal of Medicine suggests that only a little more than half of American hospital patients receive the clinical standard of care. Similarly, a RAND Corporation study found serious gaps in the quality of care received by American children.” One way oligopolistic markets excessively ration health care is to reduce the quality and therefore their costs of what little output they do provide.
The thrust of Tanner’s article goes on to wage war and quibble over the national health care systems of foreign developed nations, too largely ignoring the facts that the people in those countries basically like their health care systems unlike Americans who basically dislike their health care system, which should come as no surprise for the reasons I have indicated. Tanner really does not understand the economics of health care very well and he certainly does not understand Kenneth Arrow’s work. He appears to me to be a market ideolog writing for the Cato Institute which has a market bias in virtually every regard, even where markets cannot or do not work effectively or both.
The theory that any market will work just fine if sprinkled liberally with competition is nonsense. An example here is the US. Stock market, which is quite free, but can get things quite wrong for long periods of time before it adjusts dramatically. The same is true of the U.S. housing market. Markets are no better than the judgment of people who participate in them. There is much free market nonsense and foolishness among conservatives. They buy the ideology of the perfectly competitive model but do not well understand how markets can and do fail or get things wrong a great deal of the time in reality even with nearly perfect competition, as in the stock and other financial markets.
How is that for Equitable Distribution ???
The point that should be made, however, is that efficient, effective and affordable universal medical coverage can be achieved by legislative restructuring of the non-government health insurance industry; the Netherlands and Switzerland have both been quite successful in that regard as have other countries. While I as a Canadian can state that, after more than sixty years Canadian experience with Province based (with Federal co-funding and Federal/Provincial standards framework consensus), single payer systems work well for us and have exhibited many health service delivery and cost savings and control features. That each advanced country has developed its own unique response to the sound universal coverage at affordable cost challenge and the US will likely also evolve its own unique response.
The key is not to simply search for abstract reasons, unverified factoids and unwarranted stereotypes of foreign experiences to paper over and justify the status quo. In this respect, a better general understanding of the programs in the Netherlands and Switzerland might suggest approached forward for those who reject the government single payer systems and there are many other models from which to draw ideas. It is simply a shame, when there are so many alternative ways to address these issues, that the life expectancy of the average US citizen is about two years less than the Canadian average and that so many in the US face financial hardship to finance needed health care for themselves or other family members or basic health care is denied for financial reasons.
Bob, It sounds as though you have little understanding of the American Healthcare system. And having come from the poorest communities in the USA, (which I'll assume you have only seen in the movies) I was never denied health care treatment, even when I was one of the uninsured. This is a myth. Long before Obamacare it has been ILLEGAL to deny treatment to anyone in the USA for financial reasons. Walk into any hospital and it clearly says so in the lobby. My brother-inlaw has performed numerous operations on people at the University of Maryland Hospital that had absoultely no ablity to pay him. We don't have waiting lists. You walk into the hospital and get treated if you're truly ill. If you are indigent the hospital takes the write down. The drug companies will provide the meds for free if you have no resource. It's little more than a few forms to fill out. If you have the resources to pay, you can and should pay for services you receive. I have been to Western Europe and my wife lived there many years. Having lived under both she will tell you herself their system is a disaster. Some worse than others, but all less accesible than the USA. For the WHO to say the same thing is quite telling. These are hardly unverifiable factoids and realtively easy to verify. The fact is whether you or Kimball like it or not, the outcomes are better here in the USA. I have already demonstrated how inconsistent the Life expectancy ratio's are. So I will challenge you to site your own source. Show me in what area of specific illness or disease that Canada for example has a longer life expectancy. See if you can find even three. Cancer...Heart Disease... AIDS...Take your pick and site your source. So which system is more equitable the one that covers more with more fatalities ??? Hardly. As I have said before and I will say again. All forms of Gov't run/sponsered care are great when you have a sinus infection and want an antibiotic. When you have testicular cancer and the tumor is encroaching on your vascular system, you'll find yourself at Sloane Kettering. Aside from results related to illness neither you nor Kimball address the fact that the medical price index correlated quite closely with CPI data prior to Medicare. Then the Gov't slowly crowded out the competition to the point that we have already socialized half the country and made 50% of the market inaccessible to private insurers. Under these programs the prices went up, not down. We had no such issue before the Gov't invovled itself. Since the Medicare act of 1965 the deviation between CPI and MPI began. The HMO act of 1973 made it worse. The Gov't underpayment of hospital care exploded in 1989 making it far more expensive. Every act of the Gov't has worsened the problem. British physician Max Gammon articulated this problem very well in his "Theory of bureaucratic displacement" I have yet in all my life met anyone who said they we're going to canada or Europe to get treatment unavaible here in the USA. That's not to say it's never happened. But hardly the norm. Living 3 1/2 years in the Naples Florida area, it was common to meet Candians on vacation there. There feedback was almost exclusively the opposite of your view. If your happy that's great. But so are most Americans. Our system is far from perfect. But Gov't is the obstacle, not the solution.
I have no problem with the fact that you believe the health care system you currently enjoy is the best in the world and the objective of my comments to Kimball’s Instablog article are not intended to convert anyone to the particular form of universal health care provision I enjoy here on the west coast of Canada. My intent is simply to engage in the sharing of information, on the one hand, and, on the other, to respond to mistaken information, as I see it, expressed in relation to the system of health care available to people where I live.
You begin your most recent comment addressed to me by pointing out that all persons in the US, regardless of their ability to pay, are entitled to emergency treatment at any hospital. This is so in Canada as well. Additionally, legal residents and citizens of Canada are entitled to needed medical services in non-emergency circumstances including subsequently an emergency and these services are not restricted to those being provided at a hospital. You also mention that many doctors provide medical services as a charity to persons unable to pay or to fully pay the usual cost for these services. In Canada doctors and other medical services providers receive their normal fee for services to any legal resident or citizen of Canada. In British Columbia medications provided while admitted to hospital are generally free but prescription medications are generally paid for by the user and often covered by supplemental insurance coverage purchased by the user. The price of drugs is however generally lower than in the US because of bulk purchasing arrangements and the user can claim the cost as an income tax deduction.
Turning to the efficacy of treatment, I think we can both agree that those preparing statistics are faced with many methodological and information collection problems in trying to prepare statistics that compare outcomes from one country to another and that there is the added problem of those striving for a particular outcome slicing and dicing data to serve their needs. It follows that you can point to one study of outcomes and I could point to others but we are unlikely to find a valid way to reconcile differences between studies, reach a consensus or become any the wiser through the exercise. I will, however, refer you to the following website published by your own CIA where the life expectancy of the average Canadian is estimated to be 82.23 years as of 2009 while that of the average American is estimated to be 78.11 as of 2009, a difference exceeding 3 years. I also give a Statscan website showing life expectance estimates Province by Province as of 2005 for your interest.
www.cia.gov/library/pu...
www.statcan.gc.ca/pub/...
I fully appreciate that life expectancy reflects several factors besides the availability and quality of health and medical services available but, accepting that limitation, the difference strongly suggests that Canadians are not badly served.
At the conclusion of my March 30 – 7:59 PM comment I acknowledge the weak link in the Canadian system, potential delays for those waiting for treatment of stable conditions and note that this would decrease if health care spending (private and public) in Canada, which is currently less than 70% per person of the corresponding US amount were increased.
My March 30 – 2:25 PM comment deals with your comment about Canadians travelling to the US for treatment and Americans coming to Canada for treatment.
When the model of Canadian universal single payer medical services was developed in Saskatchewan in the 1960s (the driving force behind that development was then Premier Douglas, grandfather of Kiefer Sutherland - the star of TV’s ‘24’ – who would have thought!), the intent was to preserve the doctor/patient relationship, avoid the bureaucratic features and two tiered nature of the UK system, extend essential quality service to all people, prevent for profit medical facilities involvement and control cost escalation over time (i.e. maintain the established form of medical practice but extent this services to everyone with the bills going to the plan rather than the patient and the cost being covered by the taxpayer). On the bureaucratic angle, the administrative costs and staff needs are reduced for doctors because they don’t face the need to deal with a multitude of insurers and doctors receive payment for all patients without undue delay. Our system is not perfect either but it has sufficient coherence that informed public debates about its improvement are possible.
You misunderstand: Arrow and I are economists. As such we are concerned with how, how well and why markets function as they do, issues most others ignore because they are not trained to address such matters well. Just as you you largely first ignore such issues and then disparge those who are trained to and do focus on those issues. Unless you enter the central ring knowledgeably, your jumbled comments on these issues and myriad other issues at once are probably best ignored.
This is a bad era for Americans and I largely attribute it to the self righteous religious right coming out of the closet and joining the Republican Party and largely destroying it. There was a day when the party was dominated by middle class sensible businessmen who were not only knowledgeable and capable of learning but who also had a practical bent and knew how to engage in discourse and communicate. No longer.
Like our educational system, political discourse has been badly dummied down to the point where it no longer serves.
1. The American health care system is not sustainable,
2. Citizens of other developed nations with national healthcare systems basically like their health care systems and are not about to abandon them,
3. Americans do not like their health care system (as opposed to their treatment, when it is received),
4. So called “free markets” have failed and become troubled oligopolies in the American health care system,
5. Major reform of the American system is an imperative.
Do you think economists study nothing? Or that everything they know is already known by any competent M.D? (or MBA?) How arrogant. By the way, an MBA typically covers marketing, finance, accounting, production and like topics and is not at all a substitute for higher level economic training as you seem to think. Practical experience often counts for too little as well. Until Arrow came along and explained the relevant medical markets, no one -- even those with a great deal of experience in them --- had managed to understand what he did from afar with his training and thought. Now his views are accepted among economists and most higher up in the medical community. Even the head of the AMA has now come out in support of the need for major reform.
I have written on the problem at hand. Most economists will not speak up on the economics of health care or the economics of health care reform. They do not want the retaliation, the vocational insecurity that can ensue, or the flack like I have gotten. Most, after Arrow, have remained largely silent. Michael Tanner, for example is not a trained economist, but he is sheltered as an ideolog of like mind by the Cato Institute. He is a right wing ideolog who writes for the National Review, wants Social Security demolished, and is basically a politico who joined the Cato institute from the Georgia Public Policy Foundation and a position as the legislative director for the American Legislative Exchange Council.
You write: "Where would Milton Friedman side in this argument ??? You're an attorney who's never worked a day in your life employed as an economist." Friedman agreed with Arrow! As for not working ever as an economist, I consulted frequently as such on cases where I was paid to but did not appear as a counsel of record. I also lectured on how to use economists in cases calling for them as experts. Also, I worked during the summers as an economist for the three years I was in graduate school. Moreover, as I explain above practical experience is too often worth too little in understanding the true economics and economic theories involved. You obviously did not learn that in your MD, MBA and MS programs. Top universities are not at the top for nothing.
You should address the substantive arguments, not attack me ad homonym.
“Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own.”
Consumers spending their own money holds costs down in every other sector of the economy: Consumers obsess about prices; providers fight to earn their business. Trying to duplicate this process through a government board of experts is pointless."
" I'd rather entrust the government of the United States to the first 400 people listed in the Boston telephone directory than to the faculty of Harvard University. "
I do not believe this is at all accurate. Most from Canada come for more esoteric or equipment intensive diagnoses or treatments that are being paid for by the Canadian government because they are more available in the U.S., and Canada has elected to proceed this way rather than incur the addition equipment or R&D over head expense in Canada. This is not incompetence, it is intelligent. It helps avoid expensive duplication; it spreads the overhead and it promotes efficiency. Nothing stupid about any of that, so the disparagement of Canadian physicians is most inappropriate here.
Interestingly enough, Harvard is above the spitting and more secure in its position, except when it comes to football and skulling.
Also, a 2008 survey of over 2000 doctors selected at random published in the Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.
America's health care industry has spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms proposed by Obama and others. There are six registered health care lobbyists for every member of Congress. The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Finance Committee that drafted Senate health care legislation is Senator Max Baucus (D-MT). A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT) in 2009.
This shows us clearly who doesn't want health care reform. Surprised? Not one bit.
On markets gettin it wrong, some studies are showing that I am correct. Markets can get things wrong for longer terms, according to those studies. The housing market bubble up spanned from about 2003-2004 until recently, when it collapsed, creating the recession.
This is precisely my point and why I think Chicagoans and free market aficionados are wrong in thinking that markets cannot get it wrong except in the short term. Are we to believe that underlying or more intrinsic valuations are fluctuating as wildly over the market cycles and equally in magnitude? I seriously doubt it. Markets often overreact on the upside of the cycle with overly high prices and then overreact again on the downside of the cycle with unduly low prices. (Also, I have an article showing how excessive trend trading renders markets less capable to determine accurate valuations.) Ironically, Friedman saw this under dampened oscillation effect in other contexts (e.g., impact of money supply changes) but not in regard to markets and denied free markets would get wrong results for periods longer than the short run. In fact, I think he got it partially backwards in a way. The only way the efficient market hypothesis makes any sense to me is that the free market gets, for all time periods, exactly the results dictated by the buyer and sellers then participating in those markets. However, those buyers and sellers can easily be wrong or be mistaken by misjudgments, lack of information, wrong information and a million and one other reasons. There is no necessary magic to a free market. They do not always get valuations correctly. This is the argument the banks have used to get exemption from the FASB rule requiring assets be marked to market.
When markets that are important screw up for whatever reason over longer terms it is like a red carpet being rolled out for government intervention. Sometimes the government does better upon intervention; sometimes it does worse, often depending on the time frame. The bust in the housing market and also in the mortgage loan market substantially tied to it were clearly market screw ups fueled by unregulated greed fed by the misincentive of large upfront fees and much mistaken risk allocation and mismanagement and also by the effects of earlier government interventions seriously distorting incentives and market signals. Those markets then got it wrong big time, especially with help from the Federal Reserve. I don’t disagree with your analysis here. In housing, earlier government interventions over the years had caused a substantial misallocation of excessive resources into the housing market from other markets, making the later crash that much worse. American government too much earlier intervenes in markets, not to insure a lack of abuse in and to those markets by regulation, but to otherwise misallocate resources in regard to those markets, often according to whim and what government then thinks is “right” at the time. However, even without intervention, the stock market also screwed up big time both around May of 2009. True or intrinsic values did not swing so wildly. Too, good and bad stocks alike get dragged along collectively in such wild aggregate market swings, clearly and also indicating market failure.
It is just very hard to be dogmatic or ideological about various “free” and free markets and their virtues. They have to be evaluated case by case. Markets screw up and so does government, both in various ways. Neither is any better than the judgments of the people then participating in or affecting them.
There is much dogmatism and ideological nonsense in this area, probably because collectively and over longer terms larger numbers of free markets do allocate resources more broadly better than government , which is why general, centralized government planning does not work well.
Too many do not understand markets well, even in broad terms.
For too many, being a Republican has become an emotional, qua religious experience in the sense that facts don’t matter, only right wing Republican positions do. Facts are displaced by “beliefs” and true facts which conflict with such “beliefs” are quickly rationalized or deflected away, or more often just ignored. This is a painful process for reasonable and logical people to watch, regardless of their political persuasion.
The mental “belief” process applied by these people is the same as that adopted by religionists regarding the anti or supernatural aspects of their various religious beliefs systems, e.g., Islam: Mohammed physically ascended to Heaven on his white horse from the Temple wall or Christianity: Jesus physically ascended to Heaven after his resurrection from being dead. People who believe these things actually happened simply will not listen to any suggestion that they are physically impossible or may be the result of hallucinations. Again, facts in these cases simply do not matter. Emotional “beliefs” that are too largely independent of the facts, control. This is what it means to be a “religious nut” in politics these days.
Beliefs too much supplant facts in both religion and right wing Republican politics. Fair minded inquiry and sensible analysis are foreclosed or much worse, simply feigned for the sake of appearing sensible. Feigning sensibility and earnest inquiry on the facts is simply a temporary recloseting of religionist sentiment for the sake of appearing sensible among “normal” people. In fact, one could well argue that what separates a “belief” from a fact is that “beliefs” are held onto regardless, virtually as a matter of faith, whereas factual inquiry looks fair and open mindedly to the circumstances, what occurs and what is being done, said and will most likely occur. Factual inquiry is amenable to open discourse and the free exchange of ideas. This is not the case regarding belief systems.
Regrettably, the right wing religionist “nuts” have now become too much the dominate public voice of the Republican Party. The thinking, moderate Republicans have become a silenced minority driven into a corner by threats that the campaign contributions to them from the wealthy -- who are profiting immensely from the status quo --- and the support from the RNC will be withheld if they speak out in opposition to or vote against the new religion. It is a regrettable state of affairs. Too, the Tea Bagger crowd mentality infuses too much here. Crowds are not a good vehicle for thinking and careful analysis; they are a means of disseminating misinformation by repetition and rallying people to believe in it.
For example, those who are “believers” and love Fox News, should read the book Lies, Liars and the Lies They Tell by Al Franken and his Harvard research staff. However, because right wing Republicanism is too much a religion, I am sure nothing said here or in that book will matter to the religious “nuts” in the slightest, as it would to sensible, neutral-minded people not of that belief system. Hard and unequivocal proof of repeated bald faced sequential lying by O’Reilly and many others on the Network will not matter to them because they are working at an emotional, religious level grounded in “beliefs” and not at a neutral brain level dealing with facts. Again, the true facts don’t matter. They are to be lied past. Only right wing Republican “beliefs” are important. So it goes with rightwing nuts.
My observation is that serious, systematic lying across a broad range of issues was never the problem it is now in American politics until the fundamentalistic religionists emerged from the closet at the initial aegis of Jerry Falwell and then became a dominate part of the Republican party. Many such religionists have long held the view that lying is a means that is justified by the ends where it is God’s work that is being done, and a great deal of lying is now implicitly being justified under that silent rationale because, as I explain, right wing Republicanism now has developed the characteristics of a religious belief system.
It is truly a lamentable state of affairs for sensible, informed discourse of which we have had too little lately and for the fate of American politics. This is a truly a bad time to be living in America compared to other periods of American history, in very large part for this reason and what it has caused to happen with American political discourse and government. Nietzsche would, I suppose, view this broad state of affairs as the final death throes of religion in America, as a sort of dummied down, reactionary and fundamentalistic backlash to an ill-understood postmodernism.
www.frankenlies.com/tr...
Franken is little more than a political hack that found enough votes in the trunk of a car at the last minute to ensure his election. And he is border line certifiable. Maybe next you’d like to read us a quote from “rules for radicals.” Who is the more emotional ??? The Christian Conservative or the Socialist trying to create a Utopian society. Your comments above show you to be little more than a pretentious bigot who holds those of devout religious faith in utter contempt as they are clearly beneath your intellectual capacity and cognitive ability. Perhaps my earlier statement is incorrect. Maybe Christianity is under attack in this debate. Your characterization of the “Tea Baggers” is a classical example. As you have not likely ever been to a tea party rally. If you had you’d know that this is hardly a religious crowd. The majority are not even republicans as Rassmussen & Gallup have recently pointed out in polling. An enormous number of them are/where obama voters. Many are socially liberal and fiscally conservative. They are honest hard working Americans whom are genuinely and legitimately concerned about out of control Gov’t spending and fiscal deficits. When you return to AZ, ask your local patrolmen who was stationed at a rally. See what he has to say about the behavior and conduct of “Tea baggers” at these events. Then ask a patrolmen about the conduct and number of arrests and vandalism at the Anti Bush protests or the Code Pink rallies. The way individuals like yourself, the media, and some scared members of congress attempt to characterize them is despicable. These emotional protesting Tea baggers are the types that founded our great nation. And if you knew even a little about the history of the nation of your origin, you’d know there is little difference in the political discourse today vs the past. Try reading some of the statements made in newpapers following the Lincoln-Douglas debate. Or even some of the comments made by both JFK and Nixon about each other on the campaign trail. Whether right or wrong, political discourse of this sort has been more the norm than the rarity. Citizens like yourself from the Baby Boomer generation have proven yourselves to be the complete antithesis of the greatest generation, and possibly done irreparable damage to the social and fiscal fabric of this country with your “Great Society” entitlements. You have shown yourself to be little more than a fraud. And hopefully SeekingAlpha’s rejections of your more recent articles of pontification will prompt you to redeploy your propaganda back to where it belongs…The Daily Kos, Huffington post or maybe even the Daily worker. This way you can continue you to marinate your ideas in a more friendly culture of victimhood & defeatism.
These are strong, resentful and ad homenym words, but that is not how I would put it. That is how FJ puts it.
I would put it thus:
Those of any religion who rely on the unverifiable, supernatural or, worse, the anti-natural as tenants of belief for what they accept as factually true are extremely suspect as to their mental processes in my mind. Take Christianity and the Nicene Creed for example. Acceptance of that creed as true REQUIRES you accept as true the following factual assertions:
1. God made everything
(Is there a God? a personal God? a supreme creator? a supreme consciousness? Did it create everything? As far as reason and the absence of faith might permit us to go here is to say that what we know about the universe implies a supreme consciousness knowledgeable about the extended laws of physics and of all matter of every form in the universe. The underlying structure and the principles governing it seem not to be random, happenstantial, or self-feeding incrementalism. What we know of the big bang implies as much. We are even getting a handle on the big bang process --> energy = mass x speed of light, squared and the relationship to convert mass into energy, or mass = energy/speed of light, squared, to convert energy into mass)
2. He came down from heaven to save us
(This multiple factual conjecture is purely faith based. Is there a He or a She? Did he "come down?" From "heaven?" Was it to "save" us? I frankly deny any of this actually occurred.)
3. He caused Mary, a virgin, to become pregnant,
(This factual conjecture is total nonsense -- a zero probability event-- and purely faith based.)
4. Mary gave birth to Jesus who was God, too,
(This factual conjecture is total nonsense too and purely faith based.)
5. Jesus was killed on the cross,
(There is some, but very little independent evidence that this is true.)
6. Three days later Jesus arose from the dead,
(If he was truly dead, this factual conjecture is nonsense and purely faith based.)
7. Jesus physically ascended into heaven,
(This factual conjecture is pure nonsense and can only be faith based.)
8. Jesus will come back down from heaven to judge us,
(This conjecture is also nonsense and purely faith based.)
9. We believe in the church which adopts this creed,
(This is tantamount to saying the believer accepts as factually true the factual absurdities identified above.)
10. We believe in baptism for the remission of sins,
(This is simply a statement of conjecture, not the truth or falsity of what is said.)
11. We believe in the resurrection of the dead, and
(This is a statement of belief in what is factually, demonstrable nonsense.)
12. We believe in life hereafter in the world to come.
(How do we know there is an afterlife as a matter of fact? Only on supposition and faith.)
I submit it is most reasonable to question the thought processes of those who believe in the Nicene Creed for the reasons I have indicated here. The thought processes of “believers” are very suspect and different than "normal," in my view. They tolerate entirely too much factual nonsense for my taste. Implicit in those thought processes and that tolerance, too, is a capacity to make things up and say as fact what believers wish or want to be true. That is what I mean by they tolerate too much factual nonsense, I think.
Conceding that Jesus was an intelligent and inspired Jewish mystic should not induce or inspire anyone reasonable to contend he was God, someone supernatural or that he was born of a virgin. In fact, Jesus and his teachings have been almost totally marginalized by Pauline Christology, especially within the Catholic Church. Any man would do as well as long as he was born of a virgin, was God himself, was killed dead and then arose physically from the dead and physically ascended into “heaven.” For a further example of marginalization, Jesus taught us to always pray alone, a mandate that is flatly ignored by members of virtually all Christian churches, especially the Catholic Church.
Worse, if in truth Jesus was God and understood and knew all, why would he cry out from upon the cross, "My God, My God, Why hast thou forsaken me?" How do we explain this, assuming it is true? One significant likehood is this situation is wholly consistent with the view that Jesus, as a Jewish mystic, had become delusional, especially in regard to what he knew and understood, and in his belief and claim that he was God, which claim the scriptures confirm he repeatedly made.
Saul's or St. Paul's contribution to the mythology was to up the ante. For eons, sacrifices had been made by those of Judeo religious disposition. Usually, animals of varying expense were the sacrifices to God in that tradition. Abraham's almost sacrifice of his son, Isaac, and human sacrifice in other then unknown cultures raised the stakes. Paul's idea was to make Jesus, a man, into God so that in sacrificing him, we would be sacrificing God himself or if you will, his "Son" in his likeness. (This is why the Father, Son distinction is needed -- killing God would not do for the mythology.)
But the point is you cannot get a higher level of sacrifice than that. The ante was raised to the ceiling. This was the ultimate sacrifice in the spirit of Abraham, but a much greater one still. The weak and needful believers in myth, who wanted a truly miraculous (i.e., zero probability events) religion, loved and bought it. It was an escape from reason and disorganized daily life which they found to be too disconcerting and oppressive. The myths of all religions are invariably tailored to meet human and social needs, some better than others. Early Christian services were held in the various homes of different believers and were led by women.
Regardless, the core issue, as Nietzsche contends, is the following: intelligent people who are intellectually honest with themselves and know what we now do about the natural world, philosophy, the sciences and especially the sociology and anthropology of the creation of myths and fables of various cultures and peoples to address personal and social needs, can no longer believe in the nonsensical, mythical conjectures of fact which are required to accept and believe in Christianity, Islam and other myth and fable based belief systems. As Nietzsche also explained, it is Christianity's dedication to truth and honesty that is also its ultimate downfall, as this explanation reveals.
That is how I would put it.
But since when do you care of actual facts or what can be proven. As with the original purpose of this debate. Every resource available shows the USA has the highest rates of success in the treatment of virtually every major illness...Cancer...Heart disease...AIDS. You name it and we've had more success. Yet all you can quote is a CIA fact book that accounts for multiple other ancillary causes for mortality. You can't debate the results on their merits because there is no proof to the contrary. Yet you still endorse your idealistic views that we need to mimic a system with results that are less successful. Sounds as though you are the one who does not follow the scientific method. You choose the outcome first that you wish to see, and then selected a philosophy that would support it regardless of what the results show. That is Intellectually Dishonest.
This is our core difference. If some Christians do not believe in the historical truth and accuracy of the elements or events of the Nicene creed, then what are they left with visa vi a Christian religion? This is my point. If a person believes the truth of those events occuring, I submit it has to be on faith -- that is, the factual conjectures must rest on no reasonable or credible basis. If they don't so believe, then the problem and the religion evaporates. If they do so believe, then I am concerned about that fictionalizing thought process spreading, especially into the political arena.
Now, I agree that many selectively believe, including Catholics, but by what criteria can they sensibly do so except by credibility and reasonableness? Their selections, however made, may or may not logically destroy their religious system, but too many do not both to think it through and decide that question. I submit that is a problem in thought. To be sure, Christian belief has become seriously fragmented across a wide range of people and churches, but do they consider the coherency of what they contend is in fact left of their religion? I believe, largely not.
As you point out and Hawking suggests, none of this negates the existence of a supreme consciousness or being, but when cleaning viewed from a Nietzschean perspective, it does raise serious questions about the nature of our relationship, if any, to that consciousness, if you will.
Debunked of myth and fable, it may well be that our lot is to try to understand that consciousness a la Newton, who is said to have proclaimed on his grandest discoveries, "God I think thine thoughts after thee." To be sure, to understand our universe and ourselves certainly seems to be a major thrust of civilization, but what more is involved? There is little to provide answers without reaching back into our discredited mythical systems which too largely grew out of our own needs. This is a major quandry of postmodernism.
Perhaps the best route to understanding the supreme consciousness, at least in my mind, is to better know and understand the what and how creation came to be and what it is all about. That certainly is the thrust of science and the best of world civilization. A great physicist has suggested that is the only way life can rise above the level of a farce to at least become a tragedy.
Since you end with a comment on medicine and my views, I will as well. The problem in American is less the quality of the treatment that is provided, than it is that too little access to treatment is afforded to so many. But this is no surprise because oligopolies -- and I have identified several involved-- necessarily charge too much as a means of rationing to correspond to their restricted outputs.
You next argue as to my views, "Yet you still endorse your idealistic views that we need to mimic a system with results that are less successful. Sounds as though you are the one who does not follow the scientific method. You choose the outcome first that you wish to see, and then selected a philosophy that would support it regardless of what the results show. That is Intellectually Dishonest."
Not so, my views are primarily limited to the following:
1. The American health care system is not sustainable,
2. Citizens of other developed nations with national healthcare systems basically like their health care systems and are not about to abandon them,
3. Americans do not like their health care system (as opposed to their treatment, when it is received),
4. So called “free markets” have failed and become troubled, dysfunctional oligopolies in the American health care system; and
5. Major reform of the American system is therefore imperative.
I do not go so far as to suggest the broad reforms to be implemented are the best, the optimal or perhaps any more than the most politically expedient. I have focused on the problems here more and in my article have simply identified what problems have to be solved and what the most direct solutions are. I have not been able to garner agreement even on that. I dare not suggest global solutions or reforms as opposed to how to fix the immediate problems of the present system.
Accepting that he needed some help for his second book, Lies, Liars and the Lies They Tell, Franken got staff support from a group at Harvard. It was solely to the second book that I referred. There is no debunking of the second book on the website to which you refer us although you have to go to each entry or challenge to determine that because, like you, the website's author tries to blur the two together with his main headings.
Your ad homonym slur was overly broad and badly in error. See, you simply wished it to be so, and then said it.
Pure ad homonym vitriol.
It is one sure way to tell that your arguments are getting through and you are prevailing. As the old legal maxim has it, when you lose on the facts, attack on the law; but if you lose on the law, too, then attack opposing counsel personally.
I support social security and medicare for those that have paid into those programs over their working life times. I also support unemployment benefits for those thrown out of their jobs by the recession. Beyond that, I do not support any so called "entitlements." Again, you are just blowing smoke.
You're a toubled man kimball if this is a person you take seriously. And we are all in trouble now that he is actually a senator.
www.frankenlies.com/li...
I do not mean to take Franken's side totally in this back and forth particularly and I do not share his political philosophy and certainly not his political style. Too, my perspective and focus is different. My contention is that for years the extreme right Republicans of a religious nature, once emerged from the closet, have been too ready and able to lie and say what they believe best serves their and their Lord's political and other interests for the reasons and explanations I have already provided. That is more my concern.
In the politican arena, in large part because of the situation I have described, I believe that we are awash in much foolishness and stupidity. The quality of discourse is hampered and very poor. Here is an example of me speaking out against that very thing by a religious nut this very evening, elsewhere:
"What ???? "the Obama administration's despicable sellout of America's security, of our allies and of our economy," "the insanity of the Obama administration," "this administration’s treacherous abandonment of America’s own national security interests," “Obama can coddle every Marxist and every terrorist across the globe.” – Give me a break!
This is outrageous, hyperbolic and stupid political discourse of the lowest and worst sort. Any politician should be ashamed to be associated with this obvious fool. You can disagree with Obama civilly, but this kind of talk is pure religious "nut” extremism and grossly irresponsible."
Sorry, but that is how I see it.
Obama is simply tired of US presidents and politicians being pushed around by the Jewish Lobby. For more on these Jewish activities see www.lrb.co.uk/v28/n06/.... The authors there provide a more balanced view that the zionist Jewish community cannot stand and in fact tried to surpress from publication. Israel, which engages in spying on America, does not serve America's best interest, while America has served Israel's best interest too well, causing us to lose good will in other non-Arab parts of the world. I have lived in Arab countries and have observed the situation first hand. There is too much bad Jewish behavior in the Middle East.
Next, you are too well terrorized by Bin Lauden and his ilk. There is a threat, to be sure, but we need not act like cowards about it and tremble so. It is unbecoming. Reasonable steps -- some in compromise of our Fourth Amendment rights -- are being taken. The Director of Homeland Security, Janet Napolitano, is a long time friend and former law partner of mine and I have a good sense of what in fact is being done.
Beyond that all we have from you is simply more and more ad homenym slurrs of me personally that I simply won't and don't have the time to respond to. If you tried your style of argument in a debate setting or a courtroom, you would be quickly banned. You are a classic example of what I have written about as rightwing Republicanism as Religion in the political arena, although you are a bit better informed than most and less overtly religious, but all the topical reactions are there.
P.S. Again on another issue you are badly confused. I never said Friedman agreed with my position on health care. In fact, I have not even stated my position on what reform of the health care system I think is or would have been best! I said Friedman agreed with Arrow's analysis of why markets cannot function properly in the area. Further, all I did was write what I thought had to be done, within the framework of Obama's legislative system, in order for it to stand any chance of working reasonably well. The legislation doesn't do too much. For that, I am villified ad nausium. You should try thinking about the issues and reading more carefully and widely, instead of throwing rocks and stones at me personally. It reflects badly on you.
While I do enjoy a heated dialogue, this seemed more like a duel to the death.
It is bad form to launch personal attacks. If you take exception to an authors view, state your point ,agree to disagree, then move on.
Thank you Kimball for an intelligent article.
Anti semitism as well. At least you don't discriminate against some faiths. You apparently hate all equally. Anyone who has been to Israel... As I have... knows what a fantasy world Kimball lives in. This is the only true democracy in the region. And a country that has gone to create lengths to make constant attempts to achieve peace. And our president he has completely alienated them.
Is this the same Janet Napolitano that cut off funding to the virtual fence on out border. Then anounced to our law enforcement agencies that we need to be more cautious of the threat of our own soldiers returning home from combat. But in the meantime we no longer use the words Radical Islamic terrorist. She has become the laughing stock of our law enforcement around the nation. And the president is the laughing stock of the people that defend us in the theatre of combat. Doesn't surprise me you would associate with her. It's a shame we didn't have men like you at the chosin reservoir. They marines could have surely used a man with your attitude in the fox hole.
7 billion dollars for building Jungle gyms
Employer mandates on providing time off for breast feeding.
It gets worse. Almost as bad as the stimulus bill that spent 2.5 million on a program to educate prostitutes in china on how to drink responsibly on the job. This stuff would actually be hysterical if it wasn't our money.
The religious right has long supported Israel and Zionism because, according to the New Testament, just before the rapture, all Jews will see the error of their ways, convert to Christianity and will levitate and ascend with the Christians straight up into Heaven to sit on a cloud with God. I have heard Falwell and Robertson says so many times along with other nutty televangilists.
Those of us not of a religious habit of mind, of course, think the whole business is arch foolishness, even if it does guide peoples sentiments and behavior.
Again, all is a big part of the mind set I have been talking about as religious. Religion is a disaster for clear and unfettered thought.
Israel needs to be careful in the US, especially with its high pressure lobbying and hassleing of the press, not to more antagonize its supporters here, including the U.S. government. That should be only common sense, but the religious disposition among some Jews truly worries and scares me. The hard liners are a problem. We need to get the Middle East mess settled and resolve in the next few generations. Ironically, there are some Arab Jewish towns where the two populations live well and happily together with little friction and much cooperation and coordination.
I am not knowledgeable about the Honduran situation and do not addrress it, but am unwilling here to condemn Obama across the board. I think he is correct on Israel. A bit of tough love is needed. It is Israel too that only understands power.
Also, I do not favor or disfavor Janet Napolitano actions. She is a friend of many years that is all. We had a common very liberal legal mentor (John Frank, the lawyer who did the Miranda case in the US Supreme Court), she became a good Democrat under him and I was deemed politically incorrigible because I always called each issue as I saw it and would not go along with any party platform, even in broadest outline, as you guys do. I was deemed insufficiently loyal, politically.
A 2008 survey of over 2000 doctors selected at random published in the Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.
Because what we had was not viable, some reform was imperative. I do not argue that the reform we got was the best. It was more likely the most expedient, give the opposition involved. The problem now is how to make what we have work. That requires the further changes and reforms I have written about in my article. The relevant markets are a mess. Premiums are shooting up at 67% per year in the insurance area, profits and overhead for insurers are increasing at a 12 rate per year, the Drug oligopoly and FDA system are a mess and we seriously need more doctors per 1000 population. All of this needs to be straightened out or the reform will not work any better than what we had that couldn't either.
Since what we had was no longer viable, some reform was imperative. The reform we got probably not not the most optimal, but we have it and the issues addressed in my article were largely targeted on what more is needed to make it work. The legislation alone is insufficient to give us something workable. The changes I suggested in addition are needed. The markets involved are not functioning as they should. Premiums are skyrocketing, Insurers' overheads and profits are too high. Ect., etc, as I explained.
America's health care industry has spent hundreds of millions of dollars in 2009 alone to block the introduction of public medical insurance and stall other reforms proposed by Obama and others. There are six registered health care lobbyists for every member of Congress. The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Finance Committee that drafted Senate health care legislation is Senator Max Baucus (D-MT). A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT) in 2009.
This shows us rather clearly where the real opposition to health care reform is coming from. Basically, those with oligopolistic profits are putting their money where their mouth is. Doctors, interesting enough, seem more concerned about more prospective patients getting good medical care, even if the reforms ding their compensations a bit. However, foreign doctors in developed nations are not exactly paid at poverty levels for the most part.
See, Google results:
Search Results: US doctors support universal health care
31 Mar 2008 ... WASHINGTON, March 31 (Reuters) - More than half of US doctors now favor switching to a national health care plan and fewer than a third ...
reuters.com/article/la... - Cached -
Physicians for a National Health Program
Physicians for a National Health Program is a non-profit research and ... and health professionals who support single-payer national health insurance. ... The U.S. spends twice as much as other industrialized nations on health care, ... We endorse a fundamental change in America's health care - the creation of a ...
pnhp.org/
22 Mar 2010 ... Health care costs will continue to skyrocket, as the experience with ... U.S. physicians support government action to establish national health insurance. ... Physicians for a National Health Program (pnhp.org) is an ...
pnhp.org/.../pro-singl... - Cached
Support for national health insurance among U.S. physicians: a ...
by RT Ackermann - 2003 - Cited by 14 - Related articles
Support for national health insurance among U.S. physicians: a national survey. ... of U.S. physicians toward the financing of national health care. ...
ncbi.nlm.nih.gov/pubme...
Physicians' Beliefs and U.S. Health Care Reform — A National ...
by U Coverage - Related articles
14 Sep 2009 ... Physicians' Beliefs and U.S. Health Care Reform — A National Survey ... that he needed physicians' support on health care reform and offered ...
healthcarereform.nejm.org
Your ideology is in the way.
www.investors.com/News...
Health Law Bans New Doctor-Owned Hospitals, Blocks Expansion of Existing Ones
Monday, April 12, 2010
By Fred Lucas, Staff Writer
The new health care overhaul law, which promised increased access and efficiency in health care, will prevent doctor-owned hospitals from adding more rooms and more beds, says a group that advocates physician involvement in every aspect of health care delivery.
Physician-owned hospitals are advertised as less bureaucratic and more focused on doctor-patient decision making. However, larger corporate hospitals say doctor-owned facilities discriminate in favor of high-income patients and refer business to themselves.
The new health care rules single out such hospitals, making new physician-owned projects ineligible to receive payments for Medicare and Medicaid patients.
Existing doctor-owned hospitals will be grandfathered in to get government funds for patients but must seek permission from the Department of Health and Human Services to expand.
To get the department’s permission, a doctor-owned hospital must be in a county where population growth is 150 percent of the population growth of the state in the last five years; inpatient admissions must be equal to all hospitals located in the county; the bed-occupancy rate must not be greater than the state average, and the hospital must be located in a state where hospital bed capacity is less than the national average.
The rules fall under Title VI, Section 6001 of the Patient Protection and Affordable Care Act. The provision is titled “Physician Ownership and Other Transparency – Limitations on Medicare Exceptions to the Prohibition on Certain Physician Referral for Hospitals.”
More than 60 doctor-owned hospitals across the country that were in the development stage will be canceled, said Molly Sandvig, executive director of Physician Hospitals of America (PHA).
“That’s a lot of access to communities that will be denied,” Sandvig told CNSNews.com. “The existing hospitals are greatly affected. They can’t grow. They can’t add beds. They can’t add rooms. Basically, it stifles their ability to change and meet market needs. This is really an unfortunate thing as well, because we are talking about some of the best hospitals in the country.”
The organization says physician-owned hospitals have higher patient satisfaction, greater control over medical decisions for patients and doctor, better quality care and lower costs. Further, physician-owned hospitals have an average 4-1 patient-to-nurse ratio, compared to the national average of 8-1 for general hospitals.
Further, these 260 doctor-owned hospitals in 38 states provide 55,000 jobs, $2.4 billion in payroll and pay $509 million in federal taxes, according to the PHA.
In one ironic aspect, President Barack Obama’s two largest legislative achievements clashed. The Hammond Community Hospital in North Hammond, Ind., got $7 million in bond money from the federal stimulus act in 2009. It will likely be scrapped because of the new rules on physician-owned hospitals, according to the Post-Tribune newspaper in Merrillville, Ind.
Doctor-owned hospitals have long been a target of the American Hospital Association, which represents corporate-owned hospitals as well as non-profit hospitals.
An AHA study from 2008 says that physician-owned hospitals “lessen patient access to emergency and trauma care;” “damage the financial health of full-service hospitals and lead to cutbacks in service;” “are not more efficient than full service community hospitals;” “use physician-owners to steer patients;” “cherry pick the most profitable patients;” and “provide limited or no emergency services.”
One AHA fact sheet asserts that physician-owned orthopedic and surgical hospitals costs are 20-30 percent higher than average hospitals. Further, these hospitals lead to higher profits just for doctors, the AHA asserts.
“We don’t cherry pick patients, period, end of story. We take patients based on their need for care, not on their ability to pay,” Sandvig said. “It [the health care reform] puts control outside the hand of physicians and patients and into bureaucrats’ hands really.
The Association of American Physicians and Surgeons (AAPS) is one of many organizations suing to have the law declared unconstitutional on the grounds that the federal government cannot compel someone to buy a product.
While the provision on physician hospitals is not part of the lawsuit, it will affect it, said Dr. Jane Orient, AAPS executive director.
“If the law is declared unconstitutional, then the prohibition is part of the bill,” Orient told CNSNews.com. “There are vested interests in getting rid of physician-owned hospitals because they do a better job and are more affordable.”
The provision in the legislation and efforts opposing these hospitals can be simply explained from Sandvig’s view.
“It’s anti-competitive. I think it’s pretty clear,” Sandvig said. “We’re a model that makes sense that’s affecting innovation. We’re trying to do something better than it has been done. Anytime you do that, there’s going to be a clash between the existing and the new. Unfortunately, it’s a real David and Goliath battle.”
Doctors are going to have to be increased in number to around 3 to 4 per 1000 population instead of 2.2 we have now and they are going to get hammered on their artificially high current compensations because of the collapsing oligopoly in the supply of doctors, but, as I have shown, medical school enrollments are up and in a generation or so we will get there and doctors can go back to treating patients instead of worrying so much about their investments and managing their money.
These doctors are the ones that need to quit.
You guys are proving yourselves to be defenders through and through of the oligopolies in health care, with their attending pricing and output problems. Sorry, but I refuse to go there. You guys are too much sorry apologists for the status quo ante, which was really, like Christainty and Islam, a collection of indefensible and unsustainable positions.
P.S. If you think the ideala of conservatives like my self are driving out the “ Moderates” from the Republican party. THEN GOOD. That’s the point. The Lindsey Grahams & Arlene “The Spectacle“ Specter’s are the reason I reregistered as a Conservative several years ago. If they’d all get out then maybe I could reregister as a Republican again. No more Big Gov’t Republicans. If they don’t leave maybe a time will come for a real third party. Let us not forget…The Whig party is no more. There was a time when the Republican party was the third party. Thanks again Mr. Lincoln.
We pick up many good students in all fields from abroad. At places like Harvard, Chicago, Columbia, etc. a very large proportion of the graduate students, even in my day, were and are foreign and Jewish. They gain admission because they are most qualified.
Some of the older doctors are clearly more focused on their money than their practices. I have represented many partnership factions in groups of waring doctors and my observation is too many would sell their mothers for a buck. They can really get nasty and vindictive and from a lawyer's point of view, need much collaring so they do not get into squabbles that damage their overall legal position. They are no fun to represent. I represented one guy who was such a turkey and so good at intinidating people I suggested a Dale Carnegie course and a year working on an indian reservation after he got board certified in invasive radiology and the market had turned down. With his new manner and credentials when the market turned up he got a positon as chairman of the radiology department at a major university research hospital and was hauling down the big bucks. A year later he sent me a bonus almost as large as my original fee. He was a handful.
I agree that Falwell and Robertson are not heavy hitters in the Republican Party but they dragged an awful lot of loonies out of the closet and into the politican current and induced more closeted religionists already in the political current into more full religious bloom, complete with Bible quoting, something not a few Senators enjoy.
I haven't attended a tea party. Crowds are not to my liking. Even in college, while I came to oppose the Vietnam war, I never participated in a rally or joined a crowd, although I would watch them. Just not my cup of tea. Recessions are not the time to complain about deficit spending, although tea partiers don't know that. It is during boom times when we should be accumulating surpluses that we should all very loudly protest deficit spending, not during recessions. We get this backwards all the time.
I agree talented or multitalented people usually try to do the best they can financially and it should be so. We want people doing their best. The system does better that way.But absolute income is not always the best incentive, I have observed. Relative income among peers seems much more important within a broad range. However, money does matter for sure.
Constitutional jurisprudence has become too much of a joke in recent years, since the Supreme Court put Bush in office using an Equal Protection argument it had consistently rejected for almost 100 years and has consistently rejected since. Fourth Amendment rights have been dumped in the toilet because we are terrorized and the majority on the Court will do what it wants and then try rather ineptly to rationalize it after the fact in constitutional speak. These are bad days for constitutional jurispurdence and the Court is too much politicized on both sides. We have no true constitutional scholars on the Court.
When you chose people for the Court based on their political positions, you tend to get political hacks, not truly serious and capable judges. I have often said I could go to America's ten largest cities and in each choose two neutral, non-political and very competent courts of nine justices each, all of which from each city would be better than what we have had for many decades. The craftsmenship and decisions of the Court are too often very poor.
Government is too big, especially inasmuch as we have contracted out much of the business of govenment to private companies who usually don't have to bid or suffer serious audits and especially after government employees have not been commensuately reduced afterwards. Congress is out of control and so is the bureacracy, but there is no one that can do much about it. Obama leaned on some lobbyests and the howl was unbelieveably loud. Anyone who bucks the money making system is simply dead meat and government goes on its way undisturbed.