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The PPACA - Implementation Phase I

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  • Re: The PPACA - Implementation Phase I

    Much of the discussion here reminds me of the endless quest to perfect a perpetual motion machine: everyone has a great idea how, in a frictionless world with no entropy, to invent a machine that, once started, would continue to run forever on its own momentum.

    That's a weak analogy I suppose, but still, people keep trying to devise a clever way to circumvent a basic fact of life that will never go away no matter how much you wish it would:

    There is always rationing of one kind or another.

    That's a way to paraphrase economics 101, the most basic rule of economics that always holds true in all circumstances: what people want always exceeds what people can afford (i.e., unlimited wants must deal with limited resources).

    If you don't ration by price, you ration by time (waiting in line, waiting to be seen), or you ration by quality (St. Clown has some excellent posts on this point).

    There is no possible way to give everyone everything they want, no matter what "system" you devise.




    It is the refusal of progressive leaders to accept this reality that continues to make a mess of the system: every intervention, no doubt with the "best of intentions," necessarily and inevitably will have a side effect that was unexpected that will subvert the desired outcome.

    Only after you accept that choices must be made somehow, and then focus the conversation on who will make those choices, and how those choices will be made, can you begin to make progress.

    I like Scooby's idea the best: open it up to true competition. We need continued innovation to keep costs down; a one-payor system removes that incentive.



    (a medical devices tax? seriously? what were they thinking??)
    Last edited by FreshFish; 08-27-2013, 01:16 PM.
    "Hope is a good thing; maybe the best of things."

    "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

    "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

    "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

    Comment


    • Originally posted by FreshFish View Post
      Much of the discussion here reminds me of the endless quest to perfect a perpetual motion machine: everyone has a great idea how, in a frictionless world with no entropy, to invent a machine that, once started, would continue to run forever on its own momentum.

      That's a weak analogy I suppose, but still, people keep trying to devise a clever way to circumvent a basic fact of life that will never go away no matter how much you wish it would:

      There is always rationing of one kind or another.

      That's a way to paraphrase economics 101, the most basic rule of economics that always holds true in all circumstances: what people want always exceeds what people can afford (i.e., unlimited wants must deal with limited resources).

      If you don't ration by price, you ration by time (waiting in line, waiting to be seen), or you ration by quality (St. Clown has some excellent posts on this point).

      There is no possible way to give everyone everything they want, no matter what "system" you devise.




      It is the refusal of progressive leaders to accept this reality that continues to make a mess of the system: every intervention, no doubt with the "best of intentions," necessarily and inevitably will have a side effect that was unexpected that will subvert the desired outcome.

      Only after you accept that choices must be made somehow, and then focus the conversation on who will make those choices, and how those choices will be made, can you begin to make progress.

      I like Scooby's idea the best: open it up to true competition. We need continued innovation to keep costs down; a one-payor system removes that incentive.



      (a medical devices tax? seriously? what were they thinking??)
      Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it. Clearly rich people are more deserving.

      Also, how do you explain the fact that we currently pay more for worse care than most single payor or otherwise universal care countries?

      Comment


      • Re: The PPACA - Implementation Phase I

        After a lot of thought, I'm fully on board with the Republican plan: Don't get sick.

        The only thing I own of value is my cemetery plot so I may as well start using it. If we adopt the GOP plan today, I may be able to get in before the ground freezes.

        Comment


        • Re: The PPACA - Implementation Phase I

          Originally posted by unofan View Post
          Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it. Clearly rich people are more deserving.

          Also, how do you explain the fact that we currently pay more for worse care than most single payor or otherwise universal care countries?
          Do we? I honestly don't know. Just because the "retail price" of a procedure is $1000 in the US and $500 in the UK does not necessarily mean that we are (collectively) paying more for care. How many people are paying full fare in the US and how many are subsidized by virtue of the fact that hospitals can't refuse care, or have the price negotiated down by their insurer? If you just look at averages, well, the average price per person for care in the US is significantly higher, too, but averages can be driven by outliers. Make no mistake - the US *does* have the best advanced care in the world; rich people from all over (including the US itself) flock to the US to pay for the best treatment that money can buy. Those high-priced "concierge" services drive up the total spending on care, while doing diddly for the health of the general population, so it looks like we're spending willy-nilly without getting results.

          The US also spends significantly more on medical research than the rest of the world, who just comes along and manufactures generic versions of our drugs and learn our procedures rather than paying to develop their own. Would the rest of the world be able to spend so little if the US didn't spend so much?
          If you don't change the world today, how can it be any better tomorrow?

          Comment


          • Re: The PPACA - Implementation Phase I

            Originally posted by unofan View Post
            Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it. Clearly rich people are more deserving.
            Why stop at health care? Pretty clear people's life expectancy can be adversely affected based upon the quality/quantity of the food they can afford to eat, the quality of the water supply to keep them hydrated, the neighborhood in which they live, the safety features of the car they drive, etc...

            I think we should all get the best of everything.
            That community is already in the process of dissolution where each man begins to eye his neighbor as a possible enemy, where non-conformity with the accepted creed, political as well as religious, is a mark of disaffection; where denunciation, without specification or backing, takes the place of evidence; where orthodoxy chokes freedom of dissent; where faith in the eventual supremacy of reason has become so timid that we dare not enter our convictions in the open lists, to win or lose.

            Comment


            • Re: The PPACA - Implementation Phase I

              Originally posted by SJHovey View Post
              Why stop at health care? Pretty clear people's life expectancy can be adversely affected based upon the quality/quantity of the food they can afford to eat, the quality of the water supply to keep them hydrated, the neighborhood in which they live, the safety features of the car they drive, etc...

              I think we should all get the best of everything.
              Didn't they try that in the Eastern Bloc? Though they still had the haves and have nots.
              CCT '77 & '78
              4 kids
              5 grandsons (BCA 7/09, CJA 5/14, JDL 8/14, JFL 6/16, PJL 7/18)
              1 granddaughter (EML 4/18)

              ”Any society that would give up a little liberty to gain a little security will deserve neither and lose both.”
              - Benjamin Franklin

              Banned from the St. Lawrence University Facebook page - March 2016 (But I got better).

              I want to live forever. So far, so good.

              Comment


              • Re: The PPACA - Implementation Phase I

                Originally posted by unofun View Post
                Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it.
                This is perhaps one of the most ignorant, off-topic, useless bovine fecal matter comments you've ever made. It is totally non-responsive to the problem posed in the initial post: almost no one, not even "rich" people, can afford many of these procedures on their own. That is the reason why people band together to pool their resources. You seem to favor mandatory confiscation as your preferred method of pooling resources, yet never once have you ever offered a single justification for why it is supposed to work, especially given that the people doing the confiscating generally prove themselves to be incompetent and corrupt.

                So easy to try to tear down other people, let's you avoid any responsibility for anything, eh?

                Good intentions are worthless in this realm, unless they lead to salutory results. I've yet to see any proof whatsoever that good intentions are sufficient to produce good results, ever.
                "Hope is a good thing; maybe the best of things."

                "Beer is a sign that God loves us and wants us to be happy." -- Benjamin Franklin

                "Being Irish, he had an abiding sense of tragedy, which sustained him through temporary periods of joy." -- W. B. Yeats

                "People generally are most impatient with those flaws in others about which they are most ashamed of in themselves." - folk wisdom

                Comment


                • Re: The PPACA - Implementation Phase I

                  Originally posted by LynahFan View Post
                  Do we? I honestly don't know. Just because the "retail price" of a procedure is $1000 in the US and $500 in the UK does not necessarily mean that we are (collectively) paying more for care. How many people are paying full fare in the US and how many are subsidized by virtue of the fact that hospitals can't refuse care, or have the price negotiated down by their insurer? If you just look at averages, well, the average price per person for care in the US is significantly higher, too, but averages can be driven by outliers. Make no mistake - the US *does* have the best advanced care in the world; rich people from all over (including the US itself) flock to the US to pay for the best treatment that money can buy. Those high-priced "concierge" services drive up the total spending on care, while doing diddly for the health of the general population, so it looks like we're spending willy-nilly without getting results.

                  The US also spends significantly more on medical research than the rest of the world, who just comes along and manufactures generic versions of our drugs and learn our procedures rather than paying to develop their own. Would the rest of the world be able to spend so little if the US didn't spend so much?
                  I really hate to have to agree totally with a Cornell guy-but this post is just right on the mark. Add this to what you say-it is impossible to compare medical care here either in effectiveness or cost due to the fact that we have an entirely different population mix. To even try to compare to Japan, Sweden, Norway, etc. is absurd. As you indicate-if the medicare care is so great everywhere else, why do the wealthy in those countries and all the big shot politcos come here for the important aspects of their care?
                  Take the shortest distance to the puck and arrive in ill humor

                  Comment


                  • Re: The PPACA - Implementation Phase I

                    Originally posted by unofan View Post
                    Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it. Clearly rich people are more deserving.

                    Also, how do you explain the fact that we currently pay more for worse care than most single payor or otherwise universal care countries?
                    Catastrophic coverage insurance would be relatively cheap. A big contributor to the cost of health insurance currently (and health care in general) is that our policies are required to cover everything under the sun. Insurance used to be something you'd use to cover a big surgical event or you end up in the hospital because of 15 broken bones or something. By law we've required 3rd party payers into every aspect of health care and therefore causing everyone to order up a full suite of tests, looking for the most arcane illness, when just a single basic test would cover 95% of what the ailment could be. After all, why not? I'm not paying for the test today.
                    "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." George Orwell, 1984

                    "One does not simply walk into Mordor. Its Black Gates are guarded by more than just Orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume." Boromir

                    "Good news! We have a delivery." Professor Farnsworth

                    Comment


                    • Re: The PPACA - Implementation Phase I

                      Originally posted by DrDemento View Post
                      I really hate to have to agree totally with a Cornell guy-but this post is just right on the mark. Add this to what you say-it is impossible to compare medical care here either in effectiveness or cost due to the fact that we have an entirely different population mix. To even try to compare to Japan, Sweden, Norway, etc. is absurd. As you indicate-if the medicare care is so great everywhere else, why do the wealthy in those countries and all the big shot politcos come here for the important aspects of their care?
                      Does anyone remember when it was that the Japanese officially recognized that their people could even be afflicted with cancer? I forget when that was, but I know it was within my lifetime. It might have been only 20 years ago. That's an excellent way to cut down on medical costs - simply ignore that you can get the disease in the first place!
                      "The party told you to reject the evidence of your eyes and ears. It was their final, most essential command." George Orwell, 1984

                      "One does not simply walk into Mordor. Its Black Gates are guarded by more than just Orcs. There is evil there that does not sleep, and the Great Eye is ever watchful. It is a barren wasteland, riddled with fire and ash and dust, the very air you breathe is a poisonous fume." Boromir

                      "Good news! We have a delivery." Professor Farnsworth

                      Comment


                      • Re: The PPACA - Implementation Phase I

                        Originally posted by unofan View Post
                        Yeah, fark poor people. Why should they get a life saving procedure if they can't afford it. Clearly rich people are more deserving.

                        Also, how do you explain the fact that we currently pay more for worse care than most single payor or otherwise universal care countries?
                        Move to Vermont. They have single payer there. Along with a way for you to pay if you wish. Don't force it upon the other 49 states, though.

                        Comment


                        • Re: The PPACA - Implementation Phase I

                          Originally posted by FlagDUDE08 View Post
                          Move to Vermont. They have single payer there. Along with a way for you to pay if you wish. Don't force it upon the other 49 states, though.
                          Why force him to move to Vermont?

                          Comment


                          • Originally posted by Priceless View Post
                            Why force him to move to Vermont?
                            I'm guessing he's trying to be clever and create his own version of the "move to Somalia" line. I've seen him do better; that gets about a 2/10 from the judges.
                            Last edited by unofan; 08-27-2013, 04:54 PM.

                            Comment


                            • Re: The PPACA - Implementation Phase I

                              Originally posted by unofan View Post
                              I'm guessing that's his version of the "move to Somalia" line.
                              The problem with that is we live in a Republic (not a Democracy like almost everyone assumes). The idea is that you can hear about an idea someplace else and NOT have to move there to enjoy it. You can tell your friends and neighbors about this great idea, then they can tell their friends and neighbors and so on....Someone might even contact their Local or Congressional representative and it becomes a bill...then...well, I'll let Schoolhouse Rock explain from there...



                              However, if you tell your friends and neighbors and they think it is a horrible idea (like mandating everyone should have a Jump to Conclusions mat) then the idea dies.
                              Last edited by Priceless; 08-27-2013, 05:00 PM.

                              Comment


                              • Re: The PPACA - Implementation Phase I

                                Originally posted by Priceless View Post
                                The problem with that is we live in a Republic (not a Democracy like almost everyone assumes). The idea is that you can hear about an idea someplace else and NOT have to move there to enjoy it. You can tell your friends and neighbors about this great idea, then they can tell their friends and neighbors and so on....Someone might even contact their Local or Congressional representative and it becomes a bill...then...well, I'll let Schoolhouse Rock explain from there...



                                However, if you tell your friends and neighbors and they think it is a horrible idea (like mandating everyone should have a Jump to Conclusions mat) then the idea dies.
                                I thought a democracy was when your friends and neighbors think an idea is horrible, it dies (the tyranny of the majority) but a republic is when your friends and neighbors think it's a horrible idea, but it still passes because it's best for everyone, not just your friends and neighbors.
                                That community is already in the process of dissolution where each man begins to eye his neighbor as a possible enemy, where non-conformity with the accepted creed, political as well as religious, is a mark of disaffection; where denunciation, without specification or backing, takes the place of evidence; where orthodoxy chokes freedom of dissent; where faith in the eventual supremacy of reason has become so timid that we dare not enter our convictions in the open lists, to win or lose.

                                Comment

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