Healthcare II
17/7/12 00:52![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
root-fu.livejournal.com posting in ![[community profile]](https://www.dreamwidth.org/img/silk/identity/community.png){kind=small}
talkpolitics....
Introduction
Unfortunately for us(unfortunately, unfortunately, unfortunately * 1,000,000100), the approach taken by mainstream media in describing health insurance & healthcare is unscientific, offering little in explanatory or informational power. Suffice it to say the best the media, political pundits, analysts and experts manage is the equivalent of saying: "HEALTH INSURANCE/HEALTHCARE IS THE DEVIL".
This illustrates the phenomena well(substitute little girls for health insurers -- health insurance is the dev1l!):
In this era of technology and advancement, a common attempt offered to explain political issues is to define them within oversimplified, blanket based, god of the gaps theories.
1. We can't explain precisely how life arose from inorganic matter, therefore: God must have done it.
2. We can't explain precisely how or why american healthcare is expensive & unaffordable, therefore: health insurance, capitalism, inflation, el nino, HAARP, President Bush or the Illuminati did it.
It would appear our standards of journalism, information and analysis on key political topics and mainstream consciousness, which affect the lives and standard of living for millions, haven't evolved or progressed beyond known logical fallacies.
This implicates similar sentiments and views the media propagates in an effort to influence public opinion. Within the span of the last few years, we've seen the media demonize capitalism(CAPITALISM IS THE DEVIL), Reagan(REAGAN IS THE DEVIL), free markets(FREE MARKETS = DEVIL) and a myriad of other things with no real explantion offered as to why or how these people and things should be criticized or considered blameworthy.
If posed the question: "why is health insurance bad" the best responses given typically represent orders of magnitude of circular logic, urban myths and out-of-context arguments such as: "health insurance & capitalism are bad because they have profits". Almost as if Kim Jong, Chavez and Fidel Castro didn't profit handsomely from socialism or capitalism is exclusively the only systemic format which may imply financial gain.
Obama and his politicized band of cohorts arrive on the scene claiming to be virginal crusaders baptized in the blood of health insurance gremlins they've slain through the power of ethical government legislation. Many view them as saviors sent by a higher power to deliver us from anonymous healthcare bogeymen who hide beneath our beds as we slumber.
But, who are these faceless, evil, healthcare shadowmen who ruin healthcare for us all? What are their names--identities, motivations? Can I send them a postcard? A letter telling them I disagree with how they do things? In a world where journalists can figure out which golf club Tiger Wood's wife used to batter his SUV within 24 hours of it occurring, there appears extremely non-existent standards of awareness and accurate information on topics that are important.
In a sense, healthcare reform is like the Iraq War where the media sensationalized the urban myth of Saddam Hussein possessing weapons of mass destruction. There was no evidence for it, but everyone believed it, and fell for it anyway.
Richard Dawkins once said the problem with accepting vague and ambiguous answers to questions is it offers no explanatory power & does nothing to increase our understanding of things. Indeed, what could be more vague & ambiguous than pinning high healthcare costs on capitalism or health insurance? We may as well blame socialism & atheism for the fall of the Soviet Union as its economy was socialized and Mikhail Gorbachev (atheist) was in charge when it occurred.
Blaming capitalism or health insurance is too vague and ambiguous an answer to enhance our understanding of the healthcare issue. Neither educate us nor empower people to make rational decisions in terms of supporting the right policy. In this they're unscientific and represent media driven god of the gaps theories whereby no real attempt is made to provide real supporting evidence.
Thankfully for us, there may be a simple explanation.
A different perspective
Health insurance operates under many of the fundamental principles car insurance and other assorted forms of insurance are affected by. Cost is dependent upon how often claims are made and derived from the number of individual cases / costs.
In simplest terms:
-Say there are 100 car accidents in 2009.
-If there are 200 car accidents in 2010. (Insurance premiums rise)
-And there are 100 car accidents in 2011. (Insurance premiums decrease)
If the number of incidents rises, insurance premiums rise. If the opposite occurs, premiums fall. The most fundamental and simple method of decreasing insurance costs is to decrease the number of cases in which insurance is required.
Businesses recognize this principle. Hence many introduce incentives programs to decrease the number of work related injuries which occur. Its a tried and proven method of reducing healthcare and insurance costs.
On a broader scale, if there are 5 million health insurance claims in 2009. And, 7 million health insurance claims in 2010. And the number of claims generally increases over time -- health insurance costs will rise for everyone. Its not necessarily a result of health insurance companies being greedy, merciless or profit driven. Nor is it a fault of capitalism. Its simply a basic principle of the circumstances upon which insurance functions.
One might surmise the best method of controlling healthcare costs is to reduce the incidents of healthcare being needed. That implies people being healthy, eating food that doesn't inflict negative health conditions and things like cigarettes being regulated in such a way as to make quitting easier. It also implies ethical and moral government regulation by the FDA and similar agencies.
Unfortunately for us, under circumstances where private sector profits conflict with public self interest the government typically prioritizes profits to be of higher importance than the health or well being of its citizens. If the government could regulate nicotine and addictive substances contained in cigarettes to limit how addictive they are -- they wouldn't do it because the tobacco industry has billions of dollars to spend on campaign contributions to prevent the government from cutting their profit margins.
The road to decreasing health insurance isn't socialism or handing control over to the government. It involves americans eating healthier food, having healthy lifestyles and living in such a way as enables them to see a doctor as seldom as possible as a result of their excellent health.
Unfortunately for us, americans typically eat the most unhealthy and harmful food products in the entire civilized world. The FDA is the equivalent of oil platform safety standards. Which basically implies they look in the opposite direction everytime a case arises of wrongdoing by corporate parties. Safety and health corners are cut until we have the equivalent of the deep horizon platform exploding and polluting the health of us all.
Veterinarians recommend not feeding table food to dogs as the additives and preservatives are harmful and will can induce allergic reactions and other negative health ailments upon our pets. Basically, in capitalist america, the food we eat on a regular basis is not good enough for our dogs. But, the FDA deems it good enough for us, which would seem to be a strange precedent.
Non profit healthcare is no better. The term is misleading and doesn't imply what most believe it does.
-Cutting this short-
.........
Enlighten me, o ye of much healthcare knowledge and wisdom.
What are your thoughts on this?
(no subject)
Date: 17/7/12 12:34 (UTC)What we really have is more like prepaid medical care where payments are pooled amongst a group where all pay the same, but some people cost more than others (AKA communism). Efficiencies are gained by having a large number of people in the group so that risk is spread out amongst more people. Unfortunately no group today is large enough to keep medical costs in check, so the best system would be to have the largest group possible (AKA single-payer).
It isn't like we cannot use scientific tradecraft. We have models that other countries use which can be judged for effectiveness. We have unambiguous metrics for the general health of these populations. We certainly have metrics as to the cost of care. When these things are judged objectively, the US has the most inefficient health care delivery system in the developed world.
Then there is the moral perspective. Unless we are ready to treat people as property, saying in essence "You didn't insure yourself, therefore you will die unless you have enough resources to save yourself." Or "Sorry, but your depreciated value is $X therefore we'll cover only $X, you can choose to use it or give it to your heirs." I hope that we as a country find this unacceptable. Given that, we must somehow provide non-optional health care delivery to people regardless of cost, and so far the most efficient way to to that is single-payer. We can all have a say as to what is and isn't optional. That may be socialist but in principle, so is insurance.
(no subject)
Date: 17/7/12 14:11 (UTC)It would seem to me size isn't the key point with pooled funding in terms of efficiency. I would think it involves moreso a proportional figure. In car insurance how effective it is would probably depend on the ratio of those who drive without getting into accidents in proportion to those who are in an accident of some type. It works because costs are distributed evenly enough to be affordable for everyone. But, if there were enough accidents and enough claims it could reach a saturation point where it would no longer function so well in terms of efficiency.
You're completely right that comparing people to material things like cars is a bad comparison. That was not my intent. It was only to show health insurance isn't a unique snowflake or a special case, it operates beneath many of the same fundamental principles other forms of insurance are subject to.
I still question why single payer is considered a good system when republicans were on the verge of cutting social security funding only a few years ago. Even the mayo clinic doesn't accept medicare these days. I tend to associate massive bloat, waste and inefficiency with socialism and government run programs. I think single payer is a bad system for these reasons and more. I guess we'll have to agree to disagree.
(no subject)
Date: 17/7/12 20:31 (UTC)(no subject)
Date: 17/7/12 13:10 (UTC)But, who are these faceless, evil, healthcare shadowmen who ruin healthcare for us all?
Bill McGuire, former CEO of UnitedHealth Group, the largest health insurance company in the nation, for one. He is a bit infamous for backdating stock options. UHG is also rather notorious for jerking doctors around like ragdolls and making them gnash their teeth in rage. That's because UHG fucks people over because they can. They have numerous past and ongoing lawsuits and settlements around payments, coverage and the like. They use monopoly-like power to first-deny most claims, figuring that people won't bother to fight or challenge the decision. They're very good at calculating the odds that a patient will challenge a denial. This is one of the many reasons why they got in trouble.
It appears you really have little, if any, familiarity with healthcare operations in the US. Your questions are so woefully inadequate in the face of the mountain of evidence regarding business practices that are, on the record, in court and in settlement, designed to screw as many people over as possible.
(no subject)
Date: 17/7/12 13:42 (UTC)Their puny 5% profit margins may be too small for them to be a real reason healthcare in the United States is expensive.
-In 2007, the U.S. spent $2.26 trillion on health care source (http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Spending)
-Analysts currently expect UnitedHealth Group to come in with earnings of $1.19 per share on revenues of $27.34 billion source (http://www.foxbusiness.com/markets/2012/07/16/unitedhealth-group-2q-earnings-pregame-scorecard/)
UHG only accounts for near 1% of healthcare spending as of 2007 statistics. I sincerely doubt they're a main cause of healthcare being expensive in the United States & would guess they're a scapegoat.
(no subject)
Date: 17/7/12 19:00 (UTC)(no subject)
Date: 17/7/12 19:06 (UTC)The other one. [:
(no subject)
Date: 17/7/12 13:57 (UTC)(no subject)
Date: 17/7/12 16:18 (UTC)(no subject)
Date: 17/7/12 18:53 (UTC)Evidence?:
http://www.republicreport.org/2012/cell-phone-corruption-bill/
(no subject)
Date: 17/7/12 14:05 (UTC)(no subject)
Date: 17/7/12 15:29 (UTC)I wonder if that's an ironic comment. Hmm.
(no subject)
Date: 17/7/12 15:25 (UTC)David Healy has an interesting perspective on the deterioration of health care in the West. He points to a resurgence in the scientific use of marketing products that have no scientific foundation. In other words, we have a resurgence of snake oil salesfolks masquerading as physicians.
(no subject)
Date: 17/7/12 16:22 (UTC)(no subject)
Date: 17/7/12 16:26 (UTC)(no subject)
Date: 17/7/12 18:16 (UTC)(no subject)
Date: 17/7/12 17:41 (UTC)The government tried to fix healthcare numerous times. Each time they were defeated by lobbyists and campaign contribution funding sources who were able to thwart any attempt made.
Possibly the reason obamacare & the ACA is suspect. If it really did something to fix healthcare it would have been thwarted by those who stand to lose from the bill who have historically shut down any attempt to legitimately fix healthcare.
(no subject)
Date: 17/7/12 20:29 (UTC)How can a news media funded by pharma and insurance plans report on pharma and insurance plans? They cannot. So they report on everything but the source of all ills. They do not report on Pharma Barbies pushing pills (and jacking up the cost of said pills in the process), they do not report on the AMA freezing the number of medical student admissions in the early '70s (http://bradhicks.livejournal.com/432458.html) to restrict the number of practicing doctors, thus reducing the supply and causing each doctor's fees to rise according to the market.
Only a small fraction of media bother to report that insurance plans play hardball to reduce costs, only to see that play rejected by the biggest groups of healthcare providers. As a result, both the insurance and the healthcare providers can charge what they want. A national system of payment would not be evil as you suggest, but it would give the single payer the ability to say No, Thanks to excessive costs without review. It would produce a review system to reject drugs based on lack of efficacy or replication of expired patent. It would give the biggest payer of healthcare the ability to make sure it gets the best return on its money.
Which, of course, is not something you'll ever read or see in the mainstream press, as beholden to those ad dollars as they are.
(no subject)
Date: 17/7/12 20:35 (UTC)(no subject)
Date: 17/7/12 22:24 (UTC)Interesting points on the AMA & healthcare insurance reducing costs. (:
I'm still inclined to believe constructing a healthcare system utilizing the same flawed approach that gave us social security and medicare is an exercise in futility. Actually, that comparison is an insult to those who devised social security in the first place. I believe recent "developments" such as the TSA show the true colors of those we trust too much with our futures. There is no real difference between a government sanctioned monopoly and a monopoly propped up by the private sector. Just as there may be no difference between socialised government based monopolies and free markets without regulation. They're all background stage props from the theatre of the absurd presenting an illusion of choice.
Maybe, if healthcare reform was passed in the 1940's or 1980's by politicians who were vaguely competent we might have a chance. The government of today is a recursive cycle of fail. Its inevitable and only a question of when.
(no subject)
Date: 17/7/12 23:39 (UTC)You can decide whether or not any given government aim is likely to fail or not. I'm agnostic, meaning results driven. I do know the private, inadequately regulated clusterfuck we have now is unacceptable. If they don't lower their costs, it's high time to lower them for them. I am more than willing to prune those excesses, by intervention if necessary, even if it means destroying the existing paradigm in the process.
Angry don't begin to describe me.
(no subject)
Date: 17/7/12 20:30 (UTC)This is only partially true, and that's part of the problem. Health insurance currently is more like a third-party paying your bill than it is like actual insurance. It's this hybrid system we have that's taking the worst of both and putting them together.
(no subject)
Date: 17/7/12 22:30 (UTC)(no subject)
Date: 18/7/12 20:10 (UTC)(no subject)
Date: 18/7/12 20:42 (UTC)Pooled funds operate similarly.
Disprove if you can.
(no subject)
Date: 29/7/12 07:46 (UTC)Insurance is a protection against a large event that shouldn't happen very often. It's gambling that you won't ever need to use it.
Medical insurance currently is mostly a third-party payment scheme, not insurance. Going to the doctor regularly is not a large event and shouldn't be a part of insurance. Our system is a hybrid thing that takes the worst of two different things and puts them together.
A mutual fund is a pooled fund that does not operate similarly to health insurance or car insurance. You're using a stupid method of comparison.
(no subject)
Date: 17/7/12 23:09 (UTC)First, what the healthcare system is--as it exists now and in the past--is a collection of well-educated people about human anatomy & physiology, behavior (sort of), and medical treatment in combination with the materials and equipment needed to treat some proportion of the medical problems people have. This means there are two functions embedded in that system--information and treatment. Healthcare visits that are primarily to access information and prevent or correct problems are more likely to be cost effective in the long run. Healthcare visits required because of a medical condition--acute (suddenly, like a car accident) or chronic (like people who keep smoking and get lung cancer)--are the costly ones in term of time, needed supplies, needed facilities, etc.
So, an effective 15 minute visit with an MD or other professional that results in improved or non-worsening health is going to be cheaper--in the long run--than an ER and surgical visit from something preventable.
So, it helps if you make a differentiation.
In addition to that, a population that doesn't follow medical advice, doesn't understand it enough to follow the instructions involved, doesn't respect or seek the expertise available to them are also more likely to have more treatment visits than advice visits. Also, people who are older typically have had more time to "accumulate" health issues requiring medical care. This may also require more visits overall.
Second, many people seem to be clueless about a couple of things. First, many people have a very, very hard time understanding the intent of and valuing the opinions and decisions of other people based on how they perceive them. This means anyone "not like them" has to have bad intentions, whether or not this is true. So, when it comes to things like medical or healthcare advice, it's often very hard to get people without a personal relationship being involved to make changes in the way they do things and/or think to improve healthcare. Basically, like liberals and conservatives, if it's not MY way, it's wrong, even if it might prevent a heart attack at 45 years old, because I don't understand it.
That's one reason why you have a hard time changing what people eat with another being the sunk cost effect of investing in things like white bread made of bleached white flower, some of the vegan diets that will probably result in osteoporosis very early, and some of the dependence on meats that have been biologically altered over thousands of years toward higher contents of some forms of fats. It's not familiar and I don't think the person telling me to change has my best interests at heart.
Finally, most people lack either the ability or the willingness (or both) to understand complex, interactive systems like healthcare. It's a major reason you get the tendency to "fill in the blank" with strange, vague answers. And that's simply because most things involving a large number of agents (decision makers) tend not to follow the simplistic rules people expect and may actually act in ways that confuse people when they cooperate while being mildly antagonistic, become opportunistic to rule changes, or simply stop playing by the same rules. There's a whole area of science called "complexity science" around these principles and the underlying physical and other laws that drive them.
Even people who are otherwise intelligent and maybe even educated in certain areas fall prey toward trying to apply simple laws to complex systems and not understanding why what is realized--especially in economics and politics--doesn't fit what they expect.
So, in the healthcare system that's a hybrid of economics, politics, physical world, and human health and behavior, there's always going to be some facet that's going to be misunderstood, less understood, etc.
Anyway, my two cents' worth.
(no subject)
Date: 17/7/12 23:10 (UTC)Why?
Because they would be one bad election and a Republican majority from the US government defunding abortion, birth control, family planning assistance, required immunization, and a lot of other "nice to have" supported healthcare policies that would then become either out-of-pocket expenses (in addition to paying for healthcare) for people or outright unavailable depending on how dependent the medical system is on the single payer payment system.
I mean, it could go the other way as well, but I'm not sure there's anything the Democrats could take from the system the Republican policies depend on.
(no subject)
Date: 18/7/12 00:25 (UTC)(no subject)
Date: 18/7/12 19:53 (UTC)The media says health insurance is the devil. Very few have the capacity to think independently to question that view.
In this, yes, what I said about many being indoctrinated into beleiving something much like adam sandler was indoctrinated into believing certain things in the waterboy holds true.
I know all about Israel and its planned economy & communist depotism. None of what you said holds true.