S & P and the S&P and then there's just P
Geez, here we go.
The Congress of the United States, specifically the House of representatives and more to the point the wicked witch of the west, Nancy Pelosi, have announced a sweeping, ten year plan to overhaul the health care system in our country.
It needs it.
I just don't trust Nancy & Co to be the ones to come up with a plan.
That is my opinion. Period.
((( I just erased a paragraph that compared the House of Representatives to the Marx Brothers, but it shamed me, as the Marx Brothers had finesse, timing, and knew their limitations. Even Zeppo. ))).
Don't get me wrong, I am not a fan of the health care industry, and if ever there was a den of thieves outside of Chicago or Wall Street, it is them, but this is not the outfit to take them on, and this is not the way to do it. Leadership builds a consensus, first among the base, then among the moderates, then the pragmatists, then they face the antagonists.
The Pelosi method is something different, and it won't work, and, at best, it will set the idea back another fifteen years, or, at worse, kill it altogether.
I want to know how the financial markets, (another den of thieves) will react to this. They need do nothing at all to have enormous impact on this initiative, their timing will be key.
And I wonder if this will take away air time from Sarah Palin, or give her a big issue to trip over.
We are going to hear a lot of the "S" word for a while, get used to it. As a political system, it is not so hot, but keep in mind that we all drive on a socialist road system, drink from a socialist water network, blab and download porn and music files on a socialist internet, (tho that is changing, much like health care). It is a matter of degree, and how evil "socialization" is seems to be proportional to how potentially profitable it is for some middleman who really has no skin in the game. In most cases, it is a matter of degree.
My money is that by noon tomorrow, eastern time, we will see a headline regarding Ms Palin's opinion on the decline of the healthcare system under the current administration.
Just a guess.
posted by eccentric recluse at 5:29 PM
17 Comments:
"Leadership builds a consensus, first among the base, then among the moderates, then the pragmatists, then they face the antagonists. "
That's one of the best lines I've seen in the blogosphere. It makes too much sense to apply to the real world, though.
As a pragmatist.. I see it pretty straight-forward. Health-care is a combination of goods, and services. These have costs. You can't just legislate that everybody gets goods and services. That's reality.
The best a government can do in this arena, is to regulate (make sure doctors and medical suppliers are competent), and then, when needed; try to keep the market friendly (or un-friendly) as needed... through incentives and taxes (and tax-breaks). The very instant when a government starts promising goods and services, is when it falls apart. Medicare/Medicade, are evidence of this. Those programs alone will swallow up the federal budget, and are forcing care-givers out of the business.
A more accurate "socialized" comparison than highways; would be cars, and car repairs. Highways are the "regulated" foundation. Cars, and car maitainence are the goods-n-services. Cars, much like health-care; are an expensive necessity. Should the government do even MORE wealth redistribution.. see to it that we ALL have safe, well maintained cars ? Just what do you think that would do to the quality, cost and availability of cars ? We've seen what it does to health-care in other countries.
No thanks !
Call me what you will.. but the idea that a high school dropout, in/out of jail.. fathering children he cannot afford, getting free heal-care... while the 70 year-old man, who worked hard all his life, is told he's too old for a new hip,, makes me ill. And that WILL happen under universal health care.
It sounds like your approach to running health care would be to treat it as a corporation would treat it. Incentives and various internal "programs" that "nudge" the effect toward where you want it to be. It's all in the numbers, in other words. An excellent way to run a corporation if you want it to make money. The very "best" corporations run that way. (Trust me.) That some customers fall through the cracks is of no concern in this case, because it is cheaper, like the Pinto gas tanks, to leave them be and handle the lawsuits as they may or may not come in.
Therefore, you can see, the "universal" in Universal Health Care is an idea that no self-respecting corporation wants to entertain, and will fight to the limits of whatever set of laws they helped put into place, because it is "bad business."
And the reality is that they will help put those laws into place, which makes them, in effect, "self-regulated." Not something I want to bet my health and well-being on, because I have seen how efficient and ruthless corporations have become.
@Roy .. I can't argue about much of what you've said. It's plenty pragmatic. We really don't disagree much. It's pretty much a choice of tolerating the evils that come with either a government calling the shots; or a company calling the shots. Both are full of problems. BUT it still boils down to the reality that it's goods-n-services. You cannot just sign 1,000 page piece of legislation and "poof" everybody gets'em... and believe that quality and selection survive.
There is no perfect way out of this. And with all the problems we have currently, it's not bad enough to scrap it all, and jump to the socialized medicine.
Remember, the vast majority of Americans DO have ready access to good care. Considering that we know what will happen if the feds get to control it all (consistent world-wide evidence).. the absolute BEST we could hope for; would be trading away the "badness" that a minority of the people don't have ready access, for the "badness" of EVERYONE having to deal with a Euro-Canadian system (I'll pass).
There just is no perfect system in a real world, that will see to it that everyone gets every good and service that they need. The current system needs fixing, no doubt. But the aim for reform should be addressing the high cost of health care.. NOT addressing how to pay for it. If that becomes the government's job, we're all screwed.
Your very life depends absolutely on getting something delivered timely. PostOffice, or FedEx ?
Agreed, Anon. It seems to be such an incredibly complex problem that it's hard to imagine either side surpassing the other in terms of amassing mountains of evidence, anecdotal or otherwise, to provide rationale for support.
And then the reality is probably that the status quo could never be dismantled and replaced without grievous damage to citizens who rely on health care of any sort.
It might be more productive if we give up the comparisons (there are so many on either side of the argument as to cancel each other out) and invent the health care system we need given what we already have in place and what we want it to accomplish, i.e. our definition of universal health care.
Wow.
I go on one little drunken bender and I miss a discussion getting started.
One of the things that pops right out here is that there needs to be some standardization and agreement on terms. "Universal" is one of them.
The anecdotes about the criminal/lowlife element and 'free' health care need to be reigned in just a bit as well. There are inequities right now, and there will be forever. Run from the person or party that promises perfection, or tries to shoot down any idea that is not 100% perfect.
Some who know me already know that what I want to see first, in any reform, is some transparency.
Anon mentioned regulation of providers and suppliers. Noteworthy in their absence is the industry that has attached itself to the providers and sucks up as much as 30% of the health care dollar without providing anything more than bureaucracy and rejection notices.
Some government programs, ( Medicare/Medicaid) run pretty well, (remember that lowlife getting free health care?), on about an 8% margin. The 'private industry' average is between 35 and 40%.
There are some rather arcane rules and legalese that 'private industry' imposes on their clients as well, such as a number of different pay and fee schedules, that seem to change from day to day and depending on how close a patient is to actual eligibility for coverage.
Those are just a couple of areas that could use some reform, and don't think for a minute that any change in those minor areas will not take a major political effort, if not a special appearance by the Almighty.
The element most lacking in this, and a lot of other areas is trust and good faith, and that observation does not apply just to big business or government.
I said before that I do not have a great deal of confidence in this Congress to effect meaningful change, but they can even the playing field a little, and give the other side a bit of bargaining power.
I may be wrong, wouldn't be the first time, but what we are seeing in this and other arenas is a slow burning revolution.
If this doesn't work, sooner or later, some hothead, on either side of the line, will ratchet things up another notch.
How's that for a hangover talkin?
That's right--you just got back from distillery country! I sense your taste in liquid refreshments is tainting your outlook on any health care solution that involves rev'noors.
*Laughing* Hangovers can be a little "truth serum-ish".. They take away some of the mental energy needed to formulate deceptions..
ANYway, back to fundementals here. I hate to be redundant, but you gotta take emotion out of it. It's not only goods-n-services... It's high-tech goods, and services rendered by highly-trained professionals; passionate about what they do (passion driven in no small part by the prestige and wealth associated with being a doctor).
What everyone seems to not want to talk about; is the overall morale of these professionals. You have to believe that the very debate we're having, will drive good, young minds down other career paths. If I had a 20 year-old child, I'd be reluctant to encourage him to go 1/4-million dollars into debt en-route to a medical degree; pending socialized medicine. Same dilema for those aspiring to pharmecutical R&D.
What will we do about the inevitable doctor-shortage ? Draft young people and "intern" them. literally ? " Yoo vill be zee doctor, and like it !"
The people able to afford it, will start out by snatching up all the good doctors into private practice.. eventually grabbing them right out of med-schools.. and finally just starting school-to-practice arrangements. That's already happening in Florida. Wealthy retirees in gated communities even have their own clinics.. complete with operating rooms and MRI machines. If you moved to Florida tomorrow.. you'd be lucky to find a patient accepting doc, whose first language is English.
**continued next post**
If this was truly about improving, what's already THE best system on the planet; we'd be focusing on WHY it's so expensive.. NOT, how can we pay for it (i.e.. let the government do it).
Side note on Medicare.. Don't confuse popular, with well-run. Medicare (like any other social program), is great at first. Who can argue with free? Problem is; the very instant you start depending on others for necessities, you set into mmotion a destructive snow-ball. If you need $X from person B; then person B will need MORE than $X from person C (because he's not only not able to fund himself, he's already funding you too).. then person C will need even more than that.. and it just cascades. That (on top of government ineptitude and corruption), is why Medicare is on a path to swallow up the entire federal budget. And why the idea of turning the whole health-care business into one, giant Medicare arrangement, just won't work. But since it WILL be popular at first (free always is), we're seeing this push for it.
If controling costs (all that we really need to do), was what the politicians were striving for.. we'd see common-sense stuff, like Tort reform, and immigration control. Reign in the cost of mal-practice insurance, and take the burden of illegal aliens off the back of the health-care system.. and we'd be 1/2-way to fixing things. When doctors afraid of being sued; send people for every possible test and procedure that can be passed on to an insurance company (or Medicare).. well.. you get the idea.
What we're seeing now, is a LOT more about expanding government size and control... period.
I'll say it one more time. Health-care is a complex, high-tech product. It has to be paid for. The real world doesn't allow for every person getting the same, high-quality product; just because that's the way it "should" be. Universal health-care is as much fantasy, as universal pay-checks. You're only entitled to that which you earn. When you start giving stuff away, it dilutes the whole system, and everyone suffers. We already do a fairly decent job at filling in the humaitarian gaps. And if we focus FIRST on costs, those will get better too. The idea of thrusting EVERYone into a government fix is NOT the answer.
Funny truth re: walking the walk..
I'm about five years from buying 10 rural acres, plopping a log home on it and enjoying the golden years (I'm 50 right now). If universal health care passed tomorrow.. I could retire right now. I wouldn't have to grow up in that system, and will be at a Medicare-type age, before rationing and doc-shortages set in, anyway. In thoery, I should be cheering this thing on.
Just a couple of points. Your description of $X from person B, who will then need MORE from person C, etc., is more a description of the "free enterprise" than of government agencies, isn't it? The current system requires that we provide the stockholders with a constant and, actually, increasing, flow of revenue. This works in the free marketplace because companies come and companies go, some swallow others up, some get eaten . . . but we are talking about a permanent health care system, not a "corporation."
Just a petty gripe about your comment :"but you gotta take emotion out of it." Not fair. Just because I say we have to provide health care for everybody, which may sound emotional to you, that doesn't mean the plan will be flawed because its implementation will be designed by "emotional" (i.e. weak? Irrational?) people. All plans start out with a general idea they will be intended to serve. Some of these ideas, like free speech, for instance, are unreasonable as hell, but we believe them, and we state them out loud and decide to structure our social systems around them, just "because." No?
Hey.. *grin* If it we're simply a matter of right-n-wrong; we wouldn't BE in this situation. And if the solutions were obvious; we wouldn't be debating it...
Again, I think we're agreeing more than disagreeing. The capitalistic, free-market does indeed count on "more from the future". Economic growth IS what it's based on. And as we're seeing, that leaves it vulnerable to a contraction, or even a slowing in growth. And we know that; accept it, and deal with it, and have dealt with it. The GOVERNMENT however, has evolved into an entity that thinks it's immune.. (especially federal). It just keeps growing.. regardless of the economic condition. We've long since passed the point where "it" absorbs 50% of our productivity. Where does it end ? 60% 70% 80% ?
The answer is... it's ending right now. Per earlier posts; it matters not what you think governemt should be to us, and do for us. It simply cannot be more than the free-market is able, and more importantly, willing to support. We've jumped past that point. Even if we all agreed and came at this from the emotional side... if universal health-care pushes the government past what the private-sector will support.. it's on borrowed time.. period. We'll run out of money AND doctors, quickly.
As for the $X, and people A,B,C ... Let's examine something like Medicare. At year 2009, it has turned out to be 15 times as expensive as projected. And here's the funny thing. It hasn't even completed ONE cycle. We all talk like it's some sort of long-established institution, that has always worked pretty well. When in fact, it's not through beta testing, and had solvency issues just a few years into its exsistence. Heck.. the VERY first test-case (person who entered the work-force paying into it.. worked for 40 years.. retired and collected from it until he died at age 85) doesn't exist yet.. and will not for another 16 years ..
Even Social Securtiy itself has just barely gone one cycle.. and has been projectably insolvent for decades. This stuff just doesn't work out, because it cannot work out. That's math, not politics. Cascading dependancy is the OPPOSITE of projected growth, because it's not linear. By definition, it WILL grow faster than the economy, and isn't far from Ponzy scheming.
Where we do disagree, is the comparing of Constitutionl rights, to goods and services. Free speech is a defined right. You're born with it. Health care is a commodity. You have every right to earn and acquire it. That which you cannot acquire (for whatever reason) falls under civil responsibility. That's between the person, and the providers, and charitable entities. The government should indeed provide a bare-minimum foundation (and it does that now), but it cannot see to it that EVERYbody gets EVERYthing that they need. That's an impossible fantasy.
Moral clarification..
I'm not some evil man.. I'd be tickled to see universal health care.. I'd get five or more years of retired life out of it. I'm just facing the fact it isn't possible. And we're wasting energy and resources fighting about it.. and the inevitable UN-doing of whatever gets done by this administration, will be a horrible, additional waste of wealth that we can't spare.
Food for thought...
What effect do you think that depending on future money has had on the cost of health care ?
Isn't it fair to say that the nebulous, open-ended, borrowing from the future to pay for this stuff is indeed a prime cause of increased cost ?
A bigger than realistic pool of money to draw from, most definately pushes costs up.. ESPECIALLY when adminstered by this government.. manned by people who'd gladly damage future generations en-route to re-election.
We probably do agree, mostly. Just thinking out loud. We DO have to decide what's right and what's wrong, and act on it. I always thought so. I feel the same way about ethanol--speaking just of the notion of putting ideas first, solutions next. As long as the use of ethanol somehow winds up adversely effecting the availability of food for, say, lots of people, then we probably should decide not to do that, then figure out another way to power our vehicles. In that example, we may even actually have a chance of finding a moral solution that won't upset long-standing, traditional enterprises and "hurt the economy." It also has the advantage of being a relatively simple, straightforward idea: try not to starve people to death. But, possibly, same principle at work.
I'm sure you're not an evil man, but that statement tells me you felt a need to say it. Why's that? Just how difficult does something have to be before you throw any idea of morality out in order to solve the problem?
Well, anyway, I realize that's not exactly what we were talking about. . .
Good discussion here.
My beef with reform is that there is no clear notion of what we are trying to reform, and no clear idea of what the goal is.
I put forth a proposition earlier that there needs to be a consensus, a clearing of the air so that whatever we fight, argue and debate about is really what we fight, argue and debate about. (That is enough to make the Rush Limbaugh's of the world cry...).
If I were doing this, I would start first with the regulation of the industry. I would make the insurance trade a bit less profitable by making it a lot more transparent at its most basic level, and regulate eligibility for coverage and payment rules. These are contracts, not something to be manipulated and pulled back like a six dollar lure durng trout season.
See how that works and what savings and efficiencies can be introduced into the system, and build from there.
I would avoid any over reaching, such as what we see on both sides of the argument, I would avoid the over dramatization of the issue and keep things as down-to-earth and as simple as possible.
But that's just me.
Thanks for dropping by.
Yeah.. not exactly.. but it's an honest exchange, even if we get side-tracked.. which puts it heads-n-shoulders above the debate twixt ideological, talking heads.
I "need" to proclaim my decency.. because of those talkers. Not unlike the politician who'll sell the next generation out, keeping his power.. there are ideologues who really don't care, and don't mind keeping THEIR health-care, even at the expense of others. I'm just trying to be realistic; not incompassionate.
IDEALLY, we'd have had the foresight to have never let health-care fall under the idea of something insured. If you think about it.. it's as goofy as food insurance. Pay a monthly premium, and then just go to the store and fill your cart. It wouldn't matter if that store were run privately, or by the government.. it would end up costing us MUCH more to eat than it does now. And if it were government run.. we'd quickly end up where we'd borrow from our children's future, keeping it stocked with good food. Not to mention that "consumerism" would die. What motivation is there for food suppliers to innovate and compete, if everything is sold/bought/paid-for, before it hits the shelf ?
I spent most of my adult life in the car biz. I saw the difference between consumer repairs and insured (warranty) repairs. Mechanics and supervisors run the VIN on every car that comes in, to see if there is ANY warranty work that "could" be done. I'm also old enough to see what happened to collision repair costs, after government mandated insurance took over. The dented fender that once cost $250 to repair and repaint; became a $750 repair.. almost overnight.
There is no mandated solution to this health-care stuff. ESPECIALLY government mandates. We gotta let natural market forces work. Like ER said... beware and run from the person who claims to have a 100% solution. The best we can do, is to TRY to slowly return heal-care to a consumer-driven thing. Limit insurance (gov or private) to catastrophic illness. Sure, there will be pain during transitions.. but it'll be less painful than letting what's pretty much the driving force behind these problems, be the solution.. i.e. the government.
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