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Valkenar
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Post by Valkenar »

Bill Glasheen wrote: However that doesn't mean you compete to the extent that you deliver excellence in every measurable dimension - including service to their customers.
Oh man that's a riot. Are you implying that corporations do this? Seriously, have you looked at the behavior of the leading businesses in *numerous* areas? Are you telling me that Microsoft is delivering excellence in every measurable dimension? Cell phone companies? Home contractors? If that's your experience of reality then please let me into your plane of reality. As far as I can tell, most businesses focus on a few areas, give a bare minimum of customer service, and prosper because people care about price above all else once they have something that is minimally adequate. A far, far cry from the ideal of "deliver excellence in every measurable dimension "

Basic market forces at work.

Not to say that there aren't businesses doing it differently, and sometimes they do well. Google consistently delivers quality, so does newegg.com, Motorola and it's summation-based philosophy, are counterexamples. Still, the implication that corporations are necessarily interested in providing all-around excellence is pretty obviously wrong.
Minimize insurance mandates so that more "bare-boned" policies could be made available.
So what do you propose to do when it turns out that healthcare consumers are like all others and will buy the cheapest thing they see? You either need to decide that you don't care about people being ruined for life because of this particular poor choice, or you need some other option. For me, fixing the problem of financial ruin due to medical costs is part of the basic goal here. Costs may go down overall in a more efficient system, but you'll still have lots of people with bare-bones plans who really need a break-bones plan (not covered by the yearly-checkup and antibiotics plan).
Tort reform.
What would you do here? If a doctor makes a *preventable* mistake and a patient is left debilitated, what should happen? I mean we can look from a purely pragmatic view and try to make sure it doesn't happen next time, but that doesn't do the victim any good. Unfortunately, money is the only way we have of balancing things out. If there were a way to say, transfer the culprit's ability to walk over to the victim, that might be better. As it is, the best we can do is say "Well, being crippled, that s ucks a lot, so here's a few million from the person who crippled you"

And if you're talking about dealing with suits in cases of unpreventable mistakes, what is it you would do differently? As I understand it, those cases don't win awards anyway, though they may result in a settlement.
Standardize electronic health records so that health information can be exchanged more freely between entities.
I am generally in favor of this, but I hope you like having your records hacked. Unless you're talking about a secondary computer network, but then we're talking many billions to set that up. Is this billions part of "all costs"? Here's the unpleasant truth about computer security: it is impossible. Just like total home security is impossible.
Most health-care should cost the individual something.
How do you define "something" in a meaningful way. What is a "something" that can be applied to a single mother working at MacDonald's, but also a single tech worker making 100k?
Poor lifestyle choices should cost you.
Good idea. Now what about the fact that the poor make disproportionately more poor lifestyle choices? Sometimes that's by necessity... in this country it's expensive to eat healthy and super cheap to eat poorly. Really educating people about these thing sis a hard, expensive problem. And if you don't, then you're penalizing people who already probably can only afford the bare-bones service, which doesn't really cover what you need. Also, at what point do these penalties kick in? A lot of people now are growing up obese. At what point do you transfer the responsibility from child to parent?
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Post by Bill Glasheen »

Valkenar wrote:

Still, the implication that corporations are necessarily interested in providing all-around excellence is pretty obviously wrong.
Travel to socialist countries and you'll think otherwise.

It's in a company's best interest to deliver what the customer wants. If the customer is primarily price driven, then they CHOOSE to sacrifice on other dimensions (like valet-like service, quality, features). If a customer primarily wants quality at a reasonable price, then they may sacrifice on performance, etc. It's all a balancing act. The company finds a niche that will keep them in business - a niche that is dictated by the consumer.

Sprint lasted all of one hour in my house because of their poor service.

I will never by another GM product because of the piece of schit car I last owned from them (Saturn SL2). It's no surprise to me that they are now Government Motors. They deserve to f-ing go away.

I've paid a little more for a Progressive auto insurance policy (until recently) because of the incredible service I get from them.

Microsoft software may not be perfect, but who produces better? Show me and I'll show you the money. (I do have one Macbook pro in the house - with Office software. I also am communicating to you with a Firefox web browser.) Anyhoo... Microsoft makes me happy.

Same for Dell. I gave up on HP. They used to be good. Now their products suk. My buying patterns similarly changed.

I've ditched my health insurance company for incomprehensibly bad service. I know how good it should be, and how bad it can be. It's all relative, Justin. Wellpoint/Anthem now gets my money - even if I have to pay a little more. I also still have my Wellpoint stock, so now I have two avenues to raise hell if they don't treat me right. A couple savvy customers such as yours truly make it better for a lot of other customers.

Yes, Justin, it is MUCH better than what you get from government-run enterprises. Ask the Russians and East Germans what happened to their automobile companies when the Iron Curtain fell. I've seen these Pieces of Schit first hand. (Remember the Yugo? It's excellent compared to the Lada.) You don't know how bad it can be. You are so spoiled, Justin. Again... it's all relative.
Valkenar wrote:

So what do you propose to do when it turns out that healthcare consumers are like all others and will buy the cheapest thing they see?
Who are you to tell them they have to spend more money, Justin? It isn't YOUR money. If a consumer is prince sensitive, well LET THEM BE!!! A bare-boned policy is just that. As little as possible to cover the absolute necessities - and no more. Anything else is out of your pocket.

Do you know how well free market plastic surgery is doing? Not everyone needs a boob job. But some will pay dearly for them. That's their choice. And if their boob job has complications, well... Good luck with that!! Your poor choices ARE NOT my problem.
Valkenar wrote:

What would you do here? If a doctor makes a *preventable* mistake and a patient is left debilitated, what should happen? I mean we can look from a purely pragmatic view and try to make sure it doesn't happen next time, but that doesn't do the victim any good. Unfortunately, money is the only way we have of balancing things out. If there were a way to say, transfer the culprit's ability to walk over to the victim, that might be better. As it is, the best we can do is say "Well, being crippled, that s ucks a lot, so here's a few million from the person who crippled you"
No, Justin. The best we can do is to have a free flow of information in a quality improvement process so that you prevent bad mistakes from happening in the first place. Allowing the ambulance chasers to troll for trailer trash isn't my idea of a good system.

Punitive damages go out the window. Forgetaboutit.
Valkenar wrote:
Here's the unpleasant truth about computer security: it is impossible. Just like total home security is impossible.
Impossible is not an option.

And paper records can be passed around. Just a lot less efficiently.
Valkenar wrote:

How do you define "something" in a meaningful way. What is a "something" that can be applied to a single mother working at MacDonald's, but also a single tech worker making 100k?
In short... See The RAND Health Insurance Experiment. I'm not going to reinvent the wheel here. This has been studied pretty thoroughly.

And I DO believe this is the land of opportunity, and not a land of entitlement. Someone who earns more is entitled to more. Don't like it? See Karl Marx.
Valkenar wrote:
in this country it's expensive to eat healthy and super cheap to eat poorly.
Bullschit. I lived on $400/month for a decade while in school. I even had a little extra money left over for a dog and a car. Breakfast is cheap. Eggs are cheap. Elbow macaroni by the 3 lb box is cheap. Canned tuna (in water) is cheap. Cans of jack mackerel taste like schit, but are dirt cheap and healthy. Frozen vegetables are good for you, microwaveable, and cheap. Unsalted nuts (peanuts, walnuts, almonds, pumpkin seeds) are inexpensive and VERY good for you. Fortified high fiber bread is cheap. Fresh fruit in season is cheap. Skim milk is cheap. Lentils are cheap. Brown rice is cheap. Turkeys are cheap (I have a large breast in the refrigerator right now...) Walking is cheap. Martial arts outdoors is cheap (just ask the Chinese...).

People eat cr@p and consequently look like schit because they CHOOSE to do so. People eat processed food (laden with sugar and bad fat) because they CHOOSE to do so. Eat primarily for taste and/or convenience? You get what you get. Kids won't eat healthy? They will when they get hungry enough. Trust me... :twisted:

Sorry... I have no sympathy.
Valkenar wrote:
A lot of people now are growing up obese. At what point do you transfer the responsibility from child to parent?
As early as possible. If it costs the parents to make poor choices, the child will learn. That isn't a perfect system, but then it isn't my job to save others from their stupidity.

Kids are amazingly resilient. God knows we parents do all kinds of stupid things, and most grow up OK in spite of us.

- Bill
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Glenn
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Post by Glenn »

Yes, Justin, it is MUCH better than what you get from government-run enterprises. Ask the Russians and East Germans what happened to their automobile companies when the Iron Curtain fell.
Because "government-run" automatically equates with conditions in Communist-era Soviet Union and Eastern Europe, just as "corporate-run" automatically equates with conditions in sweatshop-era U.S. You may want to update your scare tactics to something post-McCarthy, you're showing your age. :D

On the other hand, it would explain why the only goods available for us to buy now is all crap when it comes to quality, it's all made in Communist China and other "socialist" countries.
Allowing the ambulance chasers to troll for trailer trash isn't my idea of a good system.
This is the 21st Century, they don't have to use up precious time chasing ambulances anymore...it's all online. The auto accident I was in last week occurred on a Tuesday. The police accident report went online Wednesday morning, as a public record, clearly indicating that I was not at fault and that another driver had been ticketed for causing the accident. By that same afternoon I had received 3 phone calls from chiropractic/medical offices "following up" on my medical aspects of the accident. The next day (Thursday), I had 5 letters in my mailbox, 4 from lawyers and one from a chiropractor, all seeking my business because of the accident. since then I have received probably 10 more mailings. Clearly they are trolling the online accident reports looking for business.

Incidentally the same thing happened when my car was totaled 15 months ago, except at that time I got no phone calls, fewer mailings, and only from lawyers. This strategy seems to be rapidly expanding.
And paper records can be passed around. Just a lot less efficiently.
Having worked in the new-business and customer-service areas of a life insurance company back when everything was done on paper, I know for a fact that this happened, particularly regarding celebrities. As far as I know, no copies were ever made and taken outside the company, but you never really know for sure. Reportedly Magic Johnson's HIV condition was made public when it was leaked from within a life insurance company (not the one I worked for) after he applied for the company's insurance (HIV testing is a requirement for most life insurance applications). Stricter laws and high profile court cases have forced companies to take measures to curb such activity and reduce their liability. The issue is resurfacing though with the increase in the amount of processing being sent offshore to countries without such laws and where the risk of punishment is low.
I have a large breast in the refrigerator right now...
Does this relate to the turkey comment or to the boob job comments you made earlier in your post! 8O :lol:
Glenn
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Post by Bill Glasheen »

I don't need LARGE breasts to have a good time, Glenn. Gravity is a b1tch with age you know... :roll: :lol:

As for leaking records... It happened once within a health insurance plan I worked for. Someone getting divorced asked someone they knew working for the health insurance company to get some records related to a person's health. You know... antibiotics for infections and stuff. 8O

Said employee got caught. Her butt was sent out on the street without job in a New York second. And that's the way it should be.

The health insurance company I used to work for had the medical records of politicians running for office. You'd better believe we protected those records like the holy grail. And this was before the days of HIPAA.
Glenn wrote:
Because "government-run" automatically equates with conditions in Communist-era Soviet Union and Eastern Europe, just as "corporate-run" automatically equates with conditions in sweatshop-era U.S. You may want to update your scare tactics to something post-McCarthy, you're showing your age.
I witnessed Russian Ladas and East German Trabants being driven in large numbers in Russia in August, 1993. Is 16.5 years really that long ago?

Meanwhile... The Russian mafia drove some pretty fine Bimmers. 8)

- Bill
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Glenn
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Post by Glenn »

Bill Glasheen wrote: Is 16.5 years really that long ago?
To the college students I teach, it was an eternity ago...this year's Freshmen were around 2 years old at the time! Man I feel ancient! :lol:
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Valkenar
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Post by Valkenar »

Bill Glasheen wrote: Travel to socialist countries and you'll think otherwise.
No I won't, I'll think that governments screw stuff up royally too. No monopoly on that.
It's in a company's best interest to deliver what the customer wants.
As you like to say, you argue best when you argue my point. Corporations are great at giving customers what they want. But *you* were talking about all-around excellence, implying that you get such things from corporations. You don't. You get what the customer wants, which may or may not be all-around excellence.

But it's just not accurate to imply that corporations give you excellence on all etc, etc.

I'm not arguing that we should be like Russia. But a little bit like Canada and the UK, Sweden, in this one respect would be an improvement. Sheesh, you're reacting as if I'm proposing nationalizing all industry.
Microsoft software may not be perfect, but who produces better?
Google, Linus Torvalds, Trolltech (now Nokia), the Eclipse Foundation, Blizzard, etc, etc. There are some things Microsoft does well. It's not like all their stuff is junk. Lots of people are happy with Microsoft, mostly because they don't know any better.
Ask the Russians and East Germans what happened to their automobile companies when the Iron Curtain fell.
Yes, because as we all know the two choices in the world are the USA precisely as it exists today and communist countries c.a. 1990
Valkenar wrote:
Who are you to tell them they have to spend more money, Justin? It isn't YOUR money. If a consumer is prince sensitive, well LET THEM BE!!!
...
A bare-boned policy is just that. As little as possible to cover the absolute necessities - and no more. Anything else is out of your pocket.
Okay... so this means what, exactly? That you're okay with people being ruined for life if they can't afford to have their appendix out? I guess I'm just too much of a communist for that.

You have a choice in this situation: Give them care or don't give them care. If you don't give them care, they die. Maybe that's okay with you. If you do give them care, then how do you suggest it get paid for if they don't have the money?
No, Justin. The best we can do is to have a free flow of information in a quality improvement process so that you prevent bad mistakes from happening in the first place.
This is dodging the question. Sure, you can try to prevent mistakes, but they're going to happen anyway. Unless you're denying that, you should answer what you want to do when those mistakes happen.
Punitive damages go out the window. Forgetaboutit.
I think people sometimes deserve punishment. Doctor drunk on the job? That doctor deserves to be punished. And if this doctor is especially wealthy, regular damages are not much of a punishment. As you say, it's a land of opportunity, but personally I don't think anyone should be free to hurt others as long as they can afford it.
Valkenar wrote: Impossible is not an option.
Well then don't put it on the internet.
And I DO believe this is the land of opportunity, and not a land of entitlement. Someone who earns more is entitled to more. Don't like it?
No I think that's quite fine. Again, you're trying to cast it in black and white, and I'm not buying. I'm not saying that everyone has a right to a boob job if they want it. But yeah, maybe a society that's capable a cast for everyone that needs one has an obligation to do so. I'm not talking about having equal care for everyone. Just a minimum level of care for everyone. And frankly, right now everyone can get a basic level of care by going to the ER. This is not efficient or good for anyone. It's a waste of money and it's bad for the people doing it (compared to having real primary care).

As I see it, the plan should have a tax component that varies with income, and copays that vary with income. My goal is to make people feel the impact of the choices they make, but not be forced to make unhealthy choices. Yes, that does represent a redistribution of wealth. So does building roads, or having a military.
Valkenar wrote: Bullschit. I lived on $400/month for a decade while in school.
Yeah, well life was different in the 1800s.

Seriously though, you're making it out to be way easier to eat healthy than it is. Everything you listed is much, much more expensive than a bag of store brand potato chips, or a super-sized soft drink, per calorie. Frozen vegetables are not cheap, for how full they will make you.

Besides, where do you want people to learn healthy eating habits? Are you assuming that they'll one day be like "gee I've lived on macdonald's every day since I was 5 because that's where my mom works, but now, despite having no role models or exposure to better ideas I'll suddenly decide to do a bunch of research and find out how to eat healthy, and then do it consistantly" Kids may be resilient, but people don't just pluck smart ways of living out of thin air.

I understand that you hate the culture of scapegoating and not taking responsibility, but I also think it's incredibly unrealistic to just expect that people's upbringing should have nothing whatsoever to do with the choices they make. People have options, sure, but you shouldn't dismiss the impact that a complete lack of positive modeling has.

Again, it's not black and white. I don't think you can put all the blame on people for not knowing any better, nor can you absolve them of blame for the mistakes they make.
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Post by Glenn »


Microsoft software may not be perfect, but who produces better?
Corel. My wife and I will take Corel's WordPerfect Office suite of products any day over Microsoft Office. We were early adopters of WordPerfect as a word processing application, due to it being popular in university departments because it has better desktop publishing functionality over Word. After Corel took over WordPerfect and created its Office suite, I also became sold on its Presentations software as being a better product then PowerPoint. I even go so far as to install Corel Presentations on the computers in the classrooms in which I teach so that I can use it for lectures instead of PowerPoint, and then uninstall it at the end of each quarter.

Drives us crazy when we have to use Microsoft Office (which I in particular had to for over a decade when I worked for the insurance company) for something and waste hours finding out it doesn't have functionality that we are use to from Corel. Many versions ago Word had a help feature labeled something like 'Help for WordPerfect users', and often when we would refer to it we would to see 'That feature is not available in Microsoft Word' and even one time 'You do not need that feature with Microsoft Word' with no explanation of why they deemed in unnecessary.

Microsoft's dominance of these types of products is not because it produces better products, but because it captured a large part of the market share all those years it came automatically bundled with new PC purchases. The automatic bundling ended when it lost the anti-trust suit, initiated in part by Corel, but people were already use to the Office products and have not been interested in change. Fortunately for my wife and me, WordPerfect still has support in many university department offices, including all the ones we've worked in.

My wife and I have even fallen into the trap of not taking time to change, with Microsoft Excel. With the exception of some early use of Lotus 1-2-3 and another spreadsheet program whose name I forget, we have been using Excel for so long and it has been the spreadsheet software used in any office we've worked that we have not bothered to learn the Corel Quattro Pro program.
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Bill Glasheen
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Post by Bill Glasheen »

Valkenar wrote:
I don't think you can put all the blame on people for not knowing any better, nor can you absolve them of blame for the mistakes they make.
Fair enough, Justin.
Valkenar wrote:
I'm not arguing that we should be like Russia. But a little bit like Canada and the UK, Sweden, in this one respect would be an improvement.
Just 3 days ago I was talking to a nurse practitioner working at one of these Minute Clinics now operating out of CVS pharmacies. Great idea, and quite possibly a baby step in the right direction for all of us. The week before, she gave me my H1N1 shot. We keep in touch, because she likes to pick my brain about health care reform.

She's Canadian. And as she says repeatedly, "People have no idea here how bad it is in Canada. That's why I'm here. You wouldn't be getting this kind of readily-available primary care where I grew up."

I also know quite a bit about the UK health system, as my company has a subsidiary there. I've written a proposal for a major contract for their health information systems.

It isn't always green on the other side of that hill, Justin. We'll agree to disagree here.
Valkenar wrote:
Google, Linus Torvalds, Trolltech (now Nokia), the Eclipse Foundation, Blizzard, etc, etc.
Good stuff! The more the better I say. Competition in a free market is a very good thing.
Valkenar wrote:
Bill wrote: Who are you to tell them they have to spend more money, Justin? It isn't YOUR money. If a consumer is prince sensitive, well LET THEM BE!!!
...
A bare-boned policy is just that. As little as possible to cover the absolute necessities - and no more. Anything else is out of your pocket.
Okay... so this means what, exactly? That you're okay with people being ruined for life if they can't afford to have their appendix out? I guess I'm just too much of a communist for that.
Straw man argument, Justin. Any reformer in his right mind would consider an appendectomy as medically necessary and an appropriate expense for a bare-boned insurance policy to cover.

Furthermore... In today's system I could bring my friend w/o insurance into the ER (as I have twice in the past 2 months), and said person would get the appendectomy. This individual is slowly drowning in debt, but at least there will be a tomorrow to worry about it. This would also be true of the Mexicans working illegally in my city.

You and I (indirectly) pay for that care today.
Valkenar wrote:
This is dodging the question. Sure, you can try to prevent mistakes, but they're going to happen anyway.
I am not dodging the question; I am dodging the problem. As the saying goes, the best fight is the fight never fought.

Meanwhile trial attorney's don't want that to happen. That means a loss of business. Wouldn't that suk (for them)...

I have the better solution, Justin. So does GE when they make aircraft engines. If mistakes seldom happen, then there's no need to create an entire industry motivated to take profit away from people who do real work.
Valkenar wrote:
I think people sometimes deserve punishment. Doctor drunk on the job? That doctor deserves to be punished.
Take his license away. Problem solved.
Valkenar wrote:
And if this doctor is especially wealthy....
What does that have to do with anything? It's only important if you're a wealth redistributionist. It is not evil to be wealthy. And that wealth does not belong to anyone else - including and especially trial attorneys.

But don't ask me what I REALLY feel about the matter...
Valkenar wrote:
Yeah, well life was different in the 1800s.
Careful there, cowboy, or I'll send my friend Abe over to kick yer arse! :twisted:

For your amusement - from this "Old Faht." 8)

Vintage 1960's East German Trabant Car Commercial

Lada commercial old russian

Lada commercial

And finally...

New LADA 2009

- Bill
Last edited by Bill Glasheen on Thu Jan 28, 2010 4:04 pm, edited 1 time in total.
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Glenn
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Post by Glenn »

Bill Glasheen wrote: She's Canadian. And as she says repeatedly, "People have no idea here how bad it is in Canada. That's why I'm here. You wouldn't be getting this kind of readily-available primary care where I grew up."
I get a completely different story from Canadians currently here in Nebraska (one visiting professor and a couple of students), who say that they:
- don't know why there is such a fuss over this issue in the U.S.
- don't understand why the U.S. wants to remain the only wealthy country that doesn't provide universal health care to all citizens
- and above all don't like what they see as negative misrepresentations of Canadian health care presented by detractors in the U.S. media.
As they point out, you are going to have disgruntled people in any system and they don't think it fair that the media focuses only on those for its presentation of Canadian health care.

And as far as the nurse's comment, she is likely correct, it probably wasn't available where she grew up...that recent model of care was also not available where I grew up in semi-rural Kentucky, and likely still isn't, nor is it available in most places in Nebraska from what I can tell.
Last edited by Glenn on Thu Jan 28, 2010 4:08 pm, edited 1 time in total.
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Post by Bill Glasheen »

Must be the same disgruntled Canadian MDs who fled Canada to work for the insurance companies I once worked for. Go figure...

Once thing you need to understand about health-care is that it is a highly localized phenomenon. What works (or once worked) in Rochester will not work in Des Moines. I can say this and say this until I'm blue in the face, but people won't believe me - until the data just about smack you upside the head.

What works in Canada will not fly here. And "Federal" systems will suk at any number of local levels for all kinds of very good reasons - not the least of which is our unique, heterogenous, freedom-loving, capitalistic society. We aren't all blue-eyed blonds who think alike.

See Dartmouth Atlas of Health Care.

- Bill
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Bill Glasheen
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Post by Bill Glasheen »

Speaking of Minute Clinic...

Minute Clinic - the medical clinic in CVS pharmacies

Free market solutions - at your service. Several such business ideas started (e.g. Redi Clinic in WalMart). But as with the early PC market, one such paradigm succeeded and very well may change the landscape as we know it.

No Obamacare necessary. 8)

- Bill
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Post by Valkenar »

Bill Glasheen wrote: It isn't always green on the other side of that hill, Justin. We'll agree to disagree here.
It isn't always greener, no, but sometimes it really is. But sure, sure I'll leave this alone until I feel like re-digging up the info I once had about various countries' healthcare.
Valkenar wrote: Good stuff! The more the better I say. Competition in a free market is a very good thing.
Sure is, but it's nothing like a guarantor of all-around excellence, or even the attempt, which is what you implied.
Valkenar wrote:
Straw man argument, Justin. Any reformer in his right mind would consider an appendectomy as medically necessary and an appropriate expense for a bare-boned insurance policy to cover.
So you're saying that nobody would offer a cheaper plan that doesn't cover those things? What if that's what people want to buy? What do you think the cost per month would look like for a plan that covers say, one yearly checkup and two office visits, and 50% of antibiotic medication only, compared to one that covers all "medically necessary" prcoedures (I quote that because there's no universal agreement about what that means)? If the rock-bottom is $20/mo and the bare-bones (as you seem to define it) costs $100, there are lots, and lots of people who will take the rock-bottom plan. I don't think this is a strawman, I think it's realistic. And you need a plan for what happens when those people show up at the emergency room.

As you say "You and I (indirectly) pay for that care today." Given that we're already paying for it, and paying too much, wouldn't it be better to just give everyone the same level of care they can get by going to the ER on a whim? You can go ahead and shake your fist at those irresponsible doodooheads all you want, but *you* still pay less this way.
Valkenar wrote: I am not dodging the question; I am dodging the problem. As the saying goes, the best fight is the fight never fought.
Well I don't think that all that six sigma and stuff maps cleanly to hospital work. Pprocess improvement is an important part of how we should improve healthcare. But it's not a magic bullet that's going to solve all your problems.
What does that have to do with anything? It's only important if you're a wealth redistributionist.
Because the size of a fee only has punitive value if it's large relative to a person's wealth. If you fine me $100 that's annoying, but it won't seriously affect my life. But if you fine me $10,000 that's a big deal, but I can probably get by. Fine me $100,000 and my life is ruined. If you fine Bill gates $100,000 it affects him less than $100 affects me. Fine my some of my friends $10,000 and they're homeless.

See the difference? What punishes me appropriately is not a punishment at all to someone wealthier, and is absolutely ruinous to people with less spare cash than me.

Here's a mildly amusing page that illustrates the concept
http://www.templetons.com/brad/billg.html
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Post by Glenn »

Bill Glasheen wrote: Once thing you need to understand about health-care is that it is a highly localized phenomenon. What works (or once worked) in Rochester will not work in Des Moines.
and
may change the landscape as we know it
There might be hope for you becoming a geographer yet! And thanks for the Dartmouth link, I wasn't familiar with that one and see the potential to raid it for items for my medical geography lecture. There is information galore on the geography of disease and other health issues, but good information, particularly maps, on the geography of health care and medical procedures is hard to find.
Last edited by Glenn on Thu Jan 28, 2010 8:17 pm, edited 1 time in total.
Glenn
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Bill Glasheen
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Post by Bill Glasheen »

Valkenar wrote:
Sure is, but it's nothing like a guarantor of all-around excellence, or even the attempt, which is what you implied.
If you want to create a whipping boy argument out of something I said, well knock yourself out. Rumor has it that I've been known to be wrong and/or not express myself well. Go figure...

The point is that a free and competitive market has the capacity to respond to a demanding consumer on any number of dimensions. This is VERY different than a universal health care system where a single, relatively unresponsive entity gives you something and tries to convince you that you'll like it. No thanks on the latter part. Even with Medicare, many people (including my dad) pay for supplemental coverage because Medicare just isn't that good.
Valkenar wrote:
What do you think the cost per month would look like for a plan that covers say, one yearly checkup and two office visits, and 50% of antibiotic medication only, compared to one that covers all "medically necessary" prcoedures...
Let's stop there. The literature hasn't shown much benefit for yearly medical checkups for an otherwise healthy individual. Folks with chronic diseases? Sure. Fertile women? Sure. But your average healthy male? On average it actually does more harm than good.

I don't think you'll find much of a market for this, Justin. And besides... those are fixed and known costs. There's little benefit (other than unit price) for getting insurance to cover such things.

And antibiotics are way overused anyhow. For God's sake, they're even giving them to chickens in densely populated poultry houses.

The very first health insurance policies in this country covered hospital stays. They actually were quite affordable. Medicine has come a long way since then, but... "Bare boned" insurance is more about protecting you from catastrophe and not helping you with the regular and the known.

And frankly I wouldn't be against various governmental concerns covering basic immunizations anyhow, as these are net money savers for society. So if you want government in medicine, I'd give you that.
Valkenar wrote:
Bill wrote:
I am not dodging the question; I am dodging the problem. As the saying goes, the best fight is the fight never fought.
Well I don't think that all that six sigma and stuff maps cleanly to hospital work. Pprocess improvement is an important part of how we should improve healthcare. But it's not a magic bullet that's going to solve all your problems.
I agree, Justin. However... if you don't believe that we can prevent problems, then why are there punitive damages? I mean really!!! Think very carefully what you are implying.

IMO we do all we can to prevent the preventable, we communicate to patients as much as possible about risks (informed consent), and then we keep the damned lawyers out of the doctor-patient relationship.

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Glenn
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Post by Glenn »

Bill Glasheen wrote: The literature hasn't shown much benefit for yearly medical checkups for an otherwise healthy individual. Folks with chronic diseases? Sure. Fertile women? Sure. But your average healthy male? On average it actually does more harm than good.
That's at the population level. At the individual level early detection of a health issue is obviously a good thing.

What I think does me more harm than good is my parents telling me of all the problems (some potentially hereditary, some not) they've developed in the elderly years so that I know what I'm in for. I'd just as soon find out about it if/when it happens!
Glenn
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