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This page contains a single entry from the blog posted on May 27, 2009 10:56 PM. The previous post in this blog was Another bum pro hoops call. The next post in this blog is Recession? What recession?. Many more can be found on the main index page or by looking through the archives.



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Wednesday, May 27, 2009

Ridin' Wyden

The special election just past was such a dud. No direct mail political porn! No blog ads! But the public employees union, AFSCME, is currently filling the void (at least somewhat) with ads on blogs such as the one you're reading right now, plus this handsome mailer that arrived at our place this morning:

Comments (13)

I'm not sure how your ad provider works, but google's adsense allows you to be selective about what ads appear on your own blog.

Also, any surfer with half a brain can block ads if they want:

I do like the Monster Mailer though. Made me laugh.

Something for nothing. That's what everyone clamoring for health care changes wants. Including, apparently, the purveyors of this particular piece of political porn.

Good, virtually unlimited health care will cost money - there isn't any magic formula for reducing costs and increasing quality except at the margins. We must pay for it with some form of increased taxes.

Gordon: your statements have some general validity for a well-functioning market, where there are no easy gains because the market keeps culling inefficiencies.

The medical industrial complex is galactically far from a well-functioning market. From strict income-protecting limits on the number of candidate physicians to patent protections for drugs (built on publicly funded research) to complete and utter disregard for efficacy research results and complete absence of effective consumer access to quality information (or even arrest and malpractice records of providers), the "market" in health care has the worst aspects of capitalism and soviet-style communism, all delivered with "Northern charm and Southern efficiency" (as JFK said of DC).

The amazing progress in the results throughout the VA system shows that dispensing with the phony god of a market can do wonders -- the VA is a fully socialized, single-payer system that has a very low overhead, quickly internalizes and disseminates improvements in care protocols, and gets good results.

In fact, there are major savings to be realized in health care. If you had a parasite attached to your body that weighed 30% of your own body weight, I think you'd recognize that there was a real opportunity for significant improvements in functioning. US corporate care has exactly that: a parasite that consumes 30% of the resources and provides no health benefit. They're called insurance companies.

What George said. What we spend now on health care would provide, in a single payer system, virtually unrestricted care for everybody, with something left over. But our Congress (Wyden is guilty, but so are many others) is dedicated to saving that 30% for the insurance companies and administrators. So cutting costs is hard, and the taxpayers have to dig deeper.

They were handing them out downtown yesterday as well.

Good, virtually unlimited health care will cost money - there isn't any magic formula for reducing costs and increasing quality except at the margins. We must pay for it with some form of increased taxes.

I don't think this is true. The Netherlands currently has national health care, has better ratings than the United States in patient satisfaction, and spends far less per person than in the United States. Similarly, while private health care premiums have been increasing radically in the past few years, the VA here in this country has kept costs virtually flat. Both of these seem to have found the "magic formula" or a piece of it at least that is missing from private health insurance.

There's no reason we can't keep the same quality of care and health care lower costs. It doesn't require additional taxes, but it will strip profits from some powerful lobbies such as pharma and insurance companies. The main thing stopping forward progress is lack of political will.

I don't agree with the comments in response to my comment # 1. It's easy to blame "big pharma," "greedy doctors," "greedy hospitals," "evil insurance companies" for all of our health care woes.

"Big Pharma" uses its allegedly obscene profits to produce new wonder drugs. Without those "obscene" profits do you really think researchers are going to bust their ---'s for a signed "thank you" from President Obama that they can frame and hang on the walls of their offices?

"Greedy" hospitals and doctors order all sorts of extra procedures and have all sorts of expensive safeguards because we don't expect them to make mistakes, and we'll sue their butts off if they do. Besides, our insurance companies are paying for it all (except when we don't have any).

I'm not going to claim our health care system isn't broken - it clearly is. But do you really think that a big government health care bureaucracy is going to take a lot less than the 30% cut currently going to our "greedy" health care private sector? When the inevitable federal budget problems show up, do you really think the government won't be tempted to ration our health care just "a little bit," so that we end up with long waiting times for necessary surgeries, like Canadians face?

I don't believe a single-payer system is the answer. I believe that a modified version of our current system that keeps private sector incentives as a spur to better health care is a better way - a system that ensures good health care for all Americans and takes the burden off of our employers.

I personally am willing to pay for it. But a lot of Americans, including AFCSME, apparently aren't.

"Big Pharma" uses its allegedly obscene profits to produce new wonder drugs. Without those "obscene" profits do you really think researchers are going to bust their ---'s for a signed "thank you" from President Obama that they can frame and hang on the walls of their offices?

I think Gordon is assuming that research is privately funded. This isn't necessarily the case. Most European countries finance pharma research through government grants. If this research is publicly owned, everyone gets the benefits rather than just one company. Also, there is no out-of-pocket risk to recoup if the research itself is directly paid for by taxpayers.

Also, the US isn't producing as many of these "blockbuster" drugs as it should. Studies have shown that the R&D investment per drug invented here is two or three times that of other countries. It's somewhat subjective, but based on the numbers it looks like we aren't spending money efficiently here.

Finally, recouping discovery investment from customers means that research work is focused on ability to pay not need. For example, we probably do more research on stomach stapling and hip replacements rather than child burn victims or multiple sclerosis.

Notably, switching to a public funded research model doesn't require a single payer health care system, just different government spending. However, a lot of political momentum is required to make such a change, so it's probably easier politically to lump this in with single payer.

I don't believe a single-payer system is the answer.

I'm not convinced a single-payer system is required either. However, the big nut to crack is that single-payer system inherently has incentives aligned better.

Once big difference in incentives between single payer and private systems is that private systems don't have to deal with long-term conditions. It's easier for private companies to dispute claims as pre-existing conditions than to focus on comprehensive prevention and disease management. The single payer systems like the VA will see a direct impact on their bottom line from encouraging weight loss, early cancer detection, etc. However, most private health companies only have a customer for three years or so on average. In that situation insurance companies want to avoid early diagnosis in the hopes that the patient will move on to another insurance company even though the patient and health care spending as a whole are worse off.

For similar reasons, single payer systems are better at avoiding overutilization. Here in Portland, we have a disproportionate number of back surgeries compared to the rest of the country. This is likely due to a combination of the per-procedure compensation and the chiropractic colleges in the area. These same factors are at work elsewhere as profiled in a recent piece in the New Yorker.

I agree with Gordon that a single payer system isn't required to solve these problems, but I do think it's much easier to solve these problems with a single payer system.

Ah, the poor care-starved Canadians myth arises again:

When the inevitable federal budget problems show up, do you really think the government won't be tempted to ration our health care just "a little bit," so that we end up with long waiting times for necessary surgeries, like Canadians face?

Would you rather be a Canadian waiting for your needed surgery or one of the tens of millions of uninsured Americans with no chance for your needed surgery?

Dave C. - the study abstract you link to states that lots of Canadians don't come to the U.S. to avoid their sclerotic state-managed health system.

That's probably because almost all Canadians couldn't afford to pay out of pocket for a U.S. medical procedure. So the study doesn't really prove your point.

darrellplant: I would like a health care system that doesn't require waits for necessary procedures AND provides insurance for all Americans. My belief is that such a system will cost a lot of money, which I am willing to pay. And which AFSCSME, by throwing political porn at Senator Wyden, shows that it is unwilling to pay and is looking for the cheap, demagogic way out of the health care mess. A way which I assert is a fantasy.

Wyden's Healthy Americans Act is a complete mess, which is evident if you actually take a look at the proposal, as I did last spring. It doesn't provide care across the board for all Americans, and it certainly doesn't guarantee care to anyone who needs it.

The plan's toothlessness at reforming the health care system can be effectively counted on the list of its current and former co-sponsors: Norm Coleman, Gordon Smith, and Trent Lott among the latter; Lamar Alexander, Robert Bennett, Thomas Carper, Bob Corker, Joe Lieberman, and Arlen Specter among the latter. It's almost completely a group of hard-core Republicans and conservative Democrats who've been tied to insurance company interests for decades. They're not about to roll over on the golden goose.

It'll be interesting to see how this plays out. The people at Blue Oregon are so tied to Wyden that they've heavily promoted his plan in the past, but they're oddly quiet about this latest outbreak.

@darrel: "It'll be interesting to see how this plays out. The people at Blue Oregon are so tied to Wyden that they've heavily promoted his plan in the past, but they're oddly quiet about this latest outbreak."

Yes, see beaujacques sycophancy post. The position of the BO set seems to be that turds are actually M&Ms if they come from a Democratic pol.


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