Osler's Razor

Wow. It worked. Anyhow, here's the link to the Cohen Column:

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/27/AR2009072701904.html
 

I get all of my news from E!, Us, People and the CLs, so you got me....
 

I love starting the mayhem on Wednesday night...a few extra hours of cyber-rioting.

I'm right there with you. We all know how IMPORTANT the health care debate is, and how much it really should be a part of our lives. But I for one am resigned to the fact that all the politicians are really going to do is ladle another layer of Potomac slime on top of the pile of crap health care policy currently is. I spent two years on the Hill, and I know exactly what's going on over in the hallowed halls of Congress right now--"policy" is being crafted to fit the interests of the most influential parties, including the sellout AMA, insurance companies, and big health care providers. This approach always yields solutions which are really problems disguised in the rhetoric of good intentions.

Instead of streamlining and modernizing health care and reducing costs for everyone, Congress is poised to tax us all (directly or indirectly) for the services everyone agrees should cost less. Can we really hold out any confidence that they're not just going to make paying for a doctor's visit MORE confusing, MORE complex, and MORE expensive?

Ye gods, when I imagine the havoc Obamacare is going to wreak upon our currently bloated yet mostly effective system, I almost wish he'd implement a real socialist government health plan. Maybe at least then I'd mercifully expire while waiting to see a doctor, instead of living though the hell of bureaucratic BS that is to come.
 

I base my views on my moral philosophy that it is unjust to allow private companies to run non-luxury services.

You may call me politically naive if you wish.
 

1. I, frankly, would have liked to see some sort of bad French impersonation of Prof. Osler before he signed off, but, oh well.

2. I feel entirely the same way. I read the NYT and my local paper cover to cover, every day, all year. Yet I still don't have a clue as to what is going on the the magic dreamland known as health care reform.
 

Yes, I'm actually with Jesse, to a degree. Unlike Jesse, I do trust that Obama has good intentions with health care reform, and I think that government could run some things well if given a real chance. Like Jesse, I agree that a policy change this huge can only downslide into something less than ideal as it goes through the sausage machine that is the legislative process. Health insurance the way it currently stands is WAY too entrenched, with too many players, for any of them to go gently away.

And like Lane, and Jesse, I would pay attention if we were actually going to have REAL universal health care. But it still sounds complicated, not simple, which to me sounds like it still will be fraught with problems.

And maybe that's also why I too have had to force myself to pay attention to the health care debate. I'm sort of in the tell-me-when-it's-over mode; I won't believe that anything's changed until it actually happens. I suppose I do trust that there will be some small measure of improvement in it--since I support the current party in office--but I'm skeptical that anything will change at all given the special interests involved.

I am surprised at myself that I can't bring myself to pay much attention to something so important. But I can't . . .
 

Interesting . . . I just read a New York Times article about public reaction to the proposed health care reform which concluded:

"Over all, the poll portrays a nation torn by conflicting impulses and confusion.

"In one finding, 75 percent of respondents said they were concerned that the cost of their own health care would eventually go up if the government did not create a system of providing health care for all Americans. But in another finding, 77 percent said they were concerned that the cost of health care would go up if the government did create such a system."

I think health care/insurance is something so vital that, for the people who do have it (who are often the people who vote), they want it to be better but the thought of it being not-the-same is scarier.

And maybe it also means we should pay more attention to the actual proposal, not to media sound-bites about it.

But it's hard to, I agree.
 

I read the NY Times and the local rag . Oh, and all the partison e-mail I am receiving from friends on both sides of the fence. All of it taken out of context and meant to scare and intimidate me. Understanding health care reform - no way. Until the Congress presents something tangible I will continue to wait.

I understand the type of reform that would be essential for my family. I pay for our health insurance (out of pocket). I do not get to deduct it on my taxes (this is wrong). If I am consulting then I can take part of it as a business deduction.

I would like to know that if I need care I will not go bankrupt. That is not guaranteed with my plan. Since I have my own plan, if either of us has a 'real' medical issue (new diagnosis ~ high blood pressure, skin cancer, etc...) our next renewal will be cost prohibitive and we won't be able to find a new, affordable policy as we will have pre-existing conditions.

I would like some form of computerized records. If you are assisting your elderly parents with doctor visits it gets very old filling out the medical history forms everytime you go to a new doctor or dentist. Do you really know your parents medical history. Heck if your spouse became suddenly and seriously injured, would you be able to fill out all their medical history. Probably not entirely and then factor in the 'shock' of the circumstance that brought you to the emergency situation.

These are things that concern me about health care reform along with the the millions of people who can't even get to the place I am with my own policy.
 

Government control = bad news.
 

"services everyone agrees should cost less."

Just as an initial point, I don't agree that services should cost less. Services should cost whatever they cost. And they will. It would be great if someone could invent a cheap, efficient way to cure disease. "Take this pill and you're cured, and that pill costs $2!" That would be great. But, government controlled care will not make care cheaper, it will just mean we are paying for it in taxes and debt instead of out of our own pockets.

What I don't understand is this, as Swissgirl points out, the legislative process is a "sausage machine." Legislators have their own interests at heart when they make legislation. Legislation is slow, inefficient, and bloated. The federal government is a gigantic machine where the left hand often doesn't know what the right hand is doing, and when the left hand figures out what the right hand is doing it often has problems with it.

So, these are the people we want running health care? This bloated, inefficient, slow bureaucracy?

Well, I just can't imagine that will fail to produce cheaper more efficient and certainly better care...
 

Here's a randome thought - if we went back to the days when outrageous television and radio advertising for drugs was not permitted, and drug companies were unable to spend millions (billions?) on mass marketing to a public who is in no way educated enough to self-prescribe based on some shiny marketing campaign, might the price of prescription drugs fall? Quite frankly, the entire health care system outrages me; this is but one piece of a completely broken system.
 

random, not randome. so angry i can't type...
 

RRL, isn't the healthcare system we have a bloated, inefficient, slow bureaucracy?
 

Gary:

Absolutely, the current system isn't ideal. But the question is, how did we get here? We can get into a really long argument about it, but the simple answer is, at least in my mind, as government has become more involved in health care the industry has become more complicated. Those complications have pushed out smaller insurance companies, local insurance companies, that would otherwise provide competition to those evil large health insurance companies. But those smaller insurance companies don't have the size to deal with a web of regulations and complicated protocols, so they are gone. Now we have a field with little or no competition and therefore little or no choices for consumers, which means the large insurance companies can offer limited services and make it difficult for consumers to actually get coverage even though they pay for it because there is no risk of them losing their share of the market.

As Upton Sinclair noted, historically no friend of my side, “The Federal inspection of meat was, historically, established at the packers’ request...It is maintained and paid for by the people of the United States for the benefit of the packers.”

And why would the meat packers, the large industrial corporate meat packers, encourage regulation of their industry?

Well, as historian Gabriel Kolko writes, “The reality of the matter, of course, is that the big packers were warm friends of regulation, especially when it primarily affected their innumerable small competitors.”

Similarly, you don't hear a lot about healthcare industries lobbying for deregulation because that would increase their competition, lower prices, and make the market better for consumers.

No, no, no...this is all silly...I'm sure MORE regulation will make it better.
 

RRL, you know darn well that in all economic sectors smaller competitors have been pushed out by big national corporations, even where there is little to no regulation of the industry (ie, electronics or bath towels).

It is capitalism that created that change, not regulation, or it would be limited to those areas with high levels of regulation.
 

So here's the question RRL and Gary (and others): How did you form your opinions? Is this based upon your hearfelt and longstanding belief in a certain idealogy or ruling principles? Have you read The Weekly Standard, Mother Jones, Commentary, Reason, AMA position papers and so forth?

I have a gut reaction myself against government control. But insurance company control certainly stinks.

The merits of any sort of health care reform is not what I'm getting at though. I'm interested in knowing how we form our opinions.
 

I'm the guy Osler's dad sits next to on the plane. That, and I read the paper and the Economist and things on the internet.
 

I agree with tradelawguy on drug advertising. It needs to stop!
 

Fair enough Iplawguy, I will actually participate in the discussion you want to have instead of just saying the same old stuff about how much I hate the government (though I really hate the government, so I feel like it can't be said enough).

I read a lot of things. I read the local paper (but mostly for news about Baylor football), I read articles in a variety of newspapers (all online), I read George Will, I read the National Review, I read the Huffington Post, I read Andrew Sullivan, I read Christopher Hitchens (though he really writes mostly about foreign policy stuff and how much he hates organized religion), and I occasionally cruise over and read Paul Krugman (because you must know your enemy).

My opinions are also largely based on long-held ideology. But I don't think that means my reactions to things like health care are dogmatic and poorly thought out, I just think it means that I have an overarching worldview that influences my opinions on a wide range of issues. Including this one.

My opinions are also formed after testing them through argument against people that I consider intelligent and informed, but who generally disagree with me. That is why I like this website so much, and why I enjoy fighting with Lane.

So, I guess that is how I arrive at my opinions. It isn't any one thing. It is a collection of things.
 

Hey guys! Just so that we don't get too sad that the French are gone, check this out:

http://translate.google.com/translate?u=http%3A%2F%2Fwww.washingtonpost.com%2Fwp-dyn%2Fcontent%2Farticle%2F2009%2F07%2F27%2FAR2009072701904.html&sl=en&tl=fr&hl=en&ie=UTF-8
 

Iplawguy, I arrived at my position through previous experience that the federal government isn't good at doing anything, except delivering mail and providing a national defense, and in both those areas it has a legal monopoly. And even in those two areas, everything costs more than it needs to, and much more than it would on the free market.

I'm with RRL, the system we have is full of glaring problems, but every time the gov't lifts a finger, somebody pays through the nose.

The best answer is not massive gov't overhaul, but a movement in the industry to control costs (electronic records, reduction of redundant and unnecessary care, etc.) If the gov't needs to encourage this reform with law, fine. But we don't need Congress and the White House rewriting the playbook. Once systemic costs come down, then maybe we look at moving away from an employer-based system and all of that.

And if we're going to touch on the subject of injustice, I have to remind everyone that what we're talking about isn't a lack of access to care, it's a lack of ability to pay. Very different issues with different solutions, but all too often thrown into the same barrel of rhetoric.
 

Arriving at an understanding of health care:

1. Read and listen (RCP, NPR, C-SPAN, the Razor, etc.).

2. Apply my own experiences with health care over my lifetime (watching my father's "indigent care" at the VA, being a young person who did not get sick and eschewed paying for health care, being a young father with a wife and another child on the way without coverage, and being a well-fed beneficiary of the best health care system in the history of mankind).

An Aside: haven't we all been there?

3. Political ideology: I am predisposed to apprehension regarding a national health care system. I think the government (and progressives--who try to use government to make life better for people) is/are well-intentioned but, ultimately, ham-handed and shortsighted.

4. My own personal communion with the unrelenting power of the numbers. Sustainability. How is it possible to have everything we want and NOT pay for it ultimately?
 

RRL, are you suggesting we don't have legislators writing and passing laws? Do you hate government that much?

Yes, legislation can be slow, lawmakers have their own interests and influences pressing upon them. I know this from having worked in government relations for an association in Virginia for two years and lobbying before committees. That's where my cynicism about achieving any huge changes in health care comes from.

It is what it is, and if we want democracy with the system we already have, we're stuck with that reality.

IPLG asks an interesting question, i.e. how we form our opinions on healthcare reform. I suppose mine come in large part from an overarching philosophy, as yours does: a belief in

1. affordability of health care for EVERYONE (and that is synonymous with access, because if you're homeless or got laid off and your unemployment ran out, you have no money to pay for it which means you don't have access to it, Jesse. Or only access in an emergency.)

2. A belief that a country that professes equality and life/liberty/pursuit of happiness should not assume that every single person is capable of providing for himself and keeping himself healthy. Most of us are, but bad things happen. Government in a democracy should ensure that everyone can afford, or is provided, the same basic level of health care.

3. A belief in simplicity. The current system is too complicated. Now, I will admit I don't really know how possible or impossible it is for our government to totally manage health care for the whole country. BUT I don't see how it can be any more complicated than the current tangled web is. And simplicity usually means cost savings.

So these are my underlying beliefs on which I've formed my opinions.

I also base them on personal experience of my friends and family. I have many friends who live in England or France and have had no complaints about their health-care systems. Typically, they are amazed that we have to pay so much for ours and that the preventative level is not the same. I have to believe that, if by all appearances government-run health care works in other democracies, it could maybe work in ours. Maybe.

If not that, then there needs to be something radically different than what we have. And in my 47 years, I have not seen Americans vote very often for anything that's radically different. Things usually have to be dire economically for things to change in a huge way (i.e. the Great Depression leading to public-works projects, Social Security, and so on).
 

I think that a single payer system, such as those in every other Western industrialized country and in many non-Western industrialized countries, would be the best in that it would provide access to every person in the United States.

I do not buy the arguments about long lines, rationing, and so forth that the Right lobbies in the direction of "socialized medicine."

Anyway, everyone over 65 and folks below the federal poverty level have socialized medicine. It is called Medicare and Medicaid. Also, folks in our armed services have "socialized medicine" as well.

And did not the party of small government enact the Medicare Prescription Drug Benefit in 2003. A mandate, which I might add, was charged to the federal credit card whose balance is paid by you and me.

The government may not have a good "track record" in many areas, but have private insurance companies done better by the American people?

Profits are made by denying care, denying access, and dumping people who will need expensive treatments and care.

Why there is so much opposition to single payer, let alone to government playing a larger regulatory role in this part of the economy, stems from our American pathology which sees the government, whoever that may be, as always and forever seeking to usurp our liberties.

Government should be kept in check. Undue governmental power and influence in the lives of individuals can destroy the reality of a free society, let alone a republic. Yet, does anyone honestly believe that government is always the problem in a world in which Hedge Funds have more money and more influence than many governments do.

King George had nothing on Hedge Fund managers.

Forgive me for rambling a bit, but when certain financial players can buy and sell just about anything, the mirage of a free market ought to be dispelled for what it presently is: a fantasy.

At any rate, there are some promising signs arising from the Columbian debates.

One of the good things that I have seen coming out of the Washington debates, and those around the country, is a growing consensus that: 1. insurance companies should not be allowed to exclude based upon pre-existing conditions, 2. every person should have access.

One of the ways to get to universal, or nearly universal healthcare, is through individual mandates.

And if we want to insure everyone, than everyone should contribute. In other words, if we want to achieve universal health care/access, then every person should be willing to pay higher taxes.

This could be accomplished in a myriad of ways. For starters, individuals presently pay social security and medicare taxes on earned income up to 102,000 which means simply that every dollar you earn after 102,000 is not taxed for social security of Medicare purposes. That's ridiculous in my estimation.