Right. And we’ve established that a person has the right to emergency care. Are you saying that everyone has a right to transplants? There’s no right “not to die.”
emack, the whole license thingy does sound like a nightmare, and I empathize with you. I am totally down with wanting to tear something, anything, limb from limb. But I don’t really see it as being DMV’s fault, other than whatever length their lines may be. Seems they made a reasonable attempt to communicate something completely outside of their normal sphere of influence to some other agency. And it appears that the other agency is the one falling down on the job. Methinks your ire is somewhat misplaced. [/hijack]
As for the assertion that the dead cost nothing, well, it simply isn’t true. The direct costs are substantial. The indirect costs of recruiting, training, and properly utilizing replacements for lost workers is also substantial regardless of the skill level of the person being replaced.
More to the point though, prevention of illness and death is also cost effective. In addition to the, eh, ‘final costs’ above, illness represents a huge expense in absenteeism and other loss of productivity across our whole economy. A worker coughing and hacking his way through the sales meeting, or the assembly worker struggling along with her “bad elbow” are hardly as productive as healthy workers would be. The former is also going to expose everyone else in the office, ensuring a continued and expanded loss of productivity. And the later might actually endanger other workers because of her physical impairment.
Prevention is far more than screenings for diabetes. It encompasses all aspects of ‘healthy person care’ including dietary and life style counseling, vaccinations and other preventative measures, and proactive identification and remediation of injuries and developing conditions at the most treatable (which is to say, early) stage.
Simply reducing the duration of coughs and colds by increased immunity due to better general bodily condition would save business and government probably billions of dollars annually. If people could get that mole looked at cheaply and easily before it becomes cancerous, or have that sore knee treated before it degenerated into a candidate for surgical replacement, the work force would benefit by the presence of these workers rather than their absence for hospitalization. Et cetera.
Unfortunately, it is problematic and contentious to attempt to quantify these economic benefits. Under any possible system of UHC, would there be no full blown skin cancers or zero knee replacements? Hardly. But surely, given a wider availability of care (availability in the financial sense) there would be less.
Clearly there are issues with each of the different implementations of UHC we can point to around the world. But it seems that, regardless of the problems in each different system, every one of them provides equivalent or better health outcomes for its citizenry as a whole than the US system, and every one of them does it at a financial cost lower than, and often substantially lower than, the US system. I believe this allows us to quite reasonably conclude that UHC is indeed cost effective.
That’s all that has to be said. Issues of rights, efficiency, and preventative care are all diversions from the real focus and easily argued against.
Most Americans with health insurance get it as part of a group plan at their work. UHC is the same thing, but now includes a larger pool meaning lower premiums. And since the US already has UHC for the old and the poor very little actually changes in terms of cost increases. What you see are massive savings to the typical middle class consumer.
I would be interested in seeing cites for the above - for example, that workers without health insurance are absent from work more often than those with. Or that absenteeism is lower in countries with UHC than in the US.
Another issue is that most health care costs are incurred in the first year, and last six months, of life. Relatively few newborns are employed, and most of the folks who die in the US are over 65 and retired. Therefore, it is possible to spend a lot on health care and not address the problems of absenteeism at all.
Particularly in the case of newborns. My cousin used to run the neonatal ICU at a local hospital, and most of her patients either cost a lot of money and then died anyway, or went home significantly compromised in their health status. It was not a matter of spending money and winding up with someone who could become a productive worker after they grew up - it was a matter of spending a lot of money on someone who was going to continue to cost far more than average for the rest of their lives.
Now maybe it is still worth doing, although I have my doubts. But it does not seem to me to be plausible to argue that sending all the bills to the government is OK because we will get it all back in taxes eventually.
Debating health care is hard because some of the facts are counter-intuitive. It sure sounds like we should save money if we prevent disease instead of treating it, but it doesn’t seem to work out that way consistently. It seems like eliminating cigarette smoking should save money, because we won’t have to treat as much lung cancer and COPD and heart disease. But nope - several studies found that, on average, cigarettes saved the health care system something like an average of $.37 per pack smoked.
Regards,
Shodan
You won’t see that because almost by definition to be a “worker” in the US means having employer based health insurance.
So a study wouldn’t need to be between the US an all the other countries with UHC, it would simply need to look at two similar companies in the US where one offers health insurance and the other doesn’t.
Which highlights one of the problems here. We’re not arguing UHC vs not having any medical care. We’re arguing UHC vs the US version of kind-of-UHC.
And oddly enough, those over 65 in the US have UHC.
And that’s the main reason why a cost benefit analysis tends to fail. If we consider that kid a liability to society then throw the little bugger in the trash. More often that not we consider each baby a precious joy and ignore future earning potential when considering life saving treatment.
I remember hearing about a country that limited each family to have only one child. As a result parents considered having a daughter a liability due to limited earning potential. Hilarity ensued.
No, it’s still worth doing.
Which is why that’s a shitty argument to begin with.
That and most of the facts are buried in jargon and rhetoric.
Correct, but what would your approach be for giving out the organs that are available?
Other countries are quite happy to give transplants on a basis of medical necessity, not ability to pay. There is still a shortage of organs but we end up satisfied that those that are available are going to the right recipients.
Is that the same in the US?
Around here in the US you get denied organs even if they’re available. Just because you don’t have enough pieces of official currency paper to pay for it.
But don’t you dare call that rationing. Only Governments ration. :rolleyes:
Then lack of health insurance can’t be causing all that much absenteeism.
I think a good deal of the urge to define taxpayer-funded health care as a “right” is to prevent cost-benefit analysis altogether.
As I mentioned from my cousin’s experience, [ul][li]it often isn’t life-saving, just death-delaying and wallet-emptying [*]ignoring the question “how are we going to pay for all this?” is a large part of the reason health care costs keep going up in the US.[/ul]Whether or not we implement UHC in the US, we are going to have to have some kind of de facto rationing. Saying “every life is irreplaceable” is a nice sentiment but not worth much in practical terms. [/li]
It’s an argument I’ve made before. We might save significant lives if we reduced the national speed limit to 20 mph. But we aren’t going to do that, because, whether we admit it or not, the lives saved are not worth the additional costs in time and money that a 20 mph speed limit could bring about.
Same with health care. Saying “every life is sacred” tends to wind up meaning “let’s blow the wad on medications for grandma that cost three times as much and work about 10% better”. And then she dies of a heart attack at 78 instead of 75. Is it worth it? We’ll never know if we bury the question in rhetoric about children and precious angels and whatnot.
We will never save money until we can say No. And the No won’t count until we say it even when someone’s loved one will die unless we say Yes.
Regards,
Shodan
We’ve been through this before, and you know it’s nonsense. But kudos for making rationing look scary and implying that it doesn’t happen in the US.
You managed to bring up grandma but seemed to forget that she’s already covered under the current UHC for old people. Remember? Medicare? Does that ring any bells?
So you’ve already blown your wad all over grandma, and admitted health care for the general population is cheap in comparison. And both of those groups are currently paid for first by the government and then by employer based systems, that part of the UHC equation is already coming out of your paycheck.
But you’re still scared of something, what? What has you so scared? That some of your tax dollars might pay for someone undeserving? That a $1000 might be spent and only extend someone’s life by a week?
I’d assume you’re currently paying into a company based insurance policy, are you as worried about someone in your office running up the tab?
The doomsday scenario you’re trying to scare people with just doesn’t happen except within the US, where rationing is very real and very deadly. UHC in other countries is okay spending a lot on one person because it’s rare and it’s the reason for having a health care system.
[quote=“Shodan, post:148, topic:582188”]
As I mentioned from my cousin’s experience, [ul][li]it often isn’t life-saving, just death-delaying and wallet-emptying ignoring the question “how are we going to pay for all this?” is a large part of the reason health care costs keep going up in the US.[/ul]Whether or not we implement UHC in the US, we are going to have to have some kind of de facto rationing. Saying “every life is irreplaceable” is a nice sentiment but not worth much in practical terms.[/li][/QUOTE]
emack did a fine job with the rest of your arguments; allow me to pick up this part.
If the discussion is restricted to a neonatal ICU, then there is little surprise that the end results are skewed toward poor outcomes, and the money spent is not commensurate with the “improvement” in those lives. But of course the whole point of UHC is that it is – wait for it – universal. So all those healthy kids whose “well baby care” costs a pittance vastly outnumber those who require end-game services in a neonatal ICU. It is them who provide the counter-point to the terminally afflicted.
Besides, as has been pointed out repeatedly, these extraordinary expenses for the very young and the very old are already born by all of us through our insurance premiums (those of us fortunate enough to have insurance) and our taxes for Medicare and Medicaid. It’s just that under UHC, the families of those expensively terminally afflicted would not be crushed and bankrupted before they qualify for government subsidized care.
And that is a point not already entered into the cost – benefit calculations above: The cost to society of multitudes of defaults and bankruptcies caused by the unsupportable weight of health care costs. How productive are these workers, straining to keep up second and third jobs to save the house and pay the medical bills, before they finally collapse both financially and physically and often psychologically as well?
Anyone who has any education in economics knows that workers who collapse financially and physically from these problems are simply interchangeable carbon blobs! Easily replaced; simply sweep them onto the pile, hang a help wanted sign and watch the thousand replacement resumes roll in!
</satire>
My god you’re right! We can’t let any of them die because they are all special and unique flowers that the business relies on and can never replace.
Wait, weren’t you the one that said if Stephen King died someone else would replace him?
You dont think that if Stephen King didn’t exist, America would have another, or several other, favorite horror writers? Have you any clue at all how book marketing works? I’ll grant you some writers have a better grasp of the collective psyche than others, and King has a very fine grasp of it with regard to horror, but … they are in fact, replaceable, they get replaced all the time by publishers. J.K. Rowling is gonna be hard to replace … but she will be replaced …
So what you’re saying is that they’re replaceable, perhaps even interchangeable?
I didn’t imply anything of the sort, and I don’t think it is scary. I think it is absolutely necessary, and indeed, almost unavoidable.
You are aware, are you not, that Medicare is currently running at a deficit, and is on schedule to go bankrupt altogether? Even the trustees say -
Are you sure this is a model you want to apply to the general public?
Actually more like $50,000 might be spent and only extend someone’s life by a week.
Regards,
Shodan
See page 12 of this PDf document. 58% of small employers offering health benefits say it has an impact on reducing absenteeism, with 17% saying it had a major impact.
The report, which is fascinating, also makes it clear that your view of being a worker means that you have health insurance is very wrong in the US. Page 4 notes that 4 out of 5 people without health insurance were in fact employed. Since you live in Canada, I certainly understand how you could not believe things here are this bad.
Hell no. Medicare isn’t allow to negotiate prices, fix that and you get a system more like the VA. Medicare is easy to fix, and the point remains that it’s currently part of your paycheck. Switching to UHC means they are still part of your paycheck.
Regards.
So they are not able to fix Medicare, but UHC will be implemented just fine.
Uh huh.
Regards,
Shodan
so you agree that rationing done by experts using rules worked out in advance is better than rationing done on an ad hoc basis based more or less on income?
Are you aware that private insurance companies are requesting double digit increases in premiums? If Medicare did that it would soon be solvent again - but we could hear the “no new taxes” screams all over the country.
Clearly a system with a bigger subscriber base is more efficient than one with a smaller base, so universal Medicare would help. Second, a universal systems could enforce know best practices, which make some regions have much lower health costs than others. Private insurance companies, which profit based on a percentage of income, don’t have much of an incentive to do this, and don’t have the clout in any case. Third, every doctor I go to has at least one full time person doing insurance. The larger groups have whole departments. Getting rid of this overhead will certainly reduce the costs, right? It is good that the insurance companies are finally moving to a standardized form. How very 20th century of them.
We can lower health care costs by wringing inefficiency out of the system - or we can lower them by wringing people out of the system.
And I definitely agree that looking rationally at end of life care is important. My relatives have died cheaply, by the way.
They couldn’t “fix” Medicare because the stupid Republicans had a thing against the government saving money from the poor, underprivileged drug companies.
Don’t kneecap someone and then tell them that they had better do more about getting in shape for the race.