Republicans and democrats don't understand each other

[Jeremy Roussak]

They can't.  That's what happened in Britain when the government let a child die overriding the parent's decision.  That's what happens with socialization.  Individuals lose their freedom.  It's powerful and uncaring government that decides.
https://www.vox.com/policy-and-politics/2018/4/27/17286168/alfie-evans-toddler-uk-explained

That is the most utterly ill-informed, ignorant misstatement that I have yet seen on this site, and it's certainly faced stiff competition. Even the article you cite doesn't support the conclusion you draw. Read the judgments, Alan; learn a little about the medicine; give the matter thought rather than using it for your own propaganda; and then apologise.

Jeremy

[Jeremy Roussak]

I am on the Board of Directors of a non-profit and one of our activities is providing health insurance to scientific researchers and their families.  I'm on the insurance committee and see the day to day stuff on claims.  Our organization self-insures but have a large insurance company that manages the claims. ... We have a $250,000 stop loss policy that we pay a lot of money for that will cap our payments in the event of a large claim.

The two phrases I have emphasised seem to me to be contradictory. From your description, what you do is not "self-insurance"; it is conventional insurance with a large excess.

Jeremy

[Rob C]

The trouble is most people don't understand how complicated the current system is.  Most large corporate HR departments hate company insurance plans as the largest number of questions they get come from employees who are having issues with the insurance company.  I think if you asked most CEOs the would be happy to see the government take things over in one form or another (doesn't have to be an NHS model; it could be a regulated insurance model like Switzerland or Holland) so the company could focus on making or selling stuff.

I am on the Board of Directors of a non-profit and one of our activities is providing health insurance to scientific researchers and their families.  I'm on the insurance committee and see the day to day stuff on claims.  Our organization self-insures but have a large insurance company that manages the claims.  We were in deep trouble three years ago as claims were outpacing premiums and the endowment was in trouble.  We had to make some difficult decisions about benefits and co-pays and it was not easy to do.  We stopped covering fertility treatments and tightened up the prescription drug formulary.  We have a $250,000 stop loss policy that we pay a lot of money for that will cap our payments in the event of a large claim.  One year we had several premature births and hit the stop-loss within a month.  One of those claims carried over into the next plan year and we had to eat another $250,000.  If more people had this type of day to day experience and education I would listen to them when talking about how to fix the healthcare problems in the US.  Unfortunately, they do not and only talk about how dangerous "socialized medicine" is despite not knowing much about how the current system works.

You've touched upon some of the problems with a national health sevice, in fact.

I see a national health service as one that guarantees your health, not your vanity or aspirations, or your bad lifestyle choices. Health is not the same as creating a family, which is in the lap of the gods or, perhaps more accurately - if you keep away from swans and showers of gold - inside your respective knickers and the ability of the bits therein to function according to plan. If, for whatever reason they don't, and pregnancies don't show, then that's not a "health" issue: it's a personal one that's not going to kill you or stop you working or from living an otherwise normal life: you are still healthy. There are other such things that get heaped onto the account of the poor old service; it should revert to being only about health.

Health providers being taken to court. If they are private providers, then I can understand why some patients might feel they have had a bum deal: if profit is at the heart and soul of the enterprise then what can you expect? Corners will inevitably be cut unless you have a sheik as patient. If you remove the profit motive, then everyone in the organisation will be freed to work towards the best possible outcome in the absence of fiscal strictures that may dictate how much can be spent on a delivery, for example. (I am guessing these things have an agreed top price in the medical/insurance contract.) I do not think it should be possible to sue doctors for things that go wrong during surgery, for example. With correct scrutiny, idiots do not get jobs in operating theatres. You simply have to accept that if something can go wrong, then there is the chance that it might. That's part of the risk of living. Murder by doctor is another matter.

Cosmetic surgery is another area that strikes me as doubtful. Yes, as result of birth deformity, accident or cancer, for example, rebuilds may be appropriate on the national ticket - probably are. But if it strays into vanity bcause you want to be a model, for example, and there's nothing actually wrong with you, then I hope no state or insurance company is expected to pay for that kind of thing.

Then there's the little matter of self-harm: should smokers still expect free lung, throat or mouth cancer treatment? Should those who have made themselves obese expect free heart, cancer and other fat-related sickness treatment? Folks talk convenient bravado crap about a nanny state: states have a responsibility towards their people. Not only should they take active steps to make people face the realities of their lifestyles, they should also ban the causes of so much eventual distress. Ban the marketing of tobacco products, of suggary drinks, of fatty, sweet junk foods. It may be unpoplar, but it can be done, and should be done. My wife and I both stopped having sugar with our tea because so many people we knew didn't take it, that we became used not to being offered any; today, I drink very little tea and couldn't take even a sip of sweet tea without spitting it straight out. In fact, I have taken to drinking hot water instead, and even my coffee intake has dropped considerably, but that was mainly because of post-heart attack advice.

A national health service must not be taken as synonymous with the abandoning of self-control and sensible living.

Rob

[JoeKitchen]

Tell me where I'm wrong here:

1.  Americans pay more for health care than any other nation.
2.  Americans have the same or worse health care results than any other nation.
3.  Americans frequently suffer irreparable financial ruin because they get sick.
4.  Americans suffer the indignity and insanity of reading highway billboards advertising hospitals. (who pays for those ads?)
5.  America is the only western nation to not offer universal, government funded health care.
6.  America is host to some of the world's best medical technologies, practices and practitioners.
7.  Democrats are in favour of aligning health care practices with those of the rest of the world.  Republicans refuse to consider this.

So, EITHER: the entire rest of the world (and Democrats) are wrong and Republicans (and the health care industry) are right.
     OR: Democrats (and the rest of the world) are right and Republicans are wrong.

Please correct any errors in my knowledge.

1.  Americans spend more on everything else when compared to the rest of the world, why would healthcare be different?  Plus, we have the worse diet and probably exercise the least, so our lifestyle plays a large part of it. 
2.  Once again, our lifestyle is the worse in the world.  We eat more meat, more sugar, more fructose, more processed foods.  Do you think people as unhealthy as us are going to end up better even with great healthcare than people who actually eat correctly?  Hippocrates once said, “Let food be thy medicine and medicine be thy food.”  The west has forgotten this and this more then likely why we are so bad off. 
3.  Going back to Slobo's post, at least we have the option of being served and served immediately for major operations.  The other option is death.  And before on go about the quality of other countries, you need to really look at non-emergency operations, such as those not associated with some type of accident.  In all cases I have looked, we still have the best care. 
4.  What's wrong with advertising hospitals?  Would you rather us not know what hospitals are in the area, where they are, what they perform? 
5.  Very obvious truism. 
6.  Which is precisely due to our healthcare system being largely capitalism based.  You cant expect companies to invest large amounts of money into research if they can not make a profit.  But this is exactly what many other countries do, limit prices and limit profits.  You see the results, no one really invests money into companies outside of the USA.  On top of that, while we do have a freer market based health system, it is still highly regulated and the government makes it difficult to bring a new drug or devise to market.  This means once a company develops a product, other companies in many instances dont see the reason to follow suit since it cost too much to bring it to market, allowing a monopoly to exist and providing no checks on prices.  This was on display with the Epi Pen a few years ago.  At the time, other companies responded by trying to develop their own, but it was predicted to take more then a year to get approval for a device that was nothing more then a automated syringe with a already approved drug in it.  Go figure.  Deregulating the air industry in this country had the net effect of creating more airline companies and lowing ticket prices.  Why would this be any different with medical products? 
7.  Doing so will kill the profit motive and stagnate research.  Although their are many people who are kind hearted and go into research to help the world, it still cost money to do so, lots of money.  If investors cant make a profit with their investment, they will put their money into other areas of the market.  Moneys given to the medical research world will dry up.  Sure, some universities will continue to do research and perhaps make break throughs, but the vast majority of money is currently in private companies.  This will start to disappear. 

[Alan Goldhammer]

The two phrases I have emphasised seem to me to be contradictory. From your description, what you do is not "self-insurance"; it is conventional insurance with a large excess.

Jeremy

Jeremy, you misunderstand self insurance.  Conventional insurance means that you pay a management company, say Aetna, BlueCross, or United Health care a flat rate and they assume all the risks.  they also set an underwriting margin that set's their reserve and profit margin.  In a self insurance model, the organization assumes the full liability and has to set it's own reserve and margin.  I'm not aware of any self insurance model that is designed to make a profit.  Self insurers will routinely purchase stop loss policies as a way of controlling risk and have to be vigilant to maintain proper margins.  In most cases self insurers can run a program that costs less than contracting with a profit making organization.

[JoeKitchen]

Probably because you are the most populated western country. There are more doctors, more hospitals, more universities, etc. Does that make them the best?
I recently travelled a lot in the Middle East and there are specialised hospitals everywhere. There is probably one for ingrown toenails.

What part of the Middle East?  Some of the oil rich countries have so money per capita, they dont know what to do with it.  So I am sure a lot of it goes into hospitals. 

However, once we get off of fossil fuels, their oil money will dry up as fast as water does in those countries, so this could very well be a temporary occurrence. 

[JoeKitchen]

Another point. 

I was recently reading a top ten list on the worse ways to die (do ask how I came across this).  I was surprised to see Scaphism at the number 2 rank since it is always universally regarded as number 1.  But number 1 is now considered dying of old age in a Western culture. 

Turns out we are so good at extending life, at a great cost mind you, but we still don't know how to mitigate the pain associated with this extension of life.  I once read that end of life treatments in the final couple of weeks is what eats up the most money in our medical system.  However, if spending this money to only extend life by a couple of weeks ends up making it the worse way to die, worse then Scaphism, perhaps we are misguided in our approach at it. 

[Alan Goldhammer]

6.  Which is precisely due to our healthcare system being largely capitalism based.  You cant expect companies to invest large amount of money into research if they can not make a profit.  But this is exactly what many other countries do, limit prices and limit profits.  You see the results, no one really invest money into companies outside of the USA.  On top of that, while we do have a freer market based health system, it is still highly regulated and the government makes it difficult to bring a new drug or devise to market.  This means once a company develops a product, other companies in many instances dont see the reason to follow suit since it cost too much to bring it to market, allowing a monopoly to exist and providing no checks on prices.  This was on display with the Epi Pen a few years ago.  At the time, other companies responded by trying to develop their own, but it was predicted to take more then a year to get approval for a device that was nothing more then a automated syringe with a already approved drug in it.  Go figure.   

Five of the top ten pharma companies are foreign (Bayer, Hoffmann-La Roche, Sanofi-Aventis, GSK, Novartis).  Pharmaceutical regulations are pretty much the same world wide and in fact most approvals of novel therapies occur first in the US.  There are many examples of competition within therapeutic categories for pharmaceuticals.  To cite one classic example, Liptor was the fifth or sixth statin drug to be approved in the US yet it became the number one prescribed drug as it had the best benefit/risk profile of all the drugs in the class.  The EpiPen is a complicated example to cite as it is a drug-device combination and hence requires more regulatory oversight.  Because it is an injectable, manufacturing is more complex because of sterility concerns.  While Mylan has the marketing rights for the EpiPen there have been several other adrenaline auto injectors on the market.  One was recalled last year because it delivered inconsistent doses of the medicine and AdenaClick is available for much less than the EpiPen.  Autoinjector technology is no longer covered by patents and there are numerous drugs available today that use that technology (most are high cost biologics). 

[Rob C]

What part of the Middle East?  Some of the oil rich countries have so money per capita, they dont know what to do with it.  So I am sure a lot of it goes into hospitals. 

However, once we get off of fossil fuels, their oil money will dry up as fast as water does in those countries, so this could very well be a temporary occurrence.

No, Joe: those cats understand diversification of portfolio better than you think. Heysoos, they own most of what's worth owning in London!

[Alan Goldhammer]

Turns out we are so good at extending life, at a great cost mind you, but we still don't know how to mitigate the pain associated with this extension of life.  I once read that end of life treatments in the final couple of weeks is what eats up the most money in our medical system.  However, if spending this money to only extend life by a couple of weeks ends up making it the worse way to die, worse then Scaphism, perhaps we are misguided in our approach at it.

It's not just medical treatment but cost of long term care that build up.  You see a lot of people setting up trusts to shield their income so they qualify for government assistance in nursing homes (Medicaid covers this) and the cost of home health assistance if you choose to age in place is expensive as well.

[Rob C]

Another point. 

I was recently reading a top ten list on the worse ways to die (do ask how I came across this).  I was surprised to see Scaphism at the number 2 rank since it is always universally regarded as number 1.  But number 1 is now considered dying of old age in a Western culture. 

Turns out we are so good at extending life, at a great cost mind you, but we still don't know how to mitigate the pain associated with this extension of life.  I once read that end of life treatments in the final couple of weeks is what eats up the most money in our medical system.  However, if spending this money to only extend life by a couple of weeks ends up making it the worse way to die, worse then Scaphism, perhaps we are misguided in our approach at it.

Worst way of dying contains so many variables that as a proposition, it's almost absurd. Amongst many, would be being mentally and physically well, but destitute, with your house and everything else being taken away from you. From the palace to the street.

[Alan Klein]

My understanding is that the government doesn't want to spend the money fir the amount it would cost.

[JoeKitchen]

Worst way of dying contains on so many variables that as a proposition, it's almost absurd. Amongst many, would be being mentally and physically well, but destitute, with your house and everything else being taken away from you. From the palace to the street.

Maybe, but the ancient world came up with some pretty heinous execution techniques.  Some were fast and painless, some lasted days (like Roman crucifixion) and some lasted weeks (like Scaphism).  In talking about pure physical pain experienced over a long period, I cant imagine something worse, except perhaps for now dying slowly from old age in an hospital where death is still the end result, all the while experiencing non-stop pain that would have been avoided if death came a couple weeks earlier. 

[Slobodan Blagojevic]

On the contrary, the courts (not the government)...

Courts are the government.

Unless you are a disciple of the AOC, that is, not knowing the three branches of government.

[Slobodan Blagojevic]

That is the most utterly ill-informed, ignorant misstatement that I have yet seen on this site, and it's certainly faced stiff competition...

Why, Jeremy? I am genuinely puzzled. It seems to me Alan K. simply stated a fact, no?

[RSL]

Courts are the government.

Unless you are a disciple of the AOC, that is, not knowing the three branches of government.

He doesn't know the difference, Slobodan, and certainly hasn't a clue about the three branches. He won't tell us his age or where he is, but it's pretty clear he's very young and not in the U.S., and likely not in Canada. Ignorance isn't a limiting factor for people with opinions who aren't willing to do any research. Nowadays you don't have to go to the library and sort through the cards in the catalog to do the kind of research you need to avoid this kind of ignorance. But you still have to put forth a small bit of effort. Too much trouble.

[James Clark]

Courts are the government.

Unless you are a disciple of the AOC, that is, not knowing the three branches of government.

As long as you understand that air superiority was crucial to the defeat of Cornwallis of Yorktown you’re qualified in my book. 

[JoeKitchen]

He doesn't know the difference, Slobodan, and certainly hasn't a clue about the three branches. He won't tell us his age or where he is, but it's pretty clear he's very young and not in the U.S., and likely not in Canada. Ignorance isn't a limiting factor for people with opinions who aren't willing to do any research. Nowadays you don't have to go to the library and sort through the cards in the catalog to do the kind of research you need to avoid this kind of ignorance. But you still have to put forth a small bit of effort. Too much trouble.

It's kind of sad how many people don't understand basic civics any more. 

I went to a catholic grade school and private high school, and they drilled this into our heads.  (Along doing times tables to the point where we started dreaming about it, can you imagine the torture.)  So my experience certainly does not relate to the overall public.  I have to ask, is civics still taught in school? 

I know time tables are not nearly as much, and instead we teach kids why 2x4=8 instead forcing them to memorizing it.  I am sure there is an argument as to why we need to concentrate on this more then rote memorization.  However, as a former high school math teacher I can tell you the biggest hold up kids have today in higher levels of arithmetic is not knowing products of multiplication instantly without needing to use a calculator.  So many of my students got held up in Algebra and wasted time trying to figure out which two numbers when multiplied had the product of the number currently in the problem.  (Personally I blame all of this on grade school teachers.  I tutored too many of them in college to have any confidence what so ever in their basic arithmetic skills and the ability to actually teach it.) 

I fear if civics is taking a back seat in schooling, we are only doomed for people not understanding how the government really works and getting bent out of shape more often. 

I also fear that since we are concentrating on our history too much and only skimming over the history of socialist countries and the atrocities committed within those countries, we are setting up a recipe for disaster. 

[jeremyrh]

He doesn't know the difference, Slobodan, and certainly hasn't a clue about the three branches. He won't tell us his age or where he is, but it's pretty clear he's very young and not in the U.S., and likely not in Canada. Ignorance isn't a limiting factor for people with opinions who aren't willing to do any research. Nowadays you don't have to go to the library and sort through the cards in the catalog to do the kind of research you need to avoid this kind of ignorance. But you still have to put forth a small bit of effort. Too much trouble.

Alan was referring to a case in the UK.

https://www.judiciary.uk/about-the-judiciary/the-judiciary-the-government-and-the-constitution/jud-acc-ind/justice-sys-and-constitution/

"The justice system is one of the three branches of the state. The other two branches are the executive, or the government, and the legislature, which is the two Houses of Parliament."

[JoeKitchen]

Five of the top ten pharma companies are foreign (Bayer, Hoffmann-La Roche, Sanofi-Aventis, GSK, Novartis).  Pharmaceutical regulations are pretty much the same world wide and in fact most approvals of novel therapies occur first in the US.  There are many examples of competition within therapeutic categories for pharmaceuticals.  To cite one classic example, Liptor was the fifth or sixth statin drug to be approved in the US yet it became the number one prescribed drug as it had the best benefit/risk profile of all the drugs in the class.  The EpiPen is a complicated example to cite as it is a drug-device combination and hence requires more regulatory oversight.  Because it is an injectable, manufacturing is more complex because of sterility concerns.  While Mylan has the marketing rights for the EpiPen there have been several other adrenaline auto injectors on the market.  One was recalled last year because it delivered inconsistent doses of the medicine and AdenaClick is available for much less than the EpiPen.  Autoinjector technology is no longer covered by patents and there are numerous drugs available today that use that technology (most are high cost biologics).

Well, as you stated, the USA is typically the first place a new product is release, so you have to wonder why?  Perhaps because it is easier here to start making a profit off of it? 

However, I will contest that this is a double edged sword, and that my overall free market ways does cause me to have a certain amount of confirmation bias as well.  I recently watched a documentary on new medical devices being pushed hard onto doctors by the manufacturers with little testing done.  (Regulations for medical devices are considerably lower then for new drugs.)  However, many doctors don't realize how little testing has been done, since it is assumed from the fact that other areas of medical research require a lot, and they just recommend these things to their patients with many having pretty severe results.  I think one example they cited was a new joint replacement device that was found to leach out a mentally damaging metal compound into the blood stream.  The doctor who used this device on himself nearly lost his license due to mental issues that developed over time.  Fortunately he was able to diagnose the cause and had the new joint replaced with a time tested product. 

So, yes, some regulation is needed.  Too much though can be bad.