Obamacare

GasBandit

Staff member
This is completely false. There will always be an incentive in medical advances, if only because of the completely indiscriminate nature of illness and injury. A cure for HIV, Aids, and Cancer will be found not because whoever finds it first will become rich (though they will, no matter what they charge) but because virtually everyone knows and cares about someone that is suffering from these... even the rich. Life expectancy will continue to extend because people are afraid of dying. Replacement limbs will become better and better (and cheaper) because ANYONE can involved in an accident that causes them to lose a limb. Polio treatments were devised because even people like a Roosevelt could get it. There is simply too much self incentive in ensuring that medical technology is the latest and greatest for people to stop making just because they aren't making as much money off of it.
You need only look at the difference in quality of care between the US and the UK or Canada to see the difference. Cancer survival rates are much higher here. Canadians often lament how their best doctors go to the US where they can make better money. Yes, medicine will continue to advance, but not nearly so quickly, and existing care will not be provided with the same urgency or quality.[DOUBLEPOST=1384382923,1384382854][/DOUBLEPOST]
Medicine for profit is the reason you can't watch football with a kid in the room any longer.

Uncle [me]? what is a four hour erection?
Maybe the problem there is the taboo mystification we've artificially foisted upon sex, anatomy, and human biology?[DOUBLEPOST=1384383058][/DOUBLEPOST]
He's talking about Shriner's and Saint Jude's Hospitals etc.
The CEO of St. Jude's not hurtin'.
 
I don't think this is true. Pretty sure you can have private supplemental insurance in Canada.
Only for things not covered, like getting a private room, assuming that's even available. So if you want to get something done faster you can't buy insurance for that either. Occasionally you can BUY your way to the front of a diagnostic imaging line (which means you might get to see that specialist 6 months earlier. No I'm not exaggerating about some wait times), but to get treated, not just diagnosed, no way. And btw, it's illegal to buy insurance for something like that, since it's "required" and thus even though you can buy your way to the front, you can't insurance your way to the front, ensuring only those really really well-off could afford even that.

There are other models with universal coverage which are good, even with less expense. As mentioned, UK, and many other places in Europe. But NONE of those are single-payer. Canada is. To our detriment.
 
Without personal incentive, there's no reason to strive.
There are two points I wish to make on this statement:

1.) This is ONLY true if motivation is derived through some kind of reinforcement, where outcomes influence frequency of the behaviors that precede it. There are very good reasons to believe that people do not actually function in this way. Much like modern economists are coming to grips with the irrationality of consumers, behavioral psychologists are struggling to accept that people are not as robotic as B.F. Skinner preached.

2.) "Personal incentive" is not limited to financial incentive. As an example, if you pay someone to do their favorite hobby, they actually become LESS interested in doing it.

There is a lot more to both of those points that requires more than a cursory, pop psychology understanding of how people work. Needless to say, your thoughts on the subject are considerably out-dated and devoid of the necessary nuance.
 

GasBandit

Staff member
There are two points I wish to make on this statement:

1.) This is ONLY true if motivation is derived through some kind of reinforcement, where outcomes influence frequency of the behaviors that precede it. There are very good reasons to believe that people do not actually function in this way. Much like modern economists are coming to grips with the irrationality of consumers, behavioral psychologists are struggling to accept that people are not as robotic as B.F. Skinner preached.

2.) "Personal incentive" is not limited to financial incentive. As an example, if you pay someone to do their favorite hobby, they actually become LESS interested in doing it.

There is a lot more to both of those points that requires more than a cursory, pop psychology understanding of how people work. Needless to say, your thoughts on the subject are considerably out-dated and devoid of the necessary nuance.
I'll bear my lack of nuanced understanding in mind as our health care quality continues to suffer and degrade under the tyranny of the well-meaning.
 
You know, there's a reason US doctors dont flood to the UK and Canada to practice. Listening to my brother (4th year med student) talk about the massive increases in paperwork (among other things) and how, as someone on the admissions board to medical school, numbers are dropping, I can't help but feel this is a rather inadequate solution.
 

Necronic

Staff member
You need only look at the difference in quality of care between the US and the UK or Canada to see the difference. Cancer survival rates are much higher here.
That is the ONLY advantage here, and its not universal. Preventative care does more to expand lifespans than obscenely expensive end of life care.
 

GasBandit

Staff member
THERE'S the GasBandit we know and moderately tolerate!
[DOUBLEPOST=1384389034,1384388971][/DOUBLEPOST]
That is the ONLY advantage here, and its not universal. Preventative care does more to expand lifespans than obscenely expensive end of life care.
Most private insurance already covers 100% of preventative care with no out-of-pocket. Why do we need to socialize again?
 
All of these same arguments were made against Social Security. Try and take that away now from the very people who had railed against it and see how much they fight back.
Which is another huge problem with ACA. We are adopting a terrible system no one like, but we won't be able to get rid of it once benefits start kicking in.

Considering the very low enrollment rate of the healthy young, it appears it's going to cost a lot more than anyone guessed. Further it's the middle class that appears to be bearing the brunt, but most won't see it since it's being tacked onto employer insurance plans. The funny thing is that even if you are eligible for a subsidy, if you get insurance through your employer they won't get the subsidy. You won't get the subsidy. So we are going to be creating an inequality in government supplied benefits based on who is paying for health insurance.

Of course the responsible thing for most service related businesses to do is cut all their worker hours to below the minimum required to supply healthcare, cut those benefits, and give them a small raise to cover the government health insurance after the subsidy.

It will be significantly cheaper to hire two employees and provide just enough of a pay bump to cover subsidized insurance than to hire one and pay for unsubsidized health insurance directly.

As a bonus, employment figures go up, which makes the administration look good, even though the reality is that these policies are simply creating a class of underemployed workers, reducing the total economic output of the US, and keeping far more people in poverty.

This forced stratification isn't going to end well.
 
the responsible thing for most service related businesses to do is cut all their worker hours to below the minimum required to supply healthcare, cut those benefits, and give them a small raise to cover the government health insurance after the subsidy.
Not that the trend in retail hasn't already been one of "make everyone part-time that way you don't have to spend on benefits," but codifying it just seems...well, cheap*.

--Patrick
*as in "cheap shot"
 
"The market" also unfortunately tends to prioritize short-term gains over long-term sustainability (because that will be "someone else's problem").

--Patrick
 
Generally yes, though it's often the correct choice anyway. Long term strategy is risky as well, particularly in markets that are changing rapidly. Just about anything attached to the internet can't be expected to live for more than a few years, and due to the internet and continued, and accelerating, globalization, most industries are impacted.
 
I'll bear my lack of nuanced understanding in mind as our health care quality continues to suffer and degrade under the tyranny of the well-meaning.
Even if the quality of health care does suffer, it won't be due to lack of profit incentive, per your erroneous beliefs of human psychology.
 
Even if the quality of health care does suffer, it won't be due to lack of profit incentive, per your erroneous beliefs of human psychology.
So you feel confident in saying profit incentive has absolutely zero impact in the quality of health care?

EDIT: Or am I reading your statement too broadly, and you just mean that whatever impact the ACA has on profit incentive isn't enough to reduce the quality of health care by itself? The first option seems too extreme, and the second, while more plausible, I would think would be difficult to demonstrate.
 
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So you feel confident in saying profit incentive has absolutely zero impact in the quality of health care?

EDIT: Or am I reading your statement too broadly, and you just mean that whatever impact the ACA has on profit incentive isn't enough to reduce the quality of health care by itself? The first option seems too extreme, and the second, while more plausible, I would think would be difficult to demonstrate.
Actually, I contend that reducing financial incentives might have some negative effects but that there will likely be paradoxical positive effects. Human motivation isn't a one variable system, nor is it even dominated by external incentives. For example, offering students financial incentive to improve grades in high school appears to do very little at all to improve performance. (Sorry, no link. I'm on my phone)

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Generally yes, though it's often the correct choice anyway. Long term strategy is risky as well, particularly in markets that are changing rapidly. Just about anything attached to the internet can't be expected to live for more than a few years, and due to the internet and continued, and accelerating, globalization, most industries are impacted.
While I can see diagnostics taking a hit (many office visits can be replaced by videochat), treatment probably won't take a big hit from the presence of the Internet except in certain fields (orthotics & 3D printing, for instance).

--Patrick
 

Necronic

Staff member
Most private insurance already covers 100% of preventative care with no out-of-pocket. Why do we need to socialize again?
Uninsured + Cost shifting + EMTALA

I'll see if I can find the study I saw where it showed that we pay more per capita in taxes than a lot of socialized healthcare systems, cover less of our people, and even when you add in the private insurance we only lead in late stage cancer survivability.[DOUBLEPOST=1384408210,1384407833][/DOUBLEPOST]ok, this one has some good tables up front, but it wasn't the one I remember.

http://www.commonwealthfund.org/~/media/Files/Publications/Fund Report/2011/Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf[DOUBLEPOST=1384408564][/DOUBLEPOST]Another good one, look at the spending rates in table 1. You want to tell me that our system is better you have to justify both costs and results. Costs are not just mildly higher. We spend as much as most socialist healthcare systems just for the public side of our healthcare. Add in the private side and we spend almost double what most other countries spend.

http://image.guardian.co.uk/sys-files/Guardian/documents/2011/08/07/JRSMpaperPritWall.pdf

Note table 2. We have had less impact in reducing mortality than almost every other socialized country on that list. These are countries that SPEND LESS MONEY.

So, lets break it down.

We spend more tax money on healthcare
We get worse results.

....so why is the pseudo-privatization we have now a good system?

Get past the empty rhetoric and anectdotes. Show me in numbers how our system works better. And try to show something other than cancer.
 

GasBandit

Staff member
Uninsured + Cost shifting + EMTALA

I'll see if I can find the study I saw where it showed that we pay more per capita in taxes than a lot of socialized healthcare systems, cover less of our people, and even when you add in the private insurance we only lead in late stage cancer survivability.[DOUBLEPOST=1384408210,1384407833][/DOUBLEPOST]ok, this one has some good tables up front, but it wasn't the one I remember.

http://www.commonwealthfund.org/~/media/Files/Publications/Fund Report/2011/Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf[DOUBLEPOST=1384408564][/DOUBLEPOST]Another good one, look at the spending rates in table 1. You want to tell me that our system is better you have to justify both costs and results. Costs are not just mildly higher. We spend as much as most socialist healthcare systems just for the public side of our healthcare. Add in the private side and we spend almost double what most other countries spend.

http://image.guardian.co.uk/sys-files/Guardian/documents/2011/08/07/JRSMpaperPritWall.pdf

Note table 2. We have had less impact in reducing mortality than almost every other socialized country on that list. These are countries that SPEND LESS MONEY.

So, lets break it down.

We spend more tax money on healthcare
We get worse results.

....so why is the pseudo-privatization we have now a good system?

Get past the empty rhetoric and anectdotes. Show me in numbers how our system works better. And try to show something other than cancer.
You're presenting a premise I did not assert. The only options are not "socialize" and "leave it how it was." That's a false dichotomy. The problem you describe comes from trying to straddle the fence too much, so we rob ourselves of much of the benefits of either side. Our current system is (was, really, at this point) heavily (but inconsistently) regulated, and as you note, emphasized reactive rather than proactive measures. A campaign of education and public awareness would do well to help address that, without needing to put a choke chain on the electorate and bloat the federal government to even-now unseen levels of invasive control. Many other ideas have been spitballed - and shot down with prejudice because they didn't increase federal power over the lives of Americans. Which is what the ACA is really all about, not improving healthcare.

Our interests are best served by decentralizing as much as possible - pretty much the rest of the civilized western world boasting of their socialist wonders consists of nations that are a fraction of our size and population who have not been saddled with the responsibility of hegemonic domination for the last 3-4 generations. Furthermore, even aside from their shortcomings on cancer (which, despite your dismissive attitude is still globally kills more people than HIV, tuberculosis and malaria combined), there are other horror stories of patients dying/worsening during long waiting periods for access to medical resources - resources which will diminish in supply and increase in demand. Even our beloved president has already tried to ease the way for the inevitable transition. Leftists scoff when the term "death panels" comes up, but what else would you call it when the president says in so many words your grandma is too old for the expenditure involved in surgery to save her life, and instead calls for her to be prescribed a painkiller and put in a hospice to wait for death?

We have been lied to, misled, extorted, terrified, slandered and bamboozled into a system that the majority of Americans did not want in the first place, and now clearly doesn't even work as intended - unless of course we can drop the pretense and show that the intention all along was to destroy every last vestige of the private health care industry and present single payer as the only alternative left - that the centralized federal power knows what's best for us children, and only their strict guidance and command can save us from the flying shrapnel of the health care system they themselves destroyed.[DOUBLEPOST=1384412611][/DOUBLEPOST]
Even if the quality of health care does suffer, it won't be due to lack of profit incentive, per your erroneous beliefs of human psychology.
Humanity in general suffers from the insidious stagnation of socialization. Here, the fond wish for a gentle parent figure to tell us it's all going to be alright merely enables a tyrannical power grab by miscreants and incompetents in the guise of caretaking.[DOUBLEPOST=1384412742][/DOUBLEPOST]
Actually, I contend that reducing financial incentives might have some negative effects but that there will likely be paradoxical positive effects. Human motivation isn't a one variable system, nor is it even dominated by external incentives. For example, offering students financial incentive to improve grades in high school appears to do very little at all to improve performance.
Of course not - these are children in the richest nation in the world. Their needs are seen to whether or not they have extra spending cash. Such an experiment is flawed from the very premise it starts with. However, make it so no student whose curved average slips below a C gets fed, clothed, or sheltered, and perhaps you start to see a different dynamic.
 
However, make it so no student whose curved average slips below a C gets fed, clothed, or sheltered, and perhaps you start to see a different dynamic.
It'd actually be interesting to see if there are numbers on a "less extreme" version of this. Like grounding children if their average gets below 70%. Or less extreme, but still taking away privileges. Like Smartphones (all phone privileges). TV. Internet (80%+ of your homework at the LEAST doesn't need access to it to be done). Etc. Does that give enough "motivation" to get grades up? I don't propose starving kids, but make it so that "you don't concentrate on school, you don't get to do what you want either." Given that the general technique has been in use by parents all over the place to a greater or lesser degree, is there already data on that?
 
So my company's health benefits enrollment period started today. Whoever wrote up the guide must have heard the rumors, because they make a point of mentioning right away that the High-Deductible PPO Plawn with HSA is still available. That's a relief.
 
It'd actually be interesting to see if there are numbers on a "less extreme" version of this. Like grounding children if their average gets below 70%. Or less extreme, but still taking away privileges. Like Smartphones (all phone privileges). TV. Internet (80%+ of your homework at the LEAST doesn't need access to it to be done). Etc. Does that give enough "motivation" to get grades up? I don't propose starving kids, but make it so that "you don't concentrate on school, you don't get to do what you want either." Given that the general technique has been in use by parents all over the place to a greater or lesser degree, is there already data on that?
Probably not a lot of data, and it would be riddled with anecdotal evidence. It is extremely hard to be allowed to study minors. Besides, I was great at mathematics in high school, but I failed math 20 three different times. Not because I didn't know, but because I didn't care, and no incentive or disincentive changed my mind about showing up for the tests or turning in the homework (which I had often done) because I was ... I can't even explain it now. Stubborn, thought I was proving a point. "I hate school, I like math, I'll do math but not because the school says so," was my mentality. How do you incentivise a group of people who are insane ambulatory unregulated hormones who would set themselves on fire if someone said, "You will fail if you set yourself on fire."

TL;DR: Kids are nuts
 

GasBandit

Staff member
So today, apparently Obama just declared by fiat that insurance isn't cancelled. Well, that's nice, I guess. I'm sure glad we don't have to change any pesky law or anything. Who needs a legislative process anyway.
 
As much as I loathe the idea of wading into the morass that is this thread, I wanted to point out something. Some of you are simultaneously claiming that the government is too incompetent to do anything (we need to be as decentralized as possible!), and that it has managed to manipulate public sentiment in a convoluted plot to destroy private health insurance industry as part of a larger scheme to insert itself further in the lives of Americans via control over medical records and decision-making.

You can have one or the other. It's either too stupid to provide basic services, or an evil plot to subvert and destroy America. Pick one.
 

GasBandit

Staff member
As much as I loathe the idea of wading into the morass that is this thread, I wanted to point out something. Some of you are simultaneously claiming that the government is too incompetent to do anything (we need to be as decentralized as possible!), and that it has managed to manipulate public sentiment in a convoluted plot to destroy private health insurance industry as part of a larger scheme to insert itself further in the lives of Americans via control over medical records and decision-making.

You can have one or the other. It's either too stupid to provide basic services, or an evil plot to subvert and destroy America. Pick one.
Oh no, it's VERY competent at manipulating the insecurities of the american public. It's just incompetent (perhaps willfully so) at providing actual services of value.
 
As much as I loathe the idea of wading into the morass that is this thread, I wanted to point out something. Some of you are simultaneously claiming that the government is too incompetent to do anything (we need to be as decentralized as possible!), and that it has managed to manipulate public sentiment in a convoluted plot to destroy private health insurance industry as part of a larger scheme to insert itself further in the lives of Americans via control over medical records and decision-making.

You can have one or the other. It's either too stupid to provide basic services, or an evil plot to subvert and destroy America. Pick one.
You seem to be misunderstanding. Politicians are manipualtive, the government bureaucracy is incompetent.
 

GasBandit

Staff member
From the Reuters twitter feed:

"US Insurance Commissioner's Group says not clear how Obamacare fix for canceled policies can be put into effect"

But hey, thanks for the speech.
 

Necronic

Staff member
You're presenting a premise I did not assert. The only options are not "socialize" and "leave it how it was." That's a false dichotomy. The problem you describe comes from trying to straddle the fence too much, so we rob ourselves of much of the benefits of either side.
Good point. This is the whole "house of cards" problem. I don't know if it makes sense to start from scratch or to try and slowly repair the current system. I don't think there is the political will to attempt the former, and I doubt there is the political coherency to ever achieve the latter.
 
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