[quote=""IndyBrit""]Health care is one of our wonderful, big, hairy, intractable problems. Among the issues (no particular order):
1) Health care is a "necessity", but much of the consumption of health care resources is in fact "voluntary"; how do you control consumption under those circumstances?
2) Health care is a service performed by someone, not a product that can be dispensed like surplus cheese
3) Health care requires research for continuous improvement, and the research requires enormous capital expenditure with huge lead times
4) Intellectual property systems are ill-equipped for health care technologies, due to said lead times and expense (one example - it makes little economic sense to have two companies spend 10 years and $5 BB and have only one get a patent because they file a day earlier than their competitor)
5) Some people consume very few health care resources where others can have procedures that consume many lifetimes of income
6) Some aspects of a person's health are entirely externally driven (e.g. bad genes)
7) Some aspects of a person's health have a large voluntary component (e.g. smokers, obesity, etc.)
8 ) In the spectrum of health care, one system is generally expected to cover mundane expected daily expenses (e.g. standard medications, visits for the flu, vaccines), seemingly random fantastically huge expenses (e.g. a quadruple bypass or reattachment of a lost hand), and even seemingly expected fantastically huge expenses (e.g. having a child), plus seemingly expected yet random fantastically huge expenses (e.g. said child is a preemie requiring 3 weeks in ICU). No other system that comes to mind that is expected to deal with such diversity - for example your car insurance is not expected to pay for your oil changes or to fill up your gas tank, your home owner's insurance doesn't pay to repaint the baby's room, your life insurance doesn't pay for your insulin (although maybe it should...)
9) Health care costs are largely driven by one growing segment of society (the old) creating automatic tension with the rest
10) entry to the health care field has a multi-year lead time, so the response time to an increase in demand is delayed despite financial incentives
To me, this problem is far more difficult to deal with than energy or global warming. The internal conflicts in the above points (and others I can't think of right now) make it easy to attack any position set forth, if a guy enjoyed playing Devil's Advocate like I do.
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[quote=""Kaiser_von_Nuben""]Indy, that was a fantastic summary of the issues, and yes, they all have "internal conflicts." I tend to overgeneralize in my arguments; I am more a rhetorician (where generalization is necessary) than a technician (where attention to great detail is vital). I get passionate about the health care debate knowing full well that my beliefs really don't make sound economic sense. But they come from my conscience. For example, I use a simple line of reasoning to boil down government's relationship to health care: Government is composed of "units," namely human beings. Human beings are mortal creatures who get sick, just like machine parts that wear down and fail. Government also depends on healthy people to achieve its functions, whether military, economic, administrative or financial. For that reason, government has an interest in keeping the population relatively healthy. After all, the machine can't function without functioning units, and no one benefits when people don't work due to sickness, or worse, when they die. Dead people pay no taxes (well, maybe a one-time estate tax). Government would be wise to subsidize the health of its citizens so as to preserve the very human units that compose it. I think this is a possibility in a free market system, because private individuals could always opt for more expensive health coverage. But working people who happen to have a misfortune should not have to confront a lifetime nightmare of endless bills; they should receive free care from the government if they cannot afford otherwise.
Last year the doctor told me I had skin cancer on my right temple. At the time, I was working as a consultant with very basic health coverage. The hospital performed a relatively routine operation to remove the bad tissue (it was successful). Afterward, my health plan refused to cover it and I got stuck with a $21,000 bill for an operation that lasted 45 minutes under local anaesthesia. For months I haggled with insensitive hospital "billing staff" who kept on repeating: "So how would you like to pay for this? So how would you like to pay for this?" I told them I didn't have remotely close to that amount saved. They responded: "So how would you like to pay for this?" Eventually I sent enough letters and raised enough of a stink to convince the right hospital bureaucrats that I could not pay the bill, and they wrote it off.
Just imagine what other people go through for more serious operations. It is not an answer to say "buy better health coverage." Even employed people don't get the same coverage they used to, and unemployed people can't afford $450 a month for decent coverage. My mother is a cancer survivor and widow who pays $700 a month for extremely basic coverage. Thankfully she has a little money saved from my Dad's life insurance policy, but if she had a serious illness, she'd be out on the street. As my old evidence professor used to say: "Many Americans are just one illness away from bankruptcy."
This is a shameful state of affairs, and no talk about economic incentives or doctor profitability will shake my beliefs on it. Doctors should not be in the field because they want Mercedes-Benz cars and luxury condos. They should be in the profession because they want to ease others' pain and cure diseases. Government has an interest in those goals, too, and if private people can't cough up the cash to get it done, then the Government should. Even Nazi Germany provided health care to its citizens. We manage to pay incredible amounts every month to sustain a pointless war. Why can't government increase funding for health care? I think more Americans would prefer to know that they will not go bankrupt from illness than to blindly fight insurgents in a war that has nothing to do with the United States. If taxes must increase, let them. At least we will get something for our money, rather than the bodies of slain soldiers.
Now THAT's rhetoric! 8O[/quote]
[quote=""IndyBrit""]Kaiser,
I would note two fundamental disagreements with philosophies expressed in the points you made:
1) you moved from the assumption that government is composed of units, and that in the interest of government those units should operate efficiently. What if your basic assumption was that the units operate independently of government, and that government is only a necessary organizational structure to keep units from killing each other, and that optimal operation of the government is not a worthy goal (at least not worthy enough to wipe out other optimizations such as the liberty of units).
1a) what if I ended all of my questions in a not-question mark.
2) Do you think we should wait and hope that the type of doctors we wish would appear will do so (ie go into the field because they care about others), even if that means that we have fewer total doctors?
I do agree the situation is pretty shameful. I didn't have your specific experience - but I was on my own for health care coverage for two years while having babies 4 and 5. That was definitely some stress, and I definitely experienced firsthand some of the flaws in our system.[/quote]
I was assuming by the quick questions there would be quick answers?
