Dwindling options

By Daniel Holz | September 9, 2009 5:09 pm

There’s one thing that all Americans, be they liberal or conservative, Democrat or Republican, rational or loony, seem to agree on. Our current medical system is broken, and needs to be fixed. You can listen to personal experience. You can look at pretty graphics. You can read expert discussion. Health care in the US is in need of Change.

Listening to the current health care debate is unbelievably depressing. It isn’t really a debate about healthcare at all. Instead, it has devolved into a debate about all the conservative boogeymen: big government, high taxes, Obama personally telling your doctor what to do. The “debate” is fundamentally unmoored from the actual proposals being set forth. This is one of the most important public discussions this nation has had in recent memory. The results will directly impact each and every American. And yet, the entire debate is completely incoherent and misleading.

The possibility of a “single-payer” healthcare program has fallen off the table. I’m not sure exactly how or when this option became untenable, but it shows how quickly the efforts of pharmaceutical and insurance companies can reframe a discussion. After all, there are billions upon billions of dollars at stake, which is precisely why it is such a profound issue for our long-term fiscal health. It is not at all surprising that these companies are spending millions to defeat meaningful reform. The essential goal of this reform, after all, is to reduce the amount of money our nation spends on health care (while improving overall care). Which is not at all in the interest of these companies. What is astounding is that they are actually succeeding in derailing the discussion into lunacy.

Now it looks as if a “public option” will fall victim as well, and be eliminated from consideration. An (incredibly vocal) minority has become convinced that the public option will destroy capitalism, and that Obama is the second coming of Hitler. Really. These people live in an alternate Universe. Here is a two-minute summary of the public option by Robert Reich:

As Paul Krugman says, “the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program.” In addition, “the argument against it is sheer nonsense. It is nothing but the insurance lobby.”

In a few minutes Obama will give a much-anticipated speech on healthcare. We can only hope he is able to change the nature of the discourse. We are at a critical juncture. The whole nation is focused on fixing healthcare. The diagnosis is clear. The patient is in crisis. Prospects for recovery are increasingly slim. Heroic action is needed.

Update: Text of the speech can be read here. Obama made a range of proposals, including a public option. He tells us: “Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.” I hope he can.

As if on queue, a Republican from South Carolina interrupted Obama in the middle of his speech, yelling “You lie!”. The irony, of course, is that at that very moment Obama was busy decrying the absurd claims being widely promulgated by those who aren’t interested in civil dialogue, but aim to “kill reform at any cost”. It gives a good sense of the current state of affairs: that a Congressman would actually interrupt the President, and accuse him of lying, to his face, on national TV. And, needless to say, the Congressman was absolutely, unequivocally wrong. And, “surprise”, he receives lots of money from healthcare industry lobbyists, and is basically a nutcase.

CATEGORIZED UNDER: Health, Politics
  • G

    This is exactly what is the problem with political discourse in this country. The backlash against a public option is not funded solely by insurance companies. I do not support a public option. There, I said it. Me. And as a voter in this country I have that right. I have some damn good reasons too, but it’s far easier to demonize me than to debate me. Sure, health care has problems. Yes, we should fix them. (And part of that is tort reform but that’s conveniently absent in the bill). But rush through a 1200+ page bill that most haven’t read? If this is such a problem, let’s have an open and rational debate. I really think meaningful reform could have happened if not for the public perception that congress was hellbent to shove something through. Hellbent to shove something through that Republicans did not support and had no hand in drafting. Sure, sure I know what you’re going to say – elections have consequences. But actions have consequences as well. When you act in such a partisan manner as democrats have lately it will bite you in the ass (what the heck do you think happened to republicans in the last several elections). The American people d0n’t like partisanship. Big problems require bi-partisan solutions.

    And is the whole nation so fixed on solving health care? No. For most people it’s not on the radar. What is people’s number one concern? The deficit and the recession. Do you want to know why a lot of people don’t support this whole health care reform bill? Because they’re scared to death of how much the government is spending and borrowing and they know the consequences of that action. Medicare costs 10x what they originally projected. Is it really that far fetched that some people might believe that this whole health care “fix” will cost more than we can afford?

  • Brian137

    G,
    You said, “I do not support a public option. There, I said it. Me. And as a voter in this country I have that right. I have some damn good reasons too….”

    What are they?

    “Is it really that far fetched that some people might believe that this whole health care “fix” will cost more than we can afford?”

    Yet virtually every other country in the world spends LESS than we do now. How do they manage that?

  • Don

    No, G response is exactly what’s wrong with the discourse. Instead of addressing the public option plan, we get from G that the public is scared to death (no explanation if this is justified) and that the direct consequence will be increased government spending (no explanation of the link). The discourse isn’t helped if the opponents are going to repeat their talking points and not attempt to listen to anyone offering a solution.

    Don’t tell me it’s not broken. It is. Don’t tell it can’t be fixed. It has – by a number of countries. Guess what the solution always included – the public option.

  • MonkeyDeathcar

    I’m also waiting, G, to hear these legitimate concerns.

    TIA
    MonkeyDeathcar

  • NewEnglandBob

    Sorry G, You get an F for saying nothing substantial just like the RepbliCANTS.

  • caklen

    NewEnglandBob has already disqualified himself as a partisan as has Daniel. Neither Brian or Sean have addressed my comments on the other posts. And Don’s idea of ‘fixed’ is one in which EVERY country that currently has a monopsony-public system is in massive debt/facing enormous deficits because of that program. Heck we don’t even need to go to those countries to see this (though France and Canada recently released reports indicating as such) as we can go to the model for the current proposal—Massachusetts—where the public option has only been kept afloat by a bevy of new taxes. Additionally, we’re talking about a bigger and more complicated federal program than another enormous example of the current inefficiency of our current systems to be deficit neutral–medicare.

  • Disgruntled Reader

    Isn’t this a science blog? And we’ve got health insurance and Paul Krugman and birthers and Robert Reich and partisans hooting at each other in the comments?

    Politics is the mind killer, people.
    http://lesswrong.com/lw/gw/politics_is_the_mindkiller/
    And politics is the killer of scientific discourse, and the killer of science blogs. Keep it real.

  • chuko

    I shouldn’t bother, because it should be obvious to anyone who’s done a bit of research, but:

    In 2004, the US spent 15% of GDP on healthcare. Switzerland 12%, France 10%, Canada 10%, UK 8%. In dollars per capita, 2003, US spent $5700, Switzerland $3800, France $3000, Canada $3000, UK $2300. US covers ~85% of its population for this cost, all of these others cover 100%. Health care quality for those covered is about the same in all five.

    Health care spending is increasing for all of these countries (including the US), but that doesn’t change the fact that they obviously use more efficient systems than we are using. And, in fact, US health care spending is increasing at a faster rate than these other countries.

  • Anonymous Snowboarder

    So… CBO projections? I guess those are just make believe. AP Fact checks? Those too. The problem isn’t with the “vocal” opponents (be they Republican/Independent/Whatevers) – its with the people who can’t put the pipe down long enough to realize what a disaster is being foisted on the American public in the name of “fixing” health care.

  • KC

    OK, how do you feel about a health care plan it if you knew it would double our health care costs by 2018. No? Don’t like that? That’s what we have now. Still feel like our current system doesn’t need to be fixed?

  • Kevin Hales

    It doesn’t matter what the salesman tells you, it’s what’s written in the contract that counts. And if the salesman is trying to rush you into signing, that’s when you know the deal is no good; time to pass.

    In the current context, we have a bill (several, apparently) that nobody seems to really understand. I don’t care about Obama’s pretty words say; they mean nothing once the legislation is passed.

  • Jason A.

    #1:

    Big problems require bi-partisan solutions.

    Fallacy of the middle ground. The simple fact that two sides exist does not mean the optimal solution is a compromise between them.

    #7:

    Isn’t this a science blog? … politics is the killer of scientific discourse, and the killer of science blogs.

    So go somewhere else. Jeez it gets old when someone just has to chime in with ‘This is supposed to be a science blog!!!!11′ every single time a science blogger says anything not strictly confined to the latest research.

  • justme

    >> An (incredibly vocal) minority

    The Democrats got the House, the Senate, Al Franken, the President and the media.
    And yet this is still the fault of the minority?

  • James

    Isn’t this supposed to be a stamp-collecting blog? Yet you haven’t had a single post on stamp collecting! Ever! You should start posting on topics you’re supposed to.

  • Toiski

    At the rate this debate is going in the direction it is going, both among the public and the lawmakers… The EU will be arguing in a few decades whether the US is “too big to fail” and whether we should bail them out.

  • http://www.mpe.mpg.de/~erwin/ Peter Erwin

    chuko @ 8:
    Health care quality for those covered is about the same in all five.

    Arguably, health care quality is, if anything slightly better in the non-US countries you mentioned. At the very least, they all have higher life expectancies than the US.

  • http://lablemming.blogspot.com/ Lab Lemming

    “Guess what the solution always included – the public option.”

    Tell that to the Dutch.

  • Just Learning

    This whole debate comes down to resources, efficiencies and equilibriums. Initial upfront costs for public healthcare may be higher, but that cost is being driven by expanded coverage. Currently, the apparent lower cost of non-public insurance is being subsidized by a lower life expectancy and lower healthcare standard amongst the uneducated and through the bankruptcy system (this is crudely explained as externalized costs). The healthcare cost per person will ultimately be lower under a full comprehensive system that insures everyone. This is a simple law that has been proven over and over again…often referred to as a learning curve.

  • Ian

    Obama needs to start respecting the human person – his ‘above my pay grade’ comment show us that he doesn’t. When he starts paying attention to this aspect of life, the rest will fall into place.

  • Michael

    Many people believe “Universal” health care means “Free” health care, and “free” sounds great until someone asks the obvious question, “Free…at WHOSE expense?”

    There is a cost—a heavy one—for forced distribution of any pay you have earned, and the shell game being played aims to convince Americans the best solution is to trust the federal government to manage their health care, much as they have trusted the government to manage their social security and their income taxes.

    Consider the practical implications. I, for example, live a vegan lifestyle, exercise regularly, and eat carefully and properly. Is it reasonable to force me to pay for the health care of a slovenly Twinkie-loving, cigar-smoking alcoholic who disregards his health but nonetheless feels entitled to the best care, regardless of expense to others and regardless of the poor health choices leading to his circumstance? I do not condemn those choices, by the way; they are none of my business. I only condemn the idea that anyone else should be forced to pay for them.

    What if I tripped over my feet and fell down my basement stairs, breaking my ankle? Should I send the bill to my next-door neighbor? Should I select a random reader to be forced to share the burden of my clumsiness?

    How about the bum living on the street? He was born with the same chances and tools to succeed in life as every other human being but refused opportunity at every turn. Should someone have to pay for his flu shots if the person paying does not think it is right? Should Donald Trump have to pay for my flu shots only because his ability to afford it is greater than mine (even though his responsibility is less)?

    That is not Democracy. That is Socialism and nothing more. Other countries force a public health care option because they are Socialist countries. The public is subjected to shameless media spin to dupe naïve people into believing they are standing for something moral and that our country’s march to Communism is a conspiracy theory to be as casually and callously dismissed as claims of alien abduction.

    Media further purports the issue of health care to be so dazzlingly complex that mere citizens can not wrap our tiny pecan-sized brains around the infinite nuances of an issue so complicated it requires a 1200 page bill that no Senator can summarily explain.

    The answers are not hard. Many of you have summed up possible solutions in less than a paragraph (tort reforms, consumer-driven, co-operatives, etc.).

    This is not an attack on Socialism abroad, by the way. I have no particular personal issue with Socialistic ideology. My point here is that America is not a Socialist nation. I do not want Socialism in my country.

    No American should. No public option; no pretenses.

  • mind open

    we all seem to be talking at each other, and nobody’s really listening. Challenge yourself today and try to understand or at least think about what the “other side” is saying.

  • Gadfly

    Name any country in the world with socialized medicine where there isn’t rationing of healthcare. Why is that Canada’s mortality rate from cancer is 16% higher than the US? Why is that when Brits and Canadians desperately need healthcare in a hurry they come here for it?
    I thought this was a blog about the sciences — not someone’s bully pulpit to ram social change down our throats — and insult anyone who disagrees.

  • CW

    It just seems to me that in order to combat the health insurance/health care issue as a whole, we’re over-reaching. Is the only solution to this crisis to offer a public option? I’m not sure, but it’s hard to get answers to my questions.

    For example, can someone explain to me why the federal government will be able to offer insurance plans in every state, but regulations prohibit insurance companies from selling policies across state lines?

    And in a more general sense, at what point does the government decide against offering subsidies to private companies (such as what they do in agricultural and energy industries) to drive down costs for the consumer versus offering their own products/services themselves?

    And why isn’t some tort reform in the 1200 page plan?

    And when President Obama said in two press conferences that it didn’t make sense for one doctor to run a test, and then a second doctor run the same test – does he disregard the anecdotal evidence of the importance of getting a second opinion? Has he not read Readers Digest? There are many examples of physicians making a mistake on diagnosis, or a test that was poorly administered.

    And is it realistic to think that the government will be able to negotiate lower pricing? Has this ever happened? The same entity that continues to fund planes that are never used in combat? Or the same entity that lost billions of dollars in reconstruction money in Iraq? No-bid contracts, lobbyist-funded PACs, etc. I am not saying that I don’t trust the government, but I do have cynicsm about their claims of being fiscally responsible.

    I think something needs to be done, but it just seems like the solution of a public option should be a last resort measure, which is why I am partial to the “trigger” idea.

  • jr

    it is stupid to give the government that much power
    and to politicize the whole healthcare thing
    #21 – i have been hearing the same crap for 40 years
    and am fed up. The left is just doing their power grabbing
    crap, same as when they were taking over university bldgs.

  • http://brokenglassware.blogspot.com El Charro

    Michael,

    Consider the practical implications. I, for example, live a vegan lifestyle, exercise regularly, and eat carefully and properly.

    Because it is well known that vegans never get sick, right? They don’t get cancer of any type, ALS, the flu or anything else. It is only those who eat twinkies that get those diseases. Who would’ve thought the answer was as simple as to just ban some food products.

    How about the bum living on the street? He was born with the same chances and tools to succeed in life as every other human being but refused opportunity at every turn.

    Do you really believe this? Seriously? Do you really believe that all schools have the exact same educational level? Or that anyone can chose to go the the best one even if it isn’t the one that belongs to their neighborhood? Or that kids from wealthy families have no advantage over people from not-so-wealthy ones? Or that it doesn’t matter whether you grew up living in a Manhattan or the Bronx?

    What if I tripped over my feet and fell down my basement stairs, breaking my ankle? Should I send the bill to my next-door neighbor? Should I select a random reader to be forced to share the burden of my clumsiness?

    While we are at it, let’s get rid of fire deparments. After all, it is our clumsiness and lack of care that puts everyone of us at danger. Let’s all just pay to be insured for everything and that way if someone’s house catches fire the rest of the public doesn’t have to be responsible for that. We’ll just let the fire go through until it wishes and then call the insurance company to have then build our house again, we all know how easy it is to deal with them. Imagine all the money we could save!!!! Maybe we can even do the same with police.

  • kurt

    Before you go quoting robert reich read this:
    http://robertreich.blogspot.com/2009/08/white-houses-deal-with-big-pharma.html

    I’m a strong supporter of universal health insurance, and a fan of the Obama administration. But I’m appalled by the deal the White House has made with the pharmaceutical industry’s lobbying arm to buy their support.

    Last week, after being reported in the Los Angeles Times, the White House confirmed it has promised Big Pharma that any healthcare legislation will bar the government from using its huge purchasing power to negotiate lower drug prices. That’s basically the same deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry. A continuation will be an even larger bonanza, given all the Boomers who will be enrolling in Medicare over the next decade. And it will be a gold mine if the deal extends to Medicaid, which will be expanded under most versions of the healthcare bills now emerging from Congress, and to any public option that might be included. (We don’t know how far the deal extends beyond Medicare because its details haven’t been made public.)

    Obama is in bed with the health care industry and he worse than a typical politician because he claims not to be a typical washington. he promised to change the atmosphere in washington so things would get done and he has completely failed already.
    hope! change!

  • David Wile

    We have to separate the two arguments. Health care costs drive insurance costs, not vice versa. Even if we accept that 20% of costs go to insurance company profit, US costs have been widening from the rest of the world. Similarly, every study I’ve looked at says malpractice (including insurance costs) are less than 2% of total expenses and it has not been widening significantly either. Insurance cost is separate from health care costs.

    Watch the “pretty graphics” video linked above. If we want to reduce costs, we have to limit what the services physicians can provide. You can do it by incentive. You can do it by rationing. But put the blame where it belongs. The problem isn’t with doctors or insurance or systems, it’s with us. People are willing to pay an infinite amount of money (preferably someone elses) for any amount of increase of chance of cure.

  • E

    I have to disagree with Daniel here. I am a physicist, political moderate and a cancer survivor. When I was getting my treatment, I had to take on my insurance company because the treatment plan they permitted was pretty asinine. I’ve been on the bad side of the coin. Given that, I still don’t trust the US government enough to run a health plan. They’re track record for handling big-budget, general population programs isn’t that hot. With the power of direct oversight, the government allowed the Fanny and Freddie messes. The flow of funds out of Social Security greatly exceeds the flow of funds into Social Security, but no one is addressing it because that is not an immediate crisis.

    I think a public option will result in the US government seriously overspending. I just don’t trust them. I think a better option would be for the government to encourage non-profit insurance companies. This will alleviate (but not eliminate) some of the problem.

    I still haven’t heard a good answer for the rest, unfortunately.

  • Clint

    It seems obvious change to the system is required, but disagreement centers around what that change should be. While far from being a market fundamentalist, I am justifiably worried about the ramifications of entrusting the complexity of the nation’s healthcare system to the federal government. The complexity of the system would require vast amounts of oversight at high costs, not to say the current system is not in the same predicament, but the upfront costs of rebuilding a system are high.

    Meanwhile, with the public option off the table we are facing the same problem of increased complexity. Adding regulations to create a more equitable system is a rational approach, but one that comes with significant administrative costs. We are playing the same game with the addition of a few rules. Additionally, as pointed out already, these rules are currently being written by special interests.

    The genius of the public option was its transformational capability. By setting a social standard, a minimum quality of heathcare, the innovative potential of the marketplace could be focused on beating the government option. Currently the marketplace lacks this social standard, allowing externalization of costs (by denying/refusing coverage). Robert Reich covers this much better than I can.

    Theoretically, conservative market fundamentalists should support a public option on these grounds. Unfortunately, special interests are blocking these aspects of the discussion. The argument of whether or not we should cover those whom for whatever reason are unable to provide for their own medical care (homeless, laid off, children) is moot. All morality aside, we as citizens pay for the uninsured directly through higher healthcare prices and higher taxes (to cover emergency room expenses) or indirectly through lost productivity, early death, or avoidable disability (in the case of lack of care).

  • Sean

    “In 2004, the US spent 15% of GDP on healthcare. Switzerland 12%, France 10%, Canada 10%, UK 8%. In dollars per capita, 2003, US spent $5700, Switzerland $3800, France $3000, Canada $3000, UK $2300. US covers ~85% of its population for this cost, all of these others cover 100%. Health care quality for those covered is about the same in all five.”

    This is incorrect. You need to look at the distribution of health care benefits, not just the average. People in the US with health care coverage get better quality than people elsewhere. People without coverage get worse quality.

    So the average looks worse. But the majority of Americans have health care coverage, and don’t want to see their quality of care worsened in order to prop up the average. With a public option that slowly eats away private health insurance, most Americans will pay more (because they will have to subsidize coverage for the poor, who are the ones missing insurance now) and get less.

    It is common sense that people oppose this plan, but its proponents continually mischaracterize the opposition. “An (incredibly vocal) minority has become convinced that the public option will destroy capitalism, and that Obama is the second coming of Hitler. Really. These people live in an alternate Universe.” All I can say to this is, “I know you are, but what am I?” Really?

    Here is an interesting article on rational reasons to oppose the plan:
    http://www.newyorker.com/talk/financial/2009/08/31/090831ta_talk_surowiecki?printable=true

  • Michael

    There are two main issues with the US health care system: it costs way too much and doesn’t cover enough people. We can address these problems without an 1100+ bill that no one understands or even reads. I’m one of the 83% of people who are relatively OK with my current healthcare, as expensive as that is becoming. I’m also in the group that is about 70% OK with my health care provider.

    I don’t protest – I vote. An incremental approach that is gradually phased in seems to be a rational way to address the main issues. However, power politics is already driving the debate into a bloody war of conflicting ideologies. This is why our elected officials are always so feckless.

  • http://astroroach.blogspot.com Randy Roach

    Is there any evidence that the government has ever run any large program efficiently, in our entire history? How can you look at Social Security, Medicare, Fannie Mae, Freddy Mac etc and still talk about efficiencies and cost savings with a straight face? It has never happened. It will never happen.

  • maddox22

    @32: Is there any evidence that profit-driven corporations have ever done anything to benefit anyone other than their shareholders, in our entire history? How can you look at Lehman Brothers, Citibank, Wachovia, and yes, health insurance companies etc and still talk about responsible business and the infallibility of the invisible hand with a straight face?

    @20: Presumably you favor the policies of requiring everyone to pave their own roads, provide their own security, crime investigation, and firefighting, and homeschool their children; of eliminating social security and medicare; and of getting rid of the armed forces? No? I thought you were a True American(TM) who would never allow socialism in his country!

    Anyone who thinks the insurance companies can be trusted more than the government to lower rates out of the goodness of their hearts is ignorant at best. Give me a break. You seriously believe that leaving health care decisions in the hands of CEOs whose sole goal is to make more money is going to improve the system? We ALREADY have rationing in this country. There will always be rationing as long as there are limited resources. But if you eliminate the profit motive, gee, guess what–there are suddenly a lot more resources to go around! Eliminate the profit and the maelstrom of forms, policies, etc., and you free up billions of dollars. How many people could be covered for that?

    If you’re happy with the current system, I have only one word for you: wait. Wait until you get sick. Wait until you get old. Wait until you lose your job or want to start your own business. Wait until your child or your spouse gets sick. Just wait. And then tell me whether you’re still so totally thrilled with the American health care system.

    Even if I had to wait longer for treatment, I’d rather have a national health care system and the peace of mind of knowing that I don’t have to spend months of my life arguing with insurance companies while I’m sick.

  • concerned reader

    Please stick to the science, its odd seeing all this politics coming up in my blog reader science lists. I get enough of it everywhere else.

    I even agree your take on it, but this is not the place for it.

  • Low Math, Meekly Interacting

    I guess I’m disqualified because I work for a biotech company. So I’ll just add my $0.02 in the same capacity as a Boston Marathon “bandit”.

    Against my own self-interest, I’m for the Public Option. I’m growing increasingly disheartened with the perception, earned or not, that I earn my living from the wages of evil parasitism. I don’t mind tightening my belt a little if it keeps me honest. That said, I’m certainly not getting rich here, so I hope those out there who tend to lump us profiteers together take that into consideration. A lot of us just want to do a good job, and it’s not always easy to perceive an inherent immorality in our day-to-day work.

    Anyway, while I favor the Public Option, I don’t believe it will, in and of itself, solve most of the problems, or even any of them, if there isn’t substantive legislative change to provide disincentives against some of for-profit medicine’s most onerous failings. I also tend to think that if those legislative changes are well-crafted, they might just obviate the need for a Public Option. I hate pragmatism sometimes, but if Big Gubmint is such a bugbear that involving it sinks the whole reform enterprise, I’m willing to eschew it for now. I think these so-called co-ops are a crock, so let’s just get to the meat of it: Tell insurers, say, that they can make all the profit they want, but premiums are capped, they can’t deny coverage when you get sick, they can’t exclude you due to preexisting conditions, etc. As for the drug makers, I must admit I’m a bit stumped. The world over, it’s a for-profit enterprise. What keeps costs down in many nations is the ability of those govts. to impose limits on pricing. What makes the industry so profitable is that such caps don’t exist in the biggest market, the USA. It may be that if the US govt. also started imposing such caps, by, say, allowing Medicare to negotiate, for-profit drug making may become untenable. I don’t know. Perhaps we should just wait and see. But, in the event it is possible to make drugs and make money, I might start testing that hypothesis by allow the existing Govt.-run system to negotiate pricing. It’s not the radical change we may need for the long term, but the incremental approach may be the only viable one.

  • Roman

    I think the debate here in this thread is becoming more and more sensible (not a typo).
    It starts to be about ideology and ethics. Forget about costs and profits.
    @34 – see 12.

  • http://danielholz.com daniel

    I added an update to the post.

    I’d like to thank everyone for the (mostly) civil discussion in the comments. I’ve certainly learned some things. Nobody says there’s an easy fix. And I’m not claiming that the “public option” is a panacea. But something needs to be done (morally and financially). And this will only happen if people are genuinely engaged. Rep. Wilson has kindly demonstrated that not everyone is in this camp, and that there’s a difficult road ahead of us.

  • coolstar

    What’s so incredibly distressing about reading the comments here is that the level of discourse, on average, isn’t much (if any) higher than it is in the media. Is there something about science blogs in general that brings out troglodytes? Is it some unknown conservation law that saws that reasonableness has to be balanced by utter stupidity? I see the same sort of thing on space.com and the bald astronomer’s blog: say something reasonable like Daniel did and the Obama and big-guvmint haters just creep out of the darkness…..They’re like cockroaches, they may only have a handful of neurons but it seems that they’re ALL devoted to self-defense. YOU can be the first to be a TOOL and post the obvious troglodyte reply, step right up as you know you’re gonna do it anyway.

  • Pieter Kok

    For weeks, opponents have been demanding more time for a rational debate on the thousand pages of the bill. Those weeks would have been better spent on that debate itself. You can shout “it’s hurried through the House” only for so long.

    And really, there is ample empirical evidence that a public option will not destroy the country, quite the contrary. Considering the comments so far, let me spell it out once more: the western countries with their version of the “public option” do perfectly well (usually better than the US), and no, the Brits and Canadians do not all flock to the US to get their urgent healthcare.

    And that statistic of #22 is probably bullshit as well.

  • http://www.astro.multivax.de:8000/helbig/helbig.html Phillip Helbig

    Wouldn’t it be a nice political statement if high-profile scientists, such as the contributors to this blog, would accept a job outside of the States and state as their reason the lack of good healthcare there?

  • Gordon Pasha

    Are you sure the Republican from South Carolina was wrong? The fact that the bill states that only lawful residents qualify is fairly meaningless if there are no provisions to check and enforce that. And there aren’t. It is quite reasonable to expect, based on other situations that have over history required checking for lawful residence, that such a provision is essentially unenforceable in the context of a health care institution.

  • jr

    if socalled “advanced industrial countries do it – that is a good
    reason for us to NOT do it. How many MRI machines do they
    have anyway ? I paid for the last two out of pocket – and it costs
    less than insurance.

  • http://blog.bbbeard.com bbbeard

    daniel wrote: “And, needless to say, the Congressman was absolutely, unequivocally wrong.”

    Well, gee thanks for doing your part to host a reasoned, non-partisan discussion on the health care bill. You’ve really lowered the temperature of the debate by your intellectual modesty. Not.

    The depressing thing to me is how many of the even highly intelligent commentators, and I’m including daniel, seem incapable of fact-checking anything at all, even with that Internets thing. The New York Times quoted the bill as saying “Nothing in this subtitle shall allow federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.” Now, someone looking at the lively intercourse on the health care bill might wonder how unequivocal that limitation could possibly be, given (a) the continuing criticism of the bill for covering illegal immigrants, (b) the obvious and oft-stated desire of some Democrats to legalize “undocumented workers”, (c) the sudden reduction in the number of uninsured people (or didn’t you notice Obama’s substitution of “30 million” for “47 million”?), and (d) the mysterious reference to “affordability credits”? All these are clues that the issue is very much in flux.

    Here’s another clue: the use of the word “subtitle”. Let me be the very first person to explain to you that a Subtitle is part of a Title, and in the case of the health care bill, the Titles comprise Divisions. So the provision that you seem to think is unequivocal proof of Rep Wilson’s incompetence in fact applies only to Subtitle C of Title II of Division A.

    Look, if the Democrats wanted to make sure that the bill did not provide services to illegal aliens, all they would have to do is take that little sentence, bump it up three levels, and change a few words, so that it applied to all Divisions of the bill. But I predict it will be a cold day in hell when they do that because a significant fraction of the Democrat Party thinks we should provide health care to illegal aliens. Don’t you get that? Bumping your “unequivocal” up even two levels would endanger their favored interpretation of Section 152 of Subtitle F of Title I of Division A, to wit:

    “Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.”

    How would you interpret “personal characteristics extraneous to the provision of high quality health care” if you were asked to decide whether that means that illegals had to be given health insurance?

    Now, I realize blogging must be timely to be effective. But you need to do your homework.

    BBB
    “yeah, that guy that’s so intellectually modest… not”

  • Brian137

    37. daniel Says:

    “I’ve certainly learned some things. ”

    What?

  • http://www.cosmic-web.co.uk Olaf

    The “isn’t this supposed to be a science blog?” argument never really holds much water at the best of times, but when the sidebar says

    “the blog is about whatever we find interesting — science, to be sure, but also arts, politics, culture, technology, academia, and miscellaneous trivia”

    it’s particularly stupid. If politics showing up in your ‘science’ feed reader is bad (concerned reader @ 34), then don’t put blogs which are partly about politics in a science reader. It’s not Sean’s responsibility to write so that CV fits into your categorisation of the internet.

  • http://radical-moderation.blogspot.com/ TheRadicalModerate

    I guess before beginning this little screed that I ought to go on record as opposing the public option but supporting guaranteed enrollment (the no pre-existing conditions stuff) and I’m on the fence but leaning toward supporting mandatory coverage. All of this being conditioned on finding some reasonable way to pay for it. (Hint: that’s not “waste, fraud, and abuse.”)

    If you guys really want to have a reasoned debate about the public option–or about anything else involving health insurance–it might be a good idea to remember how insurance companies make their money.

    At the risk of ridiculously oversimplifying, what you (and, if you’re lucky, your employer) pay in yearly premiums is the insurance company’s actuarial estimate of how much people pretty much like you will consume in health services, plus some amount of profit. Since some people like you will have bad luck and incur huge medical bills this year, while most people like you will only consume a nominal amount of routine health care, the insurance company has a nice actuarial model that integrates across everybody’s expected costs and divides by the number of subscribers. Voila! A premium. Pretty simple, right?

    Well, there are two terms that ought to be examined a bit more closely: “profit” and “people pretty much like you.”

    Profit first: I pulled United Healthcare’s financials for 2008. They had a gross margin of 23% and a net margin of 4%. For comparison, let’s look at another evil industry: Exxon Mobil had a gross margin of 54% and net margin of 9%. Now, a couple of (currently) non-evil industries: Cisco had a gross margin of 65% and a net margin of 21%. Kroger (the supermarket chain) had a gross margin of 23% and a net margin of 2%. (I’d do more health insurance companies, but I’m lazy. When I did this little exercise before, they were all within shouting distance of one another.)

    Health insurance is not an incredibly profitable business. In fact, it kinda sucks. To be sure, UNH’s stock (until recently) was skyrocketing. But that’s because their revenues were skyrocketing, which occurred because the underlying health services that they insure were going up so fast.

    So, we now come to the the right’s principal non-hysterical objection to the public option, once you scrape away all the death panels and illegal aliens and socialized medicine buzzwords: They worry that a publicly offered insurance plan will so erode the margins of the private health care insurance companies that nobody will invest in them, which further erodes their margins, until they finally exit the business. As the supply of private insurance dries up, more and more people get driven into public insurance and you eventually wind up with only the 500 pound government gorilla in the room.

    I’ve hopefully demonstrated that, just from a statement of income perspective, this is not an unreasonable fear. You could mitigate this fear with all kinds of restrictions on the charter for public insurance, but you’ll have a hard time convincing the right (and me, for that matter) that those restrictions can keep the camel’s nose from snuffling near the bottom of the tent flap.

    But private health insurance ought to be able to be much more agile than the public plan, right? They ought to be more creative in structuring policies and taking advantage of specific market conditions, shouldn’t they?

    Well, that’s where we come to the “people pretty much like you” part of the equation. Insurance companies compete with each other by offering lots of different plans, with different coverages, different deductibles, different copays, different lifetime caps, all at various different price points for their premiums. But notice that when we say, “people like you,” we really mean “people willing to pay the same premiums, assume the same risk, and running the same statistically proscribed chance of consuming health care as you.” In short, insurance companies create risk pools and offer good rates to pools that are unlikely to consume as many services as the risk pools that are likely to consume more services. The unflattering term for this is “cherry-picking” but it makes a huge amount of sense, both for the company and for the consumers that can be cherry-picked.

    It does not make a lot of sense from a public policy standpoint, which has a different goal: Since we as a society have decided that sick people get treated, one way or another, it follows that we are de facto sharing risk across our entire society, and we might as well share it de jure as well. So, there’s moderately broad support for “guaranteed enrollment,” which is just a fancy way of saying, “no more cherry picking!”

    So now we’ve removed the most powerful tool that an insurance company has to differentiate its products from others’. No more fancy actuarial cleverness allowed. Now you can only compete by packaging different services at different levels of deductibility and lifetime caps.

    Oh, wait! Didn’t I just hear the prez say, “no more lifetime caps”? And “you’ll get all your preventative care covered, no matter what”? So, even more constraints, this time on the services offered.

    In short, everybody wants to completely commoditize health insurance. That’s probably a good idea. But note that a commoditized plan will be a lot more expensive if you happen (as most of us are) to be in the ranks of the “cherry-picked”. I’m in moderately good health, for a middle-aged guy. Right now, I’m not sharing risk with the guy I know who’s 48, has already had a triple-bypass and two subsequent angioplasties, and still smokes and does the occasional line of cocaine. But with guaranteed enrollment and mandates on covered procedures, I will be. Think I’ll get as good a rate as I do now?

    So, commoditized market, with a major player who doesn’t have to turn a profit and is guaranteed to get bailed out when they screw the pooch, because they are literally too big to fail. I’d say that the fear that private insurers will get crowded out is rational.

    And all of the other fears flow from that. Health insurance companies are also the collective bargaining agents for their subscribers. (This is insane, but this post is already way too long…) As long as there are many of them, providers have choices about where they sell their services and nifty new gadgets and life-extending drugs. But with only one buyer, that buyer sets the price, and the seller either agrees to it, or he leaves the business.

    If that single buyer (“single payer” is really kind of a tiny fig leaf, isn’t it?) always sets the prices just high enough to attract investment dollars to provide every service needed, there’s no problem. But, with no market to discover what that price should be, that’s highly unlikely, isn’t it? So, some services go under-invested. We now have shortages for some services. And, since we have no market to allocate those services, we have to allocate them via the explicit decisions of the (single) insurance provider. We call this “rationing” when we’re being honest, and the demagogues call it “death panels” or something equally inflammatory when they’re trying to whip people into a frenzy.

    Personally, I like the idea that I can always pay for some service if it’s not covered but will save/improve my life. I like the idea of medical progress, even when some new treatment is too expensive to be covered by insurance and therefore available to only a few, because next year it will be cheaper and available to more people. But those new treatments/drugs/gadgets will only be provided when there are enough individual buyers to make a profitable market.

    Finally, on a slightly different topic: You may disagree with my (incredibly lengthy) arguments above. You may honestly think that a single payer system is the only just solution to the problem. You might even be right; who knows? We should have that debate.

    But you are a fool if the only debating tactic you can come up with is to question my motives, just as you are a fool if you question the motives of huge number of people that oppose the public option. I am not a shill for big pharma and the insurance companies. I just want to be very, very cautious about how we proceed here, because the chances of falling into a hole that will be impossible to climb out of are pretty high. I want to be (gasp!) conservative about how we proceed.

    There are certainly people out there with less-than-pure motives. But please, for the sake of the rest of us who are simply trying to find a solution that will not only improve most people’s lives right now but continue to improve those of our children and our children’s children, assume that we’re not shills, idiots, or dupes. When you frame the debate like that (as Daniel did above, I’m sorry to say), the only weapon we have left is demagoguery, which is how things got as screwed up as they are now.

  • Low Math, Meekly Interacting

    RadMod: Thanks. Seriously. There’s nothing insane about length if everything written qualifies as content. It makes scanning over the reams of content-free troll postings a bit more rewarding if one finds an intelligent argument somewhere in there, regardless of whether or not I agree with each and every point.

  • gopher65

    TheRadicalModerate: I disagree with a few of your points, but you make a few other points that are certainly true.

    I think that the point most people here are trying to make is this: if everyone on both sides spoke the way that you do (though most of them phrase it “if the OTHER side weren’t crazy”, which is disingenuous:P), and people could actually have a reasonable, rational debate about this issue, everyone would be better off.

    I don’t have time to make a detailed response, but I will say that I’m in support of a fully (or mostly) publicized system. I live in Canada, and I don’t have a good enough job to have employer supplemented insurance, so I have no insurance (we have private insurance here for things that aren’t covered by the public system).

    Anyway, about a year ago I ended up in the hospital for 3 days. They preformed a bunch of tests, yatayatayata. I got charged nothing because all of that is paid for by the public system (though general revenues. Income tax mostly). I checked what the hospital stay + tests would have cost me in the US, and it would have been in excess of 15000 dollars.

    It would take me a looooooooooong time to pay off 15000 dollars. I know people in the US who have had sudden things happen to them (in one memorable case appendicitis) who are still paying off their hospital bills. That just strikes me as… wrong.

  • http://blog.bbbeard.com bbbeard

    RadMod:

    Your post is exceptionally well-reasoned, calm, and balanced. (What the heck are you doing here?)

    Is there someplace on the web where such discussions can take place, i.e. where intelligent, data-oriented policy wonks can escape the folks who are merely trying to develop this week’s best viral meme-bite?

    BBB

  • JimV

    Gadfly said “Why is that Canada’s mortality rate from cancer is 16% higher than the US?”

    I don’t know, but I’ll take a shot. Could it be that people live longer in Canada, and that failing anything else, we will all die of cancer eventually?

    I think this debate should be on science blogs and everywhere else, until everyone (who wants to be informed) has a firm grasp of the facts and options.

  • gopher65

    Gadfly: Errrr…. according to international monitoring bodies, Canada has one of the best cancer survival rates in the world (ranked 3rd amongst rated countries). The US was ranked second, and Cuba was ranked first.

    Two points though:

    In the US when a poor person has cancer they just die in their hovel. It never gets reported because they never go to a hospital, because they can’t afford treatment (or insurance, but they’re slightly too “well off” for government programs). In Canada all of those people get counted and treated. That naturally leads to a cancer survival rate which is skewed higher than reality in the US (and cancer incidence rate which is skewed lower than reality).

    Second: Cuba beats the US. Cuba. FFS. How in the world did that happen?:P

    See linkie for a news article about it:

    http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716/cancer_statistics_080716/20080716/

  • Brian137

    chuko, in post #8, advanced the following statistics:

    In 2004, the US spent 15% of GDP on healthcare. Switzerland 12%, France 10%, Canada 10%, UK 8%. In dollars per capita, 2003, US spent $5700, Switzerland $3800, France $3000, Canada $3000, UK $2300.

    Does anyone know the breakdown of any or all of these national totals into subcategories: how much went to compensate health-care professionals, how much to pay for equipment, medications, etc.? Perhaps differences in the totals would appear to result from large differences in identifiable particular components of the cost.

  • http://blog.bbbeard.com bbbeard

    gopher65:

    Peculiar study, that. The news story says that the U.S. had a five-year cancer survival rate “for all the cancers studied” of 91.9%. But breaking the U.S. down into 17(?) regions, it then goes on to state, “the survival rate for the seventeen regions in the United States that were included in the study ranged from 78 per cent to 90 per cent.” How can the maximum regional rate be 90% but the overall rate be 91.9%? I’ll have to think about that. It also said “The disparity in survival rates crossed racial lines in the U.S., as well, with white patients having a five-year survival rate of 84.7 per cent and black patients having a survival rate of 70.9 per cent.” So… whites have only an 85% survival rate, and blacks have only a 71% survival rate, but somehow the average works out to 92%? The 6% of the population who are neither black nor white must have really good survival rates.

    The other peculiar statistic is that “Europe”, which I had understood to have paradigmatic nationalized health care, had a cancer survival rate of only 57%. So I’m doubtful that this study really makes the case that nationalized health care is good for you….

    And finally, after lecturing us about how masses of poor people in the U.S. are dying undiagnosed in hovels because they are too well-off for Medicaid but too poor to afford health insurance, you accept uncritically the Cuban government’s official statistics on cancer survival? I think you’re being gullible….

    BBB

  • gopher65

    I honestly don’t understand their US results. I just kind of assume that their must be some rational behind them that isn’t obvious from at a glance.

    Cuba, yeah. That’s why I said WTF. That’s weird.

    Western Europe has great survival rates. Eastern Europe is a conglomerate of 3rd world countries that don’t even have access to clean drinking water. Europe’s overall rating suffers a lot because of that. (Every stat in Europe except population (etc) went down drastically when they expanded to 27 countries. All of the new countries were dirt poor.) It makes no sense to me to look at Europe as a whole, because each country has its own separate system and its own separate problems. It would be the same as taking the US, Canada, and Mexico and looking at every stat in NA as an average of those 3. What would be the point?

  • http://blog.bbbeard.com bbbeard

    gopher65:

    I strongly recommend that you or anyone else seeking to understand this issue skip the garbled interpretation by Canadian TV journalists and go directly to the CONCORD study report, which is available online.

    gopher, you wrote: “In the US when a poor person has cancer they just die in their hovel. It never gets reported because they never go to a hospital, because they can’t afford treatment (or insurance, but they’re slightly too “well off” for government programs). … Second: Cuba beats the US. Cuba. FFS. How in the world did that happen?”

    After reading the CONCORD report, I can say that words fail me in describing how absolutely wrong you are. If you read the report, you will find that all the Cuban data are flagged with an asterisk as suspect. The reason is that an astounding percentage of the Cuban cancer deaths are reported solely on the death certificate; in the jargon of the report, these are “DCO”. Of the four categories studied, here are the Cuba and overall (global total) study DCO rates:

    Breast: Cuba, 28% DCO, Overall: 1%
    Colon: Cuba, >50% DCO, Overall: 3%
    Rectal: Cuba, 36% DCO, Overall: 1%
    Prostate: Cuba, 54% DCO, Overall: 2%

    What this means is that in Cuba, somewhere between 1/3 and 1/2 of all cancer victims get no treatment at all. Their status as cancer victims is only noted on their death certificate and there is no history of diagnosis and treatment such as that received by the survivors. You were right about dying in hovels, you just had the wrong country. I can’t say how angry it makes me that propagandists like you not only have no respect for facts, but you invent weird theories about Americans dying in the streets on the basis of absolutely no evidence, while the actual evidence points to the absolute lethal inferiority of systems like Cuba’s. And you seem incapable of procuring the facts, or even facing them when someone else does it for you.

    Western Europe has great survival rates. Eastern Europe is a conglomerate of 3rd world countries that don’t even have access to clean drinking water.

    If there is anything that the CONCORD study report makes absolutely clear, it’s this: if you are diagnosed with cancer, the one country in the world where you would want to live is the United States. Look at Figure 1. Excluding the defective Cuban data, the U.S. has the highest rate of cancer survival for all the countries for all the cancers studied (breast, colorectal, and prostate). [Although French females have a slightly higher, but not statistically significant, survival rate than US females, ditto Japanese males and American males -- but the total (M+F) rate is higher for the US than for either France or Japan, as the numbers in Tables 1 and 3 reveal.]

    For the record, Eastern Europe is not “third world”, it is “second world”, and it has inherited the ravages of Communism, not colonialism. You’ve heard of “Communism”, haven’t you? See “Cuba”.

    And again, your ungrounded and ignorant speculation that Western Europe has “great survival rates” is more left-wing fantasy. If you had even bothered to read the introduction to the CONCORD report, you would know that one of the major motivations for the CONCORD study is the discrepancy between American and European cancer survival rates. Just look at Figure 1. The European countries all have inferior survival rates. Let me focus on the UK, since the NHS is often used as a whipping boy or shining exemplar of universal health care, depending on which side of the libertarian/communist divide you live.

    Survival rates for different cancers (from table 3):
    Breast: US 83.9%; UK 69.7%
    Colon: US 60.1%; UK 44.0%
    Rectal: US 58.4%; UK 43.0%
    Prostate: US 91.9%; UK 51.1%

    Let me put that last number in context: if you are an American diagnosed with prostate cancer, you have an 8% chance of dying of that cancer within five years. If you are one of Her Majesty’s subjects and you are diagnosed with prostate cancer, you have a 49% chance of dying of that cancer within five years. That’s six times greater mortality risk. And though the proponents of universal health care are quick to latch on to any anecdotal statistic that seems to show their cause in a favorable light, I’d say these statistics are fairly damning. Your side should be trying to cover them up. I guess you didn’t get the memo.

    And gopher, I’m thinking you should have picked a different animal as a mascot.

    BBB

  • gopher65

    A) Did you read either of my posts? In both of them I said that I thought that the Cuban data was weird (aka, suspect). Do you just ignore anything that goes against your presuppositions? I am *anything* but a fan of Cuba, either their government or their half-assed medical system. If you’d actually read my posts instead of just inferring what I meant from my opening sentences, you’d have been able to guess that.
    _______________________________________

    B) Yes, I’m aware that some older people (60+) people refer to the (ex-)Soviet states as 2nd World. However, the term 3rd World doesn’t mean “victim of colonialism” like you seem to think it does. Nor does the term 1st World mean “Western state”.

    The term Second World originated because someone once wrote that being in the Soviet Union was like being in “a second world”. The terms First World and Third World were ret-conned into history after the fact. For a short time 1st World meant “US allied state” and 3rd World meant “everyone else” (all non 1st/2nd World countries). However, the meaning of these phrases has changed.

    In common usage 1st World now means “rich”. 2nd world now means “Use to be a power, but is no longer significant”. That is pretty much restricted to Russia, with a slot reserved for the US in 30 years (hopefully that slot doesn’t get filled). 3rd World means “poor as dirt”.

    As an example, in Ukraine the average annual income was 700 dollars a year for a family (last time I checked. That was about 5 years ago, so inflation alone will have raised that a bit). That’s “poor as dirt”. Other parts of eastern Europe have similar income levels. Therefore, half of Europe is 3rd world, by the colloquial definition the term has had for the past 25 years.
    _______________________________________

    C) The UK’s health system is a disaster by any measure. Pointing to a country whose health system couldn’t find its ass with both hands and then saying “SEE! They couldn’t do it so no one can!11eleven11!!” isn’t exactly a good example of intellectual honesty. That’s like pointing at Iran and saying “SEE! Democracy doesn’t work!!!”. Riiiiight. *Great* point you made there. Keep it up:P.

    France would be a better comparison, since their system is generally considered to be one of the better models for others to follow (healthcare wise. Economic policy though? *shudders*). France has a hybridized private/public system, and there is barely a statistically significant difference in survival rates from US figures for all types of disease… and France spends half as much as the US does (per capita of course).

    And that’s the point. Ultimately it doesn’t really matter whether any given country has a private or a public system (except to those (apparently like yourself) who are religiously opposed to either public or to private healthcare (which is silly position to take IMO)). What matters is the answer to one simple question:

    “What is the best way to achieve the optimal survival-rate to cost ratio?” <—– That's it. Everything else is merely ideology. Do you know what the answer to that question is? I don't either. But I do know that the answer isn't what the US is currently doing.

  • http://blog.bbbeard.com bbbeard

    gopher:

    Your first post said “Cuba beats the U.S. Cuba. FFS. How in the world did that happen?”

    Let me repeat that: “Cuba beats the U.S.” What I have just finished explaining in detail is that this statement is absolutely wrong. Instead of admitting your error and moving on, you attack me for pointing out your error. Am I surprised?

    You also wrote this: “In the US when a poor person has cancer they just die in their hovel.” As I just finished explaining, this statement is also without foundation. It is your fantasy. But it does apply to the country that you said “beats the U.S.” Again you can’t face your error.

    Yet you retract neither statement. Whatever. You are just confirming what I wrote, which is that you are unable to face the facts even when someone else digs them up for you.

    I’m not going to be drawn into a pointless digression of whether the definitions of the First, Second, and Third World are evolving, or whether people like you are simply ignorant of their meaning. I just advise you to go the Wikipedia article on the Third World and see if any of the definitions there can be tortured into agreement with your assertions. Keep the results to yourself. I’m satisfied that what I wrote is correct.

    Fine, France then.
    Breast: US 83.9%; Fr 79.8%
    Colon: US 60.1%; Fr 58.7%
    Rectal: US 58.4%; Fr 57.6%
    Prostate: US 91.9%; Fr 73.7%

    If you do the Z test, then the differences in survival for Breast and Prostate are significant. The differences for Colon and Rectal are marginal, largely driven by the small size of the French sample. Your statement “there is barely a statistically significant difference” is false. In particular, if you have prostate cancer, you are more than three times more likely to die of it within 5 years if you are treated in France than if you are treated in the U.S.

    What matters is the answer to one simple question: “What is the best way to achieve the optimal survival-rate to cost ratio?” That’s it.

    As I wrote elsewhere on this blog, “I’ve taught professional ethics before (engineering ethics). Cost-benefit analysis is only one tool that you may use to decide ethical issues…. I think we should be cautious in abandoning the American standard of care in order to adopt the standards of poorer countries.” That’s not ideology — that’s professional ethics. You should educate yourself on this topic.

    Unfortunately, your attitude is parroted by the less-informed ideologues of the left — and that is a major reason that charges of “death panels” gain traction in the current debate. What you are recommending is a system that is unable to come to terms with human beings’ desire for life, and you have a naive belief that cost-benefit analysis can be applied to issues of life and death without reference to other paradigms, including individual rights. Ironically, it is the opposite of “health care is a right, not a privilege”, another leftist slogan. Indeed, it amounts to “health care is a right until it will cost more to keep you healthy and living than the government decides is prudent.” Sounds like a death panel to me.

    One could make the argument from the CONCORD study that this is exactly what the U.S. is buying for its marginal expenditures on health care — survival past the point of diminishing returns. And it is precisely the desire of people like you to let more people die to save money that allows the “death panel” meme to flourish. Consider, just for a moment, what it would mean for the U.S. to have the French survival rate for prostate cancer. Using the data in CONCORD Table 1, there were 356,881 diagnoses in 1990-4, in a sample that represents 42.4% of the U.S. population, so that suggests that the overall U.S. diagnostic rate for prostate cancer was around 841,700 in that five-year period. The U.S. survival rate was 91.9%, so 773,523 survived five years. If we had the French survival rate, only 620,333 would have survived. That’s an extra 150,000 people whose lives you deem unworthy of saving.

    And that’s just for prostate cancer. If the Obama administration and you have it your way, and we cut medical care to a more “efficient” level, hundreds of thousands of people — perhaps millions — will die needless deaths. That’s even before we consider the fact that most medical innovation comes from the U.S., so starving and beating our medical sector will harm people around the world. And that is not ideology, nor hyperbole — it’s just what you get if you adopt the notions of efficiency that central planners desire.

    BBB

  • gopher65

    bbbeard: Arrrrrg! Can you even read? And I just finished explaining to you that you are putting words in my mouth. My supposed “love” of Cuba is nothing but your own personal sick twisted fantasy! If you can’t understand basic English (or “engrish” as they case may be with internet slang;)) then communication with you becomes impossible, and therefore there is no point in trying.

    So I’m done talking to you. Post here all you want, in the future I have no intention of speaking with anyone as… opinionated, prejudiced, and stuck in their ways as you are. You’re a lost cause. (As is the case with all old people unfortunately. Their brains deplasticize and they become physically incapable of modifying their viewpoint. “You can’t teach an old dog new tricks.” I sometimes forget how true that is. It’s sad that that happens to old people:(. I truly do not look forward to being 50+ and having that happen to me.)

  • http://blog.bbbeard.com bbbeard

    gopher:

    LOL. Come back anytime. Maybe after you graduate.

    BBB

  • Just Learning

    bbbeard

    Stop being disingenuous.

    Your stats seem to be impressive, until you consider that the majority of those cancer patients are receiving there funding through medicare or medicaid

    http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.189v1/DC1

    In addition, the US has a very aggressive, publicly funded, cancer research program. The US govt spends more than twice as much as the EU on cancer research.

    http://www.eubusiness.com/Health/cancer.2006-07-18/

    It is ludicrous to quote the success of the US government in battling cancer, and then claim this success for insurers.

  • http://blog.bbbeard.com bbbeard

    JL:

    Is it your impression that the results of that cancer research are being kept from the Europeans, like some sort of proprietary information? I don’t think there is any evidence that the Europeans are ignorant of cancer research — it’s simply the case that their government health plans CHOOSE not to take advantage of that research. Take prostate cancer, for example. It is the standard of care in America to monitor serum levels of prostate-specific antigen (PSA) in males of a certain age. This is one reason that we detect prostate cancers early and have excellent survival rates. However, in the UK, with nationalized health care, the NHS will not perform biopsies based on PSA tests because it saves money to do “watchful waiting”. The extensive delay imposed by the “watchful waiting” standard is one reason a diagnosis of prostate cancer in the UK is practically a death sentence. It’s not that they are unaware of the research, it’s that their government-run health care system is trading costs for lives.

    So, frankly, although your observation that the lion’s share of global medical research is done in this country is true, it has nothing to do with why the results of that research are not adopted by other countries. Other countries choose to ignore that research because it saves money, not because they are ignorant.

    A significant portion of our medical costs are funded through Medicare. A larger portion of medical costs is funded through the government in European countries. Somehow you seem to be arguing that… because some of our insurance is government funded, and we show good cancer survival rates, therefore more or all of our medical costs should be funded through the government, so that we can be more like the poorer countries who have government-funded health insurance… but who have poorer cancer survival. Or something. Get your story straight. Once you accept that the difference between the U.S. and Europe is not due to superior access to medical journals, you have to confront the fact that the primary difference between the U.S. and Europe is that we do not (yet) impose a draconian cost-control regime in order to save the government money. However, the two stated goals of “health care reform” are to cover the uninsured (which is an insurance issue, not a health care issue) and… cost control.

    What Obama wants to do [but what is not in HR3200] is head toward a single-payer system, i.e. put us all on Medicare/Medicaid — and then apply the kind of cost-effectiveness standards that are analogous to the UK NICE panels. This might prompt one to ask “why not fix Medicare first?” since it is Medicare that is going bankrupt, not Blue Cross. As the central planners fully recognize, however, if Medicare implements anything like the cost-effectiveness standards of European government-run health care, to the point where mortality rates are affected adversely, people will flee the government-run system and demand the “wrong kind” of change — i.e. a change to private insurers in lieu of central planning. That’s why it’s a priority among “progressives” to undermine the system of private insurance before implementing cost controls.

    I don’t think you’re being disingenuous. I just think you haven’t thought this through.

    BBB

  • Just Learning

    Let me ask you this question then: Why are private insurers afraid of a public option?

    It is somewhat farcical to assure me that a plan run by a democratic government will solely be concerned about denying procedures for the sake of saving a buck. It is also farcical to argue that a program run by a national government using a floating currency can ever be “bankrupt”.

    I fully understand the advantages of a competitive market system, but you seem to be arguing that somehow private insurers are interested in something other than turning a profit. Without a strong federally funded treatment and research program, all the wonderful statistics you site would not exist. None of the wonderful treatment or success in battling cancer existed until the government made it a priority. Radiation therapy is a perfect example of a medical treatment that simple could not have existed without direct government interest in nuclear sciences.

    The real question then is what makes the U.S. gov’t more effective than other gov’ts in addressing popular concerns?

  • http://blog.bbbeard.com bbbeard

    JL:

    Why are private insurers afraid of a public option?

    The groundswell of opposition to the “public option” is not grounded in the fears of the private insurers, no matter what propaganda you have been fed about “astroturfing” in this conflict.

    The opposition is grounded in the fears of ordinary Americans that the government, whose reins they appear to have let slip, will interfere with the supply/demand balance in the health care insurance market. There are several scenarios here: the government could (1) raise the cost of their insurance by shifting costs from one group to another (in the absence of demand signals!) (2) or conversely, tempt employers to cancel private options by undercutting prices with taxpayer-subsidized insurance, (in the absence of cost signals!) (3) reduce coverage for seniors in Medicare in order to pay for young uninsured people, (4) reduce the quality of medical care by trying to control doctors’ salaries by fiat, thereby driving doctors out of the market, or (5) introduce market distortions by trying to mandate the mix of specialties in which doctors are allowed to train, and so on. This list only scratches the surface of the potential unintended consequences of the government-option health care plan.

    People are also naturally suspicious because prominent Democrats have described the “public option” as a steppingstone to “single payer” — which we don’t want.

    People rightly perceive great risk in these plans, and they also rightly judge that the idiots voting on these plans — the vast majority of whom have never read the legislation — are not competent to assess these risks.

    It is somewhat farcical to assure me that a plan run by a democratic government will solely be concerned about denying procedures for the sake of saving a buck.

    Correct me if I’m wrong, but the weasel-word here is “solely”. Remove “solely” from your statement and suddenly the premise is not farcical at all. In fact denying care is how countries like Canada and the UK control costs. And the cost cutting evidently shows up in the mortality statistics. Now, who is arguing for inserting the word “solely” into your farce? I’m not.

    you seem to be arguing that somehow private insurers are interested in something other than turning a profit.

    You seem to be unaware of the existence of not-for-profit insurance companies. My insurance company is Blue Cross / Blue Shield of Tennessee, which is a not-for-profit corporation. I am pretty happy with the way my insurance works. However, I also believe Americans are “overinsured” — health insurance has expanded more rapidly than the economy in part because it allows employers to compensate employees outside of the normal income tax structure. Some liberals think this is a justification for taxing insurance benefits — but I take the contrary view, that it is stark evidence of the unsustainable distortions produced by the high marginal income tax rates we suffer in this country. Health care costs would be better regulated by a market in which ordinary transactions were priced by the market, in which consumers weighed costs and benefits because they would be spending their own money, and in which only large (i.e. catastrophic) care costs were pooled and covered by insurance.

    I should also point out that BC/BS has come out in favor of universal coverage, and the need to stop the practice of setting premiums based on health status and gender. However, BC/BS is opposed to a government-option, because of the above-mentioned unintended consequences.

    But the idea that I am opposed to the government option because my insurance company is, too, is just plain weird. To paraphrase Barney Frank, what planet have you been living on?

    The real question then is what makes the U.S. gov’t more effective than other gov’ts in addressing popular concerns?

    No, the real question is: why do some people think that government is the solution, rather than the problem?

    Personally, I think government is a mixed blessing. I like the fact that government subsidizes things like particle physics and manned spaceflight. They play a big role — albeit not an exclusive one — in medical research.

    I’m in favor of increased funding for research — I would say that one million dollars spent on medical research has a far more positive effect on morbidity and mortality than a million dollars spent administering a duplicative insurance program. As I’ve pointed out, though, medical research results are disseminated worldwide. The only way medical research affects international morbidity comparisons — and the assessment of the wisdom of a government takeover of health insurance — is in its prospective diminution at the hands of budget cutters.

    BBB

  • Just Learning

    “The opposition is grounded in the fears of ordinary Americans that the government, whose reins they appear to have let slip, will interfere with the supply/demand balance in the health care insurance market….”

    These arguments are specious. No organization can arbitrarily remove itself from following basic economic principles, there is always an equilibrium of some sort being maintained. Your point about unintended consequences might sound intelligent until one realizes that every action has unintended consequences and no one entity is immune to them. Maintaining the current status quo also has serious unintended consequences.

    I absolutely agree that central planning of entire economies ultimately fails, simply because there is no mechanism that can keep up with shifts in peoples preferences, needs and wants. This is why every dictatorial country is forced to tolerate a healthy black market…central planners simply can’t keep pace with irrational changes in culture and values.

    The U.S. is not a dictatorship, nor is the proposal on the table horribly unreasonable. You are presenting a series of false choices as being the only logical ones that present themselves. That simply isn’t true, and it simply isn’t true that group choices (like democratic ones) have no place in the free market. If you are happy with your Blue Cross/Blue Shield, good for you, but I have had equally bitter experiences with the same organization, so I can assure you that your confidence in private insurers is greatly misplaced.

    If you insist on maintaining the position that the US government is evil and its only intent is to screw old people out of their health care and send them to their early deaths, then I simply can no longer entertain any further dialogue.

  • http://blog.bbbeard.com bbbeard

    JL:

    Well, JL, your posts are getting rather thin on substance, and increasingly erratic in your reading of my commentary. so like I told gopher: Come back anytime, maybe after you graduate.

    In the meantime, I’ll comment on your observations.

    there is always an equilibrium of some sort being maintained

    Why do I get the impression that you didn’t do any better in your economics classes than in your physics classes? Not everything is in equilibrium.

    Maintaining the current status quo also has serious unintended consequences.

    I thought you just said we were in equilibrium? Now I’m confused.

    In any case, I favor changes that favor the free market. Some of these are oft-stated, such as allowing health insurance policies to be sold across state lines. I just pointed out in the previous post that we should move to a system with more individual stake in health care expenditures. We could do this with a system that allowed employers to create tax-free incentives for saving money — for example, imagine a system where employers were allowed to put $2000 in an employee’s health care account, from which you were required to cover your first $2000 of health care expenditures, but from which you were allowed to keep any unspent money, tax-free, at the end of the year. Contrast this with the current system of health care benefits accounts, where employees can put their own pre-tax money, but lose any balance at the end of the year.

    But you see a problem with this? The problem is that although we don’t live in a dictatorship, we sure as hell live in a one-party state, and any proposals coming from conservatives are immediately disregarded by the folks in power.

    I think that the government can and should legitimately require insurers to cover pre-existing conditions — part of HR3200 [sec 111, Subtitle B of Title I, Div A]. Isn’t that like requiring insurers to sell fire insurance on burning buildings? some people ask. No, not really. People really do burn down buildings to collect insurance, but as far as I know, no one has ever deliberately developed cancer — or even broken a bone — to collect payments from insurance companies. Doesn’t that interfere with the free market? others remark. Well, what we have now is a system where people are afraid to change jobs because their new insurance might exclude them from covering their diabetes or gout. The market power of private insurers, containerized into state markets, allows them to impose this distortion on the free market. Let’s get rid of it and enjoy the benefits of freeing up the labor market.

    What I don’t believe is that I should have to pay for a government option to compete with private insurers just to have that particular market distortion fixed. But “evil” (your word) politicians who want us to move toward a single-payer system refuse to sever that provision, because they want to use it as a carrot to coerce us into accepting their massive scheme.

    If you insist on maintaining the position that the US government is evil and its only intent is to screw old people out of their health care and send them to their early deaths…

    You really need to break that habit of using weasel words (“only”). If your argument is weak enough that you require that kind of conditional scaffolding to make your statements sound reasonable, you need to step back and reformulate.

    Anyway, in this regard I am concerned about two things. First, some of the people pushing this scheme really do understand that the system they want to implement will trade lives to save money. Telltale signs: they hint at the need for “very difficult democratic conversations” when talking about providing care for sick people [Obama]. They talk about prescribing painkillers instead of pacemakers for cardiac arrhythmia. [Obama]. They write about the “tough technical decisions” that their plans will enable [Daschle].

    Second, I’m concerned that other people pushing this scheme have no idea that it will (or “could”) lead to the rationing of care. Telltale signs: they dismiss unintended consequences, and bring up non sequitur straw men about dictatorship and evil government when responding to intelligent commentary.

    BBB

  • Just Learning

    “Why do I get the impression that you didn’t do any better in your economics classes than in your physics classes? Not everything is in equilibrium.”

    You can not perform a measurement or make an observation if there is not some sort of equilibrium. Go back to school when you have the opportunity.

  • Just Learning

    “They talk about prescribing painkillers instead of pacemakers for cardiac arrhythmia. [Obama]”

    I found the specific reference:
    http://wizbangblog.com/content/2009/07/21/sophistry-obama-painkillers-and-pained-words.php

    Any invasive procedure is very dangerous, and as you get older there is a higher risk of complications. Obama was very correct in stating that in many cases, a specialist may make a decision that a patient may live a longer and happier life without the procedure. In any case, it was very clear from the conversation that the choice to perform the procedure did not rest with the patient or her daughter, so to argue that the public option would take choices away from patients is incorrect.

    Watch this and then tell me that private insurers are less draconian; it is from Sicko, but has been edited down to remove any commentary (no, I’m not a great fan of Michael Moore, so please refrain from the inevitable inane comments)
    http://www.youtube.com/watch?v=RmHTte8jRLk

  • http://blog.bbbeard.com bbbeard

    You can not perform a measurement or make an observation if there is not some sort of equilibrium. Go back to school when you have the opportunity.

    Nonsense. We do it all the time. What do you think we measure when we use an accelerometer? ;-) What do you think economists are measuring when they measure growth in GDP?

    In any case, it was very clear from the conversation that the choice to perform the procedure did not rest with the patient or her daughter

    Boy, that’s not how I hear it. The patient and her daughter wanted the procedure, their doctor wanted the procedure, the first specialist said no, so they went to find another specialist, who said yes.( If that isn’t the patient choosing to perform the procedure, who chose?) THAT’S THE POINT OF THE STORY. When patients have the freedom to choose doctors, and doctors have the freedom to help (or not help) patients, everyone benefits. What everyone is worried about is the imposition of a system where the government controls the supply of doctors, and the government chooses which procedures meet their criterion for cost-effectiveness, and no one has a choice. And the fact that this plan is being pushed by someone who doesn’t even know that YOU DON’T PRESCRIBE PAINKILLERS FOR ARRHYTHMIA fills no one with confidence.

    Obama was very correct in stating that in many cases, a specialist may make a decision that a patient may live a longer and happier life without the procedure.

    In this country, doctors and patients make these kinds of decisions jointly. You seem to be fixated on a top-down, dictatorial form of health care. I’m sorry if that’s been your relationship with your doctor. You should speak up and participate in the decision-making about your health. While you still can.

    Sicko

    So this is MM’s great indictment of private health care? Nixon on tape? LOL.

    This is the same Nixon who gave us wage and price controls? The same one who pushed quotas for affirmative action? Who abandoned the gold standard? Who imposed the 10% tax on imports? Whose advisor, Herbert Stein, bragged about the unprecedented amount of regulation imposed by the Nixon administration?

    The last thing Nixon was right about was Alger Hiss. But what makes you think Nixon knew anything about the free market system? Bizarre.

    BBB

  • Just Learning

    “Nonsense. We do it all the time. What do you think we measure when we use an accelerometer? ;-) What do you think economists are measuring when they measure growth in GDP? ”

    You need a good course in math. You might also want to check out some books on conservation laws. Thermodynamics might be a good place to start as well.

  • http://blog.bbbeard.com bbbeard

    You need a good course in math. You might also want to check out some books on conservation laws. Thermodynamics might be a good place to start as well.

    LOL. I’ve got a bachelor’s and a master’s in mechanical engineering and a doctorate in theoretical physics, all from the little tech school where Sean Carroll did his postdoc. And I’ve taught thermodynamics more times than I can remember.

    But I can always use more learnin’, JL. Can you recommend a good math textbook?

    BBB

  • Just Learning

    I now know that I have very little to fear.
    In your case I would recommend going to the library and picking up a dictionary, then watch the following:

    http://www.youtube.com/watch?v=nQezXbiroiE

  • Just Learning

    Since its friday, what the heck:

    http://www.youtube.com/watch?v=Zx3m4e45bTo

  • http://blog.bbbeard.com bbbeard

    JL:

    Good Will Hunting

    Heh. Great movie. Did you know it was fictional? That wasn’t even MIT.

    On the other hand, this movie was based on a true story. And it was at least filmed near MIT. As for me, I beat the house at the Grand Casino in Monte Carlo by using a highly sophisticated strategy for placing bets on roulette. Maybe I’ll tell you about it sometime….

    BBB

  • Just Learning

    Maybe you did, maybe you didn’t; but do you think that really impresses anyone? Cheating at Roulette? Do you think your the only one who could solve such a simple multivariate problem?

    Math skills are nice, but all that means is that you get to be a tool in a toolbox. At some point in your life, if your lucky, you might stop and wonder what you can do to help the people around you. If your really lucky you might actually find a way to do it. Your existence in the universe, and all your skills don’t amount to a hill of beans except in the present.

    So the question I ask you is whether you want to be a tool for the rest of your life?

  • http://blog.bbbeard.com bbbeard

    Maybe you did, maybe you didn’t; but do you think that really impresses anyone? Cheating at Roulette? Do you think your the only one who could solve such a simple multivariate problem?…. So the question I ask you is whether you want to be a tool for the rest of your life?

    I’m trying to imagine you being a little less unhinged… but it’s just not coming to me….

    Of course I enjoy helping people. I’m helping to bring you to enlightenment, but your ego keeps getting in the way. “Snatch the pebble from my hand, Grasshopper”.

    Let’s return to the notion of equilibrium for a moment. Meditate on this: there is no equilibrium. “Equilibrium”, like “steady flow”, like “isolated systems”, is just a model we use to try to make sense of the things we see around us. Physical systems can be approximately in equilibrium, but it is more usually the case that they are changing their state of motion due to an imbalance of forces. Equilibrium is only one paradigm among many. For example, the equilibrium paradigm is not very useful for modeling oscillatory systems, where energy flows back and forth between two modes of storage (in the idealized paradigm). Equilibrium is not a useful paradigm for understanding systems that are characterized by growth, be it the inflationary universe or inflation in an economy.

    In the meantime I’ll leave you with the famous quote from Robert Heinlein:

    “Anyone who cannot cope with mathematics is not fully human. At best he is a tolerable subhuman who has learned to wear shoes, bathe and not make messes in the house. ”

    Now, it could be that you have some mathematical skills, but for some reason you are just choosing not to display them in this thread. Humility is a good thing. But I suspect that advancing any argument about health care will require something more, oh, analytical. Just tossing insults back and forth is fun, but something of a diversion, don’t you think? But if that’s all you can do, I’ll play along until a serious commenter drops by.

    BBB

  • Just Learning

    “For example, the equilibrium paradigm is not very useful for modeling oscillatory systems, where energy flows back and forth between two modes of storage (in the idealized paradigm). ”

    Since that statement indicates to me that you are very nearly capable of correcting your incorrect understanding of everything, let me repeat:

    You can not perform a measurement or make an observation if there is not some sort of equilibrium.

    http://en.wikipedia.org/wiki/Zeroth_law_of_thermodynamics

    Under the zeroeth article itself you can find:

    “It is often claimed, for instance by Max Planck in his influential textbook on thermodynamics, that the Zeroth law implies that we can define a “temperature function” or more informally, that we can “construct a thermometer.” ”

    There is actually a good link for the philosophy of the zeroeth law on wikipedia:

    http://en.wikipedia.org/wiki/Philosophy_of_thermal_and_statistical_physics

    it contains this statement:

    “Hence thermal equilibrium between systems is an equivalence relation, and this is the substance of the zeroth law of thermodynamics. According to Max Planck, who wrote an influential textbook on thermodynamics, and many other authors, this empirical principle shows that we can define the “temperature function” central to our everyday conception of heat. ”

    that leads you to this:

    http://en.wikipedia.org/wiki/Equivalence_relation

    There is a great statement there that you should read:

    “An ubiquitous equivalence relation is the equality (“=”) relation between elements of any set. ”

    Another great wiki article is this one:

    http://en.wikipedia.org/wiki/Conservation_law

    This article contains a good quote:

    “One particularly important physical result concerning conservation laws is Noether’s Theorem, which states that there is a one-to-one correspondence between conservation laws and differentiable symmetries of physical systems. For example, the conservation of energy follows from the time-invariance of physical systems, and the fact that physical systems behave the same regardless of how they are oriented in space gives rise to the conservation of angular momentum.”

    (Note: it says one-to-one!!!)

    It is very important now to review what is meant by “temperature function”, or more specifically “function”:

    http://en.wikipedia.org/wiki/Function_(mathematics)

    From here we get:

    “In mathematics a function is a relation between a given set of elements (the domain) and another set of elements (the range), which associates each element in the domain with exactly one element in the range. The elements so related can be any kind of thing (words, objects, qualities) but are typically mathematical quantities, such as real numbers.”

    and

    “In pure mathematics, functions are defined using set theory, and there are theorems that show the existence of uncountably many different functions, most of which cannot be expressed with a formula or algorithm.”

    From here it should be very clear that for someone to perform a measurement or make an observation, one must first define a function that is expressible by some formula or algorithm that utilizes the equivalence principle. Without the ability to do such, one can not make an observation or take a measurement, since any attempt to do so would be meaningless (and any device that one tried to construct would most likely output random numbers).

    Combined with the fact that there are empirically verified symmetries in the universe, we are thus able, and in some way guaranteed, to be able to observe the world around us; specifically, there are invariable scalar quantities that are measurable by all observers.

    Thus in essence:
    You can not perform a measurement or make an observation if there is not some sort of equilibrium.

  • Just Learning

    “I’m trying to imagine you being a little less unhinged… but it’s just not coming to me….”

    as far as this comment is concerned:

    http://www.youtube.com/watch?v=muP9eH2p2PI

  • Just Learning

    Although I think this song more accurately describes your current state:

    http://www.youtube.com/watch?v=7j2DHUw8SZg

  • http://blog.bbbeard.com bbbeard

    …Thus in essence….

    That’s it? You’re confused about the difference between equivalence and equilibrium?

    Let me see if I can cure just a little bit of confusion today.

    Look, fundamentally, “equilibrium” means a balance of fluxes. The word itself comes from the Latin and means “equal balance” or “equal scales” — like when a beam balance comes to rest, the net forces and moments on the balance are zero, which allows us to infer something about the quantities of matter on either side of the scale. Apparently you are misled by this paradigm, because the act of measurement has come a long way since the time of Caesar. We now know how to measure many things happening very fast. In mechanical systems, for example, we can very easily measure pressure changes happening over a fraction of a millisecond [and probably can do orders of magnitude better if we try hard -- I'm not sure what the current state of the art is]. In radiative systems, well, friends of mine measure the tracks of elementary particles with femtosecond lifetimes. Measurement does not require any sort of equilibrium.

    Mechanical equilibrium occurs when net momentum fluxes are zero and the system is in steady state. Chemical equilibrium, ditto for net flux of chemical species. Radiative equilibrium, ditto for net flux of electromagnetic radiation. You might as well start with the Wikipedia article on thermodynamic equilibrium if you want to learn more. These are all idealizations. (For the most part, thermodynamics itself isn’t correct except in the thermodynamic limit ‘N goes to infinity’.) This all has nothing to do with equivalence relations except in the trivial sense that equivalent outputs from a calibrated measurement device can be trusted to measure equivalent physical parameters. That equivalence has nothing to do with whether the object or system being measured is in any kind of equilibrium. In fact, if EVERYTHING was in equilibrium, there would be no point in measuring temperature, would there? ;-)

    I mean, this is a really trivial point. The fact that measuring a pound of sugar and a pound of flour on a kitchen scale gives the same number has nothing to do with whether the sugar and the flour are in equilibrium. I’m starting to think you’re toying with me, writing outrageously stupid things to see if you can get a rise out of me. But I’ll refrain from any further flaming, because I really suspect you may just be honestly ignorant.

    Seether/Fake It

    Heh. I know you are, but what am I?…. But seriously, you’re circling the drain of juvenile irrelevance. Get a grip. I’m sensing some doubt on your part, but cowardice, too, about directly accusing me of lying about myself. My advice is for you to knock it off before you embarrass yourself. And do a little research.

    BBB

  • Just Learning

    I have no confusion on this matter.

    I expected that you would go this route.

    There is no functional difference between the terms equivalence and equilibrium. What you are arguing is about a particular contextual use of the terms. Are you saying that terms on opposite side of an equation are out of balance? Too bad you still can’t figure that out. Since you chose this direction it shows me that you are incapable of actually learning anything and that you are just a tool, as stated before.

    In any case, I have successfully diverted you away from the focus of this thread and have demonstrated that you are in no way capable of having a reasonable opinion on the subject matter.

    However, I know at some point the owners of this blog will be forced to intervene and stop comments, so until that happens I am more than happy to continue this back and forth.

    http://www.youtube.com/watch?v=DKhnmUdmz74

  • http://blog.bbbeard.com bbbeard

    JL:

    Well, since you’ve been unable to produce any evidence to support your thin argumentation on health care, I suppose you consider your retreat a “success”. You remind me of the French army.

    BBB

  • Just Learning
  • http://brokenglassware.blogspot.com El Charro

    What everyone is worried about is the imposition of a system where the government controls the supply of doctors

    Because those who are worried about that particular thing are just plain ignorant about the current state. If you think it doesn’t happen right now you need to go and find out more about the AMA. They have been doing this for years.

    Can you, or anyone, give a good reason why limiting the number of doctors (I am not saying anyone should be admitted into a medical school, just that there is a lot of smart people who can’t make it in because of the caps) is a good thing for anyone except the doctors themselves?

    There are several scenarios here: the government could (1) raise the cost of their insurance by shifting costs from one group to another (in the absence of demand signals!) (2) or conversely, tempt employers to cancel private options by undercutting prices with taxpayer-subsidized insurance, (in the absence of cost signals!) (3) reduce coverage for seniors in Medicare in order to pay for young uninsured people, (4) reduce the quality of medical care by trying to control doctors’ salaries by fiat, thereby driving doctors out of the market, or (5) introduce market distortions by trying to mandate the mix of specialties in which doctors are allowed to train, and so on.

    Or… none of them could happen. You seem to be sure that at least one of those scenarios will actually happen. And that they are necessarily bad. What is wrong with doctors not making soooo much money for example? Or why would they be driven out of the market? Physicists, for example, do not make that much money; can you really say that they have been driven out of the market? Point 5 is related to my response above. For some reason you seem to think that there are no market distortions in the medical field right now. AMA is a huge distortion. Obama is not proposing limiting the number of doctors, he is proposing making family-care doctors more available.

    I come from a country where public medical schools are essentially free for the medical students. Schools do have a yearly quota, but that is due to availability of physical space, not to drive doctor’s salaries up by controlling the supply. Specialties are also effectively free, and actually the government pays you a stipend (like a graduate student sort of thing) if you join their medical training program: We pay for your education, but when you are done you have to work for some years (the number depends on the specialty) in an economically-hit community. During this time they keep receiving the government’s stipend, which is not a lot but it’s enough for them to start a family if they want. You don’t have to take the government’s money though. If you can/want to pay out of your pocket that is fine. And you don’t have to do that community time.

    Here’s food for thought: Law Bar Associations usually recommend a certain number of pro-bono hours although there is no penalty for falling short. Would it be so bad if the AMA implemented pro-bono medical work and makes it mandatory? Maybe 3-5 days/year/doctor in a community clinic? I am not talking about extremely expensive procedures necessarily but those are also welcome.

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Cosmic Variance

Random samplings from a universe of ideas.

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