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http://www.sfgate.com/cgi-bin/article.cgi?...MNGBSKR3RA1.DTL

It can even cover ILLEGAL IMMIGRANTS!
http://www.latimes.com/news/columnists/la-...la-news-columns


From a Republican? Wow.

looking for a re-election perhaps?

Sweet, my plan to poison the water in California with a toxin that makes people liberal is working! (whahahah!)

Seriously though, not having nationalized health care is one of the worst vices of our nation (right next to our INSANE amount of military spending). I really hope that I see a REAL health care system within my lifetime, not the piece-of-shit bureaucratic serve-the-wealthy mess that we have now.

Hey Rory, not to critizise, but you DO know that you're responding to a Topic a whole YEAR after it was posted, right?

Your criticism is noted.

I will respond with a jest of my own... I have been busy working on my Ph.D. and the discussions here have almost died while I've been away --- I see that you've done your share to keep them going

Sweet, my plan to poison the water in California with a toxin that makes people liberal is working! (whahahah!)

Seriously though, not having nationalized health care is one of the worst vices of our nation (right next to our INSANE amount of military spending). I really hope that I see a REAL health care system within my lifetime, not the piece-of-shit bureaucratic serve-the-wealthy mess that we have now.

I'm sorry, but I think that the Universal Health Care system being proposed is going to do nothing but serve "the rich" and bureaucrats. The rich will receive private health care even if they have to go to India to get it.



Besides, the UHC is not universally "fair" either. Nebraska and Louisiana made off huge with filibuster threats, which to me is a precursor towards the dangers of politicizing the health industry. Who does and does not get health care would be determined entirely by bureaucrats. Whether or not you live or die would be based on whether or not you can gain the favor of the bureaucracy. Nebraska got extra health care because it was able to gain favor, and citizens will face the same scrable to find extra health care as they struggle to wait in line for it.

UHC will lead to rationing. It always has. It does in England, and Canada. An economy cannot simply create an unlimited demand and then force unlimited supply. There will be shortages, just like with the recent Swine Flu Vaccine.

I'll take America's Health Care system anyday, because it rewards the doctors, and it rewards the innovators who find new cures. Truth be told, any liberal Canadian would too. If the liberal Canadian gets cancer, he comes to the United States to receive treatment.

Oh, and Schwarzenegger. California deserves better. He forced citizens to buy, essentially a cash advance on the people, at 10% income to pay for budget shortfalls created from his tax-and-spend policies. He's a joke, and he's using his electorate like his own personal credit card.

This response is long overdue... I put this off for so long because I actually have many many responses here, so this will be a bit of a lengthy post and for that I apologize. I have, however spent a good deal of time thinking about these issues and although my attitudes are definitely socialistic, I do not think the arguments I give below support any specific health care plan currently being proposed.

So, I will make the following DISCLAIMER: I am not arguing in support of some particular plan -- I do not like the ones on the table for the US at the moment (precisely because I do not think that they address the real problem) -- this will be an argument about the role of various economic practices in industries that are supposed to play some role in social-welfare.

Also, I should not that my earlier posts made in this thread were made some time ago and do not totally reflect my current attitudes, so don't take them as representative of what I now believe. Anyway here goes...

Who does and doesn't get health care will be decided by the policies of whatever national health care plan may be adopted. While this will certainly be bureaucratic in some respects, the current system in the US is already painfully bureaucratic. As things are now, who gets and does not get health care is determined by officials in the insurance bureaucratic systems, or the officials at hospitals, or how much money someone has when they walk in the door.

The charge that bureaucrats will be making these decisions is not a convincing argument that nationalized health care is the wrong direction, because other systems (including our current one) are even more bureaucratically top-heavy (it is not hard to find the figures on the inefficiency of the US health care system -- it is one of the worst of the developed nations in this area). Who would you rather have deciding whether or not you get health care? -- A bureaucratic official at an insurance company who has a financial interest to NOT pay for your health care if he can get away with it OR a government bureaucrat who's job it is to follow a rule that is (supposed to be) designed to benefit social welfare?

So, your real argument must have to do with the other consequences... i.e. that a national plan will lead to health care shortages, rationing etc. Indeed, this is the argumentative turn that you take next:

I must admit I am not really sure what to say to this other than the fact that I currently live in England and there is no health care rationing, there is no shortage and as far as I can tell the negatives of the foreign systems you mention are completely overblown by the US media. I have been to the doctors office several times since I have been here and I, on average, have received much better treatment than in the US in a more prompt manner, with minimal bureaucratic interference. I also know many others who live under nationalized health care plans in France, Holland, Canada and several other countries -- as far as I can tell the UK system is the worst in Europe. When I ask them about the US system, they either haven't experienced it or actually are seriously concerned when traveling there abroad.

Here in the UK the many opponents of the NHI (the national health care plan here) are pushing for an even more socialized plan -- and it is not because they are crazy or just buying some political line -- it is because they know how good the French have it.

As a little aside, I just went to the US a month ago and bought some travelers health insurance. The international insurance provider asked me where I was going. I said the US. They responded by demanding the HIGHEST POSSIBLE premium for this insurance -- I was like WTF?! It turns out the US is classified under the "riskiest" possible countries to travel with respect to medical care. US, Ethiopia -- same level.

Additionally, the existence of a national plan (like the UK has), does not eliminate the possibility of private plans. People may, if they desire, get additional private health insurance (and I know people that do this here). The existence of a national plan does not mean that you can't shop around and get the care that you want.

So the last argumentative turn you take involves the incentive structure for the health care providers -- arguing that it leads to better health care:

I have several points to make about this. I think the incentive-structure argument is completely wrong and mis-characterizing the situation (which I will explain below), but first I want to say this... I have never really been provided with real evidence for this "people come to the US when it gets bad" -- in fact, if we are just talking about what we've heard from others I have heard more stories the other way around (i.e. people go to Canada or the UK or wherever so that they can get health care without complete and total financial ruin). But I have never seen any empirical figures to back up either claim. I do know that by-and-large it is very difficult to move countries without a good reason and neither country would be willing to accept the "for medical care" as a good reason unless you're willing to pay out-of-pocket for it.

OK, so the incentive structure stuff... this, I think, is the real heart of the argument over health care systems.

You claim that the system "rewards the doctors" -- for what? Doctors, by and large, get paid on a salary-basis by the hospital and often are only punished for things like doing stuff that bring on law-suits. So maybe you mean that the hospitals/clinics get rewarded for curing patients. But that isn't right either. They get rewarded for doing procedures, giving medicine, etc -- thats what they get paid for. And if that is what they get paid for, what they really want is to keep their patients healthy enough not to die, but sick enough to keep coming back for treatment. They want to do expensive procedures that may or may not be necessary, they want to avoid treating people that do not have insurance because they cannot get paid, etc.

In short, the incentive structure for the places that actually give the health care is like that of an auto mechanic -- and we all know how hard it is to find a good mechanic.

Here is the problem with letting the free-market deal with health care... If some place is really actually good at keeping people healthy, they do not make much money. They do cheap preventative medicine, people rarely come in for serious health problems, etc. All of this means less money for the firm providing the health care (they are selling less and less expensive products). This means they'll have less money to spend on advertizing, nice fancy equipment, nice hospital grounds, etc (the stuff that brings in more "customers") and they will loose out to competitors who were only interested in keeping their "customers" just sick enough to keep coming back.

So, if what we want out of a health-care system is to keep a population healthy, we shouldn't incentivize the giving of medical treatment. If we just let money do the talking this creates a huge snow-ball effect: hosptials try to give unnecessary expensive treatment, the insurance companies figure this out and so try to dodge out of every possible expenditure you might have (even if they are the necessary ones), bureaucratic systems are put in place to try to keep this mess in check (and then create more of a mess) and the people that lose this game are the people that the industry is supposed to be helping.

We should incentivize KEEPING PEOPLE HEALTHY -- but doing that runs counter to MAKING MONEY from health care. A really good health care system would be one that is rarely used -- but that is not something we can get out of a free market system, because that would mean we would want hospitals that would try to put themselves out of business. One way to solve this problem is a socialized health care system -- If hospitals are owned publically, this is not a problem -- the government can create any incentive structure it wants (bonuses for getting people to quit smoking, bonuses for reducing the number of heart-attacks, or whatever).

In short, the free-market is a great great thing, for SOME industries. I think certain technology industries are ones that have THRIVED because of the free market structure -- but that does not mean we want to endorse the free market in all cases all the time. Whether or not we want a free-market setting for some particular industry depends on what we want out of that industry (on a broader-level of consideration). And for the heath care industry -- what we want are hospitals that, in the free-market setting, would try to put themselves out of business -- and that is not something that can be achieved or sustained by the free-market.

The free-market incentives are not the solution to health care problems, they are the sick, rotten, gangrenous roots of the problems.