"Rigid Class System in Europe" Bob Roll Comments



S

steve

Guest
On 24-Aug-2006, smacked up and reeling, "[email protected]"
<[email protected]> blindly formulated
the following incoherence:

> No, it played a delayed, indirect but very important role in
> improving health care and prolonging life expectancy for
> residents of the UK.


LOL!

Yes. And the civil war* played a delayed, indirect, but important role in
the way hamburgers are now cooked in the former soviet union.

You just never know what important developments those minor historical
incidents will eventually bring about.

steve

* US War between the states in the 1860s, for the benefit of our friends
across the water.
--
"The accused will now make a bogus statement."
James Joyce
 
P

Pudd'nhead Wilson

Guest
Ron Ruff wrote:
> Jack Hollis wrote:
> > Life expectancy is not the measure of health care. It has some
> > effect, but there are so many other components that it's hard to tease
> > it out. There's a genetic component and diet and nutrition play a
> > role.

>
> Good point! On the diet and nutrition, anyway. The fattening of the US
> probably doesn't help.


The studies Robert pointed to didn't control for Supersizing.
 
S

steve

Guest
On 24-Aug-2006, smacked up and reeling, "Pudd'nhead Wilson" <[email protected]>
blindly formulated
the following incoherence:

> Okay, that is good, but my argument is that #3 is all that is really
> necessary. Do #3 and #1,2,4 take care of themselves, because we'll
> remove the government from justice (tort) too. Unfortunately for Brian
> and Jack, we'll undo the lawyering, judge, and court monopoly cartels
> too. No more lawyer club oaths to protect a consititution of no
> authority. (http://www.lysanderspooner.org/notreason.htm)
>
> I would also like to rephrase #3: (3) Eliminate any government.


I like the way you think, Pudd'nhead...if that is, indeed, your real name.
;^)

I do think #4 is important in practical terms, however, since of the most
likely of the 4 for which we could make some political ground.
--
"The accused will now make a bogus statement."
James Joyce
 
S

Simon Brooke

Guest
in message <[email protected]>, Gabe Brovedani
('[email protected]') wrote:

> Robert Chung wrote:
>>>http://jama.ama-assn.org/cgi/content/full/295/17/2037
>>>http://care.diabetesjournals.org/cgi/content/full/26/4/1116

>>
>>
>> For those keeping score, that's one for the UK and one for Canada.
>>
>>

> Are you suggesting the American revolution was a bad idea?


No, the idea was great. It was the execution that was stuffed...

--
[email protected] (Simon Brooke) http://www.jasmine.org.uk/~simon/

to err is human, to lisp divine
;; attributed to Kim Philby, oddly enough.
 
P

Pudd'nhead Wilson

Guest
Robert Chung wrote:
> Pudd'nhead Wilson wrote:
> > But I can give
> > you some pointers: (1) Destroy the cartel power of the AMA (eliminate
> > monopoly licensing for doctors); (2) Allow free access to any drugs to
> > anyone who wants them without perscriptions;

>
> Perhaps, but as I've pointed out before, these suggestions would help if
> our problems were related to shortages in physicians or in
> pharmaceuticals. I don't think that's the case.


I don't know what you think. But you are probably aggregating costs
and using some limited set of normative quality metrics/aggregates. I
don't agree with that approach. The #_of_docs/geo-poli_area is also an
aggregate (density). But it says nothing about universal access, or
how any existing services get paid for. Moreover, it says nothing
about Supersizing Culture and its consequences.

Besides, the licensing and regulating could/should be done away with on
ethical grounds alone.

What do you mean by "our problems?"
 
J

Jack Hollis

Guest
On 22 Aug 2006 15:08:38 -0700, "Ron Ruff" <[email protected]>
wrote:

> but every Canadian I've talked to (dozens) loves it!



Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
there are still waiting lists, but nothing like what you see in
Britain.
 
J

Jack Hollis

Guest
On Thu, 24 Aug 2006 20:22:58 +0100, Simon Brooke
<[email protected]> wrote:

>>>

>> Are you suggesting the American revolution was a bad idea?

>
>No, the idea was great. It was the execution that was stuffed...


Absolutely, the British won the war a few times before they lost it.
 
Simon Brooke wrote:
> Gabe Brovedani ('[email protected]') wrote:
> > Robert Chung wrote:
> >>>http://jama.ama-assn.org/cgi/content/full/295/17/2037
> >>>http://care.diabetesjournals.org/cgi/content/full/26/4/1116
> >>
> >> For those keeping score, that's one for the UK and one for Canada.
> >>

> > Are you suggesting the American revolution was a bad idea?

>
> No, the idea was great. It was the execution that was stuffed...


You're confusing it with the French revolution. That was
the one with all the execution.

Ben
 
R

Robert Chung

Guest
Pudd'nhead Wilson wrote:

> What do you mean by "our problems?"


Bang for the buck. Poor value. On almost all objective measures of quality
of care, we do quite well: maybe not the best in the world but we're in
the middle of the rich countries of the world and that ain't a shabby
place to be. The place where we're not in the middle of the pack is in how
much we pay for that care.
 
R

Robert Chung

Guest
Pudd'nhead Wilson wrote:
> Ron Ruff wrote:
>> Jack Hollis wrote:
>>> Life expectancy is not the measure of health care. It has some
>>> effect, but there are so many other components that it's hard to tease
>>> it out. There's a genetic component and diet and nutrition play a
>>> role.

>>
>> Good point! On the diet and nutrition, anyway. The fattening of the US
>> probably doesn't help.

>
> The studies Robert pointed to didn't control for Supersizing.


The JAMA study controlled for BMI.
 
R

Robert Chung

Guest
Jack Hollis wrote:
>
>> but every Canadian I've talked to (dozens) loves it!

>
> Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
> there are still waiting lists, but nothing like what you see in
> Britain.


And what was the corresponding number for Americans? The number I'm
familiar with was from Blendon's old 1990 article on public attitudes
toward their own country's health care system. In that study, about 10% of
US respondents were satisfied with their system.
 
S

Simon Brooke

Guest
in message <[email protected]>, Robert Chung
('[email protected]') wrote:

> Jack Hollis wrote:
>>
>>> but every Canadian I've talked to (dozens) loves it!

>>
>> Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
>> there are still waiting lists, but nothing like what you see in
>> Britain.

>
> And what was the corresponding number for Americans? The number I'm
> familiar with was from Blendon's old 1990 article on public attitudes
> toward their own country's health care system. In that study, about 10%
> of US respondents were satisfied with their system.


That doesn't necessarily mean it's worse. An American commentator
recently presented a very compelling argument on British television that
the reason British railways are so appalling is because we tolerate
appalling service and don't pressure the operators enough to improve it.

British railways are appalling. In my opinion the reason they're so bad
is because they're privatised; British Rail was poor, but not as
outrageously bad as the current mess, and the lack of any coherent
overall strategy is striking. The people who own the trains don't
operate them; the people who operate them don't own or control the
tracks; and the people who own the tracks don't maintain them.
Competing, sectional private interests conspire to prevent the effective
delivery of a public service - and this despite receiving far more
public subsidy than British Rail ever had.

But a few people are getting very rich, and it's the rich few who
bankroll the political parties, so not only will it not change but our
health service, which is actually very good by international standards,
looks like going the same way.

--
[email protected] (Simon Brooke) http://www.jasmine.org.uk/~simon/
There's nae Gods, an there's precious few heroes
but there's plenty on the dole in th Land o th Leal;
And it's time now, tae sweep the future clear o
th lies o a past that we know wis never real.
 
R

Robert Chung

Guest
Simon Brooke wrote:
> in message <[email protected]>, Robert Chung
> ('[email protected]') wrote:
>
>> Jack Hollis wrote:
>>>
>>>> but every Canadian I've talked to (dozens) loves it!
>>>
>>> Last survey I saw was 80% of Canadians are satisfied. Nevertheless,
>>> there are still waiting lists, but nothing like what you see in
>>> Britain.

>>
>> And what was the corresponding number for Americans? The number I'm
>> familiar with was from Blendon's old 1990 article on public attitudes
>> toward their own country's health care system. In that study, about 10%
>> of US respondents were satisfied with their system.

>
> That doesn't necessarily mean it's worse. An American commentator
> recently presented a very compelling argument on British television that
> the reason British railways are so appalling is because we tolerate
> appalling service and don't pressure the operators enough to improve it.


Right, I wasn't implying that satisfaction is a reliable metric. In fact,
I was citing an ancient study because I don't usually pay any attention to
satisfaction data so I'm not up-to-date on it.

I do, however, have a more appropriate example, even though it's an
anecdote. A friend was trying to demonstrate that patient satisfaction
surveys aren't terribly useful as an objective measure of quality of care.
He got permission to do in-depth interviews with women who had been
recently discharged after childbirth from a couple of hospitals in his
area. Almost everyone was very satisfied with their care, citing the
friendliness of the staff, the attractiveness of the rooms, the ability to
have their partners with them, that sort of thing. However, when he went
deeper into the interviews he uncovered nearly half who either had
themselves or whose babies had post-natal complications: almost all of
them were minor, but they were still conditions that could be linked to
sub-standard care. He gave a report to the hospitals' administrations. You
can see this coming: rather than taking this as evidence that patient
satisfaction doesn't capture all aspects of quality of care, the
administrations took it as a sign that they had been successful in getting
the staff to be friendly and that their room remodeling had been
successful.
 
J

Jack Hollis

Guest
On Fri, 25 Aug 2006 09:13:39 +0100, Simon Brooke
<[email protected]> wrote:

>> And what was the corresponding number for Americans? The number I'm
>> familiar with was from Blendon's old 1990 article on public attitudes
>> toward their own country's health care system. In that study, about 10%
>> of US respondents were satisfied with their system.

>
>That doesn't necessarily mean it's worse. An American commentator
>recently presented a very compelling argument on British television that
>the reason British railways are so appalling is because we tolerate
>appalling service and don't pressure the operators enough to improve it.


Someone mentioned that all the Canadians he knew were satisfied. I
doubt that satisfaction is a very good measure of the quality of
health care.
 
R

Robert Chung

Guest
Jack Hollis wrote:

> Someone mentioned that all the Canadians he knew were satisfied. I
> doubt that satisfaction is a very good measure of the quality of
> health care.


Right, I already addressed that. What you've been avoiding assiduously are
the cross-national quality of care studies.
 
P

Pudd'nhead Wilson

Guest
Robert Chung wrote:
> Pudd'nhead Wilson wrote:
>
> > What do you mean by "our problems?"

>
> Bang for the buck. Poor value. On almost all objective
> measures of quality of care, we do quite well: maybe
> not the best in the world but we're in the middle of
> the rich countries of the world and that ain't a shabby
> place to be. The place where we're not in the middle of
> the pack is in how much we pay for that care.


Well that is perhaps obvious in a standard way of thinking, so it isn't
what I'm driving at.

When you said "our" and "we" on a geo-poli boundary basis, it implies
it is a legitimate collective of "we" accorded to those boundaries, I
wanted to know the moral/ethical value judgments one makes when they
decide it is a morally legitimate collective. I want to know why those
are the "right" boundaries. Of course, you might not be doing any such
judgement and are simply attempting to be objective as possible given
all the constraints. I understand, but I want a bit more than that.

Why should person X living in city A, be responsible for well being of
person Y, living in city B, when person X and Y don't know each other?
On what basis (of rights and privileges) can person Y make a legitimate
claim on person X for their health care, or any other "benefit" for
that matter? What is the rationale and morally correct way to set
political boundaries to get the "right" results? Who decides and why?
Why "we/our" for anything other than unanimous consent?

The comparisons are all for interfered (by gov) markets. Due to that,
no one really knows what health care "should" cost (by any chosen
boundary scan), or how much of it "should" be purchased, aggregate or
individual. No one knows what the mix of healthcare v. other goods
would be, aggregate or individual, if people could simply select based
on individual tastes and resources. I might sound like I'm dis'ing
attempts at objective comparative studies overall, but I'm not.

I reject the /political/ dictum of "the greatest good for the greatest
number." I wonder how others justify it.
 
R

Robert Chung

Guest
Greg wrote:

> Well that is perhaps obvious in a standard way of thinking, so it isn't
> what I'm driving at.


You know, I don't think I've ever accused you of thinking in a standard
way. However, sometimes a cigar is just a cigar, and a discussion of
health system performance is just a discussion of health system
performance.

> I reject the /political/ dictum of "the greatest good for the greatest
> number." I wonder how others justify it.


If you re-read my comments in this thread, you'll see that I never
advocated a particular health system, or any particular organizing
approach. A bigger problem, from my perspective, is that there are people
who believe that the current US system is above reproach. If they think
the system is the best that it can be there's no reason to ever consider
changing it.

As I've said previously, there may be reasons why one would want to
de-regulate the health care system -- just that those reasons don't have
much to do with cost or quality of care. I would think that you would be
concerned about the cost-quality mismatch in the US compared to other
countries. In the case of the US, poor value is exacerbated by rare (over
the course of the lifespan) but catastrophically expensive events. The
rarer and more catastrophic an event, the harder it is for conventional
insurance companies to manage the risk and the more likely it is for there
to be calls for increasing the risk pool -- such as in universal care or
single-payer sytems (which aren't the same thing). That's the kind of
thing that drives you nuts, so I would think you'd be concerned about
value mismatch.
 
M

Mark & Steven Bornfeld

Guest
Robert Chung wrote:

> Greg wrote:
>
>
>>Well that is perhaps obvious in a standard way of thinking, so it isn't
>>what I'm driving at.

>
>
> You know, I don't think I've ever accused you of thinking in a standard
> way. However, sometimes a cigar is just a cigar, and a discussion of
> health system performance is just a discussion of health system
> performance.
>
>
>>I reject the /political/ dictum of "the greatest good for the greatest
>>number." I wonder how others justify it.

>
>
> If you re-read my comments in this thread, you'll see that I never
> advocated a particular health system, or any particular organizing
> approach. A bigger problem, from my perspective, is that there are people
> who believe that the current US system is above reproach. If they think
> the system is the best that it can be there's no reason to ever consider
> changing it.
>
> As I've said previously, there may be reasons why one would want to
> de-regulate the health care system -- just that those reasons don't have
> much to do with cost or quality of care. I would think that you would be
> concerned about the cost-quality mismatch in the US compared to other
> countries. In the case of the US, poor value is exacerbated by rare (over
> the course of the lifespan) but catastrophically expensive events. The
> rarer and more catastrophic an event, the harder it is for conventional
> insurance companies to manage the risk and the more likely it is for there
> to be calls for increasing the risk pool -- such as in universal care or
> single-payer sytems (which aren't the same thing). That's the kind of
> thing that drives you nuts, so I would think you'd be concerned about
> value mismatch.
>
>



Just happened to catch this post--sorry, I know I should be forced to
read the entire thread. ;-)
To a certain extent, the results speak for themselves. Not only do we
get less bang for our buck, but we get poor results in absolute terms.
Many of the apologists for the status quo will blame education, illegal
immigration--you know.
At the base of this (as has probably been mentioned several times in
this thread) is the question of whether health care is a right or a
privilege. A person's answer to this question will determine to a great
extent their reactions to any other point in the argument about social
welfare.
Can our healthcare dollars be used more efficiently? Of course, but
not without regulation. I've heard that 1/3 of healthcare dollars are
spent on the last 6 months of life (I know, like the joke goes, the only
thing is, how do it know?).
The free marketers seem to think they have a measure of control in the
system as it exists now. My guess is that they haven't had to deal with
catastrophic illness in a loved one lately.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
 
M

Mark & Steven Bornfeld

Guest
Pudd'nhead Wilson wrote:

> Robert Chung wrote:
>
>>Pudd'nhead Wilson wrote:
>>
>>>But I can give
>>>you some pointers: (1) Destroy the cartel power of the AMA (eliminate
>>>monopoly licensing for doctors); (2) Allow free access to any drugs to
>>>anyone who wants them without perscriptions;

>>
>>Perhaps, but as I've pointed out before, these suggestions would help if
>>our problems were related to shortages in physicians or in
>>pharmaceuticals. I don't think that's the case.

>
>
> I don't know what you think. But you are probably aggregating costs
> and using some limited set of normative quality metrics/aggregates. I
> don't agree with that approach. The #_of_docs/geo-poli_area is also an
> aggregate (density). But it says nothing about universal access, or
> how any existing services get paid for. Moreover, it says nothing
> about Supersizing Culture and its consequences.
>
> Besides, the licensing and regulating could/should be done away with on
> ethical grounds alone.


Please explain. Does the state not find a compelling public interest
in holding professions and professionals to certain standards?

Steve


>
> What do you mean by "our problems?"
>



--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
 
M

Mark & Steven Bornfeld

Guest
Pudd'nhead Wilson wrote:

> Jack Hollis wrote:
>
>>On 22 Aug 2006 21:50:35 -0700, "Pudd'nhead Wilson" <[email protected]>
>>wrote:
>>
>>
>>>Jack Hollis wrote:
>>>
>>>>you.
>>>>
>>>>The big problem with health care in the US is that not everyone has
>>>>health insurance.
>>>
>>>No, that is not a "problem." If someone doesn't want insurance, or
>>>can't pay for it, it is their business.

>>
>>
>>If someone chooses not to get insurance, it's their business, but if
>>someone wants and needs insurance then it's not that simple.

>
>
> What are you talking about "need [health] insurance?" You probably
> mean "need health care." They are not the same thing. A lot of people
> think they are the same thing.
>
> No one "needs" health insurance, people simply *want* it to lower their
> exposure to financial and medical risk.
>
>
>>In the US, if your destitute you can get Medicaid, but it's the
>>working poor who make too much to qualify for Medicaid, but can't
>>afford insurance that are the problem. The trick is top find ways to
>>get these people health care without ruining the whole system.

>
>
> Well it isn't particularly my problem to find health care for the
> masses I don't know (or pay for it, for that matter). But I can give
> you some pointers: (1) Destroy the cartel power of the AMA (eliminate
> monopoly licensing for doctors); (2) Allow free access to any drugs to
> anyone who wants them without perscriptions; (3) Eliminate any
> government involvement (end all regulation).



Is there anyplace on earth where this has been tried where it has
worked at all? And why hang the AMA while leaving the pharmaceutical
industry (where the money really resides) off the hook?

Steve
>
> Ultimately I think I would say the "whole system" you talk about is
> exactly what needs to be "ruined."
>



--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001