"Rigid Class System in Europe" Bob Roll Comments



Steven Bornfeld wrote:

> 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.


I try not to say this. In absolute terms, our health system produces
outcomes that put us in the ninth decile of all countries, and that ain't
bad. It puts us about average among the major developed countries of the
world. The problems are: 1) we pay enormously more than any other country
and 2) jingoists think our system really does rank enormously better than
any other country. We spend 5% of GDP *more* than the next highest spender
in the world. If we're going to pay more than anyone else, I want better
performance; if we're going to get average performance, I want 5% of GDP
back.

> 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?).


I'm not sure the "right vs. privilege" thing is central. I think the more
central issue is structural: that so much of health care spending is
concentrated in one or two spells, i.e., the skewness of the lifetime
consumption pattern of healthcare dollars. Basically, we go for 80 years
needing only to consume small, relatively steady, amounts of health care
dollars but then whammo! we start burning through $10,000 (or more) per
day. Normal insurance systems can't easily cope with that kind of skewness
because it's hard to build up enough of a risk pool, so they have to
charge extra in order to manage their risk. The larger the system, the
less of a risk premium they need to charge.
 
Robert Chung wrote:
> Steven Bornfeld wrote:
>
> > 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.

>
> I try not to say this. In absolute terms, our health system produces
> outcomes that put us in the ninth decile of all countries, and that ain't
> bad. It puts us about average among the major developed countries of the
> world. The problems are: 1) we pay enormously more than any other country
> and 2) jingoists think our system really does rank enormously better than
> any other country. We spend 5% of GDP *more* than the next highest spender
> in the world. If we're going to pay more than anyone else, I want better
> performance; if we're going to get average performance, I want 5% of GDP
> back.
>
> > 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?).

>
> I'm not sure the "right vs. privilege" thing is central. I think the more
> central issue is structural: that so much of health care spending is
> concentrated in one or two spells, i.e., the skewness of the lifetime
> consumption pattern of healthcare dollars. Basically, we go for 80 years
> needing only to consume small, relatively steady, amounts of health care
> dollars but then whammo! we start burning through $10,000 (or more) per
> day. Normal insurance systems can't easily cope with that kind of skewness
> because it's hard to build up enough of a risk pool, so they have to
> charge extra in order to manage their risk. The larger the system, the
> less of a risk premium they need to charge.


I tend to agree with you, but your last paragraph sounds like a
description of the Social Security system and that's been brutally
mis-managed and is running into the same, huge, aging demographic
problem as we do with health care.
I've never seen projections that weren't politically motivated for the
cost per young contributing employed person for Social Security as we
get older with less workers contributing. My feeling is that this is
eventually going to push our minimum tax rate way up, and then if you
add in Insurance coverage for all I think were starting to talk 50%+
tax rates which makes the Developing World all that much more
attractive to corporations to ship the jobs off to since the difference
in their costs would be even wider than they are now.
It's just not possible to give all things to all people without
bringng us all down to a lowest common denominator.
Just my opinion of course. I sure as hell don't have the answer, but
I'm going to be selfish enough to look after my own family first, and
that means not voting for them to be taxed to death.
Somewhere people have to bear some responsibility for their own
situations. The problem is where do you draw that line and who do you
help?
I don't have any answers for that one either.
Bill C
 
Bill C wrote:
> Robert Chung wrote:


>> I'm not sure the "right vs. privilege" thing is central. I think the
>> more central issue is structural: that so much of health care spending
>> is concentrated in one or two spells, i.e., the skewness of the
>> lifetime consumption pattern of healthcare dollars. Basically, we go
>> for 80 years needing only to consume small, relatively steady, amounts
>> of health care dollars but then whammo! we start burning through
>> $10,000 (or more) per day. Normal insurance systems can't easily cope
>> with that kind of skewness because it's hard to build up enough of a
>> risk pool, so they have to charge extra in order to manage their risk.
>> The larger the system, the less of a risk premium they need to charge.

>
> I tend to agree with you, but your last paragraph sounds like a
> description of the Social Security system and that's been brutally
> mis-managed and is running into the same, huge, aging demographic
> problem as we do with health care.


1. The problem of health care spending is about skewness. That's not the
problem with Social Security, so it's not the right comparison. If you're
worried about huge government intervention that's one thing, but huge
government intervention isn't the only way to manage the risk of
catastrophic loss.

2. The SS system hasn't been mis-managed.
 
Robert Chung wrote:

>
> 1. The problem of health care spending is about skeanaged and is running into the same, huge, aging demographic

wness. That's not the
> problem with Social Security, so it's not the right comparison. If you're
> worried about huge government intervention that's one thing, but huge
> government intervention isn't the only way to manage the risk of
> catastrophic loss.


Ok I don't see your argument; in both SS and health care you've got
primarily, working, under 65 year olds picking up the huge tab being
generated primarily by those over that age. As they demographic shifts
to an older society, as it is the burden becomes even more skewed in
both systems it seems to me.
Less people, making less real wages, to pay for more expensive
services for more people really seems to be the core of the future
problem to me.


> 2. The SS system hasn't been mis-managed.


OK? You are about the only person I've heard make that argument. I'll
agree that we are at least getting an early start on dealing with the
demographic shift and the decreasing real purchasing power of seniors,
but, again, I don't think it's been managed well at all.

What am I missing?
Bill C
 
Bill C wrote:
> Robert Chung wrote:
>
> >
> > 1. The problem of health care spending is about skeanaged and is running into the same, huge, aging demographic

> wness. That's not the
> > problem with Social Security, so it's not the right comparison. If you're
> > worried about huge government intervention that's one thing, but huge
> > government intervention isn't the only way to manage the risk of
> > catastrophic loss.

>
> Ok I don't see your argument; in both SS and health care you've got
> primarily, working, under 65 year olds picking up the huge tab being
> generated primarily by those over that age. As they demographic shifts
> to an older society, as it is the burden becomes even more skewed in
> both systems it seems to me.
> Less people, making less real wages, to pay for more expensive
> services for more people really seems to be the core of the future
> problem to me.
>
>
> > 2. The SS system hasn't been mis-managed.

>
> OK? You are about the only person I've heard make that argument. I'll
> agree that we are at least getting an early start on dealing with the
> demographic shift and the decreasing real purchasing power of seniors,
> but, again, I don't think it's been managed well at all.
>
> What am I missing?


Social Security hasn't been mismanaged in the sense
of having fraud, waste, or inefficiencies, or even being
looted to prop up the current finances of the company
running it (which is the USGOV/ZOG). All of these things
_have_ happened to private pension plans.

The problems facing Social Security are manageable
with enough advance notice and political will (which is
in short supply) - I don't mean political will just to cut
SS benefits, but also to not spend our money on stupid
**** (estate tax cuts, vanity foreign engagements).
However, these demographic problems would exist
for any pension system, private or not. The alternative is
to go back to the pre-SS days and the indignities to the
elderly that caused the foundation of Social Security
in the first place. (Also, we could import more young
working immigrants.)

Bill (and HH), you'd probably like to read this article on pension
plans and spreading demographic risk/trends over larger pools
of employers and employees, by Malcolm Gladwell,
which appeared in the latest New Yorker:
<http://www.newyorker.com/fact/content/articles/060828fa_fact>

I think this article marks the completion of Gladwell's
transformation from a neoliberal market-market-market-
solutions enthusiast into a classic social democrat, or even
an Old Marxist union man.

Ben
Old Marxist
 
Bill C wrote:
> Robert Chung wrote:
>
>>
>> 1. The problem of health care spending is about skewness. That's
>> not the problem with Social Security, so it's not the right
>> comparison. If you're worried about huge government intervention
>> that's one thing, but huge government intervention isn't the only way
>> to manage the risk of catastrophic loss.

>
> Ok I don't see your argument; in both SS and health care you've got
> primarily, working, under 65 year olds picking up the huge tab being
> generated primarily by those over that age. As they demographic shifts
> to an older society, as it is the burden becomes even more skewed in
> both systems it seems to me.


From an expenditure perspective, SS and health care are completely
different. In SS, the payments are relatively steady, which means
relatively predictable, which means the risk is predictable and therefore
manageable. In health care, you can go for a long, long time with only a
few expenditures (for childbirth, a broken bone or two) and then boom you
get hit with the Big C. A woman I know, in her eighties, had never stepped
into a hospital except for childbirth until a couple of years ago: then a
little infection turned into endocarditis. Her husband had been
complaining about the cost of health insurance for years, saying they were
both healthy as horses. In about four days in the ICU she spent every
dollar in insurance premiums she'd ever paid in her entire life. I pointed
out to him that from that moment on every extra dollar they got was
putting them in the black.

>> 2. The SS system hasn't been mis-managed.

>
> OK? You are about the only person I've heard make that argument. I'll
> agree that we are at least getting an early start on dealing with the
> demographic shift and the decreasing real purchasing power of seniors,
> but, again, I don't think it's been managed well at all.
>
> What am I missing?


You've been buying into the scare-mongering about the SS system. The SS
system is extraordinarily predictable -- it may be scary because the
numbers are so huge, but the flows into and out of the system are steady.
Because of that, there is (almost) no risk to manage. Even an economist
could do it.
 
Bill C wrote:
> Robert Chung wrote:
>
> >
> > 1. The problem of health care spending is about skeanaged and is running into the same, huge, aging demographic

> wness. That's not the
> > problem with Social Security, so it's not the right comparison. If you're
> > worried about huge government intervention that's one thing, but huge
> > government intervention isn't the only way to manage the risk of
> > catastrophic loss.

>
> Ok I don't see your argument; in both SS and health care you've got
> primarily, working, under 65 year olds picking up the huge tab being
> generated primarily by those over that age. As they demographic shifts
> to an older society, as it is the burden becomes even more skewed in
> both systems it seems to me.
> Less people, making less real wages, to pay for more expensive
> services for more people really seems to be the core of the future
> problem to me.
>
>
> > 2. The SS system hasn't been mis-managed.

>
> OK? You are about the only person I've heard make that argument. I'll
> agree that we are at least getting an early start on dealing with the
> demographic shift and the decreasing real purchasing power of seniors,
> but, again, I don't think it's been managed well at all.
>
> What am I missing?
> Bill C

I am of course comparing a government run universal health care system
to SS. My other big questions Universal health care here would be:
A) would it just add another layer of management and continue to feed
down through the current medical system which would increase costs even
further or
B) Would they nationalize the whole system creating economic havoc for
companies currently involved in Insurance/providing/billing? How many
layoffs and corporate closing would this readjustment cause, and how
would those people be compensated?
Bill C
 
[email protected] wrote:
> <http://www.newyorker.com/fact/content/articles/060828fa_fact>


Yeah, that's a pretty good article. He focuses on pensions, but the
problem with health care fnancing is vaguely parallel -- just more extreme
and nuttier.
 
Robert Chung wrote:
> Steven Bornfeld wrote:
>
>
>>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.

>
>
> I try not to say this. In absolute terms, our health system produces
> outcomes that put us in the ninth decile of all countries, and that ain't
> bad. It puts us about average among the major developed countries of the
> world. The problems are: 1) we pay enormously more than any other country
> and 2) jingoists think our system really does rank enormously better than
> any other country. We spend 5% of GDP *more* than the next highest spender
> in the world. If we're going to pay more than anyone else, I want better
> performance; if we're going to get average performance, I want 5% of GDP
> back.


Well, yes. That and you're nicer and less judgemental than I am. That
and I'm fed up with the jingoists (I should maybe say the "jingo" party)

>
>
>>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?).

>
>
> I'm not sure the "right vs. privilege" thing is central. I think the more
> central issue is structural: that so much of health care spending is
> concentrated in one or two spells, i.e., the skewness of the lifetime
> consumption pattern of healthcare dollars. Basically, we go for 80 years
> needing only to consume small, relatively steady, amounts of health care
> dollars but then whammo! we start burning through $10,000 (or more) per
> day. Normal insurance systems can't easily cope with that kind of skewness
> because it's hard to build up enough of a risk pool, so they have to
> charge extra in order to manage their risk. The larger the system, the
> less of a risk premium they need to charge.


I don't know what can be done about this structure problem--you can
"ration" benefits at the end of life, or you can hope the birthrate goes
up slowly but steadily. Then when us boomers die off, things should
work out eventually. ;-)
But if you have people who "don't want to pay" for people who won't buy
health insurance (now costs me about $14K/yr. for point-of-service
benefits for three, with no outpatient prescription benefits--going up
yearly), and think this is someone else's problem, I figure they're not
thinking this through too well--no matter how many big words they use.

Steve

>
>
 
Bill C wrote:
> Robert Chung wrote:
>
>>Steven Bornfeld wrote:
>>
>>
>>>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.

>>
>>I try not to say this. In absolute terms, our health system produces
>>outcomes that put us in the ninth decile of all countries, and that ain't
>>bad. It puts us about average among the major developed countries of the
>>world. The problems are: 1) we pay enormously more than any other country
>>and 2) jingoists think our system really does rank enormously better than
>>any other country. We spend 5% of GDP *more* than the next highest spender
>>in the world. If we're going to pay more than anyone else, I want better
>>performance; if we're going to get average performance, I want 5% of GDP
>>back.
>>
>>
>>>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?).

>>
>>I'm not sure the "right vs. privilege" thing is central. I think the more
>>central issue is structural: that so much of health care spending is
>>concentrated in one or two spells, i.e., the skewness of the lifetime
>>consumption pattern of healthcare dollars. Basically, we go for 80 years
>>needing only to consume small, relatively steady, amounts of health care
>>dollars but then whammo! we start burning through $10,000 (or more) per
>>day. Normal insurance systems can't easily cope with that kind of skewness
>>because it's hard to build up enough of a risk pool, so they have to
>>charge extra in order to manage their risk. The larger the system, the
>>less of a risk premium they need to charge.

>
>
> I tend to agree with you, but your last paragraph sounds like a
> description of the Social Security system and that's been brutally
> mis-managed and is running into the same, huge, aging demographic
> problem as we do with health care.
> I've never seen projections that weren't politically motivated for the
> cost per young contributing employed person for Social Security as we
> get older with less workers contributing. My feeling is that this is
> eventually going to push our minimum tax rate way up, and then if you
> add in Insurance coverage for all I think were starting to talk 50%+
> tax rates which makes the Developing World all that much more
> attractive to corporations to ship the jobs off to since the difference
> in their costs would be even wider than they are now.
> It's just not possible to give all things to all people without
> bringng us all down to a lowest common denominator.
> Just my opinion of course. I sure as hell don't have the answer, but
> I'm going to be selfish enough to look after my own family first, and
> that means not voting for them to be taxed to death.
> Somewhere people have to bear some responsibility for their own
> situations. The problem is where do you draw that line and who do you
> help?
> I don't have any answers for that one either.
> Bill C
>


The short answer is we will pay either way.

Steve
 
[email protected] wrote:
> Bill C wrote:
>
>>Robert Chung wrote:
>>
>>
>>>1. The problem of health care spending is about skeanaged and is running into the same, huge, aging demographic

>>
>>wness. That's not the
>>
>>>problem with Social Security, so it's not the right comparison. If you're
>>>worried about huge government intervention that's one thing, but huge
>>>government intervention isn't the only way to manage the risk of
>>>catastrophic loss.

>>
>> Ok I don't see your argument; in both SS and health care you've got
>>primarily, working, under 65 year olds picking up the huge tab being
>>generated primarily by those over that age. As they demographic shifts
>>to an older society, as it is the burden becomes even more skewed in
>>both systems it seems to me.
>> Less people, making less real wages, to pay for more expensive
>>services for more people really seems to be the core of the future
>>problem to me.
>>
>>
>>
>>>2. The SS system hasn't been mis-managed.

>>
>> OK? You are about the only person I've heard make that argument. I'll
>>agree that we are at least getting an early start on dealing with the
>>demographic shift and the decreasing real purchasing power of seniors,
>>but, again, I don't think it's been managed well at all.
>>
>> What am I missing?

>
>
> Social Security hasn't been mismanaged in the sense
> of having fraud, waste, or inefficiencies, or even being
> looted to prop up the current finances of the company
> running it (which is the USGOV/ZOG). All of these things
> _have_ happened to private pension plans.
>
> The problems facing Social Security are manageable
> with enough advance notice and political will (which is
> in short supply) - I don't mean political will just to cut
> SS benefits, but also to not spend our money on stupid
> **** (estate tax cuts, vanity foreign engagements).
> However, these demographic problems would exist
> for any pension system, private or not. The alternative is
> to go back to the pre-SS days and the indignities to the
> elderly that caused the foundation of Social Security
> in the first place. (Also, we could import more young
> working immigrants.)
>
> Bill (and HH), you'd probably like to read this article on pension
> plans and spreading demographic risk/trends over larger pools
> of employers and employees, by Malcolm Gladwell,
> which appeared in the latest New Yorker:
> <http://www.newyorker.com/fact/content/articles/060828fa_fact>
>
> I think this article marks the completion of Gladwell's
> transformation from a neoliberal market-market-market-
> solutions enthusiast into a classic social democrat, or even
> an Old Marxist union man.
>
> Ben
> Old Marxist
>


Thanks for this Ben. I've got a print subscription, but seldom get to
read it.

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

>> 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?).

>
> I'm not sure the "right vs. privilege" thing is central.


I'm not sure it's even meaningful. What is a 'right' and who gets to
decide what is a 'right'? Any rights theory really comes down to
consensual acceptance of a single non-human authority, and, in a
multi-faith world, we don't have one. So any talk about 'rights' is
either simply woffle or else a bid for hegemony.

Which brings us back to utilitarianism, which someone upthread cast scorn
on. Well, I'm happy to agree that it's inelegant and often produces
results which are uncomfortable or seem at variance with our instinctive
sense of natural justice, but it's the only moral system which has any
real intellectual credibility.

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

;; Madness takes its toll. Please have exact change.
 
On 27 Aug 2006 11:03:23 -0700, "Bill C" <[email protected]>
wrote:

> I am of course comparing a government run universal health care system
>to SS. My other big questions Universal health care here would be:
> A) would it just add another layer of management and continue to feed
>down through the current medical system which would increase costs even
>further or
>B) Would they nationalize the whole system creating economic havoc for
>companies currently involved in Insurance/providing/billing? How many
>layoffs and corporate closing would this readjustment cause, and how
>would those people be compensated?
> Bill C



Don't worry about it Bill, the US wont have socialized medicine.
They've been talking about having a national health care system since
the days of FDR and it's never gotten beyond the talking stage. Truman
wanted national health care but never got it.

However, thanks to LBJ, the US has both Medicaid and Medicare which
are forms of socialized medicine for two specific groups, the
destitute and the elderly. However, there's a whole level of health
care available to those with personal insurance that's not available
to either Medicaid or Medicare patients.

It always amuses me when I hear the Democrats criticize the
Republicans for not supporting national health care. Considering all
the year since WW2 that the Democrats controlled the White House and
both houses of Congress by healthy majorities, you have to ask
yourself, why didn't they get it done? They sure talked about it
enough. Now that they're out of power, they blame the Republicans for
not doing what they never did.

HMOs have a lot in common with socialized medicine. You pay a flat fee
and get all the services you need for one price. Obviously, there's a
natural trend in both HMOs and socialized medicine to try to provide
as little service as possible. One does it for profit and the other
to reduce tax spending.

Private insurance has the tendency for the MDs to do as much as they
can, because they make money for doing things. The fear of a
malpractice suit also leads to many cover you ass procedures. The
physicians nightmare is being in court, on the stand with a lawyer
asking him, "Why didn't you do that Doctor?"

In the US, insurance law is almost all at the state level. So there's
a lot of variability from state to state on the exact rules.
 
On Sun, 27 Aug 2006 22:04:57 GMT, Steven Bornfeld
<[email protected]> wrote:

> The problem is where do you draw that line and who do you
>> help?
>> I don't have any answers for that one either.
>> Bill C
>>

>
> The short answer is we will pay either way.
>
>Steve


When you buy private insurance, there are state laws governing the
insurance companies. They pretty much draw the line.
 
Bill C wrote:
> makes the Developing World all that much more
> attractive to corporations to ship the jobs off to since the difference
> in their costs would be even wider than they are now.
> It's just not possible to give all things to all people without
> bringng us all down to a lowest common denominator.


Closer to the root of the problem. How can we possibly compete with 50
cents per hour labor, and retain anything resembling a 1st world
standard of living? What will we do in 10 years if (when) China decides
to exert politcal pressure and ceases to sell to us all the things that
we have completely forgotten how to make?

For those who think our "solution" is import more workers or have more
babies... that merely shifts the problem a few years down the road and
puts us in an even worse mess eventually... can we sustain an
exponential growth in population indefinitely?

The way to prosperity is to do more with less labor... ie more
efficiently. Fewer workers are then needed... so the elderly might as
well not work. If our economy had actually improved in the last 30
years rather than digress, the changing demographic would not be a
problem.

Unmanaged health care (in the US at least) has no incentive to be
efficient. There is no natural limit to the amount of research and
resources that can be spent developing new machines, procedures, drugs,
etc that may potentially prolong a person's life. Eventually, we will
need to decide if we'd rather live or spend most of our efforts trying
not to die... and failing.
 
In article <[email protected]>,
Jack Hollis <[email protected]> wrote:

> On Sun, 27 Aug 2006 22:04:57 GMT, Steven Bornfeld
> <[email protected]> wrote:
>
> > The problem is where do you draw that line and who do you
> >> help?
> >> I don't have any answers for that one either.
> >> Bill C
> >>

> >
> > The short answer is we will pay either way.
> >
> >Steve

>
> When you buy private insurance, there are state laws governing the
> insurance companies. They pretty much draw the line.


Uh, Jack, the insurance companies write the bills, their
lobbyists deliver them, and the legislature passes them.

--
Michael Press
 
In article
<[email protected]>,
Simon Brooke <[email protected]> wrote:

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

> >
> > I'm not sure the "right vs. privilege" thing is central.

>
> I'm not sure it's even meaningful. What is a 'right' and who gets to
> decide what is a 'right'? Any rights theory really comes down to
> consensual acceptance of a single non-human authority, and, in a
> multi-faith world, we don't have one. So any talk about 'rights' is
> either simply woffle or else a bid for hegemony.
>
> Which brings us back to utilitarianism, which someone upthread cast scorn
> on. Well, I'm happy to agree that it's inelegant and often produces
> results which are uncomfortable or seem at variance with our instinctive
> sense of natural justice, but it's the only moral system which has any
> real intellectual credibility.


I tried to make sense of this, even rot-13'd it. Still no
go: `moral system with intellectual credibility'? Does it
have street cred too?

--
Michael Press
 
Michael Press wrote:
> I tried to make sense of this, even rot-13'd it.


Its the Fuentes Code V2.0. Much better than pet names.
 
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.


Thank you. {laughs}

> However, sometimes a cigar is just a cigar, and a discussion of
> health system performance is just a discussion of health system
> performance.


People use it to make government policy. That is what scares me.

> > 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.


And that is why I said I don't know what you think. I wasn't accusing
you of making policy recommendations, but I know that others do based
on the dictum.

>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.


Sure, it probably is blind nationalism at its root. The subtle side is
that if you are against "nationalism," you might be against any
associated national government action to be logically consistant.

> 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.


True.

> I would think that you would be concerned about
> the cost-quality mismatch in the US compared to other
> countries.


I'm concerned about what I pay for what I get in everything. I think
the only comparative studies of government that are really important to
me is how much and in what way each restrict liberty. Health care is
only a part of what some of the "western" nations do, so it is only
mildly interesting.

> 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.


There are always calls for the government to solve "problems." I don't
want that to happen, and people endlessly doing so is why I lost faith
in so-called *limited* government (apparently oxymoronic) and became
more radical. And I don't think one can independently look at health
and health care independent of all other goods. That tact is drenched
in value judgement (about what is important). So I'm not so sure a
cigar is just a cigar in this case. No one knows what the cost of
health care *should* be, especially in the "aggregate," a slippery
notion prone to abuse.

So again, it might sound like like I against trying to get a macro
picture of things going on in some given society -- such as bang for
buck in "health care," loosely speaking. I'm not.
 
Steven Bornfeld wrote:

> The free marketers seem to think they have a measure of control in the
> system as it exists now.


Your comment is self-contradictory. If "they" are "free marketers,"
then they are against control. To the extent it is a "controlled
system," then a free marketer is against it. The US "system" is not a
free market in health care -- a free marketer could not support it
as-is. Other governments may interfere more "effectively," or at least
you might think so if you simply look at health care alone.

> My guess is that they haven't had to deal with
> catastrophic illness in a loved one lately.


It sounds like you are resorting to "they are just cold-hearted
assholes" ad-hominium, and relying on an emotional response, instead of
making a rationale critique. That is okay for the usenet.