SB 5892 is a measure to save costs in state-sponsored health care programs. The state has already been allowed to rewrite doctor prescriptions, but SB 5892 goes further.
It says, "A state purchased health care program may immediately designate an available, less expensive generic product in a previously reviewed drug class as preferred, without first submitting the product to review by the pharmacy and therapeutics committee."
It adds, "If, within a therapeutic class, there is a therapeutic alternative over-the-counter drug available, a state purchased health care program may automatically designate the over-the-counter drug as the preferred drug."
We know that generic and OTC drugs are often not the same, including differences in side effects, drug interactions, and methods of working.
There's plenty of other new powers the law would give to the state over doctors' wishes. Perhaps even worse is limiting doctors' abilities to prescribe drugs for treatments not listed on the drugs' labels, which removes the ability of doctors to prescribe new and promising treatments for a wide range of medical problems.
Not only does this bill have the negative immediate effect of reducing the potential quality of care for lower income Washingtonians, but it should serve as a warning to all of us, as many people want government to subsidize our health care, and we are seeing proof that the government is quite willing to sacrifice our care for money.
I have word there's a hearing tomorrow; I'll post when I get details.
Cross-posted on <pudge/*>.
Posted by pudge at April 17, 2009 01:01 PM | Email ThisLook, a centralized health insurance plan under the auspices of government will operate in the same manner for the same reasons as a private (for or not for profit) plan - to minimize costs.
WHEN a universal government health insurance plan comes to this state and this nation, it will most likely be similar to that of Germany, allowing for beneficiaries of the plan to opt out of the plans constraints on cost by substituting their own dollars.
This topic is really very simple once the fear of 'socialism' is taken out of the equation. It's nickels and dimes folks.
Posted by: MikeBoyScout on April 17, 2009 01:22 PMUm ... because it's the government doing it? Obviously?
Look, a centralized health insurance plan under the auspices of government will operate in the same manner for the same reasons as a private (for or not for profit) plan - to minimize costs.
Exactly, which is why we should never let the government control health care.
WHEN a universal government health insurance plan comes to this state and this nation, it will most likely be similar to that of Germany, allowing for beneficiaries of the plan to opt out of the plans constraints on cost by substituting their own dollars.
Which then costs MUCH more money for those who choose to do it.
You are only hurting your argument here.
Of course. Who said anything about the legislature prescribing anything? We're just talking about determining insurance levels.
Pudge@2 writes, "...which is why we should never let the government control health care."
Your logic is, at best, unstated. I know you don't believe that government has the moral or constitutional right to provide health insurance, but what makes you think they will do it worse than private insurance companies?
Posted by: Bruce on April 17, 2009 02:01 PMi've not hurt my argument because i don't fear MY democratically elected government. i don't fear my government soldiers in Ft Lewis, my government airmen at McCord or my government sailor in Bremerton. I don't fear the postman across the street. I don't fear my town council.
When they make mistakes or commit crimes there's a process to correct it.
Crack an economics text book.
Insurance pools minimize cost by controlling for risk by limiting the pool, and managing the expenses of services covered. WHEN the pool is universal, your left with managing the cost of the services.
The benefits of a single payer or at least less administrators is straight forward. The risk of abuse by a single tyrannical payer is significantly reduced when the administrator is a government required to obtain the consent of the majority in democratic elections tempered with protection of minority by constitutional rights.
Again, this topic is really very simple once the boogeyman of 'socialism' is taken out of the equation. It's nickels and dimes folks.
Posted by: MikeBoyScout on April 17, 2009 02:21 PMnot being snarky, but what does the definition of welfare have to do with anything?
Posted by: MikeBoyScout on April 17, 2009 02:31 PMIf you like how government runs housing, you'll love how they run your health care.
Posted by: jimg on April 17, 2009 02:34 PMDemocrat Johnson brought us Medicare with a democrat majority Congress and Republican Bush doubled down with a Republican majority Congress.
Posted by: MikeBoyScout on April 17, 2009 02:42 PMWho said anything about the legislature prescribing anything? We're just talking about determining insurance levels.
Um. Did you read the post? We are, in fact, talking about legislation that would grant new power to state agencies to modify doctors' prescriptions, and to restrict doctors' ability to write prescriptions, for users of the state health plans.
Your logic is, at best, unstated.
I showed that the state is exercising its power to get in the way of our doctors' decisions for patients that are on plans controlled by the government. It obviously goes without saying that the state could do the same for everyone, if the state controlled health care.
I THOUGHT it went without saying that this is something most of us don't want, and therefore this is a good example of why we don't want the state to control health care.
Mike: i've not hurt my argument
Yes, in fact, you did. It has already been proven that the state can harm the potential effectiveness of health care for people under the state's system (as SB 5892 will do). You say we can go elsewhere by pointing to Germany as an example, except that we know it costs a lot more to do that. So you are defending a system that has been demonstrated to either be less effective or cost more.
The benefits of a single payer or at least less administrators is straight forward.
And so are the perils: WORSE QUALITY OF CARE, as demonstrated.
The risk of abuse by a single tyrannical payer is significantly reduced when the administrator is a government required to obtain the consent of the majority in democratic elections tempered with protection of minority by constitutional rights.
SB 5892 shows that the risk is very, very high under your system.
the guvment is involved (or not) in healthcare both in the state and at the fed level at the behest of the governed, not under any mandated constitutional authority.
Correct: at the federal level, it is involved AGAINST the mandated constitutional authority.
Democrat Johnson brought us Medicare with a democrat majority Congress and Republican Bush doubled down with a Republican majority Congress.
Yep, and I criticized Bush at the time for his unconstitutional bill.
Crusader: Actually the Constitution says nothing about government in health care whatsoever. Eat that conservatives.
Exactly, the Constitution does not mention it (nor imply it), and therefore (as per the Tenth Amendment) the federal government has no right to do health care. But how does this harm any conservative argument ... ?
BenFranklin: Welfare begets "health" in a form at that time, therefore a possible link to governmental inclusion.
Nope. The federal government is never granted the power to give "welfare."
* If the government is trying to cut costs with a state-sponsored health care program, that's bad.
* If private health-care providers do something similar with a cheap medical plan, that's good.
* If you need to try to explain your case to a "poorly-trained phone bank person" with the state of Washington, that's bad.
* If you need to try to explain your case to a "poorly-trained phone bank person" with your insurance company, that's good.
* Our healthcare costs are due to "out-of-control insurance claims", NOT that we're being prescribed overpriced medication or getting unnecessary and ineffective treatment.
* Extending healthcare to everyone, without preventing folks from signing up for extra coverage, is "taking liberty away from the people".
* Leaving folks uninsured while keeping EMTALA on the books makes financial sense.
Posted by: demo kid on April 17, 2009 02:48 PMdon't bother to look it up, i'm right. It's already been proven. LOL!
Posted by: MikeBoyScout on April 17, 2009 02:51 PMFurther, not a single person here has even questioned that this can harm health care effectiveness. If you think it cannot, then please make your argument. As far as I am concerned, and I don't think I am nearly alone here, I consider it to be proven, if for no other reason that my personal experience proves it; if you need further proof than common sense provides, I am sure we can oblige.
There are in fact, several clear distinctions between private insurance and government.
First, we don't just "vote em out", if the government messes up. Just look at the banking crisis. The various groups are so quick to point fingers, deny culpability and obfuscate the truth that we really have a hard time getting to the actual truth. How would that be any different with failures in the health care system? Maybe your representative voted for that health care bill that messed things up, but you would NEVER vote for that other guy who is a crazy loony ________ (fill in your own colorful term here.) Government is not quite as accountable as we would like it to be, unfortunately.
Second, when the government wants to price control, the government CAN price control. Private insurance can only limit what it covers and then only at the risk of losing subscribers. Since the government can't lose subscribers per se, there is little to stop them form driving prices down so much that shortcuts are made or care providers are driven from the market creating a shortage in available care.
Finally, when government has that much power, it tends to use it to buy the votes it needs to stay in power. Government does not serve people so much as it serves itself by serving those people that will keep the people running the government in power.
Posted by: eyago on April 17, 2009 03:02 PMDon't believe me, go see a physician and pay out of pocket and compare your bill with the bill of someone who visited the same physician under a health insurance plan.
Posted by: MikeBoyScout on April 17, 2009 03:05 PM* If the government is trying to cut costs with a state-sponsored health care program, that's bad.
No one in any way implied that. It is the significant sacrificing of care that is the issue, not cutting costs. (And this type of thing sometimes leads to increased costs anyway).
* Our healthcare costs are due to "out-of-control insurance claims", NOT that we're being prescribed overpriced medication or getting unnecessary and ineffective treatment.
And you trust the health care program to judge what is unnecessary or ineffective, rather than the doctor? Riiiight.
* Extending healthcare to everyone, without preventing folks from signing up for extra coverage, is "taking liberty away from the people".
Providing health care to ANYONE (excepting those who are not government employees, of course, who get it as a benefit of employment) is taking away liberty from the people, self-evidently. But when it is provided to EVERYONE, even moreso, because now you are not just taking the product of my liberty to give to someone else, now you are limiting further expressions of my liberty by forcing me -- even if there's ways to opt out -- into the government system.
Oh, and the irony that conservatives are pointing out that state-funded healthcare plans are "reducing the potential quality of care" when they'd like nothing better than to kick everyone off state-funded healtcare... well...
The point of my post is that this bill proves it would be bad to have government control health care, not to show that this particular bill is bad in a system where government controls only a SMALL PART of health care insurance programs.
That said, if the government IS to provide health insurance, it should not broadly limit such basic things as doctor's decisions for off-label use of prescription drugs. There's a difference between being against govt health insurance, and handling it well once we do.
Also FWIW, I would not like to kick everyone off right now, but I would like to phase it out over time.
Poor choice of words on your part.
* If the government is trying to cut costs with a state-sponsored health care program, that's bad.
When those cuts are both mandatory and arbitrary and result in bad medical outcomes, it's worse than "bad."
* If private health-care providers do something similar with a cheap medical plan, that's good.
The critical word here is "private." If a "private" carrier does this, then you can feel free to go to some other private carrier. Can you go to some other state government in Washington, or are you stuck with the one we have now?
* If you need to try to explain your case to a "poorly-trained phone bank person" with the state of Washington, that's bad.
Of course it is. You do seem to have mastered the self-evident.
* If you need to try to explain your case to a "poorly-trained phone bank person" with your insurance company, that's good.
Again, if you don't like the service of any company, you can take your business somewhere else.
* Our healthcare costs are due to "out-of-control insurance claims", NOT that we're being prescribed overpriced medication or getting unnecessary and ineffective treatment.
WHATEVER they're "due to," adding and paying for a massive layer of additionally inept government administration certainly won't make it any cheaper.
* Extending healthcare to everyone, without preventing folks from signing up for extra coverage, is "taking liberty away from the people".
The fact that *I* have to pay for it so YOU can do it in fact accomplishes that very thing. So, yes. Thanks for asking.
* Leaving folks uninsured while keeping EMTALA on the books makes financial sense.
As opposed to you ripping me off to pay for other's choices?
Absolutely.
Damn, dumbo... you're gonna have to do MUCH better than this.
Posted by: Hinton on April 17, 2009 03:18 PMDo i think there's a significant probability this bill could impact my family's access to effective pharmacy products? No. None. Zero.
I can't comment on you and your family, but if you are telling me that YOU subscribe to a state sponsored health insurance plan, that would surprise me.
This bill is aimed at reducing the cost of state sponsored and subsidized health care plans such that TAXPAYERS get better cost control with equally effective approaches. Could mistakes be made? sure, but mistakes are made by ALL health insurance administrators and physicians.
tempest in a teapot.
Posted by: MikeBoyScout on April 17, 2009 03:19 PMyes, when you go outside any economic standard system it is usually more expensive than the cost within a system
Right, so you agree with me: you favor a system that will increase my costs, or decrease my quality.
You know a better government on the planet than ours?
Wow, Mike. You falsely accuse me appeal to authority, and then you promptly provide us a non sequitur. Just because we believe this is the greatest government around, does not imply that we can trust it or allow it to control our lives.
In fact, the reason WHY we believe this is the greatest government on the planet is BECAUSE we have the greatest capacity for freedom FROM the government in this country than in any other.
I think 26 falls under red herring.
Actually I am partial to this government, but that does not imply that it is immune from fault or potential for abuse. In fact, our framers were rather well documented disdaining a strong central government for just that reason. So, I am inclined to limit the authority and power of the government where it does not need to be and would opt rather to try and solve problems without turning it over to the government.
That also should not be read to imply that I like our current health care system or that there are not problems in it that exist and need to be solved.
Posted by: Eyago on April 17, 2009 03:28 PMNo, i don't agree with the 'iron triangle' of cost, quality, scope. Market base systems, like our constitutional representative democracy BREAK the iron triangle regularly via innovation.
If you have a better idea for health care and health care costs, present it. build a coalition or build a business and implement it.
Until then, you need to realize and come to accept that the majority has spoken (and probably will again when the state of WA votes acceptance for a tax increase to provide subsidized health care, soon) regarding its desire for health care insurance.
40 years after the Republican Party whined about Medicare being 'socialized' medicine, they did everything in their power to double the coverage. Why? Because the majority of the voters demanded it.
Time to stop whining, and put something on the table - something someone other than a small echo chamber supports. Else, live with it.
Posted by: MikeBoyScout on April 17, 2009 03:33 PMThat system tries to control drug costs just as the private sector does. I see that the State doesn't trump the doctor's decision in the law cited and can't substitute if the doctor says so.
I think that's a good thing.
I do the same with my doctor, reviewing prescriptions against the $4 list at Walmart and deciding together if a drug is an appropriate substitute or not.
I'm wary of the government deciding these things too - so the answer is to leave those folks that can't pay for insurance left out of any system so that instead I get to pick up their emergency room tab when they didn't access preventative care earlier.
What's a better answer that really costs me less money in the end?
Posted by: BA on April 17, 2009 03:34 PMAre you really serious?
You want to compare Yugoslavia to the state of WA?
Any chance the reason your care there was no good because.... it was a dictatorship?
Great Britain . . . so you contend an uninsured person here with no insurance would prefer that over the care they get at little cost with a British passport?
WA state residents needn't travel very far to find an effective and comparatively inexpensive government run single payer system.
http://www.health.gov.bc.ca/msp/infoben/premium.html
What is your cost for similar coverage? and PLEASE provide the website that shows it. :)
(inexpensive, government run, AND transparency!)
Posted by: MikeBoyScout on April 17, 2009 03:49 PMCase in point: I was treated both in Europe and here in Seattle for bouts of Bell's palsy. Over there, they looked at me, did a few quick neurological tests, told me to get ointment for my eye, drew blood for a Lyme disease test, and I was out the door. I was billed about $40-50 Here, I got an exam, and when the doctor was finished, he wrote out two prescriptions for medication that ran me about $50 (and cost the health insurance company a bit more), plus the copay for the doctor's visit.
Which care was better? The one that kicked in the cost of useless medications that were (partly) covered under a health plan, or the one where useless medications weren't even prescribed in the first place? The one where I cost the insurer more, or less? The one where I needed to pay more, or less?
Posted by: demo kid on April 17, 2009 03:57 PMYou're wrong. If you would like to rebut my points, you can, but simply reasserting yourself won't get you anywhere.
The first 3 words of our Constitution are....?
"We the People." And? The People never do wrong things? Like slavery?
If you have a better idea for health care and health care costs, present it.
Also a logical fallacy. It's a textbook red herring fallacy to defend against my criticism by saying "and what's your idea?"
Until then, you need to realize and come to accept that the majority has spoken
Please do not lie. We all -- including you -- know that the voters have never voted for universal health care, nor for this bill in particular.
Great Britain . . . so you contend an uninsured person here with no insurance would prefer that over the care they get at little cost with a British passport?
Please do not lie. katomar contended no such thing.
Also, I am curious, if the State is doing all of this - why are the Feds doing it too. ANd if the Feds are doing it, why is the State doing it too? Will we be double taxed for these programs?
And if we have the best government in the world, why are we trying so hard to reform it to have more aspects of other governments that are inferior to ours?
Posted by: SouthernRoots on April 17, 2009 04:06 PMScore one for SouthernRoots
Posted by: Eyago on April 17, 2009 04:11 PMOn drug substitutions, that's not true. I wish it were. The original bill says that, but in the additions, no! There's a whole process the doctor has to go through in order to enforce "dispense as written" when the state disagrees. Read 2(a)(ii).
(ii) The medical director of a state purchased health program has:
(A) Presented the endorsing practitioner with data that indicates the endorsing practitioner's prescribing patterns vary significantly from his or her peers, (B) provided the endorsing practitioner an opportunity to explain the variation in his or her prescribing patterns to those of his or her peers, and (C) if the variation in prescribing patterns cannot be explained, provided the endorsing practitioner sufficient time to change his or her prescribing patterns to align with those of his or her peers;
In the end the state makes the decision, not the doctor.
With generics, it is similar: the doctor "shall have an opportunity to request as medically necessary ... that the brand name drug be prescribed as the first course of treatment." But no guarantees. And it's the same for off-label use of drugs.
And while we are digging into the text, let's note that the legislature sees fit to call this bill an emergency, in order to bypass the initiative procedure.
When those cuts are both mandatory and arbitrary and result in bad medical outcomes, it's worse than "bad."
Again, the hypocrisy of claiming that cuts are bad when conservatives want to give these plans 100% cuts... well...
The critical word here is "private." If a "private" carrier does this, then you can feel free to go to some other private carrier. Can you go to some other state government in Washington, or are you stuck with the one we have now?
"Some other private carrier"? Seriously? If you're working at Starbucks or Wal-Mart or wherever and your health plan does something that you don't like, how much freedom do you have in practice to choose some other private carrier? If your private carrier doesn't cover a treatment you need for an acute condition, how much freedom do you have to switch before you die?
* If you need to try to explain your case to a "poorly-trained phone bank person" with the state of Washington, that's bad.
Of course it is. You do seem to have mastered the self-evident.
Wait for it... wait for it...
* If you need to try to explain your case to a "poorly-trained phone bank person" with your insurance company, that's good.
Again, if you don't like the service of any company, you can take your business somewhere else.
See above. Conservatives touting the power of the free market don't seem to understand that the options necessary to allow the free market to work aren't as common as they'd like to believe. And again, better to talk to a phone bank than... well... no one.
WHATEVER they're "due to," adding and paying for a massive layer of additionally inept government administration certainly won't make it any cheaper.
As opposed to a massive layer of additionally inept PRIVATE administration?
The fact that *I* have to pay for it so YOU can do it in fact accomplishes that very thing. So, yes. Thanks for asking.
* Leaving folks uninsured while keeping EMTALA on the books makes financial sense.
As opposed to you ripping me off to pay for other's choices?
Absolutely.
And there's where your argument falls apart. You see... you ARE paying for it. EMTALA is a nice, neat little bit of legislation stating that emergency treatment MUST be provided to anyone, regardless of their ability to pay. It was passed for a reason, and a good one: folks were dying in hospital waiting rooms because they didn't have insurance, or they were dying while being transported to facilities that would treat them. This is the one piece of legislation that has strained emergency care to its breaking point.
Therefore, if some uninsured guy in his 50s has an untreated heart condition, he'll be able to call for an ambulance and get treated in the ER when he has a heart attack. Never mind, of course, that the treatment he would get under insurance would increase his lifespan and cut the number of expensive hospital visits required! Our half-in, half-out system has looked at the problem, and has devised the solution that pretty much burdens us with the highest costs.
Posted by: demo kid on April 17, 2009 04:18 PMAs opposed to ALL private health insurance, where ALL the decisions are made by doctors!
Posted by: demo kid on April 17, 2009 04:22 PM1. Every person who has a full time job is eligible for employer subsidized health insurance.
2. There are a variety of health insurance companies (german version of Premera, Aetna, UHC, etc) all of which are individual companies regulated by the government.
3. Current rate for insurance is 15.5 percent of your monthly salary. Up to a certain amount. The more you earn, the more you pay for your health insurance (again, up to an upper limit). This way, higher earning people pay more into the pool.
4. If you earn more than the limit or if you are a civil servant, you can get what's called "private insurance". This insurance is not a pool system like a ppo etc, but it's based on your health. If you are young and healthy, you pay less, if you are old, etc...you pay more. Risk based.
5. If you are unemployed, the unemployment office pays your health insurance and you can opt to stay with the same company you had while you were employed.
6. If you are outside the system (neither have a job, be a family member of an insured person, not on unemployemt etc) you have no insurance. Period.
7. If you are on welfare or requesting asylum or in similar situations, you have no insurance...but as a welfare recipient, you medical costs are paid by the community you live in. Not as an insurance, but the actual medical costs. So welfare recipients receive preferential treatment as they are treated as private patients.
(Yes, Germany still has a two class system, health insurance patients and private patients).
But, as everywhere, health care costs are rising and the system is severly strained. Not only do the insurance companies try to limit their costs, but cities and communities are having major problems financing their costs.
Over the past decade, benefits paid by the insurance companies have been curtailed more and more (all with the blessing of the government), yet, as people have insurance and medical costs are paid for, there is little incentive by the general population to take care of their own medical needs (aka stop smoking, live healthy, etc).
Physicians are on strike almost every month trying to highlight the lack of care, the straining of the system etc.
Current solution by the government: Raise contributions by the insured and lower benefits.
Again, the hypocrisy of claiming that cuts are bad when conservatives want to give these plans 100% cuts...
I already demonstrated your argument here is irrational, on two fronts, demo kid. You should not compound your error by continuing to make the claim. Again: if the government IS to provide health insurance, it should not broadly limit such basic things as doctor's decisions for off-label use of prescription drugs. There's a difference between being against govt health insurance, and handling it well once we do.
I know in Liberaland it's generally accepted that conservatives want everyone on welfare to die so we don't have to continue paying for them, but in the Real World, it's not that way. We want our welfare services to work as intended, if we are going to have them.
If you're working at Starbucks or Wal-Mart or wherever and your health plan does something that you don't like, how much freedom do you have in practice to choose some other private carrier? If your private carrier doesn't cover a treatment you need for an acute condition, how much freedom do you have to switch before you die?
An excellent point, which is why most conservatives I know are in favor of various means to open up that market. You do know that "government-run" is not the opposite of what we have now, right? That is only one way to address the problems. No one here is for the status quo, so you are not making an argument in your favor, or against Hinton's.
It is still an important point, though. But your whole argument here is against the status quo, not for your ideas, so it doesn't really help you or hurt Hinton.
Yes, you do. However, you logically should not.
No. I trust the health care program to determine what care is cost effective enough to be covered, as wise public policy, for all Americans. I'm sure they won't do this perfectly, but I'm convinced that they'll do it better than our current non-system.
The speaker took colon cancer as an example. If you get it in the US, there is a 34% failure rate but you have a 41% rate in ObamaCare.
The reason is that there is a drug that we use that is quite successful but the cheaper and generic ObamaCare would only allow the drug that doesn't work as well.
Go figure, libs.
Posted by: swatter on April 17, 2009 04:37 PMI've asked the question before and didn't see a response - what's a better alternative for health care for folks that can't afford private insurance?
Let's even ignore what's better for the individual's health. I want to know what's better for my pocket book that right now pays for the enormous costs of charitable emergency room care when folks don't have primary care ahead of time.
"Opening up the market" is a rhetorical term - what's that look like? I buy health insurance annually for my employees, and I look at a whole host of providers and plans each year when I make that decision.
Is opening up the market mean I get out of that responsibility - give the employees the dollars I would have spent and let them buy their own insurance? OK. Will they get equal or better coverage shopping on their own?
Posted by: BA on April 17, 2009 05:08 PM@pudge, your post asserts ('should serve as a warning to all of us') but never directly states that the real danger in SB 5892 is that a government administered system would lead to disastrous outcomes. As some have alluded to in this thread, disastrous outcomes happen in the current system. You offering an alternative? What is it?
From a libertarian point of view, a centralized insurance system run by a representative democracy is both more cost effective and more accountable to its customers than the present system.
We all could find and cite anomalies (i.e. colon cancer) on all sides, but what's the use?
The issue for the state in this bill is cost control for subsidized health insurance.
Now, i'd love to hear the argument for letting them all die on the door step of the hospital, but that political argument is not going to get you very far. Alternatively, you could offer vouchers, but when the liberal ill-educated SOB spends it to zero and is on the door step of the hospital needing care, you're back to where you started.
And for all you constitutional constructionists.... please. There is no constitutional right to health care, but there is no constitutional right to the US Postal Service either. Why the government CAN get involved is because of 'rational basis' and the commerce clause. Why the government DID get involved is because the majority of Americans (as voiced thru their elected representatives) wanted it to.
The anti 'big government conservative' presidents of Reagan, Bush I and Bush II did nothing to turn it back, because it was politically infeasible.
I await your Voter Initiative. :-p
Posted by: MikeBoyScout on April 17, 2009 05:17 PMHow does government control reduce that cost?
When the government decides to pay doctors less and less for Medicare, does that really keep down the costs or does it harm the doctor? In this scenario, isn't the government doing the exact same thing as the evil insurance company?
Posted by: SouthernRoots on April 17, 2009 05:25 PMYou pose an interesting question. Will your employees get a better car if you chose which one they drove? Or maybe you would choose public transportation for them. How about you choose their house for them? Their children's school? Maybe you could vote for them as well. Maybe there are other decisions you could make.
I'm not trying to denigrate you and your efforts to find the very best options you can. I expect that you would try your best to give them the best coverage at the lowest price.
The point is, however, that you have to make that choice and not them. One problem with our health care system as highlighted by other posters is that the consumer really does not have much of a choice. A true free market system would separate employment from health care. That does not mean replace it with government. People who lose their jobs should not risk losing their coverage, and people should not be getting better rates for working in a company than they could buying insurance on their own. People should be able to look at all providers like they were buying a washing machine. Find the model they want, find the best price, buy it. They should not get a discount because they got it through their employer.
Of course there are lots of other things broken as well, unfortunately. I just don't buy that the government solution would solve any more than they would create.
Posted by: Eyago on April 17, 2009 05:25 PMLikewise, there's a difference between supporting a basic level of health care for everyone, and supporting a gold-standard for everyone. You didn't prove here that the "differences in side effects, drug interactions, and methods of working" for generic or OTC drugs would pose a threat to anyone, and I would assume that conservatives would be on board with trying to reduce program costs as best they could.
But hey... maybe the whole "fiscal conservative" thing is a misnomer.
I know in Liberaland it's generally accepted that conservatives want everyone on welfare to die so we don't have to continue paying for them, but in the Real World, it's not that way. We want our welfare services to work as intended, if we are going to have them.
I don't think that you want all poor folks to die, just that your policies don't make it easy for them to live. You can argue that the private sector would pick up the slack if government-run healthcare were to disappear, but few conservatives can actually demonstrate how that would work out in practice, aside from blind hope in the charity of others.
You do know that "government-run" is not the opposite of what we have now, right? That is only one way to address the problems.
Our system is a great example of a "worst of both worlds" system... neither government-run nor completely private. You and I probably agree that it can't stay in the "mushy middle", of course, but I have yet to see a convincing argument that a completely free-market system would grant poor folks cost-effective, reasonably priced healthcare.
No one here is for the status quo, so you are not making an argument in your favor, or against Hinton's.
Hinton was arguing that you could change your private provider if you didn't like the service. I noted otherwise.
Posted by: demo kid on April 17, 2009 05:25 PMI trust the [government] health care program to determine what care is cost effective enough to be covered, as wise public policy, for all Americans.
WOW.
I have no response to this except that I am extremely glad that you are in a tiny, tiny minority.
So it's OK to lower the survival rate for other people to increase it for everyone else? I can't say I agree with that. Not one bit.
There's at least two problems with the system now - one is that someone like me is making a decision on behalf of others and when I do I'm balancing plans that might work better for some folks and less well for others. That means I have to (chose to) pay someone a bit more as compensation when they're disproportionally getting the short end of the stick because the plan works better for most of the others.
Second, if I don't provide the coverage, they're pushed out into the market place where they generally can't get the quality of coverage I can get them because of the purchasing power of a group plan.
That leads to a less efficient employment system because now health coverage becomes a drag on moving from job to job - leading to a potential misfit because someone who should really be working somewhere else might be staying because of health coverage, and I'm less likely to let someone go knowing something about their personal health circumstances and what it might mean to their family.
So, what's preventing right now the private sector from providing competitive individual health coverage that moves with the individual and isn't tied to employment?
I can expense the cost if I pay the insurance directly or simply raise wages to transfer the dollars. With cafeteria plans I think the dollars don't even have to be taxed.
Posted by: BA on April 17, 2009 05:51 PMAnd it's hard, perhaps impossible, to fulfill this mandate with a free-market solution. That's why every other industrialized nation has some sort of government solution. Those solutions aren't perfect, and their existence doesn't prove that we should have a government solution. But it suggests that we shouldn't dispense with the idea based on ideology and anecdotes.
Posted by: Bruce on April 17, 2009 05:51 PMyour post asserts ('should serve as a warning to all of us') but never directly states that the real danger
Yes, it does. Very directly and explicitly. In the same sentence, even, Mike: "the government is quite willing to sacrifice our care for money."
As some have alluded to in this thread, disastrous outcomes happen in the current system. You offering an alternative? What is it?
And AGAIN, Mike, it is a red herring fallacy to attack my lack of proposal. I am criticizing this proposal. I have other ideas, but I don't have the time or inclination to indulge you at this time. If you don't want to defend this plan, don't. If you do, do. But don't pretend it's valid argument to defend this plan by attacking some other plan, or lack of it. It's not.
From a libertarian point of view, a centralized insurance system run by a representative democracy is both more cost effective and more accountable to its customers than the present system.
Please look up the word "libertarian." Get back to me when you're done.
The issue for the state in this bill is cost control for subsidized health insurance.
Yes: it reduces cost in ways that could severly impact the quality of care for many people.
Now, i'd love to hear the argument for letting them all die on the door step of the hospital ...
... which no one is making and has nothing to do with this discussion ...
And for all you constitutional constructionists.... please.
You're welcome.
There is no constitutional right to health care, but there is no constitutional right to the US Postal Service either.
You're confused. We're not talking about rights at all. We're talking about what the government is ALLOWED to do. And in fact, the U.S. government DOES have the authority to establish the U.S. Postal Service. It's right there in Article I, Section 8 of the Constitution: "The Congress shall have power ... To establish post offices."
Congress is not, however, given any power to control, manage, or fund health care.
Why the government CAN get involved is because of 'rational basis' and the commerce clause.
Only with the very broadest and obviously incorrect interpretation of "the power to regulate commerce." Not in any way that the words "regulate" and "interstate" have any serious differentiation from the words "control" and "intrastate." By this interpretation, the federal government's power is truly unlimited when any commerce is done. This is why I used the word "obviously," because it could not be more obvious that this is beyond the Founders' intent.
Further, for the extremely limited ways in which medical care actually is interstate, a "rational basis" review could not rationally conclude that "regulating" all of the nation's health care is justified for it.
That doesn't speak to the delivery methodology of how I access these moral rights.
I buy car insurance in the open market - it could have been where I would have to buy it as part of a group plan at my office. I buy health insurance through a group plan at my office - it could be where I buy it as an individual.
You're supposed to have insurance in order to drive a car, how about requiring insurance in order to live?
Then, make the "fine" the cost of the cheapest insurance offered in the market place...
Posted by: BA on April 17, 2009 06:00 PMthere's a difference between supporting a basic level of health care for everyone, and supporting a gold-standard for everyone
No one here supports the latter, so why bother saying this?
You didn't prove here that the "differences in side effects, drug interactions, and methods of working" for generic or OTC drugs would pose a threat to anyone
First, anyone who knew about this issue shouldn't need proof. It's obviously true. Second, I did prove it.
"Since all patented medicines are different, assuming that one-size fits all was a costly mistake. As a consequence, many patients who were switched onto the low cost drug experienced problems that resulted in them seeking additional medical care, or they had to go through additional administrative hurdles which in turn increased health care costs," Skinner said. The study found that over a three-year period, 2003-2005, patients who complied with the Therapeutic Substitution program had an increased use of PPI drugs, physician services, and hospital services, totaling approximately $43.51 million ($9.11 million in total PPI drug expenditures, $24.65 million for physician services, and $9.75 million for hospital services).
and I would assume that conservatives would be on board with trying to reduce program costs as best they could.
Not "by any means necessary," no. As I've proven your assumption is false, you should stop asserting it.
And as I've already said in other comments, and as the study shows, it often does not decrease, but increase, costs.
You can argue that the private sector would pick up the slack if government-run healthcare were to disappear, but few conservatives can actually demonstrate how that would work out in practice, aside from blind hope in the charity of others.
So you welcome people who will vote for gov't "charity" that costs them money, but you think it is outrageous to assume that if the gov't stops collecting money for charity, that those same people won't contribute on their own. You realize this is not your strongest argument, right?
I have yet to see a convincing argument that a completely free-market system would grant poor folks cost-effective, reasonably priced healthcare.
You haven't looked. There are plenty. And I respond that I have yet to see a socialist health care system, such as you prefer, that would not either significantly decrease the quality, or increase the cost, of care for everyone who has adequate health insurance now.
Hinton was arguing that you could change your private provider if you didn't like the service. I noted otherwise.
Almost everyone can. It's difficult and perhaps costly, but in a gov't system, much more difficult and costly.
I think health care is a moral right. I think driving a car is a moral right.
Yep. And playing video games, and shooting hoops, and going for a swim, and watching American Idol!
You're supposed to have insurance in order to drive a car, how about requiring insurance in order to live?
Massachusetts did that, and I hate the idea. Every living person must have health insurance or they are violating the law. It's the nation's first "tax" on being alive, that I am aware of, and it's despicable.
It's one thing to say you have to have insurance to drive a car. You can choose to not drive. But to tell people they have to pay, or choose to not live ... ? Insanity.
Then, make the "fine" the cost of the cheapest insurance offered in the market place...
I saw this one guy in MA who couldn't afford insurance and didn't qualify for subsidy, so instead he paid the fine. So no, you can't do that: if people can't pay for the insurance, it makes no sense to fine them the cost of the insurance.
Posted by: pudge on April 17, 2009 06:15 PM"Only with the very broadest and obviously incorrect interpretation..." You might be correct, but it has been case law since 1937. If you and others feel strongly about it, the Congress passes many laws every year you can spend your money challenging. Howling at the moon won't change anything.
"I am criticizing this proposal. I have other ideas, but I don't have the time or inclination to..." No, of course not.
My apologies to you for thinking you could offer any alternatives to what you criticize.
outa here.
Posted by: MikeBoyScout on April 17, 2009 06:23 PMBy "failure rate", I'm assuming that you mean, "survival up to xx years" or something? Watch yourself... Giuliani was tripped up by not using consistent measurement.
Any way you put it though, it's not the home run you think it is.
Okay... say there are about 108,000 cases of colon cancer per year. According to your stats, 36,720 people will die under the US plan, as opposed to 44,280 under your "ObamaCare" plan, for a difference of 7,560 people.
From your statement (and I haven't had the time to research this), you claim that adding a drug regimen will increase survival rates. I'll assume it's a complete cure, and that everyone would be treated with this from the get-go. We'll assume for the sake of argument that all patients will receive this drug, and that everyone gets the same treatment (which is wrong, since some will need more intensive treatment than others, some will be uninsured, some will be misdiagnosed, some will get the cancer again... but we'll just use this for the sake of argument).
If these supplemental drugs cost, say, $300 for a full regimen, it would be a no brainer: $300 x 108,000 = $32.4 million per year / 7,560 lives saved per year = $4,286 per life saved. Brilliant! Damn Canadians just want to kill people, eh? Stupid socialized medicine!
But what if these supplemental drugs cost, say, $50,000 for a full regimen, for a cost of $5.4 billion per year, or $716,000 per person saved? Does that make sense? What if this increased five-year survival rates, but still resulted in reduced life expectancy, at a cost of $716,000 for an expected five-year increase in lifespan on average? Does that make sense? How does that compare to other needs in the system? Two numbers don't get at that.
Let's split out the uninsured, though. Let's assume that you can divide the folks from the U.S. into the uninsured/underinsured who won't be covered the treatment, and the insured that will. Reasonable enough, since if the Canadians don't cover it, Medicare and low-end plans certainly won't. So if you're one of the, say, 50% of the underinsured, let's say you're going to be getting a version of the Canadian treatment, with a "failure" rate of 50% (assuming that some folks don't get the care they would under a single-payer system). That means that the "failure" rate for the insured is about 18%, meaning that the success rate for the more expensive treatment is quite good: $147,000 per life (or per additional individual surviving for more than five years). We can change that number up or down depending on assumptions, but that seems more manageable. USA! USA!
All this assumes that the drug is really the only effect, of course. If you have good enough insurance to cover the drugs, you're also going to have the level of care where you're going to be getting better screenings, preventative care, aggressive diagnosis of non-lethal cancer, and so forth. That would increase the effective cost, especially since that would be done for everyone on the plan. Regardless, assuming that the entire difference between the systems is due to one drug is making a big leap, and I'm wondering about that source.
Still, you might pat yourself on the back with that one, and have that warm, fuzzy feeling that USA is number one!
But... if you can assume that if there is an underinsured segment of the population that isn't receiving medical care even to cheapo Canadian standards (which is reasonable), and has a survival rate LOWER than Canada's universal health system (which is also reasonable), wouldn't the survival rate INCREASE if a two-tiered system of universal care equivalent to Canada's were put into place? The folks with the gold plan wouldn't see their survival rates change, but if the poor were even receiving care at Canadian levels, their survival rates would increase, correct? If those two percentages were the only two numbers that mattered, then why wouldn't you support a two-tiered system?
If you can assume that there is a difference in care in the US population, which you haven't denied, all those numbers mean is that there are some folks out there that can spend a lot of money and get better care for colon cancer, not that universal health care wouldn't improve health outcomes overall in the United States.
Posted by: demo kid on April 17, 2009 06:25 PMStop saying that you support the former, then.
First, anyone who knew about this issue shouldn't need proof. It's obviously true. Second, I did prove it.
That paper is for acid-related diseases in BC. You're arguing with the fallacy of composition, since you're trying to use a study about the impact of proton pump inhibitor drugs to damn the whole program. It isn't even established that the same substitution would be made in the Washington program.
In terms of whether it's "true", I'll ignore the urge to pull out Ye Olde Dictionary of Fallacies. The agency is granted authority to make substitutions, but it is part of an "evidence-based" program. There are provisions for doctors to write a prescription for the non-generic brand as well. Likewise, refills for antipsychotics and antidepressants are not subject to these rules, which is the biggest concern with generics. You're arguing in broad generalities here.
This is actually surprising, though. I never thought I'd be arguing for fiscal responsibility, while you'd be arguing for a greater expenditure of government money.
Not "by any means necessary," no. As I've proven your assumption is false, you should stop asserting it.
You didn't prove that this would be "by any means necessary". Likewise, you're relying on one study from a right-wing Canadian think tank. That's not proof.
So you welcome people who will vote for gov't "charity" that costs them money, but you think it is outrageous to assume that if the gov't stops collecting money for charity, that those same people won't contribute on their own.
I don't think it's outrageous. I think it's unrealistic.
You realize this is not your strongest argument, right?
In fact, I'd say it was my strongest! I'm at a loss as to how conservatives think otherwise.
And I respond that I have yet to see a socialist health care system, such as you prefer, that would not either significantly decrease the quality, or increase the cost, of care for everyone who has adequate health insurance now.
But this is a red herring (so to speak). The proposals put forth by the Democrats are hardly socialist: they don't nationalize health care, they don't require that everyone should have exactly the same level of coverage (no more, no less), and they can in fact save the taxpayers money in certain respects.
Likewise, how are you measuring "cost increases"? "Quality decreases"? Blanket statements like that aren't proof.
Almost everyone can. It's difficult and perhaps costly, but in a gov't system, much more difficult and costly.
If you're suffering from a condition and you need immediate medical treatment, you cannot simply change your provider. And if it is "difficult and costly", the obscene transaction costs don't really lead to a well-functioning market, do they?
Medical care is fundamentally different from any kind of private goods exchanged on the market. To assume that it could be completely deregulated and we would all benefit is wishful thinking to the extreme.
Posted by: demo kid on April 17, 2009 06:50 PMWhere you said "You haven't looked. There are plenty."
I don't need the phone numbers, just their names. I can do the research from there.
Posted by: BA on April 17, 2009 08:04 PMPeriod.
Posted by: the Sasquatch on April 17, 2009 08:59 PMSocialism is a disease of it's own, but it will kill you much faster than the democracy we are about to lose.
Posted by: GS on April 17, 2009 09:46 PMA common mantra of conservatives. Have you tried scheduling appointments with specialists here? I don't quite think that those wait times can be measured in days. And while you can certainly pull out horror stories about single-payer health care, Canadians are just as apt to pull out stories of Americans bankrupted by expensive medical procedures.
@72: Take the libtard's gov't provided/mandated/controlled health care and shove it.
Brilliant commentary. Probably the best you can do, really.
@74: My friends in England both come here for dental and medical care, because the wait in England is so long for just basic tests that deem important, is so long, that people die waiting.
People die waiting for teeth cleanings? Really?
Posted by: demo kid on April 17, 2009 10:11 PM"MRSA (methicillin-resistant Staphylococcus aureus) is a type of bacteria which has become increasingly resistant to antibiotics. MRSA infection has become increasingly difficult to treat, and can lead to death. In terms of antibiotic resistance in hospitals, the UK has one of the worst records, particularly for MRSA. For some people, the incidence of MRSA infection in UK hospitals has been one of the factors which has encouraged them to seek hospital treatment and surgery abroad.
The number of cases of MRSA in the UK has been rising sharply - from 2,422 in 1997 in England and Wales, to 7,684 in 2003/4 in England alone. Official figures show that about 15% of reported cases result in death."
You might be correct, but it has been case law since 1937.
No. Just like you pretended that the voters have asked for universal health care, you are also wrong that the federal courts ruled that health care falls under the commerce clause.
You're probably referring to the NRLB case, which was a decision actually about regulating a company's actions, not about taking on the functions of that company or an entire industry.
If you and others feel strongly about it, the Congress passes many laws every year you can spend your money challenging. Howling at the moon won't change anything.
That's a red herring.
My apologies to you for thinking you could offer any alternatives to what you criticize.
Yawn. Your dishonest attempt to twist my words into something they are not -- like your attempts to twist the meaning of votes, and of court cases -- won't get you very far.
So sad that you have to resort to such dishonesty, Mike.
Pudge, can you identify the private systems you mentioned in your post above that provide cost effective, reasonably priced health care? Where you said "You haven't looked. There are plenty."
I never said that, actually. Please reread. :-) The antecedent of my statement, from your quote, was not "private systems" but "convincing arguments."
The folks supporting the bill make a very good case that this is just a smart way to manage state health care programs, and save taxpayer dollars.
Right: at the cost of quality of care.
As for what the bill means for doctors and their patients, I'll trust the Washington State Medical Association ... over pudge on that one.
Shrug. The facts are simple: if a doctor wants to explicitly use a brand-name drug or off-label use for a patient in a state health program, the state can override his decision. This is unassailably true. Please find me a single doctor or patient who will appreciate this if it happens to them.
And anyone who trusts a government bureaucracy to make sure this does not negatively impact a single patient is a fool. Let's be reasonable here.
But what if these supplemental drugs cost, say, $50,000 for a full regimen, for a cost of $5.4 billion per year, or $716,000 per person saved? Does that make sense?
So how much is a human life worth to you? What is the price for a human life? And does that mean that if I can come up with that much money, I have the right to kill you, penalty free?
Reasoning like this is why hip replacements aren't an option for people in their 70s who have the Canadian national plan.
And Government inefficiencies and costs are the reason it takes you 3.5 years to get a pair of hearing aids when in Great Britain (and don't lose one or break one - it's another 3.5 year wait to get it replaced).
I've paid for my own health insurance for a dozen years, and plan to do so for the rest of my life. And I will guarantee that I pay less than pretty much anyone here - $159 per month (overweight, 41 year old guy with a family history of cancer). Health insurance is affordable if you shop around, take ownership of your OWN plan, and don't get that gold-standard coverage...
Posted by: Shanghai Dan on April 17, 2009 11:00 PMPeople die waiting for teeth cleanings? Really?
You know, for one trying to talk with so much "authority" on healthcare, I'm surprised you didn't know about the strong connection between oral and physical health. Not just risk of infection, but detection of diabetes, cardiovascular disease, osteoporosis, and even premature births.
Posted by: Shanghai Dan on April 17, 2009 11:04 PMThe number of cases in the US is comparable, if not higher, than in Britain. In fact, MRSA cases are rising rapidly everywhere. You're cherry-picking statistics that mean nothing in context.
Posted by: demo kid on April 17, 2009 11:06 PMStop saying that you support the former, then.
I never did. Why are you insisting on this line of assertion when you've been told many times that you are misrepresenting my views? Supporting good care in a system we have is not the same as saying I support the existence of that system; nor are they in any way inconsistent. No matter how many times you make that assertion, it will still be false.
That paper is for acid-related diseases in BC. You're arguing with the fallacy of composition ...
No, I am not.
... since you're trying to use a study about the impact of proton pump inhibitor drugs to damn the whole program.
I am damning the methods used that lead to such problems.
It isn't even established that the same substitution would be made in the Washington program.
I never implied they would. I do assert, however, that the health programs cannot prevent such problems from occurring when ordering substitutions. And that's clearly true.
In terms of whether it's "true", I'll ignore the urge to pull out Ye Olde Dictionary of Fallacies.
Feel free to try, but I am making common sense assertions here: drug substitutions can cause problems. And they DO cause problems every day.
The agency is granted authority to make substitutions, but it is part of an "evidence-based" program.
Yes, and evidence consists of statistical data which is never perfect.
There are provisions for doctors to write a prescription for the non-generic brand as well.
Yes, but in the end, the state can overrule the doctor in this legislation. Maybe you didn't realize that fact?
Likewise, refills for antipsychotics and antidepressants are not subject to these rules, which is the biggest concern with generics.
Tell that to people who every day get substitute drugs in other classes, and are worse off for it.
You're arguing in broad generalities here.
It's a very broad problem, and as the program is not implemented there ARE no specifics yet.
I never thought I'd be arguing for fiscal responsibility, while you'd be arguing for a greater expenditure of government money.
Question-begging fallacy, since it's clear that substitutions can lead to higher costs. Even if you discount that study, it's necessarily true that substitutions can cause harm, and that harm can increase costs.
You didn't prove that this would be "by any means necessary".
You're not making any sense. What I am saying is that YOU are apparently implying that I would cut costs by any means necessary, and I am showing that you are wrong. I am saying that, contrary to your idiotic notion of conservatives, I believe that if we are going to have a public health insurance program, that it should actually do its job properly (and I don't believe this is doing a proper job).
I don't think it's outrageous. I think it's unrealistic.
If you have that low an opinion of humanity, it's no wonder you're a socialist. But it actually goes far deeper than mere low opinion: you actually believe a majority of people would VOTE for something that they WOULD NOT do on their own, if the vote were no longer a viable option. That's just stupid.
Likewise, how are you measuring "cost increases"? "Quality decreases"?
Mike actually quite clearly made the case for increased cost. He asserted it and backed it up. When you have a universal system, going outside that system costs more. Cost increases.
Your other option is to stay in the system, where you will get quality decreases if the state decides to give you quality decreases ... as we are seeing with this bill.
Medical care is fundamentally different from any kind of private goods exchanged on the market.
No, it's not.
To assume that it could be completely deregulated
Funny that you would choose to end your post on such an obvious straw man fallacy.
A common mantra of conservatives. Have you tried scheduling appointments with specialists here? I don't quite think that those wait times can be measured in days.
I agree, it is usually weeks in my experience. Still better than the months I've seen in studies from many countries, including Canada and England, and I have no doubts we'd see the same thing if we switched to a universal system as you want.
What I'm saying is that they are incompatible positions. You're advocating against government-sponsored health care on one hand, partly for fiscal reasons, partly for philosophical reasons, but then you're advocating against measures to control costs. You haven't proved that this would compromise care in Washington state, and I'd argue that in a case where there are severe government cutbacks, this is probably a more responsible measure than to cut people off the rolls that may need assistance so that a few doctors can continue to prescribe name-brand medication that they don't need to prescribe.
That paper is for acid-related diseases in BC. You're arguing with the fallacy of composition ...
No, I am not.
You are arguing against this legislation here in Washington state because of issues with proton pump inhibitors in British Columbia. You're essentially stating that the entire system is flawed because of problems with one class of drugs in another jurisdiction, without proof that the same problem would apply here.
I do assert, however, that the health programs cannot prevent such problems from occurring when ordering substitutions.
You're arguing this when it is clear that other healthcare providers also substitute medications. Similarly, you haven't established the magnitude of the problem.
Feel free to try, but I am making common sense assertions here: drug substitutions can cause problems. And they DO cause problems every day.
You haven't made the case that they "cause problems every day", nor that this would pose an additional risk over the policies of other, private healthcare providers.
Yes, and evidence consists of statistical data which is never perfect.
That's the biggest cop-out I've ever heard. What exactly do you propose to base decisions on? Goat entrails?
Yes, but in the end, the state can overrule the doctor in this legislation.
If the doctor is pretty much ignoring the guidelines when compared to his or her peers. This pretty much indicates that they're thumbing their nose at requests to keep costs down.
Tell that to people who every day get substitute drugs in other classes, and are worse off for it.
The biggest objections to the original were from psychiatrists, who had concerns about generic drugs used for mental health purposes. Those concerns were taken into consideration.
It's a very broad problem, and as the program is not implemented there ARE no specifics yet.
And you're arguing against it just the same.
Question-begging fallacy, since it's clear that substitutions can lead to higher costs.
It's not clear. You're asserting something that you haven't proven.
Even if you discount that study, it's necessarily true that substitutions can cause harm, and that harm can increase costs.
Again, not proven here. You're speaking in sweeping generalities. So what are the costs? The benefits?
What I am saying is that YOU are apparently implying that I would cut costs by any means necessary, and I am showing that you are wrong. I am saying that, contrary to your idiotic notion of conservatives, I believe that if we are going to have a public health insurance program, that it should actually do its job properly (and I don't believe this is doing a proper job).
Again, this is a means to cut costs, and aside from one report that you've linked to from a Canadian right-wing think tank, you don't have proof that this would increase costs. You're scaremongering, and not relying on the facts.
He asserted it and backed it up. When you have a universal system, going outside that system costs more.
No, not at all. That indicates that in a universal system, higher care will require more money. That's undisputed, and that's true in our current system as well. The TOTAL cost, however, is different. A greater focus on preventative care, lower reliance on emergency rooms for healthcare, lower demands on employers for picking up the costs of healthcare plans, among other things, need to be considered as well in discussions of cost.
Medical care is fundamentally different from any kind of private goods exchanged on the market.
No, it's not.
Let's see... if I have the only set of defibrillator paddles around, I know how to use them, and you have a LOT of money, I think that I have the advantage in negotiations, don't you?
Funny that you would choose to end your post on such an obvious straw man fallacy.
It's not a straw-man fallacy to say that deregulation and a lack of government participation is your objective. Perhaps saying "completely" is a little out there, I'll give you that... but I'm always one for bombastic endings.
Still better than the months I've seen in studies from many countries, including Canada and England, and I have no doubts we'd see the same thing if we switched to a universal system as you want.
I'm not advocating for a system that's exactly like Canada's, or England's. We will never have a National Health Service like in Britain, even under the most ambitious reforms. Even the Canadian system isn't the same, as there never really will ever be a single-payer system in the US.
Additionally, we pretty much have a scattered socialized system already, through Medicare and EMTALA. The more important question is how we can reform and standardize that to make the system more efficient and reduce costs.
Posted by: demo kid on April 18, 2009 01:29 AMAhh, yes. The pipsqueak raises his voice again.
What I find really ironic is that I'm the one taking the fiscally conservative position here. :) I'm saying that if you have a system covering a large number of people, cost is a relevant point. Basic health care means that if you don't have a need for the gold standard, there are certain preventative treatments and medication that can increase your quality of life. Should everyone that is diagnosed with prostate cancer get expensive proton treatment versus surgery? Definitely not. But should people get treated? Yes.
Why is it that you and other conservatives advocate against government provision of health care, but then apparently believe that it needs to be absolute top of the line care if it is? I don't really give a crap if you decide to buy into a plan that gives you better treatment, but for many people, any treatment may present an improvement.
@81: You know, for one trying to talk with so much "authority" on healthcare, I'm surprised you didn't know about the strong connection between oral and physical health. Not just risk of infection, but detection of diabetes, cardiovascular disease, osteoporosis, and even premature births.
Now you're just yanking my chain. :) Good on you for that. Always good to have a light moment in amongst the arguing.
@84: Demo kid - which conservative called for 100% cuts? If you can't provide cites, then you're blowing it out of your ASS.
If you're advocating that the government has no role in providing health care, that's a 100% cut to me. In that case, you have eyes... I'm sure you can find a few examples.
@85: The first time I watched a 25 yr old social worker tell a seasoned, experienced physician what he could and could not do, I knew we were in deep trouble. This is a horrible expansion of the authority granted to such social workers, ie, government agents.
That is different from a health insurance company telling a doctor what to do in what way, exactly?
@79: "Please find me a single doctor or patient who will appreciate this if it happens to them."
First of all, I could find a whole bunch of doctors and patients utterly indifferent to generic substitution because it already happens . . . a lot. As for "appreciate," I'll take one from your book on that. These folks have no reason to appreciate it because they're not paying the bill -- we taxpayers are. The moment the doctor or patient had skin in the game, I'm betting "equivalent drug at less cost" would become very attractive.
Also, it was mentioned in the testimony on the bill that the generic use rate under commercial health plans is significantly higher than in state programs. Thought you'd be a fan of government acting more like a business . . . or perhaps you're conceding that as currently structured, state health programs are already better than those in the private sector?
As for off-label use, a bit of research suggests it's widely abused -- often at the urging of drug companies themselves -- and puts patients at risk. One article noted that Eli Lilly just plead guilty to and paid $1.4 billion for improperly promoting off-label use for one of its drugs. A guy from DOD said "This illegal activity increases patients' costs, threatens their safety and negatively affects the delivery of healthcare services to the over nine million military members, retirees and their families who rely on this system. Today's charges and settlement demonstrate the ongoing commitment . . . to investigate and prosecute those that abuse the government's healthcare programs at the expense of the taxpayers and patients."
Sounds like we should be applauding, not criticizing, what this bill is intended to accomplish.
Can you identify a handful of the free-market systems that are providing cost effective, reasonably priced health care that you say there are "plenty" off.
Now, I'm just after their geographic locations. What state, what country, etc.
Or, am I missing your point entirely and these systems are theories.
You see, I have no desire either for the government to step in and provide health care - except they will by default when you don't buy insurance and I'll end up paying for you when you end up in the emergency room getting charitable care.
So, I'm curious as to the systems that you say there are plenty of that are delivering health care to poor folks in a way that keeps their care out of my wallet.
Actually, I'm OK with paying something for the folks at the very bottom - I just would rather pay for services that are effective and preventative.
Posted by: BA on April 18, 2009 06:49 AMThat I don't appreciate having to stop at stop signs doesn't mean the law making me do so is not a good one.
That an individual doc or patient won't appreciate substitution of an equivalenet but less costly drug does not make this bad legislation . . . probably part of the Medical Association's rationale when they chose to endorse it, don't you think?
Posted by: John on April 18, 2009 07:22 AMhttp://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Senate%20Bills/5892-S.E.pdf
is supported by the Washington State Pharmacy Association. The Washington State Medical Association does not yet have a formal position on this bill.
Big Pharma (Amgen, Pharmaceutical Research & Manufacturers of America) and Pudge are opposed.
http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bill%20Reports/Senate/5892%20SBR%20WM%2009.pdf
Posted by: MikeBoyScout on April 18, 2009 08:18 AMWhat I'm saying is that they are incompatible positions.
And I have demonstrated they are not. Yet you keep making a fool out of yourself by claiming otherwise.
You're advocating against government-sponsored health care on one hand, partly for fiscal reasons, partly for philosophical reasons, but then you're advocating against measures to control costs.
And now you're back to falsely arguing that I am in favor of cutting costs by any means necessary.
You haven't proved that this would compromise care in Washington state
I have proven it COULD, and it is obviously true that there is no way the health programs could ensure that it WOULDN'T.
I'd argue that in a case where there are severe government cutbacks, this is probably a more responsible measure than to cut people off the rolls
I was not arguing for cutting people off the rolls.
... that may need assistance so that a few doctors can continue to prescribe name-brand medication that they don't need to prescribe.
And now you're literally saying that you or the state knows better than the doctor does.
You are arguing against this legislation here in Washington state because of issues with proton pump inhibitors in British Columbia
No, I am not. I obviously used that as only one example, not as the reason. Don't be daft.
You're arguing [that the health programs cannot prevent such problems from occurring when ordering substitutions] when it is clear that other healthcare providers also substitute medications.
Yes, exactly. Thank you for helping to make my point. (Or are you under the false impression that drug substitution problems do not happen literally every day for other healthcare providers?)
Similarly, you haven't established the magnitude of the problem.
This is a difference between a socialist and a (little-l) libertarian. I think it's a big problem if it causes significant problems for individuals. You believe it's a big problem if it causes significant problems for a certain percent of individuals. This is a big reason why WE do not trust YOU, because you literally do not care about the people, unless it's some "significant" percentage of them.
That's the biggest cop-out I've ever heard. What exactly do you propose to base decisions on?
How about THE DOCTORS? How is this hard for you to get? Statistics might say one in 100 has significant side effect problems from a drug substitution; that may sound good to a socialist, but if you are that one in 100, it doesn't sound good to you. The doctor is the one who should be making the decision.
If the doctor is pretty much ignoring the guidelines when compared to his or her peers.
Good doctors often do this, yes. They think for themselves, they invent new treatments, they help solve their patients' problems without being held captive to standard procedures. Screw the guidelines. I don't care about the guidelines. When I am in the doctor's office, I care only about MY problems and what the doctor thinks is best for ME. This is as it should be.
The biggest objections to the original were from psychiatrists ...
Yes, again, socialists are concerned with only what is the most statistically significant problems. Let the edge cases suffer.
Again, this is a means to cut costs
You keep saying that as thought it is the most important thing. To you maybe it is, but to us, it's not.
Do you realize that if this measure were to replace everyone's drugs with sugar pills, almost all of your arguments would stand exactly the same way? It cuts costs, so I should be in favor of it; I can't prove it will cause problems, so I shouldn't assume it might; etc.
You're being a complete ass by continuing to assert that there is any inconsistency whatsoever between being against public health insurance, and being in favor of well-managing a public health insurance program if we have one.
A greater focus on preventative care, lower reliance on emergency rooms for healthcare, lower demands on employers for picking up the costs of healthcare plans, among other things, need to be considered as well in discussions of cost.
You are completely confused. I was talking about -- as usual -- the individual. I was not talking about higher costs for "society," but for ME. Either I will have to pay more to go outside the system, or I will have to stay in the system and get lower quality of care if the state decides to force it upon me.
Let's see... if I have the only set of defibrillator paddles around, I know how to use them, and you have a LOT of money, I think that I have the advantage in negotiations, don't you?
If you have the only FOOD or SHELTER or EDUCATION or TRANSPORTATION around ... so how is this different?
Perhaps saying "completely" is a little out there, I'll give you that
OK. So you admit it was a straw man fallacy.
there never really will ever be a single-payer system in the US.
That is the goal of many, if not most, of your fellow travelers. (And it is my belief that it is Obama's goal, too. Yes, he says he doesn't want it, but I frankly don't believe him, and I have no reason to believe him.)
And regardless of whether it is single-payer, what we're talking about here -- what I explicitly stated in my opening post -- is government control over the entire system.
If you're advocating that the government has no role in providing health care, that's a 100% cut to me.
No one here is advocating cutting the program NOW, so it's irrelevant. This is logical fact.
First of all, I could find a whole bunch of doctors and patients utterly indifferent to generic substitution because it already happens . . . a lot.
You're not paying attention, John. The issue I am talking about is when the doctor says "dispense as written," which means explicitly to NOT substitute. In that case, the doctor has already explicitly expressed that he is not indifferent: he has stated in no uncertain terms that he wants a specific drug for his patient.
These folks have no reason to appreciate it because they're not paying the bill -- we taxpayers are.
Shrug. This is why I said in my opening post, "it should serve as a warning to all of us, as many people want government to subsidize our health care, and we are seeing proof that the government is quite willing to sacrifice our care for money." If government controls all our health care, we will be told to just take it, we should be glad we have any health care, and if it is of less quality, sucks to be you.
Also, it was mentioned in the testimony on the bill that the generic use rate under commercial health plans is significantly higher than in state programs.
That's irrelevant to any point I've made.
As for off-label use, a bit of research suggests it's widely abused ... and puts patients at risk.
You mean CAN put patients at risk, not that it DOES put them at risk. Yes, that may be true, but it is also clearly true that it is often used to solve significant problems for many patients, and it is further true that the state gets to make the decision, not the doctor, under this bill.
Sounds like we should be applauding, not criticizing, what this bill is intended to accomplish.
As I never spoke to the intentions of the bill's sponsors, this is a straw man fallacy.
Not well enough!
Can you identify a handful of the free-market systems that are providing cost effective, reasonably priced health care that you say there are "plenty" off.
For the second time, I did not say this. It never happened.
You wrote: I have yet to see a convincing argument that a completely free-market system would grant poor folks cost-effective, reasonably priced healthcare.
Grammatically, the object of your sentence was "convincing argument that ... ." So when I said, You haven't looked. There are plenty, I was saying there are "plenty" of "convincing arguments."
In regards to genetic fallacy, i drew no conclusions in my post. I merely stated verifiable facts. And if you must know, i didn't draw that conclusion. Your responses to your readers questions provide all anyone needs to understand your motivation.
Posted by: MikeBoyScout on April 18, 2009 08:53 AMtherefore, should save taxpayers money.
Posted by: MikeBoyScout on April 18, 2009 09:06 AMEvery other industrialized nation has some form of national health care. While none of those systems is perfect, few people in any of those countries would vote to switch to our system. Are they all just stupid?
Once the taxpayer is paying for all the coverage how does the government reduce costs to the taxpayer? Either by reducing taxation or by limiting coverage.
In other words, it doesn't.
When there is another downturn in revenues (i.e. when revenues don't keep up with the spending desires) what will happen? Will government threaten to make severe cuts in health coverage unless we vote for higher taxes?
How is government doing today in reducing or limiting heathcare costs? How's Medicare, Medicaid, SCHIPP, prescription drug benefit? Are these current programs costing the taxpayer less?
How many hundreds of billions does the government spend each year on medical research? Does that number ever get smaller?
The visible cost to the patient might appear to be smaller, but the taxpayer isn't saving any money. More government control will NOT end up saving money for the taxpayer - it will increase costs and eventually provide more restricted services.
Name ANY government programs that cost less today than they did ten years ago. Name ANY government program that provides MORE services for less money than it did ten years ago.
Think of your healthcare needs. Then look at the people in Congress or in the legislature and ask yourself, "Do I want (fill in the blank) in the doctor's office with me helping me make my healthcare decisions?" Because, by turning over control of your healthcare to the government, this is what you are in effect doing.
Posted by: SouthernRoots on April 18, 2009 10:12 AMAhh, yes. The pipsqueak raises his voice again.
Being a shade over 6 feet tall and 280 pounds, and having a verified vocal range to a low, low, low A (bottom note on the piano) I am neither a pip nor a squeak...;)
I also work for a living, so unlike most of your kind I do have to sometimes leave the blogosphere and earn that income to pay the taxes that give you the benefits you demand I provide for you. And I guess you're welcome for me paying your way...
What I find really ironic is that I'm the one taking the fiscally conservative position here.
No, you're not taking the fiscally conservative position here. The fiscally conservative position would be to let individuals direct their own costs and coverage, and use the free market and competition to keep prices down. Government intrusion and mandates have skewed that so that all plans from all insurance companies are pretty much the same. We don't have a free market for insurance; we have a fascist market with Government rules essentially mandating all policies to be equal.
You are advocating moving from a fascist position to a communist position. I see nothing Conservative in either position - I do see positions completely aligned with the Slavery Party twisted view of the world.
I'm saying that if you have a system covering a large number of people, cost is a relevant point.
Cost is always relevant. And it should be decided at the individual level. If I choose to buy a gold-standard policy, that is my right. If I choose to not buy insurance, I should bear the consequences - if any - that arise from that choice.
Apparently you and your fellow Slavers wish to eliminate these choices. And with them the ability of the individual and their doctor to decide the best means of treatment. You have decreed that "society" should determine what would be best for the individual, rather than the individual and those they CHOOSE to rely upon for services.
Basic health care means that if you don't have a need for the gold standard, there are certain preventative treatments and medication that can increase your quality of life.
Basic health care is not a right.
Should everyone that is diagnosed with prostate cancer get expensive proton treatment versus surgery? Definitely not. But should people get treated? Yes.
If they can acquire the means to any treatment desired, then the treatment should be available to them regardless of what the Government decides. I thought sanctity of the body and your right to deal with your body as you see fit was sacrosanct to you Slavers? Apparently not...
Why is it that you and other conservatives advocate against government provision of health care, but then apparently believe that it needs to be absolute top of the line care if it is?
Government should not be in the business of healthcare. Period. But if it IS going to be involved, then it should provide for as many options as the private sector provides, and it should charge the same rates and fees. Otherwise Government is circumventing the free market and actively working to destroy private enterprise.
The fundamental CONSERVATIVE position would be no Government healthcare, period. The relaxed socialist position would be Government providing equivalent services at equivalent costs to what one could get through the private market. Anything beyond that is either fascist or communist, neither of which should have any place in our society.
I don't really give a crap if you decide to buy into a plan that gives you better treatment, but for many people, any treatment may present an improvement.
Then how about you argue to get Government out of the regulation of what insurance companies MUST offer in all their plans? Why should I pay for mental services? Why should my insurance policy cover chiropractic and alternative medicines when I use neither? Why should my insurance policy cover reproductive costs when I have no need for them? I MUST accept these riders because the State of Washington has decided that it is for my own best interest I buy this coverage.
As a result I am being forced to buy that which I do not want, and my private provider is being forced by the Government to offer services they would not want to offer. The former is Communist (taking from me whether I want it or not); the latter is fascist (regulations of companies without regard to their own freedoms). So why should Government force either?
And you never did answer my question:
So how much is a human life worth to you? What is the price for a human life? And does that mean that if I can come up with that much money, I have the right to kill you, penalty free?
BA wrote:
Can you identify a handful of the free-market systems that are providing cost effective, reasonably priced health care that you say there are "plenty" off.
Any healthcare provisions before Government intrusion in the market in the 60s. As your parents and grandparents if they were all living in fear of getting just a hangnail and dying from bleeding to death, back in the 30s, 40s, and 50s.
Of course, you also PAID for those services directly to the doctor at the time of the service, and the doctor and you worked out the cost, payment schedule (if needed), and services offered and rendered. You know, that whole privacy and liberty thing.
And it still goes on today. A doctor set up a $79 per month plan for his clients and was sued by community organizers to stop. Apparently a doctor cannot decide to price and offer his services at a rate he chooses because it competes with the State in terms of offering low cost medicine.
How about letting doctors do what this doctor wanted to do - offer affordable, direct healthcare and payments to lower costs? How would you like to pay $79 per month for office visits and basic treatment? Then a small monthly payment to cover catastrophic coverage. You could have unlimited office visits and coverage for under $150-$160 per month.
But that's not allowed, because the Government said so...
Posted by: Shanghai Dan on April 18, 2009 10:16 AMhttp://en.wikipedia.org/wiki/History_of_United_States_Postal_Service_rates#Plot
Posted by: MikeBoyScout on April 18, 2009 10:20 AMEvery other industrialized nation has some form of national health care. While none of those systems is perfect, few people in any of those countries would vote to switch to our system. Are they all just stupid?
Apparently they are, because they're all moving to lower taxes and not spend trillions to get out of an economic slowdown, as opposed to your Obamassiah and the Slavery Party hacks in control who want to increase both taxes and spending...
Posted by: Shanghai Dan on April 18, 2009 10:21 AMCrusader, the right of the governed to control the government via democratic methods is a far more viable and historically proven approach to ensuring a better standard of living on the part of individuals than is dictatorship.
Problem is, we're not a democracy, and we have this thing called a "Constitution" which is supposed to limit just what the Government can do. And if the people want to change those limits, that same paper has a VERY specific means in doing so - via amendment.
Unfortunately, too many in these United States have forgotten this, and we live in a day when that document is essentially ignored because "the masses" demand it to be such, even if the masses are 51/49.
SouthernRoots, you question regarding government programs that cost less today than they did ten years ago is off topic, but i'll answer it. the USPS.
Now compare those costs against UPS, Fedex, and DHL. You'll find that if you compared the costs of services that both offer (private carriers are Federally prohibited from carrying mail), the private carriers do so at a lower cost and with more profit.
In fact, International mail is contracted by the USPS to UPS and Fedex because of the cost savings offered.
If a Government program cannot keep up with the cost savings of private industry, then the program should be cut. Period. It is a waste of resources to offer duplicative, higher priced options that also serve to skew and retard the growth of the free market.
Posted by: Shanghai Dan on April 18, 2009 10:33 AMyou bob and weave never addressing the serious flaws in your logic.
False. I've addressed every valid complaint raised against my arguments (and many more invalid ones).
You claim that the proposed legislation shall have negative affects on patient care
Quote me claiming that.
In regards to genetic fallacy, i drew no conclusions in my post.
You implied them, obviously. Don't be an ass.
The purpose of the bill and its authorization is to reduce cost ...
... by taking decisions away from doctors, even if the doctors strongly believe that their decisions are in the best medical interests of their patients.
I ... don't equate free elections with mob rule.
Our Founding Fathers equated the RESULT of an unfettered democracy with mob rule. This is why they crafted a Constitution that limited the government, so the majority could not enagage in tyranny over the minority. And this is the main reason why liberals like Justice Breyer do not believe in following the Constitution: they want the majority to force its will on the minority.
the right of the governed to control the government via democratic methods is a far more viable and historically proven approach to ensuring a better standard of living on the part of individuals than is dictatorship
Yes, as slavery proves. (Ooops!) Democracy is only viable when the majority is limited by being incapable of violating the rights of minorities.
Bruce:
Every other industrialized nation has some form of national health care. While none of those systems is perfect, few people in any of those countries would vote to switch to our system. Are they all just stupid?
I could not care less what other countries do. This is not a valid argument against anything I am talking about.
My apologies, this is obviously not a claim that the proposed legislation shall have negative affects on patient care.
So, it's a good thing, right?
bob & weave, bob & weave.
@Crusader, personal attacks are wrong? or only wrong when u ain't dishing them? don't answer. go find your meds. :-p
Posted by: MikeBoyScout on April 18, 2009 10:56 AMbob & weave, bob & weave.
Show me one point you've brought up that I have not directly responded to; else admit that you're just being an ass.
Posted by: pudge on April 18, 2009 11:04 AMI imagine you're looking at the summary of earlier testimony in the Senate Committee, which says the WSMA had not yet taken a position on the bill. But if you watch the later testimony before the House Committee (4/4, 9:00 AM), there's the WSMA lobbyist testifying at length on behalf of the bill. Apparently, the summary of the House testimony is not yet posted on-line.
I also discovered a letter supporting SB 5892 on the web page of something called the "Puget Sound Health Alliance." The group's membership list includes the likes of Boeing, Alaska Air, the Seattle Chamber of Commerce, along with other (public and private) employers, and a bunch of health care providers and organizations -- including drug companies. Appears the organization is all about health care quality, and their endorsement is pretty resounding.
Again pudge, you're a good thinker, but on this one I'll defer to the experts who pay for and provide the care. Their take on this is one I would have ascribed to you -- that government could be spending a whole lot less in providing needed and appropriate services.
Posted by: John on April 18, 2009 11:16 AMSad. Just sad.
Posted by: Bruce on April 18, 2009 11:18 AMShanghai Dan, you are very angry aren't you?
You're running a few days behind on your Marxist Slaver Talking Points. I'm a Right Wing Extremist because I believe in personal liberty, limited Government, and the right to self-determination. Heck, I even have an arsenal (being anything more than 1 firearm capable of holding more than 10 rounds of ammunition).
The Angry White Male talk went out back in 2006. It's now Right Wing Extremist. Still waiting to see what kind of arm band I'll have to wear...
Remember to take your medication?
None needed here, but - for now - that's between me and my doctor. After the Government pushes Nationalized health care through? It will be between you, your doctor, and a lifer Government employee who really doesn't care because they have a job forever - regardless of quality of performance - and they just have to push the paper through... Hope you like your personal "Tovarisch" deciding if you have enough economic viability to warrant better health care!
But at least I'm not stuck on stupid, there is no pharmacological solution for that, but I'd recommend you take a healthy dose of education: Milton Friedman's Capitalism and Freedom would be a good start. We can go from there.
Oh, and Mike? HOPE AND CHANGE! DISSENT IS PATRIOTIC!
Crusader,
Yeah, it's pretty common for the Slavery Party hacks. When shown to be vapid hulls or waste they retreat to vulgarities and invectives, hoping to change the subject.
Curious how Slavery Party Failed Abortion doesn't want to name the price he'd put on a human life (when that was a central argument of his), and how Mike simply cannot dispute the claims about the lower efficiencies and higher costs of Government as compared to the free market...
Deflect and attack, it's what the Left does.
Posted by: Shanghai Dan on April 18, 2009 11:22 AMPudge@116 admits, "I could not care less what other countries do." Sad. Just sad.
I'm waiting for you to rail against your Obamassiah, the Obama/Pelosi/Reid triumvirate and their insane approach to the economic slowdown via higher taxes and rampant deficit spending. Most other countries are doing exactly the opposite, including the socialist havens in Europe.
Oh, we're only to model and admire other countries when their actions support what you want? How does your position differ, fundamentally, from Pudge's then other than what you care about?
Bruce, you truly are a hypocrite...
Posted by: Shanghai Dan on April 18, 2009 11:32 AMYour rebuttal continued your rant, but offered us a little nugget on your ability to reason.
"In fact, International mail is contracted by the USPS to UPS and Fedex because of the cost savings offered."
Allergic to irony? :-D
Look, bad government or bad government programs need to be corrected.
SB 5892 is a PRIME example of that happening. (hat tip to John)
If governments are inherently bad, there's a real world example of life without government and government programs; Somalia.
and dan.... if you Ctrl F this thread for my posts, you'd see i have addressed the issue (Topic= WA SB 5892) on its merits repeatedly.
Yes, i've taken some LIBERTY and had some fun along the way, but hey, don't have a cow. :-)
ps. good luck with finding that arm band! :-p
Posted by: MikeBoyScout on April 18, 2009 11:45 AMShanghai Dan - for those people you can't put a price on human life. It's their morality.
Apparently only for their life. Slavery Party Failed Abortion wrote something indicating that $716,000 was too much to spend on someone, so apparently the cost of a human life is less than that.
He still hasn't defined what the price really is, and that it would be OK for me to pay that amount and kill him. Since that's the price of a human life, and he and his fellow Marxist Slavers are willing to make life and death decisions based upon that price, I do not see any problem with the offer to pay and make that decision for others myself.
Also, it would logically extend that if $716,000 is too much to spend on healthcare for someone, then we should also cap the benefits of any and all social payments or coverage to that same amount.
Went to 12 years of public school? You've already used up $130,000. Went to the UW? There's another $40,000 of your benefit. Ride the bus twice a day, 5 days a week? That's a $6 per trip subsidy, so you're down $3,100 per year or $$120,000 per 40 year career.
For your typical Marxist Slaver, we're already at $290,000 of your $716,000 allotment. Better not use too many other services or we'll end up cutting you off!
You know, I like this... Let's go ahead and play their game. Life only has so much value. When the Government costs required to support that life exceed $716,000 we will just terminate the life - so much more "fiscally conservative" that way, right?
At least that is according to Slavery Party Failed Abortion's twisted logic!
Posted by: Shanghai Dan on April 18, 2009 11:48 AMYou really do have context and reading issues, don't you? I never asked about off-topic spending or efficiencies. You answered another about the USPS being the low cost provider holding costs "flat".
It's ironic that the ONLY program you could think to try to use as justification actually has to rely on the private sector to keep those costs low. If it wasn't for the private sector doing its job, the increases would be even higher than they are relative to similar services offered by private industry.
That you cannot see the utter fail of your claim is not surprising. Marxist Slavers like you have no real concept of logic or reason. Emotion rules all. Such a sad existence...
HOPE AND CHANGE!
Posted by: Shanghai Dan on April 18, 2009 11:52 AMNo, and they won't be. Do you want the people from your insurance company there?
Dan@108 misrepresents, " A doctor set up a $79 per month plan for his clients and was sued by community organizers to stop. Apparently a doctor cannot decide to price and offer his services at a rate he chooses because it competes with the State in terms of offering low cost medicine."
Did you bother reading your own link? Your "because" clause is bogus. He was stopped because he was, in effect, providing health insurance. Perhaps the law should be changed to allow for fixed-fee practices like this, but there are good reasons for regulating the insurance industry. You may have noticed some of them in the newspaper during the past year.
Crusader@123 blathers, "Bruce - why is it sad to say that it's irrelevant what other countries do? I thought the whole idea was sovereignty, but not for America?"
You are confusing sovereignty (not being subject to the control of others) with ignorance (not being interested in learning from others).
Dan@126 wonders, "we're only to model and admire other countries when their actions support what you want?"
You obviously didn't understand (or chose to ignore) my point, which was that if the people of every other industrialized nation in the world have found national health care to work well over a period of decades, Pudge shouldn't say it's "stupid" to believe that Americans would support it.
Posted by: Bruce on April 18, 2009 11:55 AMMy apologies, this is obviously not a question regarding the cost effectiveness of government run programs.
Posted by: MikeBoyScout on April 18, 2009 11:57 AMNo one is advocating no Government; we are advocating small Government. Please see the Declaration of Independence and the Constitution.
The Government exists to promote the rights to Life, Liberty and the Pursuit of Happiness.
Too many Slavers want it to promote the right to Life for those they deem convenient, to ignore Liberty, and to guarantee Happiness regardless of the cost.
It's a fundamental difference. And the Slaver position is diametrically opposed to the foundations of these United States.
Oh, last thing about the USPS and the use of Fedex/UPS/DHL for International mail. You DO realize that the USPS is not only getting services for less than they could charge, they are actually being PAID to take those services? Via taxation, UPS, Fedex and DHL are actually PAYING the USPS whether USPS uses their services or not.
Now what's ironic?
Posted by: Shanghai Dan on April 18, 2009 11:58 AMon this one I'll defer to the experts who pay for and provide the care
I have already proven beyond reasonable doubt that this law will allow the state to go against the expressed will of doctors. That is what the bill actually says. Refusing to respond to my argument and instead saying "well the experts endorse it" is the genetic fallacy.
John, let me make something clear again: my main point is that this is a great reason to not let government control EVERYONE'S health care, which is what many in Olympia and elsewhere want to do (including our own insurance commissioner), and my comments should be understood in that context.
I know that if my family were under this -- and of course I won't provide details here -- I would be very worried, because there are in my family difficult-to-diagnose health problems that have required doctor-prescribed off-label drug use, including extraordinary dosages, that have proven to have some effectiveness, and without which our health care costs (not to mention pain and suffering) would have been drastically increased.
And there is no reason to believe that the state would not disapprove of, and disallow, these treatments, if we were under a state program. Further, there is no reason not to believe that if the state DID take control of everyone's health care, that they would not push the same sort of legislation.
So pardon me if I couldn't care less what statistics say, or what advocacy groups say: when it comes to individual situations, the averages do not apply.
You are confusing sovereignty (not being subject to the control of others) with ignorance (not being interested in learning from others).
You are confusing not being interested in learning from others with not being interested in following what others do, which was your direct implication that I was responding to. They have different populations, different economies, different needs, and different values.
Pudge shouldn't say it's "stupid" to believe that Americans would support it.
You should learn to read better, because I said no such thing. What I said is that it is stupid to presume that Americans will not give to charity if the government were to stop collecting and paying for charity on their behalf, given that the people had voted for the government to perform such charity.
If governments are inherently bad, there's a real world example of life without government and government programs; Somalia.
Governments are inherently bad. On this there is no question. Governments take away our liberty, and worse, give small numbers of people the power to take it away further.
Recognizing this fact does not mean we should therefore eliminate all of government. Baby and bathwater, after all.
The trick is to restrict the power of government such that the government is incapable of significant abuse of its power. The best way to do that is to literally disallow, through law and force if necessary, the government to go beyond certain spheres of responsibility.
The Constitution explicitly does this, which is why socialists, who prefer government power over all or most spheres of responsibility possible, have worked hard to ignore and deny the Constitution.
Fair enough. Appreciate the thoughtful response. But some things to consider:
- Unless you or your family members are paying for everything out of your own pocket, every "extraordinary dosage" with "some effectiveness" imposes a cost on someone else -- at a minimum on the rest of those in your particular insurance pool. This is true for anyone with insurance, whether it be public or private. Given that, do you really think anything and everything a particular doctor prescribes should just be paid for regardless of the evidence, or lack thereof, on its cost-effectiveness?? If you were paying out of pocket, would you agree to that?? Would you let others do that, and impose what you considered unreasonable costs on you? The question is not if a line is drawn, but where and by whom -- and in the end, it's likely to be drawn by the one paying the bill. Probably where we differ is that I don't dismiss out-of-hand the possibility that the line drawn by government could actually be appropriate -- or at least as appropriate as one drawn by a commercial insurance company.
- If I'm reading the latest version of this bill correctly, it imposes some extremely high evidentiary requirements on state health programs before a doctor's "dispense as written" authority can be overriden. Of the standards imposed, with which ones do you have a problem or do you think are unreasonable? Again, I assume you agree that "just pay for what the doctor says" is not an appropriate standard.
- The latest version of the bill also defines in some detail the circumstances under which off-label use can be restricted -- none of which seem particularly onerous. It also provides for exceptions to the policy -- which I'm betting are the same sort of exceptions that allow you and your family to get the drugs you need. Come to think of it, have you ever actually read your insurance company's policy on paying for off-label drug use? I'm guessing it's not far off from what the state is trying to do in this legislation.
Posted by: John on April 18, 2009 01:14 PMDo you think the doctor in NY would have a problem if he was charging $999 per month? How about accepting cash-only patients?
No, the problem - I guarantee it - was because it was a low cost program and that simply cannot exist because it's outside the control of the Government. The Government won't admit it, but what's the problem with people paying for a service? It's explicit in what it covers - much like buying a maintenance program for your car, or a health club membership.
No, this was completely about needing to keep the facade intact that healthcare is a "right" and can only be fully addressed by your Government masters.
You obviously didn't understand (or chose to ignore) my point, which was that if the people of every other industrialized nation in the world have found national health care to work well over a period of decades
No, I understood your point and extended it. If we're to consider the choices of others, and emulate their actions based upon their location being in Europe, then how about we do the same fiscally?
What's that? Only valid for healthcare, not fiscally? You pick and choose when to consider and emulate other nations? You're not in favor of cutting corporate taxes, and for cutting budgets rather than spending trillions of dollars?
Michelle wrote:
She was told by the 'wonderful' government-run dental folks that she would have to wait 6 MONTHS!
Good luck if you need hearing aids. It's a 3.5 YEAR wait to see a Government audiologist who will prescribe your hearing aids. If you need them adjusted/retuned? Yep, another 3.5 years before you're through the queue. Break or lose one? Another 3.5 years to wait, yet again.
Oh, the wonders of Socialized Medicine! When the perceived cost of a service is zero, guess what - people OVERUSE the service. Of course, we Conservatives understand that the cost is NOT zero; you are, in fact, paying a considerable amount for substandard service.
But the Slavers are all about perception and looks. After all, look at their Obamassiah, a man with a shiny veneer and utterly hollow inside...
Even the Chinese understand this. Medicine is NOT free as in Europe; there is a nominal charge for everything. Want to see a doctor at the hospital? Great, pay your 20 RMB examination fee first, then go see a doctor.
Doctor wants some lab tests run, like blood samples? Great, pay your 40 RMB lab fee, then go get the blood taken and tested.
Need some prescriptions? Great, pay the copay first, then get your pills.
It's cash first, even if its a small amount. Why? Because it's the best way to keep people from abusing the system. And it actually works... You can show up at the hospital, see a doctor, get a few lab tests, and leave with a treatment regimen in under 2 hours.
Try that in Europe, where the demands for free service simply swamp the system...
But that's OK, because we have HOPE AND CHANGE!
Posted by: Shanghai Dan on April 18, 2009 01:17 PMI'm not aware of any proposal to prohibit such treatment, nor to prohibit you from buying supplemental insurance on the free market to obtain such treatment, beyond whatever basic health insurance our society, as a whole, decides everyone should share the costs of. So what are you worried about?
- If your insured, access to all sorts of high-tech services and devices, and some very dedicated professionals that are often nothing short of miracle workers. But also lots of errors and inappropriate treatment; and lots of questions as to whether the "medicine" we pay for gives us the return on investment -- in terms of improved health -- that we think we're getting.
- If you're one of the 50 million or so uninsured (most not by choice), well good luck at the local community clinic or emergency room, or otherwise . . . well, just good luck.
Posted by: John on April 18, 2009 01:35 PMI'm not aware of any proposal to prohibit such treatment
This bill would give the government the power to prevent such treatment under its health programs. Would it? We don't know. Could it? Absolutely. Is it very likely someone in my situation will get their treatment denied? Of course.
nor to prohibit you from buying supplemental insurance on the free market to obtain such treatment
Yes, you are backing up my point: government health care will reduce quality or cost more.
So what are you worried about?
That it will reduce quality, or cost more. As I've said, and as you've conceded.
I understand in this state, arrangements like this are allowed. Subject to their own regulations to avoid consumer rip-offs, but nonetheless allowed, and some very successful.
Posted by: John on April 18, 2009 01:48 PMHospitals were invented by the Catholic Church during the middle ages. Healing comes from God. The government has no business dealing with it at all.
Posted by: ljm on April 18, 2009 02:00 PMTheory is great. Doesn't solve any problem until its applied.
Posted by: BA on April 18, 2009 02:17 PMUnless you or your family members are paying for everything out of your own pocket, every "extraordinary dosage" with "some effectiveness" imposes a cost on someone else
Then join me in opposing universal government health care.
do you really think anything and everything a particular doctor prescribes should just be paid for regardless of the evidence, or lack thereof, on its cost-effectiveness??
When it comes to my family, if I am convinced the doctor's choice is the best decision? Yes.
If you were paying out of pocket, would you agree to that??
If I am convinced the doctor's choice is the best decision? Yes.
Would you let others do that, and impose what you considered unreasonable costs on you?
I oppose universal government health care.
The question is not if a line is drawn
For my family, yes, that is the only question.
Probably where we differ is that I don't dismiss out-of-hand the possibility that the line drawn by government could actually be appropriate
No, I never implied anything against that position, in fact.
... or at least as appropriate as one drawn by a commercial insurance company.
Irrelevant.
If I'm reading the latest version of this bill correctly, it imposes some extremely high evidentiary requirements on state health programs before a doctor's "dispense as written" authority can be overriden.
You are not reading it correctly.
Of the standards imposed, with which ones do you have a problem or do you think are unreasonable?
First, there are no standards imposed, literally. There are procedural requirements, not standards. And what I think is unreasonable is that the doctor doesn't get to make the final decision.
The latest version of the bill also defines in some detail the circumstances under which off-label use can be restricted -- none of which seem particularly onerous.
There's only two circumstances listed: that there's another less expensive drug available to treat "the condition," and a drug review board says the limitation is appropriate. That's it. Oh, and the doctor gets to complain. Whoopee. The appropriateness of this lies in the liklihood that the drug review board will agree with my doctor's diagnosis and treatment.
It also provides for exceptions to the policy -- which I'm betting are the same sort of exceptions that allow you and your family to get the drugs you need.
No, in fact, there are no exceptions presented.
Come to think of it, have you ever actually read your insurance company's policy on paying for off-label drug use? I'm guessing it's not far off from what the state is trying to do in this legislation.
Again, what private companies do is irrelevant to anything I am saying.
SB 5892 is a measure to save costs in state-sponsored health care programs.
As the state does more and more to expand their control over healthcare, every statement they make about controlling costs should be investigated and challenged, because government has shown pitiful results in delivering quality with low costs. Look at our $9 billion defecit - how does it reflect anything close to cost containment or spending control? Why would anyone think they'll do it with these programs?
@105 SouthernRoots, you question regarding government programs that cost less today than they did ten years ago is off topic, but i'll answer it. the USPS.
Mailers Council Issues Statement on Postal Service Projected $6 Billion Deficit, 5-Day Delivery Proposal Oops, can't continue existing service without revenue increases (taxes) or service cuts.
130. SouthernRoots@105 asks rhetorically, "look at the people in Congress or in the legislature and ask yourself, "Do I want (fill in the blank) in the doctor's office with me helping me make my healthcare decisions?"
No, and they won't be. Do you want the people from your insurance company there?
Every time the medical provider makes a decision based on the requirements of the payer, that payer is "in the office" with the patient. As problematic as insurance companies could be, I think it would be even more of an issue if the ones dictating the care were government bureaucrats.
what pudge is saying is that what private companies do in reality, and what happens in other countries in reality, is irrelevant
To my argument, yes. I am talking about the pros and cons of specific proposals, not a comparison of those proposals to anything else.
What matters to pudge is that a nationwide health care plan ... would ... not cover every conceivable treatment ... leaving such treatments to the free market.
If you're going to force me into a plan, yes, you better damned well cover what I need covered, else you have no damned business forcing me into your plan (not that you have any right of any kind to do that anyway).
Idiot. I've learned to expect complete drivel from you, but you've certainly outdone yourself this time.
My argument is this: if you have limited resources available to a government program (which is becoming more limited), you need to prioritize care. With funding the way it is now, should the government pay for expensive treatments that, on average, have little effect? You can stuff whatever numbers you want into that thought exercise above, but the fact remains that money needs to go where it does the most good. You don't spend money on things that fall outside of basic care.
Of course, morons like you don't seem to realize that private insurance does the SAME exact thing. An insurance plan of $199/month isn't going to completely cover your costs if you need a heart bypass, for example, nor will it cover new treatments that haven't been approved or premium drugs. You or I can certainly pull out a big wad of cash from your bank account to cover those expenses, but if you're on the current need-based state insurance plan, you're not exactly going to have the resources available to cover that. So if the government is cutting back, then, and these folks can't just go out and drop a few hundred bucks on supplemental charges, what exactly do you propose? Giving half the people twice the care?
But apparently, I've entered this bizarro world where you're advocating both for small government and large government at the same time. I guess I need to come to expect this level of cognitive dissonance from conservatives nowadays...
And in terms of "lower efficiency" and "higher costs", where exactly are you getting those numbers? How do you know this? Is it because we're spending the most for healthcare, and getting better health outcomes only in some categories?
Posted by: demo kid on April 18, 2009 05:06 PMBy the way. I'll take GOV health care when I can get the same health care that Ted Kennedy gets.
Which won't happen.
"Then join me in opposing universal government health care."
OK, but I want to know what "it" is before I join you in opposing it, and "opposing universal government health care" is about as meaningless as saying "health care is a right."
I'd like an affordable system that provides the right care, at the right time, for anyone who wants it -- with a strong dose of incentives for people to take some personal responsibility for their own well-being. Show me a plan that gets us there, government, private sector, or some combination, and I'm for it; everything else I'm against.
That being said, your response is a non- sequitor. What I said holds true whether the bill is paid by government or a commercial insurance company.
"If I am convinced the doctor's choice is the best decision? Yes."
Now we're getting somewhere. At least you admit to drawing a line of some sort. So what's it take for you to be "convinced the doctor's choice is the best decision"? Does Medicine run in the family? A bit of time with Dr. Google? Perhaps "mini-med school" on the cable channel?
But by the way, why should the folks insured by your same company be forced to pay for poor medicine just because you're convinced it's the best decision? Oh I get it, it can't be poor medicine if you've decided it's not -- heck with anyone else, including the person who's paying the bill.
"I oppose universal government health care."
OK I get it, but so what? Whether covered by the government or private insurance, money paid for ineffective or harmful care eventually comes out of the pockets of policy-holders.
Or maybe it's this: you're OK pitching in for my friend's Iridology (based on the notion that each area of the body is represented by a corresponding area in the iris of the eye) if he pays for your off-label drugs, just as long as your each convinced your doctor's choice is the best decision? What if neither is trully effective (or even harmful) and covering it makes the premium unaffordable? Still sound good?
"You are not reading it correctly."
"First, there are no standards imposed, literally. There are procedural requirements, not standards. And what I think is unreasonable is that the doctor doesn't get to make the final decision."
So we disagree on what the bill says. Certainly makes it less likely we'll agree on its merits.
And hold it, but you just said that for you, the doctor only gets to make the final decision if you're convinced his choice is best. Sorry to doubt you again, but if others are helping foot the bill (as they do with all insurance, public or private), I bet they'd prefer to consider what's said by the experts and the evidence over your personal sense -- however wise you may think it -- of whether the doctor's choice is best.
"Again, what private companies do is irrelevant to anything I am saying."
Fortunately, your claiming it's irrelevant doesn't make it so.
We're already paying for it anyway. Why would you think that it would be BETTER to stick with a LESS efficient system?
Posted by: demo kid on April 18, 2009 06:48 PMThere is the rub.
All solutions come with problems, but sometimes we can get so lost in debating the merits or demerits of a particular system that we can lose sight of the overall issue. Sometimes we need to step back a reframe the issues and look at the give and take from a higher level.
Will this resolve ideological differences? Not usually, but it allows each to see more clearly the other side's view and minimize the invective.
As I said, health care is rationed. One can always spend more money - though with some level of diminishing returns. This is most evident with such things as terminal illnesses and quality of life issues for older folks.
One of the problems with an insurance based system is that the consumer is somewhat removed from the pricing considerations. It is even more of a problem when the consumer is not even involved in selecting the insurance program. It is exacerbated even further if there is some level of "right" or expectation to health care. Additionally, if there is an antagonistic relationship between the receiver of health care and either the provider or the payer, the consumer may drive up the cost of care by demanding treatment simply because he does not trust that his treatment is fair and appropriate. And don't even get me started on Law suits and their impact.
So, we start with the basic issue of how you make health care accessible to everyone without either driving up the costs beyond sustainability or reducing the quality or availability of care. With a centralized health care program you have the benefit of covering everyone, but you then run the risk of artificially affecting the market. Canada and the UK are good examples of how this kind of system can fail the people. In a effort to manage costs, shortages have adversely affected the quality of care. But without it, you have the problem of portions of the population without any coverage, usually the more vulnerable (though there are also the unscrupulous, cheap and lazy in this group as well.)
As has been debated during the SCHIP issue, as soon as you make something available to people at no cost, people will begin to take advantage of it even if they did not "need" it prior. In other words, people who can afford insurance might still opt for the free service to save money since "they paid for it anyway with their taxes."
There are probably three basic plans for providing health coverage for those unable or unwilling to purchase their own.
1. Universal health coverage where everyone is on a single payer system funded by our taxes. I need not go into the pros and cons of this, it is pretty well covered already.
2. A basic coverage (I think either John or Demo Kid might have alluded to something like this), where everyone has a basic form of universal coverage, funded by taxes, but also with the ability to purchase as little or as much supplemental coverage they want. This could either be government run or each person would simply be able to pick any insurance carrier they wanted that would then be compensated by the government based on enrollment - sort of a free market with a safety net. However, it creates other problems such as a 2-tiered system where the poor get substandard care while the rich get the best. Issues arise such as hip replacement, rotator cuff, maybe even heart and liver transplants. Will the basic system draw the line on these kids of procedures which effectively means that the poor will life less full lives or less long than more well off Americans?
3. Totally private system where the consumer makes all their own choices and buys whatever they want from whomever they choose. The poor and destitute would then be covered through charity. Don't think this can't be done. If Americans fully understood the need to fund a system for the truly poor, they would do it. Again, No need to discuss the merits of this program either.
The point is, with any program, there is limited resources available to fund all the care we might like. The question is, in what way to we handle those limitations. I dislike our current system because it leaves too many uncovered who are least able to handle a true medical emergency and who suffer from lack of preventative care. But unfortunately, due to human nature (or at least some humans), there are those, unless coerced in some way, would not take responsibility for paying for their own insurance needs, leaving the more responsible ones to foot the bill. However, is it any less unscrupulous to force people to pay for an unscrupulous person's health care than it is for the unscrupulous person to take advantage of the undeserved gift? It is very hard to distinguish between the needy and the unscrupulous, and that has not changed nor will it ever change. We only debate now at where we draw the lines.
I think I lost my main thrust through all this meandering, so I'll just end it here and see what the Mariner's might be up to.
Posted by: Eyago on April 18, 2009 06:49 PMI'd add (as I did above) that the current system approaches coverage for the poor in a slapdash way, and we get stuck with the costs one way or another. Better to make the system more efficient than to remove all support for the poor and expect overstretched churches and charities to pick up ALL the slack.
At least you admit to drawing a line of some sort.
Only one that was obviously implied from the beginning.
So what's it take for you to be "convinced the doctor's choice is the best decision"?
Epistemology is way outside the scope of this discussion.
why should the folks insured by your same company be forced to pay for poor medicine just because you're convinced it's the best decision?
They aren't, of course.
"I oppose universal government health care." OK I get it, but so what?
That's the main point of my post. If you don't care that I oppose universal health care, fine, then don't respond. No skin off my nose.
So we disagree on what the bill says.
No, you're wrong about what the bill says. Feel free to quote what "standards" you believe are in the bill. I read it. They aren't in there.
I bet they'd prefer to consider what's said by the experts and the evidence
We call that "the doctor."
Fortunately, your claiming it's irrelevant doesn't make it so.
Shrug. Prove otherwise.
Sure, the system is broken, but it can be fixed if the lazy-ass politicians put some effort into brokering fixing the system instead of taking the easy way out for them. That will take cooperation by insurance companies which could be had if Congress reaches out, instead of instituting Government controls for those who don't have health care. It should not be mandatory that everyone has to have it - this is a Free Country for God sakes !
Posted by: KS on April 18, 2009 10:07 PMNo matter how you set it up, there will be health care rationing.
False. This is only true if GOVERNMENT pays for the health care. There's seldom "rationing" in a free market.
Totally private system where the consumer makes all their own choices and buys whatever they want from whomever they choose. The poor and destitute would then be covered through charity. Don't think this can't be done. If Americans fully understood the need to fund a system for the truly poor, they would do it.
You're not making sense. You're saying that you want Americans to do it, while at the same time asserting Americans won't do it. Unless you're saying that the American government should do it without the consent of the American people ... ?
I dislike our current system because it leaves too many uncovered ...
"Covered" is almost completely beside the point. Why does anyone care about "covered"? Only one reason, of course: because of the astronomical costs involved, especially as increased in recent years. And as you have noted, costs have gone up largely because of the system itself.
Health insurance coverage does not matter nearly as much as reducing the cost of providing health care; and until that happens, health insurance coverage will get harder and harder to get. And if we go to a government-paid system, it will only end up bankrupting us all.
But unfortunately, due to human nature (or at least some humans), there are those, unless coerced in some way, would not take responsibility for paying for their own insurance needs, leaving the more responsible ones to foot the bill.
Or not.
Standard - something considered by an authority or by general consent as a basis of comparison; an approved model.
Ref: http://dictionary.reference.com/browse/standard
SB 5892
(1)(a) Except as provided in subsection (2) of this section, any pharmacist filling a prescription under a state purchased health care
program as defined in RCW 41.05.011(2) shall substitute, where identified, a preferred drug for any nonpreferred drug in a given therapeutic class, UNLESS the endorsing practitioner has indicated on the prescription that the nonpreferred drug MUST be dispensed AS WRITTEN, ...
(2)(a) A state purchased health care program MAY impose LIMITED restrictions on an endorsing practitioner's authority to write a prescription to dispense as written ONLY under the following
circumstances:
.....
Ref: http://apps.leg.wa.gov/documents/billdocs/2009-10/Pdf/Bills/Senate%20Bills/5892-S.E.pdf
still bobbing & weaving i see. :-)
Posted by: MikeBoyScout on April 18, 2009 10:38 PMThere is a fundamental difference you're missing; with a private health care system, the limit of care I receive is directly MY responsibility.
With a Government run system, the limit of the care I receive is in the hands of an unelected Government worker.
Do you not see the difference? After all, you were willing to put a limit of $716,000 on the value of a human life, what if your case worker decides you are only worth $200,000?
Fundamentally, you believe Government can make better decisions about your life. The conservative position (which you attempt to cloak yourself in) is the exact opposite; YOU can make the best decisions about your life.
I don't expect you to understand that...
Posted by: Shanghai Dan on April 18, 2009 11:25 PMI know Cuba's great health care system created Fidel the Spanish tourist a while back.
See if it really was just about the money we would value everyone's right to choose their medical care but that is only left to abortionists. Plying women with the word choose in the moment they need compassion and they get death stuck right inside of them.
After what I have seen in the last 3 months I am so done with discussions with those carrying the heart of darkness.
Hell comes from your lips and keyboards; a dull thud of angry bitter talk laced with the 'truth of helping the poor'.
You don't care about them it is the body count you want. Your selfish jealously born of your bitterness born of your laziness enslaves you and trys to get us all.
And yours are not? Doubtful.
The government has problems enough doing that with the military. You don't appear to consider the costs, just the hearsay from the politicians.
And you don't appear to consider the costs either. You're so fixated on this idea that universal health care will lead to mass hysteria, dogs and cats living with each other, etc. that you don't even seem to realize what it means in practice.
Sure, the system is broken, but it can be fixed if the lazy-ass politicians put some effort into brokering fixing the system instead of taking the easy way out for them.
Which is exactly what we're proposing. It isn't easy to defy the health insurance lobby.
That will take cooperation by insurance companies which could be had if Congress reaches out, instead of instituting Government controls for those who don't have health care.
"Reaches out"? I'm eager to hear how you think they can "reach out".
It should not be mandatory that everyone has to have it - this is a Free Country for God sakes !
Why shouldn't it BE mandatory that everyone has some level of health insurance available? We're not talking about a car or a laptop or whatever... we're talking about a basic level of care that people need to live and survive. And as I've mentioned above, we're already paying for it anyway, directly and indirectly.
But hey, if we're arguing that health insurance shouldn't be mandatory, then why have, say, fire protection for everyone? I mean, if I want to pay, highly-trained and well-equipped firefighters should be available at my beck and call, but if I can't, why should I get fire protection at all?
@162: False. This is only true if GOVERNMENT pays for the health care. There's seldom "rationing" in a free market.
Economics FAIL. Supply and demand are a method of rationing in the free market. It doesn't mean that supply and demand leads to the best outcomes, though.
And if we go to a government-paid system, it will only end up bankrupting us all.
If everyone demands the *absolute* top service from the government, then yes, it will bankrupt us all. Case in point as to why cost-cutting measures like the one you discussed here is essential. If you want a basic level of care, you should be able to get it regardless of your ability to pay. If you want platinum-level services, then you or your employer should have to pay for them.
Posted by: demo kid on April 19, 2009 01:04 AMHonestly, I don't know why I bother with you, since you're just an absurd, vile little man that doesn't seem to grasp elementary concepts even when they are explained in plain English.
But hey, I'll try again! (Maybe I should talk slower? Would you understand?) The point of the original post was that the state-run healthcare system for the poor, which is suffering from both cutbacks AND increased demand, needs to contain costs in whatever ways possible. If their goal is to try to provide services to as many people as possible, prioritizing care and pushing for generic drugs when appropriate is a perfectly reasonable approach. Pudge claimed that this is not responsible because of the potential for negative effects from generics, which seems like a fallacious argument to try to attack universal health care as a whole, but that pretty much looks nothing like this.
Now, in terms of what randomness you're spewing, I don't give a crap WHAT you do. Go off and sleep in a hyperbaric chamber for all I care. The limit of care you receive is still your responsibility, and you can do whatever you want with that. With a government-sponsored or subsidized system, the folks that otherwise would get squat would instead be able to get basic care. They wouldn't necessarily be able to sleep in a hyperbaric chamber like you, but they would be able to get tests, medication for chronic conditions, preventative care, and so forth.
And again, you're already paying for this anyway, through Medicare, higher hospital bills, and so forth. EMTALA essentially forces "socialized medicine" as an unfunded mandate on emergency departments in hospitals. There is a societal cost associated with all those folks that need to put on charity events to take care of insanely high medical bills, too, not to mention the costs of folks in the US dying of preventable diseases.
So this has NOTHING to do with "making better decisions about your life". This has to do with giving everyone the opportunity to live theirs.
Posted by: demo kid on April 19, 2009 01:07 AMGovernment Run Health care plans are a sure fire failure. They have never been proven a success and never have been shown to be a 'final solution'.
Wow... I can't believe we went this long without a right-wingnut bringing up the Nazis.
Hawaii shut theirs down in 7 months.
Universal health care for CHILDREN was shut down by a Republican governor because of state budget shortfalls and because the rates were so low and requirements were written such that everyone was signing up for this basic plan. Let me reiterate: I'm not arguing for a program that gives everything away for free to everyone... I'm arguing for basic, affordable, universal coverage.
If one chooses to buy medical care and coverage what in the sam hill is it your business??
I don't give a crap WHAT you do. You can join the ChiCom Traitor in his hyperbaric chamber if you like.
The angry libs rebutting here are using the poor as clubs to assault us all. Any solution that is not of their faith is evil, mean, clearly cruel!!!
And any solution that is not of your "faith" is obviously the same way to you.
Tragically I have listened to brow beaten cowered Canadians justify horrific medical outcomes based on the 'cheap rates' they pay for insurance.
And tragically, Canadians have been listening for years to stories about Americans being denied coverage or bankrupted over medical problems that would have been easily covered in the Canadian system.
You are nothing short of enslavers.
And you are nothing short of an idiot.
I'll make a deal and come in and take care of all your actions we all pay for as well such as gambling, drug use, porno, false schooling, laziness, lying, misrepresentation, abortion, selfishness, arrogance, lust, prostitution and we'll just go Taliban the other way.
Sounds like a party full o' Republicans. Maybe you can go take care of them first?
I know Cuba's great health care system created Fidel the Spanish tourist a while back.
Again, I don't give a crap about rich people or world leaders. But if we're going to play this game, shouldn't the rise of medical tourism by middle-class Americans show that our system is failing miserably and should be fixed?
And say what you want about the Cuban system, but they're actually doing a few things right. Consider that they needed to rebuild their ENTIRE medical system -- most doctors left when the Communists took over, which decimated their medical services. Building up from nothing to the point where the Cuban government has been using medical care in the Third World as a potent political tool for decades... well... that's something to be respected. I don't agree with the Castro regime, but I can respect places where they have succeeded.
See if it really was just about the money we would value everyone's right to choose their medical care but that is only left to abortionists. Plying women with the word choose in the moment they need compassion and they get death stuck right inside of them.
Blah, blah, blah. That old canard of the right never gets tired, does it? Fail to make a point, just bring up abortion!
After what I have seen in the last 3 months I am so done with discussions with those carrying the heart of darkness.
Joseph Conrad is a good author. Don't sell folks short just because they like to read him.
Hell comes from your lips and keyboards; a dull thud of angry bitter talk laced with the 'truth of helping the poor'.
Yes! Heaven is simply letting the poor suffer, right?
You don't care about them it is the body count you want. Your selfish jealously born of your bitterness born of your laziness enslaves you and trys to get us all.
So my laziness begat my bitterness begat my selfish jealousy? Nah. Don't confuse the inability to deal with the crap the wingnut right shovels out with "bitterness" or "jealously".
And I'm struggling to figure out which body count you mean. Are you talking about the body count from all those uninsured folks that might have had some chance at getting proper medical care?
Posted by: demo kid on April 19, 2009 01:33 AMNothing but personal attacks... How typically Marxist of you!
You talk about the costs of the current system covering everyone, and you want to work to somehow change that.
Here's the FUNDAMENTAL DIFFERENCE between the conservative and Marxist approaches that you keep forgetting (and I will use small words so you can follow):
HEALTH CARE IS NOT A RIGHT
OK, did you read that? Can you understand that? Each and every word is just one syllable!
The fundamental point is that, regardless of your Marxist wet dream, health care is NOT a right. Never has been, and never will be (unless we change the Constitution).
You are trying to contain costs of something that should not even exist! How to control such costs? Your approach is to ration, to tax more, to force more people on to plans to spread the costs, etc.
You're missing the obvious, simple, legal, and logical answer: ELIMINATE THE PLAN. Yes, that actually works. It contains the cost really well.
I'm sure you're going to say it's heartless, it's cruel, it's terrible! How can you do that? Two things:
1. HEALTH CARE IS NOT A RIGHT. There is no Constitutional mandate for it, at the Federal or State levels.
2. Only by using the power of DIRECT expenditures can you limit overuse of the system.
Fundamentally, what breaks down insurance plans - large, small, public, private - is overuse. Having many more people use insurance than the plan ever anticipated. That draws down your reserves and the plan runs out of funds, meaning it either closes, or it has to increase premiums.
In the case of a public insurance plan, that means increase taxes is the only option; politicians, typically being the money and power grubbing folks that most of them are, will not cut the plan, so they increase taxation.
How do you limit overuse? You charge DIRECTLY. Co-pays work really well to limit overuse. Nothing is free - you're always paying when you use services, and you are paying at the time of service.
Guess what? It may take a few years, but people will start to realize you don't go to the hospital for every ache and pain you wake up with! You wake up with a sore wrist? Hey, maybe you just slept wrong, see how it feels tomorrow. No need to go to the doctor and get an MRI.
And you want that MRI? OK, but it'll cost ya. You get to pay for those extra tests.
Suddenly you won't have that crush for demand of services.
I've been on more than a few medical teams to countries like Haiti, Laos, Burundi, Malawi. Even when on a team donating all the time and money for everything, you still charged a minimal amount. Yes, even to people who were literally dirt poor. Because it limited overuse of the system, and it increased the value of the treatment rendered, meaning it was better paid attention to.
But I expect that this will all go in one eye and out the other because you can't comprehend the fundamental fact:
HEALTH CARE IS NOT A RIGHT
Oh, and I found something amazingly profound in another post of yours - really!
Building up from nothing to the point where the Cuban government has been using medical care in the Third World as a potent political tool for decades...
And you think that our Government won't end up using Government-run health care as a political tool to support it's cause-de-jour?
Health care in Cuba is highly politicized, and if you fall out of favor with the Government good luck getting your treatment if you need it! Paperwork is misplaced, prescriptions aren't filled, doctors are booked up for months longer than anyone else...
Yes, in Cuba health care is a political tool - it's a carrot to keep most of the masses in line, and a stick to punish those who raise their own voices.
And you want to give our Governments this same power?
Now I know you're truly mad...
Posted by: Shanghai Dan on April 19, 2009 06:49 AMThe northwest's largest health insurance provider, Regence BlueShield announced dramatic restrictions to its reimbursement policy for prescription drugs prescribed by DOCTORS.
http://www.regence.com/docs/WA/medicare2009/waRxCompFormulary.pdf
It says "This means you will need to get approval from us before you fill your prescriptions".
The document further states that coverage may be limited to GENERIC drugs as they become available!
Not only does this policy have the negative immediate effect of reducing the potential quality of care for most Washingtonians (except those covered by the state government), but it should serve as a warning to all of us, as many people want government to subsidize our health care, and we are seeing proof that the private health insurance industry is quite willing to sacrifice our care for money.
Regence BlueShield could not be reached for comment, but the front page of their website clearly shows that the company is part of the SOCIALIST conspiracy "A health insurance company doesn't cover health care bills. A community does."
Pudge, I can't believe you said that. Economics is the science of scarcity, so by definition there is rationing. It's only a question of how much rationing occurs, and at what prices. But don't pretend that in a "free market" that goods are unlimited. You really opened yourself up for attack there. Unforced error.
Posted by: Crusader on April 19, 2009 06:57 AMOr is reading a 2 page bill beyond your level of reading comprehension (and thus an a priori case against public education)?
And, of course, we can thank the bobbing & weaving Pudge for never taking the time to figure that out before he posted his screed. THANKS PUDGE!
Posted by: MikeBoyScout on April 19, 2009 07:11 AMthanks for making that point. It is how I meant in it 158.
Posted by: eyago on April 19, 2009 07:22 AMbeen done. http://www.pebb.hca.wa.gov/
now what?
Posted by: MikeBoyScout on April 19, 2009 07:23 AMMan, the irony is astounding, given that all you can speak in is ad hominem attack.
The fundamental point is that, regardless of your Marxist wet dream, health care is NOT a right. Never has been, and never will be (unless we change the Constitution).
Did I say it was a right? No. What I'm saying is that the federal government can support State-level health programs.
You are trying to contain costs of something that should not even exist! How to control such costs? Your approach is to ration, to tax more, to force more people on to plans to spread the costs, etc.
No, my argument is that these systems are already in place due to a number of programs and laws and regulations that are unlikely to be changed, but that they are ineffective, costly, and in need of more reform than simple deregulation and prayer.
1. HEALTH CARE IS NOT A RIGHT. There is no Constitutional mandate for it, at the Federal or State levels.
I'm not saying it's a right, any more than having a standing army or air force or postal service or interstate highway system is a "right". Don't confuse "rights" with "functions".
2. Only by using the power of DIRECT expenditures can you limit overuse of the system.
Exactly! Don't confuse "universal" with "we'll send an ambulance for you so we can give you aspirin at the hospital". I'm not advocating for a free system at all.
Fundamentally, what breaks down insurance plans - large, small, public, private - is overuse. Having many more people use insurance than the plan ever anticipated. That draws down your reserves and the plan runs out of funds, meaning it either closes, or it has to increase premiums.
And what you're proposing IS rationing. If premiums increase, folks that can't pay will get kicked off and receive nothing under your approach. You're criticizing public insurance for rationing when ALL insurance rations health care through higher prices and lower quality.
In the case of a public insurance plan, that means increase taxes is the only option; politicians, typically being the money and power grubbing folks that most of them are, will not cut the plan, so they increase taxation.
Alright... this is where you just start blabbering. The SUBJECT OF THIS POST is cost-control measures by the state. You've argued that the cost of a human life is incalculable, but now you're arguing that increasing taxation to fund healthcare is the result of "money grubbing politicians"?
So let's see. You've said that $714,000 is well-worth the cost of saving ONE human life. If you could save, say, a thousand people under a state insurance plan with $714 million, would you advocate increasing tax revenues by that much?
I'm glad you support higher taxes to save lives.
Co-pays work really well to limit overuse. Nothing is free - you're always paying when you use services, and you are paying at the time of service.
Again, did I say that there wouldn't be a copayment? Nope. In fact, even in countries with real "socialized medicine", you need to make a copayment.
It may take a few years, but people will start to realize you don't go to the hospital for every ache and pain you wake up with! You wake up with a sore wrist? Hey, maybe you just slept wrong, see how it feels tomorrow. No need to go to the doctor and get an MRI.
Again, I didn't argue anything of the kind. In fact, I completely agree! But how is this relevant? Do you actually think that Canadian or British emergency rooms are filled with whiny people that woke up with sore wrists? (Or, more precisely, that private insurance costs aren't run up by Americans that DO go to the emergency room for these things?)
I've been on more than a few medical teams to countries like Haiti, Laos, Burundi, Malawi. Even when on a team donating all the time and money for everything, you still charged a minimal amount. Yes, even to people who were literally dirt poor. Because it limited overuse of the system, and it increased the value of the treatment rendered, meaning it was better paid attention to.
Good on you for that. That's a great thing to do.
But again, you're making the wrong argument. I have actually been in the medical system in not one but two countries with "socialized" medicine, and I had to make copayments both times. I'm not advocating for completely free care. You don't have your facts straight.
And you think that our Government won't end up using Government-run health care as a political tool to support it's cause-de-jour?
There's always a risk, one way or the other. Still, that's a false argument, since there are plenty of other government services that you would view as "critical" but would fall under the same category. It's like saying that we shouldn't have an army because we may not like what the other party might do with it when they're in power, or because military contracts may be politicized.
Yes, in Cuba health care is a political tool - it's a carrot to keep most of the masses in line, and a stick to punish those who raise their own voices.
Again, you don't seem to actually read or understand my words. I DON'T agree with the Castro regime in the slightest, and I tend to agree with that statement. However, when you consider the lack of resources in the country, having ANY medical system at all is amazing. Having a system that trains doctors from around the world? That really is a feat. You don't need to AGREE with what goes on in a country (or even with its motivations) to point out these things.
Posted by: demo kid on April 19, 2009 09:08 AM"Well then it's not a good model for what is being proposed." Who is proposing what???
Posted by: MikeBoyScout on April 19, 2009 09:21 AMThe problem is that in both our current managed care system, and in a government managed system, the consumer is removed from the point of purchase. This removes the personal shopping decisions about price, value, quality, vendor, etc. that we all make every day on all manner of items, but not on our own healthcare. It might be that in some cases, the generic drug is even better, and it might be that it's worse. In a system where the healthcare consumer gets to shop around a bit, and determine the level of quality, service, etc. the price of goods necessarily falls, and there is much better competition amongst providers. Doc-In-The-Box clinics will spring up to handle the minor cuts and scrapes for cash prices. Much lower cost MRI and CAT scanners would be available without the artificial boundaries placed around them by managed care, etc.
And the best part about including the patient in his own healthcare purchase decisions, is that then he becomes more incentivized to lower his costs through better maintenance of his own health.
Greater reduction in patient/provider input, or having the government arbitrarily make decisions in a much slower and more monolithic way, will remove the pace of information and choice that would drive a more affordable system for all.
Instead what will happen is there will end up being two systems. One for the haves, and one for the have-nots. The private for-fee system will be of excellent quality, short wait times, and health will be the primary directive. The public or quasi public system will have long lines, lower quality and the primary directive will be a continual reduction in cost to justify the ever growing voracious input of tax dollars needed to prop it up. And ironically, "the poor" who buy in to the "free healthcare" scam as sold by almost all Democrats and some Republicans, will be the ones hurt the most.
Posted by: Jeff B. on April 19, 2009 09:25 AM"It might be that in some cases, the generic drug is even better, and it might be that it's worse"
What on earth are you talking about?
How can the label on a bottle make a therapy better or worse?
A generic drug is the EXACT same drug!!!
please think b4 speaking.
Posted by: MikeBoyScout on April 19, 2009 09:33 AMPrice signals are important, yes, and they should be incorporated in any system like this. But the way that they work in the current system favors emergency, acute care over preventative care, and keeps folks that may not have the ability to pay from getting basic care.
Likewise, health insurance negotiates with providers, drug companies, etc. as a bloc. The idea of "shopping around" for a good rate is fine in theory, but it doesn't match how the market really operates right now.
But hey, if you can get a health insurance company to operate in this way, go for it.
Greater reduction in patient/provider input, or having the government arbitrarily make decisions in a much slower and more monolithic way, will remove the pace of information and choice that would drive a more affordable system for all.
Apparently, you haven't met the bureaucracy of private health insurance. I'm at a loss as to how government inefficiency and ineptitude can be roundly criticized, but private inefficiency and ineptitude gets a free pass.
Instead what will happen is there will end up being two systems. One for the haves, and one for the have-nots.
Sounds familiar... because it's the system we have RIGHT NOW.
The private for-fee system will be of excellent quality, short wait times, and health will be the primary directive. The public or quasi public system will have long lines, lower quality and the primary directive will be a continual reduction in cost to justify the ever growing voracious input of tax dollars needed to prop it up.
As opposed to the voracious input of dollars funneled in from private insurance needed to prop up the system?
A two-tiered system is always going to have it's flaws. There's no doubt about that. However, is that preferable to a "one-tier" system, either with complete government control over ALL health care, or with folks that are not in the tier at all?
And ironically, "the poor" who buy in to the "free healthcare" scam as sold by almost all Democrats and some Republicans, will be the ones hurt the most.
The poor are the poor... they'll probably get shafted in some way regardless of which path we choose. What you haven't shown here is how this would be WORSE.
Posted by: demo kid on April 19, 2009 09:44 AMAnd moreover, it's not that simple in that some drugs are the product of millions of man hours of recent research. By allowing a generic drug to be chosen over the name brand drug, the drug company who did the research is not compensated for all of that research. Do you also agree that we should allow the Chinese to open up local DVD stores where ripped off Hollywood titles are sold for $1 each?
"Do you also agree that we should allow the Chinese to open up local DVD stores where ripped off Hollywood titles are sold for $1 each?"
TOO FUNNY!!! :-D
A generic drug is identical, or bioequivalent to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
Go read up, and get back to us
http://www.fda.gov/cder/ogd/#Introduction
The example is myself. I work for myself, so I don't have an employer mandated choice. This has allowed me to purchase a much lower cost plan, with a high deductible for disastrous health issues, while allowing me to pay for lower cost procedures out of pocket. If I take good care of myself, and I do, then my total out of pocket cost over the course of the year is much less than what I would have paid on a more comprehensive plan.
Many people who are healthy would fit this plan, and might choose this plan if it were an option, and I am not defending managed care by any means. I'm simply pointing out that increasing choice, and personal accountability will lower the costs.
There's no way that either government or managed care can make these individual and personal decisions properly and expediently. We should be exploring every way to remove managed care from the equation, and also remove government care from the equation. A system of checks and balances would be much better as in accounting. Government should provide a framework within which individual choice and much more granular patient provider pricing could be agreed upon and understood upfront by all. But neither government nor managed care insurance can do the adequate job of making the personal decisions that would allow for a much more vigorous and open exchange of healthcare services that we see in most other markets in our lives. And simultaneously encourage people to make better choices so as to lower their costs.
Every time that critical buyer/ seller relationshop becomes more abstracted by layers of public or private bureacracy, the price goes up, the quality goes down, and both patients and providers become frustrated by their inability to meet at a mutually agreeable service relationship.
More and more people are completely unaware of the costs of healthcare and instead view it as a "cloud" service that is simply handed down to them from some authority. That's a recipe for the perfect storm of low personal accountability, high cost, confusion and frustration. We are seeing the outcomes of various different approaches both here, and in Canada and Britain, and neither is desirable.
Passing a blanket law for drug prescriptions is an example of the one-size fits all/ removed consumer choice behavior that is the opposite of the direction we need to go. And if the same thing had occured within managed care, there would be outrage from different quarters. Either way, the patients and doctors are screwed and not allowed to participate in the actual organic and highly personal process of healthcare.
And, a large percentage of healthcare budget then goes in to the mundane such as funding abortions and other outpatient procedures that are cheap enough that they should be almost entirely funded by individuals.
But that's why I don't smoke, eat oatmeal, workout almost daily, get good sleep, brush and floss, etc. I am going to control as much of my own healthcare as possible because if I leave it up to insurance companies or state government, I would be as good as dead.
Unfortunately, the victim policies in this Blue state encourage most people to make their healthcare someone else's problem. And then feel entitled to the highest levels of service, top notch drugs, instant gratification, etc. when they wake up one day and require extensive healthcare.
It's exactly like our credit problems. By nurturing and allowing a culture devoid of personal responsibility, we create costly hydras that no one, even large government, can control.
Enjoy the nice temps.
Posted by: Jeff B. on April 19, 2009 10:16 AM"Passing a blanket law for drug prescriptions is an example of the one-size fits all/ removed consumer choice behavior that is the opposite of the direction we need to go. And if the same thing had occured within managed care, there would be outrage from different quarters."
You don't like to read???
go read my post at 170.
Outraged? No? Cuz it is a non issue.
Posted by: MikeBoyScout on April 19, 2009 10:25 AMhttp://www.levoxyl.com/patients/1.0_why.asp
the issue is with CHANGING from one levothyroxine sodium therapy to another. Neither the manufacturers site nor the FDA identify issues with starting and continuing on a generic levothyroxine sodium therapy.
SB 5892 accounts for refills and specifically authorizes dispense as written except under specific circumstances.
Posted by: MikeBoyScout on April 19, 2009 10:36 AMYou don't get it - you're arguing about a plan that simply SHOULD NOT EXIST. Government should not be in the insurance business at all.
HEALTHCARE IS NOT A RIGHT.
HEALTHCARE IS NOT A REQUIRED FUNCTION OF GOVERNMENT.
You're argument makes as much sense as talking about whether you'd rather be hit with a 2 pound sledgehammer or a 2 pound framing hammer. The answer is neither - DON'T GET HIT!
Posted by: Shanghai Dan on April 19, 2009 10:44 AMStill can't get those meds? ;-)
What you obviously don't get is that in WA state the government DOES administer health plans. SB 5892 is an attempt to reduce the cost of those plans by modifying them to be consistent with how PRIVATE plans are administered regarding prescription coverage so that TAXPAYERS save money.
You are free to argue and fight for removing the governments of WA and USA from health care for whatever reason you like, but you are pissing up a rope.
Posted by: MikeBoyScout on April 19, 2009 10:52 AMhave a good day all. get out and enjoy the spring weather!
Posted by: MikeBoyScout on April 19, 2009 11:01 AMGood on you! Did anyone say that is a BAD thing?
Unfortunately, the victim policies in this Blue state encourage most people to make their healthcare someone else's problem. And then feel entitled to the highest levels of service, top notch drugs, instant gratification, etc. when they wake up one day and require extensive healthcare.
I feel like I'm in the middle of a farce. The SUBJECT of this post was about reasonable cost-cutting of state insurance programs. How is THAT "the highest levels of service"? No one here is arguing that state-sponsored healthcare should be the platinum plan.
Likewise, for every "victim" you identify, there are folks that actually need support. I'm much more willing to put my need to punish the "unworthy" aside to make sure that everyone has access to a BASIC level of care.
It's exactly like our credit problems. By nurturing and allowing a culture devoid of personal responsibility, we create costly hydras that no one, even large government, can control.
You can't legislate personal responsibility, as much as you want to try. I don't think that you're wrong in that many things should be up to one's own self, but we're talking about BASIC care here, the type that many people need to survive. How is making sure that folks don't die from preventable causes a "costly hydra"?
Posted by: demo kid on April 19, 2009 11:20 AMYou can't legislate personal responsibility, as much as you want to try. I don't think that you're wrong in that many things should be up to one's own self, but we're talking about BASIC care here, the type that many people need to survive. How is making sure that folks don't die from preventable causes a "costly hydra"? ~Demo_kid
The people I know that are without healthcare insurance are people that opted out of the health plan offered. They said "I can't afford that out of my paycheck", I tell them you can't afford not to have that option available, but stupid is as stupid does.
You can't legislate common sense, and some people are just too friggin' stupid to use simple logic in their choices in life. I have no sympathy for an idiot that has been offered basic healthcare to them, only to have them decline it because it's an extra 25+ dollars in their paycheck. Cry me a river.
Posted by: Rick D. on April 19, 2009 11:39 AMI do care if they decide to traipse into an emergency room when they're having a heart attack. As much as you'd like to think otherwise, these folks aren't going to be left to die by the side of the road... but we're still stuck with the bill.
@194: Show us where the money is going to come from for the same deal State employee get right now, given that a large percanetage of the population will not be working and contributing to sustain the system.
I personally didn't say that it would be the equivalent to the coverage a state employee would get. But what exactly do you mean "a large percentage of the population will not be working and contributing to sustain the system"? The baseline would be covered for everyone, and anything beyond that would be individual responsibility. Everyone would pay in, everyone would get something out if needed.
As a Government single payer system you will still have to ration healthcare, how are you going to force medical professions to accept the level of pay you will be able to offer?
No proposals presented would be a "single-payer" system. No one is suggesting that we could replicate Canada's system at all.
Posted by: demo kid on April 19, 2009 02:13 PM@196: For those of you so concerned about keeping the costs down on the State's health plan, would you be willing to drop people who ate unhealthy food (say, 5+ meals a week at a fast food joint), or who smoked 2+ packs a day? That would cut costs pretty dramatically, and mimics what the UK is doing with their plan...
Again, you're asking the wrong questions here.
If a fellow (let's call him, say, Macau Don) smokes five packs a day, eats grease from a can, never exercises, and is extremely overweight, his health care costs are going to be higher, right? Any private health care plan won't make money with him on it.
If Macau Don can afford medical costs out-of-pocket, then hurray! Cheeseburgers for everyone! If Don can't, but he's on a health plan, then more than likely than not his health care is being subsidized by someone with a healthier lifestyle. He's essentially increasing the premiums of other members on the plan, especially if the health insurance company doesn't make allowances for his lifestyle. He's a leech.
Now if, for some reason, big ol' Macau Don is uninsured and penniless, and he has a heart attack and is taken to the hospital, who pays the cost? Either the government or the hospital will eat the costs, one way or the other.
Again, and I'll say it until you get it... universal coverage is NOT socialized medicine or a single-payer system. We will NEVER have a system like the Canadian or British systems. Basic levels of care should be covered for everyone, but if Macau Don decides to have a third heart attack after eating at Fatburger, it should be his responsibility to cover the additional costs. Heck, we have a piecemeal system already anyway... better to make it more efficient and plug the gaps than run our system into the ground.
Posted by: demo kid on April 19, 2009 06:13 PMYour choice is to take the Senator Murray plan or the Senator Cantwell plan. The difference is the color of your card and the name of the plan...
But back to the question, you propose rationing basic healthcare by the State depending upon actions.
Does that mean we should restrict insurance payouts for those who ride motorcycles?
Posted by: Shanghai Dan on April 19, 2009 06:25 PMdemorat kid wrote:
"I'm not saying it's a right, any more than having a standing army or air force or postal service or interstate highway system is a "right". Don't confuse "rights" with "functions".
Oh, I see - you are saying down is up and up is down. The doublespeak is so typical of you and your ilk - YAWN...
If people do not want health care, it should not be mandatory - its the freedom of every individual if they want it or not. Anything beyond that to make it mandatory is a waste of resources and an insult to our intelligence. That was all I was saying back in #161.
Posted by: KS on April 19, 2009 06:32 PM
demo kid:
Economics FAIL. Supply and demand are a method of rationing in the free market.
Not in this context, which is an authority saying what you can and cannot have access to. A VERY different kind of rationing.
Mike:
Do you have any idea that SB 5892 attempts to reduce the cost to TAXPAYING citizens
In a way that provably threatens the health of the people under the state health programs. (As per usual, I won't respond to the tu quoque fallacy about what some private programs do; I am not defending existing programs, and it's obviously true that just because they do it doesn't mean it's acceptable for a state program.)
And, of course, we can thank the bobbing & weaving Pudge for never taking the time to figure that out before he posted his screed.
You said nothing in this comment that I didn't say in my original post, modulo the addition of your fallacy about private programs. I said up front it was to cut costs.
A generic drug is the EXACT same drug!!!
Aha, maybe this is why you don't get all this: you're wrong. Generics are often NOT the same thing at all. What's the generic of vicodin? Hydrocodone. Except it's not the same thing, even though many plans will swap the latter for the former: vicodin includes acetaminophen. (A friend of mine, in fact, was given the latter even though his dentist prescribed the former ... even though they are obviously not the same thing.)
And even if they include the exact same ingredients in the exact same amount, the manufacturing processes can differ enough to affect the final product, not to mention, as Jeff B. said, the differences in delivery mechanisms. One brand might use normal pills, one might use capsules, etc.
You're simply wrong. "please think b4 speaking."
(And this is moot anyway, because this bill allows swapping out not just generic "equivalents" (which often are not the same thing) for name brands, but also completely different drugs in the same CLASS of drugs.)
SB 5892 accounts for refills and specifically authorizes dispense as written except under specific circumstances.
And those "exceptions" are the point here. If they weren't, then there would be no cost savings in this bill at all.
Vicodin seems to be rather freely substituted by generics - so at least doctors, pharmacists, other health care professionals and insurance companies seem to think the generics are similar enough.
Returning to the original post - if I'm getting a "deal" where I'm not paying the full freight for my health care, as is the case of those folks on a state plan - why should I expect, and why should taxpayers pay, for absolute top of the line care?
This "deal" is giving me more than I can afford, and likely what I'm getting is better than the vast majority of health care that others receive on this planet.
So far the alternative seems to be 1. leave the sole decision-making authority up to the professionals that have no reason to be careful with costs (and every reason to spend more), or 2. can the program and throw these people off the state plan where the private sector can pick them up.
I'm fine with 2., but I suspect that the private sector doesn't have a product for many of these folks. So, instead I get to pay their medical costs anyway when they show up for charity care at emergency rooms.
I think it's great to be pure in philosophy and principle.
My church, and I'm sure many others do spend our dollars helping folks with medical care. I just don't think we have the resources ourselves to carry all of the rest of you.
What's the solution that points most folks toward private care at some level they can afford and really be available in the market place?
Posted by: BA on April 19, 2009 07:52 PMFWIW, in this case, the substitution was made against the dentist's wishes and the pharmacist did not inform the patient that acetaminophen was needed too.
Returning to the original post - if I'm getting a "deal" where I'm not paying the full freight for my health care, as is the case of those folks on a state plan ...
The original post is noting that this behavior by our government is a good reason not to trust them with a completely govt-run system.
My church, and I'm sure many others do spend our dollars helping folks with medical care. I just don't think we have the resources ourselves to carry all of the rest of you.
Yes, we do. Where else do you think the state gets its money? I'm not being fatuous here.
Not sure what you mean by your last comment. I was speaking about my church specifically, not society in general. The "state" doesn't get our money at all...as it works its way toward helping folks that don't otherwise have the resources to stay healthy.
Posted by: BA on April 19, 2009 10:05 PMHe did, but this is beside the point. I was only responding to Mike's comment that generics are exactly the same. They're not. (And again, this bill does not merely make equivalent or near-equivalent substitutions anyway, but also makes complete drug substitutions.)
Not sure what you mean by your last comment. I was speaking about my church specifically, not society in general.
OK. You wrote, "My church, and I'm sure many others do spend our dollars helping folks with medical care. I just don't think we have the resources ourselves to carry all of the rest of you."
I took "we" to refer to all of "my church, and I'm sure many others." Regardless, if I did not take it that way, I would have still made the same point: it is a fact that collectively, we can do it without government, if we can do it with government. (This is not a statement about everything, but specifically about "charity.")
Even amongst mundane over the counter drugs such as pseudo-ephedrine, these days the technology is all in the delivery. Some vendors have developed elaborate time release mechanisms. While active ingredient percentages may be the same as the generic version, the time release delivery is much more sophisticated to manufacture and can have a much better result for the end user who gets the drug meted out over the course of twelve hours, etc.
More and more, delivery is becoming part of the package of technology that makes the better drug.
Posted by: Jeff B. on April 19, 2009 10:50 PMRights are anything you can get away with despite what you do to others.
Constitutional rights are the rights guaranteed by the Constitution and the ones most likely to be infringed upon by the government.
The last two sets of rights are the scariest, because with these classes of rights apparently comes the requirement that governments must pay for these rights, all the citizen need do is draw upon the treasury.
Actually, if you're into governemnt control, it's kinda cool - the more money you have to spend to cover these rights, the more money you need to collect, infringing on the other rights. The more money you collect, the more power and control you have over the population. What could be cooler?
Posted by: SouthernRoots on April 20, 2009 06:18 AMSB 5892
Please read the bill.
Please understand the intent of the bill.
If you think the intent of the bill is the thin wedge to a SOCIALIST takeover, well.... good luck with that.
Generic Drugs
This is a specific term. It is not the same as generic potato chips.
The FDA defines the term and regulates use of the term.
(A generic drug is identical, or bioequivalent to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.
REF: http://www.fda.gov/cder/ogd/#Introduction)
Physicians prescribe and are responsible to know which drug and its delivery system to use. Physicians routinely use 'dispense as written' and are liable to know when to use it.
SB 5892 defines standards when dispense as written can be overridden or the authority suspended.
Key Point: If you are not covered under a State of WA plan, this bill has ZERO impact on your health care, and only impacts you as a taxpaying resident of WA - to reduce the government's cost.
best of luck!
No one is talking about the INTENT of the bill, but what it actually DOES. Intent is irrelevant. What matters is what the bill DOES.
And once again, you are wrong about "generic." READ THE BILL YOURSELF. It DOES NOT SAY "bioequivalent generic," it says "therapeutic alternative generic." That phrase "therapeutic alternative" refers not to the ingredients of the drug, but the treatment it is used for. So you can be given a prescription for acetaminophen for a headache, and be given ibuprofen. That is what the bill actually says, for both generics and OTCs: "therapeutic alternative."
You are using "generic" in a completely different way than the explicit language of this bill is.
And once again, SB 5892 gives the state extremely broad authority to override "dispense as written": literally whenever the state wants to. All the state has to do is say, "we don't like that you prescribe this drug for this problem, we prefer this other one," and that's it. End of story. Oh sure, the doctor can complain, but the state is under no obligation to change its mind. If you don't conform, they force you to conform.
Raise your hand if you want your doctor to conform instead of doing what he thinks is best for you and your family.
And while this does not affect the health care of those of us not under a state program, many of the people in and out of Olympia want to put ALL of us under a state program. And this bill is a great reason not to allow this to happen.
We're all going to die!
But not before the creeping SOCIALISTS get us all to worship Karl Marx at the Dr.'s office.
LOL :-D
Good luck with all that!
The Washington State Pharmacy Association (WSPA) and the Washington State Medical Association (WSMA) don't know nearly as much as you do.
That's both a straw man fallacy and a genetic fallacy.
If you can argue against my actual points, please feel free to do so. That you do not even ATTEMPT to do so speaks volumes.
There is a reason that NYC is full of boutique hospitals catering to the rich. They're filled with Canadians and Britons that are wealthy enough to fly here for the world's best care.
Posted by: blindman on April 20, 2009 09:12 PMREF: http://en.wikipedia.org/wiki/Medical_tourism
"A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of ten over the next decade. An estimated
750,000 AMERICANS WENT ABROAD FOR HEALTH CARE in 2007,
and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue."
REF: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/08/03/BUGA121GPF.DTL&type=health
"...patient dissatisfaction with high costs, long waits in the doctor's office or to get a procedure, and reports about errors and quality problems in U.S. health facilities as fueling both trends."
Posted by: MikeBoyScout on April 21, 2009 09:58 AMI can see that. But it still doesn't change the fact that rich citizens of countries with government run healthcare still fly here for treatment.
The reason our costs are so high is due to government regulation (insurance coverage mandates) and the HMO system that is propped up by government.
It is illegal to form co-op healthcare bargaining units. You can only get healthcare through your employer or on your own. Imagine if anybody could form a health insurance co-op to do group buys of health insurance from providers.
The other problem is that our 3rd party payment system has broken the economics of healthcare. Because the purchaser never directly buys from the seller, there is no downward pressure on prices. Instead there is every incentive for a provider to bill as high and as much as they can from the insurance companies.
I know that my dentist offers a 50% discount if I pay in cash. I have a suspicion that after the 50% discount, the total is the fair market cost of the procedure. When my dentist bills an insurance company, he's adding a 100% markup.
If the government really wanted to fix healthcare, they could start by repealing all of the insurance coverage mandates and give dollar for dollar tax write-offs for every dollar a person spends on healthcare. That would drive most people to self-insure with HSA's and cheap, high deductible, catastrophic coverage.
I know that for me, the catastrophic coverage has a $2,000 deductible and costs me $20/month. If I divert $100/month of my pretax earnings into an HSA, not only am I reducing my AGI, but I'm self insuring for way cheaper than individual family plans cost.
Ultimately the problem is that the government thinks they can fix the problem by taking it over and lazy voters are inclined to let them do so. The government *never* fixes problems, they just shift the burden around.
Mark my words...a government run healthcare system will be no better than the existing VA hospital system. There will be no more financial incentives for doctors to specialize and be the best in their field. Fixing costs will make all doctors like teachers...some of the most import, vastly underpaid members of society. We all know what has happened with teachers...quality problems abound.
Posted by: blindman on April 21, 2009 11:17 AMWhy do you only use the VA as an example when talking about government run health systems?
There are many. For example, the Washington State Public Employee Benefit Board (apropos to SB 5892); the US Armed Forces medical system, and the grand daddy of them all Medicare, to name a few.
The VA is in bad shape. The Bush Republican plan was to increase funding. The Democrat's answer to the problem is to increase funding.
What is the alternative approach?