"Wes" wrote in message
...
"Ed Huntress" wrote:
Each state runs its own Medicaid. State governments in general are
incompetent to do much more than name the official state bird. James
Madison
had it right: the more local the government, the less competent it is
likely
to be.
I'm a big fan of state sovereignty so we will just have to disagree on
that.
And there are so many fine examples for you to point to, like California,
Louisianna, Illinois, New York, Michigan, New Jersey, etc., etc. d8-)
Those sound like democrat controlled states. Take my governor, I hear she
is hot. Just
take her away, please. 
She has to be an idiot to take that job in the first place, so you can keep
her.
Regarding the Democratically controlled states: hey, somebody has to pay the
bills for those red states that get more federal money than they pay out in
taxes. g Alaska is the real welfare queen. Besides getting almost $2 back
for every dollar they're taxed, that great free-market governor of theirs
rigged things so they skim enough off of the oil companies to send a nice,
fat, $4,000 welfare check to every crackpot and rug rat in the state. Of
course, we pay for all of it.
Half the state governments in the country have a chance of becoming the
subjects of comic books.
Better half the state governments rather than all of the USA at the
federal level.
The trouble with it is that the private insurers will try to co-opt
it,
through lobbying, so that it becomes the sinkhole for people with
pre-existing conditions. Then costs will go up, and the private
insurers
can
go back to printing money.
Ed, I hope you realize there are a lot of people that really think the
public option is
going to be affordable as in 100 to 200 bucks a month. That isn't
going
to happen.
I don't know who those people are, Wes. For some people with *very* low
incomes, it may well come out to a cost like that -- as will subsidized
private insurance.
As you know since I mention it often, I catch all three hours of C-Span
Washington
Journal. The call in portions of the program is where I'm hearing it.
If you want, see if I can find anything serious. It may all just be wild
speculation; as I said, I haven't paid much attention. I don't listen to
call-ins of any kind. They depress me.
Now that you mention it. A lot of callers to C-Span are depressing. This
is offset by
some real gems of reason that get through. That was non-sarcastic.
It's like a friend of mine, an expert on classical music, says about country
music: There are a lot of talented people in that business and no doubt
there are some gems among the swarf, but you'll go deaf and blind waiting
for it to show up. Most callers to talk radio and TV make me wonder how they
made it through high school. They make me fear for the republic.
I'd still like to see a rate schedule for the public option, the
particulars of what is
covered, co pays, and all that messy stuff that ruins the dream.
Wes
Have you looked for one? There have been some projections. I haven't
paid
much attention to them myself.
My ear radar is on alert, I've never heard anything. My googlefu hasn't
turned up
anything solid either.
I'm more interested in putting an end to the
unpaid emergency room care; getting a grip on pharmaceutical costs
(which
isn't really in the bill, but which it will enable); and putting the AMA
on
the spot to start doing something about health care costs. Right now
that's
in the hands of the private insurance companies, and they've failed at
it,
utterly. That's not because they're stupid or evil. It's because they
have
no incentive to do so. In fact, their incentive is quite the opposite.
How do you deal with unpaid emergency care? That appears to be a factor
in the overall
cost of insurance since in the end, someone has to pay.
You make sure it isn't unpaid. First, you try to reduce it with a
universal
system that, one hopes, will lead to more early detection.
Okay, you are saying not using the E room as the place of last resort. I
wonder just how
much real care the unfortunate get there. Do they often get admitted to
the hospital for
real care?
I don't know how they're treated. I've never asked.
For example, once Gunner had his stents a few years back, he should have
been on a regular stress-test schedule that could have detected his
impending second heart attack. They may not have had to saw him open. Then
he may not have had a stroke.
Gunner needs to quit smoking. I don't care to speak about my specific
heart issues but I
know for a fact that if I still smoked, I'd be dead now. Do you smoke was
the only thing
my doctor wanted an answer to. I asked why do you ask and he said because
if you do and
don't quit, it isn't worth my time treating you. How is that for blunt?
I don't make a habit of slagging Gunner since I like him and think he is a
good guy when
not playing a bit of Walter Mitty on Usenet but he needs to make a change
in his life.
Point is, more medical testing isn't going to take care of the core
problems. We are part
of our treatment. As a diabetic you know you have to do you part. I know
I have to do my
part for my issues. Gunner needs to drop the cigs and start living right.
That's true, but you also have to be able to test and measure where you are,
and you need an expert to put it all together. I'm full of surprises, for
example. g Many people are.
Perhaps the extra testing might have convinced him. I don't think I
recall him mentioning
stopping smoking yet. I'd think the first encounter would have had him
flying right but
it didn't.
This is all statistical/actuarial stuff. The numbers are out there, in the
professional medical literature.
Once you have a rational, universal system going, you fold the remaining
emergency-room care into the total insured community. It already is,
actually, except that we pay it now in the form of taxes and substantially
higher hospital bills.
This is something that bothers me. We pass a law telling a business that
you will serve
bad credit risks, those that cannot pay, and you spread the losses to
other customers.
Do you think that would fly if the business was say a auto company instead
of a medical
center? How about a bank?
This isn't about peoples' retirement funds, Wes. It's life and death. In a
civilized society, you don't treat it like a business, and you don't ignore
people who are dying, whether it's their own fault or not. That's for
savages.
Now on pharmaceutical costs, I don't think we should have to pay a dime
more than any
other western country. One world price for the developed nations unless
a
case can be
made for extra costs for litigation or testing by country. Discounts to
third world
countries, I'm willing to pay for.
I've heard that in the case of other countries, they have laws under the
WTO agreements
that if a deal on pricing can't be cut, they can make the drug inhouse
reguardless of US
patents.
http://www.wto.org/english/tratop_E/...a_ato186_e.htm
Go half way down. Closest thing I can find at the moment.
Yeah. TRIPS. It's a very fluid thing. There's a lengthy discussion about
it
in a recent book that I just read, _Bad Samaritans_. The US is trying to
ram
it down the world's throat, with mixed success. You may be interested that
Canada didn't recognize foreign drug patents until the '90s. I think it
was
about the same for Switzerland -- 1988, IIRC. So it isn't a third-world
thing.
Thank you for validating that.
That's true for the US, too, BTW. We invoked it a few years ago by
breaking
a European patent (Sanofi? I forget who held the patent.) on an antidote
for
anthrax. Our military is using it now, but we made millions of doses for
the
general population after the anthrax letter scare.
Given the concern at the time, that sounds rational. I wonder if we cut a
deal after the
fact? Considering how much wealth we have expended defending Europe, I
don't really feel
too bad if we nicked something.
The idea of patents was to encourage innovation, not to enrich people who
make discoveries. Our original patent and copyright laws granted exclusivity
for 14 years. Now copyrights are for the life of the author plus 75 years;
90 years for corporate authors. I'm not sure what it is for pharma patents
now but I think it's 28 years. Then there is a little trick they use to
double that, which is producing a "new" drug which is just the metabolytes
of the original one.
It's a farce. It's also evidence of the power of lobbies.
It's complicated. The European Union produced a report a few years ago,
slamming the countries of Europe for putting price controls on drugs,
producing all kinds of tables and numbers showing that the US had grabbed
most of the world's pharma research because this is where they make their
money. They showed the jobs and tax revenues that were generated from it,
and it showed that the US came out ahead. In fact, I had one of those
jobs,
so I'm not entirely skeptical.
I have not doubt it is complicated. Pharma and the Military are two
things I truly think
the EU takes us for a ride on.
But I'm wary of it. It's one of those macroeconomic views of a
microeconomic
situation, which don't show all of the mal-distribution of costs
throughout
a society. My gut feeling is that we'd be better off with price controls
on
drugs, just like every other developed country has done. But I'm sure that
the European report was as least partly correct, that we'd lose most of
the
industry if we did so. They'd move to India and to the Third World,
because
drugs can be made anywhere.
You mean like a fair chunk of US non-drug manufacturing?
A much higher percentage. It would take a while, because the expertise is
here now. But it would go away.
We'd get the same result if we could re-import US-made drugs from other
countries. Once you do that, the drug companies have no incentive to keep
their HQ's and production facilities in the US. None.
You can only re-import US drugs if enough drugs are exported. You think
pharma is going
to ramp up exports to cut their throat? That isn't going to happen.
They're in a tough spot. We've already seen that with Canada, a few years
ago, when seniors started taking their bus tours to buy drugs.
If they tighten up exports too much, foreign countries will just break the
patents and start producing those drugs on their own. And our legislators
know what will happen if they allow re-importation. That's why such a
popular idea has not taken root.
I wish I could give you cites but last night while I was listening to
Cspan-1, I heard
that most medical centers have a year over year expectation of a 7%
annual
increase in
returns.
You'd need to see a full analysis of that. The raw figure doesn't mean
much.
Like that is going to happen.
Once the system is somewhat rationalized, with universal care and some
tools
that let us grab medical care and insurance by the balls, it will be a
matter of how intelligently we use those powers. That's a big "if." But
right now, it's running out of control, with no incentives for anyone to
control costs. As David Brooks put it, it's a system of "perverse
incentives."
I can agree that there are a lot of forces in action. Now will both
sides
agree to
eliminate the perverse parts?
Absolutely not. The conservatives will not accept the fact that the
essential problem with health care in the US is multiple market failures
that are inherently unfixable. They'll keep trying to jimmy the rules to
make a real market out of it. On this one, I agree with the Democrats:
there
is no way that anyone knows of to make a real market out of the health
care
business. You can squeeze the balloon but the air keeps moving to another
end.
If one is discovered, I'd be all for it. But I don't believe that such a
thing exists.
Health care went down hill when it went from being a calling (religious
sense) to being a
business.
Some things just don't fit the business model. We used to know that, but we
forgot.
--
Ed Huntress