"Ed Huntress" wrote:

I discussed this with colleague in UK and he told me that there are
regional panels, some will allow drugs that others will not.

Do you want to put your life in the hands of government bureaucrats?

How do you think it's handled by insurance companies in the US now? No
smoke-blowing. I was a medical editor who wrote for the health care
insurance industry.

The only difference is that the insurance companies don't respond to
petitions. They respond to their stock price.

Do you really think changing masters given the forces of economics will have a
dramatically different result?

Wes
--
"Additionally as a security officer, I carry a gun to protect
government officials but my life isn't worth protecting at home
in their eyes." Dick Anthony Heller

"Wes" wrote in message
...
"Ed Huntress" wrote:

I discussed this with colleague in UK and he told me that there are
regional panels, some will allow drugs that others will not.

Do you want to put your life in the hands of government bureaucrats?

How do you think it's handled by insurance companies in the US now? No
smoke-blowing. I was a medical editor who wrote for the health care
insurance industry.

The only difference is that the insurance companies don't respond to
petitions. They respond to their stock price.

Do you really think changing masters given the forces of economics will
have a
dramatically different result?

Wes

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.

And that's my point. We do it now. We have to do it now. If costs keep going
up (which is in the insurance companies' interest, BTW), we'll have to do
more of it in the future.

--
Ed Huntress

"William Wixon" wrote in message
...

"Ed Huntress" wrote in message
...

-snip-


i saw something, i think it was pbs, just today, was about the flu,
doctors saying they can't use tamiflu on everyone because there's not
enough, they only use it for people most at risk (seems like rationing
to me). they were also saying if there was a virulent outbreak of flu
there wouldn't be enough respirators in the united states for everyone
and some people are gonna die because there just won't be enough
respirators. who gets to decide who's gonna get the available
respirators? there won't be any obama "death panels", yet, so who's
going to decide? insurance companies?

b.w.

That's who does it now. Doctors fight them all the time. Sometimes they
win. On the average, they lose.

From the discussions here I gather that not many people have run into
multiple life-threatening, expensive medical issues. I'm used to it, both
personally and because I was involved with it when I was doing medical
writing and editing.

I'm surprised at many of the questions and statements. Guys, they've been
rationing care for decades. It got going in a big way when HMOs came in.
It's the whole business of "Managed Care." For reference, I was the
Senior Medical Editor for Publicis Managed Care, a communications company
that served Big Pharma and that wrote to the managed care insurers.

Managed care is a euphemism for rationed care. That's what most of us
have now, whether it's through company PPOs or HMOs, or through
fee-for-service insurance. It's all the same in terms of insurance
companies dictating what procedures doctors and hospitals will be
compensated for. Doctors are involved in a constant struggle with those
insurers, submitting special appeals, getting on the phone with them, and
so on. That's life in the medical world today.

I can hardly believe anyone would bring up "rationing" as an issue today.
We're living in it. We have been for a long time.

--
Ed Huntress



well, so, i'm guessing insurance companies would say, if it was a kid, or
a working age adult, "give him the respirator", if it was a old person
they'd say "he doesn't get it". does anyone have an idea of who'd get a
respirator and who wouldn't? i'm guessing kids first, seniors last?

That would most likely be up to the doctors and their hospitals, and the
decisions would be made by a hospital ethics committee. The stock of
respirators probably is a budget issue for hospitals, and wouldn't be
something with which the insurance companies would get involved.

But it's another form of rationing. The hospitals, too, have to make
judgments about where to invest their money, based on actuarial analyses of
risks. It's another example that we already live in a rationed-care
environment.

i'm saying, now, not after obama's death panels start making decisions but
during this reign of the insurance companies. if there was a 1918 style
flu outbreak, who'd get the respirators first? wondering if race and
gender figure into it too.

b.w.

Check with a hospital. It's either them, or state oversight boards, who make
those decisions. Insurance companies are more likely to nix the use of an
expensive procedure or medication, where the question of benefits comes into
play.

That's the basic set of questions involved in all rationing.

--
Ed Huntress

"Ed Huntress" wrote in message
...

"Wes" wrote in message
...
"Ed Huntress" wrote:

I discussed this with colleague in UK and he told me that there are
regional panels, some will allow drugs that others will not.

Do you want to put your life in the hands of government bureaucrats?

How do you think it's handled by insurance companies in the US now? No
smoke-blowing. I was a medical editor who wrote for the health care
insurance industry.

The only difference is that the insurance companies don't respond to
petitions. They respond to their stock price.

Do you really think changing masters given the forces of economics will
have a
dramatically different result?

Wes

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.

And that's my point. We do it now. We have to do it now. If costs keep
going up (which is in the insurance companies' interest, BTW), we'll have
to do more of it in the future.

--
Ed Huntress


i saw something, i think it was pbs, just today, was about the flu, doctors
saying they can't use tamiflu on everyone because there's not enough, they
only use it for people most at risk (seems like rationing to me). they were
also saying if there was a virulent outbreak of flu there wouldn't be enough
respirators in the united states for everyone and some people are gonna die
because there just won't be enough respirators. who gets to decide who's
gonna get the available respirators? there won't be any obama "death
panels", yet, so who's going to decide? insurance companies?

b.w.

That's who does it now. Doctors fight them all the time. Sometimes they win.
On the average, they lose.

From the discussions here I gather that not many people have run into
multiple life-threatening, expensive medical issues. I'm used to it, both
personally and because I was involved with it when I was doing medical
writing and editing.

I'm surprised at many of the questions and statements. Guys, they've been
rationing care for decades. It got going in a big way when HMOs came in.
It's the whole business of "Managed Care." For reference, I was the Senior
Medical Editor for Publicis Managed Care, a communications company that
served Big Pharma and that wrote to the managed care insurers.

Managed care is a euphemism for rationed care. That's what most of us have
now, whether it's through company PPOs or HMOs, or through fee-for-service
insurance. It's all the same in terms of insurance companies dictating what
procedures doctors and hospitals will be compensated for. Doctors are
involved in a constant struggle with those insurers, submitting special
appeals, getting on the phone with them, and so on. That's life in the
medical world today.

I can hardly believe anyone would bring up "rationing" as an issue today.
We're living in it. We have been for a long time.


Which is why I would like to see ALL health insurance programs
eliminated. Go to paying cash for ALL services. Would level the field
REALLY quick.
I don't think that the Feds have ANY legal reason to get involved. I
cannot find anything in the Constitution that says the government is a
health care provider??
--
Steve W.

"Ed Huntress" wrote in message
...

-snip-


i saw something, i think it was pbs, just today, was about the flu,
doctors saying they can't use tamiflu on everyone because there's not
enough, they only use it for people most at risk (seems like rationing to
me). they were also saying if there was a virulent outbreak of flu there
wouldn't be enough respirators in the united states for everyone and some
people are gonna die because there just won't be enough respirators. who
gets to decide who's gonna get the available respirators? there won't be
any obama "death panels", yet, so who's going to decide? insurance
companies?

b.w.

That's who does it now. Doctors fight them all the time. Sometimes they
win. On the average, they lose.

From the discussions here I gather that not many people have run into
multiple life-threatening, expensive medical issues. I'm used to it, both
personally and because I was involved with it when I was doing medical
writing and editing.

I'm surprised at many of the questions and statements. Guys, they've been
rationing care for decades. It got going in a big way when HMOs came in.
It's the whole business of "Managed Care." For reference, I was the Senior
Medical Editor for Publicis Managed Care, a communications company that
served Big Pharma and that wrote to the managed care insurers.

Managed care is a euphemism for rationed care. That's what most of us have
now, whether it's through company PPOs or HMOs, or through fee-for-service
insurance. It's all the same in terms of insurance companies dictating
what procedures doctors and hospitals will be compensated for. Doctors are
involved in a constant struggle with those insurers, submitting special
appeals, getting on the phone with them, and so on. That's life in the
medical world today.

I can hardly believe anyone would bring up "rationing" as an issue today.
We're living in it. We have been for a long time.

--
Ed Huntress



well, so, i'm guessing insurance companies would say, if it was a kid, or a
working age adult, "give him the respirator", if it was a old person they'd
say "he doesn't get it". does anyone have an idea of who'd get a respirator
and who wouldn't? i'm guessing kids first, seniors last? i'm saying, now,
not after obama's death panels start making decisions but during this reign
of the insurance companies. if there was a 1918 style flu outbreak, who'd
get the respirators first? wondering if race and gender figure into it too.

b.w.

On Sat, 19 Dec 2009 19:40:36 -0500, "Steve W." wrote:





Which is why I would like to see ALL health insurance programs
eliminated. Go to paying cash for ALL services. Would level the field
REALLY quick.
I don't think that the Feds have ANY legal reason to get involved. I
cannot find anything in the Constitution that says the government is a
health care provider??

So what! There's nothing in your constitution mentioning automobiles,
antibiotics or atomic bombs either. Don't try to use your constitution as an
excuse to remain 70 years behind the rest of the civilized world unless you do
it consistently.


Mark Rand
RTFM

On Sun, 20 Dec 2009 09:03:39 +0000, Mark Rand
wrote:

On Sat, 19 Dec 2009 19:40:36 -0500, "Steve W." wrote:





Which is why I would like to see ALL health insurance programs
eliminated. Go to paying cash for ALL services. Would level the field
REALLY quick.
I don't think that the Feds have ANY legal reason to get involved. I
cannot find anything in the Constitution that says the government is a
health care provider??

So what! There's nothing in your constitution mentioning automobiles,
antibiotics or atomic bombs either. Don't try to use your constitution as an
excuse to remain 70 years behind the rest of the civilized world unless you do
it consistently.


Mark Rand
RTFM

So then if nothing is mentioned in the Constitution, then we can simply
invade and enslave you and your countrymen?

Afterall...that nasty old Civil War was over a 150 yrs ago and its just
a thing of the past and shouldnt be paid any attention to. Correct?

Gunner


"First Law of Leftist Debate
The more you present a leftist with factual evidence
that is counter to his preconceived world view and the
more difficult it becomes for him to refute it without
losing face the chance of him calling you a racist, bigot,
homophobe approaches infinity.

This is despite the thread you are in having not mentioned
race or sexual preference in any way that is relevant to
the subject." Grey Ghost

"Ed Huntress" wrote:


Do you really think changing masters given the forces of economics will
have a
dramatically different result?

Wes

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.

And that's my point. We do it now. We have to do it now. If costs keep going
up (which is in the insurance companies' interest, BTW), we'll have to do
more of it in the future.

We ration everything. The limiting factor on you not backing up to bestbuy or whatever
store and filling your vehical with goods is your ablity to pay for it.

Somehow, there seems to be this idea that being able to pay for what you get isn't
supposed to apply when it comes to healthcare.

The one change that I'd have really liked to see would be to have access to the same menu
of plans that government employees have. We would be still dealing with an insurance
company but depending on how much we want to devote to coverage, our level of care would
follow our willingness to pay for it. We also could change insurance companies once a
year if we picked a poor choice.

I fear we are working towards no choice at all.

Wes

On Sun, 20 Dec 2009 07:53:19 -0500, the infamous Wes
scrawled the following:

"Ed Huntress" wrote:


Do you really think changing masters given the forces of economics will
have a
dramatically different result?

Wes

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.

And that's my point. We do it now. We have to do it now. If costs keep going
up (which is in the insurance companies' interest, BTW), we'll have to do
more of it in the future.

We ration everything. The limiting factor on you not backing up to bestbuy or whatever
store and filling your vehical with goods is your ablity to pay for it.

Somehow, there seems to be this idea that being able to pay for what you get isn't
supposed to apply when it comes to healthcare.

The one change that I'd have really liked to see would be to have access to the same menu
of plans that government employees have. We would be still dealing with an insurance
company but depending on how much we want to devote to coverage, our level of care would
follow our willingness to pay for it. We also could change insurance companies once a
year if we picked a poor choice.

I fear we are working towards no choice at all.

If you want better care, force the gov't to come down to our level of
insurance coverage. That'll raise our level a whole lot in and
_extremely_ short time. Talk about unmitigated gall. Public servants
with golden coverage while ours is served from grass huts. It's too
bad the unwashed masses don't get it. That one point should be enough
to cause the next revolution to start all by itself if they did grok
it. restless tap, tap, tap

--
This episode raises disturbing questions about scientific standards,
at least in highly political areas such as global warming. Still,
it's remarkable to see how quickly corrective information can now
spread. After years of ignored freedom-of-information requests and
stonewalling, all it took was disclosure to change the debate. Even
the most influential scientists must prove their case in the court
of public opinion—a court that, thanks to the Web, is one where
eventually all views get a hearing. --Gordon Crovitz, WSJ 12/9/09

Mark Rand wrote:
On Sat, 19 Dec 2009 19:40:36 -0500, "Steve W." wrote:


Which is why I would like to see ALL health insurance programs
eliminated. Go to paying cash for ALL services. Would level the field
REALLY quick.
I don't think that the Feds have ANY legal reason to get involved. I
cannot find anything in the Constitution that says the government is a
health care provider??

So what! There's nothing in your constitution mentioning automobiles,

Developed in the PRIVATE sector. Nothing to do with the Constitution.

antibiotics

Developed in the PRIVATE sector. Nothing to do with the Constitution.

or atomic bombs either.

I guess that pesky clause in there about "provide for the common
defense" doesn't apply.


Don't try to use your constitution as an
excuse to remain 70 years behind the rest of the civilized world unless you do
it consistently.


Mark Rand
RTFM


--
Steve W.

"Wes" wrote in message
...
"Ed Huntress" wrote:


Do you really think changing masters given the forces of economics will
have a
dramatically different result?

Wes

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.

And that's my point. We do it now. We have to do it now. If costs keep
going
up (which is in the insurance companies' interest, BTW), we'll have to do
more of it in the future.

We ration everything. The limiting factor on you not backing up to
bestbuy or whatever
store and filling your vehical with goods is your ablity to pay for it.

Somehow, there seems to be this idea that being able to pay for what you
get isn't
supposed to apply when it comes to healthcare.

Yeah, that's true. It's an ethical problem that's been unfolding for a
half-century. We're getting down to brass tacks now, and the issue is going
to be an important one in the years ahead. We have more medical technology
than we can afford.


The one change that I'd have really liked to see would be to have access
to the same menu
of plans that government employees have. We would be still dealing with
an insurance
company but depending on how much we want to devote to coverage, our level
of care would
follow our willingness to pay for it. We also could change insurance
companies once a
year if we picked a poor choice.

Well, it isn't going to happen as long as insurance companies have more
lobbying power than God.


I fear we are working towards no choice at all.

Wes

Insurance choices will be limited. That's inevitable. But it's not
inevitable that we'll be limited in *medical* choices. I don't see any
likelihood of a plan in the US, or in most other civilized countries, in
which you can't pay for extras on your own.

--
Ed Huntress

On Sat, 19 Dec 2009 18:39:29 -0600, "William Wixon"
wrote:
snip
they were
also saying if there was a virulent outbreak of flu there wouldn't be enough
respirators in the united states for everyone and some people are gonna die
because there just won't be enough respirators. who gets to decide who's
gonna get the available respirators? there won't be any obama "death
panels", yet, so who's going to decide? insurance companies?
snip
By long tradition this will depend on two critical social
factors: (1) The patient's net [cash] worth, and (2) The
patient's credit rating.


Unka George (George McDuffee)
...............................
The past is a foreign country;
they do things differently there.
L. P. Hartley (1895-1972), British author.
The Go-Between, Prologue (1953).

On Sat, 19 Dec 2009 18:53:13 -0500, "Ed Huntress"
wrote:

Nope. Not in terms of rationing care. We've been doing it for 30 years or
more -- or the insurance companies have.
This fall into the category "any old stick is good enough to beat
a dog with."


Unka George (George McDuffee)
...............................
The past is a foreign country;
they do things differently there.
L. P. Hartley (1895-1972), British author.
The Go-Between, Prologue (1953).

On Sat, 19 Dec 2009 19:40:36 -0500, "Steve W."
wrote:
snip
I don't think that the Feds have ANY legal reason to get involved. I
cannot find anything in the Constitution that says the government is a
health care provider??
snip
While it is frequently abused, it appears that the recent and
continuing changes in the basic social and economic/employment
structure of the US and advances in medical science have
justified the application of provisions in the Preamble to the
Constitution.

"We, the People of the United States, in Order to form a more
perfect Union, establish Justice, {possibly this
applies}==insure domestic Tranquility,== provide for the common
defence, ==promote the general Welfare,== and secure the
Blessings of Liberty to ourselves and our Posterity, do ordain
and establish this Constitution for the United States of
America."

It is well to remember that the US Constitution means no more and
no less than what the nine geezers on the SCOTUS say it means (in
spite of what you and I may think it says). The SOCTUS geezers
are known to have x-ray and micro vision much better than
Superman's and can see many things in the Constitution that no
mere mortal can.

FWIW -- the nine SCOTUS geezers have lifetime employment
regardless of physical/mental/ethical fitness, and have the very
best single payer government run health care. They also have an
inflation indexed defined benefit pension plan backed by the US
taxpayer.


Unka George (George McDuffee)
...............................
The past is a foreign country;
they do things differently there.
L. P. Hartley (1895-1972), British author.
The Go-Between, Prologue (1953).

"Ed Huntress" wrote:

Somehow, there seems to be this idea that being able to pay for what you
get isn't
supposed to apply when it comes to healthcare.

Yeah, that's true. It's an ethical problem that's been unfolding for a
half-century. We're getting down to brass tacks now, and the issue is going
to be an important one in the years ahead. We have more medical technology
than we can afford.

And if it means living or dying, everyone wants it. Politicians deal in the world of
giving things to one group by taking it from another group. Well not all but that seems
to be the normal Modus Operandi.

Now if I'm paying for mine and government taxes it to give it to someone else thus
diminishing my ability to obtain something I need and could have paid for, how is that
right? You can rob the rich and they still have something but when you rob the middle
class, they don't have much left.

Doctoring and nursing doesn't look like a vow of poverty line of work. There are huge
time and monetary costs involved in achieving competence. That needs to be rewarded for a
continuing flow of new people to enter the medical profession.

So how do we do this? Every man on his own, no one has more than the next guy, or some
rationing scheme?

As you mentioned, the technology is expensive. I've never had a MRI or CAT scan. The
most high tech thing I have had was a ultrasound of my heart a few years ago. Something
that I'm going to get done again before my deductibles reset since it has been a few
years. So far I'm dining on the cheaper part of the medical menu. Couple hundred bucks a
quarter for drugs and I'm hanging on.

I'd love to have the best cardiologist in charge of my care but you know that isn't going
to happen and I'm afraid many people clamoring for the 'public option' and other 'reforms'
think they are going to get the best at low cost. It isn't going to happen either.




The one change that I'd have really liked to see would be to have access
to the same menu
of plans that government employees have. We would be still dealing with
an insurance
company but depending on how much we want to devote to coverage, our level
of care would
follow our willingness to pay for it. We also could change insurance
companies once a
year if we picked a poor choice.

Well, it isn't going to happen as long as insurance companies have more
lobbying power than God.

Do you really think they came out of this in good shape so far?

As far as more lobbying power than God, where does the financial industry rate?



I fear we are working towards no choice at all.

Wes

Insurance choices will be limited. That's inevitable. But it's not
inevitable that we'll be limited in *medical* choices. I don't see any
likelihood of a plan in the US, or in most other civilized countries, in
which you can't pay for extras on your own.

I thought Canada forbid private practices but looked the other way because their system
would collapse without it. I'm not fully up on Canada other than understanding their
health care is regulated at the Province level.


Wes

"Wes" wrote in message
...
"Ed Huntress" wrote:

Somehow, there seems to be this idea that being able to pay for what you
get isn't
supposed to apply when it comes to healthcare.

Yeah, that's true. It's an ethical problem that's been unfolding for a
half-century. We're getting down to brass tacks now, and the issue is
going
to be an important one in the years ahead. We have more medical technology
than we can afford.

And if it means living or dying, everyone wants it. Politicians deal in
the world of
giving things to one group by taking it from another group. Well not all
but that seems
to be the normal Modus Operandi.

Now if I'm paying for mine and government taxes it to give it to someone
else thus
diminishing my ability to obtain something I need and could have paid for,
how is that
right? You can rob the rich and they still have something but when you
rob the middle
class, they don't have much left.

The Can of Worms is now officially opened! d8-)

It's a tough one, Wes. Nothing is going to work unless we get really serious
about putting medicine on a more rational footing and get those costs down
to something like the better examples in other developed countries.
Otherwise, we're all screwed.

FWIW, I don't think we're going to be able to do it, politically. In other
words, I think we're all screwed. Doing something really sensible, like the
plan they have in Switzerland, which doesn't interfere with *anyone's*
ability to get whatever care they can afford, but which still covers
everyone in the country with decent care, just isn't in the cards for the
US. I've been skeptical about the whole thing for a long time. It's
necessary, but probably undoable. We've screwed ourselves.


Doctoring and nursing doesn't look like a vow of poverty line of work.
There are huge
time and monetary costs involved in achieving competence. That needs to
be rewarded for a
continuing flow of new people to enter the medical profession.

Agreed.


So how do we do this? Every man on his own, no one has more than the next
guy, or some
rationing scheme?

The rational thing would be to have a board of experts who really know what
they're doing; who are invulnerable to lobbying interests; and who are
devoted to implementing the best possible medical care for everyone. Tell us
about such a board for *anything* in the US. Hahahahahoho...

It isn't worth getting into it again, but the "free market" approach doesn't
work with healthcare. For example, when you need a heart transplant and you
just can't afford it, do you say, "oh, well, I'll just do without, and die"?
It isn't like buying a new boat.

Perverse incentives are everywhere; real competition is almost nowhere. And
we're seeing how incapable the political process is of dealing with it. In
the US, markets and Congress are almost all we have. They're both incapable
of solving the problems. They can give us good care, but we'll all be broke.


As you mentioned, the technology is expensive. I've never had a MRI or
CAT scan. The
most high tech thing I have had was a ultrasound of my heart a few years
ago. Something
that I'm going to get done again before my deductibles reset since it has
been a few
years. So far I'm dining on the cheaper part of the medical menu. Couple
hundred bucks a
quarter for drugs and I'm hanging on.

May it remain so for a very long time.


I'd love to have the best cardiologist in charge of my care but you know
that isn't going
to happen and I'm afraid many people clamoring for the 'public option' and
other 'reforms'
think they are going to get the best at low cost. It isn't going to
happen either.

Right.





The one change that I'd have really liked to see would be to have access
to the same menu
of plans that government employees have. We would be still dealing with
an insurance
company but depending on how much we want to devote to coverage, our
level
of care would
follow our willingness to pay for it. We also could change insurance
companies once a
year if we picked a poor choice.

Well, it isn't going to happen as long as insurance companies have more
lobbying power than God.

Do you really think they came out of this in good shape so far?

They're hanging on tenterhooks, but if they get 10 - 20 million new
customers who HAVE to have insurance, there will be big doings in the yacht
clubs next summer.


As far as more lobbying power than God, where does the financial industry
rate?

God's Other Son. g




I fear we are working towards no choice at all.

Wes

Insurance choices will be limited. That's inevitable. But it's not
inevitable that we'll be limited in *medical* choices. I don't see any
likelihood of a plan in the US, or in most other civilized countries, in
which you can't pay for extras on your own.

I thought Canada forbid private practices but looked the other way because
their system
would collapse without it. I'm not fully up on Canada other than
understanding their
health care is regulated at the Province level.

There are many myths about Canada's system. Around 30% of their care is
privately funded, either through private insurance or direct payments.

But it's not that simple. Wikipedia does a fairly good job of explaining it,
at least in the introduction:

http://en.wikipedia.org/wiki/Health_care_in_Canada

Also check the "Private Sector" heading in that article.

--
Ed Huntress

On Sun, 20 Dec 2009 18:53:45 -0500, Ed Huntress wrote:

"Wes" wrote in message
...
"Ed Huntress" wrote:

Somehow, there seems to be this idea that being able to pay for
what you get isn't supposed to apply when it comes to healthcare.

Yeah, that's true. It's an ethical problem that's been unfolding
for a half-century.
--snip--
It's a tough one, Wes. Nothing is going to work unless we get
really serious about putting medicine on a more rational footing
and get those costs down to something like the better examples in
other developed countries. Otherwise, we're all screwed.
--snip--
Doctoring and nursing doesn't look like a vow of poverty line of
work. There are huge time and monetary costs involved in
achieving competence. That needs to be rewarded for a continuing
flow of new people to enter the medical profession.

Agreed.

So how do we do this? Every man on his own, no one has more
than the next guy, or some rationing scheme?
--snip--
The rational thing would be to have a board of experts who really
know what they're doing; who are invulnerable to lobbying
interests; and who are devoted to implementing the best possible
medical care for everyone. Tell us about such a board for
*anything* in the US. Hahahahahoho...
--snip--

Ed,

While I think I agree with your reaction, I don't think you're
describing a problem restricted to the United States. Isn't this
one of the basic problems of politics (defined as "the art of
accomplishing things through people)?

"The board", any panel of experts (or idiots), has to be selected by
(choose one or more): appointment, election, or perhaps an
examination of some kind. Appointments are made by other people, who
might or might not be "qualified" (or even able) to select people
who are knowledgeable, devoted, and stubb.. er, "suitably firm in
their convictions". Elections I won't address grin!, and
examinations need to be created by other people.

And once a board is selected, making them "invulnerable to lobbying
interests" certainly seems like a good idea. But... can we
effectively insulate our board from lobbying interests without at
the same time creating an overly detached and ingrown group
unresponsive to the needs of the general population? "Scientists"
are periodically accused (deservedly or not) of thinking of
themselves as a "priesthood"; academic tenure protects intellectual
freedom, but also isolates the tenured from having to face reality.

Turn it all over to The Master Computer? Often attempted in SciFi,
with predictably bad results (the problems with doing this seem to
grow out of a mechanism's having to deal with actual human beings
grin!). We come close to this with the institutions collectively
referred to as "bureaucracy": our best-so-far mechanism for
enshrining a set of rules and turning it loose to churn away
according to those rules, with consequences that are not often
considered (or even imagined) when the rules were established. Who
-- in FDR's time -- would have thought Social Security would take
over such a huge chunk of the Federal budget?

And then there's the problem of "dedication to a purpose". Most
humans seem to want (need?) to have more in their livs than One
Glorious Purpose: they want to get married, have (and hopefully care
for) children, spend time with other humans talking about sports and
current events (and their children grin!); in short, to have a
life. Those are human influences, and they will affect the members
of our board, for good and/or evil.

Hm. After re-reading the above, I think I may be coming across as
simply trying to poke holes in your idea. I hope not, since that
would be a waste of your time and mine, and self-defeating. What
I'm shooting for is more along the lines of this: these seem to be
limitations we're stuck with. Can we change them? If so, how? If
not, how do we build a system that accepts their presence (or
better, one that builds on those limitations) and still accomplishes
our goals?

Okay, okay.. we _might_ not have an answer ready by this Christmas.
But maybe next... grin


Frank McKenney
--
...[i]t was assumed by American statesmen that whatever was uttered
or urged in the name of moral or legal principle bore with it no
specific responsibility on the part of him who urged it, even
though the principle might be of questionable applicability to the
situation at hand and the practical effects of adherence to it
drastic and far-reaching. We were at liberty to exhort, to plead,
to hamper, to embarrass. If others failed to hear us, we would cause
them to appear in ungraceful postures before the eyes of world
opinion. If, on the other hand, they gave heed to our urgings, they
would do so at their own risk; we would not feel bound to help them
with the resulting problems -- they were on their own.
-- George F. Kennan / American Diplomacy 1900-1950
--
Frank McKenney, McKenney Associates
Richmond, Virginia / (804) 320-4887
Munged E-mail: frank uscore mckenney ayut mined spring dawt cahm (y'all)

"Frnak McKenney" wrote in message
m...
On Sun, 20 Dec 2009 18:53:45 -0500, Ed Huntress
wrote:

"Wes" wrote in message
...
"Ed Huntress" wrote:

Somehow, there seems to be this idea that being able to pay for
what you get isn't supposed to apply when it comes to healthcare.

Yeah, that's true. It's an ethical problem that's been unfolding
for a half-century.
--snip--
It's a tough one, Wes. Nothing is going to work unless we get
really serious about putting medicine on a more rational footing
and get those costs down to something like the better examples in
other developed countries. Otherwise, we're all screwed.
--snip--
Doctoring and nursing doesn't look like a vow of poverty line of
work. There are huge time and monetary costs involved in
achieving competence. That needs to be rewarded for a continuing
flow of new people to enter the medical profession.

Agreed.

So how do we do this? Every man on his own, no one has more
than the next guy, or some rationing scheme?
--snip--
The rational thing would be to have a board of experts who really
know what they're doing; who are invulnerable to lobbying
interests; and who are devoted to implementing the best possible
medical care for everyone. Tell us about such a board for
*anything* in the US. Hahahahahoho...
--snip--

Ed,

While I think I agree with your reaction, I don't think you're
describing a problem restricted to the United States. Isn't this
one of the basic problems of politics (defined as "the art of
accomplishing things through people)?

I suppose it is, but it's particularly unlikely to happen in the US, because
of the way our political system works -- especially these days.

Switzerland is the example I keep using, because I spent a year there
studying comparative politics and I'm familiar with the culture. An American
wouldn't be uncomfortable with the politics there -- they have a
conservative streak -- but he'd be amazed at how they can accomplish some
policies that, here, would take years of wrangling. For example, they
switched their private health insurance companies to non-profit status with
a single referendum. Can you imagine that happening here?


"The board", any panel of experts (or idiots), has to be selected by
(choose one or more): appointment, election, or perhaps an
examination of some kind. Appointments are made by other people, who
might or might not be "qualified" (or even able) to select people
who are knowledgeable, devoted, and stubb.. er, "suitably firm in
their convictions". Elections I won't address grin!, and
examinations need to be created by other people.

And once a board is selected, making them "invulnerable to lobbying
interests" certainly seems like a good idea. But... can we
effectively insulate our board from lobbying interests without at
the same time creating an overly detached and ingrown group
unresponsive to the needs of the general population? "Scientists"
are periodically accused (deservedly or not) of thinking of
themselves as a "priesthood"; academic tenure protects intellectual
freedom, but also isolates the tenured from having to face reality.

Turn it all over to The Master Computer? Often attempted in SciFi,
with predictably bad results (the problems with doing this seem to
grow out of a mechanism's having to deal with actual human beings
grin!). We come close to this with the institutions collectively
referred to as "bureaucracy": our best-so-far mechanism for
enshrining a set of rules and turning it loose to churn away
according to those rules, with consequences that are not often
considered (or even imagined) when the rules were established. Who
-- in FDR's time -- would have thought Social Security would take
over such a huge chunk of the Federal budget?

And then there's the problem of "dedication to a purpose". Most
humans seem to want (need?) to have more in their livs than One
Glorious Purpose: they want to get married, have (and hopefully care
for) children, spend time with other humans talking about sports and
current events (and their children grin!); in short, to have a
life. Those are human influences, and they will affect the members
of our board, for good and/or evil.

Hm. After re-reading the above, I think I may be coming across as
simply trying to poke holes in your idea. I hope not, since that
would be a waste of your time and mine, and self-defeating.

I get plenty of those on this NG. Yours doesn't appear to be one of those.
g

What
I'm shooting for is more along the lines of this: these seem to be
limitations we're stuck with. Can we change them? If so, how? If
not, how do we build a system that accepts their presence (or
better, one that builds on those limitations) and still accomplishes
our goals?

Okay, okay.. we _might_ not have an answer ready by this Christmas.
But maybe next... grin


Frank McKenney

Geez, Frank, why not just ask how we can all make the world a better place?
d8-)

All of your points are good ones. They apply in greater or lesser degree in
different circumstances and in different cultures. No one is immune to them
but we're more vulnerable than most.

And I'm not pining for some utopian ideal. Like most Americans, I'm very
wary of turning control of *anything* over to some board of experts. I'm
just trying to point out that there are rational and effective answers to
these questions, while at the same time saying I don't think they're
politically possible to realize.

My opinion, FWIW, is that we're in the grip of corporatism more severe than
at any time in our history, with the possible exception of the Robber Baron
era. I use the term not in the classical sense of the political-science
definition, but in the recent sense meaning something like "rule by
corporate/financial interests." That, combined with a hardening of
ideological conflicts, is producing something like political heart failure.

I am not happy about it. This conflict over health care reform, which should
be a slam-dunk in terms of the interests of the citizens of this country, is
a good example of how it works.

One of the tenets of political science today is that countries that have
long periods of internal peace, and that suffer no dramatic troubles as a
result of their external wars, become victims of their special interests.
They become unable to move; they develop hardening of the political
arteries.

That's us. That could be Switzerland, too, except that they're much more
homogeneous and they have some resistance to political gridlock. With the
upcoming elections the Dems are likely to lose some or all control of
Congress, which will make it even harder to do anything. We're becoming a
beached whale.

And the real problem with that, IMO, is that it's sapping the energy and
drive from our culture. If we can't enact health care reform, when every
other developed country has a more effective system in terms of results,
almost all of which cost roughly half as much per capita as ours, it may be
a sign that we're already screwed.

We'll muddle through. Nothing is going to collapse. The voltage is just
going to drop, IMO, and the lights will dim.
[i]
--
...t was assumed by American statesmen that whatever was uttered
or urged in the name of moral or legal principle bore with it no
specific responsibility on the part of him who urged it, even
though the principle might be of questionable applicability to the
situation at hand and the practical effects of adherence to it
drastic and far-reaching. We were at liberty to exhort, to plead,
to hamper, to embarrass. If others failed to hear us, we would cause
them to appear in ungraceful postures before the eyes of world
opinion. If, on the other hand, they gave heed to our urgings, they
would do so at their own risk; we would not feel bound to help them
with the resulting problems -- they were on their own.
-- George F. Kennan / American Diplomacy 1900-1950

Good quote.

--
Frank McKenney, McKenney Associates
Richmond, Virginia / (804) 320-4887
Munged E-mail: frank uscore mckenney ayut mined spring dawt cahm (y'all)

--
Ed Huntress