KNOWLEDGE v. NO-NOTHINGISM

12 08 2009

LLLLLLLLLLLLLLLLLLL

People on the Right have been known to scare us into doing dumb things (Think Iraq war!). A sad current  example of that practice is discussed in the article referenced below. The article explodes the myth that some on the Right have recently created about this one doctor and the larger issues he has taken positions on. The article also explains succinctly why scaring folks works so well so often.

http://news.yahoo.com/s/time/20090812/us_time/08599191583500

And, no, the “Frightening” that the Right has used in the health care debate and elsewhere is NOT paralleled on the Left by warnings about global warming. The difference is that our warnings of global warming are based on the work of LOTS of reputable scientists, while, at least in the case of the doctor discussed above, the Frightening practiced by the Right has generally been accomplished by distorting the facts.

For an authoritative look at the science behind global warming, visit the site of the Intergovernmental Panel on Climate Change:

http://www.ipcc.ch/

I always give scientists at least the benefit of the doubt, and I usually believe them when their pronouncements make sense in light of the moderate-to-good scientific knowledge I have.

I grew up in a world where extreme moralists were incessantly claiming to speak authoritatively about every aspect of life–from what happens to people after death to whether dancing should be prohibited.

I was troubled by all this hectoring, because I was serious about being a responsible guy, and I wanted to know who to believe. Then I learned about the scientific method and I realized that scientist don’t just make up their pronouncements or take them from ancient books. Instead, scientists actually TEST their hypotheses with real-world experiments, and change their ideas when experimental results require.

And then there is the fact that the child of science, technology, routinely produces new, wonderful things that we can each test for ourselves, and in the process  see the device’s underlying scientific theory  actually working, often spectacularly,  in the real world.

Since its inception around four hundred years ago, experimental science has increasingly routed the practitioners of the traditional “our ancestors believed it so it must be true” school of analysis.

What a relief for any thinking person!

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18 responses

12 08 2009
jonolan

On the matter of Dr. Emanuel – Do you concur that there are likely to be funding issues with ObamaCare since it’s based upon taxation and there’s likely to be a call to streamline the system?

If so,you have to admit that the lack of funding could reasonably create the scarcity that Dr. Emanuel’s Complete Lives System is designed to address.

Since Dr. Emanuel will, as the special adviser on healthcare policy, have a lot of input into designing the mandatory coverages in the Public Option and possibly the fee structure as well, his views of prioritizing – note, not rationing – medical services and funding for such are pertinent to the issue at hand and his views disturb a lot of people.

12 08 2009
nightman1

Informative comment!

Yes, there is always a possibility of prioritizing to the detriment of some groups down the line someday. No-one can deny that.
As I see that danger, though, I consider it (1) unlikely, since most medical people are presumably,… er, “pro-life” (including this doctor) and so would resist de-prioritizing certain groups, and, (2) assuming it one days occurs, much to be preferred to the current situation.

Under the current system prioritization is largely done by income. I was once broke, disabled, and under medicaid and medicare for a while. The medicaid patients found few doctors t treat them due to low reimbursement levels. The vast majority of the poor, not having even medicaid, had only emergency rooms.

In a society where a host of non-medical health-affecting factors are differentially applied to rich and poor (e.g., convenient physical access to, and ability to afford, healthy food), to have such a major parallel differential on the medical treatment end as well seems to me a really awful thing. The only statistic I know to back up my sense that this must kill a great many people who would live if they were rich is that Black people have a considerably higher death rate than Whites at any age.

The use of the Right of a speculative future danger of prioritization to stop a change that could lessen an large and unfair existing de facto prioritization seems sad to me. I suspect lots of them have never considered the current detriment to poor people. And, given historical attitudes on people on the Right, I suspect a lot of the more sophisticated ones simply believe that the richer you are the more you deserve of everything the world has to offer, including medical care, and thus life itself.

12 08 2009
jonolan

So far the House version of the bill is set to use medicaid’s reimbursement scheme as the basis for the reimbursement schedule for the public option. As you point out that will be a problem.

I assume they will adjust that reimbursement plan though – but will still need to “trim a lot of fat.” So I don’t think this is a down the line someday situation.

Therefor I’m back to having to say that Dr. Emanuel’s decisions / recommendations on the specifics of cost cutting make me nervous, since they would tend to weigh against the very young, aged, and disabled – who all need tend to need the more expensive care when they need it.

As for the rest of your reply – I really can’t refute the facts of it. Though, as a member of that Right you’re talking about, I dispute the use of word “deserve.” Most of us on the Right don’t think of health care as something that is or isn’t deserved.

13 08 2009
nightman1

I have to say that I think you may have a better grasp of the details of at least some of the health care proposals than I do. My rough overall view of the situation has been that in the USA we spend a lot more per person on health care than in other developed countries, with poorer results, e.g., less improvement in infant survival and overall lifespan than countries with public health care have enjoyed. In fact I recently saw a graph tracing improvement in lifespan over the last 50 years in, the US, Canada, the U.K., and Japan. The US had done the worst.

It would seem to follow that the extra money spent in the USA is being wasted in some way. One obvious way is paying for unregulated profits of insurance companies. Another would be paying excessive fees to doctors, who, like most Americans, seem to be imbued with the notion that they’re entitled to all the profit the traffic will bear.

In Germany they solve the health care problem by providing for subsidized insurance by highly regulated insurance companies. People have to pay part of the cost of their insurance. The companies’ profits are capped, and what they do is carefully scrutinized — the way public energy utilities have traditionally been handled here.

So the German model would be good for saving money, and a single-payer model like that of the UK or Canada, with the doctors’ mostly functioning as employees of the health plan, not independent contractors, would be even better. These would be very difficult to establish here, due to the monetary-political power of insurance companies and doctors.

So, as best I can gather it, the Democratic plan(s) now under consideration is that:

(1) insurance would still be THE health care financing model,
(2) poor people would receive subsidies to help them buy health insurance,
(3) guidance would be developed as to the best and most cost-effective ways to treat various ailments (Is this where Dr. Emanuel’s ideas would come in?),
(4) (very important) insurers’ behavior would be more heavily regulated, so they couldn’t screw people as they are now wont to do, and
(3) (most important of all!) a publicly-run insurer would be set up to compete with our private insurers and so bring their prices down. Over the long term this would wring a lot of the cost represented by their profits out of the system.

Sounds to me like all of the above together would work to spread medical insurance to more people, and even bring costs down, though slowly. But if the “public plan” part, which the insurers hate, is removed from the mix, though, we’ll be left with almost the equivalent of current Medicare, which provides a huge pool of money on which doctors and insurers can draw, while placing few limits on their exercise of ingenuity in maximizing their draw from it. The inevitable result, human nature being what it is, would be that the cost of medical care would keep on rising faster than other living costs indefinitely.

To me it seems like the upshot of all the above reforms, if passed, is likely to be more insurance for more people, and with still plenty of money in the system–closer to the amount we’re used to now than may be available in other developed countries, but with less waste. Under those conditions I don’t think prioritizing care to the detriment of some would be much of a problem, given the fact that it doesn’t seem to be much of a problem in those other countries now.

I wish our president had set out his overall plan for reform, as outlined above, from the beginning. It would make the idea of health care reform a lot less vulnerable to fear-mongering. People fear what they don’t know.

Still, when all is said and done, if you have a lot of money–say, enough to afford top-quality medical coverage and/or to comfortably pay any medical bills you are ever likely to receive–you don’t need health care reform. Only middle class and poor people need it in order to make them more secure in terms of access to medical care and also in terms of avoiding bankruptcy over medical bills!.

As always, then, there is class struggle element to this reform. I can see that element easily. Therefore I understand why millions of Americans who are “doing all right” in terms of access to medical care oppose this reform. But I suspect that millions of Americans who are in the classes most likely to be benefitted by the proposed reform also oppose it, either because they can’t see that they are likely to benefit from it, or because, even though they know they would be benefited by the reform, but reject it on ideological grounds.

I don’t know how large that last group is, but if it’s substantial in size, that’s testimony to the power of ideology over economic self-interest.

13 08 2009
jonolan

Actually, if you research survival rates from most deadly diseases and serious injuries, America outperforms all the other countries. Under our current system we have better “disease management” and “injury repair” than anyone else in the world.

The comparative life-span disparity is likely from other causes, namely the fact the the US has a “disease management” and “injury repair” system as opposed to a health system. Our slightly lower lifespans have as much to do with our lifestyle as anything else.

And on to the bill, which I’ve read and read and read – I might just possibly understand (It’s a stone bitch to decipher):

(1) insurance would still be THE health care financing model,
(2) both people ($80K+ income for family of 4 qualifies for subsidy, so NOT just poor) and the insurance companies would receive subsidies (see final point)
(3) guidance would be developed as to the best and most cost-effective ways to treat various ailments (Yes, this where Dr. Emanuel’s ideas would come in),
(4) (very important) insurers’ behavior would be more heavily regulated, so they couldn’t screw people as they are now wont to do (which would seriously harm their business model and force more people onto the Public Option), and
(5)NOpublicly-run insurer would be set up to compete with our private insurers and so bring their prices down. Instead…
(6) The government would define what the base level health insurance coverage would be in detail and insurance companies could bid to have their version of the plan sold as the Public Option. (Again, Dr. Emanuel’s views come into play)
(7)To some extent the reimbursement structure for doctors in the Public Option is to be based on the Medicaid standard. (Technically the bill says that it WILL be based upon it, but I believe that they modify it and improve it some)

13 08 2009
nightman1

I am delighted you’ve read the bill! I offer you the opportunity to be a guest poster here and summarize what you’ve read, free of any opining by me. It would be a public service to my not-so-many readers, and to me a source of information I’d love to have.

As for your last post. I can only carp at a couple of things:

–Re our health care, one of the ultimate points of setting up a public system is to try to convert it from a “fix diseases” model to a “maintain health” model. The current system lends itself to “fee for individual service” medicine, which leads in turns to doctors’ taking advantage by doing more procedures than needed, and insurance companies’ taking advantage by failing to pay for long-term health maintenance services (“Hey”, they can say, we pay when you get sick. What more do you want?”)

–I find myself quite unmoved by the danger to insurers’ business model. I bet if they are heavily regulated but still allowed to make a modest, RELIABLE profit, as in Germany, people can be found to invest in them and work at them. In fact, companies operating this way, to wit, electric utilities, have for generations been the “widows and orphans” class of stock par excellence. Such companies can pay (or at least “could pay”. God knows what’s happening now!) regular dividends, and people who need regular income like that.

But the only way to break insurers out of their current model, which in striving for ever-increasing profits leads inevitably to screwing people, and into the more benign “utilities” model, is to force them out of it with competition. They’ll never make the switch willingly.

–Gee, have our spineless Democratic legislators already reached the point of abandoning the idea of creating an independent government-run public insurer to compete with the insurance companies? Very sad! Because we all know that it’s hard to by regulation alone to reign in companies over the long term, as long as they keep making big money. As long as they do, they have the ability to keep churning the management “revolving door” between them and their regulators, paying handsome salaries to the folks who next year or next decade will be overseeing them — and so gradually buying themselves kinder and kinder regulations in the process.

So, any time you want to come on here and explain the bill, you can do so. I promise to criticize nothing you say. It may be a struggle, but I could manage to achieve silence in this case.

14 08 2009
jonolan

Thanks for the offer. I may take you up on it. Then again, trying to explain a 1200+ page document (in the case of H.R. 3200, which is the one I’m most familiar with) would take a long time.

As for “have our spineless Democratic legislators already reached the point of abandoning the idea of creating an independent government-run public insurer to compete with the insurance companies?” – a fully government run healthcare option didn’t make it out of committee. That has been out of HR 3200 for a long time.

It’s in some of the proposed bills though, including – I think – one of the ones in the Senate.

That’s what makes discussing or debating this difficult. There are more than one bill in the works and they’re not similar to each other – and they both change almost every day that Congress is in session.

14 08 2009
Carole

Nightman1, thank you for this blog. Sadly, I believe that the scare tactics about this reform are very effective.

I also believe that the healthcare system currently in place cannot be sustained. With appx 14K people per day dropping their insurance, due to inability to pay for it, and the kinds of premium increases we have seen just over the past 5 years, the only people who will be able to afford insurance are the very wealthy.

I can only speak from personal experience. Insurance is offered through my employment and each employee pays their own insurance. About 4 years ago, the United Healthcare monthly premiums increased by 60% – that is 60%, not 6%. The following year UH insurance company had another increase and we had to go to a lesser rated insurance company in order for our employees to be able to afford the premiums.

More and more, insurance companies are denying coverage to people for specific illnesses – and the insured is left to find care and fight the insurance company when they need to be focused on improving their health.

No one seems to “seriously” acknowledge that the current system is not sustainable.

It seems to me that there are some very good models to examine and create our own version of, while leaving the current system in place for those who prefer and can afford it.

Scare tactics are being promoted about the Canadian and British systems, but I have read and heard that people there (and in France and Germany) are very pleased that they do not have to worry that care will be available to them, should they become seriously ill – which is not the case in the US.

I believe that too many people are out of touch with the reality of Americans who are unable to afford healthcare and medical treatment. There seems to be an attitude that people are at fault for losing jobs (and some are), but our government helped create the perfect storm, due to deregulation/lack of oversight with the Wall Street, housing and automobile debacles.

The bonuses handed to the CEOs and others, of these failing companies, before and after the stimulus was approved, speak to how seriously we are off track.

It also seems to me that we are not focused on solutions and must be.

14 08 2009
nightman1

Thank you for your comment, Carole. You said all this better than I could, since you have direct experience of the history of insurance cost surges, whereas so far I am covered by a good and fairly stable plan–due I suppose to the fact that the insured population I belong to is very large.

However, I’m 61, so I won’t qualify for Medicare for 4 years, so if I lose my job I will have to pay for continuation of my plan coverage at a rate that will eat up 1/3 of my monthly retirement income.

And it’s my understanding that I would be lucky to be able to continue the plan coverage at all–which I could do under my plan due to the fact that I have reached an age when I can retire here. If I had to use COBRA to continue my coverage I would have to pay much, much more.

It took a lot of calling, e-mailing, and reading plan material just to discover the above set of parameters that apply to me. I’m trained as a lawyer so I could understand what I found from all that inquiring fairly easily. What would persons with less education and relevant experience do!

Actually, I know what they do, from watching other family members deal with stuff like this: They flail around for months trying to figure out what to do, and, in many cases, experiencing high levels of anxiety in the process.

I could say without much exaggeration that we’ve reached the point that you have to be a lawyer to know your rights regarding health insurance, and to protect them.

Nightman1

14 08 2009
jonolan

Nightman1,

I need to correct one of my previous comments. I was rereading H.R. 3200 and Subtitle B, Section 221 Does still include a fully government-run plan that would be offered in direct competition to private plans on the proposed Insurance Exchange.

Sorry for the confusion. They’ve moved a few things around.

Carole,

A large part of your sudden and continuing increase in health insurance premiums is due to a similarly sudden and continuing increase in coverage. The single largest cause of increase in premiums was the federal government’s decision to mandate that health insurance companies add prescription drug coverage to all the plans.

This caused a very large increase in the recurring expenses to the companies that resulted in a commensurate increase in premiums.

14 08 2009
nightman1

Re “sudden and continuing increases in premiums”, I’ll take you at your word, jonolan, about the government mandate. But I wouldn’t want any inexperieced young person to take that as implying that prescriptions were not covered by insurance earlier. The plan I’ve lived under since 1981 has always paid for prescriptions.

14 08 2009
jonolan

Some states have had laws requiring prescription drug coverage for some time. Some plans had the coverage even though it was not required. It varied.

When things go nationwide though, it messes with the actuarial charts and tends to raise everyone’s premiums.

And then there’s the underlying – and completely unaddressed by ObamaCare or any of the opposing plans – issue of the ever increasing cost of the pharmaceuticals being covered.

14 08 2009
nightman1

“And then there’s the underlying – and completely unaddressed by ObamaCare or any of the opposing plans – issue of the ever increasing cost of the pharmaceuticals being covered.”

Boy is there ever! Ever since the drug companies, in the person of the odious “Billy” Tauzen, now head of Pharma but then chief proponent of the new Medicare drug plan, got it written into that new law that the government MAY NOT bargain with drug companies over the price it pays for drugs for seniors, I have realized that the US of A is gradually turning into a kind of “oligarchy of corporations”.

There is so much scope for a respectable form of bribery in our strange practice of making each politician begin his campaign by collecting a very great deal of money to pay for ads, that it was almost inevitable that large companies and organized groups of same would eventually be able to dictate the contents of most laws that affect them.

Check out this from the definition of “oligarchy” at Ask.com:

“Oligarchy is a form of government where most or all political power effectively rests with a small segment of society (typically the most powerful, whether by wealth, family, military strength, ruthlessness, or political influence). The word oligarchy is from the Greek words for “few” (oligo) and “rule” (arkhos). Some political theorists have argued that all governments are inevitably oligarchies no matter the supposed political system.”

“Capitalism as a social system is sometimes described as an oligarchy. In capitalist society, power – economic, cultural and political – rests in the hands of the capitalist class or, to put it another way, the few who have a vested interest in the maintenance of the system.”

“Some authors such as Vilfredo Pareto, Gaetano Mosca and Robert Michels believe that any political system will eventually evolve into an oligarchy (Iron law of oligarchy). According to this school of thought, modern democracies should be considered as elected oligarchies. In these systems, actual differences between viable political rivals are relatively small and strict limits are imposed (by the oligarchic elite) on what constitutes ‘acceptable’ and ‘respectable’ political positions. Furthermore, politicians’ careers depend heavily on unelected economic and media elites.”

http://www.ask.com/bar?q=oligopoly+%22form+of+government%22+-economics%2C+-market&page=1&qsrc=196&ab=3&u=http%3A%2F%2Fen.allexperts.com%2Fe%2Fo%2Fol%2Foligarchy.htm

THIS IS REALLY SAD! It has grown worse every year of my adult life.

14 08 2009
jonolan

Yes.

You have to try to remember that ObamaCare – just a shortcut name – is all about controlling health insurance and nothing about actual healthcare reform.

Even the government’s own Congressional Budget Office said the plan would do nothing to lower healthcare costs or even “lower the trajectory” of it’s increase in costs over the next decade.

14 08 2009
jonolan

Oh BTW – I was doing a little research and this: http://abcnews.go.com/Health/story?id=5517492&page=1 is part of why Palin’s “death panels” resonated with a lot of people.

14 08 2009
nightman1

You are ahead of me, as is often the case. Why wouldn’t regulating insurance companies more tightly, and giving binding guidelines on proper care, tend to lower overall health care costs? (Didn’t you say in an earlier post that those forms of regulation were being proposed?)

And is there anything in there about requiring ins. companies to pay for preventive care? Example: I am around 100 lbs. overweight, am 61 years old, and have type 2 diabetes (mild so far, fortunately). I would seem to be the perfect candidate for one of those operations that lower appetite, and if I lost a lot of that 100 lbs as a result I might live longer. Type 2 diabetes has even been known to go away when that much weight is lost.

But I must say that if ObamaCare only serves to control health insurance companies, it will be a good first step as far as I’m concerned.

15 08 2009
jonolan

Requiring insurance companies to cover anything doesn’t lower healthcare costs; it just shifts who’s paying them. Real reform would have to address the underlying costs and what causes them.

There are provisions in the current iteration of HR 3200 that not only require insurance companies to cover preventative care but also require – with force of law – that people make use of it. Preventative is mandatory. What is not clear is the legal ramifications of a person not obeying his doctor’s preventative care prescriptions / treatment suggestions.

15 08 2009
nightman1

You may very well be right. But for me health care “reform” has one very important goal and one less important one. The primary one for me is to get everyone covered. The secondary one is to lower costs.

The country I live in produces a lot of wealth. I’d like to see more of it used to reduce the suffering of those of its people who are not well off, and less of that wealth used to buy ever more fancy weapons, and to enhance the lifestyles of rich people.

I’ve seen the multifarious forms of suffering caused by poverty first hand, and one of the worst of those is not being able to go to the doctor when you’re sick.

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