Another Federal Judge rules Obamacare unconstitutional

[chucky2]

But in reality, most corps don't really answer to anyone. Their boards are built with each others executives. Their major shareholders are institutional investors who don't care about anything beyond quarterly results. If results are bad they'll shuffle leadership, but the suits in the executive offices are generally totally disconnected from what's really happening in their companies. They turn to the layers of entrenched bureaucracies for answers ... and those bureaucracies have been around long enough to know just what sunshine to blow to make the new boss look elsewhere.

I agree, to a point. These Corp's though still have objectives and projects they want accomplished, they track to those, and they accomplish those - or adjust and accomplish the adjustment. They still have to stay in the black, no company can run red Q after Q and stay afloat - regardless of how much they restructure, fire, offshore, or merge.

The government, on the other hand, is nominally responsible to voters. Unfortunately, most voters care far more about American Idol than they do about their tax dollars (other than to bitch about how high their taxes are ... during commercials). Consequently, they do almost nothing to hold the government accountable. They could, but they don't.

As we've seen for basically....everything...the way our present government is presently constituted its agencies that use all that taxpayer money are accountable to no one. Politicians are voted in, voted out, but the agencies all stay the same - and they all suck down ever increasing amounts of tax dollars. The makeup of these agencies is no different than the Corp structure you outlined above. It just doesn't have to answer, at all, to financial pressure: It only has to justify if it's hitting funding allotments or why it needs more. Unlike a Corp, it will get more. Afterall, who's going to shut off Fed HC? Why, no one.

On the other hand, there is almost nothing a customer can do -- in reality -- to hold his health insurance company accountable. One can file complaints, of course, but one can complain about government health care as well. Many do, and it is at least as effective as complaining about a private insurer.

That's one of the reasons the other 1/2 of me would deal with the devil and be willing to explore a Fed HC entity. That, and job mobility/freedom. No more being held hostage by the threat of no HC coverage.

I'd really like to see the Fed though take an existing major issue, and deal with it in a managed way first though, so as to instill some type of confidence they can handle Fed HC. I just do not see them being able to do it ATM...

 

[Bowfinger]

[ ... ]
In your life, can you actually claim to have seen more dumb fuckery and inefficiency in the business world - outside of that directly caused by government or the fear of government - than in government?

Oh hell yes! I've seen cases of bureaucracy and counter-productive red tape in some companies that would make your average government paper-pusher gouge his eyes out. I've seen casual waste of literally hundreds of millions of dollars because an SVP presumably read an article about the way IT projects should work, insisted his ignorance become reality (repeatedly firing anyone who tried to offer experienced guidance), hired a CIO with a glaring conflict of interest, brought in busloads of Big Six "consultants" who milked us for every dime they could, literally delivered none of the project requirements after multiple failed attempts over four years -- none, and still got promoted because he spun the one footnote item that was delivered as a great success. While that was the most spectacular example, I've seen dozens of examples of tens of millions wasted due to politics and turf building, and countless examples of routine inefficiency.

I obviously haven't worked for every agency and every company, so my sample size is small. I never saw anything so wasteful in government, however. I'm sure such examples exist, but I never saw anything like it. In fact, the tightest budget scrutiny I ever had was one of my government positions. While you may think government gets a blank check, at the agency level you only get the dollars that are budgeted to you. They were never enough, and there was always fierce competition for them. That meant everything we wanted to do was challenged and dissected.

I once had a small, $1000 parts order challenged because I had included a $6 (IIRC) pair of miniature needle-nose pliers. I had to show that the pliers pushed the order over $1000 and therefore qualified the whole order for a bigger discount (thus actually saving money) before they would approve the invoice.

In contrast, in the private sector I regularly submit multimillion dollar items on my budget requests with no special justifications, usually a couple of lines explaining what it is and why it delivers business value. I may have to do a one-page business case when I actually order the item, though often the CIO will approve it informally based on hallway conversations, etc. Our total IT budget is roughly $1.2B this year.

At another company, back when UNIX was still new in the corporate world, I once ordered $900K of specialty UNIX software using our standard PC order form. I wrote it in in the "Other" box, below the checkboxes where one selected 33 or 50 MHz, which floppy drive(s) were needed, 15" or 17" CRT, that sort of minutia. I knew I couldn't approve $900K myself so I gave it to my boss. He approved it and it went through without question. Months later he told me he'd just learned his approval limit was only $100K, but nobody in the whole Purchasing and Finance chain had bothered to check. (This was at one of America's largest retail banks, by the way, and it still rakes in money hand over fist.)

All businesses have competition; most branches of government do not have competition. Don't get me wrong, I deal with government quite a lot, and most of the people I deal with are good, honest, hard-working people who are mostly easier to get along with than most of our private sector clients. But there's no denying that government has a unique ability, the ability to force people, at gunpoint if necessary, to fund its products and its operations. Government never has to fear going out of business due to inefficiency, or to a leaner, more innovative competitor.

Most businesses have less competition than one would expect since markets are generally dominated by a few, very large and equally inefficient companies. Young, efficient upstart competitors are generally purchased, then beaten into submission until they are just as inefficient as their parents. (I've seen that happen many times. It's one of the stupidest things corporate America does. "Hey, we like you because you are so effective and profitable. We're going to buy you. Now that we own you, we're not going to look at your processes to see how we can improve. Instead, we're going to impose our broken processes on you. Now you can suck too.)

Government competition is generally internal, and comes from the political pressure on elected officials to do more and spend less. Nobody wants to pay more taxes. See my comments above for a couple of examples.


Just to be clear, I'm not suggesting for a minute government is always, or even usually better than the private sector. One simply cannot make such generalizations. There are good and bad in both. The big advantage government can sometimes have is that it is NOT profit driven and can therefore act more in the interests of its "customers" than a business that puts profits first. It certainly doesn't always work out that way, but it can. And yes, private companies can often strike a good balance that satisfies both customer needs and profit requirements. Again, they can, but ...

 

[Tab]

My point was that Tab isn't even out of school yet and he's already making the claim that the corporate world is "absolutely filled with dumb fuckery, roughness and plenty of inefficiency."

I suspect I wasn't specific enough, but I've been working in the corporate world for 5+ years while going to school and my newest job is at a private company that regularly works with the government through contract work.

EDIT - And bowfinger is absolutely right, corporations are designed solely to make money, that's it. Nothing else.

 

[Ldir]

EDIT - And bowfinger is absolutely right, corporations are designed solely to make money, that's it. Nothing else.

That is why access to health care should not rely on for-profit corporations. Their interest is profit, not health. They profit more by denying coverage. Our health must not suffer just so some CEO can get a bigger mansion.

 

[werepossum]

Oh hell yes! I've seen cases of bureaucracy and counter-productive red tape in some companies that would make your average government paper-pusher gouge his eyes out. I've seen casual waste of literally hundreds of millions of dollars because an SVP presumably read an article about the way IT projects should work, insisted his ignorance become reality (repeatedly firing anyone who tried to offer experienced guidance), hired a CIO with a glaring conflict of interest, brought in busloads of Big Six "consultants" who milked us for every dime they could, literally delivered none of the project requirements after multiple failed attempts over four years -- none, and still got promoted because he spun the one footnote item that was delivered as a great success. While that was the most spectacular example, I've seen dozens of examples of tens of millions wasted due to politics and turf building, and countless examples of routine inefficiency.

I obviously haven't worked for every agency and every company, so my sample size is small. I never saw anything so wasteful in government, however. I'm sure such examples exist, but I never saw anything like it. In fact, the tightest budget scrutiny I ever had was one of my government positions. While you may think government gets a blank check, at the agency level you only get the dollars that are budgeted to you. They were never enough, and there was always fierce competition for them. That meant everything we wanted to do was challenged and dissected.

I once had a small, $1000 parts order challenged because I had included a $6 (IIRC) pair of miniature needle-nose pliers. I had to show that the pliers pushed the order over $1000 and therefore qualified the whole order for a bigger discount (thus actually saving money) before they would approve the invoice.

In contrast, in the private sector I regularly submit multimillion dollar items on my budget requests with no special justifications, usually a couple of lines explaining what it is and why it delivers business value. I may have to do a one-page business case when I actually order the item, though often the CIO will approve it informally based on hallway conversations, etc. Our total IT budget is roughly $1.2B this year.

At another company, back when UNIX was still new in the corporate world, I once ordered $900K of specialty UNIX software using our standard PC order form. I wrote it in in the "Other" box, below the checkboxes where one selected 33 or 50 MHz, which floppy drive(s) were needed, 15" or 17" CRT, that sort of minutia. I knew I couldn't approve $900K myself so I gave it to my boss. He approved it and it went through without question. Months later he told me he'd just learned his approval limit was only $100K, but nobody in the whole Purchasing and Finance chain had bothered to check. (This was at one of America's largest retail banks, by the way, and it still rakes in money hand over fist.)


Most businesses have less competition than one would expect since markets are generally dominated by a few, very large and equally inefficient companies. Young, efficient upstart competitors are generally purchased, then beaten into submission until they are just as inefficient as their parents. (I've seen that happen many times. It's one of the stupidest things corporate America does. "Hey, we like you because you are so effective and profitable. We're going to buy you. Now that we own you, we're not going to look at your processes to see how we can improve. Instead, we're going to impose our broken processes on you. Now you can suck too.)

Government competition is generally internal, and comes from the political pressure on elected officials to do more and spend less. Nobody wants to pay more taxes. See my comments above for a couple of examples.


Just to be clear, I'm not suggesting for a minute government is always, or even usually better than the private sector. One simply cannot make such generalizations. There are good and bad in both. The big advantage government can sometimes have is that it is NOT profit driven and can therefore act more in the interests of its "customers" than a business that puts profits first. It certainly doesn't always work out that way, but it can. And yes, private companies can often strike a good balance that satisfies both customer needs and profit requirements. Again, they can, but ...

Point taken.

 

[Fern]

Oh hell yes! I've seen cases of bureaucracy and counter-productive red tape in some companies that would make your average government paper-pusher gouge his eyes out. I've seen casual waste of literally hundreds of millions of dollars because an SVP presumably read an article about the way IT projects should work, insisted his ignorance become reality (repeatedly firing anyone who tried to offer experienced guidance), hired a CIO with a glaring conflict of interest, brought in busloads of Big Six "consultants" who milked us for every dime they could, literally delivered none of the project requirements after multiple failed attempts over four years -- none, and still got promoted because he spun the one footnote item that was delivered as a great success. While that was the most spectacular example, I've seen dozens of examples of tens of millions wasted due to politics and turf building, and countless examples of routine inefficiency.

I obviously haven't worked for every agency and every company, so my sample size is small. I never saw anything so wasteful in government,...
-snip-

Really?

Check out the IRS's attempt to upgrade it's IT system(s).

They've blown through Billions of $'s and failed spectacularly.

Fern

 

[xj0hnx]

When I see the righties pontificate about how bad government is and how wonderful the private sector is due to the profit incentive, I just laugh my ass off at their naivete. Big government and big business have far more in common than they have differences.

The commonalities and differences are not the problem, or mystery, it's who pays for them.

 

[Tab]

That is why access to health care should not rely on for-profit corporations. Their interest is profit, not health. They profit more by denying coverage. Our health must not suffer just so some CEO can get a bigger mansion.

Yea, that exactly my point. And the same goes for hospitals, and if we're going to go by "capitalism" - they should be able to decline coverage just because they feel like it.

 

[Tab]

The commonalities and differences are not the problem, or mystery, it's who pays for them.

Reduce the defense budget, replace it with socialized medicine.

 

[Bowfinger]

Really?

Check out the IRS's attempt to upgrade it's IT system(s).

They've blown through Billions of $'s and failed spectacularly.

Fern

I was speaking of my personal experiences only. Yes, I've read the stories about the IRS upgrade fiasco, and of similar government boondoggles. I've heard similar stories from the private sector, though they're generally not nearly so well publicized (bad for business). My point again is NOT that government is better than the private sector. It's that one can find both good examples and bad examples in each.

Believe it or not, in my experience one of government's problems is that it is often too focused on saving money. That's "too focused" in the sense of penny wise and pound foolish. In order to save money in this year's budget, I've seen government repeatedly neglect needed maintenance and upgrades, thus driving up operational costs and dramatically increasing the ultimate cost of fixing problems. I wonder if that's not much of the problem with the IRS upgrades, that they waited much too long, making the project far more difficult and expensive.

 

[Bowfinger]

When I see the righties pontificate about how bad government is and how wonderful the private sector is due to the profit incentive, I just laugh my ass off at their naivete. Big government and big business have far more in common than they have differences.

The commonalities and differences are not the problem, or mystery, it's who pays for them.

They are the problem and the mystery to a lot of people here, which is what I addressed. We see such comments here all the time, about how government cannot do abc or is too incompetent to do xyz, while the private sector is invariably far superior and far more efficient due to its "profit incentive." This generalization is a core part of right-wing dogma ... and it's bogus.

Philosophical or pragmatic arguments about who should pay for what are certainly a valid topic for discussion. It is a different topic, however.

 

[Hayabusa Rider]

That is why access to health care should not rely on for-profit corporations. Their interest is profit, not health. They profit more by denying coverage. Our health must not suffer just so some CEO can get a bigger mansion.

Government plans are just as likely to deny coverage because of bureaucracy and regulations. The government has no interest in health. Theirs is making sure people comply.

BTW, like the present system or not (and it needs lots of work), there isn't enough profit to fix the problems, not nearly.

If the government absorbs the health care system it will cost more than all other programs combined. Don't expect cheap.

 

[Hayabusa Rider]

OK, how are you planning for Alzheimers?

Now I have a little time to answer this.

A generic "a chicken in every pot" insurance fix is short sighted. What we need is targeted reform from the ground up. I'll hammer this point once more. All of medicine comes down to the quality of the patient/provider relationship. That's it. Everything that happens works for or against that.

Some will say that all we need to know has been learned. Not in the context of real reform. A study about this and one about that... not sufficient, because it's a complex system, probably the most complicated on the planet there's a whole lot of feedback. I have yet to see one politician or partisan who seems to get that. We practitioners do because we work with it every day.

What we need to do is have a clear goal besides "well just give it to everybody", because what is "it" and what does "it" really mean and do? Does it pay for every ill in every circumstance? Is the government going to pay millions a week to keep people alive for the last couple weeks of their lives? No, "just do it and not pay people" isn't going to work because the kind of talent needed is not commonplace. It requires a substantial portion of one's life to attain and superior intelligence and emotional tenacity to do right. That automatically means that human resources are going to be scarce and that means not cheap. So how much for a life? Does a 10 year old deserve more resources than a 90 year old? Who tells you that your wife's condition has exceeded her worth? In a world of limited resources there will be "death panels". No, not that absurd Palin concept, but someone or some metric which will apply. It's unavoidable. We haven't had a public discussion on this issue and we're "reforming" the system, which means pass the buck.

Understand that Alzheimers will cost what it costs, that diabetes will costs what it costs- same for all illnesses. As the population ages it automatically increases demand for time, attention and treatment. That means $$$$$$$$$$. Only a fool would say "if costs go up". That's like jumping off a cliff and hoping that some UFO beams you aboard before you hit. You will smash to the bottom. Gravity is merciless, and so is time and aging.

Yet how much will all this really cost? Not some estimate of carefully constructed parameters to have the CBO say something complimentary about a political party, but in fact? No one really knows what the TCO of universal coverage over X decades will be, but we'd better figure it out. What's the best way to maximize the utilization of current resourses? Where do we reallocate them and where and when do we need extra? It takes a lot of time to get a health care professional into the system. Who's going to do it? When will it happen? How's it being paid for? Just how many of what kind of professional will we need? How many hospitals when and where?

All of this comes down to that relationship in the beginning, but we're making rules and regs that start at the top without sufficient consideration.

So- we get people who know how the system works. We bring in those who practice from all fields, we bring in health care consumer advocates. We examine the complex network of health care interactions. Technology specialists, actuaries who can compute the real costs outside of partisan interests. What we do NOT need are hacks. Perhaps some sort of election process by the various professions. Something outside of Democrat or Rep control.

Get a grip on where we are now, and where we need to be in 10, 20, 30 years and more and how to get there. How many endocrinologists might we reasonably need? Neurologists? Physical therapists? In some cases we're talking more than a decade of training after an undergrad degree. We need to start preparing for the future now. That's a way to minimize the TCO of health care. Have what and who is needed where and when it has to be there. That involves a whole lot of expert knowledge to estimate.

Create options for Congress complete with reasonable cost estimates highlighting the potential advantages and disadvantages of each.

Examine the various roles of private and government options including hybrids. Model everything according to best scientific and professional care practices. Everything including methods an means is open to the public. Congress doesn't get anything before the public. All documents are for inspection to everyone at the same time so there isn't a spin doctor waiting- from either party.

Now we have something to go to the people with. Congress can attempt to mangle it, but if they try to weasel and obfuscate, the original documents are there for examination for everyone. Then the politicians who are out for power or money do so at their peril.

Once a consensus is reached we start implementation again with the idea of facilitating, not over-regulating. Medicine is a creative art and science. Every person who comes in is unique. Diseases manifest themselves differently and as often as not there are more issues than one. You cannot practice by rote or rule. Find out patients need and enable those who know what to do to do it, and GTFO of their way.

This is an issue where our representatives must relearn what it means to lead by serving. To follow those who are knowledgeable and be good stewards, not partisans in a brawl. Neither party has demonstrated those tendencies, but that's what's required to get this right.

So we have an understanding of what to expect and how to prepare. The touchy subject. How to fund it? That needs to be looked at too. Taxes? Mandatory investments in some health care fund? I don't know what's best, and right now no one does or if they do they've not been heard from. Whatever it is, it cannot be like Social Security or any other hoax lock box. It needs to be a dedicated resource for the future, and if the politicians cannot keep their hands off of it, we'd best forget the whole thing. No, better, hold them accountable. Not just "the other guy" but all of them. Stupid politics as usual isn't to be tolerated.

Whatever mechanism or mechanisms we select will be expensive because of need, but with aiding medicine to help we can cut down on complications in the future and that always saves.

 

[Darwin333]

That is why access to health care should not rely on for-profit corporations. Their interest is profit, not health. They profit more by denying coverage. Our health must not suffer just so some CEO can get a bigger mansion.

I would consider food far more important than health care, what about that?

What about the companies who make the tools and machines used in the health care industry? The companies that research and develop the drugs? Doctors? Nurses? The guy hammering nails building the new hospital? They are all profiting from health care and play a part in "access" and what is accessible, should they not be allowed to profit either?

 

[Bowfinger]

I would consider food far more important than health care, what about that?

That's a poor analogy, an (almost literally) apples to ambulances comparison in at least two key ways. First, the financial consequences are opposite ends of the spectrum. Food costs are modest and predictable. Health care costs can be crushing and completely unexpected. I've yet to hear of someone driven to bankruptcy due to an emergency sandwich or a chronic salad.

Second, the business models and profit drivers are opposites. In the food industry, profits and delivery are intertwined. The purchase, the profit, and the delivery are all part of the same package. One buys the food, the profit is a fixed part of the price, and the delivery happens at the time of purchase. Food sellers profits are tied to sales & delivery. Sell more, deliver more, profit more.

In the health insurance business, however, profits are driven greatly by non-delivery. Insurers want to sell more, they collect their profits up front, but then those profits are eroded every time they actually have to deliver their contracted services. Health insurers profit most when they deliver the least. This means they want to sell most to those who need their services least, and they want to deny services whenever they can get away with doing so.

(Before someone starts pointing out exceptions and additional layers of complexity, yes, the above are simplified generalizations. That doesn't change the fundamental differences in their business models.)

What about the companies who make the tools and machines used in the health care industry? The companies that research and develop the drugs? Doctors? Nurses? The guy hammering nails building the new hospital? They are all profiting from health care and play a part in "access" and what is accessible, should they not be allowed to profit either?

Health care providers are really a different subject than health care insurers. The business model for providers is, in general, far more similar to the food industry, i.e., the more they deliver the more they profit. Thus they aren't generally incented to deny services.

 

[Bowfinger]

Now I have a little time to answer this.

A generic "a chicken in every pot" insurance fix is short sighted. What we need is targeted reform from the ground up. I'll hammer this point once more. All of medicine comes down to the quality of the patient/provider relationship. That's it. Everything that happens works for or against that.

Some will say that all we need to know has been learned. Not in the context of real reform. A study about this and one about that... not sufficient, because it's a complex system, probably the most complicated on the planet there's a whole lot of feedback. I have yet to see one politician or partisan who seems to get that. We practitioners do because we work with it every day.

What we need to do is have a clear goal besides "well just give it to everybody", because what is "it" and what does "it" really mean and do? Does it pay for every ill in every circumstance? Is the government going to pay millions a week to keep people alive for the last couple weeks of their lives? No, "just do it and not pay people" isn't going to work because the kind of talent needed is not commonplace. It requires a substantial portion of one's life to attain and superior intelligence and emotional tenacity to do right. That automatically means that human resources are going to be scarce and that means not cheap. So how much for a life? Does a 10 year old deserve more resources than a 90 year old? Who tells you that your wife's condition has exceeded her worth? In a world of limited resources there will be "death panels". No, not that absurd Palin concept, but someone or some metric which will apply. It's unavoidable. We haven't had a public discussion on this issue and we're "reforming" the system, which means pass the buck.

Understand that Alzheimers will cost what it costs, that diabetes will costs what it costs- same for all illnesses. As the population ages it automatically increases demand for time, attention and treatment. That means $$$$$$$$$$. Only a fool would say "if costs go up". That's like jumping off a cliff and hoping that some UFO beams you aboard before you hit. You will smash to the bottom. Gravity is merciless, and so is time and aging.

Yet how much will all this really cost? Not some estimate of carefully constructed parameters to have the CBO say something complimentary about a political party, but in fact? No one really knows what the TCO of universal coverage over X decades will be, but we'd better figure it out. What's the best way to maximize the utilization of current resourses? Where do we reallocate them and where and when do we need extra? It takes a lot of time to get a health care professional into the system. Who's going to do it? When will it happen? How's it being paid for? Just how many of what kind of professional will we need? How many hospitals when and where?

All of this comes down to that relationship in the beginning, but we're making rules and regs that start at the top without sufficient consideration.

So- we get people who know how the system works. We bring in those who practice from all fields, we bring in health care consumer advocates. We examine the complex network of health care interactions. Technology specialists, actuaries who can compute the real costs outside of partisan interests. What we do NOT need are hacks. Perhaps some sort of election process by the various professions. Something outside of Democrat or Rep control.

Get a grip on where we are now, and where we need to be in 10, 20, 30 years and more and how to get there. How many endocrinologists might we reasonably need? Neurologists? Physical therapists? In some cases we're talking more than a decade of training after an undergrad degree. We need to start preparing for the future now. That's a way to minimize the TCO of health care. Have what and who is needed where and when it has to be there. That involves a whole lot of expert knowledge to estimate.

Create options for Congress complete with reasonable cost estimates highlighting the potential advantages and disadvantages of each.

Examine the various roles of private and government options including hybrids. Model everything according to best scientific and professional care practices. Everything including methods an means is open to the public. Congress doesn't get anything before the public. All documents are for inspection to everyone at the same time so there isn't a spin doctor waiting- from either party.

Now we have something to go to the people with. Congress can attempt to mangle it, but if they try to weasel and obfuscate, the original documents are there for examination for everyone. Then the politicians who are out for power or money do so at their peril.

Once a consensus is reached we start implementation again with the idea of facilitating, not over-regulating. Medicine is a creative art and science. Every person who comes in is unique. Diseases manifest themselves differently and as often as not there are more issues than one. You cannot practice by rote or rule. Find out patients need and enable those who know what to do to do it, and GTFO of their way.

This is an issue where our representatives must relearn what it means to lead by serving. To follow those who are knowledgeable and be good stewards, not partisans in a brawl. Neither party has demonstrated those tendencies, but that's what's required to get this right.

So we have an understanding of what to expect and how to prepare. The touchy subject. How to fund it? That needs to be looked at too. Taxes? Mandatory investments in some health care fund? I don't know what's best, and right now no one does or if they do they've not been heard from. Whatever it is, it cannot be like Social Security or any other hoax lock box. It needs to be a dedicated resource for the future, and if the politicians cannot keep their hands off of it, we'd best forget the whole thing. No, better, hold them accountable. Not just "the other guy" but all of them. Stupid politics as usual isn't to be tolerated.

Whatever mechanism or mechanisms we select will be expensive because of need, but with aiding medicine to help we can cut down on complications in the future and that always saves.

Wow! Well-considered and well said. (Sadly, I learned long ago that virtually nobody here will actually take the time to read and consider long, thoughtful commentary. If it won't fit on a bumper sticker, it's too hard. Maybe if you recorded it and put it on YouTube. )

I think you're right on target about the right way to fix health care. Unfortunately, it will be almost impossible to perform the kind of analysis that needs to be performed without having the results tainted by special interests. There are trillions of dollars at stake, and everyone who can spell "health care" will try to get a piece of it.

But it's the right idea.

 

[werepossum]

Now I have a little time to answer this.

A generic "a chicken in every pot" insurance fix is short sighted. What we need is targeted reform from the ground up. I'll hammer this point once more. All of medicine comes down to the quality of the patient/provider relationship. That's it. Everything that happens works for or against that.

Some will say that all we need to know has been learned. Not in the context of real reform. A study about this and one about that... not sufficient, because it's a complex system, probably the most complicated on the planet there's a whole lot of feedback. I have yet to see one politician or partisan who seems to get that. We practitioners do because we work with it every day.

What we need to do is have a clear goal besides "well just give it to everybody", because what is "it" and what does "it" really mean and do? Does it pay for every ill in every circumstance? Is the government going to pay millions a week to keep people alive for the last couple weeks of their lives? No, "just do it and not pay people" isn't going to work because the kind of talent needed is not commonplace. It requires a substantial portion of one's life to attain and superior intelligence and emotional tenacity to do right. That automatically means that human resources are going to be scarce and that means not cheap. So how much for a life? Does a 10 year old deserve more resources than a 90 year old? Who tells you that your wife's condition has exceeded her worth? In a world of limited resources there will be "death panels". No, not that absurd Palin concept, but someone or some metric which will apply. It's unavoidable. We haven't had a public discussion on this issue and we're "reforming" the system, which means pass the buck.

Understand that Alzheimers will cost what it costs, that diabetes will costs what it costs- same for all illnesses. As the population ages it automatically increases demand for time, attention and treatment. That means $$$$$$$$$$. Only a fool would say "if costs go up". That's like jumping off a cliff and hoping that some UFO beams you aboard before you hit. You will smash to the bottom. Gravity is merciless, and so is time and aging.

Yet how much will all this really cost? Not some estimate of carefully constructed parameters to have the CBO say something complimentary about a political party, but in fact? No one really knows what the TCO of universal coverage over X decades will be, but we'd better figure it out. What's the best way to maximize the utilization of current resourses? Where do we reallocate them and where and when do we need extra? It takes a lot of time to get a health care professional into the system. Who's going to do it? When will it happen? How's it being paid for? Just how many of what kind of professional will we need? How many hospitals when and where?

All of this comes down to that relationship in the beginning, but we're making rules and regs that start at the top without sufficient consideration.

So- we get people who know how the system works. We bring in those who practice from all fields, we bring in health care consumer advocates. We examine the complex network of health care interactions. Technology specialists, actuaries who can compute the real costs outside of partisan interests. What we do NOT need are hacks. Perhaps some sort of election process by the various professions. Something outside of Democrat or Rep control.

Get a grip on where we are now, and where we need to be in 10, 20, 30 years and more and how to get there. How many endocrinologists might we reasonably need? Neurologists? Physical therapists? In some cases we're talking more than a decade of training after an undergrad degree. We need to start preparing for the future now. That's a way to minimize the TCO of health care. Have what and who is needed where and when it has to be there. That involves a whole lot of expert knowledge to estimate.

Create options for Congress complete with reasonable cost estimates highlighting the potential advantages and disadvantages of each.

Examine the various roles of private and government options including hybrids. Model everything according to best scientific and professional care practices. Everything including methods an means is open to the public. Congress doesn't get anything before the public. All documents are for inspection to everyone at the same time so there isn't a spin doctor waiting- from either party.

Now we have something to go to the people with. Congress can attempt to mangle it, but if they try to weasel and obfuscate, the original documents are there for examination for everyone. Then the politicians who are out for power or money do so at their peril.

Once a consensus is reached we start implementation again with the idea of facilitating, not over-regulating. Medicine is a creative art and science. Every person who comes in is unique. Diseases manifest themselves differently and as often as not there are more issues than one. You cannot practice by rote or rule. Find out patients need and enable those who know what to do to do it, and GTFO of their way.

This is an issue where our representatives must relearn what it means to lead by serving. To follow those who are knowledgeable and be good stewards, not partisans in a brawl. Neither party has demonstrated those tendencies, but that's what's required to get this right.

So we have an understanding of what to expect and how to prepare. The touchy subject. How to fund it? That needs to be looked at too. Taxes? Mandatory investments in some health care fund? I don't know what's best, and right now no one does or if they do they've not been heard from. Whatever it is, it cannot be like Social Security or any other hoax lock box. It needs to be a dedicated resource for the future, and if the politicians cannot keep their hands off of it, we'd best forget the whole thing. No, better, hold them accountable. Not just "the other guy" but all of them. Stupid politics as usual isn't to be tolerated.

Whatever mechanism or mechanisms we select will be expensive because of need, but with aiding medicine to help we can cut down on complications in the future and that always saves.

Well said, as usual, and illustrative of the difference between maximizing the efficiency of health care and funding/administering health care. Right now the battle is to control how we as a society shall fund and administer health care, with the structuring of health care following from that. We should be concentrating on recognizing the major problems (existing and predictable) and then maximizing those, with our methods of funding and administrating health care determined by how best to maximize health care efficiency.

 

[Bowfinger]

Now I have a little time to answer this.

A generic "a chicken in every pot" insurance fix is short sighted. What we need is targeted reform from the ground up. I'll hammer this point once more. All of medicine comes down to the quality of the patient/provider relationship. That's it. Everything that happens works for or against that.

Some will say that all we need to know has been learned. Not in the context of real reform. A study about this and one about that... not sufficient, because it's a complex system, probably the most complicated on the planet there's a whole lot of feedback. I have yet to see one politician or partisan who seems to get that. We practitioners do because we work with it every day.

What we need to do is have a clear goal besides "well just give it to everybody", because what is "it" and what does "it" really mean and do? Does it pay for every ill in every circumstance? Is the government going to pay millions a week to keep people alive for the last couple weeks of their lives? No, "just do it and not pay people" isn't going to work because the kind of talent needed is not commonplace. It requires a substantial portion of one's life to attain and superior intelligence and emotional tenacity to do right. That automatically means that human resources are going to be scarce and that means not cheap. So how much for a life? Does a 10 year old deserve more resources than a 90 year old? Who tells you that your wife's condition has exceeded her worth? In a world of limited resources there will be "death panels". No, not that absurd Palin concept, but someone or some metric which will apply. It's unavoidable. We haven't had a public discussion on this issue and we're "reforming" the system, which means pass the buck.

Understand that Alzheimers will cost what it costs, that diabetes will costs what it costs- same for all illnesses. As the population ages it automatically increases demand for time, attention and treatment. That means $$$$$$$$$$. Only a fool would say "if costs go up". That's like jumping off a cliff and hoping that some UFO beams you aboard before you hit. You will smash to the bottom. Gravity is merciless, and so is time and aging.

Yet how much will all this really cost? Not some estimate of carefully constructed parameters to have the CBO say something complimentary about a political party, but in fact? No one really knows what the TCO of universal coverage over X decades will be, but we'd better figure it out. What's the best way to maximize the utilization of current resourses? Where do we reallocate them and where and when do we need extra? It takes a lot of time to get a health care professional into the system. Who's going to do it? When will it happen? How's it being paid for? Just how many of what kind of professional will we need? How many hospitals when and where?

All of this comes down to that relationship in the beginning, but we're making rules and regs that start at the top without sufficient consideration.

So- we get people who know how the system works. We bring in those who practice from all fields, we bring in health care consumer advocates. We examine the complex network of health care interactions. Technology specialists, actuaries who can compute the real costs outside of partisan interests. What we do NOT need are hacks. Perhaps some sort of election process by the various professions. Something outside of Democrat or Rep control.

Get a grip on where we are now, and where we need to be in 10, 20, 30 years and more and how to get there. How many endocrinologists might we reasonably need? Neurologists? Physical therapists? In some cases we're talking more than a decade of training after an undergrad degree. We need to start preparing for the future now. That's a way to minimize the TCO of health care. Have what and who is needed where and when it has to be there. That involves a whole lot of expert knowledge to estimate.

Create options for Congress complete with reasonable cost estimates highlighting the potential advantages and disadvantages of each.

Examine the various roles of private and government options including hybrids. Model everything according to best scientific and professional care practices. Everything including methods an means is open to the public. Congress doesn't get anything before the public. All documents are for inspection to everyone at the same time so there isn't a spin doctor waiting- from either party.

Now we have something to go to the people with. Congress can attempt to mangle it, but if they try to weasel and obfuscate, the original documents are there for examination for everyone. Then the politicians who are out for power or money do so at their peril.

Once a consensus is reached we start implementation again with the idea of facilitating, not over-regulating. Medicine is a creative art and science. Every person who comes in is unique. Diseases manifest themselves differently and as often as not there are more issues than one. You cannot practice by rote or rule. Find out patients need and enable those who know what to do to do it, and GTFO of their way.

This is an issue where our representatives must relearn what it means to lead by serving. To follow those who are knowledgeable and be good stewards, not partisans in a brawl. Neither party has demonstrated those tendencies, but that's what's required to get this right.

So we have an understanding of what to expect and how to prepare. The touchy subject. How to fund it? That needs to be looked at too. Taxes? Mandatory investments in some health care fund? I don't know what's best, and right now no one does or if they do they've not been heard from. Whatever it is, it cannot be like Social Security or any other hoax lock box. It needs to be a dedicated resource for the future, and if the politicians cannot keep their hands off of it, we'd best forget the whole thing. No, better, hold them accountable. Not just "the other guy" but all of them. Stupid politics as usual isn't to be tolerated.

Whatever mechanism or mechanisms we select will be expensive because of need, but with aiding medicine to help we can cut down on complications in the future and that always saves.

Bump. Worth reading.

 

[blackangst1]

Now I have a little time to answer this.

---snipped----

Very well said. And youre right. With baby boomers reaching SS age this year, we need to do something NOW.

 

[Lithium381]

HEALTHCARE IS A RIGHT, AND SHOULD BE FREE UNDER THE GOVERNMENT OF THE UNITED STATEs

 

[IGBT]

HEALTHCARE IS A RIGHT, AND SHOULD BE FREE UNDER THE GOVERNMENT OF THE UNITED STATEs

the tax payer doesn't owe you a living or a doctor.

 

[xenolith]

HEALTHCARE IS A RIGHT, AND SHOULD BE FREE UNDER THE GOVERNMENT OF THE UNITED STATEs

When are you lazy socialists going to get that NOTHING IS FREE!

Eventually someone has to tighten a nut onto a bolt in order for anyone to have anything.

 

[comptr6]

Another battle won in the name of Freedom and Democracy. Hopefully Bohener will now move to impeach Obumerr for forcing his massive ILLEGAL and UNCONSTITUTIONAL bill down our throats.

 

[werepossum]

When are you lazy socialists going to get that NOTHING IS FREE!

Eventually someone has to tighten a nut onto a bolt in order for anyone to have anything.

Well said. There is no such thing as a free lunch; there is only a lunch that someone else pays for. Unfortunately our morals have deteriorated to the point that a near-majority is perfectly fine with using the armed might of government to take things from others as long as they personally benefit.

On the other hand, a substantial majority of people are perfectly fine with using the armed might of government to prevent two consenting adults from marrying if personally they find that relationship to be icky, so perhaps I shouldn't be surprised. As we sow, so shall we reap.

 

[IndyColtsFan]

HEALTHCARE IS A RIGHT, AND SHOULD BE FREE UNDER THE GOVERNMENT OF THE UNITED STATEs

Good lord, are people REALLY this dense?