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Stossel Solves the Health Crisis with Capitalism

Friend of mine who was very overweight developed gallstones. She was told that keyhole surgery was the safest and best way to treat this, but it could only be done (safely) if she lost a lot of weight. She was given all the help possible to lose that weight, including a liquid prescription diet which she stuck to rigidly, and she was developing quite a nice figure....

I wish this story had a happy ending, but it didn't. Shortly before the surgery was due she fell paralysed down one side, and died of a brain tumour seven months later. Of all the horrible coincidences, that was one of the cruellest.

But it's the first part of that story I want to emphasise. Surgery would have been very dangerous at her original weight. Nobody refused to do it. But as it wasn't an emergency, she was given every assistance and encouragement to get herself to a better weight, and it was working. If the condition had suddently presented as an emergency, they'd have operated anyway, and done the best they could. Nobody is going to say, oh, she's too fat, leave her to die.

Rolfe.
 
DaN K. StAnLeY said:
I was just making a point (and should have made it clearer earlier) that if depend on tax money to survive, you should take steps to lighten the load. For example, not feeding your children/yourself garbage that could result in me (and in a UHC system, everyone) having to fork over more cash for medical bills. This is why I suggested another thread would be better to discuss this as I felt I was derailing my own thread. I realize everyone pays for UHC that's why I wasn't arguing to deny them HC (or anything actually) just pointing out the obvious I guess. That people should appreciate the entitlements they have.

Maybe I can explain better with a different example. If someone here is on government housing and pays $20 bucks a month for rent on a house, they give up some rights. They are subject to random inspections to make sure they aren't housing people they aren't supposed to be, and to make sure they are taking care of the house. Some people completely trash the homes and leave holes in the walls and poop and peep in the home. People like that don't deserve entitlements. Other people who appreciate what they are getting will take care of the homes and in some cases make improvements on their own.

I don't see anything wrong with limiting the range of products that people on welfare can buy with foodstamps if it results in them being forced to have a healthier diet. healthier diet for them= less money I have to spend on top of what they are already getting. I'm not certain but it really doesn't seem like a topic for this thread. Maybe I'm wrong. It wouldn't be the first time:p
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OK, talking about non-healthcare entitlements. Couldn't agree with you more. We don't have a food stamps system here. People in that sort of need get actual money. But I can certainly see that the ability to direct purchases in a healthy direction would be one very persuasive argument in favour of a food stamps system. (The other side of the argument is the distress many people in need feel when they are seen to be in receipt of a welfare entitlement, even to the point of refusing the entitlement because they can't bear to be stigmatised in this way. I don't know how it is in the US, but I know that in Britain some people would refuse to take food stamps if they were offered them, because they "couldn't bear the shame" of being seen spending them.)

People who trash council houses round here can find themselves evicted. Though it's usually on the grounds that they have been terrorising their neighbours - it seems to be a behavioural pattern. But what do you do with them? They usually have children. Who may be causing a mini-crime wave in themselves. You can't leave them on the streets. If you put all such antisocial families in the same ghetto, they only make each other worse and create a hellhole. If you put them into a relatively nice area, the neighbours complain and it all starts up again. Of course people shouldn't behave like that. But some of them do. The reasons are complex, and beyond my understanding. I don't know what the answer is, but depriving them of all social benefits probably isn't it.

In any system where risks are pooled, then it should be the duty of everyone to mitigate their risks - and that applies to insurance-based healthcare systems as well as tax-funded ones. But people are people. Imperfect, flawed, weak-willed, sweet-toothed. An advantage of an insurance-based system where premiums are based on the individual's perceived risk is that you can motivate people to improve their risk factors with the carrot of decreased premium prices. I'm not at all persuaded that this is enough to offset all the other disadvantages of insurance-based systems though.

In a universal healthcare system, preventative medicine and lifestyle advice is built in, and reaches everyone. You can't just say to the fatties and the smokers and the alcoholics "stop that or you'll have to pay more". And frankly, you can't say "stop that or we'll leave you to die if you get ill" either. Even though Hittman seems to have this weird idea that this happens. What does happen is advice and help and encouragement to improve one's lifestyle. And if that doesn't work, then hell mend you. But we'll still try to mend you too, if it comes to that.

Rolfe.
 
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Hittman said:
You meant this sarcastically, right? Because it is happening with smokers and the obese in UHC countries, right now. Some UHC supporters deny it, others justify it, and the really amusing ones do both.
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This sounds very much like someone who has his preconceived ideas, and isn't listening to anyone who tries to explain to him that he's got the wrong end of the stick.

The recent "smoking ban" in Scotland (and even more recently in England) was in part supported by observing that identical bans were already in place in many states in the USA, and seemed to be working well. This is related to universal healthcare how, exactly? Of course, "smoking ban" is shorthand for a "ban on smoking in enclosed public spaces". The main argument was one of health and safety for those whose workplace was that public space. As I believe it was in the USA. Which got there first.

Sadly, there's no ban on being obese. Though I do wonder how some people get on to aeroplanes.

I know of no country which has banned smoking as such, or

....participate in dangerous sports? Or ride a motorcycle? Or a sports car? Shouldn't they have to exercise? Prohibited from having more than one drink a day? And on and on and on. . .
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That was actually your post that was being replied to. None of these things are banned (or compulsory, as the case may be). None of them. In any country which has universal healthcare. Nobody is even talking about it. Don't you find all these straw men a bit of a fire risk?

Hittman said:
No, they just get denied some health care for smokers and fatties. Just some, for now. But the wise and benevolent government would never expand that. Because, they're so, you know, wise and benevolent and all. We can always trust the government to know what's best for us, and do it.

I'm still rather amused at how you completely ignored my concerns with the US government's long and historic incompetence, twice, with lame brewery joke.
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I imagine this has all been explained to you before. And you've rationalised away these explanations with

Some UHC supporters deny it, others justify it, and the really amusing ones do both.
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because you really, really, don't want to take on board the fact that universal healthcare works extremely well, and the number of people who live with it and who'd rather move to your system is so small it doesn't seem to register on the radar at all. But I'll try it again anyway.

Obesity and smoking are both really bad risk factors for surgery. Many surgical procedures are not immediately urgent. In many cases (like my friend's gallbladder operation) it's far safer if the patient can lose weight first, and then the surgery can be done with much less risk. Again, some surgery is massively less risky if it is done on someone who has not smoked for a number of months.

So patients are told, lose the weight, or kick the fags, before you have your oeration. They aren't left alone to do this either. As I told you, my friend was provided with a prescription liquid diet with the exact number of calories and vitamins and trace elements she needed, and she was losing weight magnificently on it, as said she felt fine. This is not denying patients healthcare.

But you can't force people to stick to the diet or quit the fags. What if they don't do it? Depends. Maybe the operation will happen anyway, if the surgeon judges that there's still a chance it will be successful. But maybe the surgeon judges that under the circumstances the risk is too great, and that for this patient non-surgical management of the condition is the best course of action.

Now we have red-top tabloids too. And they have a habit of grabbing such cases (few though they are) and screaming about smokers and fatties being denied healthcare. Which is about as true as the stuff they wrote about the McCanns (that is to say not at all), but why do they care if it sells papers.

And as for the piss-up in the brewery remarks. Well, you do ask for it. What on earth is it about the Americans that makes them uniquely incapable of electing a government that's half way competent? As I said in another thread - Are we just back to "all politicians are scum"? Well, our scum manage it. I don't see why yours can't.

Rolfe.
 
Rolfe said:
So patients are told, lose the weight, or kick the fags, before you have your oeration. They aren't left alone to do this either. As I told you, my friend was provided with a prescription liquid diet with the exact number of calories and vitamins and trace elements she needed, and she was losing weight magnificently on it, as said she felt fine. This is not denying patients healthcare.
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If you are arguing with americans using the word fag for a tobacco product might cause some confusion.
 
Odd that hitman would think it’s ok for doctors in the US system to select their patients based on whatever criteria they want, but when doctors in a universal system select their patients based on lifestyle they are being oppressive and taking away people freedom
 
I've been trying to reconcile these two approaches to this question, but they seem diametrically opposed.

On the one hand Dan considers that anyone benefiting from a communal pot of money ought to modify their behaviour to minimise the chance of their taking money (or at least large amounts of money) from the pool. I don't see how anyone could disagree with this. I'm also fairly sure that most of us don't practise what we preach. I don't take enough exercise. And although I'm far from obese, I could stand to lose a couple of stone. The health nuts among us are in the minority.

The truth is that there's a spectrum of lifestyles out there. At one end, there are the health freaks. Regular exercise, follow every dietary recommendation to the letter. At the other end are the slobs. No exercise, bad diet, smoke, too much alcohol, serious weight problem. Most of us are somewhere in the middle. A few vices, nothing horrendous.

What to do about it? It comes down to sticks and carrots. And frankly, almost entirely down to carrots (one of your recommeded five portions of fruit and vegetables a day, of course). Education. Information. Persuasion. Both public campaigns and individual targeted advice and help offered to suitable patients by their doctor. And you know what? This is a lot easier to do in a universal healthcare system, where the health authorities can fund public advertising, and can incentivise doctors to do their best with individual patients - who are at least able to visit their doctor in such a system, before they're seriously ill.

What you can't do is apply a stick. For one thing it doesn't work, but mainly because society simply won't accept the concept of denying or withdrawing the entitlement to healthcare from anyone as a punitive measure. Political suicide doesn't even begin to cover it. And in fact the US system is no different from the universal systems in this. The tax-funded heathcare system in the US is only a safetly-net cover for the disadvantaged, but it too cannot and does not disallow needed healthcare to people who haven't been good healthy-living citizens.

For all the macho rhetoric about freeloaders and people who don't "deserve" entitlement, the bottom line of this chain of logic comes down to a real person with a real life-threatening but treatable disease being denied that lifesaving treatment as a punishment for not being the perfect healthy-living paragon.

You can't do it. No civilised society will do it. You can educate and inform and persuade as much as you like, but there will always be people who won't listen. Until it's too late. One hopes that their experience and example might even so serve as a warning to others - nobody wants lung cancer or heart disease even if they do get treatment! But that's the limit. Allowing these people to die as some sort of enhanced "awful warning" isn't anything your society or mine will countenance. And thank goodness for that. Because which of us leads that perfectly healthy lifestyle? And if we show no mercy to others, can we hope for mercy for ourselves?

But in the red corner, we have Hittman. Isn't it terrible! If we had universal healthcare, I might be forced to modify my lifestyle. Well, no. Just like I said above. One can educate and inform and persuade as much as one likes, but there will always be the brain-dead idiots who won't listen. And you too can be that idiot if you feel like it. You probably will be punished - by the illness you get. And you may even find that in order to benefit from the available treatment you'll have to modify your behaviour belatedly (no doctor is going to perform lung surgery on a patient wich a very high chance of a bad outcome, whether or not that chance is due to something the patient refuses to do anything about). But that's the end of it. Once you've done all that to yourself, you'll get the best treatment that your condition can benefit from.

So Dan, yes, people should do their best not to become a drain on the system. But there's a limit to what can in all humanity be done. And that limit I'm afraid stops short at forcibly preventing Hittman from doing whatever the hell he likes with his life, or denying him the treatment he needs once he has proceeded directly to hell in his own handbasket.

Rolfe.
 
Rolfe said:
I've been trying to reconcile these two approaches to this question, but they seem diametrically opposed.

On the one hand Dan considers that anyone benefiting from a communal pot of money ought to modify their behaviour to minimise the chance of their taking money (or at least large amounts of money) from the pool. I don't see how anyone could disagree with this. I'm also fairly sure that most of us don't practise what we preach. I don't take enough exercise. And although I'm far from obese, I could stand to lose a couple of stone. The health nuts among us are in the minority.
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The thing here is, nobody wants to be the only one who makes sacrifices for the common good, particularly not if those who don´t benefit from it just as well. If you did those exercises and lost those couple of stone, maybe health insurance premiums would go down by 1/10 of a penny or so - but they´d go down for everyone, not just for you.

A solution - and I have no idea how feasible it is - might be to either give bonuses of some kind to those with a particularly healthy lifestyle, or penalties to those with a particularly unhealthy lifestyle. If everyone who smokes, or drinks more than a certain amount of alcohol per week, or has a BMI above a certain threshold, paid more for their insurance, they´d have an extra incentive to stop that behavior, and the extra premiums might help pay the extra cost these people cause.

The big problem I see with that approach is how to check peoples´ lifestyle. BMI should be easy enough to monitor, but smoking and drinking? No idea.

That said, I´d rather go with a somewhat unfair UHC approach, than with the private sucks-to-have-bad-luck approach to health insurance.
 
I don't see universal healthcare as unfair, even though I'm a higher earner paying in a relatively high amount, and I've taken very little out of the system for the past 20 years (20 years ago, though, I was hospitalised with pneumonia).

Here's what I said about this in the other thread.

Rolfe said:
KellyB said in another thread that health insurance for her family takes 50% of their income. This is surely unsupportable. If it's 50% of a low income then maybe it's not a huge price for the insurance, but it must be leaving the family on the breadline.

I've been trying to work out what I actually pay for the NHS. As far as I can figure it, it's about £300 a month in my taxes (£3,600 a year). Probably about a third of the total tax take. Or, if I add that notional £300 back into my take-home pay, then it comes to just over 10% of my monthly take-home pay (or 8.5% of my gross salary). (It might be less than this, as some of the assumptions I'm making are a bit shaky. It's certainly not more.)

The huge difference here is that my contribution is calculated not on my perceived risk (as my motoring insurance is, for example), but on what my income is. So, a low-risk person on a high income is going to be paying quite a lot (and actually, that's the category I'm in, despite what seems to be quite a modest contribution in US terms), while a high-risk person on a low income is going to be paying only a little.

"Oh, how unfair!" I hear the Americans shout. The low-risk person should be paying the small premium and the high-risk the high premium!

But think about it. This is a whole-life thing. I was covered by the NHS when I was a child, and earning nothing (and I can tell you, my father was earning the backside of nothing too). Ditto when I was a student. Ditto when I was just starting out and on a low income. And when I retire and my income goes down, I'll still be covered. If I should have the misfortune to be ill or injured so that I'm unable to work, the NHS will still cover me. No difference. No variation in the care I'm entitled to. And all the time, I pay just that 10% or thereabouts of my income (well, less on a very low income, because of tax allowances).

I don't just look on what I pay now as my contribution to the overall good of the society I live in at the moment, I look on it as my payback for what I've had in the past, and my contribution to what I may need in the future. And under this system nobody can look at my health record and deny me cover, and nobody can insist that I pay a premium I can't afford. I pay in when I can afford it, and it's there for me even when I can't. And if I don't ever need it? Well, hey, who wants to be ill?

I struggle daily to understand why so many Americans don't like this idea. To me, it is the bargain of the century.
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There seems to be a rather blinkered concentration on the here and now in the minds of some US posters. Right now they're young and healthy and see themselves as contributors, and it's the other people who are "taking". But that isn't likely to be the case forever. Isn't it better to pay more when you're well and earning a good income, and not to have to pay if you get sick and are no longer able to earn that income?

Rolfe.
 
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Rolfe said:
I don't see universal healthcare as unfair, even though I'm a higher earner paying in a relatively high amount, and I've taken very little out of the system for the past 20 years (20 years ago, though, I was hospitalised with pneumonia).

Here's what I said about this in the other thread.




There seems to be a rather blinkered concentration on the here and now in the minds of some US posters. Right now they're young and healthy and see themselves as contributors, and it's the other people who are "taking". But that isn't likely to be the case forever. Isn't it better to pay more when you're well and earning a good income, and not to have to pay if you get sick and are no longer able to earn that income?

Rolfe.
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Just to avoid a misunderstanding: by "unfair", I am referring only to the system´s "blindness" towards the things participants do to influence their likelihood of needing it... healthy or unhealthy lifestyle, for example.
 
Chaos said:
Just to avoid a misunderstanding: by "unfair", I am referring only to the system´s "blindness" towards the things participants do to influence their likelihood of needing it... healthy or unhealthy lifestyle, for example.
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I take your point. However, I don't believe there is any way to turn an entire population into perfectly behaved health freaks. No matter how juicy the carrot or how heavy the stick. So where do you draw the line? How many Big Macs is enough to say, you brought it on yourself, you don't get any insulin? What BMI do people get to reach before you take away their blood pressure tablets?

Behind all the cries of fairness or unfairness, of freeloaders and greedy entitlement-seekers, there are people. People who might not have been as clever or as careful as they should have been, but who now have the diabetes or the high blood pressure or whatever. You can't turn the clock back. You have a choice. Do you denounce them as unworthy to benefit from the common pool and leave them to die, or do you treat them anyway?

I know what I think, and I'm glad the society I live in agrees with me.

Rolfe.
 
I found this quite amusing given some of the other conversations I've been having:

http://www.medscape.com/viewarticle/551708_3

Even those who entered medicine for altruistic reasons and continue to be sustained by that motivation need to be compensated for their work. So one obvious answer to the question "What's in it for doctors?" is that they will have patients who have an assured way to deal with the bill. Whatever else their motivation, physicians have a powerful self-interest in being paid for the care they provide. Only the very wealthy can afford to routinely see physicians if they are uninsured.

Yet this reason may not be widely recognized or appreciated among physicians themselves. Here American history provides an exemplary tale. In 1965, the Medicare program was created, providing health benefits for all citizens aged 65 and over. The impact on the health of the elderly, and on their social status, was dramatic. Prior to the advent of Medicare, 35% of the elderly lived in poverty; in 2003 that number was at 9%.[7] Medicare is also credited with desegregating US hospitals, being the largest funder of graduate medical education and creating the field of geriatrics. But for our purposes here, the critical change was creating millions of newly insured patients. In spite of the potential boon to physician incomes, organized medicine strenuously opposed Medicare, a situation in which a misidentified fear of socialism triumphed over common sense and economic self-interest. The American Medical Association (AMA)'s well-organized campaign of lobbying and advertising against Medicare was dubbed "Operation Coffee Cup." The name bespeaks a strategy of building grass-roots opposition, and one feature of the campaign involved sending physicians' wives anti-Medicare phonograph records and tapes to play for their neighbors. One of the speeches on the records and tapes was given by Ronald Reagan and intoned that Medicare would mean that one day "we will awake to find we have socialism."[8] The socialism charge was nothing new at the time, and has remained a staple ingredient of opposition to reform, including the defeat of Clinton's Health Security Act in 1994. Medicare was passed in spite of organized medicine's massive campaign of opposition. Yet our main point is less about the erroneous ideological charges that fueled the opposition of the AMA in 1965, and more about the great irony of organized medicine lobbying fiercely against the economic self-interest of its members. In retrospect, it is clear that Medicare has had a profound, beneficial effect on physician incomes, as well as on the health status of the elderly.
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Rolfe said:
I take your point. However, I don't believe there is any way to turn an entire population into perfectly behaved health freaks. No matter how juicy the carrot or how heavy the stick. So where do you draw the line? How many Big Macs is enough to say, you brought it on yourself, you don't get any insulin? What BMI do people get to reach before you take away their blood pressure tablets?

Behind all the cries of fairness or unfairness, of freeloaders and greedy entitlement-seekers, there are people. People who might not have been as clever or as careful as they should have been, but who now have the diabetes or the high blood pressure or whatever. You can't turn the clock back. You have a choice. Do you denounce them as unworthy to benefit from the common pool and leave them to die, or do you treat them anyway?

I know what I think, and I'm glad the society I live in agrees with me.

Rolfe.
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Please... I´m not talking about denying anything to people, I´m talking about making them pay more to begin with.

I´m looking at this from the household and building insurance POV, which was the area I spent a lot of time in, back in my insurance employee days. There, if you live in an area with a high storm risk, you pay more for storm insurance. If you live in a bad part of town, you pay more for burglary insurance. And so on. You can´t change the storm risk, any more than you can change the health risk from smoking, but you can decide not to live in a risky area, just like you can decide not to smoke.

So, for example, for BMI you could say, each point of BMI above X raises your premium by Y percent above its base value. (In Germany, public health insurance is paid via premium that is Z percent of your salary, up to a certain maximum) I chose BMI because it should be easy enough to determine by check-ups, or whenever you happen to see your doctor for other reasons.
With Big Macs or booze or smoking, I could imagine a health tax of some sort levied when it is sold.

I know very well that it may be impossible to cover all risk factors that way, or even just all the important ones. I am not talking about creating a perfect situation, either - just thinking about how to create one that is better than it is now, if that is possible.
 
Chaos said:
Please... I´m not talking about denying anything to people, I´m talking about making them pay more to begin with.

I´m looking at this from the household and building insurance POV, which was the area I spent a lot of time in, back in my insurance employee days. There, if you live in an area with a high storm risk, you pay more for storm insurance. If you live in a bad part of town, you pay more for burglary insurance. And so on. You can´t change the storm risk, any more than you can change the health risk from smoking, but you can decide not to live in a risky area, just like you can decide not to smoke.

So, for example, for BMI you could say, each point of BMI above X raises your premium by Y percent above its base value. (In Germany, public health insurance is paid via premium that is Z percent of your salary, up to a certain maximum) I chose BMI because it should be easy enough to determine by check-ups, or whenever you happen to see your doctor for other reasons.
With Big Macs or booze or smoking, I could imagine a health tax of some sort levied when it is sold.

I know very well that it may be impossible to cover all risk factors that way, or even just all the important ones. I am not talking about creating a perfect situation, either - just thinking about how to create one that is better than it is now, if that is possible.
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So do you want people to pay more because they are high risk, or only if that high risk is their own fault?

Anyway, cigarette smokers and heavy booze drinkers already pay a fairly hefty tax on those purchases.
 
And the ones with the chaotic lifestyles, who can't cope and can't pay, and get the diabetes anyway - do you treat them?

Rolfe.
 
I read as much as I could of the thread, then realized it had split, so pardon my ignorance if this has been covered.

Healthcare costs are high for a lot of reasons. But we're so much better off, medically, than ever before in history.

So, if the uninsured create external costs or hidden tax on responsible people who pay for medical insurance, and don't lead dangerous or unhealthy lifestyles, isn't that just a fact of life?

We must treat the sick and injured regardless, so if it's in the form of public healthcare, where we are taxed heavily, or in the form of free market healthcare, where we are taxed in a hidden way when rates and procedure costs go up, what's the difference?

The only difference is how much it costs everyone, whether it's public tax, or private rate increase right?
 
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