Equity market says US Health Bill is killed

[Francesca R]

[Faithkills is] one of those woo guys wanting open an alernative school of medicine.

I assume that's a joke. If not, I think it's a daft supposition. A pretty strong argument could be made that the rise of altmed demand owes much of its success to restrictive licensing of supply of the mainstream kind. After all, if health insurance and medical care are too expensive or bureaucratic, what better reason to walk in to some alternative supplier whose door is open and whose first consultation is free?

 

[Rolfe]

I take your point, Francesca, but how do you deal with the very obvious public safety issues if you don't have some sort of accreditation system?

It seems to me that it's not the accreditation system as such that's the problem, but a perceived artificial cap on the numbers who can be accredited. There are certainly more people able and willing to study medicine than are actually admitted to these courses.

Rolfe.

 

[Francesca R]

Not really sure, except by some kind of "separation of powers". Don't give the professional organisation carte blanche to write the regulations, have some way of giving it to the customers and/or the public. There'd still be lobbying by the profession to scare the bejeeperjoopahjeezus out of the public of course.

The other thing I've thought of in the past (for the UK) is why all the myriad OF[whatever] watchdogs don't seem to weigh in on. or police anti-competitive barriers to the professions/industries they regulate. At least, it doesn't seem like they do to me.

 

[Newtons Bit]

How do you deal with their incentive to raise barriers to competition?

Incidentally, history shows that almost every profession is prepared to have a go at lobbying for self-written regulations, ostensibly on the grounds of public safety (rather than group interest)--manicurists, plumbers, hairdressers . . .

I sit on the Structural Engineers Association of New Mexico Ethics Committee (that's a really long name). We are currently struggling with wanting to create a specific license for Structural Engineers in our state that is above and beyond the standard Professional Engineer and balancing that with knowing it will edge out some of our own competition (which could be unethical). We are quite literally at an impasse over this.

It comes down to whether or not there are specific events that results in either the loss of property or life that could have otherwise been avoided by having stricter standards on testing, education and continuing education by the designers. There hasn't been a major event in my State such as this. However, anecdotally, every person that sits on that Committee has done retrofits on buildings or seen new construction that appears to lack a seismic force resisting system. If "the big one" hits, the people on the board who are opposed to increased licensure (which includes myself) will almost certainly change our mind due to the mass number of failures.

I don't think that really answers your question. And it is definitely a challenging one. It ultimately comes down to the question of what level is public safety really endangered by having unlicensed people working that specific field and how licensure works to protect the public. Engineering and Medicine are pretty much no-brainers. It's very easy to accidentally kill someone as a doctor. It's also easy to kill thousands of people from one mistake as an engineer. And it's up to our politicians, God save us, to determine what level of risk in public safety is appropriate.

 

[lomiller]

Not really sure, except by some kind of "separation of powers". Don't give the professional organisation carte blanche to write the regulations, have some way of giving it to the customers and/or the public. There'd still be lobbying by the profession to scare the bejeeperjoopahjeezus out of the public of course.

Part of the problem is that for many professions (possibly all professions, as this can be part of the definition of “professional") is that the only people truly qualified to determine someone’s competence are people of the same profession. You can’t really have an non-engineer trying to figure out if an engineers decisions are reasonable, nor can you have someone who isn’t a physician second evaluating the decision of a physician. That said, agree that these professional organizations can’t be completely independent only answer to its members.

 

[Francesca R]

Well thats what the professional organisations say. But then, they would, whether it was true or not.

However, in my view, a external independent body that is expert in competition policy should still be able to detect anti-competitive protectionist abuses, without specialist knowledge of the relevant field.

(I know this adds another quantum of quango, but I would hope the net result would be a dismantling of regulation that does not serve the public. No real idea though)

 

[Rolfe]

Going back to the chiropractors, the other potential problem you have to think about in a glut situation is people "making work". If it's all completely unregulated apart from a basic competence check, there is a definite risk of people being subjected to more and more tests and procedures to keep the physician's income up.

So, 80% of ano-rectal haemorrhoids settle with simple diet and lifestyle modification. Only 20% require surgery. If the diet and lifestyle advice nets the doctor $50 and day surgery for haemorrhoids nets him $1000, what percentage of patients presenting with haemorrhoids are going to be operated on, if there are doctors and to spare trying to make a living?

Rolfe.

 

[lomiller]

However, in my view, a external independent body that is expert in competition policy should still be able to detect anti-competitive protectionist abuses, without specialist knowledge of the relevant field.

Hmm so if an expert on anti-competitive behavior deems that there are not enough doctors being certified to meet the demand for medical care thus driving up salaries, but an expert on medical standards says that there are no more candidates who measure up who do you believe? After all it’s distinctly possible they are both correct…

 

[Ziggurat]

So, 80% of ano-rectal haemorrhoids settle with simple diet and lifestyle modification. Only 20% require surgery.

Why are you so familiar with these statistics?

 

[Rolfe]

Heard a doctor talking about it last week. Why, what were you thinking?

The doctor was an NHS one, who was complaining that NHS targets were providing an incentive to operate on patients who didn't need surgery. It occurred to me that the incentive could be a lot stronger in a private system.

Rolfe.

 

[Magyar]

So why is it that the USA is the only country that can not, or is incapable of putting forward a viable single payer system that would be on par with, well, any other country that enjoys it?

THis is one of the things that makes me laugh about this whole arguement from the right on this subject.

In one breath they claim that the systems that every other first world nation has developed is poor, innaficient etc, they ignore he costs and number provided to them over and over and then declare that the US can't possible do any better. All the while screaming jingoism at full volume.

 

[Faithkills]

I think he was referring to the belief that the AMA forces maximum quotas on the number of doctors a school can graduate a year to keep it's accreditation. I'm not sure if this is an urban legend or not, I haven't researched it.

I was and you should. It's done via the LCME on which the AMA has a structural permanent majority vote. The other party, the AAMC, actually wants more med schools. The FSMB controls individual licensing through which they have basically fixed prices, stopped internet medicine, stopped salaried and contract practice. You hear all about fee for service is awful? Well it's the AMA that has basically insured this is the only allowed form of service. (it's not inherently awful but it is a problem when it's the only allowed form)

He's one of those woo guys wanting open an alernative school of medicine.

Not in the least. And I certainly don't want to emulate an NHS which spends billions of pounds on crap like homeopathy/

I have to say that this is got to be the dumbest things you posted! There are a LOT of things wrong with the health care industry but standards and the AMA (I am not talking about some specific grip you may have against them)
is NOT one of them.

Where did I say anything about standards? I would love standards but that's not what we have. We have private groups with police powers, which uses those powers to perpetuate their monopoly and the profits from that to perpetuate the monopoly.

The AMA shouldn't be involved at all. Set standards for med school accreditation. Set standards for licensure.

This is the 100th aniversary fo the Flexner papers http://content.nejm.org/cgi/content/full/355/13/1339

That guy wasn't even a doctor. He was a failed businessman who happened to be connected to corporatists.

The scheme was to set up a monopoly and that's just what they did.

The curse of medical education is the excessive number of schools--Abraham Flexner, 1910.

Why don't you spend some time reading about what "medicine" was when we had your precious free market

I would advise the same.

Technology has advanced but that hasn't saved us from flipper babies and speed teens and insulin coma therapy etc etc etc all of which was a product of "approved" conventional medicine.

Basically you've begged the question that medicine would not have improved without a monopoly on the market. There's no evidence of this. You carry in your pocket a communications/computing device more powerful than a room full of computers 40 years ago. Technology advances.

People in the soviet union wouldn't have understood how bread got to the table if government didn't force people to work too. There's no evidence monopolies do anything except impede progress.

The question I asked, was for you to clarify what you meant by your assertions that your lack of universal healthcare gave you so much freedom

Where did I say lack of universal healthcare gave me so much freedom?

Fact is, you really don't know how anything would pan out if either of us got a serious illness due to data not being available.

Cancer outcomes are readily available. I have posted them.

What's unusual is that you dispute them. The typical tactic is to evade by talking about life expectancy instead of medical outcomes. Didn't you get the propaganda memo? Never let them talk about relevant data!

But don't underestimate the performance of a universal healthcare system you have no experience with, and for which genuinely comparable statistics don't exist, on the basis of hard cases and scare stories.

Of course they exist.

And why do you keep trying to sell this?

You have merely said that your overall rate of tax is less than mine (which we have agreed is irrelevant)

We agreed it's not relevant to you. I'm pleased to have choice about how 10% more of my life spent working is spent. You don't care. You think bureaucrats and politicians spend it better and more efficiently. I still wonder why do you bother to keep any for yourself in the case.

Alas we don't have these efficient angels like Blair and Brown in the US. Our guys are corrupt and wasteful. Grubbyl Merikans you know?

Recall this conversation is about US health care. I'm glad you're happy.

So could you please get back to explaining in what way I'm not free? Or just drop it?

Who am I to decide? I know my preferences. Yours only concern me inasmuch as you seem so very keen on the US accepting yours.

I believe you that higher taxes make you more free. I believe you when you assert people get more benefit from government the more they are taxed.

I do wonder why you don't care to take a higher dose of your preferred freedom though.

Stop saying Americans are more free

As I never said that, I'll be happy to 'cease'.

at the same time as trying badly to deny that this means you think freedom is how much wonga you keep back from the IRS.

I don't assume the reader is too stupid to scroll up. Why do you?

I never said freedom is solely lower taxes. More choice on how to utilize the reward from your labor is most certainly a freedom, and I do think it's a useful metric.

Nothing more have I said no matter how many times you re-assert your reductio.

(You'll be aware that America has almost the top corporation tax rates in the OECD, incidentally?)

I am of course. It's certainly a problem.

Maybe, but the idea that licensing physicians intereferes with the "Free Market" is common meme among Libertarians.

Licensing is fine. Realtors are licensed. This is a trade association. Drivers are licensed. This is a police power.

The problem is the term means more than one thing. The AMA is a trade association with police powers. This is a problem. This has created huge problems, as we see.

Where licensing is required it makes no sense at all to delegate that authority with a vested interest in restricting supply to drive up prices.

Doesn't really matter. Probably the biggest single cost of healthcare in the US is that one third of all medical procedures in the US are unnecessary. Not sure how adding more doctors is supposed to help that.

Because increasing supply is known to drive up prices? Think this through. Why is demand 'inelastic?'

AFAIK Rolf is correct, the only country where you are likely to be told “you must use this doctor” is the US. It will be an insurance company/HMO saying it and not a bureaucrat, but I don’t see how that makes much difference.

Except that's not true. I can see anyone from a huge list and if I want to see someone not on the list I pay more. But there's lots of different plans.

In Canada 90% of doctors are private businessmen who accept/reject patients as they see fit. You go see whatever doctor you want, and they give you the treatment you and the doctor deem most suitable.

So the doctor lotteries and waiting lists are a myth? It's not true that Canada has one of the worst doctor patient rations in the world

Do Canadians live longer? Sure. Is less of their GDP health care? Absolutely. Am I more likely to survive a serious illness? You bet.

I'm not trying to convince Canadians to give up Canadacare.

I'm not trying to convince Brits to give up the NHS.

I'm still wondering about all the knickers in a bunch.

Not really sure, except by some kind of "separation of powers". Don't give the professional organisation carte blanche to write the regulations, have some way of giving it to the customers and/or the public. There'd still be lobbying by the profession to scare the bejeeperjoopahjeezus out of the public of course.

The other thing I've thought of in the past (for the UK) is why all the myriad OF[whatever] watchdogs don't seem to weigh in on. or police anti-competitive barriers to the professions/industries they regulate. At least, it doesn't seem like they do to me.

On the right track. You seem to have a good head on your shoulders when you're not busy putting words in peoples' mouths

Regulatory capture and licensing as monopoly.

Big business is to regulation like Bre'er Rabbit to the briar patch. Sure it costs them but it costs new competition more thus it's a tremendous benefit. Regulation is by it's nature, as is almost all government market intervention, anti-competitive. If you want to compete you compete. If you don't you need government.

Unfortunately the stronger you make government the more you make corporations compete for government instead of to provide the best quality and best value for the consumer.

Similarly licensing, while a fine marketing mechanism, becomes immediately a moral hazard when the government gives the licensing organization police powers. Basically a trade association gets the power to tell a citizen "You may not practice this profession!". If there is a need for this sort of licensure then it must become the purview of the state. Otherwise we end up with what we have. A government paid off by monopolists. Everyone wins but consumers.

Here's a short vid of a fine example of protecting the public from interior design 'malpractice'