The Moderate Voice - Latest Comments in Poll Shows Most Americans Want Public Health Care

Re: Poll Shows Most Americans Want Public Health Care

charity01 — Wed, 15 Jul 2009 22:32:13 -0000

Personally I would have preferred the Insurance Companies, Hospitals, Drug companies would have been willing to make health care affordable rather spend 1 trllion dollars we don&#39t have. But guess what folks it&#39s this thing called greed! So now we have to look at another alternative. If the private sector rather risk going under becuase of pending profit margins than so be it! I guess that means some CEO will not be able to purchase his yacht!

Re: Poll Shows Most Americans Want Public Health Care

charity01 — Wed, 15 Jul 2009 17:32:13 -0000

Personally I would have preferred the Insurance Companies, Hospitals, Drug companies would have been willing to make health care affordable rather spend 1 trllion dollars we don't have. But guess what folks it's this thing called greed! So now we have to look at another alternative. If the private sector rather risk going under becuase of pending profit margins than so be it! I guess that means some CEO will not be able to purchase his yacht!

Re: Poll Shows Most Americans Want Public Health Care

kathykattenburg — Thu, 25 Jun 2009 04:18:27 -0000

Wow. That&#39s an impressive persecution complex Jason&#39s got there. :-)

Re: Poll Shows Most Americans Want Public Health Care

kathykattenburg — Wed, 24 Jun 2009 23:18:27 -0000

Wow. That's an impressive persecution complex Jason's got there. :-)

Re: Poll Shows Most Americans Want Public Health Care

JasonArvak — Wed, 24 Jun 2009 21:19:31 -0000

Jason, your demonizing of "the left", which from your blog, appears to be your style, is ironic, especially as you seem fond of demonizing lefties for demonizing righties. We actually could have a rational discussion, but we&#39re so polarized that it always seems to degenerate into something like this. Too bad.

GreenDreams, I do criticize lefties but I don&#39t think I demonize them. And I would love to have a rational debate among alternatives and moving towards a compromise on health care. But as long as people like Kathy keep inserting into the debate their presumption that anyone who disagrees with them or even doubts their purist demands for a second is not only wrong but a bad person, I don&#39t think that is likely.

Unfortunately, people like Kathy have no reason to alter their openly vicious rhetoric as long as their fellow liberals and leftists remain silent about it while at the same time criticizing the other side any time it puts so much as a rhetorical toe out of line.

Re: Poll Shows Most Americans Want Public Health Care

JasonArvak — Wed, 24 Jun 2009 16:19:31 -0000

Jason, your demonizing of "the left", which from your blog, appears to be your style, is ironic, especially as you seem fond of demonizing lefties for demonizing righties. We actually could have a rational discussion, but we're so polarized that it always seems to degenerate into something like this. Too bad.

GreenDreams, I do criticize lefties strongly but I don't think I demonize them. (I think the difference lies in not making direct attacks against their character even if I do criticize their behavior. As can be seen above as well as broadly throughout this site and throughout the left-leaning blogosphere, direct character attacks BY leftists AGAINST non-leftists are pretty much a routine and acceptable response to any disagreement. But any criticism, no matter how mild, BY non-leftists AGAINST leftists is considered intolerable. Also, the fact that you had no complaint about the most vicious personal assault on this entire thread undermines your legitimacy here.)

And I would love to have a rational debate among alternatives and moving towards a compromise on health care. But as long as people like Kathy keep inserting into the debate their presumption that anyone who disagrees with them or even doubts their purist demands for a second is not only wrong but a bad person, I don't think that is likely. Asking conservatives and moderates to compete on a rhetorical playing field that is intentionally and dramatically rigged against them is unreasonable.

Unfortunately, people like Kathy have no reason to alter their openly vicious rhetoric as long as their fellow liberals and leftists remain silent about it while at the same time criticizing the other side any time it puts so much as a rhetorical toe out of line. As long as their preferred audience continues to support their rigging the game, they will eagerly continue to rig it and, apparently, believe themselves to be laudable for doing so.

But please don't ask me to smile and love it.

Re: Poll Shows Most Americans Want Public Health Care

GreenDreams — Tue, 23 Jun 2009 20:29:15 -0000

Good comments, DLS. When the fight is over, regardless of what happens, we still have to deal with the major reason for cost increases. We have a high cost burden for end of life procedures that place a major part of an individual&#39s lifelong medical care cost in the last few months of life, plus we have only a few % of individuals who incur especially high costs. Clearly we will need to set some limits, and that will be harder and more contentious even than who pays, which is the focus of the current fight.

As for prevention, through lifestyle or other incentives, we could do much there. I think most are not aware of how poorly we do in this area. In the US, we have only 4 preventive medicines available over the counter: fluoride toothpaste, sunscreen, seasickness prevention and aspirin. There is actually a 5th, formerly ulcer medicines, now approved for "indigestion prevention." When we talk about "preventive medicine" we usually mean early disease detection (mammograms, prostate check, cholesterol testing). The realm of preventive medicines is relatively unexplored, except in the dietary supplement world.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:55:24 -0000

"I would agree that mammograms and all other preventative screening tests should be covered for everyone that does not have private insurance by a government health care plan."

But then you run into a serious problem. What you say (and other examples I can think of) appeal wonderful in theory, but you&#39ll find that in many cases, the tests, for example, have been considered by people already in the government(s) and rejected as not cost-effective.

This is something to keep in mind as the scope of public health care grows (as it is likely to do).

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:52:13 -0000

"Krugman is extremely left wing when it comes to fiscal/economic issues"

Well to the left (far left of the public, like a left-wing Dem or even playing with Green-dom). Part of where he appears at any time (what words he chooses) depends on the lib Dem point of view on the issue of the moment about which he wants to contribute.

Krugman is like other "economists" notably in the Northeast who are well left of the public and routinely mix their economics with politics.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:49:06 -0000

"care for our citizens"

Note the correct meaning of that word "care" here means specifically, "provide medical care," not anything more general or broad and subject to being a rationale for all kinds of entitlements as well as a way of satisfying feelings or cravings some might have.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:47:25 -0000

"As to the points about &#39rights,&#39 I have avoided using that term, though others did. Rather, it&#39s a public policy decision about whether or not we will care for our citizens."

Absolutely. There is no "right" [sic] to this (nor to so many other things that in practice are claims on others&#39 time, labor, and money). It is merely a decision to create an entitlement, that word being fully sound not only legally but conceptually.

A significant fraction strongly want public health care, and plenty among the many who are wary of too much government and loss of freedom (and privacy, etc.) would still look to it as a default alternative if everything else seems worse or intolerable eventually.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:43:53 -0000

"the assertion that a single payer (or public option) system might not save anything"

I&#39ve never said that. There are up-front savings and it&#39s logical to assume that Medicare for All would be "streamlined" compared to what we have now. But there won&#39t be a permanent cap or brake on the costs, because the demographics (aging of the population) and increasing expense of improvements in medical treatments will force costs upward. "Wellness" emphasis that goes beyond the well-known preventive care will not achieve miracles, and there are limits, anyway, to what people should be expected or worse, required [compelled] to do in the name of wellness or prevention, or what restrictions, taxes that aim at medical-related social engineering, or prohibitions people should be subjected to. Wellness at the cost of too much freedom or quality of life ends up being the well-meaning equivalent of keeping the very elderly and sick (near death) alive at an effort that some routinely argue is not justified, and in fact is inappropriate.

Food for thought...

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:38:18 -0000

"experts in relevant fields think nonprofit health care is a sensible and timely idea"

Many in academia ("experts") are more liberal than the public and form a liberal community; I would look at doctors, and others who are actual _providers_.

Many of the providers are ready to go to public health care, to simplify and ease paperwork as contrasted with what they face with the insurance companies.

They also want the lawsuit-abuse problem corrected, but I doubt a Dem administration will correct this.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 18:34:58 -0000

"2. Providing financial help to people who can&#39t afford #1."

Vouchers (for health care only, even without monetary value, but denoting what the person can receive) -- the alternative is to end all such assistance programs of all kinds (not only health care) and just give people cash (even a "guaranteed minimum income" or "basic income guarantee," to use the two favorite terms that describe this concept and objective). The simplicity is appealing, as well as the termination of so many counter-productive and harmful programs and bloated bureaucracies. (AFSCME and other organizations would never want the programs ended, but expanded instead, in addition to the income entitlement.)

* * *

"Haggling is actually the sign of a market inefficiency."

I&#39m not sure. The potential is always there, as no two people or parties are alike, and moreover, we&#39re seeing an upswing in haggling (the ability of buyers to negotiate prices downward, to be more specific here), which is a sign of a continued downward movement, decline, recession, depression, you name it.

Re: Poll Shows Most Americans Want Public Health Care

GreenDreams — Tue, 23 Jun 2009 15:29:15 -0000

As for prevention, through lifestyle or other incentives, we could do much there. I think most are not aware of how poorly we do in this area. In the US, we have only 4 preventive medicines available over the counter: fluoride toothpaste, sunscreen, seasickness prevention and aspirin. There is actually a 5th, formerly ulcer medicines, now approved for "indigestion prevention." When we talk about "preventive medicine" we usually mean early disease detection (mammograms, prostate check, cholesterol testing). The realm of preventive medicines is relatively unexplored, except in the dietary supplement world.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:55:24 -0000

"I would agree that mammograms and all other preventative screening tests should be covered for everyone that does not have private insurance by a government health care plan."

But then you run into a serious problem. What you say (and other examples I can think of) appeal wonderful in theory, but you'll find that in many cases, the tests, for example, have been considered by people already in the government(s) and rejected as not cost-effective.

This is something to keep in mind as the scope of public health care grows (as it is likely to do).

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:52:13 -0000

"Krugman is extremely left wing when it comes to fiscal/economic issues"

Well to the left (far left of the public, like a left-wing Dem or even playing with Green-dom). Part of where he appears at any time (what words he chooses) depends on the lib Dem point of view on the issue of the moment about which he wants to contribute.

Krugman is like other "economists" notably in the Northeast who are well left of the public and routinely mix their economics with politics.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:49:06 -0000

"care for our citizens"

Note the correct meaning of that word "care" here means specifically, "provide medical care," not anything more general or broad and subject to being a rationale for all kinds of entitlements as well as a way of satisfying feelings or cravings some might have.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:47:25 -0000

"As to the points about 'rights,' I have avoided using that term, though others did. Rather, it's a public policy decision about whether or not we will care for our citizens."

Absolutely. There is no "right" [sic] to this (nor to so many other things that in practice are claims on others' time, labor, and money). It is merely a decision to create an entitlement, that word being fully sound not only legally but conceptually.

A significant fraction strongly want public health care, and plenty among the many who are wary of too much government and loss of freedom (and privacy, etc.) would still look to it as a default alternative if everything else seems worse or intolerable eventually.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:43:53 -0000

"the assertion that a single payer (or public option) system might not save anything"

I've never said that. There are up-front savings and it's logical to assume that Medicare for All would be "streamlined" compared to what we have now. But there won't be a permanent cap or brake on the costs, because the demographics (aging of the population) and increasing expense of improvements in medical treatments will force costs upward. "Wellness" emphasis that goes beyond the well-known preventive care will not achieve miracles, and there are limits, anyway, to what people should be expected or worse, required [compelled] to do in the name of wellness or prevention, or what restrictions, taxes that aim at medical-related social engineering, or prohibitions people should be subjected to. Wellness at the cost of too much freedom or quality of life ends up being the well-meaning equivalent of keeping the very elderly and sick (near death) alive at an effort that some routinely argue is not justified, and in fact is inappropriate.

Food for thought...

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:38:18 -0000

"experts in relevant fields think nonprofit health care is a sensible and timely idea"

Many in academia ("experts") are more liberal than the public and form a liberal community; I would look at doctors, and others who are actual _providers_.

Many of the providers are ready to go to public health care, to simplify and ease paperwork as contrasted with what they face with the insurance companies.

They also want the lawsuit-abuse problem corrected, but I doubt a Dem administration will correct this.

Re: Poll Shows Most Americans Want Public Health Care

DLS — Tue, 23 Jun 2009 13:34:58 -0000

"2. Providing financial help to people who can't afford #1."

Vouchers (for health care only, even without monetary value, but denoting what the person can receive) -- the alternative is to end all such assistance programs of all kinds (not only health care) and just give people cash (even a "guaranteed minimum income" or "basic income guarantee," to use the two favorite terms that describe this concept and objective). The simplicity is appealing, as well as the termination of so many counter-productive and harmful programs and bloated bureaucracies. (AFSCME and other organizations would never want the programs ended, but expanded instead, in addition to the income entitlement.)

* * *

"Haggling is actually the sign of a market inefficiency."

I'm not sure. The potential is always there, as no two people or parties are alike, and moreover, we're seeing an upswing in haggling (the ability of buyers to negotiate prices downward, to be more specific here), which is a sign of a continued downward movement, decline, recession, depression, you name it.

Re: Poll Shows Most Americans Want Public Health Care

Dr_J — Tue, 23 Jun 2009 05:47:33 -0000

"Patients are not really in a position to negotiate with doctors or hospitals, even if they didn&#39t need care urgently."

Consumers are in no better a position to negotiate with grocery stores or oil companies or airlines. But grocery stores compete aggressively on price and quality. Oil is a competitive, efficient commodity. You don&#39t even have to talk to an airline to shop for the best flights and prices, just go to a search engine that lets you choose. A far cry from anything available to us for health care.

Haggling is actually the sign of a market inefficiency. If people don&#39t have good information about what the real market clearing price is, they test each other to try to find such a middle point. Doing it can be expensive, too--for example a strike may go on for weeks as both sides try to figure out where the real bottom line is, during which both labor and management are losing a lot of money. Provide a stable, transparent market, though, and no one has to bother.

Re: Poll Shows Most Americans Want Public Health Care

GreenDreams — Tue, 23 Jun 2009 05:14:37 -0000

Jason, your demonizing of "the left", which from your blog, appears to be your style, is ironic, especially as you seem fond of demonizing lefties for demonizing righties. We actually could have a rational discussion, but we&#39re so polarized that it always seems to degenerate into something like this. Too bad.

Nicera, I brought up Krugman and did not ever imply he is "beyond reproach". So many straw men here. I also mentioned a couple doctors, the WHO, and glad to cite others if you want. My point is independent of your opinion of Krugman. It is that experts in relevant fields think nonprofit health care is a sensible and timely idea, most of the public wants it (convenient dismissals of the NYT poll are irrelevant. Other polls show the same thing), and most doctors want it (again, according to multiple polls.)

To the concept of competition, in terms of patients negotiating down costs or going elsewhere, I&#39m surprised anyone thinks that would work. Patients are not really in a position to negotiate with doctors or hospitals, even if they didn&#39t need care urgently. Additionally, that idea that we could chisel down costs with savvy patients holding the purse strings, is in stark contrast to the assertion that doctors won&#39t accept lower payment e.g. from Medicare (though 97% of docs do take new Medicare patients). Then we have the idea of using less expensive care givers, further reducing the income of doctors. Also kinda reminds me of the cynical 70s era joke, "cut your employee expense by a third. Hire women."

We also have the assertion that a single payer (or public option) system might not save anything ("we can&#39t assume the savings") but yet doctors are shifting costs to insured patients because Medicare doesn&#39t pay enough. (BTW, Medicare pays about 19% less. Think we could negotiate any lower than that?)

In my own experience it isn&#39t true that docs can shift costs, thus "subsidizing" the Medicare patients, but I&#39m open to evidence. My doctor takes Medicare patients (ahem. I&#39m not one of them). A close friend who&#39s a physician doesn&#39t. My own doctor is not allowed by insurance companies to charge more than the doc who has no Medicare patients. I frankly don&#39t believe hospitals are allowed to either, but please enlighten me with something credible if so.

As to the points about "rights," I have avoided using that term, though others did. Rather, it&#39s a public policy decision about whether or not we will care for our citizens. That&#39s hardly a new or progressive idea. It&#39s strictly caveman. The health of every tribe member was considered essential to the success of the tribe. That concept of taking care of our own *for our own good* is as ancient as we are. Perhaps with some military background people could understand the idea of not leaving someone behind, even if it costs us, inconveniences us, or even presents a mortal risk to us.

Don&#39t get all touchy Jason. These comments are general and not from some script or aimed at you. Sheesh.

Re: Poll Shows Most Americans Want Public Health Care

Dr_J — Tue, 23 Jun 2009 03:19:16 -0000

Kathy: "Well, that&#39s an interesting idea."

Well, maybe this is the disconnect going on. My position has never been that we shouldn&#39t help the poor. It&#39s that we should split health care reform into two problems and address them separately:

1. Building an efficient system of doctors, hospitals, drug companies, regulators, etc that can deliver the maximum health per dollar spent.
2. Providing financial help to people who can&#39t afford #1.

The way to do #1 is a free-market system where competition forces all the players to work hard to deliver results, while minding the dollars being spent. It should be built around consumer choice, demanding transparency from providers, and should not be controlled by big bureaucratic gatekeepers like today&#39s system is.

The way to do #2 is by writing checks, or giving tax rebates, or issuing vouchers, or I&#39m sure other approaches would work fine too. The only requirement is whatever we do must not micromanage the providers by dictating prices or policies, but should let them stay focused on goal #1: maximum health per dollar spent.

We have to do both of these things. We can&#39t just do #2, because today that group consists of darn near everyone, more than we can subsidize. We also can&#39t just do #1, because we&#39d leave darn near everyone high and dry without coverage.