Notes from Howard's Sabbatical from Working. The name comes from a 1998 lunch conversation. Someone asked if everything man knew was on the web. I answered "no" and off the top of my head said "Fidel Castro's favorite color". About every 6-12 months I've searched for this. It doesn't show up in the first 50 Google results (this blog is finally first for that search), AskJeeves says it's: red.
Nice chart and probably fairly accurate. But you know that someone somewhere is going to be getting an abortion paid for by federal tax dollars. We can't have that.
Therefore, the whole thing (all healthcare reform) must be labled an evil, death paneling, grandma killing, rationing, socialist communist and/or fascist plot to take away your guns, and make you give all your money to black people and illegal aliens.
I'm assume this is the same person leaving these anonymous comments on several posts. If I know you, please leave me some way to know who are (sign with initials or a nickname or something).
But I don't get the point of these last several comments. All this comment does is repeat the crazy right-wing line in a satirical voice. We get it, they're obviously batshit crazy. While it can be funny once or twice, I don't see how just repeating this stuff this way again and again is at all helpful, constructive, or even interesting.
The other side of this is what will employers have to do in the potential new environment. The opponents of this health care plan like to point to small businesses and scare them by saying they will be taxed into oblivion to pay for healthcare. A flowchart from the other side, so to speak, might be helpful.
As a new parent and someone on the edge of keeping my job in this economy, I feel we have all had the wakeup call on needing healthcare covereage for everyone. I have employer coverage, but people also need to realize that being employed is getting more ephemeral as the days go by.
Perhaps this debate needs to be broken up into two debates.
Debate 1 - How should we pay for healthcare insurance/healthcare?
Our current system is:
a. If you work and your employer offers health insurance you may take advantage of that benefit for you and your dependents.
b. If you are over 65 you qualify for Medicare.
c. If you are poor enough or severely disabled (meaning you can't work) you qualify for Medicaid.
d. Pretty much everyone else is on their own so you better have enought money to buy health insurance.
This system came about because during a period of wage and price controls (under FDR during WWII), companies started giving additonal benefits, such as health insurance (about 70-80 years ago) instead. This became the defacto health insurance payment plan for the entire US even after the wage and price controls were rescinded.
Medicare and Medicaid were initiated in the 1960s to cover the elderly and the poor (and the elderly-poor). Old folks needed a way to pay for healthcare that was getting more expensive each year.
So that's the payment part.
What is Debate 2? Well in my view Debate 2 is - Can we improve the way healthcare is delivered in the US?
I think the obvious answer to that question is yes. Improvements can always be made.
However, the delivery of Healthcare is so decentralized on both the macro scale (hospitals operating as independent entities / standard(s) of care approaches varying widely by geopgraphy, as examples) and the micro scale (how the patient interacts with the system). Currently, there is little central (primary care) management of the patient who routinely ends up seeing multiple specialists and tries to figure out for themselves the "best course of action". It is very difficult to make meaningful change that can be widely implemented in such a disjointed approach.
There are probably dozens of really good ideas about how to improve the current delivery of healthcare. Some are being implemented, but not widely enough (can anyone say e-records?).
Unfortunately, as long as the current major payment system (private insurance) can essentially charge unlimitted premiums - and minimize/deny payment through multiple methods, and while doctors still get their payments (currently based on quantity of procedures, not quality of outcomes), the liklihood of significant and rapid improvement in the quality of healthcare delivery is unlikely.
Spending twice as much per capita than any other industrialized nation, we should be at the top of the list for outcomes.
We're not.
Back to the question of paying for healthcare.
When Palin started talking about her parents (elderly) and her son (disabled/disadvantaged) in conjuction with government "death panels" making a determination whether they get medical treatment, based upon their level of productivity to society, I started laughing.
Here's the quote:
"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil."
She is wither so stupid and/or so ignorant (or cares so little for the truth) that she doesn't realize that individual productivity is the entire basis of our current healthcare payment system.
Every day employers subjectively judge whether any current or prospective employee is sufficiently productive and worthy of continued employment (and by exptension continued health insurance coverage/healthcare).
We need to get beyond this.
Basic healthcare is a human right and access to decent healthcare should not be directly tied to employment status.
I agree. Though in some conversations with non-believers I'm beginning to think that the terminology "healthcare is a right" is a barrier. Of course rights are whatever we define them to be and as I've realized even the Declaration of Independence is kinda wrong. If liberty is unalienable then we shouldn't imprison convicted criminals.
I'd like to see a more efficient healthcare system:
1. One that doesn't burden companies with increasing costs. 2. One that doesn't force you change coverage when you change jobs (for reasons within your control or without) 3. One that gives you access to treatment, regardless of anything. 4. One that includes preventative measures in it's definition of treatment. 5. One that removes or properly aligns the profit motive wherever possible. By this I mean I'd be fine if all health insurance was non-profit. I want doctors rewarded for outcome (within their control) and not just quantity of treatment and not unjustly penalized for bad outcomes (yes that's tort reform). 6. One where costs are as transparent as possible but realizing that cost isn't the only factor in healthcare choices. Ask your doctor what something costs, they probably won't know or if they do they'll tell you two costs, what they'd charge insurance or your if you paid it yourself.
Personally I think a British or Canadian system would be best to try, but we have to improve what we have. And I'd really like policies to change the American diet to something sane. That's got to be the best way to lower costs and (in aggregate) make us healthier.
6 comments:
Nice chart and probably fairly accurate. But you know that someone somewhere is going to be getting an abortion paid for by federal tax dollars. We can't have that.
Therefore, the whole thing (all healthcare reform) must be labled an evil, death paneling, grandma killing, rationing, socialist communist and/or fascist plot to take away your guns, and make you give all your money to black people and illegal aliens.
I'm assume this is the same person leaving these anonymous comments on several posts. If I know you, please leave me some way to know who are (sign with initials or a nickname or something).
But I don't get the point of these last several comments. All this comment does is repeat the crazy right-wing line in a satirical voice. We get it, they're obviously batshit crazy. While it can be funny once or twice, I don't see how just repeating this stuff this way again and again is at all helpful, constructive, or even interesting.
I apologize. It is not my intent to be wasteful (at best) and/or boring (at worst).
Ciao
ps. Very nice post on the deep space image.
Too Tall
The other side of this is what will employers have to do in the potential new environment. The opponents of this health care plan like to point to small businesses and scare them by saying they will be taxed into oblivion to pay for healthcare. A flowchart from the other side, so to speak, might be helpful.
As a new parent and someone on the edge of keeping my job in this economy, I feel we have all had the wakeup call on needing healthcare covereage for everyone. I have employer coverage, but people also need to realize that being employed is getting more ephemeral as the days go by.
Perhaps this debate needs to be broken up into two debates.
Debate 1 - How should we pay for healthcare insurance/healthcare?
Our current system is:
a. If you work and your employer offers health insurance you may take advantage of that benefit for you and your dependents.
b. If you are over 65 you qualify for Medicare.
c. If you are poor enough or severely disabled (meaning you can't work) you qualify for Medicaid.
d. Pretty much everyone else is on their own so you better have enought money to buy health insurance.
This system came about because during a period of wage and price controls (under FDR during WWII), companies started giving additonal benefits, such as health insurance (about 70-80 years ago) instead.
This became the defacto health insurance payment plan for the entire US even after the wage and price controls were rescinded.
Medicare and Medicaid were initiated in the 1960s to cover the elderly and the poor (and the elderly-poor). Old folks needed a way to pay for healthcare that was getting more expensive each year.
So that's the payment part.
What is Debate 2? Well in my view Debate 2 is - Can we improve the way healthcare is delivered in the US?
I think the obvious answer to that question is yes. Improvements can always be made.
However, the delivery of Healthcare is so decentralized on both the macro scale (hospitals operating as independent entities / standard(s) of care approaches varying widely by geopgraphy, as examples) and the micro scale (how the patient interacts with the system). Currently, there is little central (primary care) management of the patient who routinely ends up seeing multiple specialists and tries to figure out for themselves the "best course of action". It is very difficult to make meaningful change that can be widely implemented in such a disjointed approach.
There are probably dozens of really good ideas about how to improve the current delivery of healthcare. Some are being implemented, but not widely enough (can anyone say e-records?).
Unfortunately, as long as the current major payment system (private insurance) can essentially charge unlimitted premiums - and minimize/deny payment through multiple methods, and while doctors still get their payments (currently based on quantity of procedures, not quality of outcomes), the liklihood of significant and rapid improvement in the quality of healthcare delivery is unlikely.
Spending twice as much per capita than any other industrialized nation, we should be at the top of the list for outcomes.
We're not.
Back to the question of paying for healthcare.
When Palin started talking about her parents (elderly) and her son (disabled/disadvantaged) in conjuction with government "death panels" making a determination whether they get medical treatment, based upon their level of productivity to society, I started laughing.
Here's the quote:
"The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil."
She is wither so stupid and/or so ignorant (or cares so little for the truth) that she doesn't realize that individual productivity is the entire basis of our current healthcare payment system.
Every day employers subjectively judge whether any current or prospective employee is sufficiently productive and worthy of continued employment (and by exptension continued health insurance coverage/healthcare).
We need to get beyond this.
Basic healthcare is a human right and access to decent healthcare should not be directly tied to employment status.
TT
I agree. Though in some conversations with non-believers I'm beginning to think that the terminology "healthcare is a right" is a barrier. Of course rights are whatever we define them to be and as I've realized even the Declaration of Independence is kinda wrong. If liberty is unalienable then we shouldn't imprison convicted criminals.
I'd like to see a more efficient healthcare system:
1. One that doesn't burden companies with increasing costs.
2. One that doesn't force you change coverage when you change jobs (for reasons within your control or without)
3. One that gives you access to treatment, regardless of anything.
4. One that includes preventative measures in it's definition of treatment.
5. One that removes or properly aligns the profit motive wherever possible. By this I mean I'd be fine if all health insurance was non-profit. I want doctors rewarded for outcome (within their control) and not just quantity of treatment and not unjustly penalized for bad outcomes (yes that's tort reform).
6. One where costs are as transparent as possible but realizing that cost isn't the only factor in healthcare choices. Ask your doctor what something costs, they probably won't know or if they do they'll tell you two costs, what they'd charge insurance or your if you paid it yourself.
Personally I think a British or Canadian system would be best to try, but we have to improve what we have. And I'd really like policies to change the American diet to something sane. That's got to be the best way to lower costs and (in aggregate) make us healthier.
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