Politics 09: Fire Reid and Steele.

[Grefter]

Old stuff, vagrancy laws and whatnot are so 1700s.

[superaielman]

http://money.cnn.com/2009/08/11/news/companies/continental_air_delay.reut/index.htm?postversion=2009081119

On one hand, government intervention where it may not be needed or should be in involved with in the first place. On the other hand, Continental airlines.


....


Goooo regulation!

[Grefter]

Pffffft, government intervention where it may not be needed my fucking arse.  The government has a place in setting business guidelines and boundaries in any fucking industry it damned well wants when it can justify it.  This case is definitely an OH&S issue at minimum which easilly qualifies government involvement.

Your small government shit can suck my nuts.

[NotMiki]

http://www.talkingpointsmemo.com/archives/2009/08/dont_need_to_be_a_rocket_scientist.php
http://tpmdc.talkingpointsmemo.com/2009/08/hawking-ironically-my-death-panel-saved-my-life.php?ref=fpa

kinda wanted to put this in IOTD, but it seems like all the political news recently should be, so whatever.

Investors Business Daily, boldly taking on the evil that is UK healthcare, stands up for people like Steven Hawking, who would have been deemed unworthy of life were he a British citizen.  Wait, what's that?  Hawking was born in the UK?  And they didn't kill 'im?

...

Jesus!  America!  *flees*

-----

Here's the original article, scrubbed of Hawking, but including a trivial correction.

http://www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877

Editor's Note: This version corrects the original editorial which implied that physicist Stephen Hawking, a professor at the University of Cambridge, did not live in the UK.

see if you think that's a sufficient correction to this:

People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

For my part, I think a decent correction should note that The NHS, when asked the very question, came up with the opposite answer the editorial said they would.

But that would be asking too much of an article that uncritically quotes,

One troubling provision of the House bill compels seniors to submit to a counseling session every five years,

when in fact the sessions are non-compulsory.

This isn't a matter of a difference of opinion.  We're talking about pure, simple-to-verify facts.  IBD is disingenuous at best, a sack of fucking liars at worst.  And worthless sack of shit liars segues nicely into,

http://tpmdc.talkingpointsmemo.com/2009/08/palin-obamas-death-panel-could-kill-my-down-syndrome-baby.php

Which I have no fucking comment on.

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one other thing while I'm at it,

http://tpmmuckraker.talkingpointsmemo.com/2009/08/on_election_ever_miers_tried_to_intervene_renzi_case.php?ref=fpblg

ladies and gentlemen I present to you the woman George W. Bush believed should be our third female Justice.  Because leaning on attorneys general to try to make them publicly lie about the status of an investigation in an obvious violation of DOJ policy is just the kind of experience that we look for in an impartial, non-biased justice.

EDIT:

http://www.adn.com/life/health/story/895431.html

Lisa Murkowski, R-AK Senator and opponent of the healthcare bill, provides a refreshing counterpoint of sanity from the northernest state.

EDIT 2:

http://www.huffingtonpost.com/2009/08/12/grassley-endorses-death-p_n_257677.html

Appearing at a town hall in his home state of Iowa, Sen. Chuck Grassley told a crowd of more than 300 that they were correct to fear that the government would "pull the plug on grandma."

Pull the plug on grandma.  The people perpetrating this stuff are shit.  They're beneath dirt.

[NotMiki]

http://www.nytimes.com/2009/08/14/health/policy/14panel.html?hp

The New York Times weighs in on the healthcare mess.  This is interesting.  For all its reputation as a liberal newspaper, the Times avoids directly taking sides in areas of contention in their news (as opposed to editorial) division.  Typically if two politicians disagree, it will be reported that they disagree, and it may even be noted in the story which one has the fact on their side, but that will be the extent of it.  For the main point of a story to be that a political position championed by one ideological set is factually wrong is highly unusual.

[Pyro]

There is something surreal about the national debate on health care. A sizable and loud portion of one of America's two major parties is basically calling everyone in the administration's party Nazis. That they are not being loudly refuted by reasonable voices in the Republican party speaks to a lack of courage on the part of conservative politician's in America. Which is ironic considering how much the Republican party has played on fear to grip power in the country recently (vote for/support us or the muslims will kill you).

Of course, it's always possible that there are reasoned debates going on about this topic and that they just aren't 'sexy' enough to make the news. I suppose I don't have much room to talk since I haven't studied the issue in too much depth.

[Cmdr_King]

Really, that pretty much says everything about the Times article there.  It's hard to portray the group that needs slapped with Godwin's Law as reasonable or worth listening to.

[metroid composite]

Although as far as that goes, Euthanasia for terminally ill people is one of the few Nazi policies I find quite solid.

Granted, government-forced Euthanasia simply does not work under British-derived law systems--that's asking for the government to get sued (there's a reason Canada+USA haven't sterilized anyone for eugenic reasons since...1970 or so; lawsuits for millions of dollars kicked the government's ass).  Basically, under a British Law system, euthanasia has to be voluntary on the part of the individual, and can't be mandated by the government because that ends up much more expensive than paying the hospital bills.

[Cmdr_King]

Of course, no shortage of the terminally ill are completely open to the idea of euthanasia.  Naturally, it's actively illegal and any medical professional caught at it is quickly stripped of their liscence and thrown in prison.  Making allowances for voluntary euthanasia would be a good move really, but I strongly suspect there is no such provision in the bill.  Afterall, people would just misconstrue that as government-endorsed murdering of grandma.
(Oh wait that happened ANYWAY.)

[Lady Door]

http://www.cnn.com/2009/WORLD/asiapcf/08/14/australia.right.to.die/index.html

On that note!

Is anyone else bothered by the title? "Australian quadriplegic granted right to starve to death"

Felo de se has always struck me as an odd concept. I can only justify it religiously. Granted that he is of medically-determined sound mind (and let's not start that argument), why else would you force someone to live when everything else has been taken away from them?

[Grefter]

Normal argument is all about denying society a useful resource and whatnot, ties into government incentives to breed and whatnot (being the counter side to the same coin), to kill yourself is to strip a resource from the state and weakens it as a whole and whatnot.  Laws being defined by the nation state and whatnot to be self perpetuating and blah blah blah.

Euthenasia and suicide stuff being accepted is a strongly individualistic ideal and all that (also usually fairly selfish action as well, but whatever).

So in essence, yeah it bothers me on a personal level and an idealogical level that it is being framed that way, but it is understandable, it is pretty harsh direct way of describing exactly what is happening.  That is bothers me on an idealogical level means I have a bit more of an anarchist bent than I tend to display in other issues (Or libertarian if you want to be a shit face, but I favour Anarchist ideals more than Libertarian ones).

Take that as you will.

[metroid composite]

Normal argument is all about denying society a useful resource and whatnot, ties into government incentives to breed and whatnot (being the counter side to the same coin), to kill yourself is to strip a resource from the state and weakens it as a whole and whatnot.  Laws being defined by the nation state and whatnot to be self perpetuating and blah blah blah.

No, suicide is illegal because if it was legal you could too easily use it for murder.  Say Joe Greedy's mother (who has him in her will) is contemplating suicide.  Of course he's going to nudge her in that direction.  Even if you outlaw assisted suicide, subtle hints and body language are virtually indistinguishable in the eyes of the law.

[Jo'ou Ranbu]

Normal argument is all about denying society a useful resource and whatnot, ties into government incentives to breed and whatnot (being the counter side to the same coin), to kill yourself is to strip a resource from the state and weakens it as a whole and whatnot.  Laws being defined by the nation state and whatnot to be self perpetuating and blah blah blah.

No, suicide is illegal because if it was legal you could too easily use it for murder.  Say Joe Greedy's mother (who has him in her will) is contemplating suicide.  Of course he's going to nudge her in that direction.  Even if you outlaw assisted suicide, subtle hints and body language are virtually indistinguishable in the eyes of the law.

That also being a damned good reason for disallowing euthanasia as well. While I do agree with the idea of a person having the choice to have his/her life taken away, it's just too easily turned into a practical, efficient tool for "legal" murder.

[Grefter]

Murder is illegal for the same reasons I stated as suicide being illegal.  Practical application of the removal of the resource is the kind of minor detail that Sociology doesn't really worry about at the macro level we are dealing with there.  This is all the function of things that people do and applying the question of "who benefits?" to it. 

[metroid composite]

That also being a damned good reason for disallowing euthanasia as well. While I do agree with the idea of a person having the choice to have his/her life taken away, it's just too easily turned into a practical, efficient tool for "legal" murder.

The difference is that modern euthanasia is only legally allowed in cases where the government wants you dead.  These are the cases where the Nazi policy was "you don't get a choice--you're terminally ill and costing us money.  Die now."--y'know, in 1933 when the Nazi party was being smart and getting their economy going (as opposed to 1943 when they were being stupid and draining money for racism).

Modern Euthanasia is more or less "Euthanasia's a good economic policy, but we can't force it on people or we'll be sued.  However, we can allow people to consent to it."

[InfinityDragon]

The people perpetrating this stuff are shit.  They're beneath dirt.

In today's shocking news, it is revealed that politicians lie and play to the fears of the general population.

Sarcasm aside, Obama and the democrats are just as guilty of lying and spreading misinformation as Palin and the republicans are. Some cases in point being a)Obama's claims that preventive care is the magic pill that will increase health quality while decreasing costs and b) that a major factor in the rise of health care practices are doctors being motivated by financial gain to do superfluous medical procedures. Both claims are patently false and yet are still touted by health care reform proponents, but I don't see you raging against them.

[superaielman]

Preventive health care is certainly a key to controlling hospital costs (Namely, getting people to stop going to the ER when they have colds because they don't have insurance). This doesn't mean that the current plan being floated is a good one, but you definitely want to have some insurance option for people that isn't grossly overpriced or tied to jobs. There's also a problem with MRI imaging centers that doctors own and can refer patients to, but that's pretty standard 'hey dumbass conflict of interest fix this' than anything specifically related to medicine. 

Medicare is as ruthless as an private insurance company about controlling costs. They no longer cover MRSA infections that patients contract in a hospital, leaving the hospital stuck with the bill.

I've heard talk about price controls with the plan which is just not effective as well. WE have a system of those already in the health care system, called medical billing. It sucks.

[InfinityDragon]

Preventive health care is certainly a key to controlling hospital costs (Namely, getting people to stop going to the ER when they have colds because they don't have insurance).

Universal preventive care coverage won't keep costs down. The misinformation lies in the distinction about where savings are made in preventive care. The individual who would have suffered a heart attack but did not has made a savings in cost because they no longer have to pay the massive hospital bill that would have entailed heart attack treatment.

The problem is that not everyone will benefit from preventive care because not everyone will have suffered a stroke, heart attack, diabetes, etc. Thus, the coverage provider is paying for preventive care for everyone in order to save on the costs of the few.

If that is unclear, try looking at it from the insurance perspective. Insurance is risk management. You buy insurance (any type) because you don't want to pay out of pocket costs for an unplanned major accident. Maintenance is NOT something you pay insurance on because you know what it costs and budget appropriately. In other words, there is no risk. You generally don't see  homeowner's insurance covering the costs of wear and tear maintenance or auto insurance policies that cover the costs of oil changes and periodic tune ups. Likewise, twice yearly checkups and other standardized preventive care procedures are not unforeseen costs, and therefore not a part of risk management.

This is not to say that preventive care should be avoided, but to claim that it would save money is ludicrous and false.

[superaielman]

Universal preventive care coverage won't keep costs down. The misinformation lies in the distinction about where savings are made in preventive care. The individual who would have suffered a heart attack but did not has made a savings in cost because they no longer have to pay the massive hospital bill that would have entailed heart attack treatment.

The problem is that not everyone will benefit from preventive care because not everyone will have suffered a stroke, heart attack, diabetes, etc. Thus, the coverage provider is paying for preventive care for everyone in order to save on the costs of the few.

Preventive care in the sense I'm talking about means getting people to go to a normal doctor instead of a hospital for managable illnesses. Hopsitalization is insanely expensive, and hospitals lose a lot of money from indigiant and working poor patients who can't afford to pay the bills; thus it becomes a writeoff. Encouraging people to go to a family care doctor is just using the resources you have in a far more effective manner- treating a case of the flu for 300 dollars including the expensive antiviral versus however much it costs for a trip to the hospital. When I sprained my ankle a few years back it was 900 dollars or so for a fairly simple treatment. Everyone pays for the misuse of hospitals in terms of higher premiums and costs across the board.

If that is unclear, try looking at it from the insurance perspective. Insurance is risk management. You buy insurance (any type) because you don't want to pay out of pocket costs for an unplanned major accident. Maintenance is NOT something you pay insurance on because you know what it costs and budget appropriately. In other words, there is no risk. You generally don't see  homeowner's insurance covering the costs of wear and tear maintenance or auto insurance policies that cover the costs of oil changes and periodic tune ups. Likewise, twice yearly checkups and other standardized preventive care procedures are not unforeseen costs, and therefore not a part of risk management.

Health insurance already covers preventive treatments because it's cheaper than waiting for people to fall apart and leads to generally better quality of life/cheaper treatment. We want people to go in for checkups and generally be in touch with their doctor.

One of the biggest problems by far in the country as far as health care goes is the misuse of hospitals. That has to be fixed. It's perhaps one of the biggest problems with health care in the country, right behind insurance companies being functional monopolies.

[InfinityDragon]

Preventive care in the sense I'm talking about means getting people to go to a normal doctor instead of a hospital for managable illnesses.

That has less to do with access to preventive care and more to do with increasing health awareness and treatment options for the general population (and access to non-hospital medical clinics in low income areas).

Health insurance already covers preventive treatments because it's cheaper than waiting for people to fall apart and leads to generally better quality of life/cheaper treatment. We want people to go in for checkups and generally be in touch with their doctor.

Leads to a better quality of life, yes. Cheaper in the long run (for the insurance company/taxpayers), no. To illustrate with numbers:

Say preventive treatment for Malady X costs $500 per person and Malady X itself costs $10,000 to treat. At the individual level, someone who would have gotten Malady X but didn't thanks to the treatment saves $9500. The problem is, and politicians like Obama don't mention, is that this is not applicable to large groups of people.

Say Malady X has a prevalence of 2% and the population that has insurance coverage is 100. Now it costs $50,000 in coverage to ensure that the entire population will be prevented from getting Malady X. However, if coverage only covers cost of treatment, then nobody is prevented from getting Malady X and 2 people will have it. Costs for treatment run at $20,000 total, which is significantly less than preventive treatments for everyone.

In actuality, the numbers are far more disproportionate than the ones I conjured up. Costs for preventive care for heart disease and diabetes run approximately 10 times higher than treatment costs. Note that this also assumes a 100% success rate for preventive care, which is very unlikely.

That said, you can't put a price tag on the people who are saved by access to preventive treatments...but as I said before, to claim it will also save money is just absurd and wrong.

[metroid composite]

Leads to a better quality of life, yes. Cheaper in the long run (for the insurance company/taxpayers), no. To illustrate with numbers:

Say preventive treatment for Malady X costs $500 per person and Malady X itself costs $10,000 to treat. At the individual level, someone who would have gotten Malady X but didn't thanks to the treatment saves $9500. The problem is, and politicians like Obama don't mention, is that this is not applicable to large groups of people.

Say Malady X has a prevalence of 2% and the population that has insurance coverage is 100. Now it costs $50,000 in coverage to ensure that the entire population will be prevented from getting Malady X. However, if coverage only covers cost of treatment, then nobody is prevented from getting Malady X and 2 people will have it. Costs for treatment run at $20,000 total, which is significantly less than preventive treatments for everyone.

In actuality, the numbers are far more disproportionate than the ones I conjured up. Costs for preventive care for heart disease and diabetes run approximately 10 times higher than treatment costs. Note that this also assumes a 100% success rate for preventive care, which is very unlikely.

Uhh...your numbers look like they don't apply to all preventative medicine.

If you do what the dutch do, and have a nurse give people regular checkups (sending them to the doctor if she finds something out of place) you save a lot of money on personnel costs--a 15 minute checkup by a nurse should run about $10 in actual costs given nursing salaries.

Blood tests and immunizations that I've seen run at around $100, and everyone I've talked to complains about how expensive this is and how it used to be cheaper.

That's the preventative side, let's look at the non preventative side.

Quadruple Bypass costs $1,000,000 or more.
Even super simple common procedures like hip replacement ($35,000) and broken arm ($12,000) cost a decent amount.


Obviously not everything is going to be cheap to prevent (you brought up diabetes--I've never had a physician suggest that I immunize myself against diabetes...or whatever they do on the preventative side).  But by contrast, given the numbers I googled/looked at hospital bills for above, a 1000:1 ratio for some cure:prevention ratios seems likely, which very easily saves money.

[InfinityDragon]

If you do what the dutch do, and have a nurse give people regular checkups (sending them to the doctor if she finds something out of place) you save a lot of money on personnel costs--a 15 minute checkup by a nurse should run about $10 in actual costs given nursing salaries.

There's far more to preventive care than just regular check ups. You need medications if you have uncontrolled high blood pressure or high cholesterol (to prevent that costly heart attack or stroke), that adds to costs. To screen for threatening illnesses (I'm looking at you, cancer), you need to administer tests to everyone, this also adds to costs.

Even super simple common procedures like hip replacement ($35,000) and broken arm ($12,000) cost a decent amount.

Except those have absolutely nothing to do with preventive care creating a net savings in health care expenditures. Preventive care will do absolutely nothing to reduce the likelihood of a broken arm or hip. Thus, you still have costs associated with broken bones. Thus, you are now paying for preventive care (costs money) *and* the medical procedure (costs money). There is no cost savings here at all. Not everything is preventable.

But by contrast, given the numbers I googled/looked at hospital bills for above, a 1000:1 ratio for some cure:prevention ratios seems likely, which very easily saves money.

And herein lies the problem; you've missed the point I've made two times now. Yes, at the INDIVIDUAL LEVEL there is a savings...but not everyone will need quadruple bypass surgery or long term cancer treatment. At the POPULATION LEVEL there is a cost increase because you're paying for everyone to get preventive care to screen out and treat diseases that only a fraction of the population will ever have to worry about.

Don't believe me? Why not read the CBO's assessment instead: http://www.cbo.gov/ftpdocs/104xx/doc10492/08-07-Prevention.pdf

[superaielman]

Leads to a better quality of life, yes. Cheaper in the long run (for the insurance company/taxpayers), no. To illustrate with numbers:

Say preventive treatment for Malady X costs $500 per person and Malady X itself costs $10,000 to treat. At the individual level, someone who would have gotten Malady X but didn't thanks to the treatment saves $9500. The problem is, and politicians like Obama don't mention, is that this is not applicable to large groups of people.

Say Malady X has a prevalence of 2% and the population that has insurance coverage is 100. Now it costs $50,000 in coverage to ensure that the entire population will be prevented from getting Malady X. However, if coverage only covers cost of treatment, then nobody is prevented from getting Malady X and 2 people will have it. Costs for treatment run at $20,000 total, which is significantly less than preventive treatments for everyone.

In actuality, the numbers are far more disproportionate than the ones I conjured up. Costs for preventive care for heart disease and diabetes run approximately 10 times higher than treatment costs. Note that this also assumes a 100% success rate for preventive care, which is very unlikely.

The government is already practicing prevenative health in some ways- smoking restrictions, sin taxes, etc. There definitely is a conflict there that's possible- we can't legally or morally restrict what a person eats, but it is in the government's interest to make sure people are as healthy as possible, doubly so when it's under the umbrella of government care. We're already seeing some movements in that regard. WHo the hell knows though, I'm jus tmentally wandering here.



Prevenative care doesn't mean just simple screenings (Interesting aside: There's been some talk in some medical circles about the overuse of certain screening tests as part of the problem. Miki posted a link a few months ago that touched on that. The MRI stuff and conflicts are best resolved by doctors having more time with the patients and more easy access to specialists who can explain why and how a treatment works or doesn't work.). To me it means making most effective use of our medical resources by making sure people have basic go to the doctor insurance, so they are more likely to go get checkups and go in when they're hurt.

As it is we have a large gap becuase of the current employer based system, and you can't really afford health care without it short of being privately wealthy.

Anywho. Reforms can be cost effective, and so can prevenative care if executed right, just by shifting the burden onto cheaper outlets for treatment, not that the current plan looks to be going that route. I can't say I'm surprised when there's barely a handful of health professionals in congress.

Even super simple common procedures like hip replacement ($35,000) and broken arm ($12,000) cost a decent amount.

Hip replacements run way more than that and it's a major surgery with a notable morality rate. Where are you getting those figures?

Checkups can't force lifestyle changes and a lot of the real drains on our system are from chronic conditions that only have pallative treatments, or are hideously expensive. Hi senility diseases and cancer, respectively. It isn't a magic bullet, but the basic idea of making sure people have some level of doctor access is a good one.

[Luther Lansfeld]

My grandfather's hip replacement was around that price.

[metroid composite]

And herein lies the problem; you've missed the point I've made two times now. Yes, at the INDIVIDUAL LEVEL there is a savings...but not everyone will need quadruple bypass surgery or long term cancer treatment. At the POPULATION LEVEL there is a cost increase because you're paying for everyone to get preventive care to screen out and treat diseases that only a fraction of the population will ever have to worry about.

Umm...no, no I didn't.

Seriously, I know to multiply by "occurs in 2% of the population".  Please don't insult my intelligence.

What I was questioning was not your point, but your numbers.  Let's stick with the "occurs in 2% of the population" number.  If cure costs 10x preventative as you suggest diabetes does, then yes, cure is 5x cheaper for the government; stick with cure for these maladies.  If cure costs 100x preventative, then cure is 2x more expensive for the government.  If cure costs 1000x preventative, then cure is 20x more expensive for the government.

So...grab the cases where preventative is 100x-1000x cheaper than cure.  Done.  Seems likely such cases exist since some operations hit seven figures, and the highest cost for preventative I've seen is 3 figures (and I have an endocrinologist who is hyper about preventative, so I've seen quite a lot of preventative figures).