A Modest Proposal - Dear American liberals

Crotale · Aug 21, 2009

Firefly said:
isn't the constituion a bit out of date?
it may have been relevent to sociaty 200 years ago but now?

Excuse me, but you are so wrong. The Constitution outlines our form of government and the limits and responsibilities of said government, as well as individual rights and responsibility. As Hal stated, the Constitution has been ignored in the name of social programs that are intended to "aid" society. The road to hell is paved with good intentions.

Also things can often seem clearer from the outside; a more objective view point.

Not always. The problem comes into play when the outsider has alternate interest in lieu of an objective point of view, which the former is most obvious from most (if not all) of the non-US posters in this thread. The US is not Europe or Canada. It is an entirely different animal, built upon the foundation known as its Constitution.

Firefly · Aug 21, 2009

What about progression?

Crotale · Aug 21, 2009

Progression? In what regard, health care? From what I've seen and heard, progression in this sense means more governmental control.

Firefly · Aug 21, 2009

No I mean generally. I want to get away from the whole health care thing and look at a bigger picture. Maybe from a more philosophical approach.

My confusion is how can a country's social laws progress if they’re tied to a constitution? That seems very restrictive. Can't change the law as it's un-constitutional. People and communities change over the years (for whatever reason) so therefore laws need to reflect that. For example, what was obscene 100 years ago is acceptable now. Those obscenity laws would be redundant and should be changed.

If those laws are tied to a constitution in some way then they would not be flexible enough to reflect society.

From the other end, if the ideals laid out in the constitution are enshrined in law what's the point in having them in a constitution? People are prosecuted with the law not the constitution.

Laws will always need to change with society and society forever changes. If the law books can't keep up then society’s growth will be crippled.

BTW this is just a philosophical discussion.

kiff · Aug 21, 2009

Firefly said:
No I mean generally. I want to get away from the whole health care thing and look at a bigger picture. Maybe from a more philosophical approach.

My confusion is how can a country's social laws progress if they’re tied to a constitution? That seems very restrictive.

it's not restrictive as you might think. it just restricts the federal government to certain powers (enumeration of powers) and keeps the central government in check from growing too large. the constitution allows the states to perform their own social programs. they can basically do whatever the hell they want, as long as they don't take away basic rights. this makes sure that programs that aren't successful to be localized to the state and not affect the entire country. if these experiments work out well, then any other state can then adopt it.

many states have tried their versions of universal health care and they're all going bankrupt. so, in that regard, the constitution has served its purpose very well.

that should show why it's not a good idea and also why it's unconstitutional

Firefly · Aug 21, 2009

kiff said:
many states have tried their versions of universal health care and they're all going bankrupt. so, in that regard, the constitution has served its purpose very well.s

aahhhh
And this is why some people are nervous?

We also trial things in a similar way. They're called pilot schemes here. We do it through the local police forces (or sometimes councils) and roll them out gradually if they work.

Firefly · Aug 21, 2009

i can understand people being nervous but surely the governmet both federal and state have a duty to maintain the welfare of it's citizens?

Providing a choice is good plus with federal taxes rather than just state taxes it will have enough money to work. a National health service is expensive (but worth it if successful), probably too expensive for a state to maintain so needs federal money.

kiff · Aug 21, 2009

Firefly said:
aahhhh
And this is why some people are nervous?

well, that's a good reason among others. also, some have noted that our healthcare system has been rated very low, like 34th or something. but, we were in the top 5 a few yrs back. if you factor out car accidents and casualties of war, we're magically back in the top 5 again by just factoring out non-healthcare related factors.

We also trial things in a similar way. They're called pilot schemes here. We do it through the local police forces (or sometimes councils) and roll them out gradually if they work.

sounds like a good idea. it's called federalism over here and it's a very basic and sound concept. I don't know how it can be considered outdated by any means. again, if certain experiments are good, then others can follow. if they flop OR if you just don't like them, for whatever reason, you can move and get away from it. I think it's brilliant.

EDIT:

Firefly said:
i can understand people being nervous but surely the governmet both federal and state have a duty to maintain the welfare of it's citizens?

the federal government is just supposed to give and protect certain basic rights, the ones that the states can't take away. they're considered negative rights, they don't GIVE you anything, they make sure they cant be TAKEN away.

freedom of speech, means they (states or anyone) cant take it away (negative), but nobody has to buy you a microphone (positive).

Providing a choice is good plus with federal taxes rather than just state taxes it will have enough money to work. a National health service is expensive (but worth it if successful), probably too expensive for a state to maintain so needs federal money.

many would argue that the bigger the population you're trying to provide to, takes more money per person.

either way, what if it doesn't work out well, then we're ALL screwed and the whole country is screwed. that's exactly why the founders came up with federalism and why it's unconstitutional.

Firefly · Aug 21, 2009

sounds like a good idea. it's called federalism over here and it's a very basic and sound concept. I don't know how it can be considered outdated by any means. again, if certain experiments are good, then others can follow. if they flop OR if you just don't like them, for whatever reason, you can move and get away from it. I think it's brilliant.

I agree, if it aint broke don't try to fix it.

What do you guys in the US think about the McAllen Problem?

(i love finding out about news stories from the people who live in those countries)

kiff · Aug 21, 2009

Firefly said:
I agree, if it aint broke don't try to fix it.

What do you guys in the US think about the McAllen Problem?

(i love finding out about news stories from the people who live in those countries)

Well, I live in El Paso, so I'll look into this a bit. But, in McAllen, as the article says, they have lots of medical R&D, so obviously that's going to increase the costs. Just because they have lots of R&D doesn't mean that there's necessarily going to be tons of new breakthroughs. Especially these days where tech advances (in any field) requires teams, unlike a century ago where one genius could. So, in general tech advances have a diminishing return on investment these days.

Also, we have pretty high property taxes in El Paso and a lot of that goes to our county hospital (Thomason). Thomason has a pretty good track record, at least lately, and treats many poor ppl and illegals coming over to give birth. Again, we have very high taxes here that cover that and we're also one of the poorest cities in Tx.

That's just off the top of my head, but I'll look into it

Zur · Aug 21, 2009

kiff said:
Well, I live in El Paso, so I'll look into this a bit. But, in McAllen, as the article says, they have lots of medical R&D, so obviously that's going to increase the costs.

The article says nothing about R&D, just modern facilities and equipment. Here's two interesting quotes:

Doctors in McAllen ordered 20% more abdominal ultrasounds, 30% more bone density studies and 550% more urine-flow studies to look for prostate problems, Dr Gawande reported.

Critics say this creates a conflict of interest and that staff at the hospital are under pressure to increase output by ordering unnecessary tests and referring patients to fellow investors.

This is exactly the behaviour that has caused a 1 to 6x difference in costs between hospitals here. Belgium is as socialist as you can get so shouldn't the difference be insignificant ? The trouble is that some hospitals are carrying out seemingly unnecessary tests (blood, urine, scans, x-rays...) to either get a bigger share of the pie or to keep the boat afloat.

In fact, the articles states this:

But the extra dollars and extra tests do not appear to translate into better care. Hospitals in El Paso - which has a similar population, but spends just $7,504 per Medicare patient - recently performed better than McAllen hospitals on 23 out of 25 health indicators.

So better equipment and more money does not equate to better health care. The question is, where is that money going if it's not being spent on patients ?

kiff · Aug 21, 2009

Azura said:
The trouble is that some hospitals are carrying out seemingly unnecessary tests (blood, urine, scans, x-rays...) to either get a bigger share of the pie or to keep the boat afloat.

many times that's because they have to cover their asses to avoid getting sued. many doctors say that despite knowing exactly what's wrong with a patient, they have to run a battery of tests. this obviously adds to the bureaucracy and costs. like hal was saying a while back, if the patient had to pay these out of pocket, they would think twice about just dumping the costs on their insurance company

I'm not sure how that reflects the difference between the 2 cities, since the testing standards, to avoid lawsuits, should be the same. but, regardless, it still sheds light on what really drives up costs

would you say this is an argument against the whole preventive medicine thing saving costs?

Zur · Aug 21, 2009

Well, what's El Paso doing different in terms of covering their asses as you say

? This doesn't sound like a problem with socialized health care but rather abuse in the medical sector. I mean, would you say no if your GP or some other doctor told you to get some tests ? Neither would I.

Perhaps the debate should extend to the question of whether hospitals are being run as efficiently as they should and if they are responding correctly to the needs of the local population. Because that would cut health care costs too. Tell me, who has the responsability of ringing the bell when things go too far ? There has to be something or someone because otherwise it would be like having restaurants without hygiene inspection.

To exagerate things, what sense is there in putting an ultra-modern and super expensive hospital in a place where people have average income ? It's putting locals in a position where they have to pay more to basically get the same result and have less money in their pocket the next time round when they need more care in future. In other words, it puts a dent in their quality of life overall. It's insane.

Firefly · Aug 21, 2009

Azura said:
To exagerate things, what sense is there in putting an ultra-modern and super expensive hospital in a place where people have average income ? It's putting locals in a position where they have to pay more to basically get the same result and have less money in their pocket the next time round when they need more care in future. In other words, it puts a dent in their quality of life overall. It's insane.

Would't financing it through Federal taxes rather than state taxes help spread the cost between the states. Then the Federal government could penalise or reward states.

We have league tables (for schools as well) but these aren't perfect as it can encourage hospitals to be too tight with the budget and of course patient care suffers.

Firefly · Aug 21, 2009

Just out of interest here are said League tables

Zur · Aug 21, 2009

Firefly said:
Would't financing it through Federal taxes rather than state taxes help spread the cost between the states. Then the Federal government could penalise or reward states.

I'd be tempted to say no. The reason why is because that is exactly what is in place here with practically all hospitals being partially funded by the government (much more so than in the UK). You now know what forms of abuse have come to light. Although the system in place is very different from the US, similar problems have been highlighted in that link you gave. Instead of pilfering public money, it sounds like some of these private hospitals are charging patients more than they should. So, in my opinion, spreading cost is one thing but making sure money is being spent wisely is another. It all adds up to a more efficient model of health care where both doctors and patients are involved in making sure costs are as low as possible. Insurance and legal costs shouldn't even come into the equation, at least not to the point where it balloons operating costs.

kiff · Aug 21, 2009

Azura said:
Perhaps the debate should extend to the question of whether hospitals are being run as efficiently as they should and if they are responding correctly to the needs of the local population. Because that would cut health care costs too. Tell me, who has the responsability of ringing the bell when things go too far ? There has to be something or someone because otherwise it would be like having restaurants without hygiene inspection.

ok, well, let me add this about hospitals and costs. my mom worked at a local hospital (del sol) in the medical records dept. every year (or two, forget) they had major audits (not sure if it was local, state or feds) and they had a team that worked constantly to comply to the standards and/or suppy the documents for the audit. the standards and regulations are constantly changing and requires tons of manpower to keep up with. that bureaucracy alone cost them a lot. she (my mom) also mentioned that that hospital (del sol), alone, absorbed around $10 million/yr on unpaid bills.

theabyss · Aug 21, 2009

The trouble is that some hospitals are carrying out seemingly unnecessary tests (blood, urine, scans, x-rays...) to either get a bigger share of the pie or to keep the boat afloat.

Seemingly?
It is definitely a bad thing if doctors already know what is wrong and add additionally tests. However, if there is something wrong with you and you can't find out what it is, wouldn't you want to have rather one more test than one less? Many sorts of cancer, for instance, can be cured if they are detected at an early stage.
Let's say, referring to Kiff here, you don't want to spend the money on the blood test, because you have to pay it out of your own pocket - and later find out that if you would have made that blood test, doctors could have seen cancerous cells and could have prevented the spread. So you might save some money but you might loose your life.
Sorry, that is not an option for me. Prevention is better than cure.
Oh and btw. my mother worked at an hospital too.

Zur · Aug 21, 2009

Where is the middle ground though ?

@kiff: Sounds like something that could be streamlined. Another cost cutting measure that is possible is having a dedicated logistics department to come up with any money savers that are possible (getting rid of "squirrel" stocks, getting a better deal on telephone costs through competition ...).

kiff · Aug 21, 2009

theabyss said:
Seemingly?
It is definitely a bad thing if doctors already know what is wrong and add additionally tests. However, if there is something wrong with you and you can't find out what it is, wouldn't you want to have rather one more test than one less? Many sorts of cancer, for instance, can be cured if they are detected at an early stage.

well, the later was my point.

so, you condone doing a million random tests because they might stumble upon something? if you do that to everyone, you think medical costs can be even remotely contained?

things like that (urine, blood) tests are supposed to be done on regular schedules anyways.

A Modest Proposal - Dear American liberals

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