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| 2007/9/25-27 [Health/Disease/AIDS, Health/Disease/General] UID:48182 Activity:very high |
9/25 So, anyone know offhand *why* healthcare costs are going up
at 3x inflation? What is driving this insane inflation in
health costs? Are health costs snowballing because more and
more are uninsured, forcing the fewer and fewer insured to
pay more and more to cover the uninsured? If so, is this
a government-created crisis, because hospitals by law cannot
turn away those without health insurance, and so they *must*
screw their fewer and fewer remaining paying customers?
*Where is all that money going?* --PeterM
\_ You are a scientist, Peter. Pretend American healthcare is a
natural system. What experiments would you set up to figure this
out? -- ilyas
\_ [serious callers only]
out? [Have something to contribute other than a retarded troll and
you won't be deleted.] -- ilyas
\_ Self follow-on--some claim doctors are receiving the
lion's share of the increase in cost as salary. Is that
true? Are we being driven bankrupt by a lot of greedy
fucking doctors? Or are they merely responding to
increased malpractice costs? --PeterM
\_ It's not going to doctors who, on an hourly basis, make less
now than doctors did 30 years ago. Most doctors have had to
see a lot more patients to keep their salaries flat. Doctors
say that the money is going to the HMOs. It should be easy
to verify that by looking at their profits. My guess is that
\_ Not necessarily, it could be the 'dead hand' effect. -- ilyas
the money is going to more expensive and complicated procedures
like MRIs and heary bypass surgery that were almost unheard
like MRIs and heart bypass surgery that were almost unheard
of in the 1970s and which are now extremely common. Valve
transplants, chemotherapy, and the like are very expensive.
Some procedures have been made cheaper with, for example,
laproscopy, but there are so many new ones and the technology
and drugs are expensive. Before health costs were cheaper
because you *died*. Now medicine can keep you alive for a
large fee.
\_ i just heard it was to fund the bureaucracy that is American
health care
\_ Hint: what causes inflation?
\_ Answer: increase in the money supply. There is more money
chasing after the services. Now, why is there more money doing
this?
\_ People don't want to die. For most it's worth it to pay
$1000/month in insurance to avoid dying when you need
that $150K surgery. Some treatments (like for HIV) cost
in excess of $1M.
\_ I'm not sure I agree with your explanation. Yes, people
don't want to die, and there is more money chasing
services, but isn't that because people are living much
longer, and, generally speaking, older individuals need
more medical care and have more money to pay for it?
-dans
\_ "need more medical care" = "not wanting to die"
No one *needs* medical care. It may not seem like a
conscious choice, but it is. Examine how people
respond when faced with a terminal illness. Some
people choose to go home and die quietly. Others
choose to spend thousands and thousands of dollars
on treatment that probably won't help. More people
are choosing to use expensive medical services and
that is why they are living longer. Of course,
there is a cost to doing so - a cost that a whole
society seems willing to bear so far, although I
think we are getting close to the breaking point.
\_ Um, by your rationale, no one needs food. I find
your viewpoint to be either exceptionally stupid or
exceptionally crass. Also, terminal illnesses are,
by definition, uncurable. The current attitude
toward treating terminal illnesses isn't one of
trying to cure them, but of trying to provide a
patient with an acceptable level of quality of life.
This need not be expensive, e.g., morphine is cheap.
-dans
\_ You think that we are not trying to treat/cure
terminal illnesses like AIDS and cancer? Get over
your gut-level reaction to my response and read
what I am saying, which is that people are choosing
expensive medical care versus dying. Do you
dispute that? The reason people did not
choose that medical care before is because it
did not exist. That doesn't mean it needs to
exist. Just because some people have Ferraris
doesn't mean we all are entitled to one. BTW,
we don't need medical care like we need food.
It's perfectly possible to live to 60-70-80
years old without ever seeing a doctor. People a
century ago lived that long and longer - maybe
not as many of them, but that's life. Medicine is
extending lives and that is very much a choice
people make.
people make. My gf's grandma had a valve
transplant at 87 years old. She's now 93. 100
years ago she'd be dead, but society said
it's worth $150K (or whatever) to give her
another 5-10 years of life.
\_ Thank you for proving my point. -dans
\_ Medical care is a human right. -dans
\_ No.
\_ From the UN Declaration of Human Rights:
Article 25.
\_ This document is a joke, and is
even self-conflicting.
See Article 17
\_ Kindly cite a document you deem
to be worthy of your eminence.
-dans
(1) Everyone has the right to a standard
of living adequate for the health and
well-being of himself and of his family,
including food, clothing, housing and
medical care and necessary social
services, and the right to security in
the event of unemployment, sickness,
disability, widowhood, old age or other
lack of livelihood in circumstances
beyond his control.
Your welcome to disagree, but, as I said
earlier this makes you either a) stupid
or b) an asshole. -dans
\_ Figuring out what is a human right is
a problem for philosophers, not
something you leave up for the UN to
define. Fuck the UN. -- ilyas
\_ The American notion of human rights
tends to be more along the lines of
what's outlined in our Declaration of
Independence. Specifically, I'm
thinking of "Life, liberty, and the
pursuit of happiness." What you're
talking about is guaranteeing the
success of an individual's pursuit
of happiness. This is a popular
notion with the political left, and
I appreciate that they have the best
of intentions, but their intent is
not sufficient to transform success
into a natural human right.
\_ I'm an American. What gives you
the right to generalize about the
"American" notion of human rights?
Furthermore, the idea that human
rights differ from one nationality
to the next is spectacularly
stupid. And, no, I'm not talking
about guaranteeing the successful
pursuit of happiness, I'm talking
about the pursuit of *life*.
Also, line originally read "Life,
liberty, and the pursuit of
property", but that doesn't read
as well. -dans
\_ I'm the pp and I am not the
person who wrote "No". However, I
agree to the extent that a
minimal level of healthcare is a
right. That doesn't mean all
healthcare is a right.
\_ I disagree because I think a right
cannot be something that must be
supplied by someone else. Since someone
must provide health care, it cannot
be a right.
\_ Well, everything is provided by
someone else. Food, clothing, clean
water, etc. Police/fire/security
is also provided by someone else.
\_no. liberty can be taken by
someone, but it is not "provided"
see http://en.wikipedia.org/wiki/Negative_and_positive_rights
\_ I wouldn't call any of those things
you list rights. Free speech, and
bearing arms are rights, food is
not.
see
http://urltea.com/1l4s (wikipedia)
\_ I wouldn't call any of those
things you list rights. Free
speech, and bearing arms are
rights, food is not.
\_ Apparently you don't really
understand the concept of
Human Rights. -dans
\_ What is "adequate" medical care? As
has been mentioned, there is virtually
no limit to what could be spent in
medical efforts. Perhaps it should be
the right to *access* medical care.
(I also don't think the "right to
housing" is implemented in this
country. Maybe I didn't get the memo.)
\_ That we as a society and a species
fail to implement the ideal of
human rights does not mean we
should not strive to do so. -dans
\_right. But the fact that striving
to provide "positive" rights often
results in a net loss of rights,
should give us pause in our do-gooder
zeal. See _The Road to Smurfdom_
by F.A. Hayek. -phuqm
\_ right. But the fact that
striving to provide "positive"
rights often results in a net
loss of rights, should give us
pause in our do-gooder zeal.
See _The Road to Smurfdom_ by
F.A. Hayek. -phuqm
\_ Um, no. -dans
\_ I disagree because I think a right
cannot be something that must be
supplied by someone else. Since someone
must provide health care, it cannot
be a right.
\_ Well, everything is provided by
someone else. Food, clothing, clean
water, etc. Police/fire/security
is also provided by someone else.
\_no. liberty can be taken by
someone, but it is not "provided"
see
http://urltea.com/1l4s (wikipedia)
\_ I wouldn't call any of those
things you list rights. Free
speech, and bearing arms are
rights, food is not.
\_ Apparently you don't really
understand the concept of
Human Rights. -dans
\_ No, I just think mixing up
things that must be provided (medical care) with things that just
shouldn't be taken away (freedoms) is a very basic cognative mismatch.
Certainly everyone having food and medical care is a good thing, but
they are not rights. You can disagree, but it's evidence that you can't
reason clearly. A problem I see a lot these days.
\_ It seems there's lots of mixing from all sides. You're equating
"rights" and "freedoms". Rights are what the social contract allows
one to justly claim. As such, I personally believe access to health
care and education should be defined as "rights" in this wealthy
country of ours. Freedom is an interesting word. The realm of free
men. Hmm.. Check FDR's four freedoms speech. There's a lot more
muddiness than you seem willing to admit. You're treading into
"what are we as a nation" territory with blinders on. --scotsman
\_ Who said anything about restricting this to our nation?
\_ Well, as you're claiming medical care isn't a right, you're
not talking about most of Europe, or even most of the
developed world, other than US. Do you know what you're
saying? --scotsman
\_ Insurance and gov't funded medicare/aid is funneling
tons of money into health care. The 3rd party payer is
making sure no one knows how much anything costs. Only
now with HSAs are we encouraging people to pay attention
to costs. Some of the money is going to administrative
costs of dealing with insurance/medicare reimbursement.
\_ You think medicare is less transparent than HMOs
and medical insurance companies? How much of
Medicare spending would you say goes to
administrative costs?
\_ Medicare is significantly more transparent than
private health insurance plans/companies.
Medicare's administrative costs are exceptionally
low, i.e. under 5%. This is all well documented,
and can be easily verified with a simple google
search. -dans (not pp)
\_ Have you ever actually known anyone on MC? I
do. I'd rather have the opaque HMO/POS/PPO
system.
\_ Transparancy isn't the issue. It's the issue of
knowing what insurance/medicare will or won't
cover, submitting requests for reimbursement, etc.
\_ How or why is this an issue? Yeah, insurance
could be less complex/more user friendly but,
it's not that complicated. Filing an
insurance claim is certainly no more complex
than filing taxes, and most people seem
capable of doing that. -dans
\_ LOL! Re: Taxes
My neighbor is a doctor and when his
stay-at-home wife finally decided to
help out in the office she found
thousands of dollars in claims that had
not been paid to him. There's a lot of
following up that has to be done and
the process is VERY complicated. He has
a staff of maybe 4 people to handle
this for his practice, which has 3
other partners, and his wife (who has a
vested interest in it and thus did a
better job than the staff did) found all
of this mess. Have you ever had a major
illness? If you have you'd know that even
the people billing you have no idea what you
do or do not owe. It takes months or even
years for it all to be sorted out and
even then there's probably still money
on the table that no one bothers tracking.
It's a big game where the insurance
company refuses to pay until you retain a
lawyer (more $$$) and they can have
their doctors examine you and so on.
\_ I'm sorry, but you're just wrong. The
situation where you need to hire a
lawyer to get your insurance to pay out
is an abberation. It is not the norm.
Either that or your insurance carrier
just sucks. -dans
\_ I am not saying it is the norm,
but it is common if you have big
medical bills. Have you ever had
big medical bills, especially
from an emergency (where approvals
and such were not done beforehand
and you go to the hospital the
ambulance takes you to)? If not,
you are the one who is wrong. If
so, do tell. I have personal
experience with this and when my
old employer changed medical
plans (to one that sucked) we had
an open forum where I heard
stories you've probably never
dreamed of. One guy was paying $800
per month out of pocket for his own
diabetes treatment *with insurance*
because it was "pre-existing" and
that coverage took a year to kick in.
I think you only know from
healthy 20something s/w engineer
who uses Kaiser HMO to have
bloodwork done.
\_ Oh dear oh dear are you ever
wrong. I have two navels. I was
born with one. I have a pre-ex.
I know how to read an insurance
contract. What you're describing
is neither normal, nor common.
Please go read some actual
statistics. Incidentally, you do
realize that pre-ex causes reduce
realize that pre-ex clauses reduce
what you pay as a private
individual for health care? -dans
\_ It's definitely not being eaten by doctors. Doctors' costs of
business, particularly malpractice insurance, is growing much
faster than their salaries. I have a friend who just graduated
from med school and she tells me that her net income from
practicing medicine will likely never exceed what I make writing
code for a startup. To put it mildly, this is fucked. -dans
\_ She probably will make more, even accounting for the costs
of medical school, but she won't pull ahead until very late
in her career. The nice thing about being a doctor is that
at 70 you can still see a few patients and make $80K/year
while I doubt you will be coding at that age. However, your
comment about insurance is correct. Lawyers pay about
$13K/year for malpractice insurance, but OB/GYN pay about
$100K/year. Critics would point out that doctors in the US still
make more than doctors anywhere else in the world, though,
even accounting for these expenses. BTW, why do you think
it's "fucked" that you make more than a doctor? You are both
professionals providing services society wants. I think it's
fucked that doctors make 3-4x what nurses make. It's not
like your friend is going to have a bad life or anything.
\_ Free market efficiency!
If we had socialized medicine, we'd be paying 10x for lower quality!
\_ So what it seems like to me, is that insurance policies need
to severely limit the upper end of heroic medical measures
they'll cover, and who they'll cover them for. No heart
transplants for 55-year-old males with liver disease. But yes
to emergency care for a 20-year-old in a car wreck, provided
that care won't produce a $100k/yr vegetable to care for?
No, to lifelong $1M/year drug regimens, but yes, to insulin?
\_ And who are *you* to decide who lives and dies?
\_ Is this a serious question? To answer anyway:
I'm one of the decreasing number of people who pays
insurance and so covers the cost of heroic medicine.
Seems like I should have some say into how that
money is applied?
\_ No. Really, the idea that you are some how propping up
the system with your payments is an illusion. -dans
\_ Whose payments are propping it up if not yours,
mine, and his?
\_ Magic government money.
\_ It should be decided by capacity to pay. If that's not
"fair" then what is fair? Is it worth $100B to keep the
Pope/President/your uncle alive? $300B? $3T? At what point do
you say "Just let the guy die?". It's unpleasant to think
about, but it really comes down to dollars and cents and a
life does have a value placed on it.
\_ Agreed that it sould be decided by capacity to pay. That's
not the same as insurance companies "severely" limiting it.
\_ I would say the the standard of care has skyrocketed. All those devices,
drugs, trained people, complex procedures, throw-away sterile materials,
operating rooms, MRIs, fiber-optic cameras. And most of it is just
accepted as "the norm". It goes way beyond just keeping people alive
and comparing total money spent vs. life expectancy. We pamper ourselves,
and it's in the health care industry's interest to do so.
Washing your hands and taking an aspirin would probably get the job done,
but you "have a right to the best healthcare available."
It's a vicious cycle of madness, and we're all part of it.
\_ Would any of you all believe that I didn't post my question
as a troll? I really wanted to know. Unfortunately, I don't
think the motd provided real clarity. Perhaps I was a fool
to ask. The study I Googled (and commented on above) made
the claim that most of the increase has gone into doctor's
salaries. To dans: I don't believe the economic wherewhithal
exists on the planet to provide everyone with heroic Western
style medical care. I doubt that the economic wherewithal
\_ Western style medical care really isn't that heroic. 'First do
no harm' is an ideological core value of Western medical
education, and this means doctors are trained to be skeptical
of heroic procedures with low odds of successful outcome /
medical heroics in general. -dans
exists to provide even basic medical care to everyone. It
seems insane to define "what cannot be provided" as a right.
And what about the right to keep the fruits of your labor?
That's in **direct** competition with any universal
entitlement to any product or service. We should keep
"rights" restricted to equal
opportunities (freedom) rather than entitlements. As an
extreme, if someone has a "right" to medical care, then
someone else--whether he wants to or not, must provide
that care. Doctors as slaves? --PeterM
\_ To simply put, cost rise is associated with the rise of
new medicines and new treatments, and American's attitude
of "I deserve the best treatment." Many years ago we didn't
have advanced MRI and other expensive drugs which we all
are now paying for.
\_ Please provide evidence to support your questionable
claims. When you say 'we are paying for', do you mean
'we are paying for through insurance coverage' or 'we
are paying for out of pocket'? -dans
\_ You were very free to call people "stupid" or "assholes"
above for not agreeing that people have a right to
medical care. Now, this guy said that we are paying
for medical care. He's right. There's no free lunch.
Insurance premiums come out of our pocket. What
distinction are you trying to make to invalidate his
claim that "we are paying for"?
\_ Any study that concludes that the money went to the doctors
is pushing an agenda, because there's no way that's true.
My neighbor is a partner at a busy neurology practice and he
would argue all day long about how to make money now you
have to see a lot of patients (not provide a good standard
of care), get a good survey rating (translates into
dropping patients with chronic health problems because they
complain all the time), avoid research (who has time to
participate in studies), and probably still make less than
his dad (who was a doctor) did. His dad lived in a mansion
in Larchmont and he lives next to me in a 1300 square foot
house. His dad drove a Jaguar. He drives a Passat. His dad
built a greenhouse for his mom's orchids. He waters the lawn
by hand because it's not in the budget to redo the aging
sprinklers. I don't want to say that I am basing my
statement on purely anecdotal evidence, but the reality is
that malpractice insurance and HMOs have eroded the medical
profession. To claim that doctors now make 3x more than
before (costs have risen 3X according to your premise) is
ridiculous. They make less than before just like many of us.
Let's see this study you found. Are you sure it didn't look
at gross pay for doctors and ignored that they pay 25% of
revenues for malpractice insurance and that they have to hire
2 people fulltime just to figure out the insurance paperwork?
\_ Doctors made out pretty well in this country *until* the
HMOs and high malpractice insurance came along. I think
that says it all.
\_ Yes. Now we pay 3x as much for care and it doesn't
even go to the doctor or nurses but instead to lawyers
and insurance companies. This is much better! |
| 4/3 |
|
| en.wikipedia.org/wiki/Negative_and_positive_rights human rights, some philosophers and political scientists make a distinction between negative and positive rights. According to this view, a positive right imposes a moral obligation on a person to do something for someone, while a negative right merely obliges others to refrain from interfering with someone's attempt to do something. To state the difference more formally, if 'A' has a negative right against 'B' then 'B' must refrain from acting in a way that would prevent 'A' from doing 'x'. If 'A' has a positive right against 'B', then 'B' must assist 'A' to do 'x' if 'A' is not able to do 'x' without that assistance. For example, a negative right to life would require others to refrain from killing a person. A positive right to life would require others act to save the life of someone who would otherwise die. A positive right is a right to be provided with something through the action of another person or the state. In theory a negative right proscribes or forbids certain actions, while a positive right prescribes or requires certain actions. imperfect duties A right to an education is considered a positive right because education must be provided by a series of 'positive' actions by others. School buildings, teachers and materials must be actively provided in order for such a right to be fulfilled. edit Criticism and response Critics argue that the distinction between negative and positive rights is a false dichotomy. Some draw attention to the question of enforcement to argue that it is illogical for certain rights traditionally characterised as negative, such as the right to property or freedom from violence, to be so categorised. While rights to property and freedom from violence require that individuals refrain from fraud and theft, they can only be upheld by 'positive' actions by individuals or the state. Individuals can only defend the right to property by repelling attempted theft, while the state must make provision for a police force, or even army, which in turn must be funded through taxation. Jan Narveson, the view of some that there is no distinction between negative and positive rights on the ground that negative rights require police and courts for their enforcement is "mistaken." He says that the question between what one has a right to do and who if anybody will enforce it are separate issues. If rights are only negative then it simply means no one has a duty to enforce them, although individuals have a right to use any non-forcible means to gain the cooperation of others in protecting those rights. Therefore, he says "the distinction between negative and positive is quite robust." However, this response could also be used by advocates of positive rights, since one could equally well say that people have a right to food and shelter, for example, but that no-one has a duty to enforce this right. Libertarians hold that positive rights, which would include a right to be protected, do not exist until they are created by contract. However, those who hold this view do not mean that police, for example, are not obligated to protect the rights of citizens. Since they contract with their employers to defend citizens from violence, then they have created that obligation to their employer. A negative right to life allows an individual to defend his life from others trying to kill him or to obtain voluntary assistance from others in order to defend his life, but he may not force others to defend him because he has no natural right to be provided with defense. To force a person to defend one's own negative rights, or the negative rights of a third party, would be to violate that person's negative rights. By this reasoning, slavery, is a violation of individual rights. James P Sterba argues, it might just as easily be characterised as the right of the starving person not to be interfered with in taking the surplus food of others. He writes: What is at stake is the liberty of the poor not to be interfered with in taking from the surplus possessions of the rich what is necessary to satisfy their basic needs. Needless to say, libertarians would want to deny that the poor have this liberty. The discussion often centers on the nature of rights themselves; some philosophers argue that rights are purely moral principles rather than legal rules that should be enforced by governments. Thus, in this view, one person's negative right does not impose a moral obligation on anybody else (including the government) to affirmatively protect that right against aggressors; the obligation is only to refrain from violating it themselves - a negative obligation. Tibor R Machan: In some rare cases, an innocent person might indeed be totally helpless and have no choice but to obtain resources by stealing them. Perhaps only filching that piece of fruit will stave off immediate starvation. But extraordinary circumstances cannot generate laws granting a permanent right to steal, not when stealing itself means taking by force what by right belongs to others. |
| urltea.com/1l4s -> en.wikipedia.org/wiki/Negative_and_positive_rights human rights, some philosophers and political scientists make a distinction between negative and positive rights. According to this view, a positive right imposes a moral obligation on a person to do something for someone, while a negative right merely obliges others to refrain from interfering with someone's attempt to do something. To state the difference more formally, if 'A' has a negative right against 'B' then 'B' must refrain from acting in a way that would prevent 'A' from doing 'x'. If 'A' has a positive right against 'B', then 'B' must assist 'A' to do 'x' if 'A' is not able to do 'x' without that assistance. For example, a negative right to life would require others to refrain from killing a person. A positive right to life would require others act to save the life of someone who would otherwise die. A positive right is a right to be provided with something through the action of another person or the state. In theory a negative right proscribes or forbids certain actions, while a positive right prescribes or requires certain actions. imperfect duties A right to an education is considered a positive right because education must be provided by a series of 'positive' actions by others. School buildings, teachers and materials must be actively provided in order for such a right to be fulfilled. edit Criticism and response Critics argue that the distinction between negative and positive rights is a false dichotomy. Some draw attention to the question of enforcement to argue that it is illogical for certain rights traditionally characterised as negative, such as the right to property or freedom from violence, to be so categorised. While rights to property and freedom from violence require that individuals refrain from fraud and theft, they can only be upheld by 'positive' actions by individuals or the state. Individuals can only defend the right to property by repelling attempted theft, while the state must make provision for a police force, or even army, which in turn must be funded through taxation. Jan Narveson, the view of some that there is no distinction between negative and positive rights on the ground that negative rights require police and courts for their enforcement is "mistaken." He says that the question between what one has a right to do and who if anybody will enforce it are separate issues. If rights are only negative then it simply means no one has a duty to enforce them, although individuals have a right to use any non-forcible means to gain the cooperation of others in protecting those rights. Therefore, he says "the distinction between negative and positive is quite robust." However, this response could also be used by advocates of positive rights, since one could equally well say that people have a right to food and shelter, for example, but that no-one has a duty to enforce this right. Libertarians hold that positive rights, which would include a right to be protected, do not exist until they are created by contract. However, those who hold this view do not mean that police, for example, are not obligated to protect the rights of citizens. Since they contract with their employers to defend citizens from violence, then they have created that obligation to their employer. A negative right to life allows an individual to defend his life from others trying to kill him or to obtain voluntary assistance from others in order to defend his life, but he may not force others to defend him because he has no natural right to be provided with defense. To force a person to defend one's own negative rights, or the negative rights of a third party, would be to violate that person's negative rights. By this reasoning, slavery, is a violation of individual rights. James P Sterba argues, it might just as easily be characterised as the right of the starving person not to be interfered with in taking the surplus food of others. He writes: What is at stake is the liberty of the poor not to be interfered with in taking from the surplus possessions of the rich what is necessary to satisfy their basic needs. Needless to say, libertarians would want to deny that the poor have this liberty. The discussion often centers on the nature of rights themselves; some philosophers argue that rights are purely moral principles rather than legal rules that should be enforced by governments. Thus, in this view, one person's negative right does not impose a moral obligation on anybody else (including the government) to affirmatively protect that right against aggressors; the obligation is only to refrain from violating it themselves - a negative obligation. Tibor R Machan: In some rare cases, an innocent person might indeed be totally helpless and have no choice but to obtain resources by stealing them. Perhaps only filching that piece of fruit will stave off immediate starvation. But extraordinary circumstances cannot generate laws granting a permanent right to steal, not when stealing itself means taking by force what by right belongs to others. |