Will TTD operations be impacted by Knott's incident?

GoBucks89 said:
We have the best healthcare in the world. There is a reason that the world's wealthiest folks, who can afford to go anywhere they desire, come here.

No! No, we don't. Where do you even get this kind of nonsense from? This is exactly the kind of totally unsubstantiated nonsense that moves this conversation in the wrong direction. The US has an embarassingly poor health care system, and when you consider that we spend more than almost every one else, I'm not sure how you can even say that with a straight face.

...we are going to be able to give everyone all the medical care they will ever need (without (1) rationing care or (2) pay trillions and trillions that we simply don't have)? Da plane, da plane....

The thing is, given a public option, we'd finally have something resembling competition in the health care industry. As you likely know, competition is absolutely critical to driving down these insane costs.

And really, that's why I don't get why everyone is so against a public option. If such a thing is really destined to fail, it will. If it succeeds, it drives down costs for everyone. Where's the downside? I mean, yeah, there's the money, but we're already paying out the ass for less-than-optimum health care.

Jeff said:

Of course, socialism somehow became a dirty word at some point, despite the fact that we all participate in it, whether we're paying into or collecting social security, driving on public roads, sending the kids to public schools or enjoying police and fire protection. But you know, bein' stoopid is easier.

Exactly. I can't tell you how many times I've gotten into the dead-end conversation about the "haves" paying more than the "have nots". Mind you, I'm not saying I agree or disagree with the idea.

There are a few staunch conservatives in my office that complain about the concept of the "cadillac insurance" tax. When I point out that their property tax is based on their property value and their income tax is based on their income, and as such they pay a different amount than their neighbors to drive on the same roads and such, I'm met with blank stares. You'd think I just crapped in their coffee. I actually had a guy flat-out refuse to admit that Social Security is a socialist program. I mean, WTF??? There really is this total disconnect from reality, and its certainly not helping the debate move forward.

Brandon -- I can say it with a straight face because its true. We have the best doctors, nurses and healthcare facilities in the world. We have the best medical technology in the world. People from all over the world come to be trained in our medical schools. People come from all over the world to be treated in our medical system. Go the the Cleveland Clinic heart center. You will think you are in a foreign country with all of the foreign languages being spoken there.

On what do you base your statement that the US has such a substandard healthcare system compared to the rest of the world? And when you look at how much we spend compared to the rest of the world, are you factoring in the costs that we must deal with that other countries do not? Obesity costs are extremely high in the US but not in other countries because they are not obese.

Any system that gives neither the person providing the service nor the person consuming the service any incentive to reduce costs will not reduce costs. The only way it can reduce costs is if there is some third party gate keeper. And I keep hearing politicians say that neither the government nor insurance companies will get in the way of decisions by doctors/patients so apparently there will be no gate keeper. So costs will not be reduced.

And when looking at costs and costs savings, there are two certainties with government: the costs will always be higher than expected and the costs savings will always be less. And at a time when social security it going bankrupt in the next 6-7 years, I think signing up to spend trillions and trillions of dollars makes a lot of sense. We already have 40+ trillion in unfunded liabilities. What a few more trillion?

GoBucks89 said:
Brandon -- I can say it with a straight face because its true.

Really? Is this based on data, or just your gut feeling or something? Because if all you're offering as proof is that you have a hard time understanding that brown doctor at the Cleveland Clinic, then I think you need to seriously re-assess your position.

We have the best doctors, nurses and healthcare facilities in the world. We have the best medical technology in the world.

Link please?

On what do you base your statement that the US has such a substandard healthcare system compared to the rest of the world?

Factual data:

France, Japan and Australia rated best and the United States worst innew rankings focusing on preventable deaths due to treatable conditionsin 19 leading industrialized nations, researchers said on Tuesday.

If the U.S. health care system performed as well as those of those topthree countries, there would be 101,000 fewer deaths in the UnitedStates per year, according to researchers writing in the journal HealthAffairs.

Researchers Ellen Nolte and Martin McKee of the LondonSchool of Hygiene and Tropical Medicine tracked deaths that they deemedcould have been prevented by access to timely and effective healthcare, and ranked nations on how they did.

Here, you can see that our biggest problem is access to care, especially given how much we spend, compared to other developed nations.

Any system that gives neither the person providing the service nor the person consuming the service any incentive to reduce costs will not reduce costs. The only way it can reduce costs is if there is some third party gate keeper.

Or competition. If insurance providers were actually competing, you can bet your ass they'd be giving customers incentives to reduce their health costs (which would pad the providers' margins).

I don't think you're totally off-base with what you're saying, but it all sounds like hyperbolic rhetoric that you've not fact checked.

djDaemon said:
Here, you can see that our biggest problem is access to care, especially given how much we spend, compared to other developed nations.

I think that's the crux of the issue. We do have the best health care providers in the world, if you happen to have insurance and/or the pockets to pay for it. And that's where our system fails. Too many people who can't seek treatment until it's too late.

Exactly. What's the point of having the "best health care" in the world if only the top 10% can even use it? Its easy to show how that actually ends up being NOT the best by any measure.

Now, I realize more than the upper 10% have access in the US. I'm just making a point.

We have the best healthcare that money can buy.

Now here is the problem with a public "option":

...If such a thing is really destined to fail, it will. If it succeeds, it drives down costs for everyone....

See, right there is the main fallacy. If such a thing is destined to fail, it won't be permitted to. It will survive on ever larger infusions of other people's money until it swallows the entire Federal budget. Which is of course no problem since taxes can always be raised on somebody...... If programs of this kind were allowed to fail, Social Security (which is not only a Socialist program but a pyramid scheme that would be illegal if anybody other than the government were running it) would have collapsed decades ago.

The other fallacy is that a public program would increase competition. It would do no such thing. It instead creates a disincentive for private options to exist. The public program would eventually result in the failure of private programs, although there would be claims to the contrary because the companies would still exist because their capacity would be used to administrate the public program.

Tell me this: Why is there no call for a public option for, say, automobile insurance?

--Dave Althoff, Jr.

    /X\      *** Respect rides. They do not respect you. ***
   /XXX\     /X\     /X\_      _     /X\__      _      _____
  /XXXXX\   /XXX\   /XXXX\_   /X\   /XXXXX\    /X\    /XXXXX
_/XXXXXXX\_/XXXXX\_/XXXXXXX\_/XXX\_/XXXXXXX\__/XXX\__/XXXXXX

Excellent point with the comparison to Social Security, Dave. The financing problem is obviously the most pressing concern, for a lot of reasons.

RideMan said:

The other fallacy is that a public program would increase competition. It would do no such thing. It instead creates a disincentive for private options to exist. The public program would eventually result in the failure of private programs, although there would be claims to the contrary because the companies would still exist because their capacity would be used to administrate the public program.

Wait, why? If private companies can provide insurance directly to consumers, and can do so while being profitable, there will be a place for them. Would companies really turn down an opportunity at making money, just because they're not making as much as they were?

The way I see it, there are always going to be people who will have the money and desire to obtain "luxury" insurance. Why would that market disappear?

And really, even if it did, what's so bad about that? A single-payer system, like Medicare or the VHA, can and does work, not only here, but in the UK & Canada as well. Granted, the UK and Canadian systems are different, but they work.

Taking Dave's idea of "health insurance being similar to automobile insurance" a step further another idea needs to change: health insurance should cover catastrophic events only and not cover the general maintenance that you should be doing (wellness visits, when you get a cold, etc.)

What kind of auto insurance plan covers gas, oil changes, tune ups, and tires? An expensive one. But this is exactly what we are getting under today's health insurance. There is no incentive to go out and shop around for the best price for the best service. HSA's try to go this route, where you save money in a tax deductable account for use for regular doctor's visits and for the big deductable when something catastrophic happens. When you have to go to the doctor it forces you to shop around, because you want to get the most for your money. This would also keep doctors competitive through providing services and keeping their costs under control. Kind of like what garages do when it comes to providing auto maintenance.

There's also tort reform, but that's a completely different (and long) discussion.

~Rob

I wasn't referring to the doctors at the clinic. I was referring to the patients and their families who are from foreign countries. If the care isn't top notch, why would they be coming here rather than going to another country where the care is supposedly better?

The preventable death stats don't answer the issue. You need to look at why the deaths were preventable and why they were not prevented. In my first post I noted that we have a distribution/financing issue so to the extent those preventable deaths were caused by distribution/financing issues, I am not disputing that.

Competition with insurance companies is great (though its not like we have 0 competition now). But it can only go so far in reducing costs. Particularly when there are no incentives for the doctors/patients to reduce costs. As it is now (and as it will be with every plan that I have seen being proposed), if I go to the doctor and a test/scan is suggested, I pay no additional costs. So what incentive is there for me to even consider whether the test is even needed or to shop around to see if someone else could do it better/cheaper? None. If I had to pay for it myself, I would likely think a lot more about whether the test is needed and assuming I think it is, I would likely look around to see if someone else could do it better/cheaper. And the doctor would be much more likely to compete on price. Prices would thus come down as would costs because a lot of people would determine that they do not need the given procedure in the first place.

And I suspect that most Americans would not be happy with the incentives that you think competing insurance companies will put in place. As a business matter, you will want to charge people more money if they will cost you more (use more services). And you may want to deny coverage to folks who will incur extreme costs (back to pre-existing conditions problems). And to me, the best way to decrease our healtcare costs is for people to lose weight, exercise, eat right and stop smoking. Would you expect insurance companies to put incentives to get people to do those things in place? Who well will that go over? And insurance companies can provide preferences for lost cost provides but the American public has routinely rejected any notion of interfering with patients' rights to pick their doctors.

Again, GoBucks, I'd simply ask you to provide some data to substantiate your claims.

What claims?

Well, you have made a few. You've claimed that:

1. The US has the best doctors, nurses, etc. in the entire World;
2. The US has the best health care in the World;
   
3. All people for whom money is no object come to the US for health care;

These are all things I've heard many people state, but have yet to see anyone back such claims up with actual data. The whole "we're number 1! we're number 1!" is only cute if its true. Its not. And repeating such things without questioning or verifying them takes this conversation in the wrong direction.

I mean, you're clearly against universal health care, which is cool. To each their own. But how would you react if I told you that universal health care would cure cancer, embiggen the cuteness of kittens and make ice cream twice as delicious and simultaneously non-fattening? Obviously, you'd call BS in the absence of any supporting information. That's all I'm doing here.

Well, when you resort to making up words like embiggen. For all I know you mean that Universal Healthcare will kill all cute kittens. That's just another strike against it.

Embiggen take one...

and take two. :)

Real Dictionary

How dare you.

Next, you'll probably try and tell me that Lupper isn't an actual meal!

1. There is clearly some hyperbole in my statements. Proving who/what is the best of anything that is not 100% objective (which healthcare clearly isn't) is impossible. So maybe I should have said that I think our doctors, nurses, medical technology/facilities, etc. are on par with the best in the world. Presumably you would want some type of data supporting that as well. Don't have that data at my fingertips just based on everything I have experienced and read during my lifetime. You would need to first define what you think makes a doctor the best and then compare our doctors and those of other countries to that standard. I will admit that I haven't done that though I would expect that our doctors, nurses, etc. would do very well in any of those types of comparisons.

But if you are so conviced that our doctors, nurses, etc. are sub par compared with any given number of other countries, what data do you have to support that? What countries doctors, nurses, etc. are better? And as I noted, your site with respect to preventable deaths doesn't make that case because even as the article noted, the problem with the US was access to care which would have prevented deaths not the care itself.

2. I think that goes hand in hand with #1. And I have never argued that we do not have distribution/finance issues in our healthcare system.

3. I never said that all people for whom money is no object come to the US for healthcare. But a lot of people do. It seems to me that the Cleveland Clinic doesn't have an International Center which handles foreign patient referrals for people from the east side of Cleveland. And maybe its just living in the Cleveland area and having a lot of friends who are doctors, nurses, ect. that work there and hearing a lot about foreign patients to require a lot of hard data to support it. And MD Anderson doesn't provide translation in Spanish, Portuguese, Arabic, Turkish, Taiwanese, Mandarin, Japanese, Italian, German, French and Vietnamese to deal with patients from the greater Houston area. And it seems to me that folks who travel here from other countries will tend to be richer rather than poorer. And I am not sure why someone would travel to a foreign country to get care https://my.mdanderson.org/content/index.cfm?pld=000732C6-ABD3-1BE1-891A8302A07301D1

And I agree that much of what I hear in the healthcare debate takes us in the wrong direction. And one of my biggest concerns is that we take a system that really does provide great care (again not arguing that we do not have distribution/access/financing problems) and hurt that systems ability to provide great care in the reform process. And a lot of comparisons to other countries results are skewed by the old computer programming maxim: garbage in, garbage out. Other countries do not need to deal with many of the health care issues we deal with (obesity being one of the major issues).

GoBucks89 said:
Proving who/what is the best of anything that is not 100% objective (which healthcare clearly isn't) is impossible.

Technically, perhaps. But metrics exist and have been used to examine and compare health care systems, and in the absence of a "perfect analysis", these should be indicative of how we're doing. Taking into account life expectancy, responsiveness, financial fairness, distribution and responsiveness distribution, the WHO ranks us 37th in overall health care performance. Right below Costa Rica, but two whole spots above Cuba! Go America!

Even if these rankings aren't 110% infallibly representative, I think its fair to say they give a good indication of where we're at in the US, performance wise. Put simply, we should be embarrassed.

Don't have that data at my fingertips just based on everything I have experienced and read during my lifetime.

That's anecdotal, and using such "evidence" is dangerous, especially when you're talking about poo-pooing something that would impact so many people who aren't GoBucks89. I'm not saying you're assessment is right, wrong or somewhere in between. But you seem to be basing your position on the matter on a gut feeling, when there is data available that suggests something very different.

But if you are so conviced that our doctors, nurses, etc. are sub par compared with any given number of other countries, what data do you have to support that?

I never claimed to disagree with you. I simply think if you're making such a claim, you should have actual data to back it up. "That's just how I feel" works when you're giving your opinion on the latest Lucky Charms marshmallow, but not so much with something like the health care debate.

...the problem with the US was access to care which would have prevented deaths not the care itself.

So, you're saying our ranking is being skewed by the lack of health care access in the US? Access is the #1 problem that universal health care aims to solve.

3. I never said that all people for whom money is no object come to the US for healthcare. But a lot of people do.

Fair enough. So, where's the data that backs up your claim that "a lot of people" come to the US for health care?

...maybe its just living in the Cleveland area and having a lot of friends who are doctors, nurses, ect. that work there and hearing a lot about foreign patients

Again, this is anecdotal. I'm sure I could find someone who could refute this using their own limited personal experiences. But it wouldn't make the data more relevant.

And one of my biggest concerns is that we take a system that really does provide great care (again not arguing that we do not have distribution/access/financing problems) and hurt that systems ability to provide great care in the reform process.

Maybe this is where the disconnect is. You seem to separate "access" from "quality", with regard to health care. The lack of access is exactly what we're trying to solve here. You're saying our health care system rocks! Its just that no one can use it!

Well, we need to fix that, no?

I don't think the topic title is absolutely fitting anymore.