vimothy
yurp
Worthy piece in the New Yorker from a researcher at The Dartmouth Institute for Health Policy and Clinical Practice: The Cost Conundrum, by Atul Gawande. The TDI finds no connection between cost and quality of US health care.
Obama health reform
- Thread starter IdleRich
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vimothy
yurp
And Gates is planning to increase Army troop levels by 22k over the next two years, funded via a kind of backdoor arrangement (diverting supplemental funds originally intended for vehicle purchases), but certainly not suggestive of a reduction in defence spending in the near-term.
nomadthethird
more issues than Time mag
This is exactly what doctors have been saying for years and no one has been listening. The cost keeps getting higher because costs get redistributed when people come in to see doctors, get procedures or treatment, then ignore the bill and eventually discharge the debt in bankruptcy. Somebody has to end up footing that bill, so it usually ends up being redistributed among insured patients. So now you have people being billed $500 for "clean sheets" and shit, when really what they're being billed for is someone else's pacemaker or week in the hospital. The effect of this is that insurance premiums steadily rise, so that employers can't afford to extend benefits to their employees, thus making the problem even worse, and the cycle continues.
If the gov had stepped in years ago and extended benefits (or at least forced businesses to extend benefits to their employees), costs wouldn't have risen exponentially like this. Now we're left fixing the mess that allowing private industry to run amok has left strewn all over health care. Sound familiar?
Edit: If I'm reading it correctly, this article isn't saying what you're sort of implying that it's saying. There may be local anomalies where some expensive treatment centers that use newer technologies don't have better metrics (which doesn't exactly correlate to better "care" anyway--unless you watch a lot of TV and saving lives is as easy as putting the defib on someone), and sure tons of money is wasted all over the place on unnecessary fun machines. But there's a difference between medicare spending and cost of care/treatment, as it were. This article conflates these two things.
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nomadthethird
more issues than Time mag
Aye aye aye what a bunch of morons.
nomadthethird
more issues than Time mag
Ok, this is a good example of why "preventative care" isn't as easy as it sounds, practically speaking:
All of those are technically preventative measures against more serious injuries or diseases or death. People say that we need to increase preventative measures, and sure, we do, but that's not cheap either. If the U.S. is actually in the middle-range for heart disease, this is probably why--because it sure ain't our diets or our lifestyles.
All of those are technically preventative measures against more serious injuries or diseases or death. People say that we need to increase preventative measures, and sure, we do, but that's not cheap either. If the U.S. is actually in the middle-range for heart disease, this is probably why--because it sure ain't our diets or our lifestyles.
padraig (u.s.)
a monkey that will go ape
now, hold on a minute there. it's essentially just the Army shifting funds from vehicle programs to recruiting/equipping/etc soldiers. & the main reason for it is to alleviate the strain on soldiers, to increase the time at home between tours in Afghan/Iraq from 12 to 15 months. we've also been using/relying on reserves as essentially active duty soldiers far too much for far too long. it may or may not be dumb - I'm not qualified to say - but that has to do more w/how effective a measure it will be.
keep in mind as well that the amt of $ we're talking, roughly $700 million, is like a drop in the bucket of the U.S. defense budget. the kind of cuts you're envisioning funding health care would be in the many, many billions. & Gates has, anyway, been one of the fiercest critics of unnecessary funding voted on by Congress (which is really where you want to direct your ire).
*also - just read thru that article you linked Vim, good look. really interesting. I dunno if he's right or not but I really enjoy reading what I guess you might call the "ethical doctor's" view.
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crackerjack
Well-known member
nomadthethird
more issues than Time mag
roffle@obama=hitler
I'm not big on tactical justifications, although I'm sure there are trillions of them...war is war is war there will always be another justification some old man will come up with for why we need to go kill people somewhere...(i'm sure this Gates dude is not the focal point of the trouble but that wasn't my point)
I'm not big on tactical justifications, although I'm sure there are trillions of them...war is war is war there will always be another justification some old man will come up with for why we need to go kill people somewhere...(i'm sure this Gates dude is not the focal point of the trouble but that wasn't my point)
As far as I'm aware, he hasn't apologised -- on his Telegraph blog a few days ago he reaffirmed and clarified his position. In any case, why on earth should he apologise? I really don't understand this attitude that no one can criticise the NHS under any circumstances, or (quelle horreur!) suggest that other health care systems are better. The idea that it's beyond criticism, that it's perfect, or the best system in the world, is just tribalist nonsense. Hannan's position isn't evil or even unreasonable, it's just different from yours.
If you want a statement that really does deserve a hostile reaction, how about David Milliband on Radio 4 recently, saying that terrorism under certain circumstances is justifiable? I'm not sure if the Guardian has made the same sort of fuss about that one.
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padraig (u.s.)
a monkey that will go ape
there's already a war going on, it will continue to go on whether or not the Army expands, as long as it is (which is, as always, a policy decision, made by politicians, not the military) we might as well do it properly & take care of the people who are actually stuck fighting it.
also while I'm def not a fan of this particular war - mostly for practical reasons - lumping everything together into "war is war is war" is nonsense.
scottdisco
rip this joint please
ah sorry. a mate told me he'd done so in the print edition but i didn't actually bother to check.
(i have read Hannan quite a lot in their print edition FWIW. anyway.)
to answer your question 'why should he apologise?', you're right, he shouldn't have to. they're his views. i am grateful to him for his clarity. and i didn't want anyone to infer that's what i was implying, that he should apologise. (though i note his boss David Cameron has been doing, how shall we say, damage control on this issue since it became a bigger media storm; i find that instructive.)
of course, my post did not say (or even imply) the NHS is perfect, beyond criticism or the best system in the world. (and i would - obviously - agree that holding to those sorts of rigid positions is tribalist.)
what gets my goat about Hannan is this original TV appearance in the States more than anything.
he gave succour - unintentionally or otherwise because of his own partisanship - to opponents of what is, at least, a worthy attempt to try and improve the situation in the USA (that's not arguably his fault that he gave succour, what's that Tony Judt quote about not being able to control who agrees with your opinions even if you find those agreeing with you personally unpalatable, but, on the other hand, he would know his views get a sympathetic hearing on FOX).
however, given the Institute of Medicine reported that more than 18,000 Americans die every year because they are unable to afford medical insurance (and i would like to think Hannan is aware of some of the stats of the horrific gaps in the US health system; he should read up before a major TV interview anyway), Hannan's pouring cold water on the concept of increasing access to a basic safety net sort of system is really pretty dumb IMO.
he could've gone on FOX and held a few nuanced positions, perhaps a bit of the old 'on the one hand but also', perhaps not been quite as critical given that he would know how an attack on socialised medicine would play wrt the target audience, and he should have been aware of the importance of this issue in the USA, for the well-being of millions of Americans, etc etc. (although, of course, to be true to himself - a laudable trait - he told his views honestly.)
so no, he just went on and slagged off the highly imperfect NHS, which is, admittedly, superior to how primary health care is provided (or otherwise) across the board in the USA. pretty screwy, if you ask me.
crackerjack
Well-known member
He's not simply saying the NHS isn't the world's best (it pretty obviously isn't), he's touring a country with the worst in the developed world and telling them they should stick with what they've got. American healthcare isn't just tomayto to our tomarto, it's a moral abomination which leaves millions of people completely uncovered and millions more severely under-insured.
Hannan's a dangerous ideologue who'd would like something similar introduced here. Evil? If I was bankrupted from ongoing medical problems, yeah, i'd probably call him that.
nomadthethird
more issues than Time mag
Speaking of "tribalist nonsense" I'm not a fan of war, period.
Ego-maniacal, nationalistically sanctioned bloodsport isn't going to right any sort of wrongs in the world, and I'm convinced it's the purview of schoolboys with romantic notions who haven't grown up enough to realize that war creates more problems than it solves and who would do better to go kick a ball around or get laid to feel that sense of glorious "win" than to continue the march toward immortality through Hissstorryyy. It's high time the rest of us didn't have to continue suffering because of the testosterone poisoning of a few.
This is one of those places where Zhao is right, transcending the "Ego" makes a whole lot of sense. It'd be nice if humans evolved past being barely literate apes without a glimmer of moral sense whatsoever who only live to protect their own interest and pass on their selfish genes. I don't really expect things to change, though. Not holding my breath.
nomadthethird
more issues than Time mag
To be fair to him, Fox probably conned him into being a guest somehow. He may have had no idea how his words were going to be twisted or framed. They've done this sort of thing before and they'll do it again.
Not that I've seen the footage mind you...
crackerjack
Well-known member
Nah, he's an 80s throwback to the more-Thatcherite-than-thou days of privatising everything that moves, direct descendant of the classical liberals who thought the potato famine was good for Ireland.
He's also a chronic self-publicist, whose moment of youtube glory came when he circulated an irrelevant speech to the press himself. He's just giddy on the applause and he knows America is where this stuff plays best, now the Tories have gone cuddly.
He's also a chronic self-publicist, whose moment of youtube glory came when he circulated an irrelevant speech to the press himself. He's just giddy on the applause and he knows America is where this stuff plays best, now the Tories have gone cuddly.
padraig (u.s.)
a monkey that will go ape
you know the relevant Trotsky quote (whether or not he actually said it), I'm sure. clearly, there are things that motivate people to fight. somehow I doubt it can all be chalked up to misplaced adolescent hormones, but hey. you can be convinced of whatever you want - more power to you - but I don't think the hombres armados could, frankly, give two shits. the vast majority of soldiers aren't "fans" of war either, btw. in fact, they're usually a hell of a lot warier about it than the politicians, if only b/c they're the ones who'll actually catch the sharp end & they know the real cost.
back OT, the public option - the whole goddamn point in the first place - looks to be off the table. instead we're getting some wishy-washy business about co-ops which are then supposed to compete with private insurance giants. good luck with that. they also won't, yunno, provide insurance to the 50 million odd Americans who don't have it. I guess I'd be disappointed if I hadn't been expecting some ineffectual nonsense like this from the start. here's to another round of this in 2018.
oh &, ironically enough, it looks as if the lasting effect of the whole "death panels" business will be to keep anything about end of life counseling out of the legislation. which will only hurt - you guessed it - the very same seniors who were supposed to be euthanized by the imaginary death panels in the first place. but I guess that's the price you have to pay if you don't want the Sun Belt to turn into the Gulag Archipelago for grandmas.
nomadthethird
more issues than Time mag
If only it were just adolescents...men usually find a way to valorize their egotism, and turn it into something big and important and twist it into the moral option, no matter what. And nobody said anything about soldiers being bad or uniquely responsible, either. (anti-war is not anti-solider, thanks for the reminder tho) War, especially these days, is declared by people who don't have a dog in the fight except as investors and I refuse to pretend it's anything more glorious than protecting self-interest on an extremely meta-level.
I frankly don't give two shits about what the hombres armados think or do.
WTF, I shouldn't have let myself get excited about this for even a second. I knew those fucking idiots would win the way the always do, by convincing everyone the terrorists and the Stalinists were going to take over if we didn't keep our hands off. Why are the democrats always so spineless? This is obviously (at least partially) about them not wanting to lose their seats and their control of the white house and congress.
Does anybody know how electric/agriculture co-ops operate?
The reason Hannan went on the program is that he thinks that the current reforms won't help them at all. Just because someone criticises a proposed solution for a problem doesn't mean they think there isn't a problem, or that the problem doesn't need solving. He didn't say they should 'stick with what they've got' -- he just advised them against copying the NHS.
Hannan doesn't want anything like the American system introduced over here, never said he did. As for American health care being the worst in the world ever, as many Brits seem happy to describe it, it's not quite that simple. The number of uninsured people is terrible, as we all know, but for those who pay, the health care is better than over here (look at waiting times, cancer survival rates). To Americans, stories of NICE denying breast cancer treatment, &c., on cost grounds are scary, because it doesn't happen over there.
So what on Earth is the point of it? The bill is over 1000 pages long, creates dozens of new govt agencies, spends billions of dollars and doesn't cover the other 50m people? The money would probably be better spent just paying the 50m people's premiums for a decade, or something.
nomadthethird
more issues than Time mag
Hannan seems like an utter douche, but this seems like a reasonable point, and I've been wondering why the repugs didn't take the high road and tell stories more like this one. Talking about real stories instead of using what amounted to basically threats and intimidation might have been enough to get the mob frothing at the mouth. For example, I read a story in the BBC's website some months ago about how many arthritis sufferers in the UK were being denied a certain arthritis drug because of its cost, even though it was proven to be more effective than the older alternative in clinical trials. This sort of thing is an example of exactly what rightist ideologues in the U.S. would point to as a moral disaster (oh noes, the gov is making decisions about what people can't have instead of an insurance company!) only a degree or two from the Soviet gulag.
But you do have to understand that if you're white and rich in this country, basically anything is in your reach medically, any state-of-the-art treatment--you're certainly not going to be denied an arthritis medication because it's newer and therefore more expensive. Doctors are going to throw it at you and give you 15 pens from the salesman (actually they finally banned direct-to-consumer sales gifts from pharmaceutical companies late last year, but...) Why would a middle class white guy with a family to support and good privately-held health benefits want the system to change, especially if it would cost him in taxes (that other American boogeyman)? Again, these are the same guys who listen to Rush Limbaugh telling them that "it's now straight white men who are the most oppressed group in the U.S." and they believe it. They've slowly watched their privilege slipping away (ever so slowly, not quickly enough) for the past century, and it terrifies them to realize that in the future, they will no longer be in control of everything. In their minds, losing their white-male privilege, all of these basic rights that they felt were their sole entitlements, is literally tantamount to being oppressed. (God gave Adam dominion, after all, etc.)
So you see these "white male pride"-type political groups resurging, a new wave of "lad" culture, even as Whitey gasps his last, as the boundaries between "races" become even more transparently non-existent, as the U.S. becomes a minority-majority country, as women take over colleges and outperform men in school and at work, immigrants continue to pour in from the four corners, etc. The more I read about this, the more convinced I am that it's as much about heteronormativity and traditional "family values" as it is fiscal conservatism.
So I'm predicting an extreme bout of identity crisis for American white men in the near future, complete with obnoxious NYT styles and op-ed pieces, the likes of which will make the media fixation on "metrosexuals" of yesteryear look like child's play.
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