Controlling Health Care Costs

[billvon 3,076]

>Would you employ an AFF instructor who continued to lose students
> due to faulty instructions that resulted in injury or death? If you are
> in the business of maintianing human life, you best be 100% sure
> of your ability.

Would anyone _be_ an AFF instructor if the waiver said "if at any time an instructor, pilot, rigger or DZO makes an error, you will be awarded a hefty settlement consisting of all their assets?"

I've jumped with something like 1000 AFF students. I've made mistakes; fortunately none of them resulted in serious injury or death of my students. I am also very clear about that when I teach the AFF, that I (or other instructors) may screw up, and the only person they should trust on the skydive is themselves.

>Then the use of waivers that are legally binding should be in
>place stating that the drug in question has not been fully tested
>and that you and you alone are responsible for any outcome that is
>less than desirable.

Agreed there.

>Define decent money.

You tell me. Let's say your mutual fund or your 401k fund made 6% a year. Would you drop it because it was "crippling free trade?" How about 8%? 12%? At what point would you stop investing in companies that put profit ahead of all else?

Once you tell me that number we can work backwards and figure out what the cutoff point is.

[jenfly00 0]

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One of the simplest is to get the public healthier. I say ban fat people and ramp up the taxes on Fags (Opps..Ciggrettes) and Booze.

faggots are small bundles of sticks intended for burning - I've never understood how it turned into an insulting term against hs's

Drived from a character (Fagin) in Oliver Twist.

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"O brave new world that has such people in it".

[freethefly 6]

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Would anyone _be_ an AFF instructor if the waiver said "if at any time an instructor, pilot, rigger or DZO makes an error, you will be awarded a hefty settlement consisting of all their assets?"

If the conclusion of an ivestigation shows, without question, that the instructor should be held accountable. Fortunately the instructors in our sport are highly capable and it is understood that each and every jumper who decides to jump from an aircraft does so at his/her own risk as you are not forced to do so. You assume the risk of injury or death. However, if an instructor has shown that they are incapable, they will not be employed to instruct. When it comes to a simple or not so simple surgury we place our lives in the hands of the surgeon if we wish to prolong our lifes and in this case the surgeon must continue to show that they are capable. All to often a doctor can bounce from hospital to hospital all the while performing in a less then desirable capacity. These doctors are much to blame for litigation and spiraling healthcare cost as is the system that allows them to do such. The system has also allowed those who seek to file lawsuits for the non-life threatening mistakes to do so resulting in high malpractice insurance. In some cases caps on monetary payout is great when in other cases it does nothing to make the mistake right. If a doctor screws up and causes me to be paralyzed for life then someone needs to pay for my care. That someone should be the doctor who caused me to be burdened. If a doctor used a tongue depressor that put a splinter on my tongue, no harm done and I would be only causing undue grief to file a suit. Parameters need to be defined and set and everyone from the patient to the doctor need to be held to them.

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You tell me. Let's say your mutual fund or your 401k fund made 6% a year. Would you drop it because it was "crippling free trade?" How about 8%? 12%? At what point would you stop investing in companies that put profit ahead of all else?

Once you tell me that number we can work backwards and figure out what the cutoff point is.

I took the advice of a broker back in 88 and started investing in a mutal fund through ICA. By 95 it was worth close to $50,000.00. When I entered into it shares were around $12.00. When I withdrew shares were around $40.00. I only withdrew as I needed the money to pay the debt that I had from my illness. Doctors and lawyers are not cheap. Not to mention the penalty for early withdraw. Had I still had the fund by age 65 I would had been able to retire very comfortably. If all was fine in my life I would had been a fool to withdraw. So, I say that profit was what motivated me to stay with it when my life was going great. Bill, I honstly do not know what decent money is anymore. There are times when I am just as happy now than when I cleared $50,000 back in the late 80's and early 90's. I am supposing that it depends on your situation or on what you deem to be of the most importance. How is it that people who live in the Himalayans can be content with what they have when a person who lives in the lap of luxuary is not content unless they have more of what they already have? I guess decent money is only a matter of perspective and no real conclsion can be arrived to.

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[billvon 3,076]

>Fortunately the instructors in our sport are highly capable . . .

Most are; some are not. JM's are, by and large, far more cavalier about safety and consent issues than doctors are. That's as it should be; people cannot choose to not get sick, and thus doctors are held to a higher standard.

>However, if an instructor has shown that they are incapable, they
>will not be employed to instruct.

Correct. Same happens with doctors.

>All to often a doctor can bounce from hospital to hospital all the while
>performing in a less then desirable capacity.

Again, same can happen with JM's.

>If a doctor screws up and causes me to be paralyzed for life then
>someone needs to pay for my care.

Many people have the same attitude about skydiving, despite the waiver.

But this is all beside the point, I think. It's not a good comparison. Doctors and JM's aren't really all that similar, due to the nature of the services they perform. Currently there _are_ ways to put older, less competent doctors 'out to pasture' so to speak, and there is a mechanism (lawsuit) that patients who feel they have been harmed to seek damages. So I think that we already have a mechanism to do what you describe - although it uses the laws we already have and does not "take everything" from them.

>When I entered into it shares were around $12.00. When I withdrew shares were around $40.00. (7 years later)

Now wait a minute!!!! You stayed in a fund that showed a 20 PERCENT A YEAR return? You invested in companies that showed obscene profits, and turned up your nose at companies that did not! Does your greed know no bounds?

That's a rhetorical question, of course. You are not any more greedy than the CEO's of the companies you made money off. You wanted money, and a mutual fund was a good way to get it. The CEO's in those companies were doing exactly what you wanted them to do - give you an excellent return on your money.

That's the problem. The people who are driving companies to make obscene profits are people like you. Doesn't mean you're greedy or anything; you just wanted to make some money. So does everyone else. Which is why companies who make obscene profits will be rewarded by the stock market.

[kallend 2,106]

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> There are a lot of countries out there that have better health care (as measured by average lifespan and infant mortality rates) and who spend less per patient than we do. There's something to be learned there, if we don't mind swallowing our pride and learning from someone else.

HERESY!

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The only sure way to survive a canopy collision is not to have one.

[nathaniel 0]

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> There are a lot of countries out there that have better health care (as measured by average lifespan and infant mortality rates) and who spend less per patient than we do. There's something to be learned there, if we don't mind swallowing our pride and learning from someone else.

HERESY!

Indeed. Spending, lifespan and infant mortality are not good measures of healthcare.

Someone is taking the "all people created equal" bit too literally. Prior demographics in the US predispose us to much worse outcomes than most places with apparently better healthcare. Poverty, anyone?

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[nathaniel 0]

You would measure the efficiency of the oil refining industry by price of gas, distances travelled, and rate of vehicular breakdown, and purport to thus make comparisons between countries.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[kallend 2,106]

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> There are a lot of countries out there that have better health care (as measured by average lifespan and infant mortality rates) and who spend less per patient than we do. There's something to be learned there, if we don't mind swallowing our pride and learning from someone else.

HERESY!

Indeed. Spending, lifespan and infant mortality are not good measures of healthcare.

Someone is taking the "all people created equal" bit too literally. Prior demographics in the US predispose us to much worse outcomes than most places with apparently better healthcare. Poverty, anyone?

And whose fault is that in the world's richest nation?

...

The only sure way to survive a canopy collision is not to have one.

[billvon 3,076]

>Prior demographics in the US predispose us to much worse outcomes
>than most places with apparently better healthcare. Poverty, anyone?

Is it therefore your assertion that the richest nation in the world has poorer healthcare outcomes because of the poverty there?

[nathaniel 0]

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And whose fault is that in the world's richest nation?

That depends on your philosophy. IMO there's no single cause of poverty in the US, and the proximate causes often obscure the root causes. Part of it is undoubtedly the human condition, fault of the way the brain works and interacts with our society--risk aversion coupled with inability to calculate probabilities, or inability to plan ahead. Some of it was due to skewed incentives, as demonstrated by welfare reform, and some of it probably is still. Some of it is self reinforcing feedback with society--there is a culture of poverty. And then there's the regression effect. Somebody is always going to be driven toward the extreme end of the wealth distribution.

What makes the US different from other parts of the world is our history, and in particular that we're made up of immigrants. Most of our population is due to ancestry most of whom moved here for the productivity benefits, the data seem to show. This way of looking at it, we're a nation built out of poverty and it is striking not that we have poor but that we have rich at all.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[nathaniel 0]

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richest nation in the world

That's a slogan. It does not reflect our demographics to say that all, or most, americans are rich. Most are not, and the depth of poverty inside the US exceeds that of most of our "peer" states by a huge margin.

Among skydivers you don't get a good sampling of the population. We're in luck tho, the US census provides plenty of accurate data for us to talk about.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[kallend 2,106]

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And whose fault is that in the world's richest nation?

That depends on your philosophy. IMO there's no single cause of poverty in the US, and the proximate causes often obscure the root causes. Part of it is undoubtedly the human condition, fault of the way the brain works and interacts with our society--risk aversion coupled with inability to calculate probabilities, or inability to plan ahead. Some of it was due to skewed incentives, as demonstrated by welfare reform, and some of it probably is still. Some of it is self reinforcing feedback with society--there is a culture of poverty. And then there's the regression effect. Somebody is always going to be driven toward the extreme end of the wealth distribution.

What makes the US different from other parts of the world is our history, and in particular that we're made up of immigrants. Most of our population is due to ancestry most of whom moved here for the productivity benefits, the data seem to show. This way of looking at it, we're a nation built out of poverty and it is striking not that we have poor but that we have rich at all.

Is it comfortable wearing those blinders?

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The only sure way to survive a canopy collision is not to have one.

[billvon 3,076]

>That's a slogan

Uh, not a slogan. We have the highest GDP in the world. Period.

>It does not reflect our demographics to say that all, or most, americans are rich.

It does not reflect our demographics at all; indeed it says nothing about distribution of wealth. But it sure as heck shows that the reason we're lacking in prenatal care or longevity is not a lack of money. We are certainly not too poor as a nation to have world-class health care.

It does show that we suck at apportioning resources to keep our own people (including newborn babies) alive. That's what we should be fixing.

[nathaniel 0]

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We are certainly not too poor as a nation to have world-class health care.

It's batty, imo, to talk about a nation having or not having healthcare as though it were a point of arbitrage. Healthcare is goods and services that are consumed by people. It costs money. Whether people choose to buy healthcare, whom they buy it for, and the rate at which they choose to do so should be their responsibility in my book.

It does get down to philosophy.

What you're doing is using healthcare as a mask for wealth redistribution. That's fine, but quit beating around the bush. Start talking forthright about the quantities of dollars you're taking from Peter to pay Paul, and what you'll do with those quantities. Instead we get purely magical predictions of what benefits would come to Paul if we only had infinite funds to bestow upon him.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[Lindsey 0]

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> There are a lot of countries out there that have better health care (as measured by average lifespan and infant mortality rates) and who spend less per patient than we do. There's something to be learned there, if we don't mind swallowing our pride and learning from someone else.

HERESY!

While I don't think that we provide the best health care in the world, I also don't think that longevity and infant mortality rates are the best measures for the quality of our healthcare. I think those are confounded by some pretty problematic social issues that our healthcare system....or any healthcare system....isn't going to be equipped to fix.

linz

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[billvon 3,076]

>It's batty, imo, to talk about a nation having or not having healthcare
>as though it were a point of arbitrage.

Battier than claiming the US doesn't have very good healthcare due to poverty? It's like claiming Saudi Arabians can't have cars because they don't have enough oil to run them.

>Instead we get purely magical predictions of what benefits would come
>to Paul if we only had infinite funds to bestow upon him.

Nope. We get actual numbers from other countries that show how much Peter has to pay to take care of Paul. And here in the US, Peter pays MORE to take care of Paul than in, say, Canada - and Paul still doesn't live as long. Make your magical predictions - I'll take the real data.

Personally, I'd prefer to pay less and get a better/longer life for Paul. How about you?

[billvon 3,076]

> I also don't think that longevity and infant mortality rates are the best
>measures for the quality of our healthcare.

What's a better hard-and-fast metric? Infant fatalities are something pretty much everyone wants to avoid, and lifespan is something almost everyone wants to extend. Lifestyle choices may reduce lifespan, but it would be hard to argue that better prenatal care would not decrease infant mortality.

[nathaniel 0]

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Battier than claiming the US doesn't have very good healthcare due to poverty?

Poverty causes distinct healthcare problems, which are properties of individuals. Your slogan refers to a property of the nation--it has no bearing on individuals in poverty. It is the aggregation of the properties of the individuals that define the nation, not vice versa.

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We get actual numbers from other countries

Which actual numbers are entirely inapplicable because they do not reflect our demographics due to our poverty. They do not represent the costs or the effects of those benefits on our people. There is no purpose in treating people for conditions they don't have.

What's more, the money doesn't translate evenly for economic reasons--the incentive skewing effects of such a massive wealth transfer and how it must be applied to achieve the indicated outcomes.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[kallend 2,106]

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> I also don't think that longevity and infant mortality rates are the best
>measures for the quality of our healthcare.

What's a better hard-and-fast metric? Infant fatalities are something pretty much everyone wants to avoid, and lifespan is something almost everyone wants to extend. Lifestyle choices may reduce lifespan, but it would be hard to argue that better prenatal care would not decrease infant mortality.

You just don't understand Bill. Poor women choose not to have good prenatal care.

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The only sure way to survive a canopy collision is not to have one.

[Lindsey 0]

Sure better prenatal care would decrease infant mortality. But lack of prenatal care is very different from lack of access to prenatal care. If you're a pregnant woman, it's really, really, REALLY easy to get health care. However, you have to make the choice to go to the doctor. Lots of women don't make that choice. Also, lots of women continue to do things during pregnancy that doom their babies.

How many have I seen born at less than 30 weeks because their moms were using meth or crack? Lots. How many poor people don't access health care because they live too far from a hospital and choose not to make the commute (Medicaid pays for the ride). How many don't access the system because their mothers didn't....and their mothers....? How healthy are babies born to diabetic mothers compared to those born to non-diabetic moms? What about when those babies are born at home?

I think that our infant mortalilty rates are more reflective of these issues than quality of healthcare. It's hard to keep babies alive who are born at 24 weeks addicted to cocaine. Those same babies tend to sit alone in the NICU until they're okay-enough to go home. How do you think they fare when they get their first pneumonia, and their parents really aren't any more interested now than they were before the kid was born? Back when I was social working, these were the issues I dealt with. Those issues were much bigger than the ones that come rolling into the ER....and usually a lot harder to solve.

It's not as simple as some would like to make it. And it's certainly not something that fits very squarely on the shoulders of the healthcare system.

edited to add: Bill, I'm not sure what a good hard-and-fast measure is. It's apparent what some of the problems are, though. And we can pretend to address them by pointing a finger at a tangible source. It being a visible target doesn't make it the right one.

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail

[billvon 3,076]

>It is the aggregation of the properties of the individuals that define
>the nation, not vice versa.

In our case, the average of the properties of the individuals is what defines the nation, and is also what defines our wealth as a nation. There may be extremes; indeed, there is a greater gap between the haves and the have-nots in our country than in most other countries. That does not mean the money is unavailable; it just means the money is not used for purposes of health care.

>Which actual numbers are entirely inapplicable because they do not
>reflect our demographics due to our poverty.

I'm not talking about demographics here. I'm talking about a country that takes less money from you overall and takes better care of others overall. No demographics in that statement. Again - would you prefer to pay less for better care of others, or pay more for less effective care of others? Because right now you're paying more. That wealth-redistribution scheme is sucking a lot more of your money here than it is in Canada.

[nathaniel 0]

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You just don't understand Bill. Poor women choose not to have good prenatal care.

That is actually true, the poor choose lifestyles that cause premature birth and they do not participate in prenatal care at rates commensurate with wealthier groups. Even the basic kinds of prenatal care that don't cost much or are already subsidized. I suggest you talk to someone who works in prenatal care with the poor if you doubt this--I have a close relative who does. She expresses amazement at how difficult it is to work with her poor patients and the disregard they show for their unborn.

Poor people suffer from low education levels, from botched incentives that reward them for not pursuing their long term interests, from social reinforcement of bad habits, etc. Their lousy healthcare is as much a symptom as a cause of their poverty.

Speaking in aggregate, of course.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[nathaniel 0]

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I'm not talking about demographics here.

Hence the magical thinking. You can't compare numbers between nations without examining the demographics, because the demographics indicate different healthcare needs. The demographics also indicate factors that excessively complicate the redistribution of wealth involved in matching the healthcare spending distribution from one nation to another. I don't know how to underscore this--it's an extremely difficult problem and probably not solvable. It's a dead end insofar as it serves as an analogy.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[freethefly 6]

http://www.americanfunds.com/funds/returns/alphabetically.htm
The Investment Company of America
As of date the fund is at 34.19
If things ever turn around for me I most definetly will return to this fund as it always done good.

I really have no problem with CEO's making great money. I do have a problem with the ones who do not perform yet still walk away with an ungodly amount of money while the company sinks. But this is off track from the original post.

"...And once you're gone, you can't come back
When you're out of the blue and into the black."
Neil Young

[Lindsey 0]

Thinking about this stuff makes me wanna share....lol. I have lots of stories like this one, but this is the most recent. I took call the other night for our local ER. At 4:30 am I had to go in for a woman who woke up with chest "discomfort" and felt nauseated. She was comfortable by the time she got to the ER. She was talkative and obviously in no acute distress. Her EKG was normal. All her labs looked good. She walks 4 miles a day. Her only health issues were diabetes and a hiatal hernia. She'd never had any chest pain with all of her exercize. BUT she had had 2 brothers die of heart attacks in their early 50's, and her father had died of a heart attack at age 70. She's 71 AND she has no health insurance. Her physical exam was not impressive, but her description of her symptoms and family history were enough to make one concerned.

I called (at 5:30 am) the cardiologist whom I think is the best one we have at my residency hospital, and one to whom I refer a lot of patients. After telling him the situation, he said without hesitation for me to send her to him. He knew she couldn't pay, and he wasn't bothered by the early morning phone call. I send him a lot of business that makes up for an occasional no pay.

I visited her today. Tomorrow she's having a 4-artery bypass. The cardiovascular surgeon won't get paid either, but he's taking care of her. And that's not an isolated event. Rarely do I have problems getting our best doctors to take care of those who are least likely to pay. The rest of us pay enough to cover their costs. Maybe it's different here where so many people are poor. Maybe doctors here are here because they understand and are willing to meet the need for the most part. But this has been my experience time and time again.

Now, she surely won't get the same work-up that some of us would for, say, carotid sinus hypersensitivity , but she's not paying for that either....

--
A conservative is just a liberal who's been mugged. A liberal is just a conservative who's been to jail