TomAiello

You've used that example a lot. We all know it's fallacious. All of the universal care proposals cover a ton of stuff that is far less urgent than a broken back. If we were just talking about emergency care, your example would be useful. Since we're not, it's really just misleading. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Perhaps there ought to be a "two tier" system for care after a certain age. Say, after 40, if you are ruled to have an "unhealthy" lifestyle, then you just get the basic care--no expensive measures to keep you going. If you have a "healthy" lifestyle, you could qualify for the stuff that's more expensive, and would keep you going longer. Maybe even allow an "uber-healthy" category, in which people would continue to get the most expensive procedures after age 70. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

In the "way things are" world, you must ask permission before you can: Marry Start a business Drive a car See a doctor (just kidding--but maybe we're headed that way) Well, the list would be quite long if I started just throwing all the things down you need permission to do. Is not the entity you must ask permission from your "master" in the practical sense? And the more things you need permission to do, the more complete the mastery exercised over you. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

I don't know. You were the one who brought up the length of study. I was just comparing the two different systems in that regard. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Are we talking about the way things are, or the way they ought to be? -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Sure they can--from the insurance industry who lobbied for the bill. Everyone is required to purchase their product. The only opt-out provision I saw was for religious objections. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Yes. And if their loans and investments perform poorly, they go out of business and someone a little wiser starts a bank. Other banks, who as money professionals ought to perform their due diligence, and failing to do so ought to take a loss, and doing so enough ought to go out of business? Sounds ok to me. What's not ok is funnelling those guys billions of taxpayer dollars to save their asses. They make bad decisions, they ought to face the consequences. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

These guys have a contract entitling them to certain compensation from their employer. One of the (few) proper roles of government is to see that private contracts are honored--not to change them at whim. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Have you done any comparisons to the US? US doctors need 4 years in Uni, 4 years in medical school, and 4 (or more) years in the hospital. That's 12 years of training (compared with 7 in the UK). In the US, the closest equivalent to the UK "doctor" is a Nurse Practitioner (4 years of Uni plus a Master's degree taking 1 or 2 years). -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Yes, it's in the bill. The relevant section was linked and quoted in a separate thread by Gawain. When I have more time this afternoon I'll dig it up for you again. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

More accurately. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Actually, all you'd need is sufficient votes in Congress. That's the way the system works, right? Get enough lobbying dollars together, and who cares about those bothersome facts. Majority rules! Who needs protection for the rights of the minority, anyway? -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Hey, I've got a weird idea. What if people were to face the consequences of their actions for themselves? If they got lung cancer from smoking, they'd have to pay for the treatment (or buy a health plan that would). If they got fat, same story. That way, each person could decide for themselves if the cigarette, or the donut, was worth the true cost of their actions (including their future health costs). It'd be crazy, but that way we wouldn't have to police each other's actions, because we wouldn't have to pay the bills for them. I know it's a crazy, revolutionary idea. I think I need to come up with a fancy new name for it. I've got it. I'll call it "Personal Responsibility." -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Speaking of highly paid CEO's and their purchased legislators...who do you think has shaped the current healthcare "reform" before Congress, making it require that every American purchase their product? Who is it that will really benefit from the current proposal? Oh, yeah, it's these guys, who are about to successfully pull off the biggest coup in corporate lobbying history--passing a law that forces every American to purchase their product. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

I agree. Can we stop it, please? The problem is that the lobbyists basically run the government, which hands money out to whichever special interest hires the best lobbyists. The only way to end this cycle of dependency is to eliminate the golden egg--the trough of taxpayer dollars that the special interest (corporations and others) feed at. And the only way to do that is to reduce the size of government, and reduce it's scope to interfere in every aspect of our lives (and the slush fund it has to reward the lobbyists and their clients). -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

My personal experience with doctors, and their willingness to accede to even the most unreasonable demands on their time and energy, lead me to conclude that they're more likely to commit mass suicide (check the suicide rates on physicians, by the way) than go on strike. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

You're being too kind. They intentionally chartered, created and subsidized organizations that were motivated, by design, to inflate housing prices to unsustainable levels and extend loans to as many borrowers as possible with the most relaxed standards. Who decided that Fanny and Freddie needed to "encourage home ownership" and wrote in, as their goals, driving up the percentage of people who own homes? Who funded their creation to push those irresponsibilities? Couldn't have been the same government some people now think is the solution to those problems? -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

I totally disagree. Our system tends to select the best, brightest, hardest working and most motivated to be doctors. You really think those people aren't going to succeed in some other line of work? -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so. Hmmm - I guess you never heard of the camel with the T5-T6 impaction then - One too many straws . . . Sure. But recognize that doctors, under our current system, are people who have already been through a tremendous selection process (involving more than a decade of constant striving and 6 figure debts) for exactly the same characteristics (work ethic, responsibility, desire to help others, ability to take insane stresses) that keep them from striking. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

That paragraph doesn't make sense. First you say the costs are born by the public in both systems, then you say the costs are paid by the hospital in the current system and by the federal government in in a national system. Currently, the cost of non-payment at a local hospital is born by the hospital (or the county, if they own it, or the larger hospital system in some cases, although most hospitals operate as separate cost centers even if they are in a larger system). For simplicity, let's say this is a county hospital. Currently, the county hospital eats the bill, and the taxpayers of the county are the folks who eventually foot the bill. No additional paperwork or bureaucracy is necessary to make this happen. In a proposed national healthcare system, the county hospital would bill the federal healthcare system for this cost, instead of having to eat it themselves. Now, the cost is being born by the taxpayers of the nation as a whole, rather than being focused on the taxpayers just in that smaller area that supports the hospital. By re-arranging the system, we have effectively shifted the cost from one group of taxpayers (the local folks) to another one (the whole nation). We haven't actually changed the costs--just made someone different pay them. That's not necessarily good or bad. It's certainly different though. Assuming that we think it's good to shift the costs this way (because, presumably it's "fairer" for the nation as a whole to get stuck with the bill, rather than the local people), the question becomes: "Is the added goodness (the fairness of splitting the bill out with everyone in the nation) worth the added cost (the federal bureaucracy necessary to administer the cost-splitting)?" -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Presumably the people who never have to pay for those things. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

None of the above, I guess. I'm not a doctor, but I've got a pretty good window into their lives, since when the phone rings at 3am it wakes me up, too. The 18 hour shifts sandwiching a wedding was my wedding, with the doctor in question being one of the bridesmaids. The financial calculations? I guess those are mine, now, too, since it's pretty much community property. The stress? Well, I'd like to think that I'm in pretty good touch with that, since it has a pretty direct impact on my life, and our kids' lives. I'm not a trader (you were the one with the knowledge about them, I thought, since you brought it up), although I did spend several months road tripping around with a guy who was just getting out of that. That's why I was asking you questions about them--I assumed you'd know. That leaves bullshitting...I dunno, I guess that depends on your perspective. The point is that those people are under a lot of stress. And that we depend on them to provide quality healthcare. And that it doesn't make a whole lot of sense to increase their stress by adding a bunch of new rules, while at the same time trying to cut their pay. Especially not if we still want them to provide healthcare of the quality they are now. Mostly, it's people who are having to clean up after the residents, actually, since the mentality now is "hey, when my shift is over, I go home" rather than "this patient is my responsibility." Which of those attitudes do we want to see in our doctors? Do we really want them doing shiftwork, and being incentivized to see as many patients in as short a time as possible? Is it really a good idea to put them on fixed salaries and then push them to see a higher volume of patients? Won't that tend to encourage an assembly line mentality? Is that really how we want our doctors thinking? -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

What kind of educational loans and personal time investment do those folks make to become traders? 12 years and a couple hundred thousand dollars? More? Less? Also, if you think the stresses of trading rival the stress of having someone's life literally depend on your actions, you probably shouldn't be a doctor. Most doctors take that very, very seriously, and it contributes a lot to their stress. Personally, I think it also contributes to making them good doctors. But there's a price they pay, and we're the one's who collect the benefits. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com

Interestingly, I've talked to several physicians who think that the (fairly) recent imposition of a mandatory maximum of 80 hour work week in residency has reduced the quality of care, because they don't get as intensive of training, and also because there are less provider-hours available. Read that again--they had to force them to cut back to 80 hour work weeks. And now there are concerns that there's not enough time to do all the necessary work and training. It would sure screw over the people who are currently early career physicians. They made financial decisions (loans for education) based on certain expectations of future earning. Change those rules mid-stream, and you'd expect to see a lot of people declare bankruptcy--except that they can't get out of the debts, even by bankruptcy. -- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com