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[2009-07-23 17:15:21] - Pierce: Fair enough. I provide proof that a private insurer is seemingly trying to promote preventative care and you doubt they are honest about it. You will excuse me when I express doubt at the so far unproven claim that the government is going to promote preventative care. -Paul
[2009-07-23 17:13:36] - alrighty, well this has been invigorating but I need to go get ready. peace! - pierce
[2009-07-23 17:12:39] - what? I'm just citing a source. You don't know that the original quote was from me! - pierce
[2009-07-23 17:12:00] - being a pro-preventative insurer in the current system seems like more of a PR move than something they'd do just because it's economically viable. that's nice and all and I don't begrudge them being responsive to PR pressures, but it's not as efficient a motivator as things that affect the bottom line. - pierce
[2009-07-23 17:11:25] - pierce: was that really a constructive contribution? Miguel wants to know.
-Paul[2009-07-23 17:10:46] - pierce: you're such an extremist =P -dave
[2009-07-23 17:10:38] - yeah, I'll take the baton from vinnie and say that I'd love for private insurers to get into the preventative medicine business. I just think that the current system doesn't motivate it, and I do think a government system would have that motivation. - pierce
[2009-07-23 17:09:35] - paul: I found this link saying that private insurers want americans to die. - pierce
[2009-07-23 17:09:08] - "All private insurers want Americans to die."
[2009-07-23 17:08:54] - if I'm being uncynical about the govt, I'll be uncynical about Kaiser (although that's where my mom used to work, and hoo boy, does she have terrible stories about denials). they mention on that page specific steps they have taken to promote preventative care, and I think that's great. I hope it pays off for them - vinnie
[2009-07-23 17:07:28] - dave: I agree, that's why "infinite" was in scarequotes. it's not really infinite, it's a "lifetime" wait however you define that. I feel pretty confident that factoring in all the "lifetime" waits for the uninsured in this country, we'd end up with a worse average "wait" time. - pierce
[2009-07-23 17:07:24] - Vinnie: I'm not sure how public schools and the public road system necessarily shows any foresight on the government's part. Also, need I point out that our public schools are generally a disaster as well? -Paul
[2009-07-23 17:07:02] - paul: altho perhaps he would take warm soft bills as well -dave
[2009-07-23 17:06:41] - paul: he wants cold hard cash -dave
[2009-07-23 17:06:26] - Pierce: I was told no insurance companies were campaigning about being big on preventative care and within a minute I produced a link. What do you want from me?
-Paul[2009-07-23 17:05:52] - pierce: non-members is all that matter, because then they sign up. If they get dissatisfied and leave, then they're non-members again! ^_^ -dave
[2009-07-23 17:05:23] - Pierce: A minor technicality, but the uninsured don't have infinite wait times, they just have to pay for things out of pocket. Last I checked, there were no rules against going to the doctor without insurance. -Paul
[2009-07-23 17:05:08] - oh good, a quote from kaiser permanente about what a good job kaiser permanente was doing. I'm not saying they're necessarily lying, but it's not exactly an objective source. also, why is it just non-members' perceptions that are changing? do members not think KP is doing a better job about proactive health? - pierce
[2009-07-23 17:04:56] - paul: that's cool. we'll see if it pays off for them - vinnie
[2009-07-23 17:04:49] - oops, that was meant for pierce, not paul -dave
[2009-07-23 17:04:26] - paul: altho if the people in canada died because they didn't get the procedure, i suppose their wait time would be infinite as well -dave
[2009-07-23 17:04:15] - paul: public education? patent system? public road system? I think they have demonstrated good foresight at times. like I said, I'm not even sure there is a strong enough incentive for insurance companies to reduce costs for others, so good foresight for them might be to NOT promote preventative care
- vinnie[2009-07-23 17:03:50] - Pierce: I think the fact that it has improved over the years is just an example of how computers have made our lives easier. I don't know how much credit I give to the government for that. -Paul
[2009-07-23 17:02:59] - as for canadian horror stories, they're anecdotal in that form. if you make a statistical argument then I think you have to weigh the "infinite" wait times of the uninsured in this country into our mean. - pierce
[2009-07-23 17:02:58] - Research also shows the campaign has already significantly changed consumer perceptions, showing an increase in non-members' perceptions of Kaiser Permanente as "being serious about proactively keeping people healthy, and making you feel secure that your health care needs will be met." -Paul
[2009-07-23 17:02:28] - Vinnie: http://xnet.kp.org/newscenter/pressreleases/nat/2005/072205newthrive.html -Paul
[2009-07-23 17:02:18] - <helps paul out> -dave
[2009-07-23 17:01:52] - Vinnie: Actually, I think I have, but the name escapes me. I remember those commercials for... some company where they talking about "thriving". Anybody help me out? -Paul
[2009-07-23 17:00:48] - vinnie: hmm, i guess so. i suppose the direct link for insurance companies would need to be preventative care = cost savings -dave
[2009-07-23 17:00:26] - paul: I think the DMV is a terrible example of government being wasteful by nature. I think the fact that it's improved over the years is evidence of how people's frustrations do end up recognized and addressed by government. - pierce
[2009-07-23 17:00:21] - I could see an insurance company making a PR thing about how they strongly promote preventative care and provide incentives to patients who take care of themselves, and maybe it would lead to lifelong customers and a good brand. but I haven't seen it yet - vinnie
[2009-07-23 16:59:56] - pierce: i know, i'm just saying paul's point was basically valid, even if technology has made it much more palatable today -dave
[2009-07-23 16:58:58] - paul: perhaps canada does so much better because their gun control is better than ours so their people don't shoot each other up as much <blink blink> -dave
[2009-07-23 16:58:49] - dave: fair enough, although that means you basically can't use any previous experiences as evidence because you never know when it might turn around. - pierce
[2009-07-23 16:58:04] - dave: there's a very direct comparison there, e.g., Toyota had the most crashes (well, probably not, hehe). there's such a tenuous link to insurance companies saving lives or causing deaths decades down the line, it's probably impossible to trace - vinnie
[2009-07-23 16:58:03] - Pierce: If you don't think that the DMV is a terrible example of government caring about the people, then I am done talking to you.
-Paul[2009-07-23 16:57:09] - pierce: by that logic, if the dmv took a turn for the worse in 5 yrs, then paul would be right -dave
[2009-07-23 16:57:09] - Vinnie: Relevant to this discussion, there's plenty of horror stories about the health care in places like Canada where people who needed life saving procedures were told that their procedures were optional or not urgent enough and those people were forced to get it done in the US. -Paul
[2009-07-23 16:55:21] - paul: you brought up the DMV. I'm saying it didn't "turn out" miserably so I don't think it's a good example. - pierce
[2009-07-23 16:55:18] - Vinnie: I probably agree with you that the quality of life benefits are far down the line and therefore it's hard to see the benefits. I'm just not sure why we think the government is going to magically be able to see this any better. Again, when has the government shown any good sense of foresight? -Paul
[2009-07-23 16:53:36] - Pierce: Again, I'm not saying the government sets out to waste money. That's just how things end up. Not even bureaucratic morass can stand against the march of technology for long. -Paul
[2009-07-23 16:52:59] - vinnie: or reliability -dave
[2009-07-23 16:52:41] - vinnie: mmm, i would tend to agree. Although stuff like safety in cars does generally tend to breed good brand name -dave
[2009-07-23 16:51:21] - paul: well i agree that our govt is usually terrible at saving money, but i'm not sure the bailout stuff was terrible. I can see the arguments both for and against -dave
[2009-07-23 16:51:18] - the real thing to me is that the quality of life benefits are just too far down the line. if they were apparent more quickly, then companies would definitely have an incentive to do them, to keep their customers happy - vinnie
[2009-07-23 16:51:16] - paul: and yet the DMV is not really much of a hassle anymore. you can do most of it online. surely if it was wasteful for waste's sake they wouldn't have invested in a money-saving practice like online transactions. - pierce
[2009-07-23 16:49:35] - Vinnie: I don't think anybody can look at what our government has done in the past 2 years and say with a straight face that saving money is a priority of the government. -paul
[2009-07-23 16:49:30] - paul: haha, too true. I quite agree -dave
[2009-07-23 16:48:54] - paul: I don't think people in govt or an insurance company feel any different about saving people money or improving their quality of life. the majority of people anywhere want to do that. but in an insurance company, I think those goals really are at odds. especially when you think about how quickly a CEO loses their job for not increasing profits within a few years - vin
[2009-07-23 16:48:51] - Vinnie: I'm saying that saving money is probably much farther down the list for the government in terms of importance than it is for a company. Companies have to save money, to a certain extent, or else they go out of business. Governments have shockingly little reason to, because they can always just print more money. -Paul
[2009-07-23 16:47:17] - Dave: I mean, look at the DMV. I'm sure no politician was thinking, "Let's make life miserable for people who have to change their vehicle registration", but that's how it turned out. -Paul
[2009-07-23 16:46:43] - paul: you were the one that said the govt wasn't interested in saving money. I have no idea why they or anyone or any insurance company wouldn't want to. you probably were making a joke about how they often don't save money, I guess - vinnie
[2009-07-23 16:46:27] - Dave: I probably agree with that as well. I'm sure every politician cares about people being happy, but the intent often gets left behind in the bureaucratic mess that these programs become. -Paul
[2009-07-23 16:41:37] - paul: well, i actually think the govt does care, they just have bizarre ways of showing that they care. Like they don't have to be fiscally responsible, so they dream up random things that they think will be good. A company at least is leashed by the direct threat of losing customers -dave
[2009-07-23 16:40:56] - paul: as I mentioned before, in this instance the people whose happiness and health are relevant (employees) are not the same as the customers. the people actually deciding on the plan may also be employees, but they're not necessarily representative of the whole. - pierce
[2009-07-23 16:40:27] - Pierce: I feel like companies want to keep customers about as much as politicians want to be re-elected, and that there is more of a direct correlation between insurance companies keeping customers than politicians getting re-elected. -paul
[2009-07-23 16:37:48] - Pierce: It would be nice if there was such a direct correlation of "I am mad at government for X, therefore I will not re-elect Y", but I just haven't seen it much through the years except in extreme cases. -Paul
[2009-07-23 16:37:47] - dave: well someone else might get blamed, but career-minded politicians aren't going to want to be the recipients of that blame and would have a one-level-removed motivation to improve the level of care. - pierce
[2009-07-23 16:36:37] - Dave: Sure, I agree. I'm not saying the government is comprised of people who want everybody to die. I just don't see why they would be any more concerned with people being happy and healthy than a company would be about their customers. -paul
[2009-07-23 16:36:35] - ...or the politicians' desire to be re-elected? - pierce
[2009-07-23 16:35:50] - paul: that and the fact that people might not re-elect them - but usually the consequences are so far downstream that someone else gets blamed for the problems -dave
[2009-07-23 16:35:06] - Vinnie: In the end, insurance companies need to entice customers (no matter how many levels of indirection or whatever) so at least on some level, they want to make their customers happy. If everybody is forced to use a single government health plan, the only reason to keep people happy would be the kindness of politicians' hearts. -Paul
[2009-07-23 16:33:41] - paul: i think in a broad sense the govt does care. I think they just get too bogged down in other minutiae along the way, like getting re-elected -dave
[2009-07-23 16:32:40] - Vinnie: To me, the government has shown less foresight and less desire to save money than the average company, and I'm not entirely convinced they care more about improving the quality of life of people. -Paul
[2009-07-23 16:32:19] - pierce: ahhh snarky. it all makes sense now -dave
[2009-07-23 16:31:52] - dave: I was kinda just being snarky about the deductable thing, but it's at least one example of how the burden of low-level care (including routine preventative visits) is often laid on the customer anyway. it's not a shining example of insurance companies valuing overall health over their short-term profits. - pierce
[2009-07-23 16:31:17] - Vinnie: Sure, the government is comprised of people, but so are insurance companies. I don't see your point there. And one could easily make the argument that saving money means not spending it on "pointless" preventative medicine. -Paul
[2009-07-23 16:30:46] - paul: slightly diff on social security since at one point there actually was a surplus. And besides, Congress can't resist money that is sitting around - trying to save money is something slightly diff. Now, perhaps they will just take all the savings and use it for something else ... -dave
[2009-07-23 16:28:36] - Vinnie: Hmmmm.... fair enough. I still have some doubts as to whether or not the government would have any more foresight, though. If they did, one would think social security wouldn't be as horribly underfunded as it is.
-Paul[2009-07-23 16:28:03] - paul: give me a break. the govt is bloated but they're still people. they're gonna save money when they can, they're gonna improve the quality of life when they can, and preventative care helps both of those - vinnie
[2009-07-23 16:27:35] - pierce: my insurance plan has no deductible -dave
[2009-07-23 16:27:20] - altho i wasn't considering gym memberships as preventative care -dave
[2009-07-23 16:26:52] - i think the current insurance companies have just as much incentive for preventative care as the govt. -dave
[2009-07-23 16:26:51] - and... what vinnie said, for the other point. hell, if Insurer A pays for your gym membership and then you change jobs and end up on a plan for Insurer B, then insurer A has just saved their competitor money! it's much easier to just hike up rates like crazy if someone has the gall to spend thousands of dollars on medication. - pierce
[2009-07-23 16:24:54] - paul: the government's plenty interested in saving money when they get some other benefit out of it. happy healthy people make for happy healthy incumbents. - pierce
[2009-07-23 16:21:50] - paul: there's not no incentive for them, but I think it's a lot less than the govt. it's one of those things that pays off a lot more down the line for a larger cost upfront, so in this case, it only really helps the insurance company out if they would have borne the cost of the more expensive procedure down the line, which is iffy - vinnie
[2009-07-23 16:21:14] - To be honest, I'm not entirely sure what motivation the government would have to care about preventative care. In theory it would be to save money, but when is the last time the government has seemed the least bit interested in saving money? -Paul
[2009-07-23 16:19:45] - Pierce: In fact, I'm pretty sure that's a big thing that's been offered a lot recently by health insurance companies. -Paul
[2009-07-23 16:19:14] - Pierce: I'm not sure how that drastically changes anything. The whole point of insurance is that they bet they can charge you more for insurance than it costs to cover you. If they can avoid somebody needing to spend thousands of dollars on medication or an operation by paying a pittance for a gym membership, I think they would jump at the opportunity. -Paul
[2009-07-23 16:16:18] - paul: *cough* deductable. - pierce
[2009-07-23 16:06:59] - Vinnie: "preventative care. the insurance companies don't have much incentive to offer it, but the govt does" I know I'm late to the party, but I'm not sure I agree. Wouldn't insurance companies be keen on preventative care to reduce the posibility you would need emergency care? -paul
[2009-07-23 15:48:01] - pierce: hurray! -dave
[2009-07-23 15:44:18] - dave: fine, believe in yourself and the world will be your bag of french fries. - pierce
[2009-07-23 15:42:23] - pierce: i don't like oysters, especially raw ones -dave
[2009-07-23 15:39:50] - I don't need to become a motivational speaker, friend... all the motivation you need is inside your heart! believe in yourself and the world will be your oyster! delicious oysters! - pierce
[2009-07-23 15:35:56] - pierce: are you practicing to be a motivational speaker? "it's gonna get worse before it gets better!" "lives are at stake!" -dave
[2009-07-23 15:34:45] - mig: I can understand that, but in fairness this is an issue where lives are literally at stake. - pierce
[2009-07-23 15:33:55] - mig: i have a coworker who expressed that exact sentiment. I guess I agree, because no one seems to be able to say what the bill actually does -dave
[2009-07-23 15:33:12] - I'll admit I have no idea, but I tend to be wary of presidents who try to rush bills in and try stifle debate by claiming doom and gloom if we don't do something nao. - mig
[2009-07-23 15:32:25] - *bestial roar* - pierce
[2009-07-23 15:31:37] - pierce: nice rousing speech of "it's gonna get worse before it gets better, but hang i there men!" -dave
[2009-07-23 15:31:17] - dave: hahaha, totally. I couldn't tell you a thing about this bill or whether it will help - vinnie
[2009-07-23 15:30:35] - but there are so many reasons why our health care is so high, it's not just the preventative care thing. anyway, meeting now, more later - vinnie
[2009-07-23 15:30:28] - for what it's worth, I feel pretty confident that the options currently out there are going to make things seem worse before they get better. I still think we should do them, but I understand why people are wary. - pierce
[2009-07-23 15:29:15] - i guess what i REALLY wanted to know was whether or not this specific bill was good or bad. And I guess the answer is no one really knows, because no one really knows what it does specifically -dave
[2009-07-23 15:28:30] - vinnie: yes, that's a fair assessment -dave
[2009-07-23 15:28:17] - dave: I'm willing to give up the "best care", but I don't have the best care so it's easy for me to give it up. on the other hand, I think a lot of people with the "best care" don't realize that it's only "best" because they haven't been unlucky enough to actually need it. - pierce
[2009-07-23 15:27:53] - pierce: haha, ok. I can agree to cut-back on the marketing budget - although i think that's entirely a different discussion as to whether they would make more or less by cutting it -dave
[2009-07-23 15:26:51] - dave: I think we're on the same page, the burden gets pushed on us either through hospitals or through taxes. pierce beat me to preventative care. the insurance companies don't have much incentive to offer it, but the govt does, and theoretically that's how it should cost everyone less - vinnie
[2009-07-23 15:26:20] - much more likely, in my opinion, is that drug companies will just have to cut back on their marketing budgets. since I think direct-to-consumer advertising of drugs is its own absurdity, I'm willing to make that sacrifice.
- pierce[2009-07-23 15:26:11] - pierce: i would agree with that. I guess my point was more that we pay a lot more for things like that because we want the best care. If we are willing to give up the "best care" we could be cheaper -dave
[2009-07-23 15:25:22] - pierce: give people credits for preventative care? like companies charging you higher premiums if you dont' exercise and are overweight? -dave
[2009-07-23 15:24:56] - dave: well at the risk of being callous, if it turns out that government health care drives down american expenditures on drugs, and that ends up forcing drug companies to end their "subsidies" to other countries then that's not really our problem. - pierce
[2009-07-23 15:24:42] - pierce: yes, i think everyone agrees with that, about emergency care being a problem. The only difficulty is there's no great way to solve it -dave
[2009-07-23 15:23:55] - pierce: although at the same time i asked them exactly why people always point to socialized countries and say they're better - and that was one of their reasons for why we cost more -dave
[2009-07-23 15:23:09] - it's also well-documented that the cost of emergency care is astronomically higher than preventative care. there would have to be a *lot* of fickle "doc, what do you think of my screenplay" visits to make a system that supports preventative care cost more than one that's already bearing the burden of emergency care. - pierce
[2009-07-23 15:23:05] - pierce: but yes, i do not know comparison with canada and france, they could have been talking mainly about russia and china for all i know -dave
[2009-07-23 15:22:11] - pierce: i dont' have any sites to link, i just got it from friends working in public health. I trust them decently though, because that's their exact job, to find out inefficiencies in the medical field and publish stuff about it -dave
[2009-07-23 15:20:47] - dave: I don't think that's as true as we've been led to believe. look at this graph. we spend more per capita on drugs than other countries, but canada and france aren't that far off. - pierce
[2009-07-23 15:20:36] - vinnie: so the question would be is if everyone would pay less if that person was insured - is it going to hit diff. people than the people who are hit with it now? -dave
[2009-07-23 15:20:05] - vinnie: and another way to look at it, is that everyone is already paying for the care of all those emergency cases, since the hospital just charges everyone else more to make up for it -dave
[2009-07-23 15:18:23] - vinnie: and i'm honstly not sure if all the homeless etc, who go to the hospital for care and run up bills will be part of those 46 mil -dave
[2009-07-23 15:16:36] - vinnie: that is true, hence my comment about the middle class perhaps paying less and upper class paying more if 46 mil more people are insured. However, there is a whole other class of people who want care but aren't going to emergency rooms -dave
[2009-07-23 15:16:26] - dave: yeah, not all burden gets shifted. but a lot of expensive life-saving things do - vinnie
[2009-07-23 15:14:49] - dave: the govt already does that, though. hospitals can't turn away people for certain life-saving procedures, and that cost is either paid for by the govt, or it gets shifted to whoever uses the hospital - vinnie
[2009-07-23 15:14:30] - pierce: or put another way - we're so expensive health-care wise because we're on the bleeding edge of everything. If we just used older tech discovered by others, then we'd be more efficient -dave
[2009-07-23 15:13:52] - dave: well said, and that's why I'm concerned about the baby step of a public option. it has to be something that we commit to, allow it time to grow. otherwise three years from now hannity will throw his back out spasming about the higher average cost per customer for the public plan, ignoring that it's because the government's got all the cancer patients. - pierce
[2009-07-23 15:13:36] - vinnie: the burden doesn't always get shifted to the govt. A lot of times, the private parties just have to pay or not get the care -dave
[2009-07-23 15:12:44] - pierce: regardless of whether it is govt or private industry, it means the US subsidizes healthcare for everyone else in the world (in a sense). So numbers about other countries being more efficient can't be taken at exact face value -dave
[2009-07-23 15:12:24] - god I typed that fast. let's see happen = happy, shirt = shift - vinnie
[2009-07-23 15:11:21] - well, if they government is going to take care of the people the insurers drop, it's going to be terribly cost in-effective, because the reason private industry won't help them is because they're the outliers that jack up the cost for everyone else -dave
[2009-07-23 15:11:10] - ...or they go into bankruptcy trying to pay, that burden gets shifted to the govt anyway. the insurance companies would be happen to let that burden shirt, and they try more and more to do it. that's why the govt should step in on some level. it should save us money, ideally. but the reality is that's really hard to do - vinnie
[2009-07-23 15:10:27] - dave: a hearty portion of that research cost is already fronted by the government, or by academic institutions that wouldn't be significantly affected by a transition to government-run healthcare. - pierce
[2009-07-23 15:10:10] - pierce: it's like us paying $100 for MS Windows, and everyone in China paying $10 for the same thing almost -dave
[2009-07-23 15:09:58] - dave: under UHC, they should have a greater volume of insurers. it should save money, but possibly they would lose it in efficiency. not sure. I think the biggest reason why the govt needs to be involved in some level with health care is that whenever the insurance system doesn't "take care" of someone, as someone can't/won't pay for coverage...
[2009-07-23 15:09:33] - but in all seriousness, I'm all in favor of people being skeptical of government regulation. I see government as a person: democrats want to make it obese, republicans want to subject it to anorexia and liposuction but don't really care about its overall health. reasoned skepticism is the only smart route, it's like exercise. - pierce
[2009-07-23 15:09:31] - pierce: for example, almost every other country just copies all the drugs we make - so we're basically eating all the research cost (massive money) for most of the drugs used by the world -dave
[2009-07-23 15:08:56] - pierce: and what numbers for other countries don't say is that the US has, hands down, the best healthcare if you can afford it -dave
[2009-07-23 15:07:53] - pierce: well, it's true that the govt is huge, but i think we already only have a handful of insurers, so they already have a massive amount of negotiating power i believe -dave
[2009-07-23 15:07:02] - pierce: i think we should be more scared of the govt regulating stuff like that than happy about the possible benefits honestly -dave
[2009-07-23 15:06:40] - then once the public plan got the customer volume you're talking about, I'm sure they'd relax their regulatory lust. they seem like trustworthy fellows. - pierce
[2009-07-23 15:06:11] - the only other positive that I could see happening is that a vast amoung of loss in healthcare at present is treating uninsured people who can't pay. If we somehow now insure those people through the govt (meaning tax rich to pay for the poor) then perhaps the middle class would pay less -dave
[2009-07-23 15:05:53] - dave: well at the risk of causing even more of the hairs on paul's neck to bristle, the government would have extra negotiating leverage while the public option is still small... because they're the freaking government and they'll regulate you until you capitulate to their demands. - pierce
[2009-07-23 15:04:48] - the other possible benefit for govt run health care would be that they might not just be solely out to screw people over as much and make money as the private ones -dave
[2009-07-23 15:04:14] - i think the only way the govt run healthcare could be more efficient is if they get more volume than current healthplans. I believe current insurers are already quite large, so I am not quite sure how much savings there would be -dave
[2009-07-23 15:03:10] - mig: was that really a constructive contribution? you can't just call him "obama" since no one who supports him actually calls him lord and savior? has he ever said he wanted "complete" control over the healthcare system? citation needed. - pierce
[2009-07-23 15:03:04] - jeez, i sure started a firestorm. I'm sad I didn't have time to contribute -dave
[2009-07-23 15:01:02] - paul: no, a police czar would have to worry about trends of gang activity, or comparative effects of different drug enforcement allocations, or high-profile police abuse cases (cough). or you could just ask Dee whether her department has a lot of logistics to deal with. - pierce
[2009-07-23 15:00:57] - pierce: were you listening to our lord and savior claiming that we were all doomed if we did not give him complete control of the healthcare system. - mig
[2009-07-23 15:00:11] - Anyway, I gotta run to a meeting. Bye! -Paul
[2009-07-23 15:00:00] - Either way, I don't think you got the answer you wanted from me. I'm not terribly impressed by how the government handles law enforcement in this country. I just think health care would be a bigger disaster. -Paul
[2009-07-23 14:59:18] - Pierce: Then what the hell are we arguing about?
I think your statement was more grossly undersimplified than mine, I guess. -Paul[2009-07-23 14:57:27] - Pierce: A police czar, if you will, wouldn't have to worry about how much to charge for a heart operation or which patients get to see their doctors today or if this person's operation can wait until after another person's. -Paul
[2009-07-23 14:57:20] - paul: read again, please. "they don't have to be equally complex. - pierce" - pierce
[2009-07-23 14:56:46] - paul: things have gotten worse? I didn't realize average lifespan had been decreasing. has it? what about child mortality, is that increasing in the U.S.? - pierce
[2009-07-23 14:56:29] - http://www.harrybrowne.org/articles/HealthCare.htm not going quite back to witch-mania. - mig
[2009-07-23 14:56:03] - Pierce: I disagree that they are equally complex. Not to demean what cops do, but I don't think the logistics for law enforcement match the logistics of health care. At the very least, the sheer scope is magnitudes different. -paul
[2009-07-23 14:54:29] - Pierce: It's the same thing with education. It's been the same thing with the economy. -Paul
[2009-07-23 14:54:28] - paul: you misunderstand. I'm not saying we blamed witches because of private health care. you can't compare ancient private health care to modern government health care for the same reason you can't compare it to modern private health care. it's the age, not the market structure. - pierce
[2009-07-23 14:53:32] - Pierce: The government has been progressively interfering more and more in health care for decades now and as things get worse, we keep on thinking the solution is more government control. -Paul
[2009-07-23 14:52:34] - Pierce: No offense, but your retorts are also familiar. The privart market has failed! We need more government! Oh, we still have problems? Not enough government, we need to give them more control! -Paul
[2009-07-23 14:52:19] - paul: I'd say both hospitals and police stations are complex operations that require a lot of logistical oversight. reducing law enforcement to "we just need cops" is semantically identical to me reducing hospitals to "we just need doctors". they don't have to be equally complex. - pierce
[2009-07-23 14:51:46] - Pierce: Nice straw man. Private health care = schizophrenia is caused by witches. -Paul
[2009-07-23 14:51:05] - Pierce: Managing a health care system (to the extent we're talking about here) has so much more to do than making sure enough doctors are working on a given day. We're talking about managing what doctors can perform what operations for what amount of money and to whom. -paul
[2009-07-23 14:49:52] - paul: no offense, but that's a familiar retort. "the private market" as it exists in the real world is immune to criticism because the government has interfered with it. of course, the only real world examples of an un-meddled-with health care market are from back when we thought schizophrenia was caused by witches. - pierce
[2009-07-23 14:49:17] - Pierce: I see a huge difference in those statements. Are you saying that the work that a hospital does is just as simple as the work a police station does? -Paul
[2009-07-23 14:47:20] - Pierce: No, I don't think there is a significant difference in level of indirection. Businesses want to save money just as much as individuals and the lifeblood of most companies is the quality of employees. No company actively wants a crappy and expensive health insurance plan any more than individuals do. -Paul
[2009-07-23 14:45:57] - paul: "Seems to me that you just need to have a certain number of doctors on the job each day". I'd say both your statement and this one are grossly oversimplified. - pierce
[2009-07-23 14:45:45] - Pierce: "other countries get with their unwieldy and bureaucratic government programs, and they put our private system to shame" I'm betting that all your examples are unfair comparisons because there are very few areas left in America where we have true private market solutions in place. Health insurance is definitely one of them. -Paul
[2009-07-23 14:43:55] - Pierce: I think it does about as good a job as any government (keep in mind we have a pretty miserable homicide rate, I believe). I'm not sure how law enforcement is particularly complicated, though. Seems to me that you just need to have a certain number of cops on the job each day. -Paul
[2009-07-23 14:43:35] - mig: well okay, that's because the low hanging fruit (basic law enforcement like speeding and burglary) is all handled at the state and local level. the federal government gets the harder jobs, it's no wonder they get worse results. I don't think that in itself is evidence that there's something magically less efficient about federal government. - pierce
[2009-07-23 14:42:12] - you don't have to take it to the next step and say government would be better about reducing indirection. just being fine with those first two statements would be sufficient for me to see this as an "agree to disagree" thing. - pierce
[2009-07-23 14:41:50] - pierce: on a state and local level, yes. on a federal level it is pretty fucking horrible. - mig
[2009-07-23 14:41:08] - and if you do think it does, do you agree with me that those levels of indirection are detrimental to the efficient functioning of market forces? - pierce
[2009-07-23 14:40:24] - paul: you don't think that one of those examples has a lot more levels of indirection than the other? - pierce
[2009-07-23 14:39:40] - paul: yeah, I know that's your belief. and yet we look at the results other countries get with their unwieldy and bureaucratic government programs, and they put our private system to shame. maybe there are other factors, but if there are I don't feel they're significant. - pierce
[2009-07-23 14:39:08] - Pierce: It's because of the ancillary effects that they care about the quality of their health insurance plan. Going by that logic, I don't care about my health insurance plan either, I just care about getting treatment when I am sick. -Paul
[2009-07-23 14:38:21] - paul: do you think our government (which is neither well-oiled nor particularly efficient) does a passable job with law enforcement? seems like a complicated task with lots of data and logistics, and yet we're hardly a third world nation operating under martial law. - pierce
[2009-07-23 14:37:53] - Pierce: I just felt that was odd to add because I really don't know if I think the government would be better than the market at controlling anything.
-Paul[2009-07-23 14:37:27] - Pierce: Possibly true, I suppose I should've added: "government would be at all able to control it any better than the market." -Paul
[2009-07-23 14:36:40] - paul: businesses don't get sick. the business is not an entity that cares about the quality of its health insurance plan. the business only cares about the ancillary effects (employee retention) and my case is that the ancillary effects have so many confounding influences that their importance is dwarfed compared to raw cost. - pierce
[2009-07-23 14:35:54] - could possible think they could manage it all. -Paul
[2009-07-23 14:35:43] - Pierce: Delivering mail and registering cars are simple enough tasks that I feel like even a horrible incompetant government can't mess it up too badly. But once we start getting into areas where there are thousands if not millions of bits of data to process ever single day (primarily in economic areas), I wonder how even the most well oiled and efficient government...
[2009-07-23 14:34:55] - paul: well that's self evident. the more difficult a task is, the more difficult it is. your statement is tautological. the question is not whether the government will be able to control it, but whether they'll be better at controlling it than the private market left to its own devices. - pierce
[2009-07-23 14:33:04] - mig: you didn't see where I mentioned that the plan has to be good enough on paper to retain employees. if you're thinking that's not a real example, keep in mind that a lot of times the type of thing that someone might submit an insurance claim for is also the type of thing that makes them a subpar employee (long-term disabilities, mental health issues, cancer) - pierce
[2009-07-23 14:32:23] - Pierce: Oddly enough, I think I am the opposite. The more complicated the "instrument of the market" is, the less confidence that I have that the government would be at all able to control it. -Paul
[2009-07-23 14:30:52] - hmm that's the 2nd time I've missued your/you're and their/there .... not sure what about those words that causes me to misues them so often. - mig
[2009-07-23 14:30:40] - Pierce: My point, though, is that businesses should want good health insurance plans (in terms of cost and quality) almost as much as individuals (if not more). A cheap health insurance plan saves them a ton of money and a good one will attract potential employees. -Paul
[2009-07-23 14:30:35] - ...and I think that health care is risky in the most fundamental sense of the word, and it's extremely complex in both the financial model and the nature of the product. wtb tyranny of the state. - pierce
[2009-07-23 14:29:33] - I think they should have firmer regulations in the housing and stock markets, the former because it's risky and the latter because it's complex. - pierce
[2009-07-23 14:29:03] - I guess how I'd phrase it is this: I feel that the appropriate level of government interaction in a market is in direct proportion to the complexity and risk of the instruments of that market. I don't think government should have much of a role in selling tangible goods, except for basic product safety regulations... - pierce
[2009-07-23 14:28:49] - pierce: so you're employees will complain and you'll probably have to switch (lest you lose employees potentially), and you'll make sure to do your homework better this time. - mig
[2009-07-23 14:26:23] - paul: and a number of regulations (building codes, etc) have had to be put in place to compensate for people selling "lemon" houses, too. however, I don't think the government should take over that industry because fundamentally it's still a market where the customer and the consumer are the same person. - pierce
[2009-07-23 14:24:59] - Pierce: And after you buy it, and spend time in it, and decide that maybe you don't like it, it's not like you can simply say "this house is not for me, I'm not going to buy a house like it anymore" and the problem is solved. And yet, I think we can all agree that having the government buy houses and assign them to us isn't really the solution. -Paul
[2009-07-23 14:24:16] - well ostensibly the motivation for a company to maximize the value of their health insurance is to attract and retain employees. having a good plan is not an end unto itself. if you have a crappy plan that looks good enough on paper to attract and retain employees, then that would be just as good as a plan that was actually good. - pierce
[2009-07-23 14:23:53] - hey also, the physical copies of our EP have arrived yesterday! if you'd like a copy, make sure you have $6 on you next time you see us. also maybe tell us in advance so we know to bring it for you if it's not at our place. -amy
[2009-07-23 14:23:20] - Pierce: Sure, it's not the simplest and most direct feedback, but that doesn't mean we need the government to take the decision making from us. How about buying a house? It's an insanely complicated process where no matter how many times you walk through the house, you're never sure if you're going to be completely happy with it. -Paul
[2009-07-23 14:18:24] - also germane (haha) to this discussion, my company switched insurance providers last year for cost-cutting measures and they told us in detail what changed. they also hear it from us if we have problems with the insurance company, so they get feedback - vinnie
[2009-07-23 14:17:14] - plans are definitely not that straightforward to understand - I've needed my mom's help on a few occasions (she used to work in health insurance) - but most companies have someone that can understand the plans and what employees will get. I'm not really sure where you're getting this from pierce - vinnie
[2009-07-23 14:16:57] - not exactly pure-as-the-driven-snow market pressure that adam smith dreamed of. - pierce
[2009-07-23 14:15:44] - paul: again, I don't think they're entirely ignorant, but you'll admit that those two descriptions are a lot more convoluted than "I buyed a hamberger. YUCK this hamberger is gross! I'm not gonna buy it no more!" - pierce
[2009-07-23 14:10:11] - Pierce: Likewise, I'm not sure why the feedback would be difficult to come by. Certainly the decision makers of the company would have opinions on the insurance they have decided on and they can always ask their employees as well. -Paul
[2009-07-23 14:08:46] - Pierce: I'm not sure why they can't figure out what kind of value they would be getting in advance. Certainly they can see the documents detailing what is covered and for how much money. It doesn't seem like this sort of thing is that mysterious. -Paul
[2009-07-23 14:05:52] - (i mean, just kidding all my other friends who i also love. please come to our big old party!) -amy
[2009-07-23 14:05:19] - paulkie: I don't think companies are entirely ignorant of the value they're getting, but they're fighting an uphill battle on both fronts... they don't necessarily know how much value the coverage will provide to the average employee, and they won't necessarily find out if it turns out to be subpar. - pierce
[2009-07-23 14:00:57] - gurkie: well vin and amy want a big ol party too. .p and it's just not a big ol party without gurkie! -amy
[2009-07-23 14:00:46] - mig: "I don't see why insurance companies are any different." that is exactly the issue I've been addressing with my claims about how our current insurance system subverts capitalist assumptions. - pierce
[2009-07-23 13:53:19] - amy: I want to go, I just am not positive if I can. My sister will be in town and I know her In-Laws want a big old party at some point and me to show up so I dont know if it will conflict. ~gurkie
[2009-07-23 13:48:41] - otherpie: can you make it to purcellville on fri night? -amy
[2009-07-23 13:45:51] - pie: I think Saturday would be better, yeah - vinnie
[2009-07-23 13:45:05] - also, you have to take into account that insurance companies are required by law to put coverages in all of their plans regardless of whether their customers need or want those particular type of coverages, which does hamper the consumers ability to shop around. - mig
[2009-07-23 13:43:58] - OK, vin had mentioned travis moving, but i thought since that's over at 4 it wouldn't be a problem. did not say my thinking out loud but figured party would start at like 7 or 8. so it's looking like sat would be better then. -amy
[2009-07-23 13:43:31] - Pierce: Businesses want to save money, and they would want to provide benefits which attract potential employees. I would think both of those would motivate them to choose a halfway decent (in terms of cost and quality) health insurance. -Paul
[2009-07-23 13:41:16] - Pierce: Eh, I don't think you mispoke. I think we just had a misunderstanding about what we were debating. I'm with Miguel (and possibly Gurkie?) though, in that I don't see why we assume that businesses would be completely ignorant of what kind of value they get from health insurance companies. -Paul
[2009-07-23 13:39:19] - amy: I can probably go to your party, but I am also busy helping Travis move on Saturday. -Paul
[2009-07-23 13:38:35] - but yes i want to go and saturday night would work better than friday night, that way we can stay out later - aaron
[2009-07-23 13:38:29] - pierce: even in capitalism cost is not the end all be all. capitalism would dictate that the solution that provides the most value AND cost will win out. You may provide the cheapest beer, but if people are willing to pay an extra dollar or so for better beer, than that beer is going to win in the free market. I don't see why insurance companies are any different.- mig
[2009-07-23 13:38:16] - ... but would add cost. a lot of it depends on whether the health care companies are colluding to artificially increase rates (which I don't think they are), and what kind of plan the govt goes with. it's a really complex issue so I don't feel like I could predict what will happen - vinnie
[2009-07-23 13:37:09] - amy: i want to go...? i figured pierce was answering for the rest of us helping travis move - aaron
[2009-07-23 13:36:37] - paul: okay, then I probably misspoke. it being cheaper is only half the story. the real motivation is to minimize value because that minimizes the cost to you (the insurer). the trick is to make it hard for people to realize that they're getting less value, and if they do realize it to make it too difficult or costly or risky to do anything about it. - pierce
[2009-07-23 13:36:02] - I feel pretty ambivalent about a govt health care plan. I think there's a number of steps the govt could do to reduce cost across the board, a few things they could do to provide coverage to more people at not much more cost to the taxpayer. I also think there's a big chance it could result in lower quality health care, and that it might not solve a lot of the problems...
[2009-07-23 13:35:56] - i guess nobody wants to come to our party besides pierce ;_; -amy
[2009-07-23 13:29:33] - Pierce: Well, that was my point, and I thought you were trying to refute that. All of the "flaws" that you were bringing up seemed to indicate that everything was geared towards cheaper and cheaper health insurance (possibly at the expense of quality, but that wasn't the point at the time). -Paul
[2009-07-23 13:21:54] - paul: I don't know why you thought that was the point, because that's not the point. if I said something that gave that impression, I misspoke. my point is that the current system confounds any normal relationship between cost and value at multiple levels, which is why it doesn't offer any of the normal benefits of a capitalist approach. - pierce
[2009-07-23 13:10:06] - "because of the intricacies of pricing, they may personally see a great product while others (without decision-making power) get crap" I thought the point was we were solely talking about the cost of the insurance (which the CEO would hopefully know) and not the quality of it. -Paul
[2009-07-23 12:56:24] - gurkie: I topped out around 45. Katie was still going strong, though. *sigh* -- Xpovos
[2009-07-23 12:41:49] - mig: apparently im not nerdy enough, although its shocking to me how at a specific level you can get really hard words or really easy ones... ~gurkie
[2009-07-23 12:35:53] - gurkie: i knew what an harquebus was from DnD, maybe you should get into some more nerdy hobbies. - mig
[2009-07-23 12:33:56] - A CEO might have the final say, but if it's a sane company it will have people doing that research and how it will impact everyone, not just the higher ups. - mig
[2009-07-23 12:32:33] - pierce: i also find it really hard to believe that a company would just switch insurance companies without doing any research whatsoever with how it will affect their employees. - mig
[2009-07-23 12:29:53] - I seem to be capping out around 42, how was I supposed to know what a harquebus was?? ~gurkie
[2009-07-23 12:20:42] - I disagree with someone, I think its Pierce surprisingly (but it may be both of you). If a company has a lot of complaints about their insurance company they will often switch providers to accomodate their employees. Obviously it depends on the company and the issues that the employees have had but it happens. ~gurkie
[2009-07-23 12:17:18] - pierce: except that a nationalized health care system you'd still have people left to rot in the streets (unless they're lucky to be put in the priority q) or people rotting inside their homes because their unlucky to be chosen few to actually receive the medical care they need. - mig
[2009-07-23 12:15:37] - other than those points, I'm up for a party! woo! - pierce
[2009-07-23 12:14:11] - on the other hand, having a party the night before would require squeezing it between people's workday and when they'd have to go to sleep to get to travis's by 9. - pierce
[2009-07-23 12:12:51] - amy: saturday is the day travis is moving, his schedule has us finishing up around 4pm. - pierce
[2009-07-23 12:06:01] - to be clear, that's fri jul 31 or sat aug 1 -amy
[2009-07-23 12:05:35] - hey i suddenly had a brilliant idea to have a party at our place next week. since we like never have ppl over anymore. which day would be better for you all, fri or sat? i ask bc i have been invited to play a show in purcellville and i can pick either day, so whichever day ppl want to party i'll pick the other day for the show. -amy
[2009-07-23 12:02:06] - even if they see a problem, the nature of the insurance market means other plans are likely to be just as poor, and you wouldn't even know until you'd invested time and resources into switching your company plan. - pierce
[2009-07-23 12:01:18] - paul: my example was not necessarily about greed. it was as much about ignorance. the people buying the product don't know how good the product is. because of the intricacies of pricing, they may personally see a great product while others (without decision-making power) get crap. - pierce
[2009-07-23 11:59:05] - Either way, I leave the rest of this debate to Miguel, because I am off to eat lunch. Gotta get my artery clogging food while it's still legal!
-Paul[2009-07-23 11:58:33] - the only time it wouldn't be true is if we left sick people without money to rot in the street, and personally I'd rather live in a society that abridged my right to eat cheetos than one that took that approach to its citizens' well-being. - pierce
[2009-07-23 11:58:25] - Pierce: I won't deny that CEOs can be selfish and greedy and everything else you might want to call them, but I believe that in the end, they're going to generally do what's best for the company as a whole, and I would think cheaper health care would certainly fall under that. -paul
[2009-07-23 11:57:33] - you may say it falls under the umbrella of "things I do to that don't hurt anyone else should be my decision", and I'm sympathetic to that, but the burden of health care for people who don't take care of themselves is already absorbed by the system. it does hurt others, if only a little. that's true now, and it'd be as true in a nationalized health care system. - pierce
[2009-07-23 11:56:38] - Pierce: I find it hard to believe that a CEO would choose have his company spend significantly more on a health insurance plan just so he can get some "gold plated plan". I think it's far more likely he takes the cheaper plan for the company and gets his own supplemental insurance. -Paul
[2009-07-23 11:55:55] - mig: I think it's arguable whether eating junk food resembles a "basic freedom". I think people should be allowed to do it, but asking you to occasionally vote to protect it if it's really that important to you hardly seems like a burden. - pierce
[2009-07-23 11:52:45] - I shouldn't have to vote to simply retain basic freedoms. - mig
[2009-07-23 11:52:28] - mig: "how the beuarcrats in this country treat people who try to provide free health care" I don't know what this refers to. - pierce
[2009-07-23 11:51:12] - Now I realize i'm stretching a bit there, but we are certainly heading in that direction with all the talk about taxes for fatty foods and the like. - mig
[2009-07-23 11:50:51] - mig: I don't think it's reasonable to assume that's specific to government health care. we're making smoking illegal in public places just fine in this country with our private health care. you don't like it, vote to change it. setting up a "slippery slope" to demolition man ignores a whole lot of resistance that policymakers would meet along the way. - pierce
[2009-07-23 11:48:17] - setting up the straw man of "well A has double the rates of B for the same value" ignores the convoluted nature of pricing in this particular industry. - pierce
[2009-07-23 11:48:02] - and eventually we'll be in a "demolition man" world where everything bad for you is illegal. - mig
[2009-07-23 11:47:46] - what about an insurance plan that seems very cheap, but that's because they reject claims left and right? as long as they don't reject an important claim from some decision maker in the benefits department of your company, they'll get away with it. - pierce
[2009-07-23 11:47:02] - another angle that makes me very much against nationalized health care is the very realy potential of lifestyle policing. In fact it's happening already with the persecution of smokers to the point where I think tobacco prohibition will be almost certain if this nationalized health care goes through. - mig
[2009-07-23 11:46:55] - paul: that was an amazing oversimplification of the way it works. what if the CEOs setting health care policy for their companies can afford the gold plated plan, but all their employees get minimal coverage? that would be cheaper, but provide less value. - pierce
[2009-07-23 11:44:13] - Pierce: "voting for someone who says they'll fix it is about a thousand times more effective than anything I can do in the current system" I completely disagree with this, not surprisingly. I find it frightening that we're putting our hopes and dreams on politicians being able to fix our health care problems. -paul
[2009-07-23 11:43:11] - mig: yes, there would have to be a priority queue. yes, that means sometimes there would be wait times. that's a function of the raw manpower devoted to health care, though, not the nature of the way we pay for it. - pierce
[2009-07-23 11:42:33] - Pierce: Because I can guarantee you that as soon as health insurance company A doubles their rates, 99% of the businesses that use them are going to switch to health insurance company B for half the cost. -Paul
[2009-07-23 11:42:33] - pierce: considering how the beuarcrats in this country treat people who try to provide free health care to those in need, I don't really share your optimism about the worst that a national health care system would do. - mig
[2009-07-23 11:40:19] - paul: why not? again, think about what I'm saying about this specific market: insurance is about the law of large numbers. the large insurers are protected. if the only two restaurants were mcdonalds and burger king, and the people buying food there weren't the ones eating it, they could easily inflate their prices. - pierce
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