House Votes to Repeal Obamacare Provision

[earthJoker]

Depends how you define efficiency. I would say any person who doesn't do their job properly isn't efficient, even if they do their job cheaply.

Yeah, because thankfully the world is just black and white.

Simply not true. I don't need to as much about cars as a Toyota engineer to make an informed buying decision when it comes to getting a new car, nor do I need to know as much about medicine as a doctor to make an informed decision about my healthcare.

You can compare cars easily, you can look at the engine stats, you can see how much fuel it uses. And you can make a test drive. Actually many car sellers offer that. You can't make a test surgery, just to look if you like what you get.

Same for computers. I can see, ah that Dell has 2GB RAM which is supposed to be better than the HP with 1 GB RAM. Well now try that for pancreatic cancer treatment.

[Aimless]

Again, the only "problems" there arise from everyone being forced to pay for other people's spending habits. As such, they're an argument against the government-run part of our health care system, and not an argument for expanding government control to include the whole thing.

Unless Medicare and Medicaid are expected to be shut down next year you'll have to consider ways to make the situation better. One way to make the situation better is to give those in charge of medicare the mission, the means and the authority to make reasonable decisions for eg. controlling spending. That's where IPAB comes in. That's where the idea to get people insured comes in. That's where the promotion of research into comparative effectiveness comes in. If everyone's going to be forced to pay for other people's spending habits then the least you can do is to try to spend wisely.

Could be. Kinda proves the point me and me libertarian brethren have about regulation, though, doesn't it? What the hell good is it, given that several hundred thousand pages of laws later, we're basically still stuck with the realities of caveat emptor? All those mountains of paper have done is make things more expensive and slower, but haven't actually fixed a damn thing, have they?

Well, for starters, a great deal of waste is attributed to the administrative overhead that comes with juggling many different payers. Moreover, the good medicare regions do well. But, yeah, despite the sheer volume of regulations the US has a problem. That's a clue that you can't fix things by dint of regulation count alone. But as soon as they try to fix anything, eg. by creating IPAB, everyone gets upset.

Another problem caused by government, particularly our legal system and legal climate... and as I see it, another great reason *not* to trust our government with more power authority and reach when they're so thoroughly fucking up everything they already do.

You do realise though that the IPAB effectively takes power away from congress as long as congress refuses to be sensible about healthcare spending?

The issue of your legal system and your legal climate, well, that's important, but how much does the federal govt. have to do with eg. malpractice lawsuits? And tbh I'm not sure I see why the legal system/climate has, in your view, weakened primary care in the US so clarification would be welcome

Is it the government's fault if a person is uninsured? Is it the government's fault if a person can't afford to fill his prescriptions? Is it the government's fault that medical education is so expensive? Is it the government's fault that medics are slaves to the culture of money to the extent that only a few of them consider going into family medicine? Is it the government's fault that people go to specialists who're more inclined towards expensive high-margin interventions than towards cheap--but low margin--preventive care?

The only reason those things may be the fault of the government is that the government isn't permitted to address them. Ultimately, who's at fault? Voters/patients, sure, but also the many healthcare providers who unscrupulously (or unwittingly) waste other people's money.

Well, no, the point is that if you're not an informed consumer in any arena, you're probably going to get ripped off in any purchase. Health care is no different, and should be treated no differently. No need to force "what's best" on all of us because some people are irrepressibly stupid. Applies to buying a new car, ought to apply to health care decisions as well.

Buying a new car is trivial compared to making many healthcare decisions. You don't have to be exceptionally stupid to find decision-making in healthcare a challenge--even your smartest and most competent doctors struggle with their decisions. They frequently also struggle just to stay up to date and to handle the deluge of "information" (aka. advertising). It's not much easier when you're under emotional/psychological/physical strain. What're the consequences of making "mistakes" in car-buying vs. healthcare? In one case you're embarrassed and pay more on gas or maintenance, in the other case you'll potentially be left broke, sick, weak, broken. Having a reliable guide when you're in such a state, that'd be tremendously helpful. Instead you get someone who's basically a car salesman, only worse.

The ER was open... just no doctors around. He got in to see a nurse, who couldn't prescribe anything or actually help him with his problem, but was able to schedule him to see an actual doctor first thing after the long weekend. Just another not even uncommon tale of Canada's wonderful "universal health care."

Coulda been worse... he could have been the kid who got stabbed in Toronto, and bled out on the way to the ER... because the first ER the ambulance took him to actually did close after 8PM (or something like that), on account of budget cuts. It's just what happens when you force everyone into a system where some bureaucrat gets to put a dollar value on someone's life and the quality of medical care they receive.

If we're thinking about the same case, the guy was taken to the ER by his friends just after it'd closed, and the friends declined an ambulance electing instead to drive him to another hospital. He died on the way. Unfortunately the first hospital, even had it been open, would not have been able to deal with his injuries, but I guess there's a small chance experienced paramedics woulda been able to keep him alive all the way to the second hospital.

Meanwhile, one ambulance is diverted every single minute, in the US. Or, at least, that was the case until a couple of years ago, when Massachusetts simply banned ambulance diversion (after finding that hospitals were disinclined to voluntarily stop diverting ambulances). As for your uncle, I'm glad he survived that weekend after his heart attack. This is the first time I've heard of an ER without a doctor; I dunno how common a phenomenon it may be in the wilderness of Canada. Either way, problems with emergency care isn't just a problem in Canada. It's one of the most expensive problems in the US.

[Flixy]

I see nothing wrong with an individual
paying money to get tests that are not
necessary. Do you also think it's wrong
for an individual to buy two houses?
Or a yacht? Lots of things might seem
unnecessary to you, but provide some
utility to the person paying for them.
As Cain says, the problem is only if
society is forced to bear the cost.

I did not mean morally wrong if you want to pay for extra tests. I do think it's morally wrong for a doctor to keep suggesting extra (costly) tests, if the added benefit is neglegible, but I don't know if that happens over there. If a doctor is honest about the effectiveness of a test and you still want to pay for one, be my guest. However if there is a waiting list, I do think people who need the test should get it first.

My point was more against the belief that testing itself does no harm. That is not true. Xray and CT scans involve ionizing radiation. PET scans and other scans require you to ingest or inject radioisotopes. Colonoscopies have small chances of complications.

And besides these direct risks, there will also inherently be false positives and negatives. The first will likely cause stress, unneeded procedures (with complication risks), or unneeded medication (with side effects). False negatives give you a false sense of security and may cause you to ignore symptons. The reason I bring this up is that a while back here to tests all girls from a certain age for cervical cancer (IIRC). The test itself was not directly harmful, so it sounded like there is nothing wrong with this plan, but a study suggested that false negatives and positives alone would likely cause more deaths than would be prevented.