Lou Dobbs on single-payer healthcare in Denmark

[bascule]

Truth is not a "red herring", bascule.

 

Le sigh. The speed of light is 299792458 m/s. That's the truth! But it's completely irrelevant to this thread.

 

Can you post something on topic? Like something about the Danish healthcare system? Thanks.

 

The fact that they also have to wait in America doesn't mean they aren't waiting in your beloved single-payer countries.

 

We all wait, except the people who don't have healthcare. Meanwhile America is paying twice as much as the Danes for inferior care and fewer doctors. That's the truth, Pangloss.

 

Also, do the Danes wait as much as Americans? You didn't even bother to research that topic before taking a pot shot at single payer systems.

 

Try harder? But thanks for playing.

[Pangloss]

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

 

We all wait, except the people who don't have healthcare.

 

Thanks for amending your remarks.

[bascule]

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

We all wait, except the people who don't have healthcare.

Thanks for amending your remarks.

 

Expound please? What point are you trying to make here?

 

And to reiterate a point you conveniently ignored:

 

Can you point to a healthcare system where non-emergency care isn't[/i'] rationed?

 

I'm waiting...

[John Cuthber]

When it comes down to it, all healthcare expenditure is rationed simply because, no matter how much you are prepared to spend, you still die.

The difference between an insurance company making that decision and a Govt run health service making it doesn't seem that big a deal to me.

Of course, in either case, if I have the cash I can pay for any services I like including, but not limited to, lots of propofol.

[bascule]

When it comes down to it, all healthcare expenditure is rationed simply because, no matter how much you are prepared to spend, you still die.

 

And that's the problem with bringing up rationing in regard to single-payer healthcare. It's a total red herring and a non sequitur. You could make the claim that single-payer healthcare is bad because people will die under a single-payer system. Is the implication that people don't die under the current private system?

[Pangloss]

Expound please? What point are you trying to make here?

 

That telling people that single-payer systems don't have waiting lines is an error. That's it.

 

 

Can you point to a healthcare system where non-emergency care isn't rationed?

 

I didn't say that there was one. You're making Partisan Logic Error #147: Assuming that anybody who disagrees with a point you make means that they support the opposition on the issue.

[bascule]

That telling people that single-payer systems don't have waiting lines is an error. That's it.

 

Who exactly is doing that (strawman)? I suppose according to JohnB (on a different thread entirely), wait times for NHS are substantially lower than they are here in the states.

 

I didn't say that there was one. You're making Partisan Logic Error #147: Assuming that anybody who disagrees with a point you make means that they support the opposition on the issue.

 

I'm sorry, I was only responding in kind to your red herring. Thanks for coming back at me with a strawman. That's really awesome of you.

 

Why do you feel the need to point other people's "partisan" behavior constantly? You do realize you're just as "partisan" as the rest of us?

[Pangloss]

I'm sorry, I was only responding in kind to your red herring.

 

It wasn't a red herring, because I'm not supporting the opposing point of view.

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You do realize you're just as "partisan" as the rest of us?

 

That's what all partisans think, that they're just doing the same thing everyone else is doing, compromising their objectivity for an ideological goal.

 

They're wrong.

[iNow]

It wasn't a red herring, because I'm not supporting the opposing point of view.

Just as an FYI - The use of the red herring fallacy has zero to do with which point of view you hold or support. That would be non-sequitur.

[bascule]

It wasn't a red herring, because I'm not supporting the opposing point of view.

 

That's not what a red herring means. I invite you to read the definition of a red herring:

 

http://en.wikipedia.org/wiki/Red_herring_%28logical_fallacy%29#Red_herring

 

Your original post:

 

I don't know about Denmark, but that's not always the case in single-payer systems. They get emergency care (as do Americans), but non-emergency (but still "needed") care is rationed, hence the waiting lists (and low costs).

 

You brought up rationing, however rationing is no more a problem specific to single-payer healthcare systems than people dying while under care of the system is. It's irrelevant to the discussion. You are trying to divert the conversation from single-payer healthcare to rationing. It is therefore a red herring.

 

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That's what all partisans think, that they're just doing the same thing everyone else is doing, compromising their objectivity for an ideological goal.

 

Pot. Kettle. Black.

[Pangloss]

Just as an FYI - The use of the red herring fallacy has zero to do with which point of view you hold or support. That would be non-sequitur.

 

No, I was accused of raising the issue as a red herring, meaning that I supposedly felt the opposite point of view to be correct. It was a statement aimed at me specifically. I stand by my response.

 

To bring it up[/b'] in the context of universal healthcare is a total red herring.

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You are trying to divert the conversation from single-payer healthcare to rationing.

 

No, that is in fact not my intent at all. It was solely to point out your error in saying that single-payer systems don't make people wait (to which you have subsequently agreed), nothing more.

Edited August 26, 2009 by Pangloss
Consecutive posts merged.

[bascule]

No, that is in fact not my intent at all. It was solely to point out your error in saying that single-payer systems don't make people wait (to which you have subsequently agreed), nothing more.

 

To reiterate my previous post: when did I ever say that single payer systems don't make people wait? That's a strawman.

 

It would be really nice to discuss the topic at hand, not things I never said.

[Pangloss]

To reiterate my previous post: when did I ever say that single payer systems don't make people wait?

 

In post #22:

 

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

[bascule]

In post #22:

 

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

 

That post was in regard to people who either can't get care because they don't have insurance or people who don't receive care because their insurers deny their claims. It has nothing to do with wait times. Do you see the word "wait", "rationing", "speedy", etc in that sentence?

 

So, yes, strawman.

[Pangloss]

It's fine by me if you want to narrow your statement in that manner. As I said in post #27, thanks for clarifying.

 

So no, not a strawman, or a red herring. The correct word for someone who points out a flaw in an argument without necessarily supporting the opposing view is "skeptic".

[padren]

Ok, I'm confused. Are the numbers "entirely arbitrary", or do they represent a difference in "overall cost, access, speed of service and quality"?

 

What I was trying to say was comparing the number 47 to the number 44 has no measurable difference, just an overall difference in ranking.

 

It's like a race - someone may come in #6 and another #7, but whether that is because #7 was 1 second behind #6 or 1 hour behind #6 is completely unknown and since they only consider rank, not time - those numbers do not have enough information to determine a cut off for as to side of "mediocre" one may fall on.

 

The ranks are based on the difference in overall cost, access, speed and quality of the service, but once they are distilled down to mere rankings they loose any relevance other than that one does "some amount better" and one does "some amount poorer" relative to each other.

 

Now once you select two given systems of different ranks, and compare the hard statistics between the two (such as Denmark and the US) you can actually get into some far more meaningful numbers. We can (to use the race metaphor) actually clock the wait times, see how big the gap is, and even decide what wait time we can live with and consider good and what wait time we consider mediocre at best - at which point one or both may fall on either side of that metric.

Even when we decide to set an exact amount of time as a cut off after which it is considered mediocre, that exact marker is still arbitrary - if we were fighting a desperate war and needed more doctors patching up troops we may consider longer wait times acceptable due to the harsh conditions.

 

So yes - the information we measure is not arbitrary as when we measure the wait times etc, we measure them all in a uniform fashion and they are then statistics. When we aggregate those statistics into rankings, we get very little information other than what system is technically doing better than another system with no information as to how much better or worse any two systems relatively are.

And lastly whatever we think is 'good' or 'bad' in terms of the hard numbers is pretty arbitrary as it's based on our expectations.

 

Does that help alleviate the confusion?

 

 

A note on the 'red herring' argument:

 

It's all about context: Usually wait times and rationing are used by opponents as a scare tactic to dissuade people from supporting a public system which is disingenuous because those things occur now within the private system. The clearest way to make the argument would be to say that rationing and wait times would be worse under a public system than private system - that would then need to be substantiated, but it at least acknowledges that it happens already.

So to simply say "rationing will happen" ticks off proponents because it implies that it doesn't now.

 

When proponents say there won't be rationing they mean worse than what we have now - and of course opponents will be ticked off because of course there will be rationing as it will always occur, even in the system we have now.

 

For the purpose of this argument I think we can all agree: rationing and wait times will always exist. If we want to move forward with that argument it should be on whether wait times and rationing will be worse or better under a new potential system. That way we can drop all the 'who made what claim' regarding 'no rationing' etc etc and move on.

[iNow]

For the purpose of this argument I think we can all agree: rationing and wait times will always exist. If we want to move forward with that argument it should be on whether wait times and rationing will be worse or better under a new potential system. That way we can drop all the 'who made what claim' regarding 'no rationing' etc etc and move on.

 

I think another important fact is "by how much" or "by what order of magnitude is it better or worse than currently," and "is that really a cost great enough to deter us from the other larger benefits we're looking to achieve with the change?"

 

Thanks for helping to wrestle this thing back on track, Padren.

[The Bear's Key]

To further help get back on track...it's seems not red herrings or logic fallacies, but simply just misunderstandings of each other.

 

In post #22:

 

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

Clearly bascule's not referring to wait times, but more like a compariosn between "ever" and "never".

 

• No universal: many people will get the healthcare they need. Yet many others will never.
   
  
• Universal: every person will get the healthcare they need.
  

In both cases timing is relative to the procedure, but in the case above that's irrelvant.

 

 

It's fine by me if you want to narrow your statement in that manner. As I said in post #27, thanks for clarifying.

 

So no, not a strawman, or a red herring. The correct word for someone who points out a flaw in an argument without necessarily supporting the opposing view is "skeptic".

And I really doubt Pangloss wielded bias in his arguments. He seems to have misunderstood bascule's point, who in turn seemed to view the misunderstanding as a deliberate fallacy.

 

We're only human.

[padren]

I think another important fact is "by how much" or "by what order of magnitude is it better or worse than currently," and "is that really a cost great enough to deter us from the other larger benefits we're looking to achieve with the change?"

 

That's a real hard one to nail down because even from an ethical standpoint (how much is reasonable morally) varies depending on what we have to work with at any given moment. Is it ethical to borrow against the lives of our grandchildren so we can get treatments that let us live an extra 5 years comfortably? If we come up with an ethical amount to ration right now in a time of debt and crisis and recession... will that amount still be ethical if we got out of debt and have a lot more money to throw around or, alternatively, cut taxes with?

 

And to tie directly into what you said - how equitable is the rationing distributed? In any system where anyone has no coverage, they receive 100% rationing on all but emergency room care.

 

The funny thing is I totally understand the emotional argument that I think sits in the back of everyone's mind: I work hard, I pay my bills - and that should be worth something when my child gets sick. I don't want my kid* to suffer an extra period of time just because Uncle Sam says the heroine addict welfare bum Iend up paying for got in line ahead of my kid by five minutes. If I am worried about my kid, I should be able to work harder, and get something better for that effort - a premium service, shorter wait times.

But when you have those premium services that cost more, that will siphon off the talent from the 'standard' services and the liberals will cry foul and everything I've worked harder for will be 'redistributed' so everyone, including the do-nothings never have to see someone who works harder than them get something better than what they have.

 

Now - that is an emotional argument and the only reason we can avoid it is because our current system is in such disarray - we should be able to cover everyone and end up with a better system for "the hard working people" too.

I think though, many people are skeptical that it will and it's the underlying stance that keeps people uncertain.

 

It is an interesting question - if we had the option of either style of system at equal levels of efficiency how far would people be willing to go to ensure everyone was covered, knowing it would cost themselves more?

 

(* just as an example, I don't have kids actually)

[iNow]

I am of the impression that, by pooling the risk across a larger number of participants (the entire nation), that the cost to each of us individually goes down despite the fact we are covering millions more people.

[padren]

I am of the impression that, by pooling the risk across a larger number of participants (the entire nation), that the cost to each of us individually goes down despite the fact we are covering millions more people.

 

By that logic we should be able to extend the pool to include illegal immigrants and all save even more money - including the ones who wouldn't be paying into it. The reason we are saving money isn't because we are increasing the pool - it's because the current system wastes too much money trying to keep "undesirables" out of it and the secondary costs involved in uncollected emergency treatment, losses of livelihood, etc.

 

If we are going to include all the uninsured in the pool, we will include people that either can't pay in or are known to have conditions that will cost the pool far more than they will contribute - it's like insuring someone for car insurance so they can retroactively make an expensive claim on an accident they already had. The two reasons for doing this is 1) the moral imperative and 2) keeping those people out incur costs across the board that are higher than letting them in.

 

Reason #1 speaks for itself, but #2 is the result of our very inefficient system of keeping those people out. I don't personally think it is very likely that we could ever have a private system that can keep "undesirables" out that is more efficient than letting them in because unless the uninsured just roll over and die (and not contribute to the economy anymore of course) they will find a way to be treated even if they get stuck with bills they can't pay, which still costs everyone in the end.

 

I am in favor of universal coverage because reason #1 is enough for me, and consider #2 a welcome practical benefit. Even if we could somehow magically not incur the costs associated with the uninsured while they are uninsured I'd still support covering everyone - but it would cost us more money or force us to 'spread what we have around' for lower quality.

[Pangloss]

I see universal coverage as an investment -- I'll pay for it if I get some benefit in return. And there is one -- having a healthier population around me means more opportunities for me to thrive as well. So I agree that the general concept of universal coverage really should extend beyond the usual left-versus-right memes and motivations.

 

That doesn't mean, however, that the answers are easy. There's no linear, rail-like progression; some road that we simply need to walk down from point A to point B to point C, shoving aside anyone who gets in the way with inconvenient questions (though I agree it would be best if we could ditch the lies and fear-mongering from the right). We're going to have to continue to hash out some very ugly business in the public discourse and in government over the next few months. And when we're done:

 

It's probably not going to be single payer.

 

It's probably not going to cover everyone initially.

 

It's probably not going to reduce costs initially.

 

What it MAY do -- what we'd damn well better HOPE it does -- is provide a mechanism by which -- gradually, over time -- cost will come to drop faster than rising expenses, and coverage will become universal.

[bascule]

It's fine by me if you want to narrow your statement in that manner. As I said in post #27, thanks for clarifying.

 

No, it didn't get resolved in post #27.

 

You drug this out. Like, over the course of 5 posts.

 

Seriously, are you kidding me? Let's examine a similar misunderstanding of opinion:

 

I'm not sure who he's saying "made the same argument" except me, since he's replying to me.

 

I can always misunderstand, but I don't see it here. It wouldn't really matter, except it goes with the point he's trying to make.

 

If it wasn't your implication that was in the current legislation, my apologies, however the sheer amount of disinformation being disseminated about these bills is maddening.

 

Hey look at that, a one post turnaround, as opposed to dragging it out over the course of a half dozen posts.

 

Seriously Pangloss, are you kidding me? No wonder there can't be any debate on single payer healthcare in America. The opposition cannot admit they're wrong and move on. It becomes a giant debacle, and I had to continually bombard you with criticism until you yielded and actually admitted you're wrong, kind of, still trying to shift the blame on me.

 

You completely misinterpreted what I was saying and wouldn't admit it. That's putting it lightly. You put words in my mouth.

 

It's not only half the cost, it's universal. If you need care you will get it. That's not the case for everyone in America.

 

Are you f*cking kidding me? You're saying this is a statement on rationing? This is a statement on universal coverage. It is not a statement on rationing. I don't know what distorted ass lens you're seeing my statements through. Perhaps a "partisan" one. How on earth is this a statement on rationing? Yet that's what you somehow turned this statement into, and it took a half dozen posts of you continuing to insist it was a statement on rationing before you finally admitted that it wasn't a statement on rationing. And you tried to frame it as me "clarifying" the statement to not be about rationing. You are a partisan hack, sorry.

 

I weep for America.

 

So no, not a strawman, or a red herring. The correct word for someone who points out a flaw in an argument without necessarily supporting the opposing view is "skeptic".

 

*headgib* *headgib* *headgib*

 

The correct word is "asshole". See this thread on my opinion of self-ascribed "skeptics".

 

Now's the point in the thread where you use your moderator powers to "win" the argument by giving me a warning. E-penis ftw!

 

And honestly, if you use your moderator powers to silence me, I really don't think you deserve to be moderator of this forum.

 

I really wish this thread could've been a sound, rational discussion of single payer healthcare, but you have instead injected it full of partisan invective and completely derailed it.

 

I still await your apology. Admit you grossly misinterpreted my post as I did with ParanoiA and we can move on and have a sound rational discussion. Or you can bust out your epenis and prove this forum isn't a level playing field for political discussions. It's your choice.

Edited August 27, 2009 by bascule

[iNow]

I am of the impression that, by pooling the risk across a larger number of participants (the entire nation), that the cost to each of us individually goes down despite the fact we are covering millions more people.

 

By that logic we should be able to extend the pool to include illegal immigrants and all save even more money - including the ones who wouldn't be paying into it.

A fair point. I should have been more precise with my language. I was making a slightly different argument, and didn't intend to include peripheral concerns like coverage for illegal immigrants, etc.

 

My thought process was basically an extension of the fact that small companies struggle to provide coverage at low cost, whereas larger companies and corporations are much more successful at providing quality coverage for very low cost. The reason for this is that they can spread the risk across a greater number of people. More employees of the company equals more people paying into the system.

 

By example, my sister is a lawyer at a relatively small firm, and her boss is going bankrupt trying afford coverage for his staff (he's literally about to drop coverage completely... he just can't pay for it anymore as high as costs have become). He's had to select a cheaper plan which covers very little, and on top of that, she has a $3,000 deductible. That all comes from the fact that they have such a low number of employees and practically no leverage/bargaining power. Conversely, I work for a large international corporation, and I get amazing coverage for relatively little cost to myself, and zero deductible... just a minor co-pay. While a decent percentage of my personal contributions to health coverage are actually being applied to cover other employees (not just me and my family), I am able to pay much less personally with this system since all employees as a group contribute to the pool. By combining our purchasing power, the individual costs to each of us are significantly reduced.

 

In much the same way, if payments were pooled nationally (in the same way payments are pooled at my large employer), the individual payments we each make as citizens would go down pretty significantly. It's less about the cost of services, and more about the decreased costs of individual contributions. The comment regarding "while covering millions more people" was somewhat peripheral to that point and I probably should have left that out.

 

 

 

The two reasons for doing this is 1) the moral imperative and 2) keeping those people out incur costs across the board that are higher than letting them in.

<...>

I am in favor of universal coverage because reason #1 is enough for me, and consider #2 a welcome practical benefit.

Couldn't agree more.

[padren]

A fair point. I should have been more precise with my language. I was making a slightly different argument, and didn't intend to include peripheral concerns like coverage for illegal immigrants, etc.

 

My thought process was basically an extension of the fact that small companies struggle to provide coverage at low cost, whereas larger companies and corporations are much more successful at providing quality coverage for very low cost. The reason for this is that they can spread the risk across a greater number of people. More employees of the company equals more people paying into the system.

 

Okay, I completely misread what you were saying as that by covering more people in general the total costs of the system would go down, even if the additional people you covered were 'negative contributors' and such.

 

With regards to what you were saying yes, the cost to employers or individuals goes down, but at the expense of profits for the provider as they end up receiving less per person as they suddenly have better negotiating power. Granted, I won't exactly be crying a river for those who use leverage to push small employers to the breaking point to suck every penny they can out of them but it still is just a redistribution of money instead of saving money. It will lower the amount pulled in by those insurance companies, and thus lower the total pool they have to work with to provide pay outs or at least cut down the number of corporate jets they can afford. Probably a little of both by the time it's all said and done.

 

 

I do want to add a new element that I realized hadn't been discussed to my knowledge - public to private bleed off. I grew up in Canada before moving to the States as a teen and one thing I remember was the issue of potentially allowing private health care clinics to exist side by side, which was referred to as a 'two tier system' back then. You would not believe the fear and outrage at such a morally bankrupt idea that was kicked up as it was believed that all the good doctors would immediately jump shift off the public wage capped system and run straight to the private clinics to make more money.

It's the same fear that was kicked up by the "school voucher program" that taking your kids out of public school and diverting those funds to a private school would dry up funding for public schools and hurt the public option to the point of it being third rate at best.

 

It is a fair question - you can't force a doctor to take whomever you say, so if they can take those they can charge more from, why wouldn't they just avoid taking patients from the public providers that negotiate low rates? Do you force a clinic to accept patients that are on a public option plan that will only pay half of what the doctor intends to charge? If they want to cater to the ultra rich their costs will be understandably higher and there is no reason a government should pay for a hospital stay where patients get Club Med treatment and 4 star meals... but the government can't force that hospital to take public option priced patients without breaking the entire business model of the private hospital.

 

There are not enough rich people in the country to make such hospitals too large of a threat to the talent pool but if you threw in moderately fancy hospitals that still avoided the lower prices that the public option viable it could get rather sticky. If a hospital says "we will charge a bit more, but use that to lower wait times and have better facilities" as a business model to target a specific demographic of people who can afford it and want that service over the bare bones then we could end up with a system where the disparity in health care is not unlike the disparity in under funded community colleges to that of a high caliber university.

 

Perhaps this issue hasn't come up because it's been proven to be a red herring and put to rest, but I haven't heard the reasoning for that yet, so I am curious if it's been covered.