Increasing Health Care Funding

[lemur]

The health care discussion really has two separate parts. One is the issue of people who need or want better health care for themselves or their families. The other is people who want more opportunities to make more money and consume more and acquire more wealth. People look to health care for both of these goals: medical treatment and other health care and jobs and business opportunities to make more money. But the shadow side of the discussion is what kind of wealth and consumption do people want to increase along with the quality of their health care?

 

In other words, people want healthy and even medically-enhanced bodies, but that is not all. They also want to adorn these bodies in attractive clothes and jewelry, tatoos, and hair-styles. Then they want to parade these bodies around in expensive vehicles that consume fossil fuel. They want to display themselves in elaborately decorated venues like restaurants and other public stages where the decor quietly says, "this is not just another Walmart." Producing and maintaining all these material venues, goods, and (less material) services that go with them cost enormous amounts of labor and resources and the more people have the means to consume them, the more abundant and elaborate they need to be.

 

Is there enough materials and labor for everyone to gain increased consumption and wealth access, or are at least a certain number of people stuck with a glass-ceiling on their level of consumption and wealth accumulation? If so, is there a way for these people to gain access to adequate health care without having access to the means to spoil their care-givers with the lavish lifestyles they expect and presumably deserve for their great contribution to human wellbeing?

 

Or is it necessary to withhold health care access as part of the general economic strategy of withholding economic access from the poor to avoid having to curtail it for the non-poor?

Edited March 3, 2011 by lemur

[Marat]

If we really value all human lives as equal, as we profess to do, then it is simply barbaric and hypocritical to adopt a system for the distribution of resources which denies some people their most basic needs for health care because physicians' fees are too high for no better reason than to make physicians wealthy. When a person's most basic needs are met, the person is a trillion times happier than when the same amount of resources are devoted to answering a person's desire for luxuries, so if all people really do count as equal, we are morally obligated to answer basic needs at the cost of servicing the interest in luxuries.

 

Physicians are not scientists, since the many FDA, AMA, and tort law regulations they have to operate under make most of their scientific knowledge useless and confine them to applying pre-established recipes like a short-oder cook so as to confine their treatments safely within the parameters of what is accepted as 'standard practice.' Thus they are in effect just ordinary craftsmen or tradesmen, performing a ritualized, heavily guild-regulated craft where all they have to do is apply the rules which already exist. Anything imaginative is by legal defintion 'unethical' or 'tortious' if it produces injury. In any tort suit for medical malpractice the standard question to be asked is not, 'Was the doctor applying a brilliant new innovation with a great potential for benefit?' but rather, 'Was the doctor acting within normal standards of practice?' If he doesn't want to be sued he had better make sure he stores his brain in the closet before going to work. This is not to say that a physician doesn't require a certain highly-limited sort of mechanical cleverness to distinguish overlapping indications in a complicated diagnositic problem, but this requires nothing more than the kind of thinking required by an electrician in determining why a tangled group of wires in a generator is not working rather than the genius of an Einstein reconceiving the relationship between gravitation and the shape of space. So there is nothing in what doctors do that merits the kind of inflated salaries they get.

 

Similarly, doctors getting low salaries do not seem in the least to be discouraged from doing just as good a job or even better work than those who are overpaid. Before the 1940s American doctors were often paid by farmer clients with a chicken for a house call, and doctors of that early era included truly exemplary practitioners like Holmes, Reed, and Halsted. I suffered an accident once in East Berlin while it was under the Communist regime and I received excellent care at the hands of physicians who were wearing shoes held together with wire and tape because they couldn't afford new shoes.

 

As I pointed out in another thread, if you cut the salaries of America's overpaid physicians by $100,000 a year each, they would still earn a fair income for a tradesperson and $30 billion would be saved, which would go a long way to diminishing the 40,000 unnecessary deaths caused each year in the US because of lack of access to affordable healthcare.

[jackson33]

lemur, I'm not really sure where your trying to go with this thread, so if I'm off your intended purpose please accept my apology in advance'

 

The health care discussion really has two separate parts. One is the issue of people who need or want better health care for themselves or their families. The other is people who want more opportunities to make more money and consume more and acquire more wealth.[/Quote]

 

I don't see the connection; First every person, certainly in the US has today the same opportunity to achieve wealth and what they do with it has nothing to do with consumption. Healthcare on the other hand, as a product, has a very large range in quality, cost and accessibility. The best Medical Services available are and always will go to a certain portion of Society and lesser care will always gravitate to those that can afford their skills.

 

Or is it necessary to withhold health care access as part of the general economic strategy of withholding economic access from the poor to avoid having to curtail it for the non-poor? [/Quote]

 

This would be complicated and based on opinions, but briefly people that achieve in life and that's a pretty good percentage in the US to some level already have good to excellent Healthcare Insurance, in turn the same service. Those that don't succeed, usually for reason, will receive a lesser quality, regardless whether they or some other entity (Government/the insured) pays the bill. There is a definite number of people and limited numbers of resources. It's no different than buying a car, home or Television and the person involved picks and chooses what they can afford.

 

My personal problem with affording HC to all people are the unintended consequences and the reality we all so different during our lives and what exactly those purporting anything close to a universal system for HC. Everything from genetics, through habits, hobbies, profession, life styles and so many other things, can and will determine that persons health and future HC needs....

[lemur]

If we really value all human lives as equal, as we profess to do, then it is simply barbaric and hypocritical to adopt a system for the distribution of resources which denies some people their most basic needs for health care because physicians' fees are too high for no better reason than to make physicians wealthy. When a person's most basic needs are met, the person is a trillion times happier than when the same amount of resources are devoted to answering a person's desire for luxuries, so if all people really do count as equal, we are morally obligated to answer basic needs at the cost of servicing the interest in luxuries.

 

As I pointed out in another thread, if you cut the salaries of America's overpaid physicians by $100,000 a year each, they would still earn a fair income for a tradesperson and $30 billion would be saved, which would go a long way to diminishing the 40,000 unnecessary deaths caused each year in the US because of lack of access to affordable healthcare.

The current game seems to be one of poker with high stakes. The medical providers bill as high of fees as possible and the game is to see who will pay and how much of the total will get paid before they give up. This is necessary because it is illegal to charge higher fees to insurance companies, so the providers set the fees high to get as much as they can from the insurance and people who don't have insurance either avoid seeking care or lose their shirt or go bankrupt when they can't avoid it because the consequences are too serious. This has an important economic effect though; on that's similar to the function of public health care in more socialist governments: i.e. it encourages (or requires) people to accept structured employment instead of pursuing independent economic activities (unless these activities are lucrative enough to pay for high priced private insurance or high fees for care out of pocket.

 

The reason I mention the connection with the will to material prosperity is because of the various ways in which health care and its funding are used to stimulate big capital flows. As I mentioned, there's the motivation to accept full-time employment, which generates a robust labor force for corporate profit-machines. Next, there's the pharmaceuticals, med-tech, operating tables and other furniture, wheelchairs, etc., and hospital construction that channel insurance money into numerous accounts. People see any kind of medical-related job as a route to high-pay, which is why so many people support universal health care; i.e. because it would create more health care jobs. Then people love the idea that the rich are taxed to create all these jobs because they see it as sticking someone else with the bill while their income goes up.

 

The ironic thing, to me, is that the net result of increasing jobs and income through broadening health care access at the expense of wealthy taxpayers is that all that would really happen as a result is that more people would get paid to provide medical services, and then they would go spend that money on other services that they enjoy, which is why they sought high-paying medical jobs in the first place. In other words, the net result is a bunch of healthy people spending and consuming a lot that is produced by their own labor.

 

The only reason the rich people's money even needs to be taxed is to get access to the land, buildings, natural resources, and/or whatever else is needed to put all that labor to work transforming the natural world into more Disney Worlds on every corner. I'm afraid that if people keep pushing for an economy like this, they will end up getting it if the only people resisting are the rich. I thought for a while that the green movement was an ally in the conservation of natural lands and resources, but I think most of them just want a new car and cheap gas for it at this point. So I'm afraid that unless there's a radical cultural awakening, we are headed for expensive universal health care that is going to drive the economy into a hyper-consumption frenzy. At least we'll be healthy while watching the roads widen and fill up with consumer business.

 

I like the idea of free education improving people's health through inexpensive preventive maintenance and interventions, which would give poor people access to better health and knowledge, but then I would also like to see inexpensive basic amenities for them like nice nature parks and bike roads to get around without cars. I don't know why such a lifestyle is unpopular, but many people seem to prefer high-octane consumption driving excessive service industries, materialism, etc. I wonder once they start getting what they want, when would they ever be satisfied?

 

 

[Marat]

The capitalist system is the root of the problem, since it can only function if it keeps producing things which people buy, with the capitalist trimming a profit from both the consumer who pays more than the goods produced are really worth and the workers who receive less in income than they really produce in wealth. To keep this production cycle going, even beyond what people objectively need to buy, it is necessary to stimulate demand to an unnatural pitch with advertising and by developing a consumer culture willing to purchase uselessly duplicated products (new Ipads, converting all the vinyl records in the world to tape, then to DVDs, new styles of clothes, new styles of cars, etc.) One of the best ways to stimulate demand beyond what is really needed is to make healthcare -- which always appears necessary at whatever level it can be provided -- more and more expensive, even if there is no real medical progress to support that price inflation. Such artificial inflations taking advantage of the natural belief that people must have everything which is new in medicine are higher physician fees (which make some doctors seem 'better' when they are merely better paid), new drugs which don't offer anything different from the old drugs other than their circumvent to escape an expired patent, and all sorts of new medical technology that makes next to no difference to net patient health, or even carries a concealed net harm to it, like chemotherapy and radiation therapy for cancer patients, which costs a fortune to make patients live 10% longer at the cost of reducing their total quality of life by 50%.

[lemur]

The capitalist system is the root of the problem, since it can only function if it keeps producing things which people buy, with the capitalist trimming a profit from both the consumer who pays more than the goods produced are really worth and the workers who receive less in income than they really produce in wealth. To keep this production cycle going, even beyond what people objectively need to buy, it is necessary to stimulate demand to an unnatural pitch with advertising and by developing a consumer culture willing to purchase uselessly duplicated products (new Ipads, converting all the vinyl records in the world to tape, then to DVDs, new styles of clothes, new styles of cars, etc.) One of the best ways to stimulate demand beyond what is really needed is to make healthcare -- which always appears necessary at whatever level it can be provided -- more and more expensive, even if there is no real medical progress to support that price inflation. Such artificial inflations taking advantage of the natural belief that people must have everything which is new in medicine are higher physician fees (which make some doctors seem 'better' when they are merely better paid), new drugs which don't offer anything different from the old drugs other than their circumvent to escape an expired patent, and all sorts of new medical technology that makes next to no difference to net patient health, or even carries a concealed net harm to it, like chemotherapy and radiation therapy for cancer patients, which costs a fortune to make patients live 10% longer at the cost of reducing their total quality of life by 50%.

Well, don't underestimate the value of trading in some quality of life for a few increasingly precious life experiences. Like anything else priceless, though, there's no reason extended life should be exploited as yet another means of fiscally stimulating GDP growth. I think you have consumerist capitalism pegged, with its endless series of tricks to inject increasing amounts of money into circulation to be rallied for by anyone and everyone by whatever means. I think you may be making the, in my perception common, mistake of equating this form of capitalism with capitalism generally. I think there is a decent form of capitalism possible, which involves respect for personal property and individual economic/cultural freedom (and even facilitates these with government) while averting consumerism, corporatism, etc. Generally I draw a distinction between "control capitalism" and "free trade capitalism" where one seeks to use business and money as a means of controlling/exploiting others and the other uses them to promote mutually beneficial trade among people who are truly free to reason and resist what is unreasonable. Anyway, I'm getting diverted with the general topic of capitalism. I just want to point out that shifting the healthcare funding-burden to the wealthiest tax-payers is yet another tactic of capitalism to maximize spending and revenues. Using something like healthcare is handy because it seems like such a basic necessity and right that it becomes almost impossible to resist writing a blank check to provide endless revenues for capitalist growth. The question is whether such capitalism is healthy for people even if it is the result of cherishing health as priceless.

[Marat]

I think capitalism is doomed to a vicious cycle of constantly having to stimulate ever-increasing demand to soak up more and more surplus capital in profitable activities, which inevitably means flogging the consumers to buy things they don't really need. First capital is invested; it generates a profit which becomes surplus capital; then that surplus has to be invested for a profitable return; you then have a compound growth of surplus capital for investment, which in turn has to hunt for further profitable investment opportunities. But this spiral never ceases in its demand for constantly expanding profit-making opportunities to employ the ever-increasing amount of surplus capital generated by profit-making opportunities, and eventually capitalism reaches a point where there is nothing left to employ surplus capital profitably but artificial demand -- such as is created by advertising, consumer culture, fashion, etc.

 

Eventually this runs out as well, so capital has to invent artificial bets on market performance as a way to employ surplus capital profitably, since there are no more investments in tangible assets or the real economy available to soak up all the fallow wealth. Thus we had the proliferation of hedge funds, derivatives, and other exotic financial instruments.

 

But too much money spent on pure paper gambles of that sort rather than invested in the real economy means the national economy has too much sail and too little ballast, and as soon as those insurance policies backing bets on bets on market performance come into question, since there is too leverage in the system for safety, there is a gigantic market collapse such as we had in 2008, and the response to it is that the failed gambles of the financial speculators have to be paid off by the ordinary taxpayers because these speculators are 'too big to fail,' while poor people dependent on welfare have to see their government benefits cut to take care of the resulting government deficits.

 

This is otherwise known as a shell-game.

[lemur]

But this spiral never ceases in its demand for constantly expanding profit-making opportunities to employ the ever-increasing amount of surplus capital generated by profit-making opportunities, and eventually capitalism reaches a point where there is nothing left to employ surplus capital profitably but artificial demand -- such as is created by advertising, consumer culture, fashion, etc.

Probably another thread should be started about capitalism generally, but I'll try to be brief in saying that I think you'll find that the reason capitalism tends to behave as you say has to do with its appropriation as a means to sustain class-distinctions and privileges instead of being used exclusively as a means of regulating the rational production and distribution of economic means. So, for example, the "artificial demand" you mention that keeps money flowing really has the purpose of maintaining certain lifestyle privileges for numerous people who do not work on farms, in factories, or provide many of the services they take for granted in their daily consumption habits. If artificial demand didn't exist, arguably, people who spend money on lavish lifestyles would gradually end up losing all their money to people who sold them the lifestyles they consumed. Then, those people would have to work to provide the same lavish lifestyles to the people who served them before until they saved up enough money to once again be the ones who enjoy the lavishness. However, because class-privilege sustainability is desired by people who enjoy lavishness and wish not to have to take jobs that are 'below' their level of education, an elaborate system is needed to ensure lots of money gets to people who spend lots and those who work to make the money they spend are continually motivated to provide the things the big spenders like to spend money on.

[JohnB]

Maybe you should just spend the money you have more wisely rather than spending more money?

 

The US already spends almost 3 times as much as anybody else on healthcare for sub standard results. If you aren't getting value for money then throwing more money at a problem won't work.

[ecoli]

This thread is seemingly getting way off topic. That being said, I think we're seeing that there's diminishing returns to health care technologies, no matter how the healthcare system is structured. It doesn't matter where you are on the capitalist-socialist continuum, a lot of the low-hanging fruit in health care (vaccines, etc) are gone.

[Mr Skeptic]

Perhaps we could look toward one of the sources of our health problems rather than throwing more money at the consequences. Obesity has all kinds of nasty medical consequences. And the corn we're subsidizing probably has a lot to do with our very high rates of obesity.

[Phi for All]

Perhaps we could look toward one of the sources of our health problems rather than throwing more money at the consequences. Obesity has all kinds of nasty medical consequences. And the corn we're subsidizing probably has a lot to do with our very high rates of obesity.

I still can't get anyone to adequately explain why we still subsidize sugar. I understand why it used to be necessary, but why do we still do it? And why, even with the subsidies, does US sugar cost twice as much as the sugar from other countries? This is why cheaper high-fructose corn syrup is being used in so many products, adding to the obesity problem.

[lemur]

Perhaps we could look toward one of the sources of our health problems rather than throwing more money at the consequences. Obesity has all kinds of nasty medical consequences. And the corn we're subsidizing probably has a lot to do with our very high rates of obesity.

 

 

I still can't get anyone to adequately explain why we still subsidize sugar. I understand why it used to be necessary, but why do we still do it? And why, even with the subsidies, does US sugar cost twice as much as the sugar from other countries? This is why cheaper high-fructose corn syrup is being used in so many products, adding to the obesity problem.

You think driving up the price of sugar and corn-syrup by making it more scarce would decrease obesity? I think obesity has more to do with patterns of transit and physical activity. Replace driving with pedestrianism and biking for everyday transit and how many of those people would be obese? Likewise, what would it do for cardiovascular health, digestive health, etc.? Maybe I'm making exercise into a panacea but if anything is, I think it would be exercise (along with sunshine and fresh air maybe).

[Mr Skeptic]

You think driving up the price of sugar and corn-syrup by making it more scarce would decrease obesity? I think obesity has more to do with patterns of transit and physical activity. Replace driving with pedestrianism and biking for everyday transit and how many of those people would be obese? Likewise, what would it do for cardiovascular health, digestive health, etc.? Maybe I'm making exercise into a panacea but if anything is, I think it would be exercise (along with sunshine and fresh air maybe).

 

Perhaps, perhaps not. Our body has a limited ability to metabolize fructose. The remainder must go to the liver to get processed.

Liver disease

"The medical profession thinks fructose is better for diabetics than sugar," says Meira Field, Ph.D., a research chemist at United States Department of Agriculture, "but every cell in the body can metabolize glucose. However, all fructose must be metabolized in the liver. The livers of the rats on the high fructose diet looked like the livers of alcoholics, plugged with fat and cirrhotic."^[57] While a few other tissues (e.g., sperm cells^[58] and some intestinal cells) do use fructose directly, fructose is almost entirely metabolized in the liver.^[57]

 

"When fructose reaches the liver," says Dr. William J. Whelan, a biochemist at the University of Miami School of Medicine, "the liver goes bananas and stops everything else to metabolize the fructose." Eating fructose instead of glucose results in lower circulating insulin and leptin levels, and higher ghrelin levels after the meal.^[59] Since leptin and insulin decrease appetite and ghrelin increases appetite, some researchers suspect that eating large amounts of fructose increases the likelihood of weight gain.^[60]

 

Excessive fructose consumption is also believed to contribute to the development of non-alcoholic fatty liver disease.^[61]

 

 

Similarly, glucose levels are also a problem. Foods with a high glycemic index cause a spike in insulin levels, but that eventually causes the blood glucose levels to fall below fasting levels, and you get hungry. In addition, insulin causes your body to store energy and is an inflammatory hormone. Chronic low levels of inflammation lead to all sorts of disease.

[Marat]

While the emphasis on preventative medicine is a major theme of modern health policy discussions, the Merck Manual states that 80% of disease is not preventable. People fiddle with this definition by looking at certain diseases in which heroic efforts might head off more negative consequences if 1) they could be diagnosed very, very early; 2) medical intervention so intensive that it would utterly destroy the patient's quality of life or risk severe complications could be effected; and 3) delay of the onset of the disease could be characterized as 'preventing' the disease, but in the real world not much could be done by way of prevention without a huge increase in healthcare costs. Almost all fires are theoretically preventable, but that doesn't mean we could ever reduce the size of the fire departments. Even so-called 'preventable' diseases are not entirely so. Take type 2 diabetes for example, which has a much stronger genetic component in its etiology than the unpreventable type 1 diabetes. Many type 2 diabetics are neither overweight nor sedentary, but just suffer from a heavier genetic loading for the condition.

[lemur]

Perhaps, perhaps not. Our body has a limited ability to metabolize fructose. The remainder must go to the liver to get processed.

 

 

Similarly, glucose levels are also a problem. Foods with a high glycemic index cause a spike in insulin levels, but that eventually causes the blood glucose levels to fall below fasting levels, and you get hungry. In addition, insulin causes your body to store energy and is an inflammatory hormone. Chronic low levels of inflammation lead to all sorts of disease.

Often people overeat in search of comfort for various negative emotions. If embarrassment to go out and exercise because you're overweight is such an emotion, the effect could be a vicious cycle. When people are able to interrupt such a cycle and go for a walk/run/swim/bike-ride/etc., it may give them a sense of feeling good at temporarily breaking with the pattern of hiding and eating. So what I'm trying to say is that avoiding eating the sugar by finding the strength in exercise or something else that boosts ones sense of strength/independence may be more effective than driving the price up.

[Mr Skeptic]

Often people overeat in search of comfort for various negative emotions. If embarrassment to go out and exercise because you're overweight is such an emotion, the effect could be a vicious cycle. When people are able to interrupt such a cycle and go for a walk/run/swim/bike-ride/etc., it may give them a sense of feeling good at temporarily breaking with the pattern of hiding and eating. So what I'm trying to say is that avoiding eating the sugar by finding the strength in exercise or something else that boosts ones sense of strength/independence may be more effective than driving the price up.

 

Yes, another problem we have is that our country is designed for cars and very poorly designed for biking/walking. This further contributes to obesity.

[lemur]

Yes, another problem we have is that our country is designed for cars and very poorly designed for biking/walking. This further contributes to obesity.

Agreed, but stating it as a problem of infrastructural determinism creates a chicken-egg problem of how to change infrastructure without people changing their habits first. In reality, it is usually possible to get out and walk/bike on existing sidewalks when there are no bike-lanes, but it's the fear of social stigma that deters people from actually doing it, along with the time it takes to walk/bike, etc. Regardless, I think if people really wanted to restructure their lives to walk/bike they could, though it does take a lot of effort. It would be nice if government would do more to promote it, but then they get complaints from all the people who see pedestrian infrastructure as a waste of resources needed for maintaining the preciously lucrative automotive infrastructure. They think, "how can we afford to walk when we need to work multiple jobs all over town to afford new cars for everyone in the family?"