The “slippery slope.” It’s a favorite argument of reform opponents everywhere, from all segments of the ideological spectrum, but one which has been particularly exercised by Republicans in recent years in arguing against any number of reforms.
“It’s a slippery slope,” we were told for years by those who blocked legislation to extend our anti-discrimination laws to gays and lesbians. This seemingly innocuous civil rights legislation was an integral part of a calculated gay agenda, opponents insisted, that would inevitably lead to gay marriage, or worse. Likewise, when some state senators dared to even broach the idea of a high-earners income tax this past session—perhaps merely a percent or two on incomes over $1 million—Republicans dutifully warned against the slippery slope that would inevitably lead to a broad based income tax with higher rates and lower income thresholds.
And now that President Obama appears to be leaning toward a “public option” as a lynchpin of his health care reform proposal, opponents are of course trotting out the slippery slope rhetoric one more time, arguing that merely offering consumers the option of buying into a government run health insurance plan takes us an unsteady step toward an inevitable tumble into (gasp) “socialized medicine.”
And you know what? They’re absolutely right.
Modest reforms such as these do serve as slippery slopes toward more substantive policy initiatives, at least if done right. Indeed, that, for the most part, is the intent of their backers.
For more than two decades Washington Republicans steadfastly held off gay civil rights legislation, but within a few years of its passage a series of incremental expansions of domestic partner benefits has created same-sex marriage rights here in virtually everything but name. And the name will come too, not much further down the line. That was the strategy, and it’s working.
Likewise, there are many tax reform advocates like me who couldn’t care less which income tax variation is first to make it onto the books, as long as it can stand up to a vote of the people. A millionaire’s tax? Fine by me, even if it doesn’t generate much money. For I fervently believe that once Washingtonians become accustomed to a personal income tax, rates will creep up, and the exemption creep down, adding a broader based income tax to our revenue portfolio.
And of course, the health insurance companies should fear a government run public option, for if they can’t compete—ie, they can’t provide comparable coverage at a comparable price—the market will inevitably move toward the single payer-like model they dread most.
Now some might characterize this admission as cynical and dishonest, but good policy done right is inherently a slippery slope toward better policy. As it should be. And it’s a slope we slide down only with the approval of a majority of voters.
Only a decade ago a strong majority of voters opposed gay marriage, but today, not so much. The more we normalize the so-called “gay lifestyle”… the more we become comfortable with our friends and family and neighbors living openly gay lives with all the rights and privileges the rest of us enjoy, the more we shrug “so what” at the notion of teh gays calling their state sanctioned unions “marriage” too. This slippery slope is what folks like State Sen. Ed Murray counted on when they embraced the incrementalist strategy that has been so successful in Washington state. There was nothing dishonest or deceitful about it, and as we’ll learn by the imminent failure of Referendum 71, the voting public has slid at least as far down that slope as the state legislature.
And neither should the public fear the slippery slope of tax reform in Washington state. Would most backers of a high-earners income tax like to see higher rates and lower income thresholds? Sure, but since every tax increase inevitably comes before the people via referendum or initiative, it makes absolutely no sense to get too far ahead of voters. Start with 2% on household incomes over $1 million, and eventually we’ll inch toward 3% on incomes over $250,000. After that, who knows, though with voters holding a veto, I doubt we’d ever see the household income threshold fall much below $150,000, (nor would I personally support such a low threshold without substantial reforms elsewhere in our tax structure.)
The point is, the slippery slope isn’t something imposed on an unsuspecting public, but rather the natural trajectory of public opinion in response to well crafted, well executed public policy. You see, the reason insurance companies and their surrogates oppose the public option—the reason they fear it to be a slippery slope—is that they’re afraid it will work. And that when we see that it can work, and that it can provide more access and equal or better care at a lower cost than the private sector, that voters will demand an expansion of this program too.
Y’all don’t kno what you say.
Deleted OFF TOPIC!!!!
The insurance companies’ stance seems to be that we owe them our extra money for their crappy insurance. Anything less is ‘socialism’ or, if you are a southerner, ‘de debbil!!!!’
I’ve never understood how the Republican Party, which draws so much of it’s base from rural America, gets away with it’s opposition to ANY health care reform.
One of the factors accelerating the de-population of rural America is the fact that farming is a dangerous occupation, and health insurance is prohibitively expense, even if you can get it. Many farmers are having one spouse or another commute long distances to work in towns where they can get a job which will offer a health insurance benefit, but those opportunities are becoming much more difficult to find. In some cases, a farmer will work one full-time job for the health care benefits, and then try to engage in full-time farming – at the same time.
Faced with these challenges, and with prospects for only modest profits at best, many multi-generational farms are folding. A farmer might be willing to take the health-care risk themselves, but can he really risk the health of his wife and children? Forget a serious illness or accident – even a relatively short hospital stay can cause them to lose the farm.
Note, however, that this week Republican leadership have not argued against health care reform – obviously their own polling shows that Americans are ready for some serious changes. But they are trying to peddle “more of the same”, plus caps on malpractice insurance, as reform. You even hear comments to the affect that the current American health care system is the “best in the world” – which might seem to be the case if you are a relatively well-to-do Congressman who’s health insurance is provided by the federal government anyway.
If true health-care reform includes more government participation to make sure every American has some form of health insurance available to them, this sign me up for that “slippery slope”. I’ll get the water hose and we’ll set up the Slip & Slide, and have a barbeque going on at the same time.
Apparently the slippery slope started with letting those damn women vote back in that last century; after that it was all downhill for amurka. If dem womin di-nt have der powa der wou-nt be no need fo fundin healt.
Apologies upfront for hijacking the tread, but there are some amazing photos coming out of Iran via Flickr.
http://www.flickr.com/photos/fhashemi/
mo greenburg steals 4.3 billion from aig pension. what a suprise
Congress seems very happy with their government supplied healthcare. How many Republicans have opted out of their government insurance plan and switched to a private insurer?
Great Essay
One issue, however, remains hidden. Socializing medicine WILL NOT lower its costs.
The overall “tax: we all pay for our current chaotic system is about 30% excess in admin fees BUT our syste m is about 100% MORE expensive than anyone else’s.
Socialism will cure the 30% cost, but that is a one time saving.
Preventive Care, except for children, is also NOT a way to save money. The longer people live, the more the per/person cost of care simply because older folks cost more.
Real fixes will require far more dracionian efforts, probably meaning rationing.
There some easy targets:
a. chiropractic, naturopathy, etc cost money and do not work. You want these, you should pay for them.
b. cutting edge procedures are largely invented in the US because of our profit system. These will need to be decreased and we probably will need to spend more on research to offset the loss of venture funds.
c. computerized records and ujniversal genomics.
d. elimination of prestige hospitals from any public funding … Swedish, Cedars Sinai, the Mayo, Cleveland Clinic may no longer be viable.
e. In creased use of nurse practitioners and practing pharmacists.
f. replacing ERs with community7 clinics.
AND THEN WE WILL RATION!
Tax fat people, blacks and old people who use the most healthcare. Afterall, we all know how these libs love to clamor about ‘pay per use’ when it comes to roads.
@10
A while back I saw a severely over weight woman smoking and eating junk food, I had a hard time not walking up to her and telling her that she’s the reason my heath insurance is so high.
“Pay to play” systems started out as a Republican creation. Nowadays both sides use it and, for the most part, they seem to be working out OK.
@10
What is the estimate of savings for not funding “alternative” medicine? I’ve heard the hew and cry to get rid of it, but not what it might bring in savings.
Instead of rationing, look at better medical practices, great article in the June 1st issue of the New Yorker about why costs of health care is higher in some places. Mayo Clinic is one of the leaders in lowering costs for health care by applying the best proven practices and therefore the best outcomes at the lowest overall care cost.
@11 Pay to play doesn’t fit for health care as not all health issues stem from the acts of the person needing care. Many health issues are genetic, accidental or work related. I don’t think it is the right way to go nor do I see leaving it up to individuals to decide what health care to buy a reasonable choice as well. That leaves folks using the emergency room as their primary care doctor which ends up costing very much more.
Yeah, there is low hanging fruit, but also needs to find how medicine can be practiced smarter with better outcomes for everyone.
@12
I meant to speak of Pay to Play broadly and to knock down the “you liburls” nonsense posted at 10. I agree you you on PTP and healthcare.
So Goldy, “with this seemingly innocuous civil rights legislation” do you think the gay agenda is similar to civil rights agenda?
If so how?
If not then why the comment?
Slippery Slopes:
Gov’t “voluntary” Healthcare = Single payer (Gov’t)system
WA State Income Tax = Income (Fed, State & King Co.)PLUS sales tax and anything else they can dream up taxing.
No? Then what do they have in NYC & Phila?
Cross Posted from SeattleJew
I just came across a very impressive blog called OpenPen from Tennessee. Tenn just ELECTED their first Reprican legislature since Reconstruction.
The two most recent posts on SJ tell how this has effected heathcare in the state. FRIGHTENING!!!!!!!!!!!!!!
re 9: “b. cutting edge procedures are largely invented in the US because of our profit system. These will need to be decreased and we probably will need to spend more on research to offset the loss of venture funds.”
It is my understanding and personal experience that all cutting edge innovations are disallowed by for-profit insurance companies.
So, what exactly will we be losing?
re 9: You seem to be attempting to create the impression that we have a great, though expensive, health system that will lose its cutting edge if it becomes a publicly funded single payer system. This is simply not the case.
You can not even point to Cuba for an example to illustrate your point.
Another Republican hypocrite is caught committing adultery:
“WASHINGTON (June 16) – Sen. John Ensign of Nevada, a leading Republican mentioned as a potential presidential candidate, admitted Tuesday he had an extramarital affair with a woman who was a member of his campaign staff.”
(Quoted from Associated Press under fair use.)
yeah, roger, its funny how when its a democrat like john edwards the msm doesnt touch it and leaves it to the national enquirer, but when its a republican, as you quote using fair use (lol) ap jumps right on it.
@4 I should ask my Pop, who remembers the 30s, if Republicans were against electricity and indoor plumbing for rural folks, too. I’ll bet they were! My Pop is so old he remembers when farmers steered a plow by pulling on the reins — he’s been around longer than farm tractors.
@4 Hmmm, that’s interesting. Repukes screech about “saving family farms” as an excuse to repeal inheritance taxes, which, of course, is an absolute lie because farmily farms are exempt from inheritance taxes. Yet they oppose health care reform that would in fact save family farms in the real world. Another example of the extreme disconnect between Republican rhetoric and action.
@7 I posted that yesterday.
@9 “Socialism will cure the 30% cost, but that is a one time saving.”
No, it’s an ongoing saving. The 25% to 30% the insurance industry skims off the top of our health system, not one penny of which buys health care, isn’t a one-time expense. It’s a recurring cost that happens every time an employer or individual pays an insurance premium. And it contributes nothing of value to the system because it pays for corporate bureaucracy whose function is denying claims. If you can get rid of that inefficiency, and political obstructionism is the only reason why we can’t get rid of it, you’ve achieved permanent cost savings in the 25% to 30% range.
@17 The Pooping Viking
1. Cutting Edges and Insurance Companies
Sorry, I am NOT talking abut new untested therapies, but about tested therapies that are intially very expensive.
If you look at the major therapeutic breakthroughs of the last several decades they all folloed the same pattern:
a. someone, usually NIH, pioneered basic science that enabled the therapies.
b. some drug company picked up tyhe research and developed it into an application. In every major case I can think of, these companies have been largely US based or at least hade the US as their major site of profits.
c. Once proven effective, onb the compnay’s dime or the NIH, the therapy is then paid for by insurance. Examples:
statins … basic work was NIH, developed by Merck.
bone marrow transplant … basic work by NIH. develioped with NIH funds, now a common clinical procedure.
avastin (cancer Rx) … basic research all by NIH, developed by Genentech and Monsanto, now paid for by insurance.
2. US vs Cuba Like you I admire the Cuban and French systems too, BUT their major successes are based on applying therapies developed here AND simply doing a better job of health care delivery.
In practice, the US is usually the first adopter of these new therapies. As the therapies work their way through our system, costs decrease (sometimes) anjd are adopted in the socialized systems if they can afford them.
One example may interest you. Balloon angioplasty was an outgrowth of work funded by the NIH in my lab 9and others). Because we are very careful here, the first experiments on people, against my judgement BTW, were done inb less regulated countries and produced promising
results. BUT, it was the introduction in the USA that exploded because .. for better or worse .. there was a lot of money availbale to fund the procedure.
Frankly, the procedure was not all thgat great, esp. at lengthening life. BUT, given the US market, companies played with modifications of angioplasty until it has become an effective therapy. Those “experiments” were largely funded out of insurance company dollars because the procedure was approved. They were, again, largley done by US companies.
FWI*W, I favor fulkl socialization of medicine. What worries me though, is the naivete of many liberals who think there is somne magic way of gwetting a free lunch.
@24 Roger …
You misunderstand.
The 30% is real and, as you say permanent, but once you have addressed this issue, that wad is shot. The fix will lower costs, but it ahs no affect on other costs that are inflating much higher than admin costs.
Even w/o the admin costs, healthcarfe in the US is still far more expensive and inflating out of control vs. other countries.
One of the MOST disturbing facts is the huge difference, even under medicare, of costs in different parts of the US. This has nothing to do with the 30% overhead.
re 25: “Sorry, I am NOT talking abut new untested therapies, but about tested therapies that are intially very expensive.”
“…cutting edge procedures are largely invented in the US…”
Something that is ‘cutting edge’ is generally understood to be new and untested. So, why say that if that is not what you mean? I think that you saw that I’d identified a big weakness in your argument, so you decided to redefine cutting edge procedures to things that are no longer cutting edge — but used to be. Sorry, but I’m not buying it.
And, what about all those stem cell procedures that were thwrted during the Bush years and all of the cures and solutions in that realm that are bought up by the drug companies so they can continue to market things like ‘the purple pill.’
Right there is another gap in your theory. ‘Cutting edge’ treatments are often deliberately thwarted and suppressed by for profit health care.
Keep digging that hole for yourself, SJ. If it gets big enough, maybe more people will want to jump in.
@19 Cuba
BTW, while I do admire the Cuban healthcare system, they do a many things we could not do here … eg to deal with AIDS they actually interned HIV positive people. They also do a far better job than we do at mandating vaccines.
OTOH, I would bet you a beer that the leadership in Cuba when ti needs high tech care does what the rest of thew world does .. they fly to the nearest wealthy country.
Certainly you do not see a lot of succesful treatments for glioblastoma in Cuba, but her ein the expensive place we have had a recent breakthrough that at least prolongs life by a half year or more. A Cuban wanting that therapy proabably can get it by going to Spain and paying a lot of $$.
re 26: It has to do with something called ‘overcharging for your services.’ It’s cutting edge though, so don’t worry.
What percentage of the total ampont of health dollars spent is accounted for in Medicare costs? Dazzle us with some numbers — and where you got the numbers.
re 28: “OTOH, I would bet you a beer that the leadership in Cuba when ti needs high tech care does what the rest of thew world does .. they fly to the nearest wealthy country.”
How many of those wealthy countries that they fly to have for profit healthcare?
Oh, and, “I’ll bet…” is not a very convincing intro to a factual argument. I’ll bet you are making alot of this stuff up or gleaning the web for talking points to hone your argument.
I should charge you for my services.
@27 pooping Viking
Sighhh … we can all go to our dictionaries.
The main point is that the US is and has been the major driver of health care innovations for at least a half century and that success has been supported by the gvmint, through NIH, and also by the US system that is willing to pay for new procedures that other systems will not pay for.
As for stem cells, how in hell is that relevant? The only clinical use of stem cells today, for bone marrow replacement, was developed in the US and is today largely funded by the insurace companies. FWIW, I am involved with a new therapy right now that can only be developed because most of the costs are bieng born by insurance.
This patients’s clinical needs i9n this trail will be paid by their insurace because the approach has good eviden ce that it is working, while analytical part of the sydy is being paid for by the NIH.
Interstingly, there is a Canadian site as well, another example of how other countries health care systems benefit from our own.
BTW, if you can read, look back at my original post. What I said was that as we move ot socuialized medicine, we need to be conscious of the efects this will have on R&D. I favor the move, but also want to ensure that we find someway to keep the best of what we can do now.
re 25: SJ: Drug companies spend more on advertising than they do on research. Much of the research that drug companies rely on comes from federally funded studies at US universties.
Shouldn’t we sell them the research and get a cut of the profits.
I’ll bet the ‘purple pill’ can be traced back to taxpayer funded research.
@29 Are you trolling of actually wanting a discussion? You are free to find your own numbers, if you can, that show that Medicare bears its own full costs.
No hospital in the US can live of off Medicare and also provide top notch care. Is this “overcharging?” Sure, but the overage is going into a kitty that subsidizes publically funded care. Still no free lunch.
SJ — Just come out and tell us what you do and why you are pimping for the insurance companies.
Because, the more you talk about ‘cutting edge procedures’, the closer you get to gubmint research dollars. You seem to have a point of view that you believe in largely as an article of faith.
@30 Trolling Viking
Sorry, I thought you needed a beer. Offer retracted.
To naser your question, the major wealthy copuntry is the US, however many countries with great socialized systems also offer paid for care … France, England, and Spain come to mind. Brazil is especially impressive ,, they actually have two systems.
#34 Viking Troller
I think most folks here know that I an MD PhD who has spent my entire careder doing NIH funded research. I am a UW prof if that helps you.
Come by DL and we can talk. You buy the beer.
re 33: “…that show that Medicare bears its own full costs.”
I can’t have a discussion with someone who twists the substance of my question. I never stated that Medicare bears its own costs. I asked you (you are the guy coming on as the expert)how much of the healthcare dollar is taken up with Medicare costs.
You don’t seem interested in lines of inquiry that factually challenge your OPINIONS.
@32. The Pooping Viking
Yes, they spend a lot on advertising. What does that have to do with this thread?
Yes they befit greatly form Federally finded rfesearch and I too think “we” should get more of the profits. In Canada the drug companies are actually required to fund basic science.
Basic research usually does not generate patents. When it does, the drug comopnaies do pay for these. UCSF and Stanford, as examples, make a lot of money from their great role in biotech.
FWIW, one gripe I have with both Clinton and Bush-Reagan is that they were all too willing to allow companies to patent stu7ff that actually came from public research. A lot iof want BHO to reverse those policies.
I’ll bet the ‘purple pill’ can be traced back to taxpayer funded research.
06/16/2009 at 6:42 pm
re 36: I’m not questioning your medical credentials, just that you are offering opinions on for profit insurance that don’t hold up. And I think that you can see that I am boxing you in.
How do for profit insurance companies enhance the work that you do? Are they paying for it, or are taxpayers?
And, as an MD, PhD (whatever the hell that is), you should be ashamed of biting the hand that feeds you.
@37 VP
I am not Google. Nor do I happen to know the total proportion of US health expenditures funded by Medicare.
If you want that number I suggest you spend ten minutes using Google.
@39 VP
I do not do clinical research, though I sometimes help out.
As an example, however, I am currently a subject myself in clinical trial. A very large part of my costs of care are borne by my insurance, again since those parts are clinically indicated. If the companies were not paying those costs, the NIH copuld not afford to do the trial.
Yourseems to be that you want to play Troll games, to “win” rather than discuss. I am not intrerested but am very glad that BHO approached this issue from a real world.
You are, SJ, one of the few people who have actually addressed the Pooping Viking directly. I think it has to do with the ‘pooping’ aspect, but as a medical person, you are probably desensitized to it.
The Pooping Viking is actually a historical figure. Google it for your own entertainment if you like.
39 “biting the hand that feed you”
Horsepuckies to you mate.
http://www.guardian.co.uk/uk/2.....ties.arts1
Here’s the straight poop on Viking poop. Really, I’m not just full of crap. But you really should not engage a pooping Viking on this very slippery slope.
Why is “the messiah” hiding the people visiting the whitey house? Direct from Knocked Out AKA Keith Olbermann on his lowly rated Countdown.
Looks like a slippery slope of transparency be damned!
@9: SJ spews:
Great Essay (agree)
One issue, however, remains hidden. Socializing medicine WILL NOT lower its costs.
(That depends. Adopting a more or less standard government issue system like every other industrialized country WILL DEFINITELY lower costs as a % of GNP).
The overall “tax: we all pay for our current chaotic system is about 30% excess in admin fees BUT our syste m is about 100% MORE expensive than anyone else’s.
(Actually we are approaching 140% over average per capita expense. So a 30% reduction in costs for the biggest cost system is a huge savings that we, the allegedly richest country in the world, should take advantage of, and we would be stupid to do otherwise. We all know there are other pressing needs. Thus this remark is frankly nonsensical.)
Socialism will cure the 30% cost, but that is a one time saving.
(Bullshit. It is an ongoing savings compared to maintaining our current path–how could anybody who claims to be familiar with numbers make such a bone headed assertion? And what’s wrong with saving 30% anyway?)
Preventive Care, except for children, is also NOT a way to save money.
(Well, yes it is. What lunacy to assert without the slightest basis in fact, otherwise?)
The longer people live, the more the per/person cost of care simply because older folks cost more.
(That depends on the demographics of a particular population sample. Longevity is mostly correlated with economic well being. This assertion also ignores a wide array of other system attributes, especially economic factors such as productivity. It’s not the “cost” it’s the social choice regarding the distribution of resources.)
Real fixes will require far more dracionian efforts, probably meaning rationing.
(We already have rationing. Therefore you your assertion is without content, meaning, or common sense.)
There some easy targets:
a. chiropractic, naturopathy, etc cost money and do not work. You want these, you should pay for them.
(These costs are minor in the overall scheme of things–non issue.)
b. cutting edge procedures are largely invented in the US because of our profit system.
(bullshit. Most basic advances are subsidized by government funding. What unmitigated crap…if you are going to make an argument, at least try to adhere to some sense of actual reality.)
These will need to be decreased and we probably will need to spend more on research to offset the loss of venture funds.
(More crap. Read Dean Baker on health care costs, drug research, and patent law. Then get back to me with real numbers. You are pulling this out of your ass.).
c. computerized records and ujniversal genomics.
(Whatever.)
d. elimination of prestige hospitals from any public funding … Swedish, Cedars Sinai, the Mayo, Cleveland Clinic may no longer be viable.
(Do you have a point here? This is nonsense.)
e. In creased use of nurse practitioners and practing pharmacists.
(Might be a good idea.)
f. replacing ERs with community7 clinics.
(It won’t come to that under ANY system, except maybe the one in Somalia–is that your gold standard?)
AND THEN WE WILL RATION!
(SO LIKE I SAID, WHAT’S NEW?)
“Socializing medicine WILL NOT lower its costs.”
riiiiiggggghhhhhtttttt.
The only evidence in favor of that is the evidence that about 30 nations have socialized medicine, and they have lower costs, and better outcomes too.
Strange Ghengis Khan, Puddy remembers this from some time ago
“When prices are zero, demand exceeds supply, and queues form. For many Canadians, hospital emergency rooms have become their primary doctor — as is the case with Medicaid patients in the United States. Patients lie in temporary beds in emergency rooms, sometimes for days. At Sainte-Justine Hospital, a major Montreal pediatric hospital, children often wait many hours before they can see a doctor. Surgery candidates face long waiting lists — it can take six months to have a cataract removed. Heart surgeons report patients dying on their waiting lists. But then, it’s free. “
Can you cite one factual instance of any of these evnts really happening?
Heart patients die waiting for heart donors here, too. Socialized medicine isn’t free, it just spreads the cost around more fairly.
TPV
You’ve named yourself after a mineralized hunk of shit? Even if Viking shit, and as a good Scandinavian I figure Viking shit is good shit, man, you named yourself after a turd?
@46 PTB Ass
46. Proud To Be An Ass spews:
@9: SJ spews:
Leaving of the GNP question and just focusing ion costs,l most hospitals are now operating close to the edge of insolvency. In other words is we si8mplyt nationalized the present system, then we would not reduce costs unless we literally rebuilt an enitre new system.
I did not make myself clear … yes, we certainly can cut admin costs by creating a single payer. My point was that this does nto solve the underlying problem of inflation of the costs of medical care. To accomplish this over the long term we need to address many issues besides the profit margin of payers.
Sighhh. The math is simple. To start with we now have a huge cost of death. As we prolong life, the incidence of death will stay the same. So that cost does not decrease unless we cause people to die of less expensive diseases. Unfortunately that is unlikley as most of the causes of death in the elderly are expensive. Moreover, while folks who live longer may be less ill, they still live longer and older poeple have more disease than younger people.
We do not have rationing in the same sense that Europeans or Canadians do. What we have is a sort of cap and trade system where if you can pay for anything, it will be done here.
Yep, and I said there are some asy targets.
I said cutting edge therapies, NOT basic science. Basic science identifies therapeutic targets but Pharma and Clinical med. pay for DEVELOPMENT. Some examples, .. statins, angioplasty, tumor angiogenesis inhibitors, anti (HIV) viral drugs, Gllevec, her 2, ALL of these were discovered using gov funds but developed with private funds.
If you think Baker is so good give me more reason to read him. What does he say that is worth my time? Or shall I urge YOU to read Popper?
No, it is not nonsense. I chose these because they all cater to a high paying elite clientelle. Such hospitals would fail if they needed to live off of medicare level funding. We certainly can argue about whether we need Swedish.
Tx.
@49 TPV
Here we agree,. Most of those horror stories about Canada are BS except for the very vocal upper middle class and above who an get more attention here than in Canada.
Again, the major problme any reform needs to address is how to bring the cost of medcine here down to European levels.
One promising sign is the geographic variation. Some affluent parts of the US (eg Seattle) are actually6 low cost relative to opther areas (eg Florida). I wonder how Seattle and Vancouver compare in their costs of health care?
re 52: Good. Then there is a chance we can get started down the right road.
This time around, Harry and Louise are uninsured, so the chances of them being manipulated are lessened.
The biggest roadblock is legislators who are financially beholden to the insurance industry. They used to call that bribery, but now it’s ‘free speech’.
re 50: I named myself after the Viking, not the turd. The Pooping Viking lives in an active, vital world, where regularity is a boon not to be taken lightly!
PV
That is one roadblock but only one. Others include:
a. physicians concerned with the way they practice medicine or with their incokme (two different things).
b. unions who see this as part of their pay issue.
c. companies that finally understand that it makes more sense to build airplanes then to play doctor.
d. doctrinaire believers in alternative medicine.
e. doctrinaire believers in satre run enterpise and their collegues who have the same level of faith in the “free market.”
f. politicians who see all legislation as serving re-election.
g. All to real lack of data on how changes in management can be reconciled with cost containment.
Harry and Louise were only part of the problem faced by Clinton’s mismanaged effort the last time. Almost any of the above could be a new Harry and Louise in the hands of its proponents or opponents. The impressive thing so far is how well BHO has done in creating a coalition.
Re 55: Then we are back to the original problem of the single payer solution being declared ‘off the table.’
That is like creating a task force to try and find ways to end the Iraq war but insisting that actually ending the war was ‘off the table.’
The prospects of succeeding at the stated task become zero. You can tinker with the war and posibly ameliorate it a bit, but you can’t end it.
I disagree.
The white paper published during the campaign by Obama’s economist, argues that the complexity of the changes required by going to a single payer were unmanageable by government.
This means there are two problems with single payer. There is an obvious political cost. The second is that it is unlikely that any single payer system will fulfill the management concerns of moderates.
The good news is that compromises from single payer are about as difficult as compromises from the free market. However, the failure of our current “free market” is now very obvious to all but the Reprican Remnant. This failure creates a window where a lot can be done.
Obama’s team proposed what some of the other side have finally recognized as a wedge or stealth program. Having a state funded alternative he argues will force the changes you and I both support. This addresses the real concerns of management types while leaving little room for the rad reps.
As one local example, Swedish is arguably the best hospital/practice in town. I suspect that the Swedish Board, comprised of some of the most influential folks in this place, is happy with the current system. How do we get them to buy in? For example, they have a large number of physician owned services that I expect raise the costs of care but do provide important services. As a small example, I think Swedish is now the only system in town with a hypertension clinic. Why? Medicare does a lousy job of reimbursing for blood pressure care. Swedish has more patients whose programs, supplemental insurance, etc can pay for a specialist.
I do not want to lose the excellence of Swedish to some sort of for-the wealthy only enclave.
Even here in Seattle, reorganizing Swedish, what is left of the PHS, Group Health, UW, and Harborview so they all work together is a huge challenge.
The hope would be that Obama’s Federal program would be designed well enough to act as a constructive force ..just as medicare is in many areas, to drive innovative reform.
Roger @ 21:
I hope you do get a chance to ask your Pop about the 1930’s and Republican attempts to keep the government out of the electric power business.
My own mother, who would be in her mid-80’s if she hadn’t died earlier, remembered well how the private power companies would want to have a monopoly (franchise) on power supplies in the cities, but refuse to provide it to the rural areas because, they argued, the cost of laying the wires was too high, and the farmers were too poor to pay for the increased cost. Not that they wanted the government to do it either – no, they insisted that only they had the right to provide electricity, whenever they felt like getting around to it. And they were against increasing available power supplies through hydroelectric projects, because that would have led the push for cheaper power. They were quite happy having just enough power available to support the higher price they charged the wealthier customers in town, beyond that they didn’t want any more.
She recounted how workers for the Rural Electric Cooperative would be harrassed, with power poles cut down in the night and workers and their families threatened, violence against them being encited by charges that they were “communists” and “socialists”. These weren’t stories she read about in history books, she grew up on a farm in south Alabama during the depression.
She told me that was why she always voted Democrat, because she well remembered the day when they first were able to turn on an electric light in their home.