Comparing Veterinary and Human Health Care

February 25, 2010 at 9:31 pm 38 comments

While this is a gross oversimplification of the system, Balaker makes a couple of interesting points.

I should be a poster girl for health care reform. I’m middle-aged, self-employed and I’ve got a bunch of potentially bankrupting preexisting health problems. But when I see the kind of unintended consequences that arise out of relatively simple, well-intentioned programs like South Carolina’s certificate of need requirement, I remain convinced that rapid institution of broad sweeping reforms is a very bad idea. Changing a few things at a time would mean that problems in the system (and there are plenty of them) will take longer to fix, but a step by step process of reform could help prevent potentially catastrophic adverse effects.

In the world of politics there is sometimes a drive to achieve change by pursuing a system completely different from the status quo. But effective change is rarely made in a spectacular way.  Like our world’s climate, health care is an incredibly complex, dynamical system well beyond anyone’s capacity to understand or model accurately. I really hope our elected representatives don’t unintentionally throw it into a dangerously chaotic state of disequilibrium.

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Smorgasbord No More Dog “Ownership” in Wisconsin?

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  • 1. Rob McMillin  |  February 25, 2010 at 9:56 pm

    I am genuinely afraid to discuss this here because of the commenters it is liable to attract, some of whom are now (and I would hope will continue to be) my friends.

    Sex, religion, and politics, you know.

    David Goldhill’s Atlantic piece from last year (skip ahead to the last page for the impatient) comes fairly close to my own thinking. (I would add that taking the AMA out of the business of deciding how many new doctors we get each year would be a big help, too.) What is being pushed through Congress is a disaster, more of the same that got us here with nothing to really reduce costs in any aspect.

  • 2. Rob McMillin  |  February 25, 2010 at 10:13 pm

    One other thing before leaving: the United States is not unique in the exponential rise in medical costs. This is a feature shared by virtually every OECD country studied at that link, and they all — save for the U.S. — have some form of third-party-pays medical delivery system. Eight of them, over the most recent 14-year period studied (1990-2003), had cost growth rates that were actually higher than the U.S. (Japan and Germany were not included for various reasons.) This core fact is pushing people out of state-run systems and into privately run medicine (albeit still with insurance), as for instance is happening in France.

    It will start at the top, but the myriad internal contradictions of third-party-pays systems will eventually out. They are probably most pronounced in the U.S. for a number of reasons, but this does not change the endgame of all such attempts to eat lunch and have someone else pay for it.

  • 3. Rob McMillin  |  February 25, 2010 at 10:14 pm

    Ack … wish I had a preview. I meant to say that most of the other countries in that KFF study had state-run systems, and all have third-party-pays systems in the main.

  • 4. SmartDogs  |  February 25, 2010 at 10:55 pm

    That was fantastic. And yes, I read the whole thing.

    And I agree with you about the “reform” being pushed by Congress. As in some parts of the dog training world, their focus seems to be more on ideology than results…

  • 5. Rob McMillin  |  February 26, 2010 at 12:46 am

    It appears that the Atlantic has changed their online archives like, just now. Here’s the correct link for the David Goldhill piece.

  • 6. YesBiscuit!  |  February 26, 2010 at 5:54 am

    I’m uninsured and desperate for sweeping change. Unfortunately, the health care reform being proposed falls far from it. I support it, because I’ll take what I can get, but I had hoped for so much more – both ideologically and substantively.

  • 7. PBurns  |  February 26, 2010 at 6:42 am

    LET’S HAVE DEATH PANELS!

    YES! YES! YES!

    Just like at the local dog shelter, only this time we can KILL HOMELESS PEOPLE…. and OLD PEOPLE … and CRIPPLES.

    Just like at the vets office when poor people cannot afford to fix Fido, we can CHEER WHILE THE TRAILER TRASH have to pull the plug on their parents, their spouses, and their children.

    YES, YES, YES!

    Perfect.

    Great thinking.

    P.

  • 8. Ken Chiacchia  |  February 26, 2010 at 7:13 am

    My own emerging bugbear — for reasons I can’t get into — is tort reform. If you look at the numbers, it’s a bit of a boondoggle: legal costs’ contribution to medical costs isn’t large, and reform can too easily become a get-out-of-jail-free card for irresponsible companies (which is why it’s got the specific political backing it does).

    But until you’ve seen a baseless but determined suit take forever to make its way through the system, making its victims miserable every step of the process, you can’t fully appreciate how little we’ve come from trial by combat; we’ve just traded Armani for Florentine, and moved the proceedings inside.

  • 9. Ken Chiacchia  |  February 26, 2010 at 7:31 am

    Is P. kidding? You know the “death panel” thing was a total fabrication? They took a measure meant to make end-of-life counseling available to everybody (and which, if you’ve gone through a loved one dying slowly or had anything to do with retirement homes, you know is a really, really good idea) and kept insisting without proof that it said much more than was on paper.

    They were counting on people not reading the text, or more to the point simply not listening to the other side (which both sides are guilty of in health care reform), and unfortunately they were right.

    If I’m being sarcasm-challenged, sorry — it’s just that the positions have become so cartoonish on both sides that you can’t assume people aren’t being dead serious, no matter what they say.

    I should have added one more thing to my previous comment — again for reasons I can’t get into, I’ve had the opportunity to study both the Irish and UK health systems recently. The US, Ireland, and UK are at different points on the spectrum: US has minimal public health care; Ireland has a blended system; and the UK is mostly public.

    Here’s the bad news, along the lines of what Rob said: all three are driving their countries bankrupt, and all three have shocking lapses in care (ironically, it’s the poor who get the bad care every time — it just happens for different reasons). And in all three countries, people riot whenever anything more than tinkering is suggested to fix the system. In all three countries, people are letting their fear of things getting worse paralyze them — and are demonizing anybody who disagrees with them.

    I’m pretty close to being willing to throw it all out the window, despite the fact that the current system isn’t such a bad deal for me personally (a good employer-based plan — though many people really don’t know how good or bad their plan is). Washington gets an unfair rap on a lot of things (who out there thinks the government is so inept and wasteful they’re willing to do without the U.S. Marines? Their own personal Social Security account?), but the one thing they don’t do well is gradual change — too many opportunities for the vested interests to derail, delay, water down.

    That’s my take, anyway.

  • 10. Dorene  |  February 26, 2010 at 8:54 am

    As a disabled person, I’ve found Medicare much easier to use and far less of a hassle than private insurance. I’d love to see Medicare become the “public option.” The infrastructure is there and most doctors grumble, but accept Medicare. Also, if you’ve ever lobbied the government and lobbied your private insurance company, it’s been my experience that it’s easier to lobby the government and affect change. (Not easy either way, but with government, you have a fighting chance)

  • 11. PBurns  |  February 26, 2010 at 9:01 am

    YES, I am kidding … except that this is what the Tea Baggers REALLY want .. this is is what the most brain-dead in the GOP want.

    Ron Paul, the libertarian, won the most recent GOP straw poll and REASON is a libertarian rag which actually thinks this is how veterinary care works.

    Hint: this is NOT how it works or how it is.

    DEATH PANELS?

    YES!

    The GOP support DEATH PANELS! Yahoo!!

    DEATH PANELS for immigrants, and black people and women with breast cancer, and old people, and cripples, and ANYBODY WHO IS NOT 100% HEALTHY and white and a Christian.

    Because if you cannot afford a bypass, then you deserve to die.

    And if you cannot afford breast cancer treatment, you deserve to die.

    And if you cannot afford to go to a doctor and your cold becomes pneumonia, you deserve to die.

    The only good people are the really rich, white, chrisitan, male ones.

    You know — the folks that built this country by enslaving black people, killing the Indians, exploiting the immigrants and leaving behind stripped mountains, dead rivers, and toxic waste spills.

    The only good folks are the ones who cheered for child labor, who opposed OSHA, who fought the minimum wage, and who think the only things that should be subsidized are road contstruction, big industry and suburban tract homes.

    Don’t you miss the the good old days before we let women and black folks vote?

    If we hadn’t made that mistake, think how many more Republican voters we would have!

    But here’s the good news: If we can get stupid Americans to treat their families like dogs — if we can get them to embrace DEATH PANELS — then all those pesky people who are not rich will die off sooner.

    YES!

    Who could oppose that? No one!

    So rally around the GOP Veterinary Health Plan for humans.

    A man with a blue solution is standing by to help us all balance the budget.

    It’s very important that old people, and poor people and cripples and the sick die as quickly as possible, because there is no higher value than lower taxes.

    P.

  • 12. retrieverman  |  February 26, 2010 at 9:36 am

    If you look into PBurns’s blog, there are lots of good (from my perspective) health care posts:
    http://terriermandotcom.blogspot.com/

    It has a search function. Just type it in there.

    I don’t think that hospitals could function without at least some protectionism. Technological advanced equipment costs a lot of money.

    Maybe in the old days when the doctor came on a wagon with a medicine bag. But that was back when we lived to be about 40 on average.

    America does have great medical technology. There is no denying that, but the system that delivers it is horribly broken.

    I do think this video does raise a point about hospitals– and their role in increasing the cost of health care. I’ve seen it happen with members of my own family.

    I don’t think this is going to be solved without some kind of government interference.

    Ken is exactly right about tort reform. My state went through a big tort reform push a few years back, and all it did was lower the costs on medical malpractice premiums for doctors. Costs continue to skyrocket in every other area.

    Tort reform sounds good. Everyone hates lawyers. Until you need one.

    To be honest with you, I’ve tried to be a libertarian before, but I cannot be an intellectually honest one. So I am by default a social democrat.

  • 13. retrieverman  |  February 26, 2010 at 9:42 am

    How veterinary medicine works:

    http://terriermandotcom.blogspot.com/search?q=veterinary+medicine

    I’ve learned a lot from those posts.

    Veterinary medicine is far more inefficient and crooked than human medicine.

  • 14. retrieverman  |  February 26, 2010 at 9:44 am

    I will say that for a libertarian rag, Reason is pretty well written.

  • 15. Rob McMillin  |  February 26, 2010 at 10:24 am

    One of the serendipitous things about Facebook is the group of people you get to become friends with as a consequence of having interesting friends yourself. One such I met that way was Dean Calbreath, the San Diego Union-Tribune’s business columnist. And the discussion on health care we got into was, in some ways, enlightening. He has traveled a fair piece, lived in Prague for some years, and is very enthusiastic about the state-run system there. His mother, on the other hand, spent her dying days fighting Kaiser Permanente for basic things (I seem to recall oxygen, but it’s been months since we had these discussions). So for a while, we went round and round on:

    Dean: I’ve lived in Europe with a state-run medical system, and you haven’t. You have no standing to criticize European state-run medicine therefore. Further, my mother’s terrible experience with Kaiser is representative of what’s wrong with medical care in the U.S. State-run systems are much better.
    Me: Well, all right. But your mother didn’t die there, either, so your experience and your mother’s experience weren’t directly applicable or comparable.

    Which is to say, there’s a tremendous amount of confirmation bias in all discussions of these issues.

    A lot of polling data shows how many people love having state-run or -financed health care; the Canadians love their system, the Aussies do as well, etc. But what I always wonder when I read this is, how many of the people polled have actually had to deal with a genuinely expensive medical condition? At some point, every system has to grapple with actual costs, and at some point, somebody has to say “no”.

    The “death panels” thing was an intentional Republican smoke screen to drum up opposition from Medicare recipients, it’s true, but later on, there was talk about actual death panels in a Newsweek article that received, from memory, fairly warm notices in some “progressive” circles.

  • 16. Rob McMillin  |  February 26, 2010 at 11:12 am

    Washington gets an unfair rap on a lot of things (who out there thinks the government is so inept and wasteful they’re willing to do without the U.S. Marines? Their own personal Social Security account?)

    1. You don’t actually have any specific claim with Social Security. I don’t recall the specific court cases that set this precedent, but even the language Social Security uses (“obligation” rather than “liability”) is specifically designed to evade responsibility.

    2. Congress is using Social Security receipts to paper over the deficit, and has been since Lyndon Johnson was President.

  • 17. Rob McMillin  |  February 26, 2010 at 11:18 am

    And — I would visit Terrierman’s blog more often but because it has so much Flash (read: YouTube) content and so many articles on the home page, it loads painfully slowly.

  • 18. Dorene  |  February 26, 2010 at 1:05 pm

    @Rob

    Social Security may be an “obligation” rather than a “liability” but no politician is going to axe those benefits overnight. Witness how those whose retirement age is being pushed back are decades in the future, not those close to actual retirement and those periodic letters which list what your benefits would be now (if you were disabled) and at early, regular and late retirement.

    As someone who had to “cash in” for disability, I’m very grateful to have it.

  • 19. Rob McMillin  |  February 26, 2010 at 1:44 pm

    I don’t think this is going to be solved without some kind of government interference.

    The government already has immense mandates and restrictions on the provision and delivery of health care. Between state and local governments, half of U.S. health care spending comes from some government entity.

    And despite all this, health care is only getting more expensive.

    The present bill plans to achieve its cost-cutting through future reductions in payouts to Medicare-accepting physicians, and other cuts to Medicare. (The specifics may be found in this CBO PDF on page 5, table 2.) The problem I have with this is that — if these are legitimate, why is it that they’re not implementing these wonderful cost savings right now? And the answer, to me, is obvious: they have no intention of cutting Medicare, not really.

  • 20. Rob McMillin  |  February 26, 2010 at 2:16 pm

    Dorene’s comment reminds me of another point I was going to make this morning but got sidetracked and deleted. Along the same lines as Social Security papering over the deficit, while I was digging through the UK budget last year in trying to find out how much their National Health Service costs to operate. By my reckoning based on the 2008 budget, they were actually a billion pounds under revenue (a surplus), while their own internal blog actually places the figure higher at £1.8 billion. My issue is this: Social Security revenue partially fills in the deficit now, getting applied to the general revenues on the fantasy that the obligations it is amassing will be paid back. What’s to prevent the same thing from happening with a state-run medical care system?

  • 21. Mike  |  February 26, 2010 at 3:01 pm

    My solution to health care reform.

    Remove the link between employment and health insurance.
    Increase health savings accounts.
    Remove minimum insurance requirements so people can buy catastrophe only insurance for cheap.
    Give anyone making less than (some appropriate dollar amount) a voucher to buy catastrophe insurance.
    Remove barriers to low-income clinics where a trained nurse can tell you if you just have a cold or if you need to go to a real doctor.

    Do all of that one or two at a time so we can judge the results and see how things change on their own.

    Of course, no on will listen to me.

  • 22. retrieverman  |  February 26, 2010 at 3:14 pm

    Market-based reforms sound good in theory, but you need to keep in mind that most people aren’t very good consumers. To have a market work, consumers have to have some grounding in reality.

    I don’t know if you’ve talked to most Americans….

    Social safety nets are things we have because we have a more democratic society. They weren’t imposed upon the population.

    Those social safety nets are easy to poo-poo, just as it’s easy to attack lawyers.

    But when you need either, you start singing a different tune.

  • 23. Rob McMillin  |  February 26, 2010 at 3:57 pm

    To have a market work, consumers have to have some grounding in reality.

    Which means what, exactly? That people are too stupid to figure out when they’re being conned?

    Third-party-pays systems aren’t getting the job done now. They can’t because of the disconnected feedback loop on costs.

  • 24. retrieverman  |  February 26, 2010 at 4:06 pm

    I don’t think anyone is seriously proposing a state run medical system. A public option is something you’d have to buy into. It would be something like a public university.

    Dennis Kucinich and John Conyers are not major policy makers in whatever will be passed.

  • 25. Rob McMillin  |  February 26, 2010 at 4:24 pm

    I don’t think anyone is seriously proposing a state run medical system.

    No, but even Obama said a year ago that what he has in mind is only a “down payment” on universal care. I read that as the first step towards something like the Canadian system, at least; and those with the gold, get to make the rules.

    A public option is something you’d have to buy into. It would be something like a public university.

    Interesting you mention that. Public universities haven’t exactly done a whole lot to reduce costs, either, and there’s a good argument they’re making post-secondary education appreciably more expensive.

  • 26. Viatecio  |  February 26, 2010 at 6:26 pm

    I’m know this is probably pretty trivial in light of everything else, but why not start with things like putting money where it matters…such as, not in stock options and millions upon millions in paychecks for the CEOs? Because that’s pretty much where all the premiums go.

    I do like Mike’s ideas. Insurance used to be for catastrophes, and since people started whining about having to pay for EVERYTHING, it covers preventative now. I do wonder how much of this has to do with the drastic increase in health problems (obesity, heart problems, Diabetes, etc) and the increasing cost of medical technology?

    We DO need change, and everyone who needs it deserves quality health care. I just don’t like the way Congress tried to strong-arm it through this time, though. Little changes at a time add up, and usually garner less negative reaction than a big change like what was being proposed.

  • 27. Viatecio  |  February 26, 2010 at 7:52 pm

    Correction: Everyone deserves health care. Because everyone will need it at some point.

  • 28. The husband  |  February 26, 2010 at 9:40 pm

    I’m going to wade into this health care discussion because I’ve liked the civil discourse to date and you are all to be commended for. But I’d like to add a few things for your consideration as I like numbers and work for an insurance company (but one that does not sell health insurance)

    According to the Kaiser Foundation, health care expenditures have gone up from $714 billion in 1990 to a little over $2.2 trillion in 2007, or approximately a 7% annual increase.

    When you look at that annual 7% increase, let’s look what may be the causes of that increase for your consideration:

    1. The Consumer Price index (CPI) has gone up at a rate of about 3% per year since 1990, so I and most rational people would expect costs to increase by about that rate.

    That leaves 4% unaccounted for.

    2. Our population has gone up at a rate of about 1% per year since 1990. More people means more people using the system, generally resulting in a pro-rata share of increases in cost. So I can understand another 1% increase in expenditures due to population growth. BTW: The annual rate in increase in the number of doctors has not kept pace with this rate, ie supply / demand. Plus medicine is more specialized due to the complexity which is good. Many foreigners come to the U.S. when they get diagnosed with cancer and other diseases because our specialized doctors are very, very good, and actually provide better care with better outcomes than those in other countries.

    That leaves 3% unaccounted for.

    3. Our obesity rate has skyrocketed since 1990 and we are just starting to pay for it. The CDC estimates that since 1990, health care expenditures due to obesity have increased from approximately $19 billion to over $140 billion in 2007 accounting for approximately 1.0% per year in of the overall increase in health care expenditures. Plus…Cleveland Clinic estimates now that 30% of all their patients they currently see are being treated for conditions partially or totally due to obesity…ie hip replacements, knee replacements, diabetes, high cholesterol levels, high blood pressure, ect. In fact, they and a few other publications have estimated that approximately 30% of all health care cost increases over the next 10 years will be due to our inability to keep our weight down. In other words we only have ourselves to blame for this. You want to control health care costs in the future…here it is ! But let’s not allow companies to charge for it, like a car insurance company charges more for a driver with more driving offenses.

    That leaves 2.0%.

    4. We are on average an aging population that lives longer. Older people require more health care and cost more money. Plus, due to many medical advances and of course, the development of a slew of new drugs from those EVIL pharmaceutical companies, we can now treat many things we could not treat back in 1990, or we at least can slow the progression of many diseases. While it is hard to come up with the exact increase in expenditures due since 1990 due to aging and these advances in medicine, I don’t think it would be unfair to place the increase these expenditures to maybe 1% per year.

    That leaves 1%.

    4. We love our prescriptions and our doctors find it easier to give them to us then sometimes say “no” to us. Plus, doctors need to charge more due to the skyrocketing costs of malpractice insurance due to all the lawsuits and a few “jack pot” courts (like what used to be in Mississippi), which leads to that wonderful solution called “defensive medicine”. I’m sure this has lead to an increase in overall costs, but cannot place a real number on it. My gut is this is another 0.5%.

    That leaves maybe 0.5% per year.

    By putting these numbers up here, I’m not saying that people are not having problems affording health care…they are…but to maybe offer some reasons for why health care costs are “exploding” and will continue to explode. Why they can’t afford it is another whole post.

  • 29. Mike  |  February 27, 2010 at 7:42 am

    The reason that people use insurance for everything is that they don’t see themselves as paying for it. Their employer pays for it. How many people would, if given the option, take the extra $13,000 to $23,000 that their employer is paying for their benefits, pocket half of it to spend on their other bills, and get medical insurance that will cover “Oh no I broke my leg” or “I have cancer” but not “Johnny has the sniffles.”

    From a quick survey of other insurance markets, I’m thinking about everyone.

    The public option does nothing to fix this problem. The public option does a little bit to fix the problem of people being out of work losing their health insurance. This is pretty much the only good thing it does.

    Even with that, estimates show that it would only help about half or less of the uninsured with requiring a federal mandate to buy insurance, which no one in the electorate wants, and Obama himself campaigned against because he *knew* no one wanted it. But you don’t “solve” the other half of the people without insurance (many of whom are already eligible for some kind of assistance and just don’t ask for it for whatever reason) without that mandate, and the additions to the bureaucracy to punish people for not acting in their own self-interest.

  • 30. Dorene  |  February 27, 2010 at 8:59 am

    For those of you who think that just knowing the price of care will help you make good decisions, I have an exercise for you:

    You have a 2 year old child diagnosted with autism. Figure out the treatments for this child.

    Most insurance excludes autism treatment. Even in states like PA, where there is supposed to be state help, the reality is that most treatments are denied or shuffled so that payment never really happens so that parents are on their own deciding:

    1) Which course of treatment to try

    2) Which priced treatments the family can afford

    3) Which professionals to hire

    At least in this exercise, the parents have a fairly clear brain — unlike when someone is facing cancer (my cousin Ed with prostate cancer), is not feeling well, yet must make important decisions on treatment to save his life, all of which are covered by insurance, yet don’t have clear-cut statistics on which has a better outcome in his situation. Or myself when dealing with raging migraines — when y ou’re in that much pain, you want it to stop, not comparsion shop on hospital emergency rooms for the cost of a Demerol shot.

    Dealing with health care issues just isn’t the same as buying a car — and sneering at people because they can’t be “good consumers” (not here, but elsewhere) doesn’t deal with the reality of why people are accessing health care to begin with.

  • 31. Eleanor  |  February 27, 2010 at 12:13 pm

    “if given the option, take the extra $13,000 to $23,000 that their employer is paying for their benefits, pocket half of it to spend on their other bills, and get medical insurance that will cover “Oh no I broke my leg” or “I have cancer” but not “Johnny has the sniffles.”

    From a quick survey of other insurance markets, I’m thinking about everyone.”

    From my experience with employers who offer a similar option, you would be wrong.

    I’ve been an RN for over 20 years. I’ve worked in hospitals, clinics, nursing homes and home health care agencies. I’ve even worked in The Dreaded Insurance Companies (and in fact, work for one now)

    The causes of our heath care crisis are numerous and complex, ranging from everything to irresponsible consumers to greedy providers to yes, short sighted insurance companies.

    Much of my career has been in case management, the entertaining task of trying to keep all the plates spinning while achieving the best AND most cost efficient outcome with the resources available.

    The stories I could tell….. All we have to do is look at Medicare and Medical Assistance to know that government isn’t going to lead us to do things any better.

    A bit of personal responsibility and ethics and common sense would take us a long way. Too bad you can’t legislate that.

  • 32. Rob McMillin  |  February 27, 2010 at 1:27 pm

    Dorene: my brother is autistic. He has, in particular, Asperger’s Syndrome, one of the milder forms of the disease. Often, people can have conversations with him for minutes before detecting something is wrong. But there is; he will never be able to drive, he hasn’t had a paying job from someone other than family since he was in his 20’s, and has never had a girlfriend.

    The course of discovering this was rather long; the trail started, as I recall, at a neurologist’s (the most boring place in the world to this then-8-year-old); mom left in tears, and we knew for sure something was wrong, the John Tracy Clinic having declared his hearing in working order.

    So we spent the next decade-plus trying to figure out what was wrong with him, why he was eight years old and still hadn’t spoken a word to anyone. Tests, tests, and tests, endless batteries of tests, and doctors who, every one of them, had opinions that differed from the last.

    After his screaming freakouts stopped, he suddenly started talking.

    Today, it would have been handled differently, but there’s little prospect of a cure still. There is a remediation that helps, a very expensive therapy that requires many, many hours and days and weeks of highly-trained professional help; this can run to $70,000 or more per year.

    I don’t have time to track down the links right now, but this particular situation highlights an interesting point: not all the Canadian provinces actually pay for this therapy. (Saskatchewan does, I recall, which is why a lot of parents with autistic children have moved there.) There is not infinite resources; someone must say “no” at some point.

    And the “experts” don’t always know their heads from a hole in the ground, either. Whether the payer is a government or an insurer or a private individual, this will still be true.

  • 33. SmartDogs  |  February 27, 2010 at 1:41 pm

    Hey guys – MAJOR computer problems held me up since I posted this. Sorry ’bout that.

    Dorene – another problem is that just having the money to pay for it doesn’t necessarily make the care available – or of good quality.

    Eleanor – amen! The most serious epidemic we suffer from today is that lack of personal responsibility, ethics and common sense.

    Rob – the article from the Atlantic was excellent. Goldhill has some interesting ideas. Unfortunately I don’t think there’s herring’s chance in an orca tank they’d be listened to in DC. Your point on public universities and cost is also food for thought.

    I didn’t expect to light so many fires with this – but I’m really pleased with the volume and tone of the comments. Smart Readers!

  • 34. Dorene  |  February 27, 2010 at 3:37 pm

    Unfortunately, I agree that having the money doesn’t mean that the care will be there OR that it will be of good quality. In my particular disability, not only can you not get money for care out of the insurance companies (and it’s an option for states to opt-out for Medicare/Medicaid), but the defination of “quality care” is very squiggly. So, you have to decide (much like autism) from the spectrum that is available, who is shilling to pad their own pockets, who is really trying to help you and is the care worth paying out of pocket for or appealing elsewhere. To make it worse, sometimes it is and sometimes, it isn’t — and often, one learns the hard way.

    Health care — it’s way too complcaited!

  • 35. SmartDogs  |  February 27, 2010 at 4:16 pm

    Yes – more so even than dog training!

  • 36. Gina Spadafori  |  February 27, 2010 at 4:33 pm

    What a wonderful thing to find respectful discourse on this subject! I’d like to recommend a Frontline doc from a couple years ago, “Sick Around the World.”Different countries have taken different toad to the same end: Good, accessible health care for their entire populations.

    Including scrapping an entire system and starting from scratch. I have come back to it — and the book that came from it — several times. Well worth the time, both.

  • 37. agus  |  March 3, 2010 at 9:26 am

    Good article and thanks for your information.
    Thanks

  • 38. manny  |  March 17, 2010 at 9:38 am

    In the world of politics there is sometimes a drive to achieve change by pursuing a system completely different from the status quo. But effective change is rarely made in a spectacular way.

    Two spectaculars you may have overlooked. 1776 and 1788. 1776, the decision to unite and become independent from the crown and the scrapping and 1788, scrapping the Articles of Confederation for the US Constitution. Great political change can be done. It will always be resisted by the entrenched interests, (loyalists and anti-federalists), but it can be done, and done well. The problem is we have no 21st century versions of Jefferson, Franklin, Adams, Hamilton and Madison as far as I can see. No one in DC is willing to compromise for the common good. It’s all about party and getting/staying in power.

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