[ExI] Healthcare thread again

[Omar Rahman]

Rafal,

I've merged these two threads here for simplicity.


On 28 Nov 2013, at 19:02, extropy-chat-request at lists.extropy.org wrote:

> Message: 5
> Date: Thu, 28 Nov 2013 11:48:35 -0500
> From: Rafal Smigrodzki <rafal.smigrodzki at gmail.com>
> To: ExI chat list <extropy-chat at lists.extropy.org>
> Subject: [ExI] Healthcare thread again
> Message-ID:
> 	<CAAc1gFg-ASF2U=qmzqOGn43bG8huNBB=ANaDCUnbuOgumpU=Xg at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> On Tue, Nov 26, 2013 at 9:09 AM, Omar Rahman <rahmans at me.com> wrote:
>> 
>> Date: Tue, 26 Nov 2013 03:44:10 -0500
>> From: Rafal Smigrodzki <rafal.smigrodzki at gmail.com>
>> To: ExI chat list <extropy-chat at lists.extropy.org>
>> Subject: Re: [ExI] Warren Buffett is worried too and thinks
>> Republicans are "asinine"
>> 
>> On Fri, Oct 25, 2013 at 3:53 AM, Omar Rahman <rahmans at me.com> wrote:
>> 
>> 
>> I would prefer the Federal government to implement an insurance policy that
>> MUST be accepted at all hospitals and only pays a FIXED cost for procedures.
>> Comparison shopping doesn't work well in health care because there is a too
>> much time pressure and you don't have time to move to Arizona/Hawaii/etc
>> where procedure X is covered and/or cheaper than where you live in a 'State
>> Model' situation as you have proposed.
>> 
>> 
>> ### Omar, you are repeating standard leftist boilerplate on medical
>> care (at least what they say when they don't talk about the single
>> payer). You hit all the points, even the notion of impossibility of
>> patient informed decision making in medical care. Just think about the
>> following sentence for five minutes: "It is generally impossible for
>> an individual to reasonably choose a doctor/hospital/insurance plan".
>> Cogitate on the details, try to imagine how a human might go about
>> this task. Only a propaganda-elicited learned helplessness can stop
>> you from reducing it to an absurdity. Or think about this one: "Fear
>> of the police is a good way of making sure there are enough surgeons
>> healing patients everywhere".
>> 
>> Rafal
>> 
>> 
>> 
>> Rafal,
>> 
>> I actually took the five minutes you suggested.
>> 
>> Conclusions:
>> 
>> 1) these statements are yours but you seem to be proposing them as 'my
>> position'
>> 2) these statements are falsifiable on first reading
>> 3) this is an invalid form of argumentation known as 'Straw Man' see
>> https://yourlogicalfallacyis.com/strawman
> 
> ### I'd say they are translations of your statements into a form where
> the substance and more importantly, their implications become obvious.

I'd say that the translation of my arguments into your words so that you can trivially refute them is precisely what makes a 'Straw Man' argument. 

> After all, you do want to send the police after any surgeon who dares
> charge a different price for a procedure, don't you? That is exactly
> what you wrote, "MUST be accepted at all hospitals and only pays a
> FIXED cost for procedures".

They can charge a different price as long as it's lower. The free markets should be able to supply that, right?

> ----------
>> 
>> Rafal, as a doctor it would seem that you are in a better position to make
>> an informed choice about health care than the vast majority of people. But
>> are you really? With the multitude of 'competing' plans out there how can
>> you be sure unless you read and compare them all.
> 
> ### Obviously, no. When I look for a car mechanic, I don't spend a
> year visiting every shop in driving range, I look until I find
> somebody good enough. There is absolutely no difference between car
> mechanics and doctors in this respect.

I'd also say that you are wilfully ignoring my statements about not needing perfect information to make a decision in order for you to say that you don't need perfect information to make a decision. 

> -----------------
>> 
>> Insurance is a form of gambling. (You are betting you are going to get sick,
>> the insurance company bets that you will not get 'sick'.)
>> You are not 'the house'. (The rules are different for each side, with one
>> side having a statistical advantage.)
>> 'The house' makes the rules. (The house decides what 'sick' is and what, if
>> any, treatment applies.)
>> 'The house' always wins in the end. (The house always makes a profit from
>> cheating you at the most helpless and miserable points in your life.)
> 
> ### No. The only way they make a profit is to maintain a reputation
> for being not more difficult to deal with than their competitors while
> keeping their prices not grossly higher than competition.

You can make profits in a multitude of ways both legal and illegal, ethical and unethical. Having a good reputation and decent prices would be one of the more legal and ethical means. What's your point?

> That's why
> insurance plans already cover vastly more than necessary. That's why
> HMOs died, because they tried to use evidence to limit coverage of
> insanely expensive treatments.
> 
> You have it exactly opposite-wrong: The problem with private insurance
> is not that they cover too little but that they cover way too much
> already and O-care would make it even worse. I could cut my patients'
> treatment costs by 80% with minimal reduction in their survival and
> health but since they are insured we never get to talk about costs
> anyway, so the money gets spent.
> --------------------

Costs can be discussed in both public and private contexts. What you seem to be saying is that the costs are too high in the existing private programs. Interestingly I, and international studies concerning the percent of GDP spent by various nations and their health outcomes, agree with you that the US private health insurance industry is very inefficient. Nice to know we have some common ground to build on.

>> 
>> The argument I make for 'socialised medicine' is that I want to be 'the
>> house'.
> 
> ### Yeah, I noticed, you do want to have armed personnel at your
> behest, to make people do as you say.
> 

Yes, I have millions of minions. All jack booted by the way. They even have little jack boot slippers to go with their pyjamas. Our plan for world domination is to make people healthy so that they are helpless to resist us. Of wait....that won't work very well....won't they be all healthy and stuff and be able to fight back?


> --------------------
>> 
>> Well, I want to be 'the house' in a collective society, with my fellow
>> citizens and workers, with whom I shall unite to form a glorious republic of
>> the people, for the people, and by the people. See all those very positive
>> words in the previous sentence? How is it that when I string them together
>> like that some list readers will be 'seeing red' in more ways than one?
> 
> ### Because, very reliably over the last century or so, when those who
> said the same stuff actually got to make decisions, the first thing
> they did was to have people like the list readers taken out back and
> shot. No doubt thinking positive thoughts all the time.

Sunshine puppies la la la 'BANG BANG BANG'...you've got me figured out! Or you've pegged me into some ridiculous caricature so as to make me seem some sort of extremist and therefore trivial to argue against? I think deep in your heart you want to be a farmer you have so many Straw Men around......

> 
> --------------------------
>> 
>> Rafal, as you may know, I live in Poland. If you ever pass through Warsaw we
>> can meet up for coffee and discuss 'extropian' things. Would you agree that
>> Poland has a dysfunctional health care system? I certainly think so. There
>> are, at least, three causes in my opinion.
>> 
>> 1) poor management of public systems
>> 2) poor funding of public systems
>> 3) the existence of private hospitals which exist mainly, in my opinion, to
>> allow 'rich' people to jump the queue and get prioritised care in public
>> health care institutions
> 
> ### I have been only an occasional visitor in Poland since 1990 but I
> am quite familiar with its health system, since most of my friends and
> family are doctors, and yes, it's dysfunctional. The public system
> should in my opinion be completely abolished. That would cure all
> problems.
> 

So we agree that the Polish system is dysfunctional too. Would privatisation 'cure' the problem of millions of people losing the health care they paid for during their working lives? No. Reform of the existing system is the only fair option for those who have paid into it.

> -----------------
>> 
>> How do we account for the undeniable human need to receive the best health
>> care possible? Isn't the right to the best health care in fact the right to
>> self preservation? I think that it is.
> 
> ### No. Receiving the best health care possible is not
> "self-preservation". It is receiving help from others.

Frankly, you need to learn to read. I am conflating the right to 'the best' health care with the right to SELF preservation. I thought I was conceding a point to you actually. My thought was that the existence of public systems should not limit individuals from seeking whatever addition treatments they deem necessary.

> You may
> politely ask for it. You may pay. But making peremptory demands on
> other people's time and resources, backed by threat of violence,

Where did I misplace my millions of minions? I could really use a jack booted thug right now! 

> is
> wrong. It is especially wrong in the situation we are discussing, when
> you are not fighting to preserve your life in an emergency. Almost all
> citizens can easily pay for all reasonable medical care from their
> incomes, if they use a catastrophic health care plan - so claiming
> there is a "need" is disingenuous. It is not need, it's greed,
> demanding something for nothing.
> 

You completely missed my point as it was clearly explained a few sentences further on.

> --------------------
>> 
>> My best case solution would be to have:
>> 
>> 1) a single payer solution (which meets some agreed upon minimum standard of
>> care) that everyone must pay into
> 
> ### But why, why? Why do you demand dominion over me (an "everyone")?
> Why do you say I "MUST" do what you want? Can't you just leave well
> alone, live and let live?

Why must? To avoid the free rider problem. 

> -----------------
>> 
>> I believe we have a right to health care in society to whatever level we
>> collectively agree to fund it.
> 
> ### Yes, the royal "we". Actually stands for bureaucrats pushing me
> around and claiming it's all for my good, and for the children, too.

At least it seems I'm not being portrayed as a dictator but as some form of royalty. Hmm......wait....is that better or worse than a dictatorial 'commoner'? Most human societies have collectively chosen to leave that funding level at zero by the way. 

> 
> The way I see it, the desire for all these single payer wonders is
> based on a moral wrong and an illusion.

> The wrong is the demand to
> control the lives of others justified by the invocation of a
> collective good.

We usually call that being a citizen and living in a society. Go try driving on the left in the US and when the police catch you please inform them that is it morally wrong for them to control you by having 'rules of the road' just to have the collective good of avoiding head on collisions.

That's what governments do. If you don't like it I suggest you get seriously extropian and colonise some asteroid or something because basically every square cm down in this gravity well is covered by some claim of control.

> The illusion is in the belief that the collective
> good will be well-served by a hierarchy of men with nobody to watch
> over them but the collective itself.

"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

Just to highlight: MORE PERFECT UNION.......PROMOTE THE GENERAL WELFARE

'Promote the general welfare' practically mandates something like socialised health care right in the first bloody sentence off the constitution.

Government of the people, by the people, for the people......what part of this is hard for you to understand?

That's EXACTLY what the US is supposed to be about.

> 
> Count me out of your collective.
> 
> Rafal


No man is an island.....

> Message: 16
> Date: Thu, 28 Nov 2013 12:54:01 -0500
> From: Rafal Smigrodzki <rafal.smigrodzki at gmail.com>
> To: ExI chat list <extropy-chat at lists.extropy.org>
> Subject: Re: [ExI] Warren Buffett is worried too and thinks
> 	Republicans are	"asinine"
> Message-ID:
> 	<CAAc1gFiQkwDx6=Sf=nbaiokdDXFcggUtxcBav2+0=QVu=-mHsQ at mail.gmail.com>
> Content-Type: text/plain; charset=UTF-8
> 
> On Sat, Nov 2, 2013 at 10:42 AM, Omar Rahman <rahmans at me.com> wrote:
> 
> Once a person is 26, they are probably going to be mature enough
>> to understand that, like it or not, 'something bad is going to happen to
>> them sometime' and pony up for health care. For them it isn't going to be
>> about 'getting' health care, they will be thinking of the context of
>> 'losing' the health care they had until age 26. Once that shift takes place
>> in the general population it's game over.
> 
> ### EMTALA says (you know about EMTALA, don't you?) a hospital can't
> turn away a person with a medical emergency, no matter whether they
> are insured or not. Why should a 26 year old be stupid enough to pay
> 15k per year for coverage they won't use (chronic disease and
> pre-death care of the elderly), if they know they can get emergency
> care for free anyway?
> 
> Rafal


Emergency care is not free. They can't turn you away but they do attempt to collect fees for their services later and, if you aren't completely broke, they do.

Besides that, there is a lot more to health care than emergency care. Do I really need to tell a Doctor this?

If health care is costing you 15k a year you should come back to Poland. You could pay into the public system here, have a supplemental private policy, and have  enough money left over for a mountain of kielbasa to send your cholesterol levels through the roof so you have an excuse to use all that healthcare you paid for.

Regards,

Omar Rahman


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