[ExI] Healthcare thread again

Thu Nov 28 16:48:35 UTC 2013

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.
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".
----------
>
> 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.
-----------------
>
> 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. 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.
--------------------
>
> 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.

--------------------
>
> 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.

--------------------------
>
> 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.

-----------------
>
> 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. 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, 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.

--------------------
>
> 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?
-----------------
>
> 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.

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. 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.

Count me out of your collective.

Rafal