health care is too expensive to give to everyone.

There is no way we are going to get cost down without sacrificing care and provide it to the Baby Boomers.

We can make some people suffer a lot or we can all suffer a little.

Suffer a lot means that Charlie can’t get his kidney and liver at 68 years old.

Suffer a little means that 40 year olds don’t get mammograms and 20 year olds don’t get pap smears.

The question we have to ask is:

Does Charlie deserve a double transplant at the cost of a thousand mammograms (or ten thousand) that will save the life of two (or ten) women nearly have his age?

Guess what? Charlie says yes, and the two women say no. Charlie votes and only half of the two women do.

Guess who wins?

Here’s the good news. For those of you that have recognized the problem of incentives, you’ll appreciate this.

There is a way to incentivize Charlie to trade the kidney and liver for a dirt nap.

In doing so, the government saves thousands in costs, Charlie’s heirs get bequeathed enough to bury him (and then some), and the economy is rescued fromt he brink of collapse.

Details forcoming.

I think MikeReynolds is more talking about what I mentioned in the post above — incentive.

Nobody is claiming all doctors are greedy and evil. Nobody is claiming that all politicians (hell, ANY of them) are selfless and altruistic.

The issue here specifically is incentive. Pay-for-service by definition incentivises service, not care. It creates a constant “push” for everything the medical providers do. Does that guide and control all their decisions? Of course not.

Does it have an impact? Surely it must.

No doubt most (if not all) doctors make decisions for the good of the patient. Maybe the doctor advocating radical and extreme treatment to prolong somebody’s life for a few weeks is doing so primarily because they don’t want their patient to die — that’s sort of a big part of their job.

But doctors are ALSO influenced by selfish concerns . . . demonstrably so. Ever seen a pharmaceutical rep? Ever wonder why they almost always look like hottie covergirl models? Its not because of their extensive knowledge of the product line. Do doctors prescribe the new (expensive) drug-of-the-week becasue GSK incentives them to do so? Some do. Lots do.

Lets say I’m a doctor. My patient is terminal. I don’t want them to die. Lets try a major procedure. Might not help . . . but doctors often see patients as things rather than people (occupational hazard), and trying different procedures and treatments often has a “why not”, “playing with a big new toy” flavor.

The fact that I can get paid more for two weeks of treatment than I did for the last two years of the patients treatment can’t realistically be considered a “non-issue”.

Does it drive treatment decisions? Probably not. Is it an inherently bad way to pay for care? Not necessarily so. But thinking its not a factor to consider when looking at the issue seems naive.

The existing “law” for doctors is the law of the free market. They make money from performing procedures. So what exactly would motivate a surgeon to say, “Look, you don’t need or want this surgery, all it would do is drag out your miserable existence for another six weeks.”

Why would a surgeon say that to a patient? Altruism? Are you a big believer in altruism? Because I have to tell you that the predicate of a free market is individuals acting in their own interests. It is very much in the surgeon’s interest to perform surgery. And there is really zero doubt that health care in this country is about ass-deep in unnecessary but very profitable procedures.

Unless you propose eliminating Medicare the vast majority of these pointless but very profitable procedures are going to be paid for by the taxpayer. So don’t you think it’s a good idea for the persons paying — the government, meaning us — to have some say in how many pointless procedures a doctor performs? Or is your wallet just an open trough at which any doctor may feed?

It looks like we’ve wandered back into the “doctors are foot-rustlers and tonsil-diggers” territory. The problem I have with the heart of your position is that it seriously distrusts doctors to act in the best interests of their patients in favor of their pocket book while we can trust politicians and bureaucrats to do the right thing. The argument of “we’re paying for it so we should have the ultimate say in it” paves the road to a massive erosion of personal liberties - particularly when liberals want to move us to a system where the government pays for everyone and for ‘every thing’. You’re comfortable attributing altruistic virtue in bureaucrats and politicians (if I’m not misreading you it seems because you think they accurately represent you) and I’m more comfortable attributing altruistic virtue to doctors. Also, I don’t see how getting Medicare to demand these sorts of meetings with doctors solves the problem in your mind - if these doctors are so sinister that they are going to give their patients bad medical advice then how does forcing them to give this bad advice fix anything?

“I’ll take the greedy businessman over the political hack who will make his decisions on who lives and who dies on the basis of party and faction.”

Really? Good luck with that.

Slight disagreement though. The middle-level bureaucrat isn’t making paper-shuffling decisions based on party loyalty — they’re making decisions based on getting out of the office at 4:30. Health-Care “decisions” won’t be heard by Senators and Representatives . . . but by regular working stiffs.
Do you think that IRS paper-pushers do their job entirely differently when a new administration comes into power? Or the DEA? Or the EPA? The case worker doesn’t say to themselves “How can I promote my political ideals with this case?”, they say “How can I close this case?”

And assuming politics does come into play, the other party INSIDE the government can expose it. When politics in the Justice Department became SOP, the Dems screamed bloody murder. In a private company, who INSIDE the company is there to argue for the other side, the patients? Nobody. Unless the Insurance company is idiotic enough to write in documentation “lets kill off these dog policies that cost us money by keeping people alive”, then the patients (YOU) are SOL.

If a caseworker at a private insurance company can avoid paying a big medical bill for a patient, they can get a promotion, a bonus . . . financial incentive for themselves. If a case worker in the government can block a payment . . . they get squat.

Who has an incentive to screw you? Whether or not they actually DO act in a malicious manner . . . who has the incentive?

Anyone who thinks there will be any degree of altruism or even rationality from either private concerns (MooseR, Jackson1234) or the government (you, Marge) is deluded. Until I hear someone explain how the status quo will improve with a government takeover I’ll pass on that option. The actual problem is the uninsured and underinsured, and that should be the focus rather than blind trust the healthcare industry will become Santa or a federal-run, single-payer system will be any less of a political hack job fuck up than Medicare is.

Both private insurers and government make health care decisions. If you assume:

1) That both find an advantage in collecting as much money as possible while paying out as little as possible, and

2) Private insurers are more efficient, you are left with:

Conclusion: private insurers are more likely to kill grandma.

Of course in reality it goes more like this:

1) The CEO of Aetna makes more money every time he can refuse to pay.

2) The GS 16 gets diddly squat for cutting anyone off, therefore:

Conclusion: private insurers are more likely to kill grandma.

In fact, aside from your assumption of government perfidy, I doubt you can construct a logical argument that would lead to the opposite conclusion.

“I have to go with (b.) You really don’t want to leave that decision in the hands of someone whose stock options rise in value if you die.”

I’ll take the greedy businessman over the political hack who will make his decisions on who lives and who dies on the basis of party and faction. I read your description of Medicare, largely right, above. It really undercuts your argument when you come to think of it, to wit, the biggest government health program already makes political decisions.

She was also far from the only one raising questions about the provision. Noted snowbilly fear-monger Charles Lane of the WaPo wrote an op-ed pointing out the problem of simultaneously paying doctors to counsel patients on living wills, etc while at the same time grading them their ‘effective’ use of medical resources.

The existing “law” for doctors is the law of the free market. They make money from performing procedures. So what exactly would motivate a surgeon to say, “Look, you don’t need or want this surgery, all it would do is drag out your miserable existence for another six weeks.”

Why would a surgeon say that to a patient? Altruism? Are you a big believer in altruism? Because I have to tell you that the predicate of a free market is individuals acting in their own interests. It is very much in the surgeon’s interest to perform surgery. And there is really zero doubt that health care in this country is about ass-deep in unnecessary but very profitable procedures.

Unless you propose eliminating Medicare the vast majority of these pointless but very profitable procedures are going to be paid for by the taxpayer. So don’t you think it’s a good idea for the persons paying — the government, meaning us — to have some say in how many pointless procedures a doctor performs? Or is your wallet just an open trough at which any doctor may feed?

The “involvement” of government was that Medicare would pay for the doctor’s visit - once every few years. That’s it. Period. No instructions to the doctor to tell them how to advise their own patients. No death panels. It was pure fear mongering and a bogus, fallacious slippery slope argument.

ed.

Medicare doesn’t already pay for a doctors visit for any reason? A doctor can’t spend 10 minutes talking to a patient during a yearly exam?

It concerns me when a bill has to micro-manage things at this level.