Choice Makes People Healthier AND Saves Money

Luck plays a big role in life, but good luck is often the point where opportunity meets preparation, while bad luck enters through doors left open for it. We choose behaviors that determine life outcomes. This applies to health. A boozing, smoking, overeating, couch potato kills himself slowly AND costs society health care money & productivity. Most people think the guy should pay.

Government and business cannot solve the health care crisis without incentives for healthy lifestyles. But this exacerbates inequality and besides who wants to kick someone when he is down, even if he did it to himself?

Telling people "I told you so" is not very satisfying when they are really in trouble. Just because heart disease results from year of bad habits does not make the victim any less sympathetic. And of course we can never be sure. Some smokers and boozers live long healthy lives. Others do all the right things but still die young, as Jim Fixx and Pistol Pete Maravich showed us.

Humans are very good at learning with effect rapidly follows cause. We are less good at learning when the effect of our action lies far away in space or time, especially if there is uncertainty as in the cases above. Good health is especially difficult to understand and attain. It requires up front payments. It takes months or years for the effects of diet or exercise to become apparent. On the other hand, eating those donuts while sitting in front of the TV provides immediate satisfaction. Our very natures are against us. It is very easy for young people to stay in good condition and they can get away with abusing their bodies. The bad habits they learn become detrimental or deadly as they age, but they might mistake the problems as natural effects of aging. So what can we do?

Inform and empower the people. There are roles for governements, firms & individuals.

The links in the initial post point the way. We need to make good lifestyle choices pay off immediately. We can do that with incentives such as higher insurance premiums or a more sophisticated high-deductible health plans with Health Savings Accounts (consumer directed plans). Since most people will not follow the links, I will cite the study that found a 3-5% decline in health-care costs for employees in consumer-directed plans but a 8-10% increase for those in traditional plans. That is a lot of money AND a benefit to health. That is a real win/win.

Most people are afraid of change even if it benefits them. They also fear risk. Politicians play on this and many oppose plans that give individuals choice in matters such as insurance or pensions on ideological grounds. Although the overall result will be positive for a majority of the people, different choices produce different outcomes. Some people don't like that. They forget that fairness and equality of outcomes are sometimes mutually exclusive goals, and equality of outcomes is almost always at odds with effectiveness.

Posted by Jack at August 4, 2006 11:35 PM
Comments
Comment #173446

I like where you’re going with this like for me sometimes I need to do a total detoxification. Not just from crappy foods but like for example toxic democrats that should really be labeled as in state terrorist supporters, who spill haltered for the country with every maniacal word. If anyone wants more information in how to deal with these artifical toxins like a Hillary Clinton refer to the toxic poison democrat avoidance group in the process of forming as of now because if that bitch becomes president I’m leaving for Cuba (as long as Castro dies)!

Posted by: Joe at August 5, 2006 12:57 AM
Comment #173459

Joe

No need for these kinds of posts. Democrat and Hilary hating is not our topic. What do you think of choice in health care?

Posted by: Jack at August 5, 2006 7:38 AM
Comment #173463

A very touchy subject you picked Jack but an important one also. it is also a very emotional issue too. Health care is an expensive cost in this society. It has also stopped being looked upon as being a privilege and seen by a lot of people as a right to the point of demanding universal health care.

A funny thing is that we have laws that says that the individual must pay for insurance on any car he owns. Laws also declare that the individual must pay insurance on a house he has mortgaged. A person will even pay for a life insurance policy. a person can even buy health insurance for their pets now days. Yet when it comes to their own health care they want someone else to pay for the insurance or they should receive free medical care.

You say that raising premiums would be one incentive to getting people to take better care of their health. To me that is a disincentive because people are already crying about the high costs and one reason they want someone else to pay.

Better education on health is one incentive that works. a good example is smoking. and most people have a good idea of what foods are healthy or not. and they know exercize is important. what it comes down to is a matter of the choices we make in life or as you said the habits we formed.

Another big problem, in my opinion, is the family life style also. We have become a society where families no longer sit at the dinner table and have a good nurishing meal any longer. Everyone comes home, looks in the fridge, and gets the easiest thing to eat or stops at a fast food place before coming home.

Good hard physical work is also missing. this is especially true among our youth. Child obesity is one of the problems stated so often when health is discussed.

Our own technology that has made life so easy can be blamed, even the disciplone of medicine had a part in our lack of health by allowing us to live longer.

We are our own worst enemy when it comes to health.

Posted by: The Griper at August 5, 2006 8:52 AM
Comment #173464

I think choise is a good thing in health care. In Canada the government runs the health care. They have long waits to see Doctors, you can almost forget emergency rooms. I think if we had more choices in health care coverage and far better choices in prescription drugs we’d probably have less complaining. The prescription drugs is my main concern especially for the elderly.

Posted by: KAP at August 5, 2006 8:52 AM
Comment #173465

KAP,
“you can almost forget emergency rooms”

Huh? I have no idea what your talking about there, and I suspect neither do you. Emergency rooms in this country are filled with the uninsured. Under Canada’s healthcare you do have longer waits for elective procedures. Nothing is perfect, but a heart attack in Canada won’t bankrupt you. In the US, it will get you fired and then bankrupt you after you can no longer afford insurance.

Posted by: gergle at August 5, 2006 9:08 AM
Comment #173467

I’m an RN. I’ve worked in ER and CCU and have seen the results of poor choices. The problem is, we work longer hours, it takes two incomes to raise a couple of kids, fast food is too easy and excercise is only done in expensive health clubs. The 50’s way of life has been gone for, well, 50 years now. Some employers in Michigan now require nicotine tests. If you smoke - even in your off hours - they can terminate you or make you pay all of your health premiums. Some employers now offer on site fitness centers and will actually pay employees to work out. These are good things.

Health care costs too much because people expect perfection and cures for everything from doctors who don’t know everything. And when thier preconcieved expectations are not met, they sue. The attorneys get rich, the doctors pay hugh malpractice insurance and the patient gets the short smelly end of the stick. What is needed more than anything - even more than education (because that’s actually pretty good at this point) - is a cap on damages awarded by juries that don’t know the first thing about medicine, and on how much a trial lawyer can earn on one case. THAT is how you fix health care. Get the lawyers and the courts out of the picture. costs will come down.

Posted by: Ilsa at August 5, 2006 9:12 AM
Comment #173470

P.S.
If a person makes stupid choices - smoking, obesity, drinking, they should automatically be barred from sueing any health care professional for any reason other that gross malpractice - like a surgeon taking off the wrong leg or something. IMO.

Posted by: Ilsa at August 5, 2006 9:15 AM
Comment #173471

Jack,

Good post. Not exactly the kind of subject I enjoy reading. I don’t like being told its time to get off my ass and act like an adult.

Charging higher rates to the unhealthy among us is a Sin Tax — if you want to indulge in slothful, gluttonous behavior, you gotta pay. But it gets into an area that might be difficult to manage. If the idea is that documentable unhealthy behavior is to be taxed, are the insurance companies going to levy fines for promiscuous behavior? Is family medical history going to dictate fines for otherwise benign behaviors? For instance, if you are fair-skinned, do you have to pay an extra premium to be outside alot?

I don’t mean to throw water on the idea; we need good ideas. Especially in health care and insurance cost reduction. I think there is merit in your idea. I think it should be coupled with serious tort reform. The days of multi-million dollar judgements against doctors and hospitals must end.

Maybe we can sign up for lower premiums if we waive our right to sue. Naw, that would never work.

Posted by: Charlie at August 5, 2006 9:30 AM
Comment #173474

Ilsa,

Thanks so much for your long hours and hard work. Your work is truly thankless. You work harder that most doctors, but don’t get paid anywhere near the same amount. Nurses rock.

You also hit the nail on the head. We are a litigious society and with so many frivolous lawsuits, too many physicians are unable to purchase malpractice insurance and are driven out of business. Those that can make the payments charge astronomical rates. All because we are in the habit of suing over a stubbed toe. And jurors are willing to hand out ungodly sums of money after listening to some high paid lawyer tell them that the doctor was negligent for not telling them to wear their shoes.

The American Medical Association appears to have lost so many members that they no longer have much clout. Unfortunately, the American Bar Association’s lobby is too strong for law makers to work on capping damages.

Lawyers really do seem to be at the root of this crisis. There’s only one way out of this - start sending nurses to law school.

Posted by: G.K. at August 5, 2006 9:57 AM
Comment #173476

ahhh - if only I could pay for it! Actually, I know a few nurses that are also lawyers - they, unfortunately, are not part of the solution. Once they became lawyers, they became part of the problem. What’s the old saying about killing all the lawyers?

Posted by: Ilsa at August 5, 2006 10:02 AM
Comment #173478

I would like to point out that government and industry are also contributing to the unhealthy lifestyles of the citizens of the world. The fast food chains, tobacco companies, and the companies that produce high fructose corn syrup and other food ingredients play as important role in this issue

The only thing these companies have in mind is the bottom line, shareholder enrichment, and expanding sales. If their products contribute to the decline and health of the world then that is just the way it is.

Take a look at how they market and advertise to children so they will have brand recognition and loyalty for the lifetime of the individual. Tobacco companies were prohibited from trying to “hook” young children and teenagers by the cessation of advertising on television and the print media. Should the organizations that advertise unhealthy food and products be forced to the same type of regulation? I would argue yes.

For those who think it is an individual’s choice to eat, drink, or smoke, please note that the companies that sell and promote unhealthy and healthy products spend millions of dollars in research in human psychology to engender brand loyalty. That is why a major target of the fast food chains, cola, and snack food is children.

Advertising is a powerful tool. That is why there is so much of it!

We have a conflicted society. It is alright to allow makers of unhealthy products to promote and sell their goods, but we condemn those who use them because of the bad choices they make by saying they bought it upon themselves, they should know better and should pay for their bad behavior. While it is true one is responsible for their own actions there are powerful forces attempting to influence the individual to buy products that are not needed and unhealthy.

The pharmaceutical companies and the healthcare industry then benefit after people endure a lifetime of bad health choices.

The corporate world has everything to gain by keeping the status quo. Things will not change under the current system until there is as much profit in helping people as there is in promoting and selling products that are detrimental to good health.

Posted by: jim guy at August 5, 2006 10:18 AM
Comment #173481

Jim,

“While it is true one is responsible for their own actions…”

That says it all. This need not be an antecedent clause. It stands on its own. People are responsible for their own actions. Period. If we are to become a sane and functional society again, we must regain this simple cornerstone to civilization.

I have heard recently that advertising variably works and doesn’t work. I’ve read that advertising makes people do things they would not normally do and that it has no effect at all — that we habitually tune it out.

The truth undoubtably lies somewhere in between. But I refuse to subscribe to the notion that I am driven to drink, smoke or eat because of advertising. Instead, I submit that these actions are my own and the responsibility lies with myself.

It is high time we all adopted such an attitude.

Posted by: Charlie at August 5, 2006 10:40 AM
Comment #173484

I agree with Charlie. We are ultimately responsible for our own well being.

On a side note, I had major surgery a few montha ago and they sent a nurse into the recovery room to give me the required (I think) lecture about smoking. She stood about 5’ tall and weighed around 200 lbs. I told her obesity was just as bad a problem as smoking and I would quit smoking when she quit eating….The lecture didn’t last long.

I know I am slowly killing myself with nicotine but that is MY choice. I LIKE the warm feeling the smoke makes as it enters my lungs. I like the rich bold taste of Marlboro Red. I enjoy the calming effect it has after a stressful situation. I have weighed the options and decided that for me it is worth it. It is MY choice and I don’t think anyone should be able to take that right from me.

Posted by: tomd at August 5, 2006 11:11 AM
Comment #173485

Chralie,

I agree that if everyone realized that they are responsible for their own actions the world would be a much better place to live.

The point I am attempting to make is that we are bombarded with advertising from cradle to grave. These messages influence the psyche and thought processes of everyone exposed to them.

In an ideal society we would promote what is good and not promote what is considered to be bad. Who gets to make these choices is another matter.


Posted by: jim guy at August 5, 2006 11:11 AM
Comment #173487

tomd:

“I have weighed the options and decided that for me it is worth it. It is MY choice and I don’t think anyone should be able to take that right from me.”

I agree with you 90% of the way. The problem is, eventually, your choice is going to become MY problem. At very least, as soon as you get on Medicare when you’re 65 or whatever, there is a huge chance that I am going to start having to pay for your choices.

That quadruple bypass you might need at age 68? My dime. Lifelong supply of oxygen that you’ll carry around? Yep, my money.

My point here isn’t to say that individuals don’t have the right to smoke. I have a pack of smokes in my backpack as well. But the truth is that, sooner or later, your choices have public consequences.

Posted by: Arr-squared at August 5, 2006 11:20 AM
Comment #173493

Jim Guy,

“In an ideal society we would promote what is good and not promote what is considered to be bad. “

This is Brave New World stuff. I prefer freedom to say, do and think what I please. And if I can so can RJ Reynolds, Nabisco and GM.

Personally, I don’t care who promotes what as long as it is legal. That is what a nation of laws does. Freedom is a wonderful thing. By definition, it does not come with an instruction booklet and a Guarantee/Warranty.

Posted by: Charlie at August 5, 2006 12:14 PM
Comment #173494
Government and business cannot solve the health care crisis without incentives for healthy lifestyles.

Jack,

Government and business cannot solve the crisis because they helped to create the crisis. 50-60 years ago people were much more fit than they are today. They were much more active, but they also ate differently. Remember the 4 basic food groups? The main staple at every meal was meat.

For years, the government told us to reduce meat consumption and instead eat a diet that was modeled after a diet to fatten up livestock. Refined carbohydrates became the main staple. Problem is, is that refined carbohydrates cause a chemical and hormonal reaction in the body, mainly insulin and serotonin. When you eat those refined carbs, insulin skyrockets. Unfortunatly when they refined the carb, they removed the most benificial parts. Without the fiber that whole carbs contain there is nothing to slow down the release of sugar into the blood. When insulin is done doing it’s job, it does not simply just disappear from the body. It wants more work to do, suddenly you get the cravings for more food.

They are finding out that insulin can be far more damaging to the body than fat. It causes inflammation and can actually lead to the heart damage that causes heart disease. Cholesterol is not the main culprit. Cholesterol actually accumulates in the arteries because it is used as a repair mechanism by the body for insulin related inflammation damage. When we eat refined carbs we are causing an unnatural flood of insulin in the body, some people walk around with chronic high insulin levels.

Serotonin is a feel good hormone in the body. When you eat carbs, serotonin increases. That is why some people increase their consumption when under stress. It has also causes food addiction in some people. Addiction that can be as hard to break as smoking or drugs. I know, I am a food addict. I am currently undergoing laser therapy to break my addiction. They use the same therapy for smoking and alcoholics. So far, so good.

Today, the government recommends a diet much more reliant on fruits and vegetables, which is a step in the right direction. However, refined carbs are still there, and years of being told to eat them is a hard habit to break. If people want to become healthy they need to stop watching their fat intake and start watching their refined carb intake, which if far more dangerous.

Why did the government advocate eating tons of refined carbs in the original food pyramid? Was it really out of concern for American’s health? No it was because of agriculture lobbyists. Look at the food on the old pyramid, not from a nutritional standpoint but from an economical standpoint. Refined carbs are cheap, and have a virtually indefinite shelf life. The profit on refined carbs is huge. As you go up the food pyramid, profits decrease. Fruits and vegetables, meat and cheese, dairy, etc. all go bad, creating a lot of waste and lost profits.

The new food pyramid is an improvement with more emphasis on fruit and vegetables. If you want to know how to eat healthy, the next time you go to the grocery store notice how it is setup. Not all are set up the same, but in general most have whole foods around the perimeter, and all the refined carbs are in the center. Stick to buying foods only from the perimeter where they sell whole foods and avoid the center.

Sorry for the rant, but it is not as easy as just saying we need to take personal responsibility for our lifestyle choices. There are many strong contributing factors. Food addiction can be just a strong as smoking or drug addiction. If insurance companies are truly interested in lowing healthcare costs, they should pay for preventive care. The laser program I am in now is not covered by insurance, as I suspect most weight control programs are not. If they helped cover the costs of such programs people would be healthier and “big ticket” claims should decrease.

Posted by: JayJay Snow at August 5, 2006 12:20 PM
Comment #173496
The point I am attempting to make is that we are bombarded with advertising from cradle to grave. These messages influence the psyche and thought processes of everyone exposed to them.

Jim Guy,

I don’t think the problem is advertising. As I said above, I think the problem is the addictive nature of what is being promoted.

Posted by: JayJay Snow at August 5, 2006 12:23 PM
Comment #173498

KAP,

I work in an Emergency Room. Every day our beds are filled with Medicaid and uninsured patients, because doctor’s offices will not see them. We have no choice. By law, we must see every patient that comes to the ER. It doesn’t matter if they are there for a stubbed toe, or a pregnancy test. We have and must see everything. We have patients that own thousands of dollars in ER fees, because they come there for the stupidest things, we still have to see them no matter what.

The worst part is that they are the most demanding patients in the ER. The ones that are truly sick and belong there rarely if ever complain. Would you or a loved one want to be a patient in the ER having a stroke or a heart attack and have your care compromised because the dumb ass in bed 6 is distracting your caregivers about the wait, and accusing your nurse and doctor of discrimination because s/he has Medicaid?

It is truly ridiculous, and we need to address the system to get these people out of the ER, so that we can give the best possible help to those truly having an emergency.

Posted by: JayJay Snow at August 5, 2006 12:41 PM
Comment #173500

Ilsa…surely you jest, being legally discharged from your job for smoking on your own time! Do they also administer a body mass analysis and fire those who don’t meet the norm? I hope you’re a liberal Ilsa, cause I would hate to hear this from a conservative. Wait, I know I would never hear this from a conservative! Jim

Posted by: Jim at August 5, 2006 1:05 PM
Comment #173503

Jim,

I am a liberal, and I think it is horrendous that employers can fire you for what you legally do on your own time. I also think it is horrendous that they can fire you for no other reason than your sexual orientation. Believe me, it is not liberals who say that is a good thing.

Posted by: JayJay Snow at August 5, 2006 1:23 PM
Comment #173505

“as soon as you get on Medicare when you’re 65 or whatever, there is a huge chance that I am going to start having to pay for your choices.”

When I get on Medicare, I will be using an “insurance” program that I’ve paid into for over 40 years. Isn’t that what insurance is for?
If you don’t want me to use it then I’ll be happy to opt out of the whole social security thing….Oh! that’s right we can’t do that either.

Seriously, where do we draw the line and who gets to decide where the line is drawn. Do we go after JJ because he has an eating problem? After my cigs are gone will coffee be next? Surely caffene can’t be good especially in kids.

Posted by: tomd at August 5, 2006 1:32 PM
Comment #173509

Conservatives are all for personal responsibility, until it comes to moral issues like sex, drugs, gambling, and physician assisted suicide, then personal responsibility can take a flying leap.

Liberals are all for personal responsibility until it comes to safety and welfare issues, then personal responsibility goes out the window.

The ONLY party that is truly for personal responsibility is the Libertarian Party.

Posted by: JayJay Snow at August 5, 2006 1:37 PM
Comment #173511
Choice Makes People Healthier AND Saves Money

Jack,

Saves money for whom? HSAs save money for employers, not employees. The figures you cite “3-5% decline in health-care costs for employees in consumer-directed plans but a 8-10% increase for those in traditional plans.” are costs to employers not neccessarily employees as you state. The next sentence that you left off is “The study did not look at the cost trend for consumers.”

Since Republicans are pushing HSAs it is fair to assume that someone on the supply-side is making out like a bandit, while consumers will suffer. That is the usual way Republican plans work.

Posted by: JayJay Snow at August 5, 2006 2:13 PM
Comment #173518

JayJay

It is good to cut waste. No matter who is the initial beneficiary, we are all better if we do not waste money, time and resources. There are no losers if people stay healthier. My employer gives me four hours of six leave every two weeks. I can accumulate this year to year. I don’t get sick so after 20 years I have enough leave to be sick for about a year and a half (if you account for holidays.) Am I being ripped off if I don’t get sick and use “my” hours? My employer saves a lot of money if people like me don’t get sick. How terrible is that? But maybe it would be a good idea if we could figure out how to incentive others to be more responsible. Some of the people in my office are sick exactly the number of hours they earn in sick leave.

The other problem is the health care costs are becoming unsustainable, no matter who pays.

You should not base your judgment on envy. If I am better off, it does not keep me awake at night worrying if others are “MORE” better off. Of course, I am not a liberal. Maybe that’s is one reason.

Posted by: Jack at August 5, 2006 3:03 PM
Comment #173523
My employer gives me four hours of six leave every two weeks. I can accumulate this year to year. I don’t get sick so after 20 years I have enough leave to be sick for about a year and a half (if you account for holidays. Am I being ripped off if I don’t get sick and use “my” hours? My employer saves a lot of money if people like me don’t get sick. How terrible is that? But maybe it would be a good idea if we could figure out how to incentive others to be more responsible.

Jack,

Sick time is given as a benifit to the employee. My employer recently eliminated sick time. The hours that were previously earned as sick time have been rolled over into our PTO time. We can now use these hours for illness, vacation, personal time, etc. When we quit we get a check for the balance of hours. We can also give our hours to other employees that are suffering a hardship. My employer saves nothing if I don’t call in sick. They probably do save administrative costs by having only one account instead of a seperate sick bank.

You should not base your judgment on envy.

I don’t envy anyone. A lot of Americans are better off than I am financially, however I am perfectly content with what I make. Money is not the center of my life. My time and experiances are much more valuable to me. My point was that you were misrepresenting who was saving money. The study did not say that employees saved money, it said that employers saved money. Part of that saving comes from a shifting of costs. I have nothing against employers saving money ethically.

If I am better off, it does not keep me awake at night worrying if others are “MORE” better off.

Very few things keep me a wake at night. What if you were worse off, while someone else was better off at your expense?

Posted by: JayJay Snow at August 5, 2006 3:41 PM
Comment #173528

There are ways to save money on health care.
1) Everyone pay with cash. Turn in quarterly the bills for insurance purposes. The paper shuffle for insurance starts with extra staff people at the doctor’s office and the pharmacy whose jobs are strictly for dealing with insurance companies and billing. Save 4-15%.

2) Pay with cash. Not credit card. Save an additional 1-2%

3) Limit damages for medical malpractice. Save $$ and time for all the extra tests that were really unnecessary.

4) Limit damages for prescription manufacturers. Yah, occasionally someone is going to be harmed by a drug side-effect… kinda sounds like things wouldn’t change much from the way things are now! But the cost of prescription drugs would drop.

5) Triage for emergency rooms. Common colds and flu, etc. get sent to a local 24 hour clinic across the street or elsewhere in the hospital.

6) Hospitalization for uninsured people is on a pro-rated cost basis. They must pay 80% of the “cost” of their stay. More people will get insurance if they know they have responsibility for their own lives. There is extremely low cost insurance for hospitalization only. The expensive insurance plans include doctor visits and prescriptions and tests, etc. Many states allow people to sign up for low-cost plan run by the state.

“No hassle insurance” = high cost insurance.

“Everyone gets attention at the emergency room” = poor care and high insurance costs.

“People with no insurance deserve the same care” = those who pay for insurance get the shaft.

Posted by: Don at August 5, 2006 4:18 PM
Comment #173535

Jim and JayJay,

You can look it up, but here in Michigan a few major companies, including one Community College, instituted a non-smoking policy that allows for either employees to be terminated or they have to pay more for thier insurance. It has already been tried in court and the companies have won. Now, I am a conservative. I’m also a former smoker (quit 10 years ago - Thank God!) As a health care professional, I used to use the double standard “do as I say, not as I do”. For years, I didn’t weat a seat belt either. But over time I’ve grown up. Smoking and not wearing a seat belt are just plain stupid. It may be a choice but so is setting yourself on fire. Not too bright.

I personally believe that people must take responsibility for thier choices - even having to pay for them. I’m sick and tired of seeing patients come to the ER with smokes in the pocket, the large Mountain Dew and bag of chips, asking for the phone, blanket and social worker to get them the cab slip so they can get home. Oh, and yes, they are the first to whine if the wait is too long or if the doc doesn’t give them that shot of demerol that they actually came in for - not the abdominal pain caused by the Dew and chips - and really pissed if they can’t get the ride home for free. The reason they are there is because the docs can’t see them because they can’t get paid by Medicaid (of which Michigan has one of the largest populations on the public dole - our welfare system is SOOOOOOOO huge!). Most people don’t work for free so why does the government expect the doctors too?

Any way you look at it - conservative or liberal - this system is costly, ineffective, and lopsided, but I stick to my guns on personal responsibility and not letting the lawyers run things.

Posted by: Ilsa at August 5, 2006 5:24 PM
Comment #173536

Jay Jay
I was referring to the er’s in Canada. With their universal health care it’s kind of hard to see a Doc. When I was up their dismantaling a company that the company I work for here at home bought out, the supervisors that were with us told us to be very careful because they didn’t want us going to the hospital up there. I’d like to see universal health care here but from what I hear about the problems Canada is having I don’t think it would be a good idea. I am all for choice.

Posted by: KAP at August 5, 2006 5:25 PM
Comment #173540

hehehehehe — if any of you think universal health care is a good idea then you’ve never belonged to an HMO where some suit decides whether you need that heart surgery or not……no freedom of choice, no say in your own healthcare, no treatment for certain diseases………….not pretty.

Posted by: Ilsa at August 5, 2006 5:30 PM
Comment #173544
1) Everyone pay with cash. Turn in quarterly the bills for insurance purposes.

Don,

How does that help? 1) That is fine if you are wealthy, but some of us paycheck to paycheck shmoes just don’t have extra money laying around to get us by until (if) the insurance company decides to reimberse us. 2) Instead of having people trained to deal with insurance companies you would just put the burden on people who don’t know anything about it, vulnerable to being screwed over by the big insurance companies.

5) Triage for emergency rooms. Common colds and flu, etc. get sent to a local 24 hour clinic across the street or elsewhere in the hospital.

Emergency rooms cannot, by law in Michigan, turn away patients due to their complaint or ability to pay. The hospital I work for had an urgent care center, it closed due to decreased reimbersment from insurance companies and increased cost. There are no other clinics in the area. After hours the ER is it.

They must pay 80% of the “cost” of their stay. More people will get insurance if they know they have responsibility for their own lives.

Who is going to get them to pay that 80%? We have a hard time collecting anything, much less 80%. Most just don’t care and don’t pay. Even if they owe the hospital thousands of dollars and refuse to pay, we still have to see them.

Posted by: JayJay Snow at August 5, 2006 6:22 PM
Comment #173545
We need to make good lifestyle choices pay off immediately.

Huh? In the first place, it sometimes takes years to determine what the bad choices are. Am I the only one who recalls when doctors would recommend cigarette brands and when patent medicines containing mostly alcohol were used to maintain health? In the second place, who decides what are the “better choices”? What about the scare a few years ago having to do with the effect that aluminum cookware and/or teflon coating had on health? Is drinking bottled water a better choice than drinking tap water? If I drink 8 cups of water a day am I going to be more healthy than someone who drinks 8 cups of coffeee a day? My doc says as long as it doesn’t keep me awake at night, there’s nothing wrong with drinking as much coffee as I feel like.

You say you’re for choice but it seems like you’re proposing to dictate “healthier” habits that may or may not be healthier. Which is more likely to result in better health and longer life: driving 5 miles to work or bicycling 5 miles to work? What about when you factor in the danger of breathing polluted air or being run over by a truck?

We can do that with incentives such as higher insurance premiums

I think most medical and life insurance companies already charge higher premiums for smokers. I’ll put it this way: mine do. As a non-smoker, I think it’s great. But I’m not sure how this goes along with your call for more choice.

or a more sophisticated high-deductible health plans with Health Savings Accounts (consumer directed plans).

HSAs are a crapshoot. What you have to do is figure out in advance how much you will probably spend on qualified (i.e. breast enlargement is not qualified) health care in the following calendar year. If you in fact do spend that much money or more, the HSA helps. If not, you lose that money. Now to me, if the year is about to end and I’ve still got money in that account, I’ve got to find some way to spend it or lose it. And the only thing you save, in their current incarnation, is the income and SS tax you would have had to pay on it. Doesn’t really help much.

Ho hum… another day, another simplistic, half-cocked missive (moderator note: I’m criticizing the message, not the messenger) on the Reps/Cons board. So what else is new? Why aren’t you guys writing about the blossoming of WWIII your fearless leader has successfully orchestrated?

Posted by: Crazy_joe_divola at August 5, 2006 6:24 PM
Comment #173546

Ilsa,

I know. The company that fired 4 workers for refusing to take a nicotine test was Weyco Inc., an insurance company. I think it is absolutly discusting that they can get away with firing someone for what they legally do on their own time.

Posted by: JayJay Snow at August 5, 2006 6:28 PM
Comment #173548

Actually, I really appreciate you bringing this up, Jack. Because there is really only one solution to the problem of health costs spiraling higher and health quality (not health care quality) spiraling lower.

And that solution is to outlaw health insurance and deregulate life insurance. Why do you think health care costs more and more each year while the health of this country on average continues to get worse and worse? Docs and pharmaceutical companies can charge more and more every year because they know someone will pay it, whether the insurance companies or one of the governmental payors such as Medicare. If health care was like a grocery or a bookstore, the health care system would have to charge according to what people are willing to pay, not what their insurance covers them for.

There would be so many other benefits of such a system that I just have neither the time nor the interest in enumerating. Net-net, though, people would come to take responsibility for their actions as they affect their health. it will never happen.

Posted by: Crazy_joe_divola at August 5, 2006 6:35 PM
Comment #173555

tomd:

“When I get on Medicare, I will be using an “insurance” program that I’ve paid into for over 40 years.”

Well, no. Like social security, payments deducted today go to pay the benefits of today. Not one of us is happy about that, so let’s lay that aside.

Again, the issue isn’t that *I* want or don’t want you to do anything. The point is simply that private choices often have public consequences.

Insurance doesn’t mitigate this at all, really. The whole logic of insurance is that the insurer gambles - if you never use much medical care, the insurer makes money off your premiums. If you do consume health care, the cost of that health care is met by raising your and others’ premiums - it’s a game that only the consumer can lose.

Posted by: Arr-squared at August 5, 2006 7:13 PM
Comment #173560

JayJay -

The problem is that no one wants to take responsibility for their own health care. So, you’d rather pay a bunch of middle-management types to know stuff about you they don’t need to know, just because you can’t save a few dollars to pay your own bills?

If you have to foot the bill for 3 months, you’re going to make wiser choices in terms of what tests and what procedures are performed. You’re going to say “Hey, Doc, is this test really necessary and what are you looking for with it?” You are not going to be paying for the insurance person at POS (Dr’s office, lab, pharmacy, specialist office).

Further, what great knowledge do you need to put your medical bills in an envelope and address it to your insurance company? I used to do it that way, and it worked. I’d get a nice reimbursement check every three months. I didn’t have a bunch of medical bills coming in the mail and 17 mailings from my insurance company each month. Who pays for all that billing? Who pays for all those insurance mailings? YOU DO.

The point is, take responsibility for your own medical care if you want to save money.
——————-
Now to the point of this thread…

I don’t want to pay for someone else’s bad habits!

If you smoke, if you’re overweight due to over-eating and insufficient exercise (I am), if you drink heavily or take illegal drugs, participate in random acts of sex with random partners… you should pay higher premiums. Why should everyone subsidize your bad habits?

Whenever you make people take responsibility for their own health care, health care costs will go down. Whenever we make it easier for people to get health care; making it so they don’t have to make any real financial decisions; making it so they don’t have to reach into their own pocket for the $120 it costs… we increase the number of worthless procedures and unnecessary visits.

The most effective way of reducing health care costs is to directly involve the pocketbook of the healthcare recipient.

Posted by: Don at August 5, 2006 8:19 PM
Comment #173561

BTW -
What I’m talking about above does not include hospitalization. That bill is too big and has too many twists and turns for the average layman to understand.

What I’m talking about is the doctor visit, lab test, prescriptions, etc.

Posted by: Don at August 5, 2006 8:24 PM
Comment #173562

Ilsa:

Any way you look at it - conservative or liberal - this system is costly,

No question. Not only is it costly, it is becoming costlier faster than the overall statistical price inflation rate AND it is becoming costlier faster than the other three life requirement cost classifications (food, fuel and housing).

ineffective,

Not sure what you mean by ineffective, but for what is at its essence a communal (not to say communist) endeavour trying to cope with and survive a “free-market” social-Darwinist regulatory environment, the medical care system in this country does a pretty good job. Could it be more effective? Absolutely. Could it be more cost-efficient? No question. But anyone who wants to receive medical care in this country can do so on some reasonable terms, so I think it’s pretty effective by that measure.

and lopsided, but I stick to my guns on personal responsibility and not letting the lawyers run things.

People who say things like this have never been in a situation where they have been, are being or will be screwed over by someone or something over which they have no control, nor can they imagine ever being in such a situation. Sure, people file frivolous lawsuits all the time but most of them are thrown out by the lawyers themselves before getting within miles of a courthouse.

Do this: Google Robert Courtney . Now tell me if you think the civil lawsuits that were filed against him should not have been. Tell me if you think those lawsuits were not reasonable punishment for what he did. Tell me if you think those lawsuits do not go a long way toward dissuading future would-be Robert Courtneys that they had better think again about enriching themselves at the cost of other people’s lives.

One man’s frivolous lawsuit is another man’s justice.

Posted by: Crazy_joe_divola at August 5, 2006 8:32 PM
Comment #173564

Jack,

Aren’t you concerned that if all participants were charged for their health insurance purely on their health risks that:
a) People with arbitrary less than optimal health circumstances will never get insurance and if you were to lose your job you will not be reinsured after COBRA?
b) We will decrease the number of people who can afford insurance
c) As we decrease the number of people who can’t afford insurance we will decrease the funding available for people who need the insurance
d) You are punishing children for the choices of their parents
e) That health costs of those uninsured will skyrocket because of a-b-c-d and those costs will either:
i) Bankrupt hospitals or
ii) Increase Medicade costs even further
???
Becareful of what you wish for.

Posted by: Dave1 at August 5, 2006 9:08 PM
Comment #173597

Re: Tort reform and pharmaceutical company protection from litigation.

Oh how I just love it when people who have never been harmed by our medical system start bantering about ideas on limiting damages awarded to the victims. How right that idea seems: protect and reward the people responsible for the injuries and throw down some more hardship on those who’ve been grievously harmed.

Would that every guilty party would have such protections; perhaps next we should apply this logic to criminals. Guilty of murder? Hell, the guy deserved it anyway, let’s piss on his grave and throw his family to the wolves; here, have a cookie. Armed robbery? Damn those people with all their nice things, just begging to have you steal it all, let’s bitch at them for asking for compensation for the things stolen; here, have a cookie. Assault? Is that even a crime anymore? Oh well, that guy’s head just shouldn’t have been in the way of your baseball bat, let’s put some salt on his wounds and send him on his way. Would you like a cookie?

Sound good? No? Why not? Oh, seems you still have some allegiance to the idea of justice floating around in that ball of grey matter.

Why is it then, that when a group of individuals band together, give their group a classy name such as Merck, or Pfizer, or Bayer, etc…, that they can then go about willy-nilly injuring and killing people without fear of reprisal? No one ever goes to jail and somehow there are actually people out there who stand by their sides and complain that the people they’ve hurt should just shut up (the one’s who lived anyway) and go away without any sort of meaningful and lasting recompense. Has any group of citizens ever been given this sort of power and carte blanche authority to maim, torture and kill in the history of our country? What makes them any different?

One could argue that they also do good works, that the people who are helped by them far outnumber the injured. But let’s take a look at that shall we? If a man becomes a firefighter early in life and devotes his time and energy to saving people, eventually saving 100 people from a horrible death by the time he reaches the age of 50, do these positive attributes and deeds then give him the ability to go out and kill, say, 2 people and not get punished for it? No? Then why would this logic then apply to any other non-governmental entity? Is it because these entities are profitable? What a world…

At the age of 23 I was given a prescription drug which subsequently caused severe damage to every single tendon and muscle in my body, along with nerve damage, severe fatigue, near destruction of my short-term memory, and a myriad of other debilitating maladies. Over 19 months later, I am still being tortured every single day, all day long. Nearly unable to walk, with limited use of my arms as well, the pain is, quite literally, unbearable. It truly, really sickens me to see people who don’t know me (or any other victims) or have to endure such indignities and cruelties to sit back from the comforts of their daily lives and expound on and pontificate about how much my life is worth.

There are tens of thousands of other victims of the class of drugs that did this to me as well, some much worse off than I am; who are you to tell these people what their lives are worth?

25,000 people (minimum). Enough bodies to fill most people’s homes to the breaking point with slowly decaying flesh. With more than enough left over to fill up the entire neighborhood as well. This is how many people died as a result of a single drug: Vioxx; a freaking massacre, to say the least. 3,000 people died on 9/11, and we banded together, determined to wipe those responsible from the face of the earth forever. We were willing to spend well over 300,000,000,000 dollars of our collective funds doing so as well. Nearly 10 times that many (minimum) die at the hands of one group of our fellow countrymen and the response is to propose legislation shielding them from having to pay anything for their crimes of altering study data and gross negligence.

Over 100,000 people die in this country each year due to adverse reactions to pharmaceuticals. Welcome to the culture of life*.

Wonderful that the media only reports on the frivolous lawsuits, thereby giving people the idea that that is all there is. Everyone in the country can talk for hours about the woman who spilt hot coffee on herself and won a bunch of money. How many of you can name any case where someone who was grievously injured was afforded justice? Guess there aren’t any then…(yes, that’s sarcasm).

But what about tort reform? Surely we need to stop those greedy bastards from suing doctors and taking money away from those poor insurance companies. I mean, less than 2% of insurance company profits (which are at record highs all over the country) is certainly more important than someone whose life has been irrevocably altered. Just look at how well capping damages worked in Texas and elsewhere, where medical malpractice insurance premiums are climbing higher and faster than in the rest of the country. All those poor bankrupt insurance companies, forced out onto the streets while those greedy victims are sitting high on the hog and swimming around in their ill-gotten money like Scrooge McDuck in his bin.

And who cares that corporations are 160 times more likely to file a lawsuit than an individual? That the 7 million corporate entities in the US file 4 times as many lawsuits as the near 300 million citizens do? Who also cares that these cases filed by corporations are 69% more likely to be sanctioned by the presiding judge for filing frivolous claims or defenses? I mean, jeez, we need to stop those damn victims from exercises their rights and seeking justice when their lives have been ruined. Just don’t let any of these facts get in the way of corporate and government (if there’s a difference anymore) interests, right?

Blame the victim, they’re the real enemy; never discuss capping the amounts that companies can charge for medical malpractice insurance. No way, that’s un-American. Screw the little guy, who’s being tortured or even possibly dead, simply because they took a pill or went to the wrong doctor.

Welcome to the culture of life*.

*The culture of life contains no guarantees or promises of equality, neither explicit nor implied. The culture of life is void where prohibited by law.

Posted by: Liberal Demon at August 6, 2006 8:52 AM
Comment #173603

Liberal Demon,

I am sorry to hear of your situation. It sounds like you got a really raw deal.

Posted by: Charlie at August 6, 2006 9:35 AM
Comment #173604

Crazy Joe,

My HSA refunds the unused balance at the end of the year, but I have to ask for it. Your HSA sounds like a nightmare. I suggest telling your employer to switch plans or something.

“And that solution is to outlaw health insurance and deregulate life insurance.”

This is completely unnecessary. Moreover, it is socialist — something I will reject instinctively. But more to the point, there are ways to improve the system we have. Don has outlined some good ideas above. And I would listen to Ilsa. She is on the front lines and providing insightful information.

Posted by: Charlie at August 6, 2006 9:44 AM
Comment #173607

Jack:
Interesting ideas… however, human psychology is not as simplistic (i.e., behavorial) as your post assumes…. nor, have you factored in the financial costs of healthy choices, especially viz-a-viz choices in nutrition: eating well costs more than eating poorly (lifestyle choices are a factor of socio-economic level)…. nor, have you considered the moral and ethical implications of what your propose…. nor, have you considered the political impossibility of implementing it: it would essentially unravel the GOP’s “southern strategy” and its coalition with the religious right which are built on abstract fears such as racial equality and gay marriage. These abstract fears would evaporate when these folks are faced with the disproportionately negative impact of your proposal on them and their families.

Finally, you might want to look at systems that work and see what you might learn from them. No reason to re-invent the wheel. A recent JAMA research article would be a good place to start. Here’s a link to a brief overview of that article: http://www.livescience.com/humanbiology/060502_unhealthy_americans.html

Posted by: Dr. Poshek at August 6, 2006 10:29 AM
Comment #173614

Dr. Poshek

“eating well costs more than eating poorly”

What evidence do you have of this? Going to the grocery store, I can buy several meals worth of fresh vegatables, nuts and breads for the cost of one KFC dinner.

“nor, have you considered the moral and ethical implications of what your propose”

Please explain. I fail to see the moral dilemma in being responsible for one’s own health and behavior.

I followed the link and read the article. I saw nothing in it that would contradict Jack’s statements or premise. Much less anything about a “system” which we might learn from.

The article quotes the authors as saying “We cannot blame either bad lifestyle or inadequate medical care as the main culprits of these socioeconomic differences in health” and then goes on to list five BEHAVIORAL effects on health.

I simply do not see how you have made your point. And please leave out the political demagoguery (“abstract fears such as racial equality and gay marriage.”)

Posted by: Charlie at August 6, 2006 11:43 AM
Comment #173620

“I agree that if everyone realized that they are responsible for their own actions the world would be a much better place to live. The point I am attempting to make is that we are bombarded with advertising from cradle to grave. These messages influence the psyche and thought processes of everyone exposed to them.”

OK Jim, so should we also make it less profitable for Hollywood to make movies promoting violence and destruction because the constant barrage of images might “influence” some young child to blow up his family house or kill the little neighbor kid next door, or take a gun into school and cap a few bullies? How far do you want to take this?

The important point has already been made. The INDIVIDUAL is to blame for their bad decisions, influence notwithstanding. Stop trying to lay the blame off onto everyone else. You should instead promote better health education in school and at home, a more detailed education in what is good and what is bad and why, and for the parents to make responsible decisions about what their child eats.

No company should have to be held liable for the end result of the use/abuse of their product…
you can choose to use it or not (this goes for food, drinks, alcohol, tobacco, guns and everything else). As an adult, if you or anyone else is swayed by advertsing, it is because deep down you wanted to be.

I personally am fat…I eat the wrong stuff and I know that. I don’t blame anyone else for that decision. I also have health problems related to smoking. I don’t hold the tobacco companies at fault for my smoking years because they didn’t hold that cig to my mouth and light it, I did that. I TAKE RESPONISIBILITY FOR MYSELF!!

Children are under the care and supervision of their parents, and should be fed and educated by them. Advertising should have no effect because the parents control what the kids eat and drink, until healthy habits are formed, after which it becomes second nature.

People need to stop trying to blame everyone else for their problems. God, or evolution, (or whatever force you believe in) has endowed human beings with a free will and the ability to make rational, mature, well thought out and execuited decisions, free from the constraints of instinct and outside influences. We need to exercise that free will and decision making ability, and take responsibility for our actions and the consequences of those actions. PERIOD!!

DaveR

Posted by: DaveR at August 6, 2006 12:24 PM
Comment #173624

Arr-squared—

“I agree with you 90% of the way. The problem is, eventually, your choice is going to become MY problem. At very least, as soon as you get on Medicare when you’re 65 or whatever, there is a huge chance that I am going to start having to pay for your choices.
That quadruple bypass you might need at age 68? My dime. Lifelong supply of oxygen that you’ll carry around? Yep, my money.”

You are forgetting…TomD paid for that as well…(presumeably he pays taxes). If you are going to use that analogy, then do you also think that it is wrong for people to get unemployment benefits, food stamps, welfare, health care from public health facilities, and other “free” services? All of these are taxpayer subsidized and benefit only those people who need these services, while being paid for by everyone in society. And yes, I acknowledge that there certainly some people who receive these various benefits who need to through no fault of their own…but there are also people who receive these benefits for conditions or situations they helped create and could have avoided (their “choices”).

If you have a problem with subsidizing Tom’s smoking, then you should have problems with subsidizing John Doe’s drug rehab and Jane Doe’s alcoholism treatment, and the bad heart their son has because they fed him fatty food since he was born and now he is 5 years old and weighs 200 pounds, and their undernourished baby who is 20 pounds light and sickly because they sold his publically subsidized formula for money to buy drugs and booze and smokes. Where do you draw the line? Who gets your blessings for their “bad” behavior and who gets your censure?

Don’t get me wrong…I am not saying whether I am for or against paying for other people’s bad decisions. I am merely playing Devil’s advocate and making the point that you cannot talk about cutting one person off from the public dole (for situations they created themselves) without cutting EVERYONE off for the same sort of thing.

At least Tom sounds like he is responsible enough to (maybe) pay for his own insurance and treatment. I have met many people who aren’t.

DaveR

Posted by: DaveR at August 6, 2006 12:51 PM
Comment #173625

JayJay—

“Conservatives are all for personal responsibility, until it comes to moral issues like sex, drugs, gambling, and physician assisted suicide, then personal responsibility can take a flying leap.”

I am a conservative, and I am definitely for personal responsibility. Your above observation is flawed. Persoanl responsibility IS a moral issue…if people would exercie it, we wouldn’t feel like we had to do make laws forcing them to take responsibility for their actions.

For instance:
I support legalizing drugs to break the stranglehold of the cartels and help curb drug related crime…just don’t blame me when you get addicted to cocaine or meth and need rehab b/c your wife left you or you can’t hold a job. I don’t use drugs and have no desire to do so. But if I did, I certainly wouldn’t blame you or anyone else when I become addicted or get busted and go to jail.

Gambling? It is not an addiction…it is a weakness of character and a lack of personal control. My wife and I both gamble in the local Indian casinos…we set a dollar limit we will spend and we stick to it. We exercise responsibility and personal control. Is it a moral issue? No, it is a personal one. Should gambling be illegal? Nope, as long as I don’t have to pay for your “addiction” rehab.

Sex? What part? The having it part or the getting pregnant part?
I say, f—k all you want to…what do I care? But when you get HIV/AIDS or syphilis or some other STD, don’t blame me for your predicament and cry about how we aren’t finding a cure fast enough. Cancer has been around for literally thousands of years and there isn’t a cure for it yet either. Sometimes that is the way it goes. Deal with it.

As for the pregnancy aspect…sex is a choice. Pregnancy is a choice. Using condoms or the pill or an IUD or a diapraghm (or…GASP!!…not having sex at all) so you don’t get pregnant is a choice. What to do with your own body is a choice, right up to the point that you actually become pregnant (by “you” I don’t mean just the woman but a couple…after all, it takes 2 to tango). When that happens, the choice has been made. You are now responsibile for creating a new life, and it isn’t “your” body you should be concerned about any more. You made your choice, now live with it.

Abortion is NOT birth control!! It is a refusal to deal with the consequences for one’s actions and take responsibility for the life that has been created as a result of those actions.

With the exceptions of rape or dire threat to the life of the mother, abortion should not be an option once pregnancy has occurred. There were other options available and they were ignored. Murdering an “unwanted” child is not one of those options. If the child was
“unwanted” you shouldn’t have allowed yourself to get pregnant in the first place!!

Is abortion a moral issue? Yes, it is. Should I have the right to tell you what to do with “your” body? Yes I should…because it isn’t your body I am concerned about. It is the life within that body…the one who didn’t ask to be there and who doesn’t have the ability to make a choice whether to stay or to go. We don’t allow you to use “your body” to commit murder or rape or assault on another person…why should this arguement be allowed to commit an atrocity against a totally innocent unborn life? (I already know the answer that abortion advocates give…but that answer is b-llsh-t and a cop-out. Just another example of avoiding responsibility).

When you choose to exercise your free will and you decide upon a course of action, you also accept the responsibility for the consequences of that action. You can’t go back later and go “Ooops, I goofed…can I get a redo?” You have to deal with the circumstance you created.

THAT…is called personal responsibility!

DaveR

Posted by: DaveR at August 6, 2006 1:39 PM
Comment #173627

DaveR,

I agree totally. Women rightly say that when a man get’s a woman pregnant he is responsible for child support “because he was there”. Women should have the same responsiblity toward the baby as the man does. Some seem to want women to have all the rights and none of the responsibility.

While gambling may not be an addiction in the sense you are saying, it sure looks and feels like one to a person in that trap. Addiction causes lack of control, but is not the only thing that can cause a lack of control.

You are right that when people expect the government (read as “the taxpayers”) to pay for medical care, then government gradually makes laws to protect the taxpayer from too great of expenses. An example is lawsuits against fast food places because people overeat. Helmet laws for motorcyclists because when they get head injuries the government pays for their care because they can’t afford to. There are so many other instances where people’s choices are restricted because of the underlying assumption that the government will take care of them no matter how extreme the risk they are willing to take.

Posted by: Steve S at August 6, 2006 1:51 PM
Comment #173631

I have to agree with Ilsa here. I have worked in healthcare for the past 14 years and have seen with my own eyes how costs have skyrocketed, and have seen what has triggered many of the increases in fees. The cost of malpractice insurance is staggering, I know one small group of a few physicians that pays in excess of $250,000 a year despite the fact that in a combined total of 40+ years experience not one of them has ever been the target of a malpractice suit. Why? Mostly because it has become the industry norm as a result of outrageous lawsuits. I know physicians who actually consult with their contracted legal department before treating patients. Why? One word, fear. They know at any given moment they can be sued and what that can mean to them and their patients. It affects the cost of the care delivered as well as the quality of care.

I am not saying that settlements should not be awarded, in the case of Liberal Demon, absolutely. The case against Merck in respect to Vioxx is clear, there were inadequate long term studies done prior to release of the drug. It was pushed through the FDA because of strong pharmaceutical lobbies. The result was tragic, and Merck should be held accountable.

However, many of the awards given are in excess. The trial lawyers are going to get every last drop they can, and it will continue to get worse, they will drive up costs in all areas (not just healthcare) unless there are limits put in place. Can you put a price on a life? The answer is no, but be reasonable when being compensated for an injury. I’ve known of settlements in the millions for injuries that will have no effect at all on a person in even the short term, but I guess the million dollars in emotional damages paid by the doctor are worth the $2,000 in lost wages. There are people getting involved in class action suits who have had absolutely no ill effects from a given drug or specific treatment seeking millions because they see deep pockets and a lawyer who is willing to take from them. Where is the balance?

Capping malpractice will lower the cost of malpractice insurance, lower the cost to physicians and bring down healthcare costs overall. It’s not the miracle cure to the problem, it won’t be the magic wand that makes the problem go away, but it would be a huge step in the right direction.

Posted by: sheldon at August 6, 2006 2:30 PM
Comment #173632

Charlie, based upon his statesments above, obviously did not read the article to which I linked. The entire text of that article follows. Also, actually reading the JAMA article, as I did, is recommended (it’s available here on the WWW).

——————————————————-

Middle-aged English people are healthier than Americans of similar age, a new study reveals.

Despite the fact that the United States spends more on medical care per capita than the United Kingdom—$5,274 compared to $2,164—Americans ages 55 to 64 suffer from higher rates of many life-threatening diseases and conditions than their counterparts across the Atlantic.

A new study—limited to non-Hispanic whites—compared both reported and documented health data of nearly 6,500 Americans and more than 9,000 Brits.

What ails us

At 12.5 percent, diabetes prevalence was twice as high in the United States and hypertension was about 10 percentage points higher. Heart disease was also 50 percent higher among Americans, while the rates of stroke, lung disease, and cancer were higher as well.

“You don’t expect the health of middle-aged people in these two countries to be too different, but we found that the English are a lot healthier than the Americans,” said study co-author James Smith of the RAND Corporation, an independent research organization.

The team of English and American researchers also concluded that Americans get less exercise and are more frequently obese, while excessive drinking is more common in England. Smoking habits are similar in both countries.

Income a key:

They also noted that in both countries, the less education and income people had, the worse their health, which may be the key to understanding the observed differences.

“We cannot blame either bad lifestyle or inadequate medical care as the main culprits of these socioeconomic differences in health,” said co-author Sir Michael Marmot of University College London. “We should look for explanation to the circumstances in which people live and work.”

The study is detailed in the May 3 issue of the Journal of the American Medical Association.

Posted by: Dr. Poshek at August 6, 2006 2:49 PM
Comment #173640
I am a conservative, and I am definitely for personal responsibility. Your above observation is flawed. Persoanl responsibility IS a moral issue…if people would exercie it, we wouldn’t feel like we had to do make laws forcing them to take responsibility for their actions.

DaveR,

My observation is not flawed. You say you are a conservative, which may be so, but you sound more like a libertarian. Conservatives on a whole are for regulating morality, and limiting personal responsibility.

If someone uses drugs or gambles their life savings away then they need to take responsibility for their actions. I never said that society should foot the bill for their poor choices. The conservatives passed the online gambling ban, not liberals. I should have the choice as to whether I want to gamble or not, and I should have to live with the consequences if I lose. Conservatives want to limit what I choose to do with my own money. Liberals don’t want me to suffer the consequences of my actions. Both are wrong and both are limiting personal responsibility.

Sex? What part? The having it part or the getting pregnant part?

No, not the getting pregnant part. I never mentioned abortion nor do I take a position on abortion. I do not have a uterus; therefore, I do not feel qualified to take a position. It is kinda like when a heterosexual tries to act as if they are an expert on homosexuality. Unless you’ve lived it, you have no clue. I will say though that I am completely against any type of publicly funded abortion. If you get pregnant and decide to have an abortion, then you need to take personal responsibility to pay for it.

On the other hand, if someone wants to sell sex for money, and someone wants to pay that person for sex, then they should be allowed to make that choice. It is nobody’s business but their own. Conservatives are all for prosecuting victimless crimes like prostitution.

I should also have the personal responsibility to marry whom I want and should be able to take personal responsibility for raising a family. Currently conservatives are blocking me from taking personal responsibility for my life, including whom I can marry and how I raise my family.

When you choose to exercise your free will and you decide upon a course of action, you also accept the responsibility for the consequences of that action. You can’t go back later and go “Ooops, I goofed…can I get a redo?” You have to deal with the circumstance you created.

THAT…is called personal responsibility!

I agree 100%. However, it is conservatives who are trying to limit my freedom of choice, thereby limiting personal responsibility. Liberals limit personal responsibility by saying that after I make a bad choice they will make everything all better. Both sides are wrong. The only party that believes that you should have the choice to live your life they way you see fit, and have to live with the consequences if those choices turn out bad is the Libertarian Party. Both the Republican and Democratic parties are for limiting personal responsibility.

It really irritates me when the Republican Party claims to be for personal responsibility and for less government intrusion into our live when they clearly are not.

Democrats clearly are not for personal responsibility either, but at least they don’t lie and make it part of their platform.

Posted by: JayJay Snow at August 6, 2006 3:47 PM
Comment #173653

Dr. Poshek,
Are you a medical doctor? or a phd? Just wondering.

Comparing Americans to the English is interesting but not really a valid point. First of all, most americans are of European descent - Italians, Germans, Polish, etc…. with a healthy mix of African (continental) thrown in. Not the same in England. Different ethnic backgrounds predispose people to certain health problems that have nothing to do with lifestyle. For example, did you know that nearly 100% of all Asians are lactose intolerant? Weird but true. Blacks are much more likely to have high blood pressure and diabetes than whites - but there are a lot of bi-racial and whites with African-American genes who could easily have been in the study you talk about.

As for socio-economic (where and how people live and work) factors - those vary considerably from street to street, city to city, but all levels can be found nearly everywhere. Most decently populated areas have hosptials and clinics that can provide basic healthcare. Advanced healthcare in this country is available everywhere I can think of - I’ve been all over the country.

Choices are still the main influence any one person can have on his or her own health: Wear seat belts, helmets, don’t drink and drive, don’t drink, don’t smoke, don’t screw around, don’t have unnecessary operations, etc…

The COST of healthcare is also a choice. I HATE having to pay for govermental programs that provide abortions, welfare for people perfectly capable of working, medicaid for people who abuse the system, etc… I hate having to pay higher insurance premiums because other people consider ‘their choice’ their problem. It comes out of MY pocket - in higher premiums, taxes and lower wages (because employers can’t afford the premiums on the workers comp insurance mandated by law).

But then, I’m not a democrat. I don’t believe in the public having to provide for personal choices. I don’t want the government ‘helping’ everyone. I want people to help themselves.

Oh, and by the way, unless you’re bleeding profusely, obviously deformed, can’t move, or having crushing chest pain - STAY OUT of the ER! It’s for EMERGENCIES. There are immediate care centers and clinics all over the place. Use them.

Posted by: Ilsa at August 6, 2006 4:33 PM
Comment #173657

JayJay,

FYI, Conservatives do not want to limit your personal freedoms. We just don’t want to have to pay for them. Democrats want us to pay for them. And no one is stopping you from marrying or raising a family but a society is made up of many people and in this society the majority rules or we would have anarchy. At this time, as well as for our entire history, certain behaviors have been considered ‘wrong’. That’s still the norm. Are you suggesting that all our laws, morals and values as a country be changed to suit the minority? Is the least common denominator where you would put the curve? If so, you should read some history books - ancient history - and you’ll find that civilizations that catered to the minority positions died. Roman, Greek, Egyptian - all great societies that fell because personal preferences (I didn’t say freedoms or liberties) were allowed free reign. When the rule of law is gone, so is the society. There are places that allow for what I’m guessing you want. Find them, be happy, but know that your choices are your own - the consequences should also be your own.

Posted by: Ilsa at August 6, 2006 4:45 PM
Comment #173659

I’m with the “right to make choices” crowd. I don’t want the government or anyone else telling me what I can eat or drink or wear or anything else.

I quit smoking in 1985 because, one, I couldn’t afford cigarettes anymore and, two, I got tired of coughing my lungs out on the floor every morning.

It’s true that people who make bad choices that negatively impact their health are making health care more expensive for everyone. But, that is one of the prices we pay for living in a democratic society.

What I’ve never understood is that the government forces tobacco companies to label their products to warn users about the risks, but continues to subsidize tobacco growers with several millions of taxpayer dollars.

Somebody explain that one to me!

Posted by: ulysses at August 6, 2006 4:47 PM
Comment #173663

Ilsa—

NICE JOB!! Well done girl! (re: your recent response to JayJay).

DaveR

Posted by: DaveR at August 6, 2006 5:21 PM
Comment #173668

JayJay—

“Conservatives on a whole are for regulating morality, and limiting personal responsibility.”

No JayJay…maybe far right-wing religious conservatives are for regulating morality. But regular Joe conservativces such as myself are ALL ABOUT advocating personal responsibility, not limiting it. However, in the absense of proper exercise of individual responsibility for one’s actions, laws have to be made to regulate and control unacceptable behavior. It is unfortunate, but society wouldn’t exist without laws telling people what they can and cannot do.

I believe that the word morality, as you are using it, imples deep religious connations. Apparently you are one of those who see this as a bad thing. But as Ilsa noted, morality has ALWAYS been one deciding factor in making laws for the good of society. If the majority of a societiy’s people want to make a law based on their own personal moral beliefs (such as limiting marriage to heterosexuals), then that is the way it is. Maybe that will change, maybe not. But again as Ilsa noted, majority, not minority, rules in our society.

So tell us, where do YOU think we get our prohibitions against acts such as murder or rape? Against theft and burglary? Do you believe that we are just born knowing right from wrong? Or does it come from a “higher source”? I would argue that in any society, almost all of their laws come from somewhere within their core religious belief system. Therefore, it follows that some laws would seem to be based on regulating “moral” behavior.

However, just because a law originates from morality does not make it bad. Again, it is against the law to kill someone (except in some cases such as self-defense). That law obviously originates from within a code of morality.

Would you argue that it is bad to stop people from wantonly killing, any time they please? Should we just be allowed to cap someone because they pi—ed us off? Or because we don’t like the color of their skin or their gender, or the fact that they have more stuff than we do, or live in a nicer house, or drive a better car? If that is the case, I want to knock a few dozen of my neighbors and fellow citizens ASAP, for various reasons! If you take away this morally based restriction against murder, what is to stop someone from walking around killing people just because they are in a bad mood that day?

I think that the major difference between what we conservatives advocate, in terms of morally based law and personal responsibility, and what you more liberally thinking folks support, is in our definition of what is “acceptable” behavior. This is compounded by the arguement over what types of behaviors should be under control through the rule of law and what types of behaviors are personal and therefore of no concern to the government.

The way I see it, you support the idea that people should be allowed to do whatever they want, whenever they want, without restriction, regardless of right and wrong. You are so afraid of defining what is right and wrong that YOU would allow anything, in a well meaning but misguided effort to “stay out of people’s lives”. This is borderline anarchy.


“Conservatives are all for prosecuting victimless crimes like prostitution.”

BAD EXAMPLE!!! Prostitution is hardly a victimless crime. I am sure there are a few examples of people getting into protitution by their own choice.
But haven’t you seen enough movies, news stories and crime dramas about bad pimps, drug addled whores working for the next hit, and teenage runaways forced into prostitution by savvy street thugs, to know that almost NO ONE becomes a prostitute because it has always been their lifelong dream!!

Should we mention the proliferation of STD’s which have been passed on by, and sometimes to prostitutes, eventually making their way into the lives and bodies of innocent wives, husbands, girlfriends and boyfriends, and unborn children?
My wife got an infection and had to have her uterus removed b/c her ex-husband brought her an STD gift from one of his many TDY’s overseas. I think she would be VERY insulted and offended to find out that you think she is not a victim of prostitution.

Victimless? Tell that to some worn out 25 year old addict working the strip in LA or NY. Tell that to my wife. I think they would both vehemently disagree.

There are definitely some moral behaviors that can and should be regulated by law.

DaveR

Posted by: DaveR at August 6, 2006 6:10 PM
Comment #173669

Ilsa, Personal preference?? Want to expand on that? This sounds like quite a new tilt on history.

No one wants to pay for anyone else’s free ride. Why are the rich allowed a free ride in our tax system? What responsibility do corporations who profit in our society owe that society?

It’s common to blame the other guy. One needs to follow the money and see who is actually benefitting. Hint: It ain’t the poor schmo’s.

Posted by: gergle at August 6, 2006 6:20 PM
Comment #173670


Ilsa,

You can’t say in one sentence that you do not want to limit personal freedoms, and in the next say that it is ok to limit personal freedoms because that is what the majority wants. Which is it?

And no one is stopping you from marrying or raising a family

Conservatives are certainly stopping me from marrying the person I see fit to marry and raising a family with them. You better look at the record of your conservative buddies in congress.

but a society is made up of many people and in this society the majority rules or we would have anarchy.

Majority does not = personal freedom. Nobody is advocating anarchy. Personal freedom does not = anarchy. You should be free to make your own choices and suffer the consequences of those actions if harm comes to another person. That is crime with a victim, not anarchy. If you kill some, steal something, defame someone, etc. Those are crimes with a victim and should clearly be prosecuted.

BTW: Do you have any proof that the majority of Americans are not in favor of helping others when they make a mistake? Do you have any proof that the majority of Americans are not for seat belt laws, helmet laws, safety regulations, welfare and all the other things conservatives claim restrict personal freedom? If majority rules, then shouldn’t that be for everything, not just the things you personally don’t like?

Are you suggesting that all our laws, morals and values as a country be changed to suit the minority? Is the least common denominator where you would put the curve?

No I am not suggesting that all our laws, morals and values as a country be changed. I am suggesting that we allow people to have personal freedom and be accountable for their actions. I am suggesting that we stop punishing victimless crime that only costs the taxpayers more money for prosecution and incarceration.

You say that taxpayers should not have to pay for the consequences of individual actions, but that is exactly what happens when we enforce moral regulation.

If so, you should read some history books - ancient history - and you’ll find that civilizations that catered to the minority positions died. Roman, Greek, Egyptian - all great societies that fell because personal preferences (I didn’t say freedoms or liberties) were allowed free reign.

No, you should read some history. You should start with the founding documents of this country. The federalist/ anti-federalist papers would be a good start too. Our country was not set up as a pure democracy for a reason. Our country was set up as a Constitutional Representative Republic exactly because our founding fathers did not want important issues subjected to “mob rule,” or majority rule.

When the rule of law is gone, so is the society. There are places that allow for what I’m guessing you want. Find them, be happy, but know that your choices are your own - the consequences should also be your own.

Nobody is advocating abolishing the rule of law. I am advocating personal choice in matters where no victim exists. I never said that you should not pay for the consequences of your actions when they cause harm to others. If I drive drunk and kill somebody, then by all means I should have to pay the consequences for that. Drinking the alcohol is my freedom of choice, getting behind the wheel of a car drunk and killing someone is the crime. If I sit in my house and smoke a joint then go to bed, why have I committed a crime? I have harmed no one.

You cannot have it both ways. Either you are for personal freedom or you are for restricting it in some way. You can call it whatever you want, and you can try to justify it however you want, but at the end of the day it is still restricting personal freedom.

Posted by: JayJay Snow at August 6, 2006 6:22 PM
Comment #173671
Ilsa—

NICE JOB!! Well done girl! (re: your recent response to JayJay).

DaveR
Posted by: DaveR at August 6, 2006 05:21 PM

DaveR,

Actually, all she did was write alot into what I wrote that wasn’t there.

Posted by: JayJay Snow at August 6, 2006 6:24 PM
Comment #173676

Charlie:

My HSA refunds the unused balance at the end of the year, but I have to ask for it. Your HSA sounds like a nightmare. I suggest telling your employer to switch plans or something.

It doesn’t sound like you have an HSA. I’m not sure what it is but it’s not an HSA. Tell me, how much do you put in it, how much do you typically use and how does it save you money?

“And that solution is to outlaw health insurance and deregulate life insurance.”

This is completely unnecessary. Moreover, it is socialist

Uh, no. What is socialist is where you pay premiums into a system such as a medical insurance provider or medicare according to your ability to pay, then they pay out for other people’s insurance claims according to their need. Sound familiar? I routinely pay $1000s in premiums into the highest deductible insurance plan offered by my employer and receive maybe $100s in benefits per year. On the other hand, some of the lower paid employees pay $100s in premium and receive $1000s in benefits. That’s socialism buddy.

— something I will reject instinctively.

If you really understood and rejected socialism, you would agree with me that medical insurance should be outlawed, that we should all pay for exactly what medical services we use. Do you understand what socialism is, at all?

But more to the point, there are ways to improve the system we have. Don has outlined some good ideas above.

OK, here are Don’s ideas and my comments:

There are ways to save money on health care.

1) Everyone pay with cash. Turn in quarterly the bills for insurance purposes. The paper shuffle for insurance starts with extra staff people at the doctor’s office and the pharmacy whose jobs are strictly for dealing with insurance companies and billing. Save 4-15%.

I know of no health care providers that provide a discount for cash, so I’m not sure what he’s talking about here. Sure, there is some paperwork that has to happen to pay medical bills that probably add to the cost. But the reason why the medical care system hasn’t improved their paper handling processes is because they can already make so da-n much money without doing so, there’s no real payback. It would be like them worrying about picking up pennies on the ground when they’ve got $100 bills hanging from the trees.

Regarding Don’s snide remarks about paperwork and turning in claim forms, I don’t know what archaic provider he’s talking about but with mine, once I check into the hospital or doctor’s office or request a prescription to be filled, everything flows between them and my insurer via their computer systems - no paper. There are definitely a lot of people involved still, but a lot less than would be if it was all physical paper. This is another reason why providers prefer credit cards – no cash handling, so no theft, counterfeiting, fraud.

Next…

2) Pay with cash. Not credit card. Save an additional 1-2%

Again, if you or Don know of any providers who provide this discount for cash versus credit, especially in the KC area, let me know. None of mine do. In fact, in general, providers prefer to be paid with plastic because they do not have back-end collection costs associated with bad checks and the like.

3) Limit damages for medical malpractice. Save $$ and time for all the extra tests that were really unnecessary.

I disagree that this would save that much. I don’t know too many GOOD docs who order unnecessary tests because they know the insurer is likely to deny the claim and the patient can’t afford to pay for it. I’m sure there is a lot of anecdotes about this kind of stuff happening but not
much real data. I’ve said it before in this thread and I’ll say it again: if you really think malpractice
damage claims should be limited, Google Robert Courtney.

4) Limit damages for prescription manufacturers. Yah, occasionally someone is going to be harmed by a drug side-effect… kinda sounds like things wouldn’t change much from the way things are now! But the cost of prescription drugs would drop.

What makes you think the price of drugs will drop? How do you know they just wouldn’t keep that
money to add to their already astronomical profits.

5) Triage for emergency rooms. Common colds and flu, etc. get sent to a local 24 hour clinic across the street or elsewhere in the hospital.

The only people who get their routine medical care from ERs are those without insurance in the
first place. If there was no medical insurance, prices at the doc or the 24 hour clinic would drop
to the point where people without insurance could afford it. As long as there is insurance, there is basically unlimited demand, with limited supply, hence the price keeps going up. Without medical insurance demand will drop, allowing process to stabilize.

6) Hospitalization for uninsured people is on a pro-rated cost basis. They must pay 80% of the “cost” of their stay.

You can’t get blood out of a turnip. And it goes against the humanitarian and altruistic principles of medical care to deny care to the poor. Let me guess, you call yourself a Christian, right? Ever heard the words of the Lord, “Whatsoever you do to the least of these, that you do unto me.”?

More people will get insurance if they know they have responsibility for their own lives.

Not if they can’t afford it. Not if they can’t afford to buy food, housing and fuel. Not as long as medical coverage is subsidized by employers and the unemployed pay full price.

There is extremely low cost insurance for hospitalization only.

I’m guessing the extremely low cost you’re talking about must be pennies a year, for you seem to have neglected to specify what you mean by extremely low cost. Note, however, that extremely low cost usually means extremely low coverage. Besides, the hospital is the MOST expensive setting for providing health care. A responsible system would provide practically free coverage for preventive care and make the hospitalization portion the expensive part. The last thing you want is for poor people to have great hospitalization and poor preventive coverage if what you’re trying to do is save money. Don’s got it exactly backward.

The expensive insurance plans include doctor visits and prescriptions and tests, etc. Many states allow people to sign up for low-cost plan run by the state.

Exactly, it is exactly backward if what you’re trying to do is save money and be responsible.

And I would listen to Ilsa. She is on the front lines and providing insightful information.

I am listening to her, you don’t have to tell me that. But with all due respect, sometimes the frontlines are not from where you want to be making the strategic decisions. It’s too easy to be blinded by the light or miss the forest for the trees, pick your metaphor.

Posted by: Crazy_joe_divola at August 6, 2006 6:45 PM
Comment #173679

Fries…Burgers…Pizza…Hot Dogs…. The American foods. Heres the truth: you can eat anything you want out there. You just have to balance it. I hate it when people sue fast food restaurants. It is not the food that makes them fat, it is the sitting around. Everyone’s intake should be different. It depends on your job and what you do in your little free time.

As for cigarettes, tobacco, and alcohol, I don’t
care if people use them, just stay out of public so the people that choose not to do them won’t suffer from them. The govt should ban public smoking areas. Slowly kill yourself only in your house, so you won’t endanger others.

Posted by: stubborn conservative at August 6, 2006 7:03 PM
Comment #173682

“The way I see it, you support the idea that people should be allowed to do whatever they want, whenever they want, without restriction, regardless of right and wrong. You are so afraid of defining what is right and wrong that YOU would allow anything, in a well meaning but misguided effort to “stay out of people’s lives”. This is borderline anarchy.”

No, the old saying “My right to swing a fist ends at your face” applies. And just because you have clear ideas about right and wrong does not mean anything; the relevant point is that you are willing to impose your view on others. It also does not mean that your ideas make any particlar sense. At any rate, overstating your case does not make your case more persuasive.

I love to play poker. Every Friday night I get together with some buddies for a $25 buy-in tournament. None of us will face a hardship if we lose. Yet the government of my red state says this is a crime. It’s not very serious about it — Class C misdeamnor, $50 fine. The only gambling legal here involves the state-run lottery. So it’s ok if you take bad odds from the state but not ok to play poker with friends.

To my mind, this is typical of the conservative mindset — and if you want to say that such “moral” tampering is not conservative, go ahead. Republicans have no problem getting in bed with “moralists” for political expediency.

Here is another example. Gays can’t marry in my state. Why? I don’t know — opponents talk about God and toss out empty phrases such as “threat to the family”; they often imply that gays will do a poor job of raising children, or worse, may molest them. Gay marriage is a threat to their idea of what a family is, but not to marriage itself.

If you vote Republican, you have to be honest with yourself — your party has no problem with legislating “morality.”

—-

Lifestyle choices — of course we should as a nation eat better and exercise more. It is disingenuous, however, to insist that what seems clear on an individual level must be clear across a society at large. Look, it is possible to resist the cultural influences on lifestyle choices, but on a large scale, these influences do have an effect. By and large, we do not train our children to resist cultural influences — we teach them to sit still in their chairs and not disrupt the class. If we are lucky, some reading, writing, and arithmatic gets taught too. A student can go all the way through graduate school and never encounter the idea that the underlying premises of our culture can be and should be challenged. We push math and science now for the purposes of utility, not because we truly wish for people to challenge our underlying assumptions. Look how the commodity of education is advertised — it’s all in terms of getting high-paying jobs.

Kids are enticed into eating fast food by toys, clever advertising gimmicks, and other, even more devious ploys. My eight-year-old daughter, for instance, is rewarded by her school for reading a certain number of books with coupons to Pizza Hut. When I raised hell about it, I got a blank stare from her teacher.

I do my best to teach critical thinking skills to my daughter, but I have to compete against an entire culture devoted to the ideology of consumerism. It should be no surprise that massive efforts to push junk food are effective. Saying people are responsible for their own life choices is both true and disingenuous. In the present case, it is used to justify more-exclusive health insurance plans.

This is a much larger issue than diet and exercise. Today I read a news story citing a recent poll that claims half of Americans believe Iraq had WMD at the time of the invasion. And we know a large fraction still believes Iraq was behind 9/11. I do believe citizens are responsible for their own ignorance, but I am not above pointing the finger at all those right-wing wacko pundits who encourage if not downright foster these misperceptions.

In general, our culture does not want people to actually think because if they did, the very system would be challenged. Say the name “Marx” in a public school and watch parents and politicians get apopleptic. Yet you don’t have to be a Marxist to appreciate the powerful insights in Althusser’s “Ideology and Ideological State Apparatuses. Somehow, democracy and capitalism are synonymous in the American mind. It is not a stretch to say that when we elect presidents we choose between candidates who are much more alike than different. We have to choose either Coke or Pepsi, and then believe that we’re actually given a choice.

Posted by: Trent at August 6, 2006 7:29 PM
Comment #173688

“If so, you should read some history books - ancient history - and you⬬ find that civilizations that catered to the minority positions died. Roman, Greek, Egyptian - all great societies that fell because personal preferences (I didnⴠsay freedoms or liberties) were allowed free reign.”

I would love to see some support for this claim. In each case, the power of a very small class of land-owners was privileged. They occupied the minority position. In the case of the Roman Empire, these land owners were often all too willing to support the invaders as long as their personal perogatives were preserved, more or less.

The fall of the Greek states had much to do with their inability to band together effectively, their internecine warfare, and the superior power of the Romans. I’m not sure which minority positions you claim are responsible for the downfall of the Greek states. If anything, the homosexual ethos — to the extent it existed — seems to have been strengthening factor, and not one that led to downfall.

The Egyptians I’m rusty on.

Posted by: Trent at August 6, 2006 7:58 PM
Comment #173689
But regular Joe conservativces such as myself are ALL ABOUT advocating personal responsibility, not limiting it. However, in the absense of proper exercise of individual responsibility for one’s actions, laws have to be made to regulate and control unacceptable behavior. It is unfortunate, but society wouldn’t exist without laws telling people what they can and cannot do.

DaveR,

Am I missing something here? You are doing the exact same thing Ilsa did. “I am for personal responsibility … but, and this is a big but.” No, you can’t claim to be for personal responsibility then turn around and advocate restricting personal responsibility.

If the majority of a societiy’s people want to make a law based on their own personal moral beliefs (such as limiting marriage to heterosexuals), then that is the way it is. Maybe that will change, maybe not. But again as Ilsa noted, majority, not minority, rules in our society.

Ok, but shouldn’t that be for everything? Why do you rag on liberals who advocate helping the poor through public welfare programs? The reason they want to do that is because taking care of our neighbors is the morally right thing to do. Helping save peoples lives by making them wear a seat belt is the morally right thing to do. If the majority want the rich to pay more in taxes and redistribute it to the poor, then why isn’t that just the way it is, as you put it? Seems like a double standard to me.

Our country was not set up as a pure democracy for the exact reason that our forefathers beleived that certain things should not be subjected to majority rule. Sure we can change the Constitution, but the founders made that a difficult process, not simply a case of mob rule.

So tell us, where do YOU think we get our prohibitions against acts such as murder or rape? Against theft and burglary? Do you believe that we are just born knowing right from wrong? Or does it come from a “higher source”?

Those are clearly crimes because they have a victim. That is pretty clear cut I think. Yes, I do believe that we are born knowing right from wrong. Even the Bible says that the truth is not written in ink nor stone, it is written on our hearts.

Are we beginning to commend ourselves again? Or do we need, like some people, letters of recommendation to you or from you? You yourselves are our letter, written on our hearts, known and read by everybody. You show that you are a letter from Christ, the result of our ministry, written not with ink but with the Spirit of the living God, not on tablets of stone but on tablets of human hearts.

Such confidence as this is ours through Christ before God. Not that we are competent in ourselves to claim anything for ourselves, but our competence comes from God. He has made us competent as ministers of a new covenant—not of the letter but of the Spirit; for the letter kills, but the Spirit gives life. ~2 Corinthians 3 [emphasis mine]

Would you argue that it is bad to stop people from wantonly killing, any time they please?

Um, no.

Should we just be allowed to cap someone because they pi—ed us off? Or because we don’t like the color of their skin or their gender, or the fact that they have more stuff than we do, or live in a nicer house, or drive a better car?

Um, no.

If that is the case, I want to knock a few dozen of my neighbors and fellow citizens ASAP, for various reasons!

Go ahead, but you will have to suffer the consequences when you get arrested and tried for murder.

If you take away this morally based restriction against murder, what is to stop someone from walking around killing people just because they are in a bad mood that day?

I do not need to be religous to know that killing someone is wrong. Look at the early Christians, one of their commandments was thou shalt not kill, yet they went around for hundreds of years killing thousands of people because they wouldn’t convert. A lot of good religion did them. There were tribes around the world that never knew religioun, but they didn’t go around just randomly killing each other. (BTW, many of those tribes, including Native Americans, accepted homosexuality as normal. In fact some tribes held homosexuals up high as spiritual leaders, refering to them as “two spirits.” It wasn’t until the introduction of Christianity that bigoted homophobic views were even considered.)

This is compounded by the arguement over what types of behaviors should be under control through the rule of law and what types of behaviors are personal and therefore of no concern to the government.

Sorry, but my family life is none of the governments concern, and what I do in the privacy of my own bedroom should certainly not be under the control of the law.

The way I see it, you support the idea that people should be allowed to do whatever they want, whenever they want, without restriction, regardless of right and wrong. You are so afraid of defining what is right and wrong that YOU would allow anything, in a well meaning but misguided effort to “stay out of people’s lives”. This is borderline anarchy.

SAY WHAT? You are reading an awful lot into what I wrote that isn’t there. I never said that people should be allowed to do whatever they want when they want. I am not afraid to define what is right and wrong at all. If your actions cause harm to another person, then that is wrong! I really wish you would stop putting words in what I wrote that aren’t there.

But haven’t you seen enough movies, news stories and crime dramas about bad pimps, drug addled whores working for the next hit, and teenage runaways forced into prostitution by savvy street thugs, to know that almost NO ONE becomes a prostitute because it has always been their lifelong dream!!

Well, I certainly wouldn’t call crime dramas and movies a good source of information on the subject!

I thought you were for people being responsible for the consequences of their actions. How come not here? If prostitution were legal it would be much easier to control the situation. Instead, of having a black market where anything can happen on the streets, it would be moved into safe business locations. I will say though, that while I do not think prostitution should be a crime, I do think that we as a society can say that solicitation cannot take place on street corners or publicly owned property. There is a big difference in saying where something can happen, and saying that it cannot happen at all.

Should we mention the proliferation of STD’s which have been passed on by, and sometimes to prostitutes, eventually making their way into the lives and bodies of innocent wives, husbands, girlfriends and boyfriends, and unborn children?

The crime here should not be the act of prostitution itself, it should be the harm knowingly caused to others. Just like drinking alcohol is not a crime, but harming someone while drunk is. If the prostitute knowingly passed the STD then she should be held responsible for the harm she has caused. I would also think that the person paying for services would have to bear some of the responsibility too though, since he must not have used protection. If he passes that STD onto others whom he has created a bond of trust, such as a spouse, then that spouse is a victim of the cheater, not the prostitute. If he unknowingly passes it along to someone he knows only casually then it is hard to say that there is a victim, since the person contracting the STD should have been personally responsible for their own protection by either abstaining until a bond of trust could be established or used protection.

Again, if prostitution were legalized it could be made safer by controlling the situation. This is where you get into where a victimless crime turns into a crime with a victim. Employers could require that their workers take measures to be clean and get regular tests for STDs. As it is now anybody can do whatever they want, as long as they don’t get caught. If a prostitute knowingly passes an STD onto someone else, then we have our victim and our crime. Besides, if prostitution were legal, most would look for prostitutes at established businesses where the practice is controlled, rather than on the streets where anything goes.

My wife got an infection and had to have her uterus removed b/c her ex-husband brought her an STD gift from one of his many TDY’s overseas. I think she would be VERY insulted and offended to find out that you think she is not a victim of prostitution.

Is she the victim of the prostitute or her ex-husband? I say she is a victim of her ex-husband. He not only gave her a STD, but he broke her trust and marriage vows. I guess that is the personal concequence of marrying someone you can’t trust.

Victimless? Tell that to some worn out 25 year old addict working the strip in LA or NY. Tell that to my wife. I think they would both vehemently disagree.

Actually, what you are saying is that the worn out 25 year old prostitute is a victim of the law. If prostitution were legal, she wouldn’t be on the streets, she would be working for a business, and probably alot better off. Again, I feel bad for your wife, but in reality she was a victim of her ex-husband, not the prostitute.

Posted by: JayJay Snow at August 6, 2006 8:01 PM
Comment #173690

These are some of the longest comments I have ever seen in a single thread.

Posted by: JayJay Snow at August 6, 2006 8:03 PM
Comment #173693
A student can go all the way through graduate school and never encounter the idea that the underlying premises of our culture can be and should be challenged.

Trent,

You hit the nail on the head. Just because society has done something for hundreds or even thousands of years doesn’t make it right. Slavery was practiced probably from the beginning of time until just recently, relative to history, but that doesn’t mean it was right and that we should continue the practice.

  • Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour; a long habit of not thinking a thing WRONG, gives it a superficial appearance of being RIGHT, and raises at first a formidable outcry in defense of custom. But the tumult soon subsides. Time makes more converts than reason. ~Thomas Paine, Common Sense
Posted by: JayJay Snow at August 6, 2006 8:31 PM
Comment #173698

Everyone,

DaveR & Ilsa advocate “mob rule” at the expense of minorities. Apparently, fairness plays no role here. What I cannot figure out is how that squares with Republicans giving the majority of tax cuts to a minority of taxpayers. If majority rules then shouldn’t those tax cuts be going to the majority working & poor classes at the expense of the minority rich?

Posted by: JayJay Snow at August 6, 2006 8:59 PM
Comment #173699

JayJay—

-“Actually, all she did was write alot into what I wrote that wasn’t there.”

Actually that post was personally directed to her and really none of your business, especially since I made no comments or responses of my own regarding anything you had said…maybe you should have stayed out of it. It wasn’t really an open post.

DaveR

Posted by: DaveR at August 6, 2006 9:00 PM
Comment #173702

DaveR,

First, the comment was about me specifically and you mentioned me by name in your comment. I’m afraid that does make it my business.

NICE JOB!! Well done girl! (re: your recent response to JayJay).

Second, you are on a public discussion board. All comments are open to public critique. From WatchBlog Rules for Participation:

Critique the Message, Not the Messenger. This means you may critique any points made in another person’s writing or comments.
Posted by: JayJay Snow at August 6, 2006 9:32 PM
Comment #173704

Ilsa:

If so, you should read some history books - ancient history - and you’ll find that civilizations that catered to the minority positions died. Roman, Greek, Egyptian - all great societies that fell because personal preferences (I didn’t say freedoms or liberties) were allowed free reign.

You should probably stop making up “history” as you go along. Whatever slight credibility you might have had prior to this post, you just blew.

Posted by: Crazy_joe_divola at August 6, 2006 9:36 PM
Comment #173709

JayJay—

You read my words, then chose to ignore them and “answer” issues I never even talked about.

-“Well, I certainly wouldn’t call crime dramas and movies a good source of information on the subject!”

They are when they are based on real circumstances and real life. And you still never did address the issue…about prostitution not being on most women’s list of “Things I want to be when I grow up”. It is not a victimless crime.

Legalizing prostitution? That has nothing to do with your claim that it is a victimless crime. And my wife getting STD from her husband makes her a victim of prostituion as surely as if she went there herself. The hooker had the STD and gave it to him, not the other way around.

There was no reason to insult my wife either. That was a low blow, even for a lib. Like you have never made a bad judgement call…trusted someone only to have them betray you? It doesn’t make her any less of a victim of the whole situation because she dared to actually trust the man she married (what a concept).

-“Go ahead, but you will have to suffer the consequences when you get arrested and tried for murder.”

I agree…that was my whole point. You can’t do anything you want…and murder is illegal…and that is a moral judgement.

-“I do not need to be religous to know that killing someone is wrong.”

You claim that you believe we are born knowing right from wrong, and that you don’t have to be religious to know this, then you quote the bible to back up your claim. So where does this knowledge come from, if not from religious morals? I guess it just appears from thin air…right about the time your head pokes out from the birth canal? Amazing.

You didn’t debate the issues with me, even the ones you originally brought up yourself. You ignored them and instead tried to redirect the conversation…whether because you felt you were loosing; were unable to make a good arguement for your position; or to throw me off track and fluster the debate altogether. The readers of this thread will see my words and understand what I meant, and they will know that you were unable or unwilling to debate the issues you yourself introduced in the first place.

I am off the clock now and going home.

Ilsa…awesome. Keep up the good fight.

DaveR

Posted by: DaveR at August 6, 2006 10:08 PM
Comment #173712

JayJay—

When in doubt, whip out the Rules for Participation. Its not about the rules JayJay. That post required no response from you. But whatever…

DaveR

Posted by: DaveR at August 6, 2006 10:12 PM
Comment #173715

You know, after re-reading Jack’s article, I realized I misread a key passage. Above I spoke of more exclusionary health care insurance, but that’s not what Jack was writing about. Mea culpa. His article seems reasonable to me, and the Newt article he linked to seemed reasonable too. A plan based in part on outcomes appears to be a powerful idea that would encourage preventive health measures.

Posted by: Trent at August 6, 2006 10:47 PM
Comment #173717
You didn’t debate the issues with me, even the ones you originally brought up yourself. You ignored them and instead tried to redirect the conversation…whether because you felt you were loosing; were unable to make a good arguement for your position; or to throw me off track and fluster the debate altogether. The readers of this thread will see my words and understand what I meant, and they will know that you were unable or unwilling to debate the issues you yourself introduced in the first place.

DaveR,

I’m not sure where this came from. I went though your comments point by point. What points exactly did I ignore? I stayed on the topics that were raised by both of us. I am not sure where you think I redirected the debate, or to where you think I redirected it to. You made your points and I made mine. Isn’t that what debate is?

You read my words, then chose to ignore them and “answer” issues I never even talked about.

Such as?

They are when they are based on real circumstances and real life.

They are called “dramas” for a reason. Although, Julia Roberts seemed to have made out pretty good though. Huh?

I prefer to formulate my views from my experiances and real life, not dramas. Do you actually know anyone who is a prostitute? I do.

And you still never did address the issue…about prostitution not being on most women’s list of “Things I want to be when I grow up”. It is not a victimless crime.

I can’t answer for anyone else’s choices, but they are choices which are the very foundation of personal freedom and personal responsibility. As I said above, I have a couple of friends who are male prostitutes. Neither seem like victims to me. One is gay and a free spirit who enjoys life more than anyone I know. The other is straight, and believe me he doesn’t complain about getting paid to have sex with women. (BTW, he does a very, very good business. It is a stereotype that only teenage runaway girls wind up being prostitutes. From what I have seen hanging out with him, women can be down right horney!) Neither of them does drugs, and insist on protection. My straight friend did catch a treatable STD, though — From his longtime girlfriend. Needless to say they are no longer together. The reality is, is that some people do choose to be prostitutes and do enjoy their work.

Legalizing prostitution? That has nothing to do with your claim that it is a victimless crime.

Why not? If there is no victim then why is it a crime?

The hooker had the STD and gave it to him, not the other way around.

That may be so, but he is the one who made the choice to visit a hooker and he is the one who made the choice not to use protection. He chose to violate his wife’s trust and marriage vows, not the prostitute. If you want to talk about taking responsiblity for your actions, that is a good example. Your wife was a victim, of her ex-husband.

There was no reason to insult my wife either. That was a low blow, even for a lib. Like you have never made a bad judgement call…trusted someone only to have them betray you?

I apologize if you think I insulted your wife. I was just trying to figure out how your wife was a victim of prostitution and not the victim of her ex-husband’s actions.

Yes, I have made bad judgement calls, and I paid the price for those bad judgements. I didn’t try to blame it on a whole other third party. I took responsibilty, did what needed to be done, and moved on.

So where does this knowledge come from, if not from religious morals? I guess it just appears from thin air…right about the time your head pokes out from the birth canal? Amazing.

I think I made it clear that I believe they come from a higher power. Now, whether that is the God of Jesus, Krishna, Mohammad or one of the other thousand Gods that people worship, I don’t know. What I do believe is that right and wrong are written on our hearts, not in some ancient myth cycle.

Posted by: JayJay Snow at August 6, 2006 11:02 PM
Comment #173718
JayJay—

When in doubt, whip out the Rules for Participation. Its not about the rules JayJay. That post required no response from you. But whatever…

DaveR,

Now, what were you saying about ignoring the issue and redirecting it?

Posted by: JayJay Snow at August 6, 2006 11:07 PM
Comment #173719

DaveR,

Actually, I think in a very broad sense some of what we call morality is given to us at birth. Empathy, for example, is a human trait, and while its precise manifestations are no doubt cultural, it is part of the glue that allows us to be social creatures.

I am not saying that values we consider important don’t have to be taught. Of course they do. But in the main it is a demonstrable mistake to claim that values we find in the Bible originated in the Bible. Some apparently did, no doubt — the desire to destroy those who worship other gods may be original to the Old Testament (at least, I don’t know of precedents). But the injunctions against theft, murder, etc. certainly do predate the Bible.

At any rate, Biblical texts reflect the values of the people of the time. This seems clear; much of the law in the Old Testament is culturally specific and done away with by Christians.

I have an annoying neighbor too, but I won’t murder him, and not because a supernatural entity forbids it. I don’t want to cause suffering because as an empathic creature I feel the suffering myself, to a degree. Also, I don’t want to live in a society where I might be done away with myself on a whim. And when people do kill, I want them put away for my protection and for the protection of the people I care about. Recourse to a divine injunction is not necessary to want killing to be illegal and punished.

Frankly, it’s a bit disconcerting to hear people say that without God we would have no compunctions against committing atrocious acts. Are the people who make these statements prevented from murder only because of divine injunction?

Posted by: Trent at August 6, 2006 11:10 PM
Comment #173726

Trent,

Well said. We all feel a wide range of emotions from guilt, saddness, remorse, joy, empathy, love, etc. We are born with these emotions. They are not something we can learn from an ancient book. These are mostly involuntary reactions we feel within our own bodies, not something that occurs through a process of reasoning.

We like the way certain emotions make us feel, like joy and love, and dislike the way other emotions make us feel, like remorse and anger. Emotions give us a powerful innate ability to tell the difference between right and wrong.

Posted by: JayJay Snow at August 6, 2006 11:30 PM
Comment #173729

JayJay

Paid sick days cost employers since they are paying for something they are not getting. If you take 10 sick days a week, your employer is paying for two weeks he is not getting. Out of a group of 100 employees, at least two are there to make up for sick time. Sick time is actually worse than vacation time, since it is usually not anticipated.

I think that your employer’s idea of just giving sick and vacation time together is a good one.

I believe I understand your thinking on many matters and I often agree with the process, but we start from different premises. It is a fundamental left/right divide.

You seem to worry about fairness, which you conflate with equality. I also worry about fairness, but I consider equality an impediment to fairness. I think the difference is how we view dynamism over time. If you look at one point in time, not treating people equally looks very unfair. But if you look at the situation over time, as people make choices that create different outcomes, creating equal outcomes seems very unfair.

Take an example of a “wealthy” man and a poor one. Does the wealthy man deserve more. It depends. I have colleagues who are more successful than I am at their jobs. They have more money. But they often sacrificed leisure, family and health to do it. I am happier and healthier now. Would it also be fair for me to demand an equal share of their money?

Re conservatives - I don’t care what people do, as long as they don’t bother me about it or demand special treatment. This is the lifestyle choice. Some lifestyles are more risky than others. Fine. But when people get in trouble they cannot cry foul.

I know you are interested in gay rights, so let me use that as an example. I don’t care what people do with each other as long as it is voluntary. But I usually don’t want to know (that is part of not caring). I don’t want hetro people telling me about their affairs nor do I want it from gays. I don’t ask and I really don’t want them to tell. Why? Because I don’t care. That is tolerance.

Dave1

These are precisely the challenges.

It gets worse. Intelligence and self discipline play a role in healthy lifestyles, so the rich are not only better off financially, they also tend to be healthier, so we will “punish” the worst off.

But I do not see much alternative. We have cured many of the traditional maladies. Many of today’s problems are partially self induced. How do you stop people from being stupid? I don’t know, but I think making it clear that they pay might concentrate even the simplest minds.

Dr Poshek

Good in theory but harder in practice. It also linked to articles such as optimists are healthier. I understand that married people are healthier too. I bet Republicans are healthier than Democrats. All these things are good things to do or be. The problem is getting people to do or be them. Comparisons to Euro countries is problematic. The U.S. is a bigger and more diverse society. If you compare particular American regions or states to European countries (which makes some sense in terms of diversity and even populations), it would be more appropriate. I bet the upper Midwest compares favorably to Europe. Otherwise you have to compare the U.S. to the whole EU.

Posted by: Jack at August 6, 2006 11:48 PM
Comment #173732
And you still never did address the issue…about prostitution not being on most women’s list of “Things I want to be when I grow up”. It is not a victimless crime.

DaveR,

I’m sure garbage collector, septic tank cleaner, sewage treatment operator, gravedigger, horse doo picker-uper, crop pickers, and many other professions are not exactly topping the list of “things I want to be when I grow up,” either. Give people a choice between the “jobs Americans don’t want to do” and prostitution, I wonder how many would choose prostitution? I have a feeling quite a few would choose prostitution, if it were legal, over even better jobs than these.

Posted by: JayJay Snow at August 7, 2006 12:02 AM
Comment #173738
Paid sick days cost employers since they are paying for something they are not getting. If you take 10 sick days a week, your employer is paying for two weeks he is not getting. Out of a group of 100 employees, at least two are there to make up for sick time. Sick time is actually worse than vacation time, since it is usually not anticipated.

Jack,

I disagree. Sick time is part of my compensation package. It is a benefit of my employment. My sick time is not unlimited. As I said my employer rolled sick time into PTO time, so I technically don’t have sick time. But even so, the amount of PTO time I have is limited. I can call in sick 10 days, but if I don’t have 80 hours of PTO, then I don’t get paid. My employer is not paying for anything they are not getting.

When you compare job offers you are not just looking at a base rate of pay (or at least you shouldn’t be.) You should be looking at total compensation package; including health, sick time, vacation, retirement, etc. Those are all things that are figured into my compensation for working for your company. Most companies don’t just pick the person who will work for the least amount of money, they want to attract the best they can find. They can only do that by offering an attractive compensation package.

I have no guilt using PTO time that is awarded as part of my compensation.

You seem to worry about fairness, which you conflate with equality. I also worry about fairness, but I consider equality an impediment to fairness. I think the difference is how we view dynamism over time. If you look at one point in time, not treating people equally looks very unfair. But if you look at the situation over time, as people make choices that create different outcomes, creating equal outcomes seems very unfair.

I must disagree with you again. Equality is fairness. Everyone should have equality in opprotunity, not equality in outcome. If you give the same opprotunity to two people and one runs with it and makes it into something great, and the other squanders it, then that is the choice you made and the choice you live with. I have never advocated equality in outcome, only opprotunity.

Does the wealthy man deserve more. It depends. I have colleagues who are more successful than I am at their jobs. They have more money. But they often sacrificed leisure, family and health to do it. I am happier and healthier now. Would it also be fair for me to demand an equal share of their money?

No, I never said that someone who does not do the same amount of work should be paid the same. I am full time, but I have the option of working 80 hours a pay and bringing home a full check, or working 72 hours pay and bringing home a smaller check, but with the same benefits. I choose the smaller check, because money is not at the top of my most important things list. I feel that my free time is much more valuable than money. Some people may feel differently and work not only the 80 hours but also pickup 20 hours of overtime (which happens a lot where I work). They will take home much more money than I will, but they will also have less free time than I will. It is just a trade off of what you feel is important in your life.

But I usually don’t want to know (that is part of not caring). I don�t want hetro people telling me about their affairs nor do I want it from gays. I don�t ask and I really don’t want them to tell. Why? Because I don’t care. That is tolerance.

I agree. The only reason that it is “out” there right now is because people are being oppressed. They are trying to publicize their plight. It is usually easier to hate someone when you don’t know them. If gays were treated equally and fairly then the whole issue wouldn’t be a big deal. People would simply go about their daily lives.

I read somewhere that some legislators in Massachusetts who originally supported a gay marriage ban no longer see it as a big deal and have withdrawn support for the ban. The main reason given was because after gay marriage became legal, the doom and gloom that people predicted didn’t happen. People got married and went on with their lives.

Posted by: JayJay Snow at August 7, 2006 12:41 AM
Comment #173749

I’ve always been amazed that the states have the audacity to sue the tobacco companies for the negative effects of smoking. The States probably make as much money, if not more, on taxes than the cigarette companies do. Further, I first started smoking back in high school when I drank on the weekends. I started smoking reguarly in college and have done so for 7 years. I’m addicted, not something I’m proud of, but no tobacco company executive ever came to my house and forced me to smoke at gunpoint until I was addicted. I chose to be so. Now, I’m trying to quit using nicorette. I hope I succeed, but I doubt Iraq is the best place. Oh well, being in the Army is another choice I’ve made.

Too few people want to take responsibility for their own actions, and we as a society let them get away with it. We need to start holding people accountable, starting at the top. If a politician is corrupt, he or she should be voted out of office. Any person who particpated in cooking the books for corrupt corporations should be jailed for at least 20 years and have all of thier assets confiscated, no exceptions for stuff they hid in the name of their wife or children. Part of the idea of personal responsibility is that choices carry consequences. Until we as a nation start imposing real consequences, lawbreakers will have no reason to stick to the law.

Posted by: 1LT B at August 7, 2006 2:29 AM
Comment #173751

Charlie-

Thank you for your sympathy, it is truly appreciated; a ‘raw deal’ is one way of putting it, I suppose.

Sheldon-

I agree with you that malpractice and prescription drug costs have skyrocketed; to do otherwise is to simply ignore reality. However, trying to make a connection between litigation and these costs is to make the same error. Insurance and drug companies raise these costs because they can, not because they have to.

Many states have already capped non-economic damages to $250,000. Malpractice insurance costs in these states have, on average, risen higher, faster, than in states without such caps. This alone should show anyone that the premise that litigious payouts are the cause is completely false. The only result of these laws is an increase of the company’s bottom line. (Here is one source for this, as there are too many to put here)

There has been no explosion in the number of lawsuits (at least the ones filed by individuals, corporate-initiated lawsuits are a whole other beast (check out this link)), nor has there been any significant increase in the overall size of damages awarded to plaintiffs over the last two decades or so. This whole issue is merely a fabricated boogeyman used to manipulate people into creating protections for companies who are raising the costs of health care, hurting people and doctors, and making obscene profits doing so. Doctors are being gouged and put out of business not by their victims (or potential victims), but by unscrupulous corporations who will use any excuse, no matter how specious, to try and raise their profit margins.

While there are some unscrupulous lawyers out there who will take any case no matter how unsubstantiated, the majority limit themselves only to cases with merit and where the defendant-to-be is undeniably responsible, and for obvious reasons. Before you try and disagree, please consider the following: the high probability of frivolous cases being thrown out before even reaching trial, combined with the costs associated with initiating a lawsuit, force these lawyers to only pursue cases where there is a high probability for a favorable outcome. This is basic business sense, as devoting the number of necessary man-hours and funds into something that will, in all likelihood, not pay out is ridiculous and would inevitably result in the bankrupting or even eventual disbarring of the person who was engaged in such practices. The idea that lawyers take every single case that falls into their lap in hope that one sticks is, like most other claims being made regarding this issue, completely erroneous.

In the case of Vioxx, there were not, as you put it, ‘inadequate long-term studies done prior to the release of the drug.’ Studies were plentiful, the potential risk associated with the drug were documented and well-known; unfortunately the documents and the knowledge were all either suppressed, altered, or simply left unshared. Rampant reports of high numbers of deaths due to the Cox-2 inhibitors were coming in shortly after they were released onto the market. The FDA, due to egregious and plentiful conflicts of interest and acts of negligence, simply ignored these reports and allowed the deaths to continue unabated. A simple web search back in 2001 (or even earlier perhaps) would have yielded the data that eventually came to light in 2004. The same thing has occurred so many times throughout history as to make the situation almost laughable-if it weren’t torturing, maiming and killing people, of course. Look at the history of drugs such as DES (diethylstilbestrol), or, if you’d prefer something more recent (and still ongoing) look at the class of drugs which injured me, fluoroquinolone antibiotics. The data is there, the horrible stories of suffering, agony and death are there; the problem is that no one is listening. Would that they were just deaf, instead of sitting back with their fingers in their ears going ‘la-la-la-la-la’ while people are screaming as they succumb to agony.

You say that many of the awards are in excess, but I ask you, who is to determine what is excessive and what is appropriate? The choice here is fairly clear: politicians who receive backing from the corporations whose actions are responsible for the case in question, or a jury of peers? I would, in all cases, choose a jury as to choose otherwise is to undermine and callously disregard our rule of law (and, I believe, our Constitution) entirely. Remember that a million dollars sounds like a lot of money, but if the person receiving it is going to be completely disabled for the rest of their life, it only amounts to $20,000 a year for 50 years. Certainly not excessive, and in many cases is actually an insult which will end in poverty for the recipient if you can stand back and ignore the initial shock value of such sums. Yes, in some cases the reward greatly outweighs the damages, but I don’t feel qualified, not knowing all the details, to make such a decision. In most of these cases, the blurbs we hear about the ‘facts’ in the case are not even close to entire story; again, that’s what juries are for.

Your last paragraph contains one truth, however I don’t think you meant it this way: ‘capping malpractice will lower the cost of malpractice insurance.’ Yes, capping the amount that insurance companies can charge for malpractice insurance will lower such costs. Anything else is just stealing a cookie from someone who is suffering in order to give it to the person who owns the factory.

Posted by: Liberal Demon at August 7, 2006 7:28 AM
Comment #173753

JayJay

Most of the things you wrote are reasonable, but I don’t think you pick up both ends of the stick. If you support unequal incomes/outcomes many of the other redistributive ideas go out the window (as they should).


I know it leads to hard choices where there are no good results. Should we give a liver transplant to an alcoholic? Should we pay for a gastric bypass for a fat guy? Incentives always have a plus side but also a minus one, since something is being withheld.

Re sick time, in the case of your employer I believe it is clearly part of your compensation. As long as everyone keeps to the system it will be fine. What about someone who gets sick after his vacation and taken all his off time? You will probably see an article in the local paper criticizing the cruel employer. The challenge to a system like yours is that it subject to this kind of attack.

In a perfectly rational world, we would get no paid holidays at all. Instead, you would get the total compensation package and take leave w/o pay whenever you wanted time off.

BTW - I really agree with your statement “Most companies don’t just pick the person who will work for the least amount of money, they want to attract the best they can find. They can only do that by offering an attractive compensation package.”

You could yet achieve Republican status.

Posted by: Jack at August 7, 2006 8:16 AM
Comment #173767

Jack,

I’m glad you recognize there are severe inequities involved. But, isn’t the “Devil in the deatils”? It’s one thing to propose risk based insurance, but another to do it. Even setting rates based on smoking habits was a drawn out process. Let the insurance companies decide, and the next thing they’ll include is driving habits, track your credit card bills to see if you eat at McDonalds, etc… (Yeah, yeah, slippery slope argument. Doesn’t mean I’m wrong)

I think this must be done a case by case basis in a very public and politically costly process. Otherwise, we’ll be eliminating millions of people from the insured list leaving the gov’t to either pick up the tab or abandon it’s citizens.

Posted by: Dave1 at August 7, 2006 9:20 AM
Comment #173776
You could yet achieve Republican status.

Jack,

I wouldn’t put money on it. I am actually finding the Libertarian Party much more attractive these days. The Republicans would have to make drastic changes in their views on social issues to become attractive to me. (plus, I am not a big fan of supply side economics)

Posted by: JayJay Snow at August 7, 2006 10:21 AM
Comment #173847

What about those of us middle age folk who can’t even FIND health insurance?.

After my husband retired (age 65) we discovered that neither of us can even get insurance. His company did not allow us to continue with their insurance - so now we have COBRA which will end in April ‘07 and have had a Thyroid condition which I have taken medication for 15 years. It does not stop me from being able to work, think, play, drive, etc.

The cost of raising
The cost of raising.

My husband has the less serious type of diabetes. He is NOT over-weight, does not drink alcohol (neither of us do) does not smoke (neither of us do)use legal drugs, watches his sugar level, and excerises by walking our dog, (Lab puppy) 2 hours every single day.(we both do, and we both ex cerise as much as we can.)

We have had health insurance companies literally hang up on us when mention the word diabetes.

I’d been more than happy to pay for it, even, a bit more, if we could just find a company who would take us. Our current coverage is Cobra, which we lose in April of ‘07.

Neither one of us caused our particular problems. They were not our choices to make. They simply began all by themselves.

If any of you know of a insurance company that might take us, please let me know.

Also Jack,
I’m glad that you have finally open your eyes, by acknowledging the idea of CHOICE - I assume you mean that for women as well….(laughing out loud)

Posted by: Linda H. at August 7, 2006 3:28 PM
Comment #173873

JayJay

Don’t limit your aspirations.

Linda

I think abortion is morally wrong, but the woman involved has to make the choice. Like most Americans, I am in favor of abortion with restrictions. I always thought it strange that when my daughter was under age I had to sit in the office while she had her wisdom teeth pulled (surgery), but she could have had an abortion w/o telling me or her mother.

Posted by: Jack at August 7, 2006 6:39 PM
Comment #173904

Jack,
I found it interesting that you only responded to the
very end of my very long ( I know, I know -too long)
response regarding health care and choices.
It’s the type of restrictions that I was referring too.

Please take a moment and re-read my post, and try to respond to it, as I know of lots of older couples in the same position my husband and I.

Posted by: Linda H. at August 7, 2006 9:39 PM
Comment #173906

Jack,
I found it interesting that you only responded to the
very end of my very long ( I know, I know -too long)
response regarding health care and choices.
It’s the type of restrictions that I was referring too.

Please take a moment and re-read my post, and try to respond to it, as I know of lots of older couples in the same position my husband and I.

Posted by: Linda H. at August 7, 2006 9:42 PM
Comment #173923

Linda

Much of what I would say to you is included in the original post, but let me try to make it more specific. Insurance is meant to spread risk. For example, we might expect 10% of the population to develop a particular kind of malady, but we don’t know which 10%, so we all pool our resources so that the risk doesn’t wipe out any particular individuals.

At the same time, it makes sense to try to reduce risks. Again, risk is spread. When a person avoids sickness everyone in the pool benefits. Nobody wants to get sick, but some people are better about doing the things to keep themselves healthy than others.

We have both a moral dilemma and a moral hazard. The moral dilemma is how much everyone should pay for one person. This is a relatively recent problem. Just a few years ago, we could claim to want to keep any individual alive as long as possible because we knew it was NOT possible. This is less of insurance issue than a biomedical one.

What I am in favor of doing is putting people in insurance pools based on behaviors that can be changed. I would make it illegal to discriminate because of genetics or age. In other words, we should not allow an insurance pool to be created of only athletic 20 year old women. But I do believe that people with bad habits should pay more. An obese person should pay more as should a smoker or a boozer. I would give the person a choice. Lose the bad habits or pay more. I understand that some people will now claim that obesity, boozing or smoking are conditions beyond the control of the participants. This is incorrect, since it is obvious that some people have given up overeating, boozing or smoking. Consider the difference between a real condition and a voluntary one. A six foot tall man can do very little to reduce his height and virtually nothing to get taller. That is a condition. A fat man can change his body. It might be hard, but it is his choice.

So my (long) post will not exactly address your problem. If you are in an insurance pool when you are 22 and healthy, I believe that you should be allowed to stay in that pool when you are 65 and not so vigorous. On the other hand, if you take up bad habits, you should pay more.

Your question requires addressing the general problem of national health care. That is another story. My opinion is that we should all be covered by a program similar to the one offered to Federal employees and members of Congress. You can look up the system. Individuals pay part. The Feds pick up part and there is some choice among plans. They also have access to medical savings accounts.

The other thing has to do with the nature of insurance. Insurance means spreading risk. If something happens to almost everyone in a population there is no need for insurance. It is not a risk; it is an expense. We all need food so we don’t get insurance that pays for our food. The same would go for routine medical care.

Posted by: Jack at August 7, 2006 10:58 PM
Comment #174044

I sort of thought that Food Stamps might be considered to fall under that very broad definetion!
(Joke)
As you say we all need to eat, but you and I pay full price, while others don’t…

Posted by: Linda H. at August 8, 2006 1:11 PM
Comment #174053

Jack,

Were you an over-the-shoulder micromanager in industry? For a conservative you certainly enjoy creating massive Gordian regulations.

Posted by: Dave1 at August 8, 2006 2:16 PM
Comment #174078

Dave1

Remember how Alexander the Great solved the Gordion knot problem. If you cut through it all, the only regulation I advocate is to require health insurance companies not to use non-behavior based criteria in their pooling. Do you believe we should be able to descriminate against someone based on his/her genetic type, race, or ethnicity? If you do, we disagree.

Otherwise, I would just allow firms to do as they wished. I think they SHOULD charge smokers, boozers etc more. I would not force them, but I believe if we ALLOWED them to they would do it by themselves.

Posted by: Jack at August 8, 2006 5:19 PM
Comment #174117

Jack,

First; alcoholism is a medical condition so you can’t use that behavior. But anyway, let’s extend your proposition;
What about wearing seat belts? That’s a behavior.
What about sexual behavior? Homosexuality? Promiscuity?
What about eating meat, vegetarians live longer.
You are trying to force preferred behavior through insurance pooling. Sorry, but that is a conservative response; force people to do what you think is right for the benefit of business profit.

Posted by: Dave1 at August 8, 2006 9:28 PM
Comment #174119

The following are some passages from a white paper on universal health care prepared by the American Medical Student Association. The paper itself is here.

“Over the last few decades, the United States has witnessed skyrocketing health care costs. Health insurance premiums have been rising on average by double-digit percentage points over the past five years, a rate of increase that is 2-3 times the rate of inflation. Because of these out-of-control health care costs, there has been a steep rise in the number of uninsured Americans. Currently, more than 45 million Americans lack any form of health insurance, and millions more are “underinsured” – they have insurance but lack adequate financial protection from health care costs.”

“While this problem was formerly a problem confined to low-income Americans, more and more middle-class citizens are becoming directly affected by the problem. In the face of rising health care costs, fewer employers are able to provide their workers with health insurance; the percentage of employers offering health insurance dropped from 69% in 2000 to 60% in 2005. Even if employers are able to provide health insurance benefits, the trend is towards providing high-deductible insurance that covers an ever-shrinking percentage of health care costs. The net result is that more and more employed middle-class Americans find themselves with low-quality or no access to health care.”

“The most direct way in which the insured are affected by the lack of universal health care is illustrated by a 2005 study that surveyed people who filed for personal bankruptcy. In this study, 46.2% of those surveyed cited a medical cause for their bankruptcy. Of note, only 32.6% of those citing a medical cause of bankruptcy were uninsured at the time of filing, meaning that almost 7 out of 10 people in the survey were insured when they filed. In other words, high medical bills and lost income due to illness can lead to bankruptcy even for the insured. A society that believes that people should pay a lot of money for the privilege of having health care is a society in which only the extraordinarily rich are truly immune to the threat of medical bankruptcy.”

“Even if one were to assume that universal health care would entail a large outlay of money with no economic return, the amount of money it costs to cover all is literally a drop in the bucket of the U.S. economy. In the end, universal health care is a matter of budgetary priorities, and therefore of moral priorities. As the world-famous Princeton health economist Uwe Reinhardt put it, “The issue of universal coverage is not a matter of economics. Little more than 1% of GDP assigned to health could cover all. It is a matter of soul.”

Posted by: Trent at August 8, 2006 9:32 PM
Comment #174146

First; alcoholism is a medical condition so you can’t use that behavior. - Yes I can. How do you get people to stop drinking? Do they get a medication or do they have to use behavior changes? If you can behave your way out of something, it is a behavior problem.

But anyway, let’s extend your proposition;

What about wearing seat belts? That’s a behavior.
- Yes. Most states have seat belt laws anyway. My only problem is knowing about it an enforcing it.

What about sexual behavior? Homosexuality? Promiscuity?
- Yes. Depending on the results. Actually your problem is promiscuity and stupidity. Homosexuality in a reasonably monogamous relationship is no more dangerous than similar hetero behavior. A monogamous homosexual couple has a greater chance of being hit by lightning than of contracting AIDS. If you are coming down with venereal disease with some regularity, you are probably doing something stupid and you should cut it out or pay higher premiums.

What about eating meat, vegetarians live longer.
-All that counts is the results. They do charge more if you have high cholesterol etc. If your weight and blood are good, nobody should care what you eat.

I am interested in the results of behavior. If you insist on sky diving and wrestling with wild animals, I think your insurance rates should be higher. I am not punishing you, just accounting for the voluntary risk you are taking. More prosaically the same goes for smokers, boozers and fatties.

Posted by: Jack at August 9, 2006 12:16 AM
Comment #174175

Jack,

Good article, I hope my slightly off-topic posts didn’t bother you, but some of the responses to it touched on some of my ‘hot button’ issues and I feel compelled to respond to anyone who promotes those ideas.

I was fairly shocked when you said: “My opinion is that we should all be covered by a program similar to the one offered to Federal employees and members of Congress.”

I just wondered if you realized that this is the exact plan that John Kerry proposed during the lead-up to the 2004 elections? It seemed to me that he was severely lambasted by the majority of Republicans for even mentioning it and that it was repeatedly labeled unfeasible and unworkable (with some of the usual ‘socialist’ perjoratives rearing their ugly heads), etc…

Personally, I never quite understood the opposition to it, as it relies on the premise that the plan can only work for the ‘elite’ in this country and not the common man; this position seems mighty hypocritical to me.

Whether or not it ever would have been actually implemented had he been elected is fodder for another debate, but I have to say that it’s good to see people from ‘The Other Side’ promoting such causes. Perhaps some day the divide will be breached.

Posted by: Liberal Demon at August 9, 2006 8:01 AM
Comment #174183

Jack,

You missed my point. You want insurance companies to charge health premiums based on their definitions of acceptable behavior. Not only that, how do you measure someone wearing a seatbelt or how many sexual partners is too much or whether you practice safe sex (remember the religious right doesn’t want people to know about those things). I was pointing out that there are inumerable behavioral choices all of which effect risk indices. I, for one, do not want my life monitored by some asswipe actuary behind a desk so he can set a premium.

Also, you said you don’t care about the diet or sex, just the results. Meaning, you want a non-behavioral characteristic to be another deciding factor. You want to charge someone more for getting the clap, what if I want to charge you more for risking your back moving rocks?

Again, it’s control over individuals for profit that conservatives love. To hell with the person, give me their wallet.

BTW: Alcoholism is defined by the AMA as a medical condition.

Posted by: Dave1 at August 9, 2006 8:30 AM
Comment #174201

Jack, I think you are way off base here.

Regulating insurance pools for obvious racism or ethnic discrimination makes sense, but regulating genetics and age is nonsensical. The whole purpose of pools is to limit risk. The idea is to crate a pool that will create a competitive edge for the provider.

Understanding the problems of pools, you are moving toward an understanding of why healthcare is a poor competitive business. It abuses those it does not benefit. It denies those that need it, common decency and human value.

We have a natural pool. It is called America. Why should anyone be denied necessary healthcare? Heroic efforts or vanity based plastic surgery could be a reasonable source for private pools.

Responsible Healthcare begins in an industry that promotes whizbang fixes that have questionable value. Why should our insurance inustry support this? They have. They have failed Americans. Make a new drug, or machine, even if you can’t prove it really does anything better, and you’ve created a road to your wealth. This should not be rewarded.

A private group of companies with regulated profits and medically responsible criteria set by knowledgable doctors, without financial interests in the business seems to me a more reasonable fix.
This is not a competitive industry as it exists. Why pretend it is or even can be?

Posted by: gergle at August 9, 2006 10:58 AM
Comment #174217

gergle,

I agree with your post, but, to be a nitpicker; the purpose of pools is to share risk. Jack is proposing we force people to reduce their risk taking by allowing insurance companies to decide who pays for those risks. I.e. create micropools with dozens if not hundreds of characteristics.

Posted by: Dave1 at August 9, 2006 11:39 AM
Comment #174218

Gergle, using all Americans as a natural pool would imply that we’re all in this together, and that it would imply that securing good health care for all Americans, despite circumstances, is a moral obligation and a measure of our values. It would deny some the ability to get cheaper health care than their neighbors in the name of national interest, and it would give all of us a stake in promoting healthier lifestyles. Clearly your idea goes against fundamental American ideas.

Posted by: Trent at August 9, 2006 11:48 AM
Comment #174240

Trent,

Cool post, took me a couple of reads…

Posted by: Dave1 at August 9, 2006 12:49 PM
Comment #174702

Gergle

NOT characteristics. Behaviors. Behaviors can be changed. Behaviors are choices.

Posted by: Jack at August 10, 2006 8:23 PM
Comment #174835

Jack,

The reality is you want the profit motive to control peoples behaviors, and by extension their beliefs. Some American ideal that is.

Posted by: Dave1 at August 11, 2006 12:48 PM
Comment #174879

Dave1

Just asking people to help pay for their own behaviors instead of passing the costs on to society. The person imposing his behavior (and by extension beliefs) is the one who refuses to change or pay for his harmful behavior. That is not an American ideal.

Posted by: Jack at August 11, 2006 3:47 PM
Comment #174960

Dave1,
Granted, sharing risk is idea behind pools, but maximizing profit is the goal of any business. Skewing a pool to maximize profit is what the real game is all about.

Jack,

Are you suggesting that we penalize all people with type A personalities by making them hum mantras and burn incense? We know they are at risk for more disease. Perhaps we would have to eliminate all corporate CEO’s from the “pool”.

Personaly, I think healthcare is an inalienable right, not spelled out in the constitution, but not disparaged by way of the 9th and tenth admendments. The problem is that sophistication of the mathematical modeling for risk makes pools no longer a fair game. The market is now a game of deception and legalistic maneuvering that is all about tricking the system. There is no fair pooling model that any business will accept, that I am aware of. It is in the interest of the society to create a market that is fair and just.

Posted by: gergle at August 11, 2006 8:01 PM
Comment #174964

P.S.

Jack, you sound a lot like a proponent of temperance. We know where that has ended up before. We all eventually become sick. We all eventually die. The largest factor in this is genetics and nutrition, which by the way, genetics and parenting also governs risk taking behaviors. Do you want to punish the weak and abused? The problem is that the model is no longer a game of spreading risk, it is a game of avoiding risk. When we only insure the “Supermen” at reasonable premiums, that begins to sound like Nazism.

Posted by: gergle at August 11, 2006 8:10 PM
Comment #175113

I guess caregving is a bad lifestyle choice, too.

Wear and tear of stress

Posted by: gergle at August 12, 2006 12:36 PM
Comment #175159

Gergle

I was born in Milwaukee and come from a long line of brewers on my mother’s side and a long line of boozers on my father’s. I am not in favor of temperance. But if you start behaving in ways that cause problems, I do not think society should bail you out.

Health care as a right depends on what you are talking about. BASIC health care is one thing. But what about all the electives and what about the high cost, low payout things? I am really not interested in having my life extended by six months when I am 95 and frankly I am unwilling to pay for you to do it either.

You are right that we will all die and sometimes we will be sick. It is nobody’s fault, but sometimes nothing can be done and sometimes it is not worth it to try.

Posted by: Jack at August 12, 2006 5:28 PM
Comment #175883

Jack,

Ahhh, now you get to the crux of the problem. Define healthcare. That’s the game of the insurance industry.

Posted by: gergle at August 16, 2006 2:43 PM
Comment #197967

i have daugther that is going kemo was wondering if we could help with anything.thank you, please contact me

Posted by: mike at December 6, 2006 2:32 PM
Comment #217329

This is clearly an issue with pharmaceutical companies promoting their drugs for other uses than what they are approved for. The blame all goes to the pharmaceutical companies telling Doctors that it can be used for these cases. WBR LeoP

Posted by: Marina at April 18, 2007 4:18 PM
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