mandatory health insurance.

Opinions?

Universal health coverage is an admirable goal but I don't know how you can successfully implement it without addressing the issue on the cost side, i.e., the insurance companies.

who generally suck at economic decisions.  

One aspect of health insurance as generally managed is that it includes psych diagnoses, which are purely subjective, and usually made for the purposes of satisfying insurers.  

Psych diagnoses are a judgment of behavior (read the clinical diagnostic standards of the DSM) which fundamentally eliminates the usual social process of negotiating appropriate behavior among the interested parties, and replacing it with what is usually a consensus that the patient does in fact piss off important people in a specific way - so if you want attention, are tired of work, you piss off your boss and go on disability leave...some shrink tries to talk you out of it, and guess what the correlation is between your insurance and your mental health...so this aspect of health insurance is an open ended cost.

IMHO, this should be undertaken on a purely economic basis, ie., only where the benefit outweighs the cost.  If not, it should be an individual option.    

The health and competitiveness of a nation is going to depend on how willing it is to discard uncompetitive practices and useless people.   If the Chinese or Zambians are willing to make people  pay for what they cost, then they will have a competitive advantage and tend to displace us in that degree.

Logically, I doubt we have a choice but to make policy decisions along economic lines.



-- Modified on 4/5/2006 2:39:21 PM

just like the environment and a host of other issues.  There are things that are more important than money.

Tom Cruise was a member of this board. Welcome aboard, Tom.

-- Modified on 4/5/2006 4:17:22 PM

as is the environment, and everything else.  Somebody will do the work, ie, pay the bills, and pretending there is no bill is sheer nonsense.

It's not that something is more important than money.  Money is simply a management tool.  If you do not have the resources (ie, money is the fluid form) then you can want all you want, it still ain't going to happen.

The country will not afford open-heart surgery for everybody.   Any health insurance plan assumes that people have an incentive to protect themselves, and stay well.  If we insure every derelict lush, that's very humane, but also very expensive, and you will find it does not make that vagrant any better citizen.   Same with psych diagnoses, which cannot be predicted.  If a housewife is bored enough, she will become depressed.  If she gets a real problem, her depression will be cured.

Many policies have the effect of creating problems where there were none before.  In fact, what IS a problem is a cultural definition.  

Dying is pretty much inevitable, and the question is, what steps do we take to keep our neighbors from dying?  Well, it depends on the circumstances, and IMHO, a lot of those decisions, and the responsibility should be individual.

E.g., I do not want to be told I cannot go motorcycling racing because it's too dangerous for my insurer.  (We have already made helmets and seatbelts mandatory for precisely that reason.) But I don't want to pay for people who engage in that sort of high-risk behavior, and I should not be required to.

National policies ARE economic decisions.   What, are you working for a non-profit, that you're a professional beggar?

If so, you could try.

sometimes resulting in multiple posts.

-- Modified on 4/5/2006 10:21:51 PM

-- Modified on 4/5/2006 10:26:30 PM

I have 30 years experience in the health insurance field and health care purchasing decisions are certainly driven by price just as any other purchasing decision is.  is doesn't matter whether the decision is being made by a corporation, a small employer or an individual.  The decision ultimately comes down to affordability (that, in part is what consumer driven health care is about), impact on competitiveness and profit (every one has a stakeholder to answer to, whether shareholder or business owner).

However, I disagree with him strongly on other points. I clearly have a conflict of interest in disputing his representations concerning psych benefits, but am willing to hazard his reaction. It is true that psych claims by their very nature are difficult to arbitrate. That is why they are scrutinized before being approved and are subject to internal limits within a health plan (out patient visits usually are paid at 50% of the charge (rather than 80%) up to a maximum of 25 to 50 visits per calendar year; inpatient visits typically are limited to a specific number of days per year). As to LTD claims for psychiatric illnesses, insurance carriers require more documentation, conduct more intensive research and on-going investigation than for any other type of diagnosis. Not just any wastrel is able to receive benefits.

Spock, why do you ignore soaring drug costs? This involves a much broader cross section of the human species and poses a far more serious cost issue than psych claims. Are people who are prescribed statins, beta blockers, pain medications, etc. also to be excoriated as drains on socity as a whole and excised from the corporate body?

But, where you really cross the line, sir, and demonstrate that perhaps you really do belong to an alien species is in your casual and callous assertion that a nation's, OUR NATION'S, "health and competitiveness ... is going to depend on how willing it is to discard uncompetitive practices and useless people".  In response, I would contend that any nation, especially our nation, that is willing to discard as useless any of its people(just who are these people anyway?)is not ensuring its health but its certain demise.

Actually psych and any other dx can be predicted with a fair degree of precision when spread over a large enough group of individuals. Insurance actually is based on the law of large numbers where risk over time cannot be predicted with any certainty by individual insured persons. But actuaries, through the analysis of historical claim data, can predict how many diagnosis for "X" condition per 1000 covered people will occur over "Y" time frame. It's not nearly as inexact or unpredictable as you might think.

or just snipe?

Would you like to tell us, e.g., the clinical diagnostic standards for, e.g. ADHD?

Perhaps you'd like to explain how somebody can prove a neurological disfunction by showing that a child is the least attentive in their group?

Can you discuss the legal, educational and social ramifications of this?   Or would you just prefer 'miracle, mystery & authority', this time from a group that admits they have no objective standards?  

Would you like citations?  Or is it too much trouble to figure things out?

~What the hell, it is only my opinion. (*so what if I am called a heartless bitch again*)

Mandatory Health Insurance has a different vision in my thought pattern. Perhaps the fact that a parent will be mandated to insure their child and cover their health care..... but of course that would mean working and there are so many arguments that support unemployment!

Since it is my tax dollars that will be spent to keep those who "can't afford" it, health wise, I guess I should vote affirmative (*especially considering the fact that my true profession is in the medical field and it will help to socialize medicine, thus compromising my future income*) .... SURE I'd vote to financial be responsible for the children of employable Americans who chose not to better themselves or the children they give birth to. Gheez, bring me a 4X4 or just call stat. The bleeding just seems to be running rampant.

Realistically, I vote we have mandatory vaccinations of children, assistance for the elderly and let everyone else fend for themselves.

I was so tired of assisting with a stab wound or an injury caused by violence in my Clinicals it was disgusting. (*Most of my clinicals were done in the indigent care facility*) wow... what a surprise! Probably upward of 60% of the care was self inflicted or as a result of individual involvement in illegal activity.... and your tax dollars are paying for that.

I also had unbelievable case loads of children with sniffles using the ER as their primary form of health care because their moms would rather spend the money on "a new weave" or acrylic nails. Many sit awaiting Gov't assisted cures for the ailments they have created in their designer jeans with designer hand bags.

The plea for assistance seems moving but the reality is health Care can be included with most work plans.... problem #1 many of these people are encouraged not to work.

Mandatory Health Insurance, yes but defined differently... mandatory to insure your children or have them placed in a home that actually wants to care for a child and is responsible enough to step up to the financial demands. As far as American Taxpayers footing the bill on yet another socialist idea No, you will never have my vote. Long live capitalism and the empowerment of those with ambition that work towards a better way of life.

And guess what.... many countries already have Govt funded Health Care, research the quality of care and then come to your own conclusions. I am an advocate of empowering people and offering avenues of opportunity not hand outs. Show a man how to help him self and he will be forever changed, give him what he needs and he will be satisfied just for today.

I seem to feel that basically Tusayan and I have similar feeling but I just chose to express mine to the general public in language easier for the masses to understand and less sugar coated.

Although BannaJoe does have a point and I would completely respect it....I feel that it is a reality that although Money isn't everything it is what we base our Country on. (*we could all kick back in Margaritta Ville but then, we would probably encounter poverty and pollution there eventually anyway, so out the window with the idealist point of view*) sorry BannaJoe but my main career field is within the real world.... I am only afforded the luxury of the world of "hobbying" on a part time basis, definitely not the real world in my experience!

Unfortunately, Spock seems to be the voice of logic here and I have to agree with most of his points.... sad as it maybe and bitch as I might... bottom line is I feel the taxpayers will be burdened with absorbing the expenses yet once again for those who choose not to. Just my thoughts ~T

Thetan all worked up, dude--and since I generally do not partake in insane dialogues, I guess I will just sit back and snipe.

statistically, but long term trends cannot be.  For example, could you have predicted the balloon in ADHD diagnoses 30 years ago?  

Do you believe this is anything but a cultural phenomenon?

Statistics are very useful in some applications, but the real problem is knowing the limits of statistics as a mathematical model.

that "no (person would be) left behind" is politician's talk.  You are involved in the industry, you make decisions daily that do in fact have the effect of cutting people off.  

You may not see it that way, but it's critical that you understand it from the other side, and know the effect.  

We ALL make decisions on a daily basis that tend to cut people off, and we should.  You are just involved in a particular industry that draws lines in health care.

It is bad politics to tell people the truth, that some people will ALWAYS be left behind; it's the nature of life.  

There are many questions involved in those decisions (like, what exactly is usefulness?  Is GW Bush useful?), but thinking that your values are the only valid ones is the hallmark of an ideologue.

My initial and basic point is the subjectivity, and nonreproducibility of psych dx.   The only way to manage those is as you pointed out, have a limit.  There is a cutoff if there ever was one.  For you, miles from the patient, to assume you know the fact, is clearly not based on the fact of the case.  You must make the decision based on policy, and it is important to understand that your decision is policy, not fact - there will be fraud claims, and there is also injustice in cutting people off.   That is the way life is, and I prefer honesty to BS, because it is less likely to lead to poor choices.

integrity, and deal with issues you raise.  

But, suit yourself.

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What's wrong with giving the private sector the same Insurance OPTION that our government offical's currently use ? at least it gets people insured, and if it's optional, if you have the income to afford better coverage elsewhere well then great I'm sure someone will be willing to sale a premium option, but isn't some option better than NO option which is what an increasing majority of Americans are facing now ?

psych dx are not independently confirmable; are 100% subjective, and (if you look at the DSM clinical disgnostic standards) are made entirely by comparisons of behavior between the pt and an unstated, undescribed norm.  IOW, it's whatever the psych says it is.  

THAT is the reason ADHD dx vary from 0% to 50% (virtually every elementary age boy in Long Island) across the country.  Does this not scream at you?

None of that is a real problem.  The real problem arises in leading people to believe that an organic disorder can be identified by comparing behavior among people, WITHOUT any other investigation.  That is precisely what the Soviets did to dissidents like Sakharov; and of course we would never do that, would we?

The problem is the misrepresentations about the nature and degree of our knowledge.  The problem is pathologizing behavior, which is profoundly undemocratic in that most DSM diagnoses are nothing more than a confirmation that a pt has issues with themselves or authority.   Any person who does not at some point doubt themselves and/or authority is truly crazy.

as soon as you realize that it (and everything) depends on the underlying economics, then you realize that at some point, the decision has to be made - deliberate or by default - to cut a person loose.  

Doctors make triage decisions all the time.  It's only politically unpopular to talk about it.

pop pills until you acheive nirvana.

Are we manic-depressive, or what?   Balance is what you need, dude, and you need to be able to accept uncertainty, without needing to label it, or beat the shit out of it.   Because neither does anything except waste effort.