Freeloader Mothership

(Let us delve, oh my long-suffering and indulgent readers, into the realm of real economics, an area of study much neglected in the utopian groves of academe. It’s almost as if our isolated professariat, protected behind the great bulwark of tenure as they are, have become afraid to get their hands a little dirty discussing economics in any but the emotionally satisfying but ridiculous terms of various strengths and and flavors of marxism. -PB)

Can’t Fight Human Nature

The bottom line is this: We are, most of us, potential freeloaders and it is only fear of the wolves prowling outside the door that keeps us working as hard as we do. For my part, if I could find a job that paid as well as Emergency Medicine but required less work, I’d jump on it like a bum on a quarter. It’s not that I don’t like my job because I do. It’s just that taken as a whole, the fun only outweighs the crappiness of much of it if we put a decent salary in the scales. Two hundred thousand a year? A great job but not perfect. Thirty thousand? I’m not getting paid enough to do this shit. In this the Hamburger flipper and I are kindred spirits. We have to ask ourselves every day and every shift if it’s going to be worth it. The burger flipper however, has less to lose by falling into the bosom of the state and having all of his needs provided for by someone else. That’s why disability is so appealing to many of my patients but not to me. The crappy monthly subsidy they would receive as well as the modest benefits allowed by our welfare Social Justice system are not too much less than many of them could achieve on their own with the effort they are willing to expend. Some are just lazy, some sincerely believe that they are incapable of upward mobility, and some are categorically unable to breath and chew at the same time but for whatever reason, work has no appeal quite like leisure supported by somebody else, especially the modest leisure ambitions of the poor and lower middle class which involve, short of winning the lottery, fishing, hunting, eating, watching television, booze, weed, sports, and the other simple pleasures of life. Three week vacation to Italy? Not even on the radar screen. The key concept here is that every one of us has a price at which he will eschew work, or at least work that we must do to live and not a hobby masquerading as a job.

So you see, cradle-to-grave welfare Social Justice of which free medical care is only the first step wouldn’t work for me at the price the nanny state is offering. But that’s the seductive appeal of the European model for people who are not willing or able to make much more than what the nanny-state promises. The huddled masses yearning for the secure bosom of the mammary-government will give up the freedom to enjoy the fruits of their own labor to eat somebody else’s fruit. The problem is that we’re never as frugal with somebody else’s fruit as we are with our own so the natural progression in the self-fulfilling prophecy that is socialism (a word from which even socialists now run screaming), dictated as it is by immutable human nature, is an easy progression from a sense of gratitude to entitlement and then to demands for even more of somebody elses’s fruit. Eventually the ante is upped enough where even productive citizens would be crazy not to take their share of the fruit. People are lazy, not stupid.

Providing the fruit however only works as long as there are enough suckers to pay taxes. Eventually the tax burden, especially in a progressive tax system, makes the economic incentive to expand your little corner of the economy, creating the goods and services that are the wealth of any nation, next to nothing. If I am taxed at 90 percent for any income I make over a certain amount allowed by Your Sweet Lord, the Gubmint,’ the extra money I make for seeing a few more patients or working an extra shift is minimal and not worth getting out of bed except that I can go fishing instead. Your desire to see a doctor, in fact the heart-rending pleas of the baby-boomer hordes about to descend locust-like on the medical care crops will fall on deaf ears. No economic incentive, no production. The money for free medical care, not to mention for every other new right discovered by the Trailer-Park-Ghetto-Academia Axis, has to come from somewhere and it will come from increased taxation. In due time, this excessive taxation will have a deleterious effect on the ability of the productive sector, the little understood, much maligned engine that produces of all the little things in life you enjoy, to continue to create the wealth necessary to make everything free.

Many years ago I worked for a Wood Products company that was considering buying a plywood mill in the former Soviet Union. They quickly dropped the idea because after seventy years of communism (socialism’s retarded cousin) the mill was like most factories in the Soviet Union; a bloated, inefficient, poorly-run concern employing mobs of redundant, low-payed workers making a shoddy product that you couldn’t give away in the West. This particular mill made a third as much plywood with a thousand employees as a typical American mill can make with only fifty. And it was plywood of incredibly poor quality, stuff that even the most dishonest contractor would reject out of hand, and they wasted prodigious amounts of wood doing it.

A typical American plywood mill has one modern computer-controlled lathe that can peel a log down to about the diameter of a broomstick. Veneer, the strip of wood coming off a spinning log and what makes the layers of plywood, is money. The more veneer you get from a log the more plywood you can make at a lower cost. The ex-Soviet mill had five nineteen-seventies era lathes, most of which were broken at any given time, that could only peel a block (a log) to about eight inches in diameter. This valuable piece of the tree was then chipped and used to fire the boilers. American mills occasionally produce large peeler cores but only if the price of dimension lumber (e.g., two-by-fours) that can be sawn from the cores exceeds the value of the veneer. We certainly don’t burn money as hog fuel.

Theoretically the Russian mill was a progressive factory. No one could be fired and everybody had all the benefits that could be offered by the Motherland in that now forgotten dark freeloader empire. But they made crappy plywood that no one would buy unless they were forced which is the modus operandi in a command economy. Most of the workers stood around doing nothing for most of the day, absenteesim was high (but irrelevant if you see my point) and when the time came to pay the piper, the plant (and the whole country) had no value and could not honor its obligation to ensure a worker’s paradise built on the equitable distribution of goods and services by a central committee. Folks, they were selling the mill. And they were desperate to sell it which is not exactly a ringing endorsement of the progressive principles upon which the factory (or the empire) was run. Without incentive, and surely their was no incentive at this plant to even show up much less do quality work, there is no possibility of progress. A factory, and a society, cannot support a mob of time-servers and malingerers for more than a generation or two, particularly in the face of external pressure from more advanced societies, that is, ones that are maybe less “progressive” but more entrepreneurial.

Now consider another large socialist state, General Motors, which at one time I understand used to manufacture automobiles but now is primarily concerned with supporting a large dependency class and for who the production of automobiles is merely a sideline. The unions to which GM is a prisoner, with the best of intentions but now obvious short-sightedness, have contributed mightily to running the company into the ground. For many years, when times were good and Japanese cars were rinky-dink pieces of junk, the management of GM could afford to cave to union demands offering lavish benefits to its employees. People were still buying and the costs could be distributed into the high volume of increasingly poor-quality automobiles being built by employees who slowly, oh so slowly, began to resemble their more progressive comrades in various worker’s paradises around the globe.

Now, the high quality automobiles are being built in Alabama and South Carolina in mostly non-union shops. The benefits aren’t as good but the jobs are there and sustainable for an industry where competition is fierce and an extra thousand bucks per car for benefits to people who haven’t actually worked for the company in forty years makes all the difference. The ripple effects of this kind of sustainable enterprise spread throughout the South. Birmingham, Alabama is a thriving, growing city. Flint, Michigan, once the center of the American automobile industry, is a crime-ridden ghost town for which the joke among real estate agents is that they will cure AIDS before you can sell a house in that depressed market.

Not to mention that the pressure from wages and benefits has forced both Mercedes-Benz and General Motors to invest heavily in automation, technology who’s purpose is to reduce payrolls and expensive employees.

Is this fair? Not the right question because fair’s got nothing to do with it. Since we were talking about plywood mills, I’ll have you know that one of the last non-automated steps of its production occurs on what is known as the “lay-up” line where, for fifteen bucks an hour (good wages in my rural Lousiana Parish), workers fit irregularly shaped shards of veneer (“core”) between two moving ribbons of continuous veneer (“face”) before the entire assembly moves to the press. (Come on, you guys have looked at a sheet of plywood, right?) The person who invents a practical automated lay-up line can patent it and be set for life because the competitive edge provided to Georgia Pacific of not paying those salaries will let them eat their competitors for lunch…until everybody gets an automated lay-up line and then everybody can coexist in a state of uneasy parity until the next breakthrough.

And yet, despite the drive to shed jobs, the result is not a nation of jobless ex-plywood workers clogging the soup kitchens. Progress may be heartless but the net effect, the increase in the material prosperity of a nation by increasingly efficient production of valuable things (either goods or services) spurs new growth in sectors of the economy that the aparatchik running the Soviet Plywood mill couldn’t even imagine. Even in the Wood Products industry for example, although the low-wage menial jobs are almost gone, there is an ever growing demand for someone, anyone, who knows his way around Programmable Logic Controllers, the computerized nervous system of a high tech factory.

Finally, let us consider the United States, one of the largest economies in the world and whose business should be business, not attempting to directly provide for all of the needs of its citizens. We don’t even need government programs to encourage work or even to discourage freeloading. People will find their own way but only provided that there is an incentive to keep the wolf from the door. An economy that diverts large portions of its scarce resources to not only support but encourage the non-productive is not a viable concern for too long; the length of time the ponzi scheme can continue depending of on the momentum you have going into it as well as the willingness of lenders to extend credit. But you can’t support a growing number of eaters on a finite pie. The pie has to get bigger or everybody gets a progressively smaller piece. One day the shieks of Araby and the Mandarins of China will decide that supporting your demented granny’s right to that free fourth heart cath is not a good credit risk and then we’re all screwed.

So sorry.

44 thoughts on “Freeloader Mothership

  1. This is an awesome post! One of your best, in my humble opinion. If only the presidential candidates would read history or if that were to difficult – just read this one post. I’m off now to do my part to contribute to the nanny-state.

  2. You speak the truth my friend. Please keep up the good work.

  3. PB, I think we should merge our blogs.

    Maybe call it the The Happy Bear, Or the Panda Hospitalist.

    Our views on so many things are essentially the same.

    FREE=MORE

    which will eventually become

    MORE=BANKRUPT

    That is a guarantee.

  4. On the subject of company benefits, the other end of the spectrum is also an interesting example. When a company (like Walmart) skimps out on providing any benefits for their employees and doesn’t pay them very much it is good for their bottom line, but bad for the American taxpayer. These people don’t get paid enough and don’t have health insurance and so if anything medical goes wrong (or they just have the sniffles) they go see Dr. Panda. I think it is rather interesting that the socialist types promote things like universal health insurance as helping the little man but in a way they are really helping companies like Walmart. (Walmart can let people, their employees, go become a burden on the taxpayers and not get too much flack for it)

    (Wal Mart pays poorly for me and thee but there are many people, I assure you, who look at getting a job at Wal Mart as a coup of sorts.   Benefts or not, most people, most of the time, do not need comprehensive medical insurance which seems to be the Holy Grail when if anything, we should be working towards a system where everyone pays for as much of their routine medical care as they can afford and, if anything, the government subsidizes major medical for those who can’t afford that kind of insurance, perhaps agreeing to make up losses on patients who fall way, way out of the boundaries of the risk pool. -PB)

  5. Pffttt… Fair? Who is talking fair? Be happy! As I told you before, corporate America will have its way. $$$ talks. $$$=power. That’s why the feds are doing their corporate rescue thing for the subprime mortgage disaster. You aren’t sooo deluded that you think it has anything whatsoever to do with people who are losing their homes, right? They are rescuing corporations, dear Panda. Same, same with the coming advent of some form of universal healthcare. Corporate America WANTS it to happen. They need healthcare costs for employees reduced.So, it WILL happen. It is quite clear to me that the real needs of individual human beings have absolutely nothing to do with it. It isn’t about healthcare. It isn’t about “fairness.” It has nothing whatsoever to do with “social justice.” It’s all about giant for-profit corporations. So, be happy Mr. Bear. And I will be happy too. I’ve been working for it for 20 years and waiting for it for as long. And I really don’t give a damn anymore about the motives – because I live in the real world and am conscious everyday, every minute, of how this real world works.

    And by the way, the only housing I have ever owned is a “trailer.” I rented it for 10 years while I went to a remote place in which temperatures are often -60 with a windchill of -125 for many months of the year. I had a child with multiple differences/disabilities who I put (as a single parent)through arguably the finest school in the world to remediate them – the difference between a kid with a 140 IQ who without appropriate remdiation would be on a trajectory to become the smartest cocaine dealer in the bunch, and a kid with a degree in economics/polysci who works as a researcher in a non-profit think-tank in DC. Each year of those 6 years in school I paid for, while renting out my trailer, cost between 20,000 and 27,000 each year.I worked very, very hard and indicidentally, froze my arse off. It was well worth it. Oh and I’ve done my job for anywhere between 8.87/hr and 100,000/year. Either way, I’d do it. I and many other folks are missing the assumed “freeloader” trait that you and Happy seem quite sure we all possess and operate under…

    My husband is retired military and I have a retirement coming which I could access in one year, but will wait untill age 60.My retirement comes with a lifetime paid super-high quality health insurance policy. So, we will be doubly insured and then triple insured in our 60’s. Universal Healthcare will do nothing for me, or my husband personally. We enjoy excellent health and our health insurance status is enviable. In fact, it will COST me under a true single-payer plan. And I am ecstatically fine with that.

    The thing is, I realize I’m not the center of the universe, nor the only person in the U.S. Why would I for one minute think that everybody else would think/feel/act like me???And though I’ve worked alot in ERs, they aren’t the only places I’ve worked over a 24 year career, thus far. Gallows humor is important for sanity – for survival, especially in an ER. I’ve been known to refer to more than one pt as a “bottom feeder” or a “creature from the deep” and then there are the “reptiles…” But the difference between us, you and I, is that I am also very clear that everyone isn’t just like me, and that the view of life one gleans from the ER is truly confined to the ER. There are “bottom feeders” and there are saints in this life. I’ve worked with them all. I will continue to work with them all – because this is the human condition. And generalizing to the world from one’s narrow workview in the ER is a dangerous and very strangely skewed view of humanity. You’re functioning as a Frog in a well who can only see the small patch of sky above him…

    I KNOW who I can control in this life…only me. I don’t and don’t plan to begin to make it my job to monitor/control everyone else. If I did, the outcome is highly predictable – @ times I’d be outraged, @ times elated and @ time sorely disappointed. So what? Oh well. Humans will keep on being humans.

    And universal health care will NOT break us – by a longshot.On the other hand, continuing to pay United Health Group’s CEO( and the rest of his ilk) 122.7 million a year WILL break individuals and companies and is outrageous – utterly unacceptable.

    So, bring your hands together, Mr. Panda – clap!calp!clap! The very bastions of the free enterprise world you so admire are coming to the rescue (theirs!) and it’s going to be a good, good thing for us all. Relax…it’s already in the process of happening. ;)

    http://www.nchc.org/about/

    Oh and as you say – a hat-tip to the Happy Hospitalist for being the only IM/only MD, for that matter,in my 24 years of experience outside psych/CD treatment circles who clearly puts it out there that CD is a huge health issue and needs to be treated, as does mental illness.

    (Listen, I do not worship at the altar of free enterprise any more than I slobber over rock stars or other celebraties.  But paraphrasing Mr. Churchill,  Capitalism is the worst of all economic systems except for all the others.  I am in complete agreement that total, complete Darwinian Capitalism is not a great idea but we need to move closer to that direction on the continuum than the other.  As for CEO salaries and other bogey-men, who cares?  We can’t spend 16 percent of GDP on medical care and not have somebody making money, justified or not.  If the CEO of every insurance company dropped dead tomorrow your premiums would go down by, what, ten bucks?  When you fixate on the bogey man you are easy prey to your political masters who would rather you had this simplistic world-view than an education about economics.-PB)

     

  6. Yeah, I’m sure you’re right, Brian. None of the politicians have the grasp of Intro. to Microeconomics that Panda does.

  7. Panda For Surgeon General!

    better yet… Panda for President!!!

    Wait, I wouldnt wish either of those jobs on you..

    Keep up the outstanding work. You fuel a lot of my positions for debate in my poli sci class.

    Doc H,
    HM2 USN
    OSU- Pre AT/Pre Med

  8. All in all, pretty excellent essay. You and I would never be political friends but I have tremendous respect for your well-argued positions, and find myself slanting a little bit more fiscally conservative each time I read one.

    Birmingham, while a lovely growing city thriving thanks to UAB, the biotech industry, and a whole host of New South banking industries, didn’t get any of that from the car factories you mentioned. I wanted to give credit where it was actually due.

    Anyone that drives by Lincoln, where Honda is, (or the Mercedes-Benz factory, also situated in quasi-rural Alabama) can point to an entire industry having revitalized previously dying towns. Vocational training is up, support industries are moving in, and it looks in general like I’ve heard Flint did back in the northeast heyday. Since this generation didn’t grow up with union expectations I sincerely hope that it’ll last until we’re all driving carbon-free scooter-jets.

  9. We can argue economics all day and many of us have different views each likely with some valid points. However, the truism that resonants with me when I read this post is what I see in the Emergency Department and in life in general each day – Panda says it best – “The bottom line is this: We are, most of us, potential freeloaders and it is only fear of the wolve prowling outside the door that keeps us working as hard as we do.” I wish that our government leaders would consider this important point before creating more entitlement programs.

  10. (1) Well, there are several ways to view the freeloading problem (or, why poor people choose to stay poor!). One is that the benefits of staying in a low income group are too high. Another (given lip-service in your post but probably the real focus of most social justice programs) is that the cost of upward mobility is too high. You don’t really do much to distinguish those things in your post, and comments about 90% income taxes hints of burning strawmen (yes Virginia, the Soviet Union was bad, but that fact alone doesn’t imply free market healthcare, qed).

    (2) What percentage of the poor and unemployed do you think are there despite their best efforts, and what percentage because they’ve made the conscious choice to freeload (assume for the purposes of this question that the two groups are mutually exclusive, although the logic of econ 101 dictates that they are not).

    (3) do you really think you’re in ED because it truly maximizes your income with minimal work? Even within medicine, I’d say you’ve incorrectly estimated things (hello, anesthesia), and when you factor in the debt-load and opportunity cost of medical school and residency, well that justification becomes downright strange. Yes, you’re probably not going to stick around in ED if the salaries are cut to 20K/year, but that doesn’t mean you’re only in it for the money. More likely, your decision represents a combination of utility (not necessarily income) maximizing desires with failure of imagination. I mention this not as a gotcha! type of thing, but because of the primacy of monetary incentives in your post in general (only part of the puzzle, obviously).

    (Emergency Medicine probably pays better than all the other specialties with three-year residency training.  While neurosurgery, dermatology, radiology, and opthalmology pay considerably more, kindred spirit as I am to the many hamburger flippers, I am not smart enough (as demonstrated by grades and board scores) to do any of these specialties even if I had an interest which I do not.  I considered Anesthesia but I don’t really like to read magazines and do Sodoku puzzles that much so it wasn’t for me.

    As to the percentage of patients who are freeloaders…well…all of them, potentially.  Nobody, and I mean nobody, will pay for anything if they can get it for free.  The trick is to set things up so people don’t expect to get things for free.  And as to the percentage of the poor who elect to be poor as compared to those who can’t help it, I don’t care. 

    As for strawmen, look, I gave you some concrete example of how comprehensive welfare, even for the best of intentions, can end up hurting the society its supposed to save.  Pointing out historical fact is not building a straw man.  The Soviet Union, the largest empire in the history of the World, at the end had the non-military GDP of Delaware.  There’s a reason for this and it was largely because the pervasiveness of their welfare state obviated the need for anybody to do much of anything.  I presented this to demonstrate a general principle, sort of to make it obvious what I think the problems are with providing everybody with everything they need for free. -PB)

  11. “Trailer park – ghetto – academia axis?” Go $@#$ yourself….(The rest of your post deleted.  You may not insult anyone including me on my blog unless it is done with good humor. -PB)

  12. TheProwler says:

    “which involve, short of winning the lottery, fishing, hunting, eating, watching television, booze, weed, sports, and the other simple pleasures of life. Three week vacation to Italy? Not even on the radar screen.”

    I had to stifle some pretty good laughs after this one, because I’m in a library. Great post.

    as for alexa-blue: “(3) do you really think you’re in ED because it truly maximizes your income with minimal work? Even within medicine, I’d say you’ve incorrectly estimated things (hello, anesthesia)”

    You also need to like what you’re doing. If something is mind-numbingly boring, just because it’s less work does mean it’s preferable. I could be a security guard watching cameras for 10 hours a day, or I could run as an EMT in an ambulance for the same amount of time. The incomes would be pretty similar. One would be a lot more physical work and mentally taxing, but it would also be a lot more fun (the EMT), in my opinion.

  13. I think “Trailer-Park-Ghetto-Academia Axis” belongs in the Pandictionary.

  14. Medschool Mayhem says:

    I think its impossible for me to both agree and disagree with so much at the same time.

    Government provides services to its population, such as police, firefighting, roads, etc. Why should health-care be any different to those services?

     

    (Because these things do not suck up twenty percent of our GDP or have the potential to bankrupt the nation.  As for roads and other infrastructure, these are too expensive for anyone but government (generally) to construct.  Medical care is like food, shelter, housing, and transportation, that is, a thing that people should pay for themselves except in extraordinary circustances which is why we used to have medical insurance until it became “comprehensive.  We give food, housing, and medical care to many of the poor and that’s fine. -PB)

  15. David Deitsch says:

    In you post, you paraphrase one of my favorite Winston Churchill quotes. Here are two gems fron Winny that you can quote verbatum:

    “Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy. Its inherent virtue is the equal sharing of misery.”

    “The inherant vice of capitalism is the uneven division of blessings, while the inherant virtue of socialism is the equal division of misery.”

  16. SexPanther says:

    “I considered Anesthesia but I don’t really like to read magazines and do Sodoku puzzles that much so it wasn’t for me”

    Ouch, PB, ouch. I know you’re joking, but it still hurts. At least we’re not those bastards in PMR!!

  17. Again, if you could make more money with equal work doing anesthesia (let’s call that marginal profit “free lunch”), but don’t because you prefer digital disimpaction and suturing head lacerations on drunks to sudoku and magazines, why would you assume that anyone else is different?

  18. Alright. I’m with you so far; Uncle Sam should not buy all of us health insurance, agreed. Its the basic principle of robbing peter (the productive members of society) to pay paul (the chronic back pain slob getting vicodin from you for free because I paid for it).

    But how do you get Mr Vicodin to pay for his own health care? Do you deny him at the ER door until he ponies up? Or do you force him to get insurance?

    I would love to see a part two of this post, which obviously is a lot more difficult to write, entitled: Mothership Drops Off Deadbeats

    Great blog, by the way.

  19. I have read a lot of similar ideas on medical websites. But what are the alternatives?
    A soviet system is out for the obvious reasons.
    A pure cash and carry system is unlikely to work especially with low wage earners for the obvious reasons.
    A corporate insurance company run world is…gag…what we have now!!
    Also, the underclass in the US knows that the professional classes hold them in contempt. Your opinion of these people in likely telegraphed in many ways. Do lineman work harder to protect a quarterback who gives them respect than one who doesn’t?

     

    (I eschew sport metaphors because of this kind of thing.  I’m a doctor, not a quarterback and the nice fellow assembling my Gordito at Taco Bell is not working for me but for himself.   Having worked plenty hard for my whole life including stints in fast food, landscaping, and shelf stocking I inherently understand and respect what is involved in these kinds of jobs from the ketchup level (so to speak) and not as some intellectual abstraction.   I also have extensive experience in real industry, the kind where we make things that people buy, and the complicated dance required to produce even the simplest of things is not an abstraction to me either.  Not that it should matter (and I suppose you’ll have to take my word for it) but I believe I have the street cred’ to tell you what I think without having to be apologetic or obsequieous to anybody.  I’m just telling you that it is not compassionate or caring to structure society so people can elect not to work.  It wins the adulation of the Social Justice pimps but in the long run it damages society in ways that are obvious to anybody who has a historical perspective.  -PB)

  20. Which brings us back to my original question. What kind of society would you like?
    You’ve outlined problems with socialism and the corporate state.
    Are there nations that have a better grip on things than we do?
    I do not consider myself a defender of the status quo. Personally, I think that I’m rather agnostic about the ideologies that are out there. Socialism devolves into the soviet state and laissez-faire turns into the rule of the mafia equally.

  21. Alexa-blue –

    It’s apparent that you’ve taken an economics course, or at least read up on some economics terms.

    A) It’s a fact that America is the most upwardly-mobile country in the world. Check the immigration rates for some anecdotal evidence. I’d love to hear what costs to upward mobility you think are more significant than the benefits to staying on the government teat.

    2)Nobody knows what percentage of those on welfare are freeloaders, but it would be a quick exercise to find out. REQUIRE EFFORT TO OBTAIN BENEFITS. It wouldn’t be too long before those able to work would realize that they could spend their 8 hours a day either pretending to find a job convincingly enough that they receive their benefit, or actually working somewhere and making more money.

    Last) You know as well as I do that Panda is not maximizing income- he’s maximizing utility. He’s on a high enough salary stratum that income and utility have started to separate, ie: there’s only so much food you can put on the table before it rots. However, for the first 30k – 50k we assume that maximizing utility tracks evenly with maximizing income because you need approximately a fixed amount of dollars to put a roof over your head and food in your kids’ mouths. If you’ve ever been hungry, this makes lots of sense.

  22. ace – read the rest of the post – panda outlines a solution (involving non-comprehensive medical care – since most people are healthy and don’t need it). if i paid out of pocket for my well-checks and removed the middle man, a large portion of the cost of healthcare is removed – paperwork for insurance companies is estimated to cost us 33% of that 16% GDP.

    i think the bigger point of this post is that this is a complicated problem, but the solution is NOT socialized medicine. the solution might not be right there in our faces, but to settle on socialism because there is no other solution is stupid.

    and i can’t say that the current set-up isn’t frustrating. as the current system is now, a pt won’t take htn meds and ends up in renal failure. now instead of a pt getting a $4 prescription, this patient is costing us thousands of dollars a week to get dialysis, and some day a kidney transplant.

    do i think socialized medicine would take care of this? of course not. one would be hardpressed to convince me that a pt can’t spend $48 dollars a year to prevent a deadly condition – just cancel the cable, internet, lower the car payment, etc. socialized medicine would just ultimately condone supporting the patient on dialysis (because i promise there will continue to be people who just don’t care until it’s too late).

  23. Panda, I will agree that this post is your best in a while. It sounds as if a presidential candidate were giving the speech. Unfortunately, while his supporters would be adamant, there would be few voters—as few people are willing to openly say that other should not be granted access to healthcare.

  24. As for CEO salaries and other bogey-men, who cares? We can’t spend 16 percent of GDP on medical care and not have somebody making money, justified or not. If the CEO of every insurance company dropped dead tomorrow your premiums would go down by, what, ten bucks? When you fixate on the bogey man you are easy prey to your political masters who would rather you had this simplistic world-view than an education about economics.-PB)

    I am not focusing on “bogeymen.” If anyone has “bogeymen” they are focusing on – obesessing on – it’s you – the “deadbeat bogeymen.” I am stating what is fact about what makes the economic wheels of this country turn, and thus shapes all kinds of social and health policy. In this case, big money cajones are getting squeezed. It has nothing to do with “deadbeats.” Healthcare policy WILL change because those who really have the power @ the top to change it are feeling squeezed in the wallet. And I get an on-going education about economics since I have an adult child who is an economist, thank you very much! ;) And, would it make a huge difference if all the CEO’s salaries in insurance companies translated into funding – certainly. The salary of the cited CEO could fund approximately 34,000 poeple under a single payer system. And I have a BIG problem with paying for such expensive FOR PROFIT healthcare in which about 30cents on every dollar goes to “administrative” costs. I have a problem with the fact that because I am very well insured, I lool like a cash-cow in any healthcare encounter. That, too, is a BIG problem and I have seen it in action, repeatedly,on the inside of healthcare and on the patient’s side of the industry. You are certainly aware that in hospitals other departments, such as surgery, are used to off-set the money-losing ERs.(Hint: If you have the luck and grace to be a well insured person, be informed – be very informed when it comes to Healthcare providers and procedures/surgeries…) You’re a cash cow in systems salivating for them.

    Not that it should matter (and I suppose you’ll have to take my word for it) but I believe I have the street cred’ to tell you what I think without having to be apologetic or obsequieous to anybody. I’m just telling you that it is not compassionate or caring to structure society so people can elect not to work. It wins the adulation of the Social Justice pimps but in the long run it damages society in ways that are obvious to anybody who has a historical perspective. -PB)

    Plenty of folks who read your blog have lots of all kinds of work experience and the idea that you or anyone else should have to apologize for any non-abusively stated opinion is odd. Conversely, whatever all your working experience is, it makes you no more qualified to discuss these issues than many, if not most, in your readership. Everybody has their life/work experience; everyone has their “corner.” HOWEVER, the idea that anyone who does not agree with you – such as all those who have researched this issue and put forth economic indicators/information which differ from yours are people who lack any historical experience/perspective is poppycock. And I am talking here about people for whom this is a life’s work, as much research has been done in this area and information abounds- from health economists and others. Some share your views and some (a whole bunch!) do not. That someone does not come to the same conclusions as you have cannot be used to relegate them to the status of “historical perspective deficient.” The truth is, there are a bunch of folks in your camp and a currently bigger bunch of folks who aren’t in your camp. They don’t see things the way you do, not for any lack of “historical perspective” or lack of braincells or experience.

    The deciding factor will be in whose camp BIG BIZ falls. Reality IS reality.

    (But you see, you read my articles and interpret them through the lens of your own particular outlook whether it has anything to do with the article or not.  I never mentioned health insurance, CEOs, or the many, many problems in the way medical care is bought and sold which you lay out in a very articulate manner.  These are all important issues and addressing some of them as well as many of the other problems I have mentioned in other articles (tort reform, futile care) will go a long way towards making medical care less expensive.  But the article is about human nature, economics and how creating a welfare state, something that we are pretty far along in doing, is not going to magicly make the problems go away but only worsen them in the long run.  We can hardly pay for the welfare state we have and I believe that two-thirds of the federal budget already goes to legally mandated entitlements which, as they carry the force of law, are almost impossible to trim back.  And we don’t actually have the money (the value of goods and services) to make good on these future obligations.

    We are so ridiculously over-doctored in our country anyways.  A diferent topic, of course, but the point is that the structural problems of the system are not going to be made better or cost less by giving medical care away to everyone but only by addressing those problems which requires the exact opposite of having government in charge.  The idea is to remove as much as possible the role of government and other third parties and as much as we can make buying and selling medical care a simple transaction.  The multiply comorbid are never going to be able to afford their medical care out-of-pocket but most people, most of the time, can pay for most of their routine medical care and medications if they weren’t conditioned to expect it for nothing and especially if the costs and inefficiencies associated with the current system of “hide the reimbursement” were removed. 

    But make medical care a right?  Bad idea.  It is and needs to be considered a service like any other which, for charity and mercy’s sake as a nation we may give to those who need it but can’t afford it.  Everybody else needs to pony up. 

    As for historical perspective, to be accused of setting up a straw man by giving an irrefutable example of the dangers to a society of the welfare state gone mad as it had in the former Soviet Union does not exactly show a grasp of history on the part of my critics.  -PB)

     

     

  25. mem says:

    “The salary of the cited CEO could fund approximately 34,000 poeple under a single payer system.”

    I call bullshit. It was estimated that 43 million people would use Medicaid in 2004, at a total cost of 295 billion. That’s $6800/person… about $3200 more than you alot them in your shady math. Oh, what’s that you say? Efficiency gains in a single-payer system would cut costs in half? Bullshit again. Have you met the Federal Gov’t?

    Right, right. I guess all we have to do is cut reimbursements some more. That way we’ll lose our supply of physicians. Then poor people will be paying with their watches instead of their wallets… which is probably fine because they aren’t busy wasting their time at a job…

  26. Todays 1/15/08 WSJ: Wait times longer for ER patients. They infer that it is due to larger numbers of uninsured and underinsured turning to you for medical care.

    Do ERs (inadvertently) help sustain the freeloading culture? This is my point: people can get healthcare regardless of their insurance status. Wouldn’t mandates force the freeloaders to earn their keep?

    I am not sure of the answer, but I think it’s a good question.

     

    (Yes…and no.  Most of the patients in most Emergency Departments have health insurance, be it private, Medicare, or Medicaid.  In fact, most Emergency Departments are money-makers which is why you see the explosion of modernization and upgrading of facilities.  Our hospital has just built a beautiful, plush ED with almost twice the capacity and this was not done out of charity or a desire to serve the poor.   They also encourage, through advertising, the use of the ED for just about anything.

    Remember that all poor children and their mothers, through Medicaid, have health insurance as do all of the elderly through Medicare.  That’s your demographic, mostly the elderly, who make up the bulk of patients.  Our hospital built a new pediatric ER just to cash in on all of that free medicaid money out there.  Leaving aside the trauma and acute presentations of non-chronic medical problems (appendicitis, renal stones), the vast middle at least in our department mostly use the ED because they don’t have a primary care doctor (because the thought of establishing care never occurred to them…hell, I’m 43 and have been to the doctor only four times that I can remember) or they can’t get a timely appointment and know that they’ll get a the kitchen sink thrown at them in a relatively timely manner.  We have plenty of uninsured but not all of them are indigent and hopeless.  Why do you think almost every Emergency Medicine blogger comments on the well-dressed, well-accessorized with the latest personal electronics, tatoos, jewelry, and bad habits patient who pulls out the latest cell phone and jabbers incessently to their friends about their leisure plans but can’t afford four dollar antibiotics at Wal Mart? 

    Now, these are not universal facts.  Big urban EDs have more of an uninsured, completely poor population as well as a lot of illegal aliens.  But it is true that people use the ED as an excuse to not get medical insurance or to pay for their own medical care.  I had a young, otherwise healthy uninsured girl come in for a mild sunburn.  I guarantee she didn’t pay the $300 dollar bill for her visit.  We see everybody because of EMTALA which, if it were implemented according to the intent of the law and not for fear of litigation, would allow your ED to turn away any minor complaint at all.

    So you see, the problem is very complex with many competing interests and giving medical care away for free is not going to change much except remove whatever restraint there currently is to keep people from being even more ridiculously over-doctored. -PB)

  27. “I had a young, otherwise healthy uninsured girl come in for a mild sunburn. I guarantee she didn’t pay the $300 dollar bill for her visit.”

    But Im sure she’d find the $300 to pay me if she saw me for Botox. It ain’t right.

  28. TheProwler says:

    “Again, if you could make more money with equal work doing anesthesia (let’s call that marginal profit “free lunch”), but don’t because you prefer digital disimpaction and suturing head lacerations on drunks to sudoku and magazines, why would you assume that anyone else is different?”

    Alexa-blue, the whole point is that he isn’t assuming that he’s different than anyone else. If he could get paid for doing what he does for leisure, he would.

    DERMDOC: “But Im sure she’d find the $300 to pay me if she saw me for Botox. It ain’t right.”

    Ain’t it the truth?? A resident on SDN posted that a patient came into the free clinic to be arranged with a surgeon who would remove a thyroid nodule/tumor for free, a savings of thousands and thousands of dollars. Recent surgical history? Oh, yeah, breast implants. The patient paid $5000 cash for a boob job, but wasn’t willing to pay for a needed operation.

  29. Medschool Mayhem says:

    Because these things do not suck up twenty percent of our GDP or have the potential to bankrupt the nation.

    But Panda, Canada (for example) spends a less than we do. We would have to ration care to a better degree, but we would spend less or the same, not more.

     

    (Exactly, if we ration care like most of the Freeloader Kingdoms do.  The question is whether Americans who are accustomed to eating deeply at the buffet of medicine will accept their 80-year-old-granny not getting dialysis or being told, “No.”  I happen to think free markets do a better job of rationing than governments.  But if Medicare, a program that costs ten times as much as the wildest doomsday scenarios of its creators, is an example of government’s ability to control costs, I sugggest we are all in trouble.  The government will ration care by decreasing reimbursements which will inevitably lead to shortages like price controls inevitably do in any sector of the economy (the reason many doctors don’t take Medicaid, for example). -PB)

  30. Jobe,

    I know that Panda is not fond of links, but it is late and sometimes a link in which you may do your own reading and digesting is far more efficient than my trying to to hammer it through in words, point by point.The link is to a single page. I’d suggest you enjoy checking out a number of pages on the site.

    My numbers, re: how the cited CEO’s annual salary translated into care for 34,00 came from 6 nationally published pieces on the subject, compiled for a single payer system educational info briefing.

    http://www.pnhp.org/single_payer_resources/pnhp_research_the_case_for_a_national_health_program.php

    I DO have experience in Fed systems – more than one. Are they Nirvana? No, they are not. But I would take either of the 2 I have practiced in in a heartbeat over any for profit system. There are a plethora of reasons for this. Additionally, a whole bunch of the finest Docs I have worked with were many year “products” of Fed systems. There are alot of incredible minds/Docs who are intensely devoted to their patients/practices and to furthering whole specialty areas for the nation in Fed practices. I have had the great privilege of working along side a few I’d truly describe as giants – and totally humble about it all. Amazing humans, amazing MD/DOs – and amazing healers – respecters of life. Hardly the “slackers” that folks who spread fear and loathing about any governmental linked healthcare would have you believe!My first experience a Fed system was in the 80’s and my last was for 9 years, 92 -2001, though in part of it I was actually in a tribal system that was very strongly linked with and partially funded by the Fed.)

    And no, aboslutely not, would I ever support anything that would reduce #’s of PRIMARY CARE physicians.There’s enough info out there about this subject as well, that I need’nt belabor why. One of the things I feel stongest about, as far as Physicnas are concerned, is the abject murdering of primary care by the current non-system, system of care and payment. While primary care is crucified, procedures, many with great risks,(not to mention astronomical costs!!!) become deified and utilized and actually pandered(too often with little to very shaky to no real justification) to the extent of creating a system in which the words “trust” and “ethics” become a truly alien concept for all.

    Panda,

    We simply have to agree that we disagree. Ideologically we live on different planets. ‘S ok. that you are a thinking human to whom what you do matters is basis for alot, as far as I am concerned. As Shadowfax wrote recently or maybe not so recently, we all agree that healthcare in the US is broken, or, at the least, that it has some major areas of “sickness” and is badly in need of surgery! And that is the important starting place. I believe that you are invested, deeply, in what you are doing. Many of your other posts are reflective of that. THAT I can always honor. Some of the attack-dog stuff around freeloaders and stereotypical whomevers is always going to be way over the top for me. But, that’s what the little red X @ the top right hand corner of the computer screen is for. ;)

    HOWEVER, what is all this quack-quack about “most” ERs being money-makers??? Demand has risen by 26% between 93 and 03. In the same period, the # of ERs declined by 425, the # of hospital beds by 198,00 and there were 703 hospital closures. It is not an across the board thing, but, not very many ERs actually MAKE $. And many are huge financial losses.

  31. Medschool Mayhem says:

    Exactly, if we ration care like most of the Freeloader Kingdoms do. The question is whether Americans who are accustomed to eating deeply at the buffet of medicine will accept their 80-year-old-granny not getting dialysis or being told, “No.”

    Well, we would absolutely have to ration like Europe & Canada. There is no way around it. That type of thing comes with a nationalized health system. But that system, where your 80 year old granny cannot get dialysis, but your 37 year old uncle won’t be rejected for chemotherapy due to some ‘pre-existing illness’ is a better system than the one we have now.

    I happen to think free markets do a better job of rationing than governments.

    Perhaps thats true for certain things, where people would be reluctant to waste their own money on frivolous treatments, but if you have cancer, you don’t really have a “choice”. You need chemo/radiation/whatever.

    (That’s my point.  In no way should primary care be free to anyone but the poorest of the poor.  Even the elderly with means should have to pay for routine doctor visists and their routine medications.  As far as major medical expenses, that’s one area where the taxpayers might serves as a guarantor for inexpensive major medical insurance. -PB)

    But if Medicare, a program that costs ten times as much as the wildest doomsday scenarios of its creators, is an example of government’s ability to control costs, I sugggest we are all in trouble.

    Well, the current system doesn’t work. That’s clear. Something like a fourth or a third of all spending goes toward the insurance company’s bureaucracy. Will physician reimbursement decrease? Yup. But it will still be a better situation and though you’ll have less grannies getting dialysis, you’ll have less 25 year olds falling through the cracks.

     

    (I want you to be the one to tell the elderly that they are out of luck.  It’s easy to conceptually state that the elderly and multiply co-morbid will receive limited and severely rationed care but in practice, the firestorm that will result the first time we put granny down will incinerate everyone who supported it politically.  It is politically impossible to ration care in the United States like they do in Europe.  -PB)

  32. “The unions to which GM is a prisoner, with the best of intentions but now obvious short-sightedness, have contributed mightily to running the company into the ground. For many years, when times were good and Japanese cars were rinky-dink pieces of junk, the management of GM could afford to cave to union demands offering lavish benefits to its employees.”

    What you are neglecting to mention is that GM promised those “lavish benefits” in lieu of actual money. They chose to keep the gigantic profits the hard work of their employees generated for nearly 20 years and spend it on higher and higher wages for more prominent and (supposedly) more effective management. Instead of spreading those profits among the workers (and you yourself said that nothing motivates a worker as well as good hard cash), they promised them healthcare till they died and a pension that would allow them to retire rather than work themselves into the grave. Those guys weren’t stupid, but they were uneducated and well aware of the dearth of options available to them when they got too old or sick for factory work. They took those promises. So did the teachers in Michigan. All that “excessive” healthcare those old teachers are receiving now is payment for 30 years of work for very little actual money.

    It wasn’t “the best of intentions but now obvious short-sightedness” it was pure greed. No one is calling for the return of what I would consider excessive compensation from the executives who ran the Auto industry during the glory days. They have had the benefit of that wealth for 30 years and so have their children.

     

    (I’m calling bullshit on this.  Not only did GM workers make good money but they got lavish benefits.  A typical line worker might make anywhere from sixty to eighty thousand dollars a year plus medical, dental, pension, and etc.  Now, it was hard to get one of those jobs de novo (and impossible today) but to say that GM workers were paid sub-standard wages is ridiculous.  I started as a Civil Engineer with four years of college and for half of what somebody with no education could get at Ford or GM.  And my benefits, while not bad, were not lavish.  As a licensed professional engineer later in my career my salary was advanced to a princely $52,000, much less than a senior union member putting doors on a Suburban. I had to kick in some for health insurance, and my “pension” was a 401K.  I’m not complaining, just putting things in perspective.  The UAW was so strong at one point that it forced the auto manufacturers to pay idle workers who otherwise would have been laid-off.

    Now, you can’t blame the rank-and-file from taking all they can get.  But the UAW is insane as a group.   No company is a bottomless pit of money for long and to force contracts on your employer that will bankrupt them is short-sighted.  No doubt GM owes what it promised.  That’s the nature of a contract.  But my point is that GM, like a nation, cannot meet its obligations and is going under.  In fact, they are currently desperately trying to “buy out” current employees, guys who they don’t need but can’t fire even if there is no work for them.

    People should get paid what they’re worth.  Unions, if they are extremely powerful like the UAW, tend to artifically elevate wages beyond the actual economic worth of the worker.  Not sustainable.  Sorry.  Do you think the current young people in Michigan would rather have jobs that pay like BMW in South Carolina, less than GM with fewer benefits but decent pay none-the-less, or scrape for minimum wage jobs like they have to today?  The unions have killed the goose and as The Boss says, “These jobs are going boys and they ain’t coming back.” 

    As for teachers, who cares and what does this have to do with anything?  Teachers also have a strong union and at least in my township, they get paid fairly well for their level of education and the amount of work they do.-PB)

  33. “The huddled masses yearning for the secure bosom of the mammary-government” – PB

    The Disproportionate Share Hospital (DSH) Program paid about 50 billion to hospitals for lost revenue in 2007. So why should taxpayers bail out hospitals for lost revenue due to poor business practices? Where’s the personal (or community) responsibility in that? Freeloaders.

    Wow, that was easy. I like this blame game.

    (You don’t make sense and don’t understand a basic concept or two.  If I own a grocery store and am forced by the government to give away groceries to anyone who walks in the door, how is this a poor business practice on my part if I am forced to close shop?  Or, to put it another way, you can’t make ice cream from shit.-PB)

  34. Patrick Caldon says:

    It’s very simplistic to chart a capitalism socialism scale and place systems on it. When it comes to the implementation of real systems, they inevitably have some market-based components and some globally-overseen components, and deciding which component should be in what spot is hard.

    The overriding principle should not be “capitalism generally works better”, the overriding principle must be that there is a law of unintended consequences in this area — we must do what works, rather than what ideology tells us to do. For instance in a vaccination program, it’s clear that a globally-overseen program will work better than a market-based program, thanks to effects like herd immunity. Similar comments apply to smoking-cessation and antenatal programs. I personally would far rather get sick (and pay taxes) in a country which has a national health scheme than one which does not.

    Note also that all national system to my knowledge involve co-payments of some kind or other at some stage of treatment; I’ve just been treated for an accident here in Australia, and I am substantially out of pocket for my pleasure. Rationing can work by substantially subsidizing health-care without paying for it in its entirety.

    Furthermore there’s nothing to stop a nationalized system having a market based insurance system bolted onto the side. The national system provides minimum standard care and public health on a waiting list basis, the bolt-on provides experimental treatments and allows waiting lists to be bypassed. Pretty much every national system has some variation on this model.

    I suspect the real problem is in the detail of how the US national health (medicaid and medicare) is implemented. My guess is that there is no incentive for hospitals to cut costs under the current system, and indeed an incentive towards over-servicing. I suspect if the hospital were funded on the basis of the degree to which sick people were made well rather than the length of stay, the complexity of the procedures applied and the number of diagnostic tests used, then medical costs would drop dramatically.

    Sometimes the coercive power of the state is useful and its application leads to a better outcome. Sometimes it doesn’t. There is no formula for working out which is more appropriate bar “suck it and see”.

     

    (http://thechronicleherald.ca/Front/1032464.html  The coercive power of government in action.  Listen, if health care is a right, how on earth can some people be allowed to more of the right simply because they can afford to.  -PB)

  35. BlackSails says:

    Adrian said: “So why should taxpayers bail out hospitals for lost revenue due to poor business practices? Where’s the personal (or community) responsibility in that? Freeloaders.”

    I think every hospital would happily refund all that money if the government also agrees to stop forcing patients on them.

  36. I am “the current people of Michigan. Furthermore, I grew up in Eastern Michigan and literally every kid I knew had at least one parent who worked for GM. I think I have a better handle on this situation than you do. You are absolutely correct, people should be paid what they are worth. My point was that when those “lavish benefits” were negotiated, the line guys weren’t paid what they were worth in comparison to the profits their work was producing. I didn’t say they were paid “sub-standard” wages, you did. And your estimate of their wages is hilariously high. I’m sure some people with tons of seniority made a lot of money, but to say that the average line guy in the 70’s made 80K is silly.

    This might not be sustainable, but that’s not the fault of the people who were promised those benefits. They agreed to those contracts and gave concessions based upon those promises. When I hear you arguing that management and stockholders from the glory days give back their “benefits” to pull GM out of its mess I’ll respect your argument.
    Your title calls old union members who are utilizing the healthcare benefits promised to them “freeloaders”…I call bullshit

     

    (Once again, you are reading with the intention of venting.  I used GM as an example of a socialist “state” that incurred obligations that it cannot possibly honor in much the same way that our country has incurred obligations (to seniors in the form of Medicare, for example, and retirees in the form of Social Security) that it cannot honor either.  This is not the result of high executive or government salaries but of regular people like you and me expecting something from nothing.  GM can look for the government bail-out but what can a country do except either raise taxes, renege on its promises, or borrow money from increasingly unenthusiastic creditors at ruinous rates?  The damage to our economy from over-extending benefits that cannot be paid is analagous to GM closing plants because the automobiles they make with overpaid union workers cannot be sold at anywhere near the profit to keep the whole concern viable. 

    So, whether it’s the fault of the union rank-and-file or not, people who know better; you, me, and other responsible voters need to be a little less short-sighted and elect people who understand that there are no free lunches.  Joe Blow working the line might not know any better but the leadership of his union should.

    By the way, GM has about 300,000 employees and close to 800,000 retirees or others drawing benefits from the company.  Let’s say the average cost per year of a retiree is $50,000.  Do the math and you will see what a staggering cost this is for people who are non-productive to the company.  Multiply that by the average life of a retiree and you see what I mean about the cost of obligations.  Remember, this is money that has to be paid but in no way contributes to the production of automobiles.  (This year GM has a 20 percent negative profitability, both because of their obligations to support their pensioners and because they make crappy, ugly automobiles that people don’t want.)  That’s sort of the problem in miniature for a nation that overextends itself.

    By the way, the typical salary of a GM mill hand or whatever you call them is around $25 per hour or $50,000 per 2000-hour year which is sort of standard.  And they can’t be fired and in many cases are paid even if they work or not. Not to mention benefits.  Retirees, who get some percentage of their terminal salary as a pension only pay around 800 bucks a year for their family’s medical insurance which is comprehensive.  It’s not the salaries and benefits of active workers that are a problem, those are a fixed cost of doing business, it’s the obligations made to retirees, many of whom will live for twice as many years retired as they worked for the company…some of whom draw up to 90 percent of their terminal pay.  Even the military can’t come close to that and they are viewed as having decent retirement benefits.  Good, bad, right, or wrong.  It’s not sustainable.-PB)

  37. Well, I don’t think I’m “venting”, just disagreeing with you. I still don’t feel like you’ve answered my argument, because when you are talking about the burden of retiree’s healthcare on GM, the average salary NOW isn’t relevant, only the monetary compensation vs. retiree benefits at the time the contract was negotiated. You are absolutely correct, it’s not sustainable. GM should have, and probably did, project those figures out at the time. They had every intension then of doing what they are trying to do, and you are advocating now…to take it back. I’m saying your argument is not valid. You can’t compare that situation with the ramifications of “the socialist state…where people like you and me expect something for nothing” because GM got into this situation as the result of negotiation, where the other parties were required to give up things in return for future benefits.

    (You can most certainly compare the two although it is not a perfect analogy.  I don’t care why it happened or who’s to blame.  The problem of unsustainable entitlements exists for GM and the the United States.  In the case of GM, it is not because of executive salaries. Executive salaries in GM account for about 4 billion of their operating expenses per year.  Their obligations to retirees and current salaries for labor are several hundred times higher than this so you could line up all of the executives and shoot them and you’d still have the same problem.  Do you get that my article is about the dangers to a country of overextending itself and not, even though I am somewhat anti-union, about the money problems of GM?  If you agree with me then you agree  with me.  And I’m sure you’ll also agree, just on the evidence alone (Flint a ghost town, Chrysler about to lay off 19,000, GM trying to buy out employees, etc.) that not only is the situation for the unionized auto industry unsustainable but things can never be the way they were forty years ago.  Same with a country.  We cannot sustain entitlement growth as a nation.  So sorry.  Vent away but there it is. -PB)

    I’m interested to hear your alternative to the current situation. Just let people die in their own vomit? Let the poor die of cancer and diabetes while those who can afford it receive treatment? Let the children of the poor, uneducated, drug abusing “Trailer-Park-Ghetto” dwellers wander the streets on their own after their parents win the Darwin Award? We certainly won’t be able to house them in orphanages since that would be socialist.

    (This is a straw man.  If you read my blog you know that I think most people should pay for their own primary (routine) health care on the free market as well as their own major medical insurance with the government as a guarantor of the risk pool (so people with pre-existing conditions are not priced out).  I also believe that tort and regulatory reform are crucial, not to mention allowing doctors, by some mechanism, to be the ones who determine when care is futile.  The government, for its part, can run the numbers and determine which expensive interventions really show a benefit and only act as a “guarantor” for those, all others pay cash.  A lot of people, by the way, die in their own vomit, some with excellent health insurance.  Same with cancer, not all of which can be treated effectively.  As for orphanages, I’m with Newt Gingrich on that one.  Better to take children away from the scumbag parents (who I see all the time) and if it costs us some money, well, that’s a price we have to pay.  But free medical care for all just because you don’t want to pay a cent for it?  No way.  It will bankrupt the country…I mean quicker than the current entiltlement burden is going to bankrupt us. -PB)

    I just plain think you are wrong. The current system sucks, it can be and is abused, it places a financial burden we have not earned on law abiding, good and righteous citizens…but the alternative is worse. I don’t think I, or you, have it that bad. The current system has innumerable benefits to physicians to offset the difficulty and inconvenience and even the taxation. You are the direct financial beneficiary of many ridiculous and unfair billing practices due to the current system.

    I guess my point distilled would be that people who live in glass houses shouldn’t throw stones.

    (Ad hominem.  I can be the worst human being in the world.  A complete scumbag.  The very Devil himself and still be right. -PB)

    I’ll go away now.

  38. Medschool Mayhem says:

    I want you to be the one to tell the elderly that they are out of luck. It’s easy to conceptually state that the elderly and multiply co-morbid will receive limited and severely rationed care but in practice, the firestorm that will result the first time we put granny down will incinerate everyone who supported it politically. It is politically impossible to ration care in the United States like they do in Europe.

    PB, we are already telling 25 year olds that they cannot get chemo. If I had a choice between telling an 85 year old and 25 year old, I’d certainly tell the 85 year old. Politically speaking, the fact that you are often denying care to a 25 year old isn’t spelled out, and neither will denying care to a granny, but I know which one I’d rather have.

    In any case, I have zero doubts that socialized healthcare will happen sooner or later – there is just too much momentum in that direction…the important thing is to pick the right method that strikes the best balance possible.

     

    (you see, your comments are well thought out and well presented.  My response would be that statistically, very few 25-year-olds need chemo or any medical care at all for that matter.  There is very little political risk in denying medical care to twenty-somethings as a group.  It’s just not that big a problem or a worry for most of them.  But denying interventions and treatments to the AARP crowd?  Political dynamite.

    But I agree that we will have some kind of socialized system (more than now, I mean) in the future.  The TPGA Axis is too deranged and the electorate is short-sighted. -PB)

  39. Medschool Mayhem says:

    My response would be that statistically, very few 25-year-olds need chemo or any medical care at all for that matter.

    Right, but then covering them for conditions like cancer wouldn’t be prohibitive, would it? Regardless of the fact that most twenty five year olds don’t really see the hospital all that often, the fact is that when they do, that’s the age group that we should be focusing our attention on, as they are the ones that are likely to have a long and productive (and income-generating!) life ahead of them.

    There is very little political risk in denying medical care to twenty-somethings as a group. It’s just not that big a problem or a worry for most of them. But denying interventions and treatments to the AARP crowd? Political dynamite.

    Fair enough – the AARP is a huge voting bloc, you are right there. Do I think socialized medicine can be a nightmare? Yeah, absolutely. I hope to be a doctor someday soon, and I’m a career changer like you, so I know what goes on in the real world, rather than the pre-med bubble.

    The world of medicine would be better served to find the plan that would be most beneficial and go after that, because wholesale rejection of nationalized healthcare will simply mean that the healthcare community will get a plan they definitely don’t want.

    With that said, I have no problems with having a mixed system where if you make a certain amount, you would have to pay out of pocket for coverage (progressive), but that coverage should be full, and not partial where they can deny you based on paperwork, past conditions, or other minutia.

    I don’t even have a problem with making everyone pay for preventative care, primary care and things of that nature. But I cannot agree with denying treatment to people with life threatening diseases for any reason whatsoever. I think its absolutely outrageous the type of things we let insurance companies get away with (and its not their fault either – their job is to make profit obviously, I’d be pretty pissed if I was an investor in the company and they didn’t do that).

    To help physicians, you can do things like making the patient pay for physician’s legal costs if they don’t win (like they do in Great Britain). You can also help them get away from Cover Your Ass mentality that permeates anyway. It’s too much to hope that a government system could actually lessen the bureaucracy, but if the litigation goes down significantly (which I believe it would if they had to pay for your costs if you lose), I am sure physicians such as yourself might have more time to see patients instead of filling out their forms.

  40. nihilobstat says:

    “The world of medicine would be better served to find the plan that would be most beneficial and go after that, because wholesale rejection of nationalized healthcare will simply mean that the healthcare community will get a plan they definitely don’t want.”

    What we’ve seen of national healthcare has largely guided our opinion and response to it. I believe that you have good intentions, but please understand that there are good, sound reasons why many are adamantly opposed to national healthcare. Some basics?

    1. Entitlement programs foster dependence, not progress.

    2. Mandated personal spending is not the role of government. If one chooses to spend his paycheck on a Vegas binge of hookers and blow, that’s his choice. It is, after all, HIS money, and taking it away by legal means to “give” it back to him (and others) in another, more virtuous form does not reduce the fact that you are robbing him of his freedom of choice.

    3. In the event of a wrongful denial of care by an insurance company, you have the right to address that wrong within the law. With a national healthcare system, your denial of care has no redress, as the denial carries the force of law.

    4. Government has no incentive to improve efficiency. Indeed, by providing more jobs, they benefit by reducing efficiency. Trusting the government to reduce waste by centralizing all functions beggars belief. Do let me know when the IRS finishes its new IT implementation, started in the Bush (41) presidency. Meanwhile, Turbotax works quite well.

    The list goes on, and these problems are not addressed. Believe me, we’ve seen the plan we definitely don’t want, and its name is national healthcare.

  41. Great read, Panda.

  42. You are a GENIUS! It’s so simple, yet 90% of the population just doesn’t get it for whatever reason. Please keep this up.

  43. Nice post. This statement by Adrian Rogers sums up my feelings about socialized medicine, welfare, and any other of the host of government handouts available today: “You cannot legislate the poor into freedom by legislating the wealthy out of freedom. What one person receives without working for, another person must work for without receiving. The government cannot give to
    anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other
    half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is about the end of any nation. You cannot multiply wealth by dividing it.”

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