Gov't asks insurer to explain self (in Debates)

HHS secretary asks insurer to justify 39% rate hike

I really should have started Verifex Health Systems LLC a while back. I could have already raised my premiums by like 120%, and all I would have had to do is respond to some stupid letters from the HHS secretary, oooh so scary.

Like the UN and nuclear bombs. The WMDs go unchecked.

Yes,

It is quite sad. Too bad the people in California cannot chose other health insurance providers since they cannot shop health insurance across state lines.

When there is a lack of fair competition, a monopoly can basically do what they want.

There are some things that should have never been allowed to be run _for_profit_
Health insurance is one of those things.

There are some things that should have never been allowed to be run _for_profit_Health insurance is one of those things.

*gasp*

but we have the best doctors in the world!

And also the most lawyers!

And one of the worst health care systems.

Yes, we have more lawyers than doctors in the US.

1.14M to 800k.

What a country!

And one of the worst health care systems.

As a whole yes.

Its so we can sue them after they fix us up. :D I mean how dare they save my life but paralyze me in the process!

That is very wrong. Our health care system is the best in the world. Access to it is the main problem. Those with access experience the best care, the brightest physicians and the newest technology available.

There are certainly problems gaining access to the system, and these features need to be addressed in the health care bill. Not the practice of medicine itself, which is one of the many flaws of the current bills in Congress.

Let us all hope that Obama is being truly honest when he states he wants to meet with the other side in the debate and work on a bipartisan solution. And that this is not yet another broken promise.

Although personally with his already known support of the current bills, I suspect this is little more than lip service to the other side of the debate.

My big fear with obama's new health plan is, the quality of medicine will inevitably go down.

Didn't you just say we have the worst healthcare system in the world? How can the quality go down from there?

Didn't you just say we have the worst healthcare system in the world? How can the quality go down from there?


Like ranger said its not that the we have bad health-care its just that a huge chunk of the population doesn't have access to it. In my book that would make it a huge failure. Regardless though, with a government run program more people will have access to it, but overall the quality will go down.

Why?

Doctor's will not be making the same amounts of cash they are making now. Compare the wages of a Canadian Doctor to our own and you'll see that. Which brings us to a very "communist like idea". "Why should I work harder then him when I'm getting the same amount of pay"?

American doctor, meet random world doctor.
He will explain to you the concept of "ethics", "satisfaction of a well-done job" and "gratification derived from patient satisfaction".

Huge amounts of cash seldom make people work BETTER, but it sure does make them work MORE... at least for a while, then it makes them work less since hey, why bother pushing the envelope (and also, still not better).

This is interesting, look at this [WARNING: PDF AHEAD!] page 4 and page 8, skip to the bottom of page.

My question is, why is it that the second lowest percentage income seems to be paying overall more then the 1st, 3rd and 4th lowest percentage incomes.

Come to England. We'll fix you up for nothing. Although there is a waiting list : )

My wife, who has been in Hospital since last Wednesday was asked by one of the nurses looking after her who her consultant is!!

"errr, shouldn't you be telling me?!?"

Scotland by the way.

How is that the best health care system? If you have 100 doctors for one guy locked in a vault that no one can get to, that may be the best freakin' health care for that one guy, but it's a terrible system.

We're not that far off from my crazy analogy--having our health care decisions made for us by our "employers" barely made sense when people stayed with single companies their whole lives. Now, the recession has revealed how tenuous and ridiculous it is to have our health care dependent upon who we work for. Basically, if you don't work for a decent company, health care is in an inaccessible vault.

We have 15% of our population that does not have health insurance. That is far from inaccessible.

We need to enact changes to make sure that 15% gets access. We can debate what the changes should be but that has already been done.

Sentences one and three are correct. Sentence two contradicts the others.

A system that leaves out the poorest 15% is not the best in the world. Far, far, far from it. As I've said many times, I'd rather have sub-optimal health care than none at all.

Ok, I just woke up, so I look stupid. I disagree with Ranger's first sentence. Obviously I'm not reading right.

*sigh*

Obviously, my main point stands.

Even if you only go by quality of healthcare rather than access I'm pretty sure the UK, Australia, Germany and Switzerland would all have something to say about Rangers ridiculous statement of who is best.

Tell that to those the come to America for care.

I am typing about the quality of care, not the access or the cost.

We have the best survival rates for heart disease, cancer and COPD.

You do not see foreigners go to Germany for care but you see prime ministers of Canada come to America for care.

Prime ministers with fat wallets who can pay for premium care. Let's see some poor foreigners who come over for our system rather than the other way around. Many Americans are now going to India for care because our terrible system has let them down.

You say you're not talking about access to care, but the quality of the care people can buy access to. Well, the rest of us are talking about access, and that what makes the system so bad.

Those are 2 different things.

Our quality is the best in the world.
We have to work on getting access to those that contribute nothing to society and have no care.

are those the only ones you think are unhappy with the current system or what is the major issue with our current system?

According to most the studies I have read, most people with insurance are quite happy with the quality of care.

Their major complaint is the cost of care. But nothing is free. One has to pay for the highest quality of care in the world. Which is what everyone in America expects.

No waits, access to the best technology and best doctors.

This all comes at a cost. And if someone has to forgo their Disney vacation to be able to buy health insurance, o freaking well. If you have to drive a 6 year old car to be able to buy quality insurance, o well. That is price one has to pay to be able to access the best system in the world.

It seems people want others to pay for their ability to have the best care possible, in the quickest time with access to the best technology and drugs possible.

It is so easy to say let us cover everyone when others pay for it. If people want complete coverage, that comes at a high cost. And sacrifices have to be made by EVERYONE. Not just the "rich". More taxes on the "rich" is not the answer.

I could go on and on, but I seem to be in the small minority on this subject as most people here seem to expect the best and most expensive care on the planet for free. And have others like me pay for it. And not have to sacrifice themselves.

First of all, where are your stats for that?

We seem to be average:
http://www.nationmaster.com/graph/hea_hea_dis_dea-health-heart-disease-deaths
http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer

We are number 1 in spending:
http://www.nationmaster.com/graph/hea_spe_per_per-health-spending-per-person

As for the main argument--you act as if that 15% uninsured is a good number, as if 85% of people are worry free. How many people have insurance that would really cover cancer? How many people have insurance that would drop them after removing a benign tumor?

So even if you're in the 85%, you can't really live with any surety of our "system." The moment you get laid off or your insurer denies you, you're on your own, wondering how you could possibly be one of the "15%"

>I could go on and on, but I seem to be in the small minority on this subject as most people here seem to expect the best and most expensive care on the planet for free. And have others like me pay for it. And not have to sacrifice themselves.

Uh, no. We pay *the most* (per capita, in the world). So is it shocking that people expect *the best*? Instead, people are constantly saying we have the best healthcare as if it were a patriotic mantra as opposed to actual fact.

As for your argument that "leaders come here for healthcare," that means...nothing. People are streaming to India for surgeries...maybe they're the best:
http://en.wikipedia.org/wiki/Medical_tourism_in_India

Clearly people are going overseas because they think the healthcare that they can afford there is better then what they can afford here (WITH INSURANCE!). I doubt it's the 15% going overseas...it's the 85% that still can't afford a root canal in the States.

All of this is moot anyways. If you want to believe US healthcare is great, you can choose to live in your perspective. But in 10 years (if nothing changes), you may see your perspective change as that 15% grows and the security of the other 85% declines.

Bolfen

Your posts about rates are very nice but very misleading with respect to my discussion.

In America we have more heart disease overall due to many factors including obesity and poor nutrition.

I am typing about survival.

See this link:
http://www.webmd.com/heart-disease/news/20040920/us-tops-canada-in-post-heart-attack-care

With respect to cancer, the US has a high prelevance of some cancers especially lung due to smoking.

But we have the best survival rates.

See this link:
http://www.lesjones.com/posts/004642.shtml

People go to India due to the cost, not the quality.

what people are you talking about here?

most of the "people" i know that are unhappy with the current system are frustrated by insurance companies having all the power and charging whatever they like, eliminating coverage if it seems too expensive and having all the power in these choices.

people are also frustrated by seeing costs on their medical bills that are then written off as being too high if they have coverage but charged to them at full price if they have no coverage.

i could go on with issues involving our current system but they would probably be ignored as they don't fit in with an "entitlement" mindset that people seem to attribute to the only ones unhappy with our current system.

That's somewhat reversed. A lot of times, medical costs are inflated to pull as much as possible from medicare and private insurance, but then discounted (as charitable writeoff, no less) for the uninsured.

For example, I just had a client who's husband received quite a bit of "defensive" medical tests. He's a 1099 contract worker, so no health care coverage. The hospital then discounted $5000 off of his hospital stay.

i am speaking only from my experience. i was told that the hospital might discount it if i asked in regards to an mri that wasn't covered by my insurance. i paid the full amount though and no one ever complained.

Dude,

As with almost everything in life, one can negotiate.

We have had many a person without insurance need an MRI. The amount we "charge" is far different than the amount we get from insurance companies.

All you had to do is shop around if it was not STAT and negotiate the best price. We have done MRI's, including reading fees for as little as 300 USD for a cash payer.

In fact, cash payers are preferred due to the lack of need to go through the insurance maze of paperwork.

that in itself though is another example of why honest hard-working people are frustrated with our current system as well though and it is another side of that same coin. when people have to beg to be discounted because they lack insurance which results in different amounts being charged for the same services, something is wrong other than a preponderance of a sense of entitlement.

So poor people without health care contribute nothing to society? Myself and all my co-workers contribute nothing to society? Young adults, students, laid off workers, and those affected by the recession contribute nothing to society?

Or was this just more bull crap liberal bashing?

Admins: can we start fining stuff like this?

I think admins just prefer to stay out of these threads.

thanks, that just brings about another problem. i did not know the insurance wouldn't cover it as the hospital failed to schedule a pre authorization appointment. it cost me 2500 bucks out of pocket and this was several years ago.

i had crappy insurance, i admit that. it was crappy insurance that started out at around 100 bucks a month for me and my daughter. it was my choice to go with cheap insurance as a self-employed though as it is prohibitively expensive to add us to my wife's. she's a public school teacher in texas and she has good insurance that we have to pay about 150 bucks a month just for her and the school pays part. to add my daughter & i though it would cost 600 or so a month.

the crappy insurance was fine though except for the fact that every quarter it would go up by 25 to 50 bucks per month. i finally decided to go through the hassle of getting on different, better insurance after the "cheap" plan was costing me over 300 dollars a month.

this is about the fifth time in 20 years of being self-employed that i have had to change insurance due to the costs sky-rocketing. each time, the process gets a little more restrictive and i lose coverage due to pre-existing conditions just from aging. i have also been kicked off of insurance once due to the fact that i was being prescribed steroids for asthma for two weeks.

i have paid every bill that i have ever had both medical and otherwise. i have never been on any government program including unemployment. being self-employed, i pay about twice in taxes as most as i have to pay the part that an employer usually pays.

the only thing i feel entitled to is honest dealings in return for my honestly earned money. i do not feel that our current medical system or medical insurance system gives me that.

So free speech is great when it conforms to what you believe.

But if someone wants to speak something you do not believe, you run to the admins (aka government) to solve all your problems?

As far as liberal bashing, if it the truth... It seems you want everything but someone else to pay for it.

Ranger,

You say that letting people shop across state lines for health insurance will prevent things like this story from happening. What do you say about the fact that almost every state has different regulations regarding health insurance?

Wouldn't every health insurance company need to comply with every single state's insurance regulation in order to sell their insurance there? Wouldn't that mean companies that don't comply with all regulations everywhere would have a competitive advantage over companies that did, and that each states AG would essentially need to police every health insurance company in the entire country?

And finally, why do you trust insurance companies so much?

Seems to work for car insurance. States have different regulations with respect to car insurance. Same thing would apply to health insurnace.


See remarks about car insurance. But when you have some states with only 2 or 3 insurance companies able to write policies, there will be higher prices. When competition occurs, prices drop. Of course there HAS to be some regulation to prevent collusion etc..
As an example. In Jacksonville a policy costs 2-3 times what the exact same policy costs just across the border in Georgia. Why? Competition.


I trust them far far more than the government for many reasons.

1) They cannot run it as a loss proposition then run to the people for more taxes to stay afloat. Like the post office or social security or medicare.
2) They can be regulated by the government. Vs letting the government run it and regulate itself. Which is a prescription for disaster. Inmates running the asylum type of deal.
3) When private industry runs something they look for ways to cut costs and maximize profits. With proper regulation they will look for ways to control costs.
4) Every business the government has run, they have run into a loss.

I am not stating the insurance companies are angels. But I trust them far more than the government. But tons.

I understand the comparison between health insurance and car insurance, but please understand this point when I make it. Car insurance functions on the principle that people who drive cars should be careful so that they don't need to use the insurance, but when something bad happens, they will have something there to help them.

Health insurance functions currently on the same principle: When you get health insurance you should still be careful so you don't need to use it. Health insurance, just like car insurance, goes up when you have health problems. This systemically weeds out people who drive poorly from driving because they cannot afford expensive insurance. However, this is where the analogy falls apart. If someone has too many health problems, they are still allowed to continue on living (for now) and having health problems.

For a system geared in much the same way the car insurance industry works, how do you propose a for-profit company reduce costs and maximize profits when someones life is in the balance?

There's a difference between having a rational discussion about health care and using valid points to back up your claims... and resorting to crap like "everyone who disagrees with me or can't afford health care is lazy and useless."

Guess which one I'm against? But I don't expect you to see the difference. You were never able to before.

Excellent point.

And the problem of putting up to 30M new people on the healthcare rolls.

However, opposed to the current plans that are going to cost over 1B dollars, there are other ways to decrease costs.

First, as I stated, letting insurance companies compete over state lines. It works quite well for the auto industry keeping costs down for good drivers.

Second, and something people do not want to read but tort reform is a must. As a radiologist I see plenty of studies done for defensive medicien. I see many studies done to CYA. I see plenty of garbage lawsuits that are settled since it would be more expensive to try the case.

Third, There has to be a method of individuals and small businesses being able to create an insurance poll to compete with bigger companies for discounts.

These are some of the ways to lower costs.

However, one has to realize that to cover 15-30M more people with the same healthcare as we have now will not be free. And everyone, not just the 'rich' should have to participate in the sacrifice.

But the government is not the answer. More layers of middle management, living off the government, is not the way to lower costs.

LB,

So when it is something you do not like, run to the government for help?

Typical liberal. They cannot do for themselves so have the 'rich' provide it for them through government. I have to pay for bad decisions you make. Just great, just freaking great.

I came from a lower middle class family and worked my butt off to get where I am. I took out huge student loans, which I payed back. Sorry if you do not want to do the work to become successful, but that is what you have to do to succeed and not rely on the 'rich' to give you everything.

I am so sickened by the entitlement society we have become.

I stated in the post you attacked, that we need to provide care to those that contribute nothing AND have no care. This is statement based in fact. There are people who suck off society. I am not saying it you or your co-workers. There are really people who have 8 kids and live off the government. But we should find a way to cover them.

You completely ignored my entire post and just re-stated yourself, I brought up some real criticism of this one idea, and I would like you to address it.

Again, you reduce the entire Left to the role of spoiled child running to mommy.

This is exactly what I'm calling you out on. Stop it. I'm getting really bloody tired of reading your inflammatory crap. You don't want to discuss the issue like an adult, you just want to troll and insult people. It's ironic that the guy reducing the opposition to spoiled children is the only one who lacks the maturity to have a rational discussion.

And on the "not pay for it" nonsense that you continue to spew out without any sense of reasoning or understanding of the Left's position on the matter: when did we ever say nobody was going to pay for it?

NOBODY CARES!

Let me restate things a bit clearer.

When there is competition, different companies can use different techniques to lower costs. Whether they have better deals with some health providers than other companies, less admin costs etc..

Part of the solution, if you read my entire post, is to be able to pool individuals and small companies into one unit for purchasing power.

As we all know, those who utilize more healthcare drive up the cost. That is one of the reasons the current plans in Congress make it mandatory for young healthy people to buy insurance. To distribute the cost.

I am perfectly fine with that, as long as EVERYONE is helping to pay. Not just the 'rich' as is in the current plans in Congress. Without carveouts like the NE kickback, the LA purchase and the union exemption from the excise tax.
Unfortunately nothing is free. Healthcare does not come from the sky as something just given. There is a cost.

To help insure those with chronic, expensive illnesses, the healthy and young have to pay the cost.

Is this what you were asking? Did I now answer it better?

That is much clearer, thanks! :)

I hope it wasn't a Freudian slip that you said only the young and healthy should pay for health care. I think the healthy people should help pay for the unhealthy people, no distinction between young or old.

Anyways


I get that, I'm just asking about the company itself. The insurance pools, tort reform, etc. aside, if company A has a bunch of insurance policies, and they need to cut costs to increase profits for shareholders, as legally mandated by publicly held companies, what should I do?

The easiest way I can think of is to increase premiums for people who get sick, remove them from the rolls entirely, or tell the health providers that you only cover these low-cost treatments/drugs. Off-hand I can think of a million ways to reduce costs for a health insurance company (I used to work for one lol). But the main thing I'm getting at is that most of these cost-cutting measures end up punishing the policy-holder for being sick, do you understand what I'm saying?

It's okay to punish the bad driver for getting into accidents, but do you think someone who is sick should be punished for being sick?

You stated it better. Typically older people in general are not the "healthy" ones we think of.

That is a dual edged sword.

Do we pay for the drug addict who injected a dirty needle and gets HIV?

Do we pay for the liver transplant of the alcholoic?

Do we pay for the coronary bypass on the obese person who eats McDonalds everyday and never touched an exercise machine?

Or should we make those people pay more for their healthcare?

It is a fine line we have.

But allowing people to pool together will stop most of the abuses that we currently see. Not all but if you let individuals and small businesses have the same benefits as large corporations such as IBM prices will go down for most and possibly up for others.

The biggest problem is that once you force healthy people who have chosen not to have insurance to buy it, what comes next? Forcing them to buy government bonds for the good of the country? Forcing them to all drive Insights?

There is no one solution that covers it all. But government takeover of the healthcare field will have the inmates running the asylum. If private industry does it, then at least the government is not in control and running the industry.

However, some of the proposals I stated earlier will lead to less overall cost of healthcare and are some of the proposals unilaterally dismissed by the other side of the debate. Without any consideration.

I'm really confused what you actually think now.

This was your first reply:

And now your last reply:

So, do you support it or not?

I think it's cruel and inhumane to argue for people being punished for getting sick; even the drug addict, and the alcoholic, and the obese person. I think that all of those "morally ambiguous" health quandaries you brought up can be addressed at their roots with separate policy decisions, besides the "Too bad, die!" (and I'm paraphrasing) that you mentioned.

You took that out of context or I did not explain that right.

Everyone who is in the insurance pool. I am not in favor of making people have to buy insurance. They can decide not to, but if they do not, I have no pity if they have to declare bankrupty or pay the rest of their lives to pay off their medical bills. It is a risk they take.

So you think it is ok to keep paying repeated 1M+ liver transplants in the patient that continues to drink even after their first transplant? Or pay for all the drugs a HIV drug user needs? Sometimes one has to let people experience the sequela of their decisions and not be a "nanny state" taking care of their every need.

Your paragraph is very altruistic, however, that does not work in the real world. Am I advocating rationing? No, but I am advocating people being responsible for their decisions.

If a person gets sick from nothing they caused, of course, they should not be "punished" for it.

Ranger, you seemed to ignore when I said ignoring access, which includes cost as that is a barrier to access funnily enough.
The countries I mentioned are far superior in the majority, you may very well be very highly regarded in your position as many others from the US but the number of lawyers has no effect on "problems" unless the majority of physicians provide reasons for malpractice.
You also said that people don't go to Germany for their medical problems yet a larger percentage of sportsmen/women go their for their specialists.
the standards to even be a nurse in the countries I mentioned are ridiculously high and to become a basic doctor, let alone a surgeon or specialist in the UK, the requirements are stricter than anywhere else in the world.

*there
Don't know why I typed their >.<

Awesome, a "worth" argument, clear as crystal, at last. I love it when you fully show your true colors, Ranger!






Yep, we sure do.

If not, then we start making decisions, and that's OK. As long as I get to be the one making the decisions.

And then I would make MY "worth" question the following:

Do we pay for people who make righteous, judgmental, strawman-ish, false dichotomy arguments? Do we pay for people who go on and on and on and on about all the problems they overcame in their own life without ever giving one good whit about what others may have endured in theirs?

No. We sure won't.

So, we either say yes to care without putting strings on it (kind of like food stamps -- people can't buy things like alcohol, but that can buy steak, lobster, caviar...) or we do put strings on it and I get to decide.

Deal? If not, then who does get to decide? You? I don't think so. You don't get to make decisions concerning other people's lives no matter how awesome you think you might be.

And I can say whatever I want! Free speech!

Sut,

So you believe people should have no personal responsibility? That it is ok for the alchololic to continue to drink after getting a liver transplant and for society to keep giving them a liver even though the cost is almost prohibitive and the amount of livers available are small?

That they should be able to do whatever they want with no regard to the cost to society and let the government bail them out?

See, I disagree completely. People have to take responsibility for their actions. They need to be responsible for what they do and realize that actions have consequenses.


No, certainly I do not want to pay you for all those righteous, judgemental etc.... argument. That would be stupid.

But I would pay for people who make lucid well researched and discussed arguments that others just cannot understand.

I never said what you are inferring I said (something or other about personal responsibility...), so I'm not sure how to respond to that.

There is also no point in responding to your closing line, seeing as how you have already (fallaciously) decided I cannot understand.

Finally, you didn't answer my very apparent question: Who decides on these coverage questions you ask?

You?
Me?
A majority?
A doctor panel?
A eugenics board? (hey, those people with recessive genes that could lead to various genetic disorders shouldn't have gotten married, right? Personal responsibility? I'm not going to cover their genetic mutant baby!)
So-called "experts in the field?"
An unregulated free market?
A regulated free market (which, of course, leads to "what kind of regulation, and who makes THOSE policies?")
Some other entity/idea entirely?

The answer, "I don't know, but sure not the gal-dang gubbmint!" is not an answer at all. Come to the table with an alternative, or the answer to all your questions has to simply be "yes." That is the only consistent stance unless you have a plan in mind.

Our own health service is starting to question whether it should be treating people who do themselves harm in this way, or through drugs, or cigarettes, or through being obese, and increasingly whether or not it should treat gang members for gun shot wounds .

The thing is who decides? I'd be the first to agree that people more and more are not taking responsibility for their own lives, but who decides that they then should shoulder extra costs for their care?

Additionally, you're worried about those people having their healthcare (and probably their life) paid for by your taxes? Is that worse to you than your taxes going in the direction of the military and perhaps being used to kill people?

The military is trying to keep the world and US safe from militants who want nothing than to create chaos and bring their own style of governance/religion to the entire world. By using terror and targetting innocent people.

So, no it is not worse.

As to who decides on who gets care, that is a great question.

When I was a resident, I was part of the liver transplant team. We had to decide who received the livers that became available. Some very difficult decisions were made. Not all 100% correct, but we did the best we could given the limitations of the scarcity of livers.

I am sure it would have to be a multidisciplinary approach, encorporating physicians, ethicists, actuaries, and government officials at least. The government officials need to be in the process to help oversee the private insurance industry to prevent abuse. Oversight. If the "gal-dang gubbmint" controls both the payment/access and the oversight, that leads to corruption and mismanagement.

And in my world view, if the crack addict who has HIV wants curative drugs, then they have to go into therapy and be clean. Otherwise they get nothing unless they pay cash for it.

Just like the alcoholic who did not get a liver transplant since they would not stop drinking. The situation that arose many times when I was on the transplant team. My father-in-law was in that exact situation. He had to stop drinking to get a new liver and has been clean ever since his transplant.

You say those two things as if they are related...? How is spending so much on such a massive military making me safe from terrorists? Don't tell me you believe in things like "airport theater" and full body scans? Even if you do, what do aircraft carriers and billion-dollar jet fighters have to do with that? You think one more F-15 lessens the chance of someone setting off a body-bomb on some busy street corner?

Please. The "world police" rhetoric and war on terror stuff cannot be something you believe is _working_?



Weird. That sounds like the make-up of a "death panel". Right-wing folks are FOR this now? To use your own rhetoric when you rail against liberals, Ranger, it sounds like the right conveniently uses certain terminology to vilify a concept when it suits them, and then advocate the SAME concept (under a different name, of course) when it no longer requires fear-mongering to quell. I believe you called that hypocrisy.

Like I said in an earlier post, your care-control idea and thought on personal responsibility are all well and good, but you can't stop at just the alcoholics and needle users, man! You must ride the personal responsibility train all the way:

-- Genetic disorders: Sorry breeders. The medical establishment will provide the ability for parents to check their genetic pre-dispositions BEFORE having babies, and if the parents still want to roll the dice on having a kid when known genetic dangers exist, that is their decision. But I am not footing their bill when junior ends up with cystic fibrosis or sickle-cell anemia. Their decision, their responsibility. By the way, ladies over 35? Don't even THINK about having a baby (the medical establishment will provide sterilization if you want to make the RIGHT choice), because if your offspring ends up with Down Syndrome, yikes. That is going to be expensive to cover on your own!
-- Domestic Abuse victims. Sorry, spouses. You decided who to marry, now you live with that choice. Kids, come on in -- you can't choose your parents, so you're off the hook on this one. We'll give you care, er, well, if the "care panel" says it's OK.
-- Sports injuries. You didn't HAVE to try to block that shot, right? Came down on that ankle a little wrong? Ouch. Here's the deal -- you're too aggressive and too competitive, and you still decided to play sports? At the very least, we get to test you for drugs and/or steroids so that the care panel can make the right decision on whether you deserve care. Give me your wallet already, just in case.
-- Car accident and no insurance? You decided not to have insurance, and you decided to get behind the wheel, so I can't help you. You have to learn responsibility, friend-o!

Looks like we're kind of stuck. I don't want my taxes paying for these people, because I am not going to have kids, am not getting married, don't play sports, and don't have a car. And I would like your "care panel" to represent MY views on worth, decisions, and personal responsibility. Don't I have just as much a right to be represented as you are?

And if you see, smell, or detect in any fashion any alcohol amount passing the lips of your father-in-law, I fully expect you to report him to the authorities and rip his liver out. I wouldn't want to have to drop another "h"-bomb.

Couldn't you just take care of all the sick people regardless of how they came to be sick, and then enact sound public policies that would discourage and treat people with addictions/unhealthy behaviors? I mean wouldn't that be the best of both worlds?

Yes, it would.

But then who would get to control things, Veri? Who would get to decide these difficult "worth" questions? Finally, how could we be assured that the people who deserve good things got them, and the people who don't deserve good thing don't?

Sure, in a perfect society.

However, what do you do to that person who gets the liver transplant but keep drinking? Or the HIV patient that still uses drugs?
Or the coronary bypass patient that still eats McDonalds every day?

Before Obama was elected, there was not 1 attack on American soil. Since then, at least 3. One has to be tough in the war on terror. As we have seen, presenting an open hand to dictators who want nothing more than our destruction lead to nothing. In fact, it enables them to keep doing what they were all along.

I never advocated the word Death Panel. And if I did before, it was a mistake. And yes, Sarah Palin is an idiot. A raving idiot who is becoming very dangerous. The sort of person that could not spell CAT if you spotted her the C and A. That aside, however, the vile attacks from the press were the worst I have ever seen.

We can debate each specific instance you want, and every possibly permutation of each instance within more permutations. But we can do that some other time when I have more respect for your tone of posts.

If you want to have an informed discussion, we can have a nice civil one. But until then, this will be about all we can chat about, the fact we see things very different from different angle and points of view.

So pearl harbor, 9/11, and the shoe bomber never happened?

Pearl harbor was quite a few years ago IIRC.

After 9/11 and the shoe bomber, how many attacks were there on American soil? Zero.

Perhaps I should be been more specific on that statement. Silly me for assuming that was obvious. Bad Ranger!

never mind Atlanta, Oklahoma City, the anthrax scare...

I'm wondering how the unsuccessful Christmas day bomber was Obama's fault. I'm sure he's about to get blamed for it... just not sure how.

Terrorism:

Let us think of the actual reasoning behind terror attacks.

Terrorists do not attack America because they hate our freedom; they do not attack America because of ideals.

We get attacked for simple reasons, we have been messing around in other countries affairs because of preemptive war philosophies, and an inherent need for America to project its power onto everything and everyone. We have been supporting dictators and terrorists in the Middle East for ages now. A strategy of continued war will only create more hostility towards us, and we will NEVER win the war on terror, because there is no way to do so.

The Oklahoma City bombing occurred on April 19, 1995, maybe before 9/11, I cannot be sure.

The Centennial Olympic Park bombing was a terrorist bombing on July 27, 1996 in Atlanta, again possibly before 9/11 but my mind wanders.

The 2001 anthrax attacks in the United States, also about or just before/after 9/11, before the current anti-terror protocols were placed.

Again, I should have been much clearer in my previous statement.


I should have put the addition of after 9/11, until he was elected.

I really have a little fault with Obama personally with the Christmas day bomber, however, I have a huge problem with how his administration handled the situation from the moment he was Mirandized to now. And I have a big problem with calling it a "man-made disaster" instead of what it really is-terrorism.

Just like the Fort Hood killings.

Ranger, if you are seeing tone in my questions, it is because I never knew this:



Lord Bob brought up the whole "death panel" fear tactics topic on another thread, several times, and you didn't say anything about it. So, I assumed you were not against the use of that term. And while I have never seen you support Sarah Palin, it is with unexpected relief that I read you think she is an idiot. I apologize to you, and apologize for making assumptions, but here's the deal: even when I try to find common ground with you on topics (to avoid such misunderstandings and assumptions), I get my words twisted or silence at best. What am I supposed to think?

As for the medical coverage scenarios, my "tone" is supposed to be projecting one main thought (and it does, there is no way to miss it): One cannot make decisions like these without being prepared to make ALL the decisions, and wherever one tries to draw the line, one will be making mistakes for someone, somewhere, at some time. However, if you relinquish control, and go more along the lines with what Verifex states, one doesn't need to make such decisions. One doesn't need to keep having "worth" discussions where someone tells us how hard they have toiled and how lazy other people are. That can all. go. away.

I mentioned the genetic disorders in my scenario list because you keep bringing up drug addiction and alcoholism. So, let me reduce my questions to a single direction: if it is proven at some point, at least enough for something like a genetic DSM classification or ICD9 code, that addiction is a genetic disorder, then you will reverse your stance on all of your points about HIV and drunks? If it in the genes, then surely control needs to err on the side of care, yes?

It gets better. This is important because, as you know, the medical community makes mistakes. Homosexuality used to be considered a psychological disorder. Imagine your "care panel" deciding what sort of insurance premium a homosexual should pay, or what sort of care they should receive if they, oh, I don't know, get AIDS from unprotected sex. Imagine how that would go were homosexuality still on the books as a "disorder". Your thoughts?

You mentioned a perfect world, making very clear you don't believe there is one. I agree. So what would make your care panel any less fallible? That's why I err on the side "care for all you can, without judgment, and educate to overcome problems." (basically, like Verifex said).

If you think of proper health care access as white and access-control mistakes as black, then your system will always, no matter how perfect you strive to make that control, be gray. If you take away the access control, the system remains white, at least in its intentions.

Things are never "black or white" as we both know.

The world itself changes moment to moment. And you are correct about mental illness.

However, if the drug addict refuses treatment that is person responsiblity. If it is offered to him/her.

Also, if a homosexual gets HIV from unprotected sex, in this day and age, then of course that is personal responsibility. I do not care what people do behind closed doors (the social liberal in me), but when they obvious disregard the known methods of controlling the spread of HIV, what does one do? Enable them or make them take responsibility.

The medical community makes mistakes. However medicine just as much an art as a science. One has to use ones past experiences to make the proper decisions for today. And they standards change year to year.

Every case is different. Just saying if x does y and z occurs will it be covered is not right for many reasons. Each situation needs to be evaluated and discussed in a proper forum with the proper people.

When I was on the transplant team, there were times where very difficult decisions had to be made. And some were life and death ones. Not all were 100% correct, but given the information we had at the time, we made the best one possible.

But back to Palin:

At first I thought she would be a fresh of new air for the Republicans. And, contrary to what some people state, she did revive a half dead McCain campaign.

But after a while, it became quite obvious to me she is an idiot. Unfortunate, but it be what it be. The sooner she leaves the public eye, the better for everyone. However, now that she is on Fox, that will likely not happen.

I would love to see a Texas Steel Cage match between her and Olbermann. I think she might even take him.

Ranger, how exactly do you deal with scarcity of resources like organs for donation and stuff? I know they have a waiting list, but do certain characteristics of the person or about the situation either elevate or lower someones position in the waiting list?

I mean, if I was a raging alcoholic, and I refused to seek treatment, and then I needed a new liver, would I be guaranteed a spot on the waiting list just like any other person?

Ranger, thank you for continuing to discuss with me.

On Palin, first... I have to say, at this point, the seeming legitimization of Palin is about the only bi-partisan and multi-media thing going in this nation. *smile* And, like you, it makes me sad. It seems every news outlet keeps talking about her, keeps asking about her, keeps comparing her and contrasting her against various things. People on both the right and left say Palin this and Palin that. It is really nauseating. It's something the cynic and skeptic and iconoclast in me really struggles with -- society's propensity to keep memes alive, no matter how abysmally stupid they are. In this case, the abysmally stupid IS Sarah Palin, so I agree with you in the use of the word "dangerous."

As far as the medical decisions, you said a mouthful when you said medicine, at least parts of it, are more art than science. I agree. And I think that is where we disagree at a meta-level (and that's OK). When something is an "art", I don't think putting controls on it, or having "worth" discussion about its application is a good ideas. There are a couple reasons for that, in my mind. One, it is hard to consistently discuss something that is, in its nature, subjective (like art is). Two, by opening up everything and putting a universal system in place, I can let myself "wash my hands of it" when it is art. Science, not so much, because there I still feel like trying to take some control to keep ekeing out efficiencies. Not so with art.

As an anecdotal example, I'll go back to food stamps. I'm not going to tell you that when I look at candy, junk food, and high-priced meats in a cart being paid for with food stamps that it doesn't irk me. Especially when I look at my cart containing tuna, pasta, and some bulk goods to make big casseroles so I can use leftovers for lunches (don't worry, I eat well, and am very happy with the food I have -- this isn't an image or health thing for me). But I will say that if someone asks me for a can of food for something like a food bank that helps homed families in decent neighborhoods, I don't feel bad passing. My tax dollars are already at work. Now, I might give to programs to help the homeless or something, since I figure it is harder for someone without an address to get food stamps, but I DO draw the line once in a while, especially when a global, no-judgment program is in place.

I imagine I would think the same way about national health care. Will it potentially irk me to know a drug-addled skeleton who isn't looking for work can get the same care as me? Maybe. But like food, as long as my care is adequate, what do I care? And if anyone comes asking for more in the way of health care, I can say, "Already donated, thanks."

And yes, I am fully aware that, in a way, my insurance premiums already are "donating" to the under-insured and uninsured, just like when my car insurance has to pay for an uninsured motorist rear-ending me. I figure that if I am already paying the difference anyway, it might as well cover everyone.

Veri,

There are quidelines.

First based upon need.

Patients are classified into groups based upon the urgency of their need and their physical condition.

For patients with alcoholism they have to be abstinant for at least 3 months.

Here is a good site with some information:
http://www.guideline.gov/summary/summary.aspx?doc_id=7271

When an organ comes up, the highest need patient with the best blood match typically gets it.

But to answer:
No, you would not be on the list.

Although, against some of my objections in committees, we have transplanted organs into alcoholics. With the "promise" that they would stop drinking.

The problem is that we are not paying for everyone with the current system. And with the waste in the current system, to cover everyone will cripple the economy.

There is so much abuse and mismangement in the healthcare system. Not to mention ideas that if used will lower costs for everyone. Including tort reform, portability of insurance and creating pools of individuals for purchasing power.

But I take the opposite view of your food stamp example.

Food stamps, IMO, should be for necessities. If people buy candy, high priced meats, liquor etc.. that is not right and should not be allowed. That is abusing the system which was designed to help. Things like that are prime examples why the governments should not control or run things. If people want to donate candy, liquor or high priced meats, great. Otherwise people have the staples of living.

I am not stating I would privitize food stamps, but better rules need to be in place.



Medicine is an art but also a science. That is why we have medical schools. To give doctors the ability to make the best decisions with the information they have.

To have a blanket, care for all without personal responsiblity is wasteful. Sometimes hard decisions have to be made. And that is where informed people need to be allowed to make those decisions. And sometimes hard decisions have to be made.

If we can cover everyone without taxing us to the ground, cutting Medicare, and without special interest excemptions, great. But having it under the government control is not good. At least not from what I have seen as how government runs a business and the "great" oversight it has.

I guess that is where we disagree most on healthcare. I guess, and tell me if I am wrong, you want government to run it. I want it to be run privately with government oversight to prevent abuses. With a free market approach to lower costs and increase access.

I want everyone covered, it works in other countries (nationalizing it), and I don't trust private businesses from what I have already seen:

-- Pharm companies pursue what I consider less-needed drugs, like Viagra, to simply make a lot of money. They know exactly what they are doing, and what they are doing is chasing the money (exactly as capitalism would dictate! Not their fault!)
-- Pharm companies use "garbage pail" drugs that they barely understand (like Welbutrin (sp?)) to make money (I was told this by a psychologist who had a high enough degree and experience to be allowed to prescribe drugs).
-- Private insurance companies, by their nature, want to pay for as little as possible and charge the highest premiums possible -- that is how they make money. I have worked in both the health insurance industry and crop insurance industry, and have several friends who are actuaries. If an insurance company isn't rejecting every pay-out they can, they aren't a very good company. Dennis Haysbert can take his caring attitude and "good hands" and shove it. He doesn't care about me, and neither does any other insurance company.
-- There is no reason for efficiency when the medical/insurance industry can charge whatever they want. Here I agree with you, that competition is needed, but I don't know how to make that work. The way I see it now, things are basically price-fixed across the board and only going higher. Tort reform isn't going to change that.
-- The medical industry, like many powerful interests (defense spending is another one) are entrenched. Some believe diabetes will never be cured because there is simply too much revenue involved in keeping it under control. I am actually not that cynical, but sometimes it is hard not to be when I see drugs like Viagra and Cialis flooding ads and becoming "billion dollar" drugs, while the Advair that I need to breathe is still considered a high-tier drug in a lot of insurance formularies meaning I pay the highest co-pay possible. Great, I can get an erection as I gasp for air and pass out from lack of oxygen.

In summary, everywhere I look I see the nasty bits of capitalism (you have to admit the "invisible hand" simply fails in certain instances) creeping into the medical industry. It is the "perfect storm" of free-market-gone-wrong. You've got fear, you've got safety nuts, you've got crying children. So that covers the political and media sides. It's also huge and unavoidable -- people are going to get sick). Finally, it requires huge resources to get into: hospitals are expensive, and education of doctors is arduous. That means high barriers to entry and entrenched money.

When listing all that, it sounds sort of like a utility, doesn't it?

Utilities are already heavily regulated by the government, and are STILL monopolistic and hard to manage. I'm not saying to nationalize all that, because that's off topic. But I am mentioning utilities as a precedent -- these large, integral industries DO get heavily regulated, almost to the point of gov't control in some regions. And if we were trying to pioneer this national health care stuff, I'd say no way. But we aren't. It's been done, and it works in other places.

I didn't just wake up one day and think Hope! Change! Health-care! I've thought a lot about it and tried to draw parallels to other real-world scenarios. And while I think capitalism has its strengths, my eyes are wide open to its weaknesses. Put those things together, and yeah. I think it is time for nationalized health-care, and we can still have all the efficiencies you talk about and eliminate waste in doing so. Eliminating waste can be done in _any_ program, including gov't ones.

I'm a raving alchie, and have destroyed my liver. If I pay for private healthcare, it's ok to get a new liver.

And then continue to drink it into the ground.

And need a new one.

As i'm paying for the private treatment. Right?

It's my money, it's my body, it's my life. Only I can decide what I want to do with it.

And if I pay for medical insurance, or I pay the taxes that fund a health service, then the same applies, does it not?

I'm paying anyway. And I'm the customer. I want and need a new liver, and I've already paid for it. So give it to me and what I choose to do with it after is only my buisness.

I agree regulation is needed. Perhaps not as much as utilities but some is needed.

I would like to address the points you just made please:

Unfortunately drug research is not free. It takes on average 800M to get a drug to market. http://healthaff.highwire.org/cgi/content/full/25/2/420#SEC5 The drug companies have to make drugs that are for recreational purposes to recoup some money and of course make a profit. So if they make one that does nothing else like Viagra, so what? Market conditions drive if it will make money. In addition, the world gets these drug for much cheaper than we pay in the US. They have to charge what they do in the US to attempt to recoup the cost. If they could not, then they would stop developing new drugs. Like new chemotherapy agents, antimicrobials or other needed drugs.


If any drug is not appropriate or clinically effective, it almost always fails. There are cases when a drug gets through trials and is proven to be bad. Wellbutrin is a known antidepressant that works for a number of people. Again, if the drug is not effective, it will not be prescribed and used. Wellbutrin has proven its effectiveness.

Well that is a problem. Of course. As is the case with almost all industry. They are there to make a profit. But competition is key. Right now we have, in some states, 2 agencies providing all the policies. What incentive does that give them to be more honest? Almost none.


As above, competition is the key. I have little idea about price fixing, but the private sector and physicians as well as the teaching segment of healthcare all base reimbursement rates on Medicare. More competition leads to lower rates. IE. In Arizona, where I used to practice, there was an MRI on almost every block. The rates were as low as 250 for a scan and reading. In places without competition the rates were over 2x.


Well that is unfortunate. As you know it is a cost/benefit ratio type of deal. I speak with a lot of drug reps at work, and they all tell me that if I have a patient who cannot afford their needed meds, to let them know and the companies almost always have plans to give the needed drug to people for little or no charge. You are likely in the grey zone. You make too much to get free drugs but not enough to easily afford them.

But with respect to Viagra and Cialis: They are not covered under very many if any insurance plans. And they are over 10 bucks a pill. But if someone wants to spend the money to have relations with their significant other more power to them.

If you want, we can discuss tort reform in another thread as it is not as simple as some people think. It is a multifaceted problem that if dealt with can lower health costs significantly. If not, it only drives up costs and in some states, drives good doctors away, leaving a huge shortage. For instance, where I live, South Florida, it is almost impossible to find an OB. Being a physician I was lucky. Even those with insurance cannot find an OB where I live easily. All part of the access part of healthcare we both want fixed.

That would be great IF there was not a finite amount of livers.

However, there is a severe shortage of livers.

But, we all know that lots of money, donated to academic centers tend to let one skirt the rules :( I have seen it in person.

Agreed. :(

That's why I prefer a 'service' to a 'business'.

"However, there is a severe shortage of livers."

Perhaps this is an issue for another thread, but would not a free market in organs solve this problem?(i have to debate about this in my bioethics class and would love some CB perspective on the issue)

Yes, a free market would definitely solve this problem, because a free market doesn't care if you are young or old, stupid, sick or a Darwin award winner, as long as you have the $$$.

</s>

Let us give BadFish the opportunity to tell us exactly how he thinks a "free market organ system" would work, before we presume that:

a. Only the highest bidder lives
b. The already-least-advantaged die

Or, in some other way, let him differentiate "organs" from "children", so as to tell us how organ auctioning would work out well but we frown on selling children (and frankly they aren't even a particularly limited resource).

Free market is not the term I should probably have used. But I do think that as a supplement to the current system people should have the opportunity to sell their organs legally. It may be a flawed workaround to a bigger problem, but obviously, there are people who want to sell their organs and people who want to buy them, and I don't see why anything should stand in the way of this. However I haven't researched the topic thoroughly and could probably be convinced otherwise.

Re reading that, yes, it sounds incredibly wishy-washy, but again, I'm not 100% knowledgeable on the topic and don't want to take too firm a stance without intimately knowing the issue...

Quick! Somebody on the internet was wrong. GET THEM!

Instead of research, let's just ponder for a moment "there are people who want to sell their organs and people who want to buy them, and I don't see why anything should stand in the way of this."

We'll need your definition of "people" and "want" and "anything", as relates to sellers.

What I'm seeing so far is: instead of Haitian women giving their children to any congenial and well-fed-looking passersby on the vague promise of "a better life" or at least regular meals (even given the risk of child-sex trafficking), they just sell one for parts and get to keep the rest with the proceeds. It's almost win-win!

Well, win(s)-win-lose-die. People with money get parts, Mom gets to feed the remaining children, there are less children available for the traffickers, and one kid is neatly and humanely dissected.

Ah, that makes a bit better sense. So the idea is an open market where organs are sold for cash to the highest bidder, but there would still be the existing donor market with waiting lists for everyone else.

Quite frankly, I don't know where I stand on such a thing. The initial thought of selling your organs on iOffer.com is highly disturbing, but I also hold the notion that what you do to yourself of sound mind is none of the governments' business. Furthermore, none of us have the right to tell someone to suffer (or possibly die) while waiting for a kidney transplant when we know supply would increase with money being offered.

Bast: I would think that a legal, government regulated system of organ sales would reduce that sort of thing from happening rather than encourage it. There's ALREADY plenty of incentive to do what you have described because there is ALREADY a black market in organ sales. In this case I would think government regulation would be more than fair and possibly even effective.

Sorry it takes so long for me to respond; my internet is extremely spotty right now and i can only get on for a few seconds at a time at best.

Now you have gone from "free market" to "legal, government regulated system". You started at "I do think that as a supplement to the current system people should have the opportunity to sell their organs legally." This only implies you think it shouldn't be _illegal_ to sell parts, not that you think sales should be _regulated_ by the government. In fact, "free market" flies directly in the face of "government-regulated".

Now, in addition to definitions for "people" and "want" and "anything", you'll need to tell us what you mean by "legal, government regulated system".

'In fact, "free market" flies directly in the face of "government-regulated".'
Yes, this is why I revised my statement. I shouldn't have said free market. It's not what I meant. I probably should have just said "market".

As for the system I'm proposing, well, it would take me many moons to single-handedly come up with a fair and just way of doing this, but basically, a seller would come forward with a healthy organ they wish to turn into cash. Then a buyer would be found, the operation would be performed, and both parties would have gotten what they wanted. Perhaps some sort of federal database would help with this to prevent people from selling more organs than they actually have.

As for this: "We'll need your definition of "people" and "want" and "anything", as relates to sellers."

Could you explain what you want me to do here? I would think the first two are self-explanatory... the third maybe could use some more detail. I believe that people (by that i mean, "people") who want (by that I mean, have some sort of desire) to sell their organs have the right to do so- within the bounds of reason. No, I don't advocate picking up random Haitian children to gut them for a profit. I apologize if that's the conclusion you reached.

Thank you for making me laugh after cringing reading the rest.

I was also amused watching QBRanger re-enact a Daily Show skit.

http://www.thedailyshow.com/watch/mon-january-11-2010/fright-club

Fast forward to the 4 minute mark for the long version with news clips, fast forward to 7 minute mark for just the John Oliver skit.

In any case, my view on health care reform can be summed up as follows:

We have to change the incentive system which perversely rewards usage and not health. QBRanger inadvertantly made my point for me as I quoted actual mortality rates stats and he was concerned about survival rates when treatment was performed (ie, the more treatments, the better his stats look). My argument is that a good health care system would encourage behavior that would lower the number of heart attacks, not just improve the survival rate after a heart attack. That might mean more coaching sessions with a nutritionist instead of more double bypass surgeries.

But right now, who has the incentive to do that? Health insurers have a little incentive (the nutritionists are actually a real example). But insurers rarely have appetite for innovation. Innovation costs money, and in the insurance business, it usually does not pay off quickly to the bottom line. You see, the problem with QBRanger's faith in the market is that health insurers also do not have incentive to minimize total costs. They just have the incentive to minimize *their* costs and be as invisible as possible.

So in summary, providers currently have incentives to INCREASE usage and insurers have incentive to be invisible (ie, reduce their overhead and pass as much of the costs to the customer/patient). That leads to an overall increase in usage and costs. That's why we have the most expensive (and NOT the best) health care system in the world.

"As for the system I'm proposing, well, it would take me many moons to single-handedly come up with a fair and just way of doing this, but basically ..." No, it won't.

There are (at least) two ways to do it.

Define your way into it: "people" excludes the mentally incapable of giving informed consent (minors, the mentally deficient, etc.), "want" means "would choose to do so free from coercion economic or otherwise" (if that's your definition, your pool of potential sellers just dried up because what living person sells organs unless they're suffering some economic pressure to do so?) etc. Add your definition of "anything". And your definition of "well-regulated", and (now that you've added another modifier) "within the bounds of reason". Every time you are asked to clarify any aspect of (or term in) your position, do so. Pretty soon you'll discover you have a complete plan. Or you will conclude it (plan creation) can't be accomplished in this manner. Or you will conclude that the idea (in need of a plan) is a bad one. (You will have arrived at Truth via dialogue -- See Sut-erian comment on journey versus destination, means and ends.)

Or

Choose a framework from which your system will be derived. Perhaps you think Utilitarianism based on Greater Good will give you the necessary framework for decision-making as it relates to how best to go about creating an eBay-for-organs plan. (hint: it won't) Choose one, fit your "problem" into it. See if it gets you where you want to go. If yes, congrats. If no, why? Because it's a crappy philosophical underpinning? Or because it's a crappy idea no matter whose thoughts you try to use to hold it up?


"No, I don't advocate picking up random Haitian children to gut them for a profit. I apologize if that's the conclusion you reached." It's not _my_ conclusion, it is a logical possible outcome of your plan, as it stood at the time. If you can come up with a plan that doesn't leave open the obvious likelihood that people end up selling (or even _having_) children for spare parts, you are closer to getting your Used Organs Lot up and rolling!


[Lazy option: You can watch some House and some Law & Order and conclude that the current system is what it is because all the alternatives you are going to think of are far worse.]

OK, OK.

Hm...

Say person A wants to sell their liver. They head on over to Organs R Us. They go through a background check to test for any prior health problems that would conflict with donating an organ. Let's also say this person must be over the age of 18 and a citizen of the USA. We'll say Person B has already come into Organs R Us and signed up as a potential recipient. Pending approval and matching blood types I suppose, Person A undergoes the operation, Person B receives the organ, and then Person B pays Person A. This system is what I thought of in my head when first I posted.

Flaws?

"and then Person B pays Person A." Is your plan assuming that Person A can only sell things he or she can live without? Because, so far, this has not been specified at all. Realistically, Person B pays the estate/heirs of Person A.

Your current system allows me (the buyer) to hang around those Easter Seals camps 'til I find a 19-year-old Down Syndrome "seller" that I can bring in to your shop, get to sign the forms and ... save my own life. If you're fine with this aspect of your plan, good on you!

Your plan allows Sarah Palin to raise that Trip? Trig? Trooper? 'til he's over 18 and then sell his parts.

Your plan makes the Seven Pounds plan a real option. My family needs money, I'm depressed about this, we're hopelessly screwed. But if I can kill myself for $100,000 because I've lined up a guy that needs a liver, a guy that needs a heart, and two lung buyers .... my family benefits! They might rather have me around, but I think they'd be better off with the money. I'm not in my right mind because of the depression but still ... If you're fine with this aspect of your plan, good on you!

Now, you said earlier that the "selling" part should be coincidental to the current system. Currently, I am (actually for real) a potential donor. As a reasonably healthy, reasonably young person, if something happens to me, my organs go via donation (that is, "for free") to whomever can use them. But if selling them is an option, I'm totally going for the "sell what you can" plan, in the event of a tragic gutter-cleaning accident. My estate will get the money from the sale of my parts as a direct result of my ignominious fall into a rose bush. My heirs could get a good $250,000. Why would I still be a "donor" _at all_? The for-profit system ends up effectively replacing the "donation" system with the "selling" system and only the wealthy get organs. If you're fine with this aspect of your plan, good on you!

If you create a system wherein the reasonably healthy always have the _option_ of selling parts, how long before the "hey it's your damn problem" brigade says that no one should get any kind of social aid until they're out of saleable bits? We've already got people (right here in this very community) who think poor people, obese people, and alcoholics don't deserve medical care (and they vote). Why should people who still possess a back-up kidney get Social Security? They're sitting on a veritable Gold Mine! If you're fine with this aspect of your plan, good on you!

Define your terms! (for real) If you don't want Sarah Palin to kill her kid when he's old enough, then "Let's also say this person must be over the age of 18 and a citizen of the USA." has to include something about mental deficiencies. And while you're at it, maybe something about psychological disorders that affect or impair judgment. Probably you need, legally, to go with the "capable of giving _informed_ consent" line.

So it becomes "Let's also say this person must be over the age of 18 and a citizen of the USA and is found to be mentally sound and in every other regard capable of giving informed consent."

"Say person A wants to sell their liver. " You have to define "want". I can say I "want" to sell my liver to come up with the extra $125,000 my family needs to keep our home out of foreclosure. But does that mean the bank can "force" me to sell my liver (or even the parts of it I could legitimately do without)? There are plenty of methods of coercion. If you are interested in the "fair and just" plan it was going to take you many moons to come up with, this is probably something you'll need to address.

"any prior health problems that would conflict with donating an organ." Is "life" considered a prior health problem that would conflict with donating? If yes, then I can't sell my heart 'til I'm not using it anymore. Beyond that, if I sell one of my eyeballs for $15,000 and then I lose the sight in my other eye, have I given up my rights to Social Security Disability Income? Do the tax-paying rich have to support my blind sorry self for the rest of my days because I sold my back-up eyeball at 20-years-old, back when I was too dumb to apply the amazing power of foresight? Or now that I'm blind anyway, should I just give it up and sell my heart?

The whole "informed consent" idea is a good addition. We'll put that into the plan.

As for "only the wealthy get organs", i have no philosophical problem with this. "only the wealthy" get lots of things. What I'm trying to solve is the low supply of organs. My plan intends to create more supply. I don't care who it goes to as long as that person is in need. When a wealthy person needs a liver, they need it just as much as a poor person needs it. Yes, this means people without the means will often go without. This is not so different than the current system. However I admit that if I had the ability to solve this problem I would do so, and so I will state that this is a big flaw and one I'll have to think about before the debate in class.

Could a bank force you to sell your organs? No. The whole reason I'm making this argument is because I believe nobody has the right to tell you what to do with your own body (provided you have the mental capacity to make your own informed decisions). So organs would be exempt from creditors, much like social security and pensions. (Did I get that right? Those things are exempt from creditors, right? I'll need to research this...) But I still firmly believe it would be great to have the OPTION of selling your organs to get said banks off your butt.

Could my system and the current system of organ donation truly co-exist? With the option of selling your organs, who would donate? Well, who really just up and donates organs randomly? Is it not often for a family member or a friend, in which case the money likely is not even a factor? I'll need to research this.

"if I sell one of my eyeballs for $15,000 and then I lose the sight in my other eye, have I given up my rights to Social Security Disability Income" I think yes, because you can buy another eyeball to replace the one you previously sold. If you sell your car and decide to walk everywhere, and then you (for whatever reason...) need a car, it's not up to anyone but yourself to buy you one.

Remember, this is for a bioethics course, which is a Philosophy class. I think and do many things in reality that do not coincide with my philosophical beliefs (mostly Kantian) so just think of that before you label me a monster (or an idiot).

Anyway, I need to do more research before I discuss this much further... I'm running into brick walls with all my arguments because I don't know enough yet.

The only thing you have to be is consistent. This is rather the point. And why it matter for your philosophy class. But then you have to be aiming for "consistent" not "fair and just" for your system. (the difference between philosophy and politics, if you will)

If you are willing to stand by the outcomes, based on Kant, regardless of reality then you _win_! As soon as you have to say "Oh, wait, I'm going to modify _that part_ to get a more-palatable outcome" then you aren't being either consistent or fair/just. You lose.

*matters

I want to carry my (fictional) alchy example above a little further, especially with regards to limited amounts of 'care' (in this case livers). (Before I continue, I apologise if anyone finds this discussion disturbing, or upsetting. Especially if it touches on any personal experiences.)

I'm a multi-million pound leader of Business. I work hard, and play hard. I need a new Liver due to my hard playing, binge drinking ways. And I'm sure to conitnue on with them after getting fixed up with a new liver.

I'm in hospital next to a young student, who does nothing but leech from society. She's sufering from a rare disease, and needs a new liver.

But, there's limited supply.

That's all good. Supply and demand and all that jazz. Good for business, it will drive the price up.

I'm fine with that, and prepared to pay whatever the cost is for my new liver. I can easily afford it.

The sponging student however, will need *us* to subsidise her, if she gets the liver instead.

Sponging waster.

I contribute. To business. The economy. Society. I'm important.

What's she done? Nothing.

I'm paying for myself, I'll own that liver.

She'll have to use *our* funds to get it.

Even with a limited supply, I'm the one that should get that liver, right? Even if I'm going to abuse it after.

BadFish, you do realize some of these organs you are talking about are required for living, right? If you sell your liver, then you are dead.

Just off the top of my head (pardon me, Bast, I'm going for specifics, so if you have already covered it, good.):

-- If someone sells a NON-vital (as in, not die) organ, like a kidney, I assume that person is from then on uninsurable as far as anything renal-related. Heck for anything. In other words, they've opened the case and voided their warranty. My premiums aren't going to help pay for the after-effects of someone literally living fast and loose with their parts.
-- If someone sells a vital part, I don't get it. They'd be dead?
-- Selling someone ELSE's parts... Well, selling kid parts would be pretty silly. The demand for parts is mainly from adults where organ failure is more common. So, I would just say there is no such thing as anyone selling someone else's parts. Even if the other person is your ward, you are required to take care of said ward, not make money from him/her. So that is all out.

OK, so we are down to this:

-- Only right-minded adults (like writing a will) are allowed to sell their parts. If they sell a part, any part, they are no longer insurable without paying their own premium entirely (no workplace help, no avoidance of pre-condition). In fact, the premium should be such that whatever they make in the organ sale is pretty much gone in a couple years if they do, in fact, want to remain insured in some fashion from then on.
-- If a right-minded adult wants to give an organ that means they are then dead, fine by me. They are an adult and right-mined.

This pretty much makes your system fairly limited, fairly simple, and pretty much like any other regulated industry (sanity checks, no children exploited, etc.) Sounds good to me.

As for your "why not use this to reduce the paucity of organs?" That one is far, far too easy. Verifex already mentioned it -- it's called education. Educate people on quality of life and how their organs can help. Educate people to make sure they have their affairs in order and loved ones know they wish to donate.

What could possibly be simpler? Why are you trying to use a capitalistic solution where simple education could suffice?

Because I got assigned the topic and side at random. I actually wanted to argue about the pharmacist conscience clause but it was not to be.

Then did Bast and I just help write your paper for you? *smile*

No paper, it's an in-class debate. And you definitely helped with that, so thank you both!

Debate-wise, I would read Bast's comments again, too... My style is more bullet-point-and-bluster, while hers is more debate-ready. That's kind of always the way it has been. *smile*

You guys can have your dystopian future of legalized organ selling. But I'd like to note that I think as soon as you go down that route, it would just be a hop skip and a jump to wade into the waters of growing harvest-able hosts for your organs. I mean honestly, we're already alive, just grow a new one for extra organs. Yes, it's creepy as all hell, but it would all be in the service of keeping who are already alive, still alive.

I look forward to owning my own organ farm. :D

Also, I missed this earlier:



LOL

because being American changes basic human nature, amirite

It seems to. You missed the "avocation" vs. "I wouldn't work at all if I had to pay taxes that just helped other people!" argument. We didn't get very far, so "why the richest Americans continue to work" wasn't fully explored, while we did hit all the high points regarding society's drains and how much we can pour down them.