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View Full Version : L.E. Modesitt, Jr. on the Health Care debate


JSUCamel
08-25-2009, 02:46 PM
http://www.lemodesittjr.com/blogs/blog/2009/08/health-care-debate.html

The other day my wife asked a very simple question: Why doesn't someone just lay out in plain language on all television networks a simple explanation of all the controversial points in the proposed healthcare legislation and explain the options in each case and their alternative ramifications and costs?

My less than simple response was something along the lines of... First, we're talking roughly one thousand pages of legalese. Even translating that into plain English would take weeks, and it would end up at least three times as long. Second, and more important, most members of Congress wouldn't want a plain- language version of any option out there. Third, even less would they want a cost analysis of the provisions.


Believe it or not, this is not because Congress -- or the Administration or the Republicans or the Democrats -- has a nefarious agenda. It's because the basic facts about health care are totally unpalatable to almost everyone, if for a range of reasons.


Why?


I just read a pair of comments about the state of health care in the United States. One commentator -- a member of Congress -- declared that the USA had the finest health care in the world. Another pointed out that we spend more on health care, either in total or on a per capita basis, than any other nation in the world and that something like fifty nations have better overall health and wider healthcare coverage than does the United States. And both statements are essentially accurate. Overall, the best of U.S. health care surpasses any other nation, although there are certainly first-rate facilities that rank with the best anywhere in many other nations. The problem is that so-called first rate health care in the USA is essentially limited to the wealthy and those on expensive and comprehensive health care insurance plans, and they and their employers are paying high premiums for that insurance.


Those other nations cited as having "better" health and health care concentrate their health care, again, for the most part, on providing a far wider range of "basic" and preventative care to the vast majority of their population. In those nations, unless they pay large sums for private care, often in other nations, someone 65 and older may not ever get a triple heart bypass, or elective surgery for a rotator cuff that's painful and uncomfortable but not debilitating. There won't be two months on a respirator with family hoping for a miraculous recovery -- which might happen, but probably won't. There aren't hip replacements for 90 year olds, and rebuilt knees for 75 year olds. There often aren't intensive physical therapy facilities for older stroke victims... On the other hand, almost all the poorest children receive basic care to some degree, and maternity care for poor women is usually better than what millions of Americans receive... or don't get at all or in very limited ways.


This raises the question of what exactly is "better" health care. Is it overall generally improved health care for a population as a whole, or the most advanced care possible?


In the USA, we have a truly massive medical-industrial complex. There are the miraculous drugs, whose development is expensive, especially with the small number that actually survive all the testing required by the FDA and all the tort suits filed against the manufacturers, and all the ads telling wealthy men to seek erectile dysfunction medication. Under the current accounting systems of the drug companies, these costs are largely paid for by U.S. health care consumers... one way or another.


We have advanced prosthetics, some of them computer-aided, and local and regional dialysis centers. It seems, according to media ads, that everywhere one looks, there are cancer centers, many providing remissions or cures for the most deadly of cancers -- but don't look at the bill.


But... critics point out that are some 47 million uninsured Americans. This is a problem, no doubt about it, but it's not quite the same problem as the critics claim it is. Something like 12-15 million of these "uninsured" actually have the funds to pay for insurance -- and don't, because they'd rather spend the money on something else. Another 10-12 million are children, many of whom are eligible for state and other programs, but for whom knowledge, red tape, and parental ignorance limit enrollments. Every year, my wife refers students to doctors... and there are always students who say that they or their parents don't have insurance. Yet in many cases, these parents make more than my professor wife does and either have no health insurance or remove their children from the insurance when they reach 18. These parents and children drive newer cars than she does, but they opt out of insurance, claiming it is too expensive. To me, at least, that tends to suggest that health insurance isn't exactly a priority. My dentist will treat indigents in Africa and Central America on his own dimes, but gave up treating "poor" patients in his home town when he discovered how many of them were driving expensive late-model vehicles like Cadillac Escalades.


Add to that the lifestyle and obesity problem in the USA. Despite the fact that for almost all people, clinically defined obesity [not just being 10-20 pounds overweight] is indeed preventable, it's continuing to rise, and with it, associated health care costs are also rising.


All in all, the basic problem facing the Congress is really very simple -- and impossible to resolve. Americans want universal access to the highest levels of health care for their entire lifespan -- and given the technological and surgical abilities of American health care, providing that level of health care to everyone is fiscally impossible. Even if all drug malpractice costs were eliminated, and drug companies were forced to allocate costs across all nations, we'd be lucky to see a 20% reduction in pharmaceutical costs. Right now, according to figures I've seen, something like between 5% and 10% of hospital costs are for covering the expenses of treating the uninsured. Administration costs have risen from 5% two decades ago to 15-20% today. But... even if a universal health care plan were adopted that eliminated the uninsured and cut back on administrative costs and unnecessary tests, etc., we'd be extremely fortunate to see the average daily hospital bill cut by one third, and with another 15% of the population using services they did not use before or used infrequently, most of those cost savings would be eaten away.


The unpleasant and simple fact is that high-tech comprehensive health care is what everyone wants... and what the vast majority of Americans also want is someone else to pay for that care. Those who already have adequate care, especially older Americans, are clearly terrified that "reform" will remove the level of care that they already enjoy -- and that they will deprived of most care in their later years -- something, incidentally, that Joe Haldeman suggested years ago in The Forever War. Rather than face the very hard choices surrounding health care, and putting them out in the open, as my wife suggested, the Administration and Congress are avoiding specifics and targeting high-income Americans, who, ironically, are indeed already paying for their own health care. The problem with this approach is that it won't work. The magnitude of potential costs is so great that there's not enough tax revenue to pay for what everyone wants, even by going to the extreme of taxing the wealthy out of everything [which wouldn't work anyway, for different reasons, as I've addressed several times previously].

Gilshalos Sedai
08-25-2009, 03:11 PM
So, he's not for socialized care, either. I do think his point is a good one, though.

Kurtz
08-25-2009, 03:21 PM
Starts off well but the paragraph referring to those who choose not to pay for welfare is fairly wishy-washy.

JSUCamel
08-25-2009, 03:35 PM
So, he's not for socialized care, either. I do think his point is a good one, though.

I don't think he's not for socialized health care; I think he's just pointing out that we have to make a choice: do we want high-tech medicine for those who can afford it, or do we want the basics for everyone? It's impossible to get the former for everyone, and the latter isn't enough (for Americans).

JSUCamel
08-25-2009, 03:37 PM
Starts off well but the paragraph referring to those who choose not to pay for welfare is fairly wishy-washy.

Wishy-washy? How so?

Zanguini
08-25-2009, 03:50 PM
I wonder if he would accept a comprehensive health care plan for his own characters.

Sinistrum
08-25-2009, 04:07 PM
I think this puts the situation in clear perspective and really what its saying can be applied to all mass human activities. You can either allow some to succeed greatly and others to fail, or everyone can just scrape by. That is always the choice dictated by limited resources and differences in human capability and its the one we face now in the current health care debate.

Kurtz
08-25-2009, 04:11 PM
Wishy-washy? How so?

Is fairly unspecfic about the millions that 'choose' not to pay for insurance, bemoans his wife's lot, and uses a seemingly particular incident his dentist experienced as a general point.

Plus I spent $9 on a rather dire book of his 4 years ago and am nursing a life-grudge because of it http://i661.photobucket.com/albums/uu332/IIJM/forum/meh.png

JSUCamel
08-25-2009, 04:14 PM
Is fairly unspecfic about the millions that 'choose' not to pay for insurance, bemoans his wife's lot, and uses a seemingly particular incident his dentist experienced as a general point.

Plus I spent $9 on a rather dire book of his 4 years ago and am nursing a life-grudge because of it http://i661.photobucket.com/albums/uu332/IIJM/forum/meh.png

Uh, he gave about four examples of people who 'choose' not to pay for health insurance. Rich people who can afford it, children whose parents don't understand the process, young people (students) who think they're invincible, and people who think health insurance is too expensive and choose to take the risk of not having it.

I'm not sure what's wishy washy about that.

Kurtz
08-25-2009, 04:21 PM
More that those people add up to more than 50% of those uninsured. He may be right, I don't know. He didn't offer much else.

$9

Sei'taer
08-25-2009, 04:44 PM
Plus I spent $9 on a rather dire book of his 4 years ago and am nursing a life-grudge because of it http://i661.photobucket.com/albums/uu332/IIJM/forum/meh.png

LMFAO...I, for one, am glad Kurtz is back.

Ishara
08-25-2009, 04:54 PM
do we want high-tech medicine for those who can afford it, or do we want the basics for everyone? It's impossible to get the former for everyone, and the latter isn't enough (for Americans).

I really, truly think that this oversimplifies the issue (which I understand he was trying to do, but does a disservice to the debate). It's also untrue from the perspective of someone who lives in a country with socialized healthcare.

I am TIRED of people spouting examples of how the elderly won't receive x, y, and z and that there is no available elective a, b, and c. I call bullshit. If you're denied anything it's not for lack of funds or technology - please, we have the same medical technology available here in Canada as you do, and are home to some of the most significant health care breakthroughs in the world - it's because it's not conducive to your health. If elective surgery at 75 will likely kill you, hey, you won't likely find a doctor willing to perform said surgery. If you want elective surgery at 31 for whatever, let's say a deviated septum for instance, then you get it - you just have to WAIT. That's why it's called elective. It's not as important as say, a heart surgery. Probably even to you.

You can have both. You can have high-tech medical technology available to the relatively few (and I'm talking percentages here, not trying to marginalize), and you can have the basic health care for the needy. End of story. If you have to wait for your elective stuff a bit longer then so be it, but no one is saying you can't have it all! (At least no one here in Canada.)

Look, the quote in my sig? "Courage my friends, it's not too late for a better world?" Taken from Canadian history when we were faced with the same issue. Tommy Douglas, the Greatest Canadian (and grandfather of Kiefer Sutherland), was right. It's not too late.

JSUCamel
08-25-2009, 05:12 PM
You can have both. You can have high-tech medical technology available to the relatively few (and I'm talking percentages here, not trying to marginalize), and you can have the basic health care for the needy. End of story. If you have to wait for your elective stuff a bit longer then so be it, but no one is saying you can't have it all! (At least no one here in Canada.

Well, you can. You're absolutely right. But that's not what Americans seem to want, and it's certainly not what the Obama administration seems to be saying. The attitude in America is that, by BIWIDNB, we want health care, high-tech health care, and we want it for everyone.

The ideal, of course, would be a compromise like you suggested, with the high-tech for those who can afford it and the basics for everyone else, but that's not what Americans want. Americans want to think that they deserve the high-tech health care, whether they can afford it or not, because by Pete, America is the best, greatest country in the world.

Of course, you're right. But that's not what America seems to want.

Sei'taer
08-25-2009, 05:27 PM
I am TIRED of people spouting examples of how the elderly won't receive x, y, and z and that there is no available elective a, b, and c. I call bullshit.


It's because of this (http://www.youtube.com/watch?v=U-dQfb8WQvo).

Now, older people are scared because of that. A lot of baby boomers see that as a push off on them to save money for the rest of the system. Evidently this woman was on medicare, but she didn't have to wait and possibly die when all she needed to continue life was a pacemaker, she just had to find a doctor willing to do the surgery. AMericans don't like to wait. Maybe it's a flaw, I have no idea, but it's the truth. People cuss each other at stoplights, or the drive thru, snort and moan in line, raise hell at the DMV, have to have faster and faster internet, thirty-six lanes at Wal-mart open and ready to check you out. It's just they way we are.

I don't know one way or the other how it will work. I have other things about it that concern me right now and don't really care about that part at the moment.

JSUCamel
08-25-2009, 05:41 PM
I have other things about it that concern me right now and don't really care about that part at the moment.

I agree. I've been looking closer at one of the proposed bills, and while I like most of it, there are a few things that I'm scratching my head over and wondering what they were thinking.. and I'm not sure I like them. What's really weighing on my mind right now is whether these things that concern me are worth the gain that I think we'll get from it. I'm still on the fence about that.

All I do know for sure is that something needs to change soon. For my sake, at least.

Dragon Thief
08-25-2009, 06:31 PM
Plus I spent $9 on a rather dire book of his 4 years ago and am nursing a life-grudge because of it http://i661.photobucket.com/albums/uu332/IIJM/forum/meh.png

You, sir, have just been repped.

jason wolfbrother
08-25-2009, 10:55 PM
Which book if you don't mind me asking? I have yet to find one of his that I didn't like.

The Corean Chronicles got a little dry and I didn't finish the series but that's the closest I come to one I dislike ;). I certainly don't begrudge the $ I paid for his Sci-Fi books ;)

JSUCamel
08-25-2009, 10:57 PM
Which book if you don't mind me asking? I have yet to find one of his that I didn't like.

The Corean Chronicles got a little dry and I didn't finish the series but that's the closest I come to one I dislike ;). I certainly don't begrudge the $ I paid for his Sci-Fi books ;)

Agreed. I've enjoyed every Modesitt book I've read. Some are better than others.

Kurtz
08-26-2009, 06:48 AM
The Magic of Recluse, or something along those lines anyway.

Eye poison.

Zanguini
08-26-2009, 08:53 AM
As a stand alone book in which he never really reveals or allows you to understand the magic. its pretty good.
I couldnt finish the Corean Chronicles either, but the first 4 books I read were really well done and an interesting magic system with great discriptions of cavalry battles and tactics. However when he went back in time to do a back story that i didnt really want I stopped reading... I think it would have been much better for him if he just ended the series there.

jason wolfbrother
08-26-2009, 10:33 AM
Agree compeletely. I finished the first part of the Corean Chronicles. I started the 2nd trilogy (quadrilogy) whatever and didn't find it as interesting. didn't even finish the first book.

Magic of Recluce was the book that got me hooked on L.E. Modesitt, Jr. hmm interesting ;)