The American Medical Association has come out against the government insurance plan proposed by President Obama, according to the New York Times.
As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system. …
While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.
The ostensible AMA message is that resource allocation should be done via the market, not the state. Critics of the AMA who may fault it for its monopoly power may critique it from that vantage, but it would be inconsistent for them to turn around and claim that replacing one monopoly by a government monopoly is a logical improvement. What is being debated here goes beyond the specifics of a government plan. At issue is the principle of how resources should be allocated. President Obama has recently proposed controls on executive compensation, not just for TARP related firms, but more broadly across the economy. The Washington Post writes:
But with the spotlight now on executive pay practices, senior administration officials are moving to address concerns at firms well beyond those implicated in the crisis. Yesterday, officials proposed two pieces of legislation that separately empower shareholders and the Securities and Exchange Commission to exercise more oversight over executive compensation at all publicly traded firms.
The first measure would give shareholders more say on what companies pay executives. Traditionally, stockholders have had limited influence and the authority only to elect a small number of members who sit on a company’s board of directors. The second measure would expand the SEC’s power to ensure that the corporate committees responsible for deciding compensation act independently of the top executives whose pay they set. Most large corporations have such committees, and their record in rewarding risky management has at times been troubling. Conflicts of interest between committee members and executives are common.
(Plus, watch Barney Frank illustrate my point without conceding it after the Read More)
Should he be given the authority to do it? The devil in these proposals will be in the details, but it’s not obvious that the government can do a better job at supervising resource allocation than the private sector. The debate doesn’t focus on this, however, because the Obama administration very cleverly assumes that it’s true and simply challenges his Republican opponents to come up with another government plan. He’s says ‘I’ve got a plan for change, what’s your plan for change?’ Yet it is not necessarily the case that either plan is better than the status quo. One example of how President Obama does this is the following:
President Barack Obama challenged Republican critics Thursday to offer alternative plans for overhauling U.S. health care, declaring he’s “happy to steal people’s ideas” but that doing nothing about out-of-reach costs and uninsured Americans is not an option.
“What else do we say to all those families who spend more on health care than on housing or on food?” Obama said at a town hall-style meeting, surrounded by supportive citizens in the nation’s heartland. “What do we tell those businesses that are choosing between closing their doors and letting their workers go?”
Now it may be the case that major improvements are possible in employment compensation. But it is not necessarily the case that the improved or optimal solution is a member of the universe of solutions proposed. In a set consisting of a current compensation system and the Obama compensation system the Obama system is not ipso facto better. That has to be demonstrated and very often it is not. It is simply assumed. Similarly, the existing US health care system may not be the best, but it is not necessarily inferior to Obama Health care. Most consumers know that there has to be a reason to change products. You don’t change simply because someone comes along to sell you something. Sometimes the consumer even tries something and decides he was better off with his former product. For President Obama to say that in the absence of another proposal that his system is necessarily better is a logical fallacy.
Each alternative in the tree must be evaluated according to its own expected value. In creating solutions the trick is to find a direction of improvement and most people understand that movement across the solution space is not always, nor even commonly in the direction of improvement. ‘Do nothing’ or ‘do nothing until you know more’ is very often the best strategy. Many a man has walked into a car lot and looked around without buying anything. The problem with walking into the Hope and Change car lot is the assumption that you always have to walk out with something; and you only have two choices at that.
But that brings us right back to market principles. The reason browsing through a shop is so beneficial to consumers is that have a choice. In the case of government-mandated compensation and government-run health insurance, the underlying organizing principle is that you are too stupid to make your own choice, and therefore it must be made for you through some kind of compensation czar or health czar. Now it may be true that choice can be misused, but it is not obviously true, nor is it even generally true. Which is why the former adage was that government should stay out of things unless there was a compelling public interest to intervene. There was a time when the default setting was for the government to do nothing unless it was obvious that they should. Today, things have been reversed. The default argument is for the President to challenge his political critics to do something or let him do it.
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In the case of government-mandated compensation and government-run health insurance, the underlying organizing principle is that you are too stupid to make your own choice, and therefore we must make it for you through some kind of compensation czar or health czar.
That is not the organizing principle. Rather, it is that medical care should be organized so that it is available to everyone.
I do not favor the government becoming the medical provider for the entire country, but I don’t see any purpose in misrepresenting the “organizing principle” of those people who do favor it. Let’s have a serious debate about the issue instead of setting up straw men to knock down.
I am surprised the AARP have not joined the conversation.
If the US adopts a single payer system, as we see in other countries such as the UK and Canada, we’ll see a lot of rationing. I imagine the elderly will be impacted negatively by this.
Surely, they must be giving this some thought??
Need I mention that the delicate geniuses who are pushing ObamaCare…have absolutely no intention of participating in it themselves? Can you imagine, oh say, some well-connected pol taking a number and patiently waiting for treatment of his festering hangnail in a friendly neighborhood ObamaCare “Ministry of Wellness” clinic?
Me neither.
Next time you hear Lord Obama whining about a “two-tier medical system” here in the United States, just remember: this is, in fact, precisely what he intends to bring about whether by accident or design.
Rather, it is that medical care should be organized so that it is available to everyone.
Closing the gaps doesn’t necessarily mean that health care should be re-designed as a government health plan. And it isn’t the fundamental reason for “health care reform”. The uninsured can be brought in by other publicly subsidized ways. But the main arguments for Obama’s plan aren’t based on insuring the ininsured, rather on the idea that it will improve the quality of care at lower cost. The health care plan is being sold as a way of preventing the bankruptcy of the system.
To do that, they argue, we should move to a global optimum, not a local optimum of plugging the gaps. And that requires a government health system, because only the only way to attain that global optimum is with the big solution.
Obama’s misrepresentations are mind-boggling.
That there is something wrong when someone does not have insurance.
That government can run any system more efficiently
That a government run system would be less expensive.
That medical care is a generally available commodity that is not distributed fairly by the private market system.
That everyone deserves equal medical care.
That any person’s wants should be somehow be provided by the government intervention.
These are positions so obviously wrong-headed that they should not merit rebutting.
The media that reports his positions without skepticism makes them an accessory to his obfuscations and that there is an unquestioning reception in the general populace to such nonsense is a very bad sign for our future.
I have always relied on the WSJ for sanity in news reporting and Rush for incisibe criticism and analysis, but it is only here with the BC that I find clear recognition of what is going on.
I find it incredible that Wretchard can on an almost daily basis create this wealth of historical and critical essays that penetrate to the foundation of our existence.
Slavery is what is being proposed.
I am against slavery.
The “details” of this slavery are unimportant.
When the market decides, failures disappear. When the government decides, failures redouble and grow.
Wretchard, if you insist that the proponents’ organizing principle is that “you are too stupid to make your own choice” then no serious students of the issue will take you seriously.
Your musings that some gaps will not being filled in real-life practice does not compel any serious person to deduce that therefore the proponents’ organizing principle must be that everyone is too stupid to make decisions.
Get serious. Show some basic respect for other people’s opinions and motivations.
Can you cite even one example of any proponent who formulates the organizing principle in the insulting manner that you do? Of course, you can’t.
Their argument is as I said: Medical treatment should be available to everyone in the society.
Wretchard, if you insist that the proponents’ organizing principle is that “you are too stupid to make your own choice” then nobody will take you seriously.
The nice thing about this site is that you don’t have to take me seriously. You’re an intelligent man and can decide not to read the comments on this site and go elsewhere. But imagine a situation where, no matter what URL you typed, you’d wind up here. What would you call the organizing principle of such an Internet? Now you can claim that the point of such an architecture would be to ensure that you never got a 404, and hence it’s a feature, not a bug. But I claim it’s a bug not a feature.
Advocates of government intervention cite market failure. That can occur when people won’t make the right individual decision for themselves, such as in the Tragedy of the Commons. There are genuine instances where markets do fail. The executive compensation regulation proponents explicitly say is that decision makers undervalue the long term for the short term. They misinvest, hence government regulators must correct that tendency. The other code words they use for this argument are “greed” or “short-sightedness”. Politicians call you too stupid to make your own choice all the time. I just happen to notice it.
The market for healthcare services today is greatly distorted by the intervention of the Federal Government, which is the largest payor for those services.
In 2007, Americans spent about $2.2T on healthcare. Of that, about 20% was spent on Medicare, 18% was spent on Medicaid, and 7% was spent in other public programs. This means that about 45% of all healthcare spending was controlled by government. The Federal Government sets its prices through the Centers for Medicare and Medicaid Services (CMMS). It establishes the reimbursement for doctors, physicians, drug companies, etc.
Reimbursement rates set by CMMS do not cover the cost of healthcare. As a result, private payors effectively subsidize healthcare for Medicare and Medicaid users. Last year, according to Millican, a healthcare consulting firm, hospitals lost $30B on Medicare. Hospitals get about 32% of total Medicare dollars, so this equates to about $141B in revenues, meaning a margin of about -21%. If everyone in the country moved onto a Medicare system, this would mean that Medicare healthcare reimbursement to hospitals would be about $704B, and hospital losses would grow to $148B – an annual increased loss of more than $100B. These losses would bankrupt the entire hospital sector. And the economics of Medicaid are much, much worse.
At the end of the day, there are only two ways to match supply and demand: a market and a queue. The question of universal access is a crock. Today, everyone in the US has access to healthcare; the problem is that not everyone can afford to pay for the access they would like to have. But this is true of all goods and services – I have access to a private jet, if I can pay for it. But I can’t, so I have to fly on commercial airlines (or ride the bus, or drive my car, or walk).
Right now, the system uses market mechanisms, but the price-setting role of CMMS is straining the system in the extreme. How much longer can private payors subsidize government healthcare expenditures? We are essentially faced with a choice between
It seems to me that the best way to reform the system is to implement the following:
Of course, with the current leadership in Washington, this sort of approach has approximately zero chance of being adopted. Rather, if the Obama Administration gets its way, we will eventually end up with a government-controlled system, i.e. Washington sets all prices. This means a queue for matching supply and demand. This means healthcare rationing. Sorry, it’s just the way it works.
Think bread lines in the Soviet Union. Not good for bread eaters, not good for bakers, not good for society. A true lose-lose-lose system.
L3
Leo Linbeck:
Of course, with the current leadership in Washington, this sort of approach has approximately zero chance of being adopted.
That sort of approach had zero chance of being adopted in the last Admininstration too. What was done to make even one improvement during the past eight years? Nothing at all. It seems that the Republicans’ organizing principle is that everyone is too stupid to recognize any problems and to reform anything at all.
What we have now is that if you cut your foot on a Friday night and have to go to a hospital emergency ward to get five or so stitches on the wound in a 15-minute procedure, then you will be charged around $600 if you do have medical insurance and $900 if you don’t have medical insurance. The smug person with insurance eventually will be charged $100 out of pocket, and the other, miserable guy will be hounded for the full $900.
People who have good medical insurance are oblivious to problems that other people have. People without medical insurance cannot convince a family doctor to accept their families as patients. People without insurance are charged higher, maximum fees — whatever the hospitals, clinics and doctors can get away with.
So, people are fed up and they are scared. They feel they are being treated unfairly and can be bankrupted by a medical establishment that makes lots of money. People without medical insurance suffer big disadvantages when they try to deal with this medical establishment, and people who do not have good jobs cannot get medical insurance. Even people who do have good jobs and can get medical insurance are seeing their premiums rise and their benefits fall.
The Republicans had an opportunity during the 2008 Election campaigns to explain to the public how another Republican Administration would reform our medical-care system. McCain squandered that opportunity, yakking instead about being a POW during the Vietnam War and about how Obama and Ayers were buddies. McCain promised to give every family $5,000 for medical insurance and nobody (not even McCain himself) knew what McCain was talking about.
The consequence is that the Democrats are running the show now, and they intend to make medical care available and affordable to everyone.
If the Republicans want to participate in political negotiations to make the reforms as practical as possible, then they will not be welcome if they misrepresent the Democrats’ intentions and motivations along the lines that the Democrats simply think that everyone is too stupid to make their own decisions.
Mike Sylwester: “Medical treatment should be available to everyone in the society.”
Why?
Mike,
You sound like a true believer. I was one too until I worked for 12 years as a family doc in the Indian Health Service. It will be interesting to see how “available and affordable to everyone” works out. I’m guessing long Queues and major Gov’t debt. Servicing the debt will then make the pie smaller and smaller. Anyhow, the Dems are running the show now, God bless us.
Lord Acton
Wretchard:
… imagine a situation where, no matter what URL you typed, you’d wind up here. What would you call the organizing principle of such an Internet?
Browsing merrily around the Internet is not a good comparison to having to deal with a situation where your child might have cancer and you can’t even get a family doctor for your family.
Bravo, Leo.
The private insured are subsidizing those on the dole far more than people realize. That is perhaps the biggest problem subverting health care cost management. The problem with Health Care costs began with Medicare. That government intervention, and it was much more benign in the beginning, is what distorted the market and started costs spiraling upward. The Medicare/Medicaid boondoggle has just expanded over time.
The idea of a cost for services paid by every individual patient in some way must be put back into the system for health care costs to be reined in. Because our favored special interest groups have been told to believe they have an absolute right to unlimited high quality “free” care, there is no incentive for them to limit responsibly or prudently their use of the our subsidized health care system. Consequently, costs spiral upward endlessly.
Obamacare surely will expand this subsidized health care to a greater and greater share of the population to buy more and more votes. The “free care” for the special interests has to be paid by someone, and so the now declining productive portion of society will be asked once again to carry the load for the victim classes. We will hear endless excuses to expand subsidized coverage, and more and more of the populace will be subsidized. But my and other’s big worry is that once the health care rent seekers are sufficiently over 50% of the population, it will become almost impossible to end Obamacare. The Democrat’s ultimate goal is that the payers will be greatly outnumbered by the subsidized, who won’t give their subsidy. The Democrats will then have achieved a political death grip on our political system. We will then be forever stuck with a corrupt politically motivated health care bureaucracy, we can’t vote out of power, that seeks greater and greater control over the economy and our lives.
My experience is that doctors and other medical facilities tend to cut SERIOUS cost breaks when dealing with people who don’t have insurance.
If you want to see what “free” health care will look like, take a look at any inner-city emergency room on Saturday night. It’s generally not a pretty sight and the care provided for the cost accrued is ridiculously expensive.
Leo Linbeck’s solution listed above is a very good one. I wish I had any faith whatsoever that there was a hope of it being adopted in this Administration.
Mike Sylwester: your reasoning fails to impress me. Your insulting of our host impresses me even less. Did you fail to learn in youth the rudiments of what is required to be a good guest?
Mike Sylwester:
If you won’t throw in the towel, let me do it for you. I can’t stand the sight of so much blood. You have been refuted by our host (in the most elegant way I have ever seen), by L3 in a fusilade of facts, and by others with sheer derision. Wake up dude! You are flat wrong and all I can say is that I imagine you as looking like someone like “Floyd R. Turbo”. The Johnny Carson character that wore the cap with the earflaps who always identified himself as “Floyd R. Turbo – American”. Unfortunately, he always made points that were ridiculous but created hilarity for the audience.
Responding to #13 and #14:
I prefer a medical-care system based on the free-enterprise system.
However, a medical-care system based on the government as the major provider is feasible. It is done that way in many other countries.
In our own USA, the government provides medical care to the elderly and to the poor. There are lots of problems, but it is done.
In our own USA, the government provides education to all young people. There are lots of problems, but it is done.
The USA has a system where most people get medical insurance through their employers, and then the medical insurance companies act as an intermediary between the individual and the medical establishment. There are lots of problems, but it is done. Most people now recognize that this system is obsolete, but this system has not been reformed.
In the USA’s current system, people who don’t have medical insurance through their employers are at a huge disadvantage when dealing with the medical establishment. They can’t get a family doctor, so when they eventually must go to the hospital for treatment, they are charged outrageous prices. When you walk into the hospital emergency ward, you must sign a bunch of papers agreeing that the hospital can charge whatever the hospital wants to charge.
There are problems with the current system, but the Republicans did not do anything during their past administrations to fix those problems, so now the problems will be addressed by the Democrats, who don’t prefer free-market solutions.
If the Republicans want to be taken seriously in negotiations about reforms now, then the Republicans should talk seriously and respectfully and should recognize that the Democrats are running the show in proposing and advancing reforms. Saying that the Democrats just think that everyone is stupid is not a good approach.
If my saying that causes me to be blocked from commenting in this blog, then I don’t care. I’ve already been kicked off of Rantburg for speaking my mind there too. There are lots of blogs on the Internet where I can comment.
Mike,
Again – what you are proposing is slavery.
If you pose that a person has a Positive Right (say to bread) then someone must supply that bread.
That person is a slave.
That is the effect of Positive (as opposed to Negative) Rights.
In 1993 Hillary tried to make my wife and me criminals in order to control us. If we continued to take money from private patients she could fine, put us in jail, or kill us if we resisted.
Force (death) is the ultimate threat of totalitarian government.
Death or slavery is what is being proposed here.
Do not try to disguise this with good intentions.
Mike Sylwester:
When ten people tell you that you have a tail, it behooves you to at least turn around and take a look.
NP
Browsing merrily around the Internet is not a good comparison to having to deal with a situation where your child might have cancer and you can’t even get a family doctor for your family.
There’s no reason why a single payer system is the only or even the preferred way to provide a doctor for your family. All health care systems have gaps. The Australian health care system, for example, is a hybrid public-private system where people get private health ensure to bridge the gap between the level of care they need and what the state can provide. In fact, the private ensurers advertise themselves as “gap coverers”.
The gap takes several forms. One gap is the time that you may have to wait for a public bed versus the time you need it in; the other is between whatever the public system protocol supplies and what is state of the art. For example, one person we know is being treated for breast cancer, but the approved protocol for the given stage of the disease does not include Herceptin, which costs $50,000 for a full course. To get the Herceptin you’ll either have to have private health insurance or go out of pocket. Maybe the approved government protocol for that type of treatment will eventually change, but for now, that’s what it is. There are people who left trapped in serious gaps. Private insurance allows you to fill those gaps because the gaps are real.
Similarly the US debate, I think, ought to be about how to fix what is broken and fill the gaps that need to be bridged. I understand your wish that everyone should be covered — truly covered — but that has no correlation to whether your system is public or private or hybrid. It has to do with whether your system works or not. This is the key issue. The way it has been framed, I think, is the wrong one.
Government health provision has one often unspecified downside: competition with other government programs. Once the government is put in charge of the health care system, that system will inevitably experience competition not with the private sector, but with other government programs for resources. Debates become about whether to decommission another destroyer to build another hospital, or cancel some kind of pension to hire another 1,000 GPs. This is what the debate is about in many countries even today. When you get Obama Health Care, remember this: ACORN will compete with health care for resources.
That’s why it’s not a mischaracterization to say the current debate is about choice. Choice is central to the problem, not peripheral. It’s not about providing coverage to those who don’t have it. That can be done in other ways, not necessarily by a single payer system. Public health systems like Britain’s NHS aren’t too bad at providing basic health care, but they have dreadful records at curing a child of cancer. I helped a friend look up the mortality tables and on average, you don’t want to get sick of breast cancer in the UK. You’ll never get as much health care as you need. But you ought to have a chance to get as much as you can. Choice, as in the Herceptin case, is not an abstract quantity. The worst feeling in the world is to be in a health care system in which you are theoretically covered but you won’t get the treatment you need because it is not in the approved protocol.
I really mean it when I say that my philosophical objection to this health care debate springs in part from the idea that we are too stupid to make our own decisions. That we have misallocated resources and they will be better allocate by a government dominated system. By and large patients are better off with more choice than less choice. Coverage is not in universal correspondence with “government health care”. It is a function of how well you can close gaps.
“Affordable” is an interesting term. One hears it a lot, but I don’t think I’ve ever heard anyone define it.
If the aggregate sum of “affordable” for all US patients is $X, but actual costs to provide those goods and services are $X + $Y, how is this gap to be closed?
[I suspect that $Y is in the hundreds of billions per year; at best a large fraction of $X, perhaps even > $X.]
Do we force those providing those goods and services to do so at below market rates? [see #20]
Do we seize the property of some citizens (e.g. $Y in taxes) to pay these costs?
Do we have a duty to provide “available and affordable” care to every US citizen? To everyone in the world? To aliens illegally within the borders of the US? At some point $Y is too large – what do we do then?
Re: Langley (#20)
So far, my only proposal in this thread is that Wretchard not say that the the current Administration’s organizing principle is that “you are too stupid to make your own choice.” Rather, Wretchard should recognize that the Administration’s (not my!) organizing principle is that medical treatment should be available to everyone.
In this thread I have not advocated any particular change of our medical system. I have not advocated that even one medical institution or service or function be taken over by the government. I have not said that it would be better if anything at all were taken over by the government.
Rather I have advocated that we all recognize problems in our current system and that we discuss the issues in manner that respects the intelligence and motivations of people who are trying to deal with those problems. Straw-man arguments like the one Wretchard asserted are not helpful and should not and will not be taken seriously by serious people.
And as a consequence I am being treated like a rude guest on Wretchard’s blog.
Mike Sylwester:
You are a deluded progressive. Good intentions (which we all have)do not equate to reality. We must determine the best of bad choices. Singing “Kumbaya” will not change that.
NP
Mike, I don’t think you are being rude. But I don’t accept that I’m insulting you (at least I did not intend to, and apologize for giving any offense) for criticizing Obama’s health care reforms in the terms that I did. I truly don’t think they are a solution to the problem. And for those who have health needs, they won’t bring help if they don’t work.
Mike Sylwester:
Move north to Canada and see how socialized medicine really works. We have to go to the US to get anything non life threatening done in a reasonable time. And there are still those who go broke paying for specialty drugs not covered by the system.
Mike Sylwester,
You may have noticed that I did not specify either Republican or Democratic leadership. I consider the healthcare mess to be of bi-partisan origin. In fact, the incentive for the rapid expansion of employer provided, pre-tax healthcare was established by the Nixon Administration. When wages were frozen by executive fiat, employers and unions collaborated to have employer-provided health insurance classified as “non-wages,” thus allowing for higher compensation that did not violate the freeze.
In any event, I understand that people are fed up and scared. These are the precise pre-conditions for really, really bad policy to be enacted. Political interests are exploiting the popular fear you describe to promote legislation that, if passed, will make medical care, on average, less available. Sure, you may be able to get Tylenol, but you’ll have to wait 3 months to get the MRI that will show that your headache is caused by a brain tumor, not merely job-related stress. Over time, lower supply with growing demand will make care less affordable. What is the cost of waiting for an essential procedure? Pretty high. Alternatively, you’ll be able to go to the “private” system that will truly be unaffordable for the average person (cf. England).
I agree that the rhetoric can sometime be overheated in this debate, whether it’s saying that politicians think the public is stupid or saying that some people are oblivious to others’ problems. But I think this kind of hyperbole is common in public discussions of important issues. Better to have a thick skin and focus on the problem, methinks.
It seems to me that the fundamental issue here is whether our leadership in Washington believes that, somehow, medical care is different than any other good or service in the economy. If so, why? It can’t be an argument based upon necessity – again, food is more necessary than healthcare (it is quite common to survive without healthcare for a month; food, not so much). But we have figured out that markets are better than central planning for matching food supply and demand. The historical record here is pretty clear.
The Obama Administration’s argument appears to be that healthcare is an entitlement for the consumer. It is easy to understand this point of view, but it ignores the harsh reality that any exchange of goods and services has to work for the producer as well as the consumer. Prices have proven themselves to be the best mechanism for matching the wants of the consumer with the capabilities of the producer. My fear is that the expansion of a centrally-controlled system (which is sort of what we have now), will make the current mess much, much worse.
Now, I don’t think, in today’s environment, it will be effective to argue for “no change.” But it seems to me that the argument is whether to change toward more or less government intervention in the healthcare market. Above, I suggested three pretty fundamental changes to the system that would decrease government distortion of healthcare markets and will, I maintain, result in a much better match between supply and demand (IOW, make healthcare more affordable and more accessible). There are, no doubt, other ways to improve the system. But I have to agree with W that the current rhetoric coming from the President is pretty lame: “it’s my plan vs. no change.” This is, I believe, W’s fundamental point in his piece above.
I accept your contention that the Democrats’ intention is the make healthcare more available and affordable. If you are correct, these are good intentions. But good intentions are not enough; our leadership must promote policies that will have this result. I would argue that putting the government in control of healthcare pricing – which is, effectively, where the President’s plan will lead – will do neither.
A centrally-planned system will decrease availability – you only need to look at Europe and Canada to see that the result is rationing and queues. And I also argue that central control will make it more costly in the aggregate – by setting an artificially low price, demand for goods and services will increase, and the ensuing losses will have to be made up with increased taxes, on us and/or our children. We have already seen this with Medicare: subsidized prices drive up demand, and the result is an unfunded Medicare liability of $85T. Sure, it’s “affordable” when you go to the doctor, but with a tax burden that lowers incomes, slows growth, and increases unemployment, the true cost of such a system is much, much higher.
So, I guess, our disagreement is not on ends, but on means. But that is, after all, what most serious policy disagreements are about…
Anyway, I appreciate your willingness to engage on this important topic, and wish you all the best.
Cheers,
L3
Wretchard:
You are a gentleman. You have made points,both in your post and your comments, that are orderly and well-reasoned. This is the reason that your blog is a daily “must” for me. I hope that you do this for the rest of my life.
NP
Wretchard (@22):
I really mean it when I say that we are not too stupid to make our own decisions. By and large patients are better off with more choice than less choice.
Again, name me one person in the Obama Administration or anywhere else who has said that you are too stupid to make your own decisions and that this is the organizing principle for the Administration’s proposed reforms of our medical establishment.
You are simply insulting the Obama Administration and other proponents of reform with your misrepresentation of their position. Why do you insist that your gratuitous insult is sensible or helpful in the discussion of this issue?
It’s sensible and just plain polite to acknowledge the Administration’s motive, which is to make medical care available to everyone in the country. Of course, you then can point out all the gaps and other impracticalities of the Administration’s proposals. That part of your discussion is reasonable — and, in my opinion, correct.
Of course, after you name at least one person who actually and explicitly advocates the “organizing principle” that you purport, then maybe your assertion might deserve some intellectual respect.
I should stop posting comments now, but I can’t resist adding that at a time when we are living through the nightmare caused by “affordable housing”, AKA the sub-prime meltdown, which was justified under the banner of universal home ownership, why asking why we should accept a health-care debate set up along the same structural lines should cause unease. The politicians said it is about “home ownership for all”. Well was it? We should always look under the label through the glass wall of the jar and into the contents. Just because they call it “health care reform” doesn’t mean it is. Looking past the label doesn’t mean calling people liars.
Simply because they advertise it as universal coverage doesn’t mean you’ll really get treated. When we are told “if you are against health care reform you are against treatment for the poor and unprotected”, it is like asking when you stopped beating your wife. That’s changing the subject.
And to loop back to the start of the post, listen to Barney Frank’s video. He argues that just because his proposal is full of defects doesn’t mean we shouldn’t do something to change the status quo. I would have answered that simply because he had something to sell didn’t mean one had to buy it. It doesn’t mean that everything Barney peddles is bad. But caveat emptor.
Mike Sywester:
You dumb bastard! Of course, no one has “said” that we are “too stupid” to make our own decisions. However, that is just what they mean. I would like to meet you just to confirm my impression.
NP
I applaud the reassertion of the idea that insurance, properly understood, is a vehicle to hedge a rare but catsstrophic event through broad amortization. That sentiment is of a piece with the observation that one of the great problems in health care costs is that the costs of even the mundane procedures are hidden from the consumers. Every knee sprain does not warrant an MRI, but in a world where it costs you a $10.00 co-pay to have either the MRI or the X-ray, what gets chosen?
I doubt that a government in the progressive mood of paternalism will risk exposing the patient to making economic choices like this regarding health care. Why would it, especially after it has argued the whole thing as an inherent right? You can’t put a dollar figure on an inherent right. That means you can’t control costs very well, either, absent the queue L3 spoke of.
So I don’t think this effort is going to go well in America. It’s going to be a costly monster – especially given that the Baby Boomers are now moving en masse to the portions of their lives where health care costs begin their inexhorable rise.
Mike,
After reading your subsequent posts, I’d revise my penultimate sentence to say:
It appears we are more in agreement on policy than I surmised from your earlier posts. My only argument with you at this point is that our shared preference for a free enterprise-based system is largely at odds with your other observations.
The fact that we provide subsidized healthcare for the young and old doesn’t mean it will work for everyone. My argument is that the only reason it “works” now is that there is a massive subsidy from private payors and future generations.
In other words, it doesn’t really work. It just looks like it does. Today, anyway. And the current mess is the result of the fact that the bill is coming due, and we’re out of money.
As W points out, we just finished watching this movie. Few of us liked the ending. Ironically, the actors haven’t changed. Only the genre. But whether it’s Hamlet or Alien, everyone ends up toast.
Cheers,
L3
Barney Frank told a CNBC interviewer, “This interview is over,” and stormed away. Or maybe he pranced away. I don’t know, I wasn’t there. The interviewer was asking him about the Obama administration’s plans to determine the proper pay scale for private company executives, which Barney is in favor of. Timothy Geithner, Secretary of the Treasury, says while he is not in favor of the government setting private company pay scales, he believes the shareholders should have a say in what company execs earn. The problem is how to ask the shareholders what that pay should be, since most shares of large publicly held companies are held by major investment institutions. No, if this goes through, the shareholders will not determine executive pay in private companies, the government will, which means guys like Barney Frank and Tim Geithner will decide what the CEO of Microsoft should be paid. I talked this over with a five year old I know and she said, “I love Barney.”
She said if I were a designer kid
I’d want Barney for a daddy
I’d love him for the things he did
Though some say he’s a baddy
So what he’s played the Congress game
‘Cause so do many others
What e’re he’s done it’s just the same
As his Congressional brothers
I love him for his winning smile
I love him for his color
You can see purple for a mile
It never gets no duller
When I pointed out we weren’t talking about Barney the purple dinosaur but Barney the congressperson, a man who wants to help President Obama turn the country into a socialist paradise, a replica of France, a man who somehow forgot to declare all his income come tax time, a man who never saw a socialist program he didn’t like, she thought a moment before replying.
She said they’re just like robbers who
Just want to steal our freedom
There is no difference ‘tween the two
Just tweedledee and deedum
I like my country like it is
Why do they have to change it
They want to take away the fizz
And really re-arrange it
You say that Barney’s not a star?
He’s not what I’ve been thinkin’?
He’s not a purple dinosaur
He’s more like something pinkin’?
Well just for that I take it back
We’ll fit him for some nooses
If I’da known he’s just a hack
From lib’ral Massachoosses
Moral: You can fool some of the people all of the time, you can fool all of the people some of the time, but you can only fool a five year old once.
“You are simply insulting the Obama Administration and other proponents of reform with your misrepresentation of their position. Why do you insist that your gratuitous insult is sensible or helpful in the discussion of this issue?”
So your main complaint is that there should be no insult directed towards the Obama administration, while you are free to say that “the Republicans’ organizing principle is that everyone is too stupid to recognize any problems”
It’s all clear now.
Re: Leo Linbeck (#28)
So, I guess, our disagreement is not on ends, but on means.
What disagreement? I agreed with every word in your statement @28. I also agree with your three proposals in #11.
Again, I have not advocated here or anywhere else that the US Government take over as the provider of health services.
I just don’t think that people who are fed up or scared in the current system are stupid or that people who advocate reforms think that everyone is stupid.
I do recognize that the proposal that the government do take over as provider is a respectable position. That system would have lots of problems. But the current system has lots of problems too.
Now that the Democrats have won such a decisive victory in the 2008 election, they will move this issue forward, and the Republicans should play an intelligent, cooperative role in the discussions and negotiations. We Republicans had our chance to guide the discussions during the last eight years. Now we ought to be respectful and cooperative, not contemptuous and insulting.
We never seen the powers that be discuss supply constraints.
Last time I checked every doctor I knew of was very, very busy… working flat out, I’d say.
So now comes the Big 0 with a mechanism to consume even more medical output…
Prices must shoot higher.
But 0 doesn’t want to pay up.
So it’s a given that he’ll institute price controls on medical labor nationally — how ever the mechanism may be.
——
All of the current 0 schemes should be abandoned.
Instead, the regime ought to simply open up ever more medical schools and just pick up the tab. We’re paying for everyone’s medical education with public monies though the back door anyway.
Based on current international norms America needs to graduate about five times as many doctors per year as is current.
Importation of alien doctors must come to an end: they are needed in their own societies.
Likewise we need to train vastly more nurses. This is where Federal dollars actually would make positive returns.
America’s economic ills are directly related to the excessive wages earned by Doctors, Lawyers, Professors, Bankers, Media Personalities each in their own way able to restrict entry and out pace inflation by hefty percentages year in and year out.
Government guild support must come to an end.
As France showed, that can be pretty brutal if the common man has to use farm tools.
This phenomena is exactly what terminated the various dynasties of lore — either east or west.
Having wealth over concentrated was a major factor in the Great Depression — and will be seen to also be so in this Greatest Depression.
Putting a Gonnabee in charge of anything results in its destruction. 0 is merely following his script.
Re: Louie 723 (@36)
So your main complaint is that there should be no insult directed towards the Obama administration
I don’t object to insults directed toward the Obama Administration.
I do object to nonsensical insults directed toward the Obama Administration.
The Obama Admistration does not propose an organizing principle that “you are too stupid to make your own decisions” so I indeed did object to Wretchard’s assertion along those lines. It was a cheap, gratuitous insult on Wretchard’s part, and I called Wretchard on it. So, sue me.
Mike Sylwester,
I just don’t think … that people who advocate reforms think that everyone is stupid.
If I rewrote this statement
would you agree? I do think this is the governing assumption of the President’s plan. And I think that’s the fundamental point here, adjusted for stylistic preferences.
As to whether it is better to cooperate in a game which is rigged against you, or to fight to redefine the game, that is a different question. I happen to think that this game will be won on the 1st tee, not the 18th green. It’s all about defining the question:
If Rs cooperate in crafting policy that follows the D formulation, they cannot win. Therefore, the fight – and, alas, it will have to be a fight – is over which way the question is defined. Cooperation at this point in time is a bad strategy, IMHO. It was the same strategy that gave us McCain-Feingold and McCain-Kennedy.
Hmmmm, I’m sensing a pattern here…
Cheers,
L3
PS – Check out my #34 response to you RE: “our disagreement”
“The Obama Admistration does not propose an organizing principle that you are too stupid to make your own decisions”
Not in so many words. But as a paraphrase, “You are too stupid…” pretty well sums it up.
Or maybe you’d prefer “We know better”.
Mike Sylwester @ 9: “Get serious. Show some basic respect for other people’s opinions and motivations.”
Snerdly, why don’t you be the one to show wretchard some respect for his opinions?
“Can you cite even one example of any proponent who formulates the organizing principle in the insulting manner that you do?”
Yeah, YOU!
“Their argument is as I said: Medical treatment should be available to everyone in the society.”
Talk about strawmen! Been to any emergency room lately? They are used as urgent care facilities. None can be turned away, by Federal law. – Mike or whoever you are, I do not care, if you don’t like it here at BC. Unless you want to make decent arguments/discussions then go elsewhere. Or are you some type of paid troll? The truth is that healthcare is available to all if they are willing to pay for it in some form or another. The thought that it is some kind of discovered “right” is just specious.
“…the Republicans should talk seriously and respectfully and should recognize that the Democrats are running the show in proposing and advancing reforms.”
I am going to show your administration the very same respect that you showed ours which is ……. NONE!! Dude, give it up. You must really have an O/S that has an ID10T error.
We are in the greatest fundamental change of this republic since it’s founding. The Left wants us to get bogged down in these kind of discussions endlessly. There is no intention of bipartisanship from The 0bamanation nor his supporters and that is evident. Either you deal with us fairly or soon we will deal with you, fairly or not. Time is running out and people are getting angry.
1st discussion point – Where does the Constitution spell out that health care is some sort of discovered right? Be precise.
Walt @ 35
I apologize. I thought the thread was about Barney Frank and exec pay, so I put something together without reading deeply into the comments. My bad. Won’t happen again.
Walt Erickson
Mike, your We Republicans had our chance to guide the discussions during the last eight years. Now we ought to be respectful and cooperative, not contemptuous and insulting. is –like similar remarks of yours above –misleading in the extreme. Evidently you do not remember the treatment received (from Obama’s party) on every single entitlement reform initiative George Bush and his team proposed. You should do a little search before attempting to sell the falsehood that the previous admin just coasted along on these issues because they all had it made anyway and just didn’t give a rat’s ass about somebody who had to cough up the dough for his own medical care. For starters, take a look at the Second Inaugural speech –watch the video –watch GWB lament the lack of progress of these critical reforms, and the Dem side leap to its collective feet laughing and cheering and appauding for an extended time. What an indelible statement of sentiment, except for you, for whom it must have been quite delible. But maybe it’ll refresh your memory, if your memory is in fact the reason for the apparent disconnect between what really happened and what you’re choosing to characterize.
Also, as far as your intimations that one is a goner without the commons standing by to pay the man for one’s care, i can offer this: i dropped my grand plus-a-month insurance policy back in the 70s when i went ‘on my own’ in the oilpatch, and raised four kids paying medicals out-of-pocket. One upshot is none of ever gets sick because we don’t need to go where the germs are in order to et our due from our policy, or to muse our company bennies else they ‘go to waste’. I keep a high deduct catastrophy policy, all else is out of pocket, and the saved premiums, plowed into mostly oil stocks over the years, have grown um, greatly, putting me incalculably ahead of the pittance i’ve paid out for medical care. The same money would’ve made some insurance dudes the same substantial slug of private property had i sent it to them instead of keeping it and making it work for the original earner (me) instead.
Lastly, continually accusing (and falsely at that) someone of rudeness is pretty damn rude itself.
COBRA is a fine example of the problems created by ham-handed government solutions.
COBRA is the obligatory extension of health insurance coverage which the federal government required U.S. insurance companies to make available to employees who have been discharged as redundant (not for cause) by their employer.
Typically the employer will have been paying the employee’s health insurance premiums as a “benefit” of employment. After being laid off the now unemployee must pay the premium.
Now, you might be tempted to think it should make no particular difference to the Insurance provider, so long as the premium is being paid.
It ain’t necessarily so.
Long ago, the point of insurance was for a group of enterpreneurs to pool their resources against losses that experience had shown to be statistically inevitable, so that no single business would be overwhelmed by the loss. (Read up on the start of Lloyd’s of London.) As Insurance companies have become much more sophisticated in the financial instruments and investments used to buffer their liabilities, they’ve increasingly become entrenched in investment and the financial market.
Some have been very successful at pulling in money. As money has increasingly concentrated in the coffers of the Insurance companies on a scale equal to the banking system, they have become increasingly risk-averse. It would be fair to say that for the last three decades, many insurance companies simply use every slight-of-hand they can manage to maximize the ratio of income from premiums compared to paid benefits.
For instance, in the reckoning of the Health Insurance Provider, an employee’s discharge multiplies the actuarial probabilities of that person’s risk of injury…
- suicide attempts
- sickness
- depression
- accident
- increased susceptibility to stress-induced diseases
…all of which result in increased exposure for the Health Insurance Provider!
So, an insured person’s change in employment status – regardless of circumstance has historically been used by Health Insurance Providers as an incontestable non-negotiable basis for termination of coverage, requiring the insured person to re-apply and face higher premiums because of higher age, new infirmities, waivers for conditions which can now be designated as pre-existing. In the worst case (for the laid off employee) no insurance company will offer coverage at any price, because of some hideous medical problem that only manifested since the last time the person applied for a policy. Call it “churning.” Presumably the system was put in place and administered with the full cooperation of state legislatures, insurance commissions, and federal regulations. (Thanks to many years of regular and well-funded industry lobbying.)
This sorry shell game was obvious to anyone in the system as early as the 1980′s, and has prompted a lot of people to press the government to reign in the Insurance “industry.” One response by the federal government was COBRA. You can imagine that the industry would resent being forced to extend coverage to a vast new class of claimants already known to be more likely to incur costs undeniably correlated to the change from employed to unemployed.
What I noticed – and I admit this is just anecdotal, but it was consistent through three different episodes of unemployment – was that the Insurance companies that were OBLIGED by government regulation to provide the extended coverage under COBRA provisions made a number of attempts to mishandle my accounts, giving incorrect mailing addresses, refusing to acknowledge receipt of checks for which I had USPS confirmation of delivery, et cetera. The point is that the law allowed them to terminate coverage without any appeal or possibility of reinstatement if the payment was late by so much as a minute after midnight on the due date.
I’m not wailing “poor pitiful me!” over something now six years past. Just trying to make sense of it, especially in relation to current situations.
I thought things through, and on reflection it seems pretty obvious that the insurance companies thoroughly resent being forced to provide the coverage, and specifically demanded that they have an escape clause, which allows them to terminate with prejudice for a single late payment.
No grace period.
wretchard:
Imagine, if you will, a riverside city where rich and powerful people erect large mansions with a riverside view. That is their decision. Let’s say these mansions exist along a bend in the river. So far, so good.
Then, imagine if the floodwaters rise. The levee protecting the city is on the verge of breaking. The city engineer recommends that a secondary levee get constructed to save most of the city if the first levee breaks. Then, the rich and powerful people with mansions along the riverbank get wildly upset; they fear getting abandoned. So, despite how the bend in the river makes it nearly impossible to protect their fancy homes, this rich and powerful faction uses its clout to stop the city from constructing a secondary levee that would save the rest of town.
Then, imagine if the main levee breaks. Because the secondary levee wasn’t built (due to frantic lobbying by the rich riverside faction), the rest of the city gets flooded and gets put onto the nation’s evening news for days on end.
There comes a time, in times of crisis, when triage is necessary. There are times when there just aren’t enough resources to go around and some form of rationing must happen. If the rich “riverside faction” obstructs the interests of the many by blocking a secondary levee, the entire community gets hurt.
So, when should the interests of the majority to not getting flooded override the interests of the powerful (and often elected) minority of riverfront homeowners? At what point should one rely upon the judgment of engineers rather than politicians and lobbyists?
Concerning health care, the key political question in my mind is whether the “riverfront faction” consists of insurance companies and HMO’s, or whether the “riverfront faction” consists of Washington bureaucrats and politically connected lawyers and lobbyists who can milk new loopholes. Who is threatening to destroy the city in which they live in order to ensure that their own interests get top priority?
I bet there are a lot of folks who might wish for a similar escape clause for elections.
I repeat for what it’s worth that none of the people who cite the reckless compensation policies of private industry will say a word against the even more conspicuously irresponsible LOOTING of Fannie Mae by Franklin Rains, Jamie Gorelick, and other Democrat cronies who set up a system of outrageous bonuses to reward themselves for all the worthless home mortgages they authorized Fannie Mae to purchase at TAXPAYER EXPENSE.
Several hundred million dollars in bonuses, they pocketed without any regrets, if memory serves.
I might feel the teentsiest inclination to give serious consideration to the administration if there were any acknowledgment at all of the corrosive corruption of Democratic elected officials over the last decades, but they’re a bunch of lying bastards.
The honorable William Jefferson, famous for commandeering National Guard Vehicles to help him salvage his cash bribes in the devastation of Hurricane Katrina, was defended by his Democratic buddies even after the hundreds of thousands of dollars of cash were found in his freezer.
Ah, to hell with it.
Any political party that still celebrates Ted “Chappaquiddick” Kennedy as a hero has no moral standing to answer to the enormities of Jihad.
Mad Fiddler, on COBRA:
I worked for a while in an accounting shop for a small enterprise. It was small enough that some human resources functions, such as health insurance, fell under my purview.
This was in the 1990′s.
From that experience I can sympathize with your dealing with insurance companies regarding COBRA.
Every time a former employee went on COBRA the experience was just as you describe from that former employee’s point of view. At first he would experience sticker shock. Health insurance became tons more expensive. In reality it did not. What happened was that the hidden cost that was formerly carried by us was transferred to him. Unilaterally he was shocked.
The second shock to the former employee was the amazing hastles, the bills coming in arrears, the errors, waivers, etc. — these were also hidden costs suddenly coming into view. All though headaches were always there, but shielded from the employees to a large extent by us. The line to bewildered COBRA folks who called up was, “Now you feel our pain! Sorry!”
It is a disadvantageous position, too. When we would call up with frequency enough to get on personal terms with folks on the other end of the line and with full knowledge on that side of the phone that we spoke as representatives of a large group and not a lone COBRA wolf, I’m sure we got more attention.
Yet I think the foremost problem is simply that folks don’t realize how expensive and how complex health insurance is when the employers have put in a layer to insulate them from those concerns to the extent that they can. And I’m talking about even the simple level of making monthly payments, which is crazy with corporate insurance bills which are always coming in late and full of problems.
Again, this is a part of the theme that the real costs of health insurance are removed from the system’s users. And, on this end of the problem, it’s purely bureaucratic and compliance based costs. It’s got nothing to do with the point of delivery of the service.
The feds think they are going to create efficiencies here by hiding all these costs even more. They’re not going to be successful, I’m afraid. The only way you can reduce these costs is to expose them and let people make their own choices. Then and only then will there be a demand for savings.
walt, your verse interlude
was anything else but rude;
so slightly off-topic
we’d need be myopic
to fault such a lightly unclued.
MF/48; ah, to hell with it
i hear ya man. Folks have forgotten about that Raines/Gorelick racket, they were adding everything that came in above their bonus trigger to a secret slush account from which they’d make up any quarters that came in under their bonus triggers –never missed a single incentive bonus! And they were setting their own bonuses! Yipee! Ten million doesn’t piss off the public? Well let’s do twenty!
Then they get caught, and the punishment is, they have to retire from Fannie Mae. Oh, poo.
Ten thousand Duke Cunninghams in ten thousand lifetimes would never get anywhere close to what that one scam –among the thousands being spun by cohorts –cost the taxpayer in one lousy year.
And yet –it was an “accounting problem”! No fault! Yipee!
And here we have Mike preaching comity and respect and meeting halfway. It’s like partial-birth abortion –how do you meet halfway? Don’t kill the baby, just severely injure it?
Mike, Watch Obama showing respect about halfway thru this very very short video clip from the inaugural speech in 2005. This isn’t the cheering jeering stamping feet segment –i haven’t found that one yet –tho i think HotAir –or Maggie’s Farm, or Belmont (?), ran it recently.
Gorelick, after looting Fannie, went to the same DC law firm that provided Obama’s deputy AG David Ogden, the prominent mouthpiece of the mob’s kiddie porn division. Oh you think i’m kidding? Just do a search. The only one that tops Ogden for cahootin’ impropriety is John Deutch, lately apologizing for putting every nuclear weapon research and material stockpile soft-target in the USA on the web “by mistake”, also the same guy who as Clintons CIA director “by mistake” put 17,000 top secret CIA files on the web (or on his open home AOL account) and who was pardoned by Clinton before he could be tried, and who has now been appointed Obama’s spy-satellite czar, and who is on the board of Citibank, which just announced that it has a little “off-book asset” (CDS, anyone, unregulated in yr 2000 by Gary Gensler, Obama’s chief commodity regulator, in his job as as Clinton’s deputy treasury sec) problem of a mere ONE POINT TWO TRILLION DOLLARS, and is now 34% –and counting –gov’t owned (the government’s bank –with which it will manipulate –because the printing press can it will –the entire free-world banking industry going forward, in order to turn the
west into the third-world the EZ way, thru political-and-nuthin-but banking).
ANYBODY NOTICE ANY PATTERNS HERE that might reflect on the efficacy of the new health care plan? The new energy plan? The new Plan plan? The promises and personnel? Anything look a little ‘off” here, Mike? Mike?
Here is a unique thought. There is absolutely nothing wrong with America’s health care system! It is the best system ever created and will be remembered with great fondness for it ability to deliver innovative solutions to the masses at reasonable costs while at the same time serving as the engine of our economy through massive job creation ( it is 18% of GDP). The secret to the wonder of our system is innovation led by the creative spirit of capitalism – whether it is heart valves; MRIs, vaccines or pharmaceuticals- it is doctors and researchers using their God-given talent trying to make the world better and perhaps getting rich and famous at the same time. THAT is what Obama is going to destroy by reducing the “cost of health care”. He is really going to kill innovation which will slow down the cost curve but also kill the patient as well as the industry. It is very sad to watch but anybody familiar with the failure of the soviet system understands why it failed – it destroyed the creative spirit! That is why I know this guy is a communist-statist – he hates the individual.
Mike –
In practical terms you will get a HUGE fight. It’s a resource allocation and for some poor Black kid to get free visits to a Doctor, older White people MUST DIE. It’s as simple as that. It’s what Obama wants.
But for older Americans, a health-care rationing system which puts protected political groups: Blacks, Gays, connected SWPL Yuppies and aristos like Ted “Swimmer” Kennedy, and perhaps some young White Women, in front of the queue and older, White Americans in the back, told it’s “their duty to die” as one Democratic Governor put it, is going to guarantee a fight.
Older White Americans WILL FIGHT. As will private insurers, private hospitals, and the like.
Obama proposes free Medical Care to poor Blacks, every Mexican illegal alien, at the cost of denying life-saving health care to Older Americans, and quality of life to Middle Aged White Americans.
They’ll FIGHT. Fight with everything, digging up every scrap of dirt on Obama (and bet your tuckus there’s plenty — he’s a pol so that’s a House Bet) and his pals. It’s a brutal fight to the death. Quite literally.
Obama’s also taking on (in case you didn’t notice) Bill Gates, Warren Buffett, Steve Jobs, Jeffrey Immelt, David Geffen, Jeffrey Katzenberg, and whoever is running GE at the moment, I forgot. He’s proposing to SET THEIR PAY and create winners and losers (based on how much money he can extort from them).
Now, that worked in Chicago, because it was easier to pay or flee.
Do you honestly have any IDEA of what kind of men Gates, Jobs, Immelt, Geffen, etc. really ARE? How much power and resources are at their command? How much loyalty they command through PACs to Obama’s own people?
Obama is picking fight, after fight, after fight, after fight. Worse, he’s not destroying the guys he fights with. The Chrysler Dealers he screwed over to protect Mac McLarty’s dealerships are still around. They’re ANGRY. They have nothing to lose and you can bet they will all fund and promote local Reps against Dems. ALL OF THEM. He’s made permanent enemies out of them. Without in fact killing them and distributing their wealth to followers. He’s done the latter but not the former.
Blue Dogs face a wipeout over this in the House.
It was fine to complain about GWB. But Bush did not rock the boat domestically, he was go along get along. Obama is providing a scorched earth against Business Executives (most of whom backed him and feel betrayed), the Health Care Industry, Energy producers, and Whites, all to fund/give patronage goodies to his ACORN goons and various non-White backers.
You tell a Local Congressman to vote to kill Grandpa by rationing health care in favor of Illegal Aliens, so Miguel who crossed the border yesterday can have a free check up at the cost of bypass operation for Grandpa. Cause guess what, that’s exactly what will be coming.
I’ll certainly cede the point that a system like Sweden’s can operate — as long as everyone is the same race/ethnic group, everyone has “honesty” and not exploiting the system ingrained into them, and no immigrants and folks from other races who think the natives are “suckers” are allowed into the nation or system.
Welfare, Democracy, Immigration/Multiculturalism. Pick any two.
To reinforce #42, can anybody point me (Mike, this means you) to a power or duty of any part of the Federal Government in the Constitution that has any involvement or control over the medical products and services industry?
IOW, does this administration or any other have any jurisdiction here. If so, cite it. Article and Section please.
If not, this whole issue is just another usurpation of power. We’ve had enough of that.
( On top of Google News just now: )
Petraeus: Afghanistan attacks at high
CNN – 2 hours ago
(CNN) — The top US general, David Petraeus, painted a bleak picture of Afghanistan’s immediate future, saying insurgent attacks have risen to record levels not seen since 2001.
Insurgent attacks soar amid surge ABC Online
US Commander Wants Civilian-Military Approach in Afghanistan Voice of America
AFP – The Associated Press – Reuters – Dallas Morning News
all 598 news articles »Email this story
( yes, Mr. President, do let’s suspend (in the name of problems that were largely nonexistant until you started trying mightily to make them monstrous) all else but the wrecking of the employment, housing, legal, contract, medical, energy, and banking institutions by which American live their lives, because there’s nothing else important going on that needs an American President’s attention.
Goddammit, are you all idiots?
What we need is more doctors.
Work on that, much of the ‘problem’ goes away.
Course, we have the problem that Jamie Irons says we’re all too damned dumb in America to be doctors.
Regardless of that–
Take the money from the Desert Debtor, the fast train from LA to Vegas, and build a medical school in Boise.
That would help in our state.
Do the same in your state.
Can you understand that concept?
FWIW, I work in the healthcare and technology fields, and I end up going to a fair number of healthcare reform events organized by various government agencies and professional societies. The “too stupid to choose” perspective is very, very frequently voiced, and it seems to be a basic assumption held by many of the players in healthcare reform. To be fair, it’s probably more politely expressed as “too ignorant/uneducated to choose.” When I’ve taken the trouble to challenge that view at such events, I’m typically looked at as though I must have just fallen off the turnip truck, despite having several Ivy League degrees. Believe me, if you are not from a Cambridge, MA or San Francisco academic/medical background, you are held in contempt for your presumed ignorance by many of the reformers.
(By the way, I reluctantly comment under a pseudonym, since I’m already viewed with suspicion by colleagues who are troubled by my concerns about preserving personal autonomy, freedom, choice, markets, etc. Advocating such things as a healthcare professional in my very blue state yields a very lonely Bostonian with limited career prospects.)
Get off your stupid ass, Whiskey, get out there and go to medical school.
That should shut you up for, maybe, eight years.
A True Blessing.
and you, bob –get off yer Alice Chalmers and run for local office.
But not in Boise. Too noisy.
Buddy, I’m too old.
But, I think I got an idea here.
More docs.
Less government.
Buddy – You don’t meet the Wunch halfway. They are criminals by any sane definition, and their conduct has caused more damage to the USA than Imperial Japan managed – at least in financial terms – to say nothing of the knock-on effects on the rest of the world.
They should be hanged as the traitors they are.
Rationing is just around the bend, if any of Sen Kennedy or Mr Waxman’s proposals are passed. They have each worked in that direction for years. The problems with ObamaCare are multiple.
1) Getting health insurance to everyone is a big problem. Some young people don’t care. Congress has not figured out how to coerce them into “participation.” That will take some doing and probably run through the Supreme Court, if it is not voluntary.
2) A big mover in health care costs is “defensive medicine” and the trial lawyers see malpractice reform as an inviolable sacred cow. Good changes in that direction would save a lot of health care dollars for marginally useful tests, especially radiology and chemistries. This will be slow to change because of physicians’ habits, but it can change.
3) “Expert panels” to determine what specific tests and procedures are “approved” is a political fight, not just a scientific fight. This is hard for many to believe who have not been involved deeply in health care for years, but it is true. There is money to be made from approvals of drugs, devices and procedures. If there is money to be made, there are “experts” to testify. If there are “experts to testify” then there are political fights to be had.
4) “Pay for performance” is an anti-person measure. It makes the physician with the patient failing to get better enough want to dispense with that patient. Physicians cannot coerce diet changes and the “obesity epidemic” is testament to that failure.
5) Doctors have traditionally taken care of people, rather than disease and attempted to teach people how to live safer/better. This has been attacked by the narrowness of expertise and no doctor wants to be INEXPERT. Thus, the generalist has been replaced with the narrow specialist in internal medicine and people are shunning internal medicine because the office costs go up faster than the Medicare reimbursement. IF we can address some of the other problems on this list, this one can come back into balance.
6) More doctors might help, but adding medical schools for the C students to get admitted will not help health care a whole lot. Present academics in grade school through college do not sort out the committed student very well. Commitment to a lifetime of learning and education is needed to have good physicians/doctors.
All medical insurance programs are based on a large pool of healthy individuals subsidizing the smaller pool of sick individuals.
0bama is faced with gaping holes in SSI and Medicare. Both governmental pools are filled with sick people who have overwhelmed the remaining healthy people. There are linkages between the two.
A lot of people on SSI are also on Medicare. They are poor elderly and sick. There is also a significant degree of governmental insurance fraud involving both Medicare and SSI.
0bama’s plan is clear. He intends to force the healthy private sector individuals to pay for the throngs of sick people in the governmental sector medical programs. 0bama’s plans are a con-game at best and out right theft at the worst.
Mike Sylwester, if you’re still here:
You haven’t answered my question back at #13. You said “Medical treatment should be available to everyone in the society.”
My question is, Why?
After you answer the fundamental question, we can discuss the details (never mind that medical care already IS available to everyone so your underlying premise is a lie, we can discuss that later).
Please, let’s get your underlying premise on the table for discussion.
The question of “more docs,” although put somewhat roughly by bob, is an interesting and important one.
Having been in around healthcare quite a bit, I’m not sure the problem is that we don’t have enough MDs. I think the problem is that there is no cadre of “mid-level” providers of healthcare.
For the most part, the mid-level care – the initial triage, regular physicals, etc. – is provided by primary care docs. In reality, there is no reason for these folks to be full-blown MDs, requiring medical school, internships, residency, and $300,000+ of educational debt. You don’t need flight attendants and dispatchers who are certified pilots.
Increasing the number of physician-assistants could change this situation more than opening up medical schools to all-comers. PAs can do lots and lots of the basic work that MDs have done in the past. These folks inhabit the space between a nurse and an MD, and are trained to work like primary care MDs. Experience in any job is the most important qualification for success – ask yourself: if you were going to have an appendectomy tomorrow, would rather be operated on by a 65-year-old surgeon with a degree from Guatemala who has done a thousand appendectomies, or be the first guy operated on by a summa-cum-laude MD from Harvard? Give me experience every time (and, BTW, the statistics back this up). PAs can become very effective healthcare providers over time, and earn a good living (although never as much as specialist MDs).
Additionally, a lot of mid-level care is currently provided by interns and residents, who (due to lack of experience) make lots of mistakes. And after they acquire the experience they need, they move on to fellowships and become specialists, often for economic reasons.
Of course, physicians are a guild that like to control the supply of their labor. Hard to blame them for that, I suppose. But the real win-win here is for us to encourage (or, rather, stop discouraging) the natural evolution of the market system toward the emergence of a cadre of well-paid, permanent physician-assistants who can increase the supply of basic medical care. Lowering standards for MDs won’t do that – it will simply lower the rewards for those who have the talent to be an MD, and thus assure that the quality of care decreases, especially for high-acuity cases that really need extraordinary talent.
L3
Leo Linbeck 67
PAs and NPs can be superb providers, but the current implementation of the system has a supervising MD:midlevel ratio of around 1:2.5. More importantly, the supervising MD owns all the liability and pays all the judgments.
I’m not sure this model will survive a ratio of 1:20. I’m not saying it won’t, but this is a prime example of perfectly foreseeable “unintended” consequences.
gokart-mozart (#13 and #66)
You said “Medical treatment should be available to everyone in the society.” My question is, Why?
I did not say that it is my opinion that medical treatment should be available to everyone in society.”
I said that was the opinion of the Obama Administration.
Mike S. wrote, way above: “The smug person with insurance eventually will be charged $100 out of pocket, and the other, miserable guy will be hounded for the full $900.”
List price is a problem, for sure, for folks with no insurance. It’s not a problem for the government payer, however. I listened to a Wisconsin hospital administrator speak about reimbursements. E.g., a rotator cuff surgery costs $15,000 (going on memory here); private insurance pays most of such patient’s bill, with hospital and physician writing off the rest. For a Medicare pateient, the government pays about half the cost. Ouch. Medicaid? Some hundreds of dollars only, forcing the private system to subsidize the government payers. If there is only government funding, rationing and lowering of quality seem inevitable. But the administrator was for a new Obama plan, thinking that he’d get help to cover hospital losses. I didn’t see why a government plan would help him, except in the very short run.
If government pays less for procedures, and the government is a single payer, would not medical profession salaries will go down and quality decrease? Maybe gap coverage is a possibility, as Wrichard says is the case Down Under.
If Congress is governed by any new government policy, and has the same coverage I have, I’ll be o.k. with that. But if some animals are more equal than others, I’m not o.k. with that.
Re. Mike S’s opinions, Aristotle adivses that one listen to public opinion (and Mike represents what is probably a majority of public opinion) and take it seriously. The public opinion represents arguments that may be latent but need attention.
gokart-mozart,
I agree that 1:20 would be probably not work. I’m not sure that we’re not missing a middle level here. PAs, as currently implemented, are probably not the solution. I guess my thought is that, were it not for the regulatory regime in place today, there could well emerge a different kind of position, much as law firms have found that having non-partner, experienced attorneys, working for a salary and without the stress and liability of a partner, is a good way to fill the middle of their organizations to better serve their clients.
Just a thought.
Cheers,
L3
“because the Obama administration very cleverly assumes that it’s true and simply challenges his Republican opponents to come up with another government plan. He’s says ‘I’ve got a plan for change, what’s your plan for change?’ ”
Have the voters set the total compensation limits for all government employees, including those in the GSEs and the now government owned auto companies. Yes, that means we’d get to set the limit for those UAW members working at GM, as well as the execs of Fannie Mae and Freddie Mac. Members of Congress included, naturally.
The ballots can be included on our federal income tax form.
Turnabout is fair play, right?
My only conribution to this discussion is that we cannot afford universal health care primarily funded by the government, because we are broke as a nation. It is physically, mathematically and fiscally impossible to raise enough revenue to be able to afford more than two thirds of all the government expenditures, both existing and proposed; this is simply unsustainable. Reason and common sense alone should make nationalized health care- defacto or otherwise — dead on arrival. That it is being seriously considered is a condemnation of the reckless, irresponsible nature of modern American government.
Let’s try baby steps…
H needs to straighten out the VA hospital system.
If it can’t be set straight then we are forewarned.
——
American medical colleges turn away qualified candidates right and left. Their slots are deliberately limited by the AMA which certifies medical schools.
If you want to get the price of oil up on a chronic basis you stop drilling for it.
If you want to get the wages of doctors up on a chronic basis you stop graduating new ones.
The slots available at sanctioned medical schools has not kept up with population growth — especially where it counts: the elderly!
Medical school admissions are not turning away flunky C students…
They are shunting aside A students all the time, especially white guys. It is open policy to ‘re-balance’ the process such that lower scoring minority applicants get a super boost up.
America has approximately 2.2 doctors per 1,000… the lowest ratio in the developed world.
And of those doctors only a third received their degree at a domestic institution!
That is, 0.7 doctors per 1,000 are native graduates!
We are graduating about 20% of the doctors per capita versus our peers.
Stop the false argument that this is due to a lack of suitable candidates. That is a fantasy.
Another baby step in the news today, if you want to get cigaret smuggling profits up, tax ‘em ten times the cost they add to the medical system (and don’t net out the savings for Social Security).
For that matter, if you want to keep illegal drugs prices up, half-fight a sort-of War on Drugs.
Also, blert, why stop at the VA system? Medicare (and Medicaid) are already the government model of government-run health care –let’s salvage the one dollar in three said to be wasted in THOSE programs first, before we expand to the ‘universal’ –as a sort of bona-fide from our government to we the people.
74 blert:
I have been teaching at medical schools in NY and Boston for 33 years.
One third (at a minimum) of medical school undergraduates are conspicuously unqualified, usually by temperament or personal attributes, for their chosen profession. The decision in the late 1960s to allow women to matriculate in large numbers and to increase output from 8500 to 17 600 MDs per year has led to unprecedented legal and disciplinary problems.
What makes you think that there are MORE than 17 600 US college graduates/year who should be doctors? Based on my experience, I think the actual number is much less.
It’s not about grades. That sh*t is for lawyers.
The powers that be have decided that Marcus Welby MD was not ideal.
A TON of talent has given up on ever becoming a doctor — they know that the system is rigged against white guys.
Allan Bakke had to get the Supremes to intervene.
Anti-white discrimination is the elephant in the room.
There are many, many talented guys I knew in college who simply gave up when they saw the lay of the land: they abandoned their live-long hope of medicine.
That the admissions process is selecting the wrong players is plain.
Nationally we are consuming three times as many doctors as we domestically graduate.
The balance come from immigration, about a third, and ex-territorial American institutions. ( Grenada, et al )
How is it that we are producing only 0.7 doctors per 1,000 while Spain has 3.3 doctors per 1,000?
Any actuary can tell you the math doesn’t add up.
Not only does medical school admission discriminate against whites it also thwarts asians and Jews. All three classes if permitted to compete on merit would leave no slots for hispanics or african-americans to speak of.
Females are also over promoted: unless they remain childless they represent a bad investment in medical output. Their child rearing years must cut right into the heart of their medical career. I’d estimate that this makes a female MD 30% more expensive in net medical production output versus the resources required to educate her.
You can’t work your way around it: bearing and raising a child must come directly from the time and energy she would otherwise have for patients.
Medical careers are not that long, many MD’s burn out after just 25 years. Others transition to management or professorial roles.
In short, we’ve walked away from the approach that worked and have adopted the hollywood mythos of medical egalitarianism.
—
If any school is serious about improving their selections then they should read John Wareham. Better yet, get him to consult. His selection approach is excellent. His methodology is sound.
http://johnwareham.com/the_anatomy_of_a_great_executive_36189.htm
After reading Wareham, you’ll come to spot the Gonnabee in record time, no better example being H himself.
Grades and unshaped interviews are very poor predictors.
Wareham’s methodology is behind the success of Rupert Murdoch, a long time client.
I’d estimate that this makes a female MD 30% more expensive in net medical production output versus the resources required to educate her.
Many of those that aren’t retired by 40 work part-time. I know three female internists who only work weekends, taking hospital call.
Someone who has done the math figures that by the time a part-time female physician is 40, she will have seen 10 000 fewer patients than her male colleagues. This figure practically guarantees incompetence.
Every single thing predicted by opponents of open female medical school enrollment when it was argued (1965-1970) has come true. Every. single. one.
We may be headed for a time when the gap will have to be filled by volunteers trained to a level somewhere between EMT and Paramedic. That means skills ranging from first responder to advanced life support.
It would require a TON of changes in our system. The present EMS system (“Emergency Medical Services”) is contingent on a well-established and functioning hospital network with designated specialized trauma facilities and teams. The basis of the EMS system is that it’s meant to provide basic life support and transport to a state-of-the-art hospital trauma facility.
Maybe what we need is a low-tech primary-care system that can provide treatment for injuries that are not life-threatening, dispense or prescribe specified medications, and do “triage” to identify patients that might need more advanced diagnostic or therapeutic services. I know that’s easy to say, but right now hospitals are swamped by patients with hang-nails, headaches, and hematomas.
“Neighborhood clinics?”
On submarines and destroyers in World War II, corpsmen performed a lot of life-saving medical procedures “above their pay grade” – or so a lot of sailors will testify.
The lawsuit-obsessed culture that has festered into being in this country has made a shambles of “good samaritan” inclinations. If there’s a horrific vehicle crash – multiple casualties, bodies lying about obviously injured – laws in some regions require EMTs to stop and render aid even if they are NOT on duty, but do not protect them from lawsuits from the people they are assisting. In Virginia Beach, VA, a drunk driver in a Mercedes smashed into a VOLUNTEER RESCUE SQUAD AMBULANCE with its lights and siren going. Because the ambulance had just started moving through an intersection against the traffic light, the AMBULANCE DRIVER was arrested, tried, and sentenced to prison, despite the high blood alcohol level of the other driver.
It’s an incredibly complex situation all around – medicine and all the “healing arts” can take decades of study, and there are some people who simply should never be allowed to touch a patient or make medical decisions for another living creature.
But I ‘spect circumstances are steering us inevitably toward having to provide stopgap informal medical care, whether it’s by boy scouts with special merit badges, former ranger/seal medics, nurse/practitioners, or shamans waving smoking leaves.
I know, I know… we already have that in the so-called “Doc-in-the-box” clinics, except that they have fully accredited Medical Doctors on staff. (Hey, I found my favorite physician at one of those, a board-certified emergency physician!)
Comments from Gokart-Mozart and others with specialized knowledge would be much appreciated.
79 and 80:
There are lots of good arguments for, and lots of excellent imaginary redesigns, involving other-than-physician providers. The problem is liability – and it’s not principally a lawyer problem, although they help make it worse.
People expect the best from their doctor, and they are angry when they don’t get it. The imaginary “standard of care” involves the “average” physician, not the best – but half of the physicians are below average (by definition). Take an informal poll of most of your non-plaintiff friends and neighbors (potential future jury members) and ask them what should happen to a doctor who makes a mistake that leads to a death. Their responses will reveal a belief to you that a) Doctors should be inerrant, b) medical errors are fully equivalent to crimes, and c) such “criminals” should not work, ever again.
Now, a moment of reflection will reveal that this creates an impossible situation. Everyone makes mistakes. In thirty-forty years, over tens of thousands of patients, this will actually be rather common. Most are trivial, some are not. Most really serious nonculpable errors involve misdiagnosis. Diagnosis is a subtle and complex skill which is not appreciated by most students nor by most of their teachers. It grows and grows throughout a career, and is almost impossible to objectively test for or measure.
Right now, physicians supervise mid-levels and are completely accountable for their work. Flooding the zone with midlevels is possible, but with no supervision their lack of training and especially their lack of experience with diagnosis will become a problem. Now, this is a problem we could easily afford, were it not for the view of your friends and neighbors that the process should guarantee inerrancy.
The lawyers don’t generate this demand. They just service the market. Until that changes, the supply problem cannot be fixed.
In alternative medicine circles, there is a machine called a
SCIO. It was developed by a guy at NASA, and he now makes them in Eastern Europe.
What it does is that it scans the body with radio waves to identify disease, bacteria, level of hormones, bodily fluids. Every living organism and element has a radio wave signature so this computer/machine has been programed with over 16,000 disease signatures to be able to identify every known disease, bacteria, virus etc, and the level of infections. It has been approved by the FDA for diagnostic purposes. It is better than other tests for viral diseases which cannot tbe identified with a drug test. St. Johns hospital in Santa Monica has several. They are not that expensive.
Where the FDA and the Drug companies have heartburn, is that it not only can diagnose, it can treat. The scanning process can be reversed; where a disease has been identified by its radio wave signature, the SCIO machine is designed to focus small amounts of radio waves at the appropriate signature to attack the disease. These treatments are not overwhelming; the dosages are small. Raging diseases are not knocked out in one treatment. But this machine is particularly effective against those diseases than cannot be treated by traditional medicine, particularly those of the auto-immune kind.
Now the point of this post, to affirm the track of recent comments, is that this machine does not need a doctor to operate it, although a supervising MD would/ should review results and treatments. It could easily by operated by a nurse. People not licensed as an MD in the alternative medicine underground are using it now.
If used properly medical advances like this machine should be able to cut medical costs.
Unsk 82 “although a supervising MD would/ should review results and treatments”
Why? Why on Earth should a licensed MD “review results” of something he has no training for or knowledge about? So there’s somebody to sue?
#67 Leo Linbeck:
As a physician (a generalist), I disagree that midlevel providers can provide the same level of care as a physician, even for just “physicals” and routine care. Though midlevels have their place and serve a useful purpose, I can tell you that the difference in information I receive from an MD or a PA when I accept a patient from them is significant…the level of understanding of the disease process and what is going on IS significant…supervision is often necessary.
Not to say that midlevel providers are unhelpful or unnecessary…I think they will be necessary, in increased numbers, in the future. In any case. Just don’t think you will necessarily be getting the same level of care if you have a significant illness, or a not easily recognized or diagnosed condition.
As a side note, I can confirm the commentator’s impression above that most doctors (primary care especially) are working flat out. I think we do need more doctors. I don’t think the current status quo is encouraging more people to go into medicine, nor is the (personally frightening) debate about healthcare reform going to.
By the way, responding to another commentator, there are plenty of good students who would make good doctors who aren’t going into medicine b/c of the bottleneck (admission to medical school), decreasing compensation, increasing workload, risk of litigation, etc. The problem is not a lack of good candidates. Increasing the number of medical students by 10 or 15%, to start with at least, would result in little drop of quality of physicians.
Dear GoKart-Mozart,
Thanks for your comments, and your years of study and service. You provide much food for thought.
Only in one area do I question your judgment: you seem far too forgiving of the contribution of litigation attorneys to the current mess.
Ah, well, now I come to think of it, the problem can properly be laid at the feet of a two generations of judges and juries who have been raised with several corrosive ideas:
1) If anything bad happens, it has to be someone’s fault.
2) There’s pots of money in the hands of manufacturers, doctors, hospitals, and it’s there only because they swindled it from poor deserving victims, so we need to balance the scales and re-distribute the wealth by awarding damages to people who have suffered, even if their suffering wasn’t precisely caused by the people we’re taking the money from.
My highly attentive brother notes that within the last couple of decades the U.S. courts made a significant change in the area of expert scientific evidence, giving the presiding judge control over what evidence would be allowed to support claims.
Anyone have some special knowledge of that?
Thanks to all for a fascinatin’ discussion.
Gokart- because the results are still a medical diagnosis. In any case of a serious nature , a doctor is the appropriate person to consult and plan the treatment. What this machine does is screen out those not in need of serious medical attention. It’s just a tool to be used.
What this machine does is screen out those not in need of serious medical attention.According to whom? And by what standard of evidence?
Doctors should do what they do and leave the rest of this crap alone.
29 years in the pharmaceutical field and all I can say is there are so many inflated costs it’s a joke.
You can’t just replace OTC $3 therapies with chemically identical Rx $150 therapies and not have it hurt the entire health care system.
There are so many examples of just this kind of rip-off that its unbelievable.
So much of health care is a scam, much of it is just putting drugs on the street, folks maintaining their “disability”, “victimology”, and on and on. One thing, national health care may get rid of some of this abuse, heaven knows something has got to happen.
Anyway, get ready for rationing, it’s coming fast fast fast.