I just don’t think that would happen to him if he was American. Even if it did it would have been a huge hassle, and probably would have seriously interfered with raising his three kids.

1. What right has anyone to make billions of dollars on sick people?
2. Does anyone know what the word social responsibility is?
3 If you are at a dinner and 10 people attend, why shall you not split the note, everyone has eaten but only you and me pay, that’s not fair or?
4. How much of my dollars that I pay to insurance is used to propaganda against the healthcare reform?
5. How is it possible for almost all western countries to have a grate healthcare but to a cost that is half of what we have in Usa?

You are making an EXPLICIT “moral argument” when you say “seems most fair.” “Fairness” does not exist in vacuum as a criteria. It presumes and implies moral criteria.

You keep digging yourself into a hole…

Check your dictionary man. Words don’t just mean one thing. In the dictionary you can find several lines that describe the different ways you can use the word. The following illustrates this well:

From Dictionary.com -
8. Consistent with rules, logic, or ethics: a fair tactic.

This obviously isn’t concerning rules, because its a proposal for something new, so we are left with logic or ethics. You would like to think that I HAVE to be making a moral/ethical argument here, whereas the sentences and paragraphs that follow lay out a logical argument for why this idea makes the most sense. I actually use that phrase more than once… yet I do not ever make a moral judgment. Your repeated attempts to make it seem so really are peculiar. You’d have to completely ignore the rest of the post to come to the conclusion that I’m making a moral argument… Do you always get this obnoxious when you lose an argument?

And no, it’s not nutrients that the poor are generally lacking. Nutritional deficiencies are blessedly rare in America, thanks to things such as the enrichment of even cheap white bread and KoolAid. It’s not what’s lacking, it’s what they get too much of. Namely, carbs and fat.

We must be living on different planets then… because I took a Human Nutrition Course last year that argued the exact opposite. We consume FAAAR too many calories in a day than we need, and are not consuming some of the vitamins and minerals we should have in our diets to be healthy. The worst of it has been mitigated by enrichment of things like white bread, rice, pasta and whatnot, but I just fundamentally disagree with you if you think that eating less calories and consuming more essential vitamins is not what doctors have been telling us needs to happen.

And as far as the bum comment, thats not a straw man. Just laziness on my part… trying to stay active in here, write posts and keep up with the rest of my life. Insert homeless in there and move on. If this hinders the seriously minute amount of people who have the opposite problem than the rest of us (aka too many calories) then they need to have better access to food banks and other programs. If you let the smallest minority dictate policy like this, no program would ever be initiated.

And regarding diabetes, like I said before. Argue with the ADA if you want. I’m going with what they said over you. So sue me.

And by fairness I’m not implying right or wrong. Again you read between the lines something that isn’t there. I explained what I meant and you just decide to ignore it, in that the consumption of those things lead to the problems that lead to the costs.

Funny, all my computers are Windows-OS units and none of them give me any trouble at all. Of course, I built them all, so I know good hardware was used and they were properly planned and competently assembled. And I did all the OS installs myself, so I know they’re not factory-kludged with worthless registry-clogging paid-sponsor bloatware or inappropriate cookie-cutter installs. And I declared the house a no-Vista zone before it was even released and left everything on XP, which means everything actually works and runs well.

And if anything does go wrong, I don’t have to call anyone’s tech support in Bangladesh (I *am* the tech support — that’s why I build them right to begin with) and unlike an Apple/Mac product, I can quickly fix it myself using reasonably-priced standardized high-quality parts easily available almost everywhere.

It all depends on what you count. I count the time I would spend on hold to Windows tech support people who I can’t understand once I get through. And I have to count the cost to my mental health of screaming, “Why? Why? For the love of God why don’t you work?” All that waiting and rage is costly to me.

Don’t mess with the cult: we’ll hack your computer and make all the icons prettier.

There are no government mandates on how the computer industry should provide products and services to their consumers, nor is there any government-managed computer manufacturer.

In addition, while costs on older technology are constantly being reduced through market forces, the newest technology is always expensive when it comes out. A high end PC 10 years ago might cost $5,000 – about the same as today’s high end PC’s.

The problem with health care is that nobody uses last year’s model. You don’t take medicine to manage a disease, resulting in horrible side effects, if there is a cure available. If you need an MRI, you get an MRI, not one of those old clunky X-rays from the 1980’s.

Technically speaking, health care costs have actually fallen through the floor. If you want to get the best health care treatments available – in 1985 – they would cost you practically nothing today.

But I’ll skip the “better” argument there, as rabid Apple fans are like religious zealots. With torches.

I’m an Apple user. Don’t tell me Steve Jobs isn’t getting products out faster. By the time I unwrap the latest gadget it’s already the “old” version.

The rule of thumb for engineering development is “Better, faster, cheaper. Pick any two out of three.”

When was the last time we went to the moon, despite our quantum-leap better computers? Has moon flight gotten better or cheaper, or is it happening faster? Can I go visit?

Computers.

NASA flew to the moon with less computing power than my little $1200 MacBook. And they didn’t even have music.

Cheerfully granted that it’s a rough sketch. I am all for counting everything.

I don’t think it’s reasonable to conclude that until someone can give you conclusive and unassailable data you’ll just stick with your preconceptions.

We all have a tendency to muster anecdotal scenarios that support our conceptions. I’m as guilty as anyone else. Like I’ve said before, I think you can make a bitchin’ moral argument for preventative care. But if one is fair-minded, then it’s reasonable to at least suspect that the presumption of economic benefit is very questionable. More preventative care means more care provided, which means more dollars expended. Unless the additional expenditures result in greater reductions elsewhere within the system, the economic argument for preventative care is unsound.

My take on healthcare reform is that overwhelmingly the main problem is cost. You can never make something better, faster, and cheaper at the same time. At best you can pick two and the remaining variable goes the other way. If you want to seriously reduce one, then the other two BOTH go the other way.

“Cancer” is a place holder for exotic orphan diseases I don’t want to look up (that kind of research ruins one’s day) and a grab-bag of more common diseases.

I can believe that less frequent is probably just as good because the majority of prostate cancers are slow-growing. I think they push the yearly because there you are in the office getting an annual anyway. So why not bend over and cough?

I agree: regular exam. It’s cheap and it can find a host of problems. Just caught a basal cell carcinoma — not at all threatening, but it could have been a melanoma — on a visit for an entirely different purpose. (Cool little scar on my chest. I’m thinking of going to a plastic surgeon and have it turned into a third nipple.)

I mostly agree but cancer is a bad example. There are hundreds of different forms of cancer (at least) all constituting different diseases. A single “cure for cancer” is like a single “cure for viral infection” or a single “cure for autism.” Not realistic for treating conditions that have similar symptoms but multiple diverse causations.

Cost-effectiveness and outcomes of annual PSA/prostate screening: Believe it or not, questionable benefit as compared to less-frequent screening. Just sounds wrong, doesn’t it? But true according to Johns Hopkins. Notable quote: “…no good clinical research exists to confirm that PSA screening in general reduces deaths from prostate cancer…”

The best “preventative care” is really just regular primary care with a doctor familiar with the patient’s medical history. That good old annual checkup and look-over exam, with not all that many tests required. We need more primary-care physicians. LOTS more.

I could care less what the calorie per dollar ratio is.

Poor people sure do. Did you check the link? There’s piles of research along those lines. Poor people eat high-energy-density foods because they’re cheap and available. Not even in question, a long and copiously documented fact perfectly in line with utility maximization of income by said poor. You propose, essentially, to tax the poor to modify their behavior, by raising the prices of their most cost-efficient and easily available calories in order to get them to eat fewer calories. You propose to raise the price of food in a way that will fall hardest on those least able to afford it. (It’s almost surreal that one of the major problems of America’s poor is that they get too much to eat.)

It would help if there was a public information campaign, on the level of drinking and driving

Um, they were pounding it into kid’s heads when *I* was in grade school, and that was back when we still hadn’t landed anyone on the moon. From having kids I know they still do so, even more so. Every poverty program I’ve ever been involved in emphasized it over and over. Every food pantry I know of passes out the pamphlets with every care package. Short of forced re-education sessions…

And if you’re going to argue that a bum can’t get enough calories from healthy sources, then I wouldn’t argue with that. But very very few people have a hard time finding enough calories in their diets… its nutrients that are lacking.

Who’s throwing out straw men there? I never said any such thing…unless you wish to characterize all poor people as bums. If you do, that’s entirely your own assignation and I’ll be happy to call it elitist claptrap. And no, it’s not nutrients that the poor are generally lacking. Nutritional deficiencies are blessedly rare in America, thanks to things such as the enrichment of even cheap white bread and KoolAid. It’s not what’s lacking, it’s what they get too much of. Namely, carbs and fat.

Re: diabetes — That the full manifestation of an inherited condition can sometimes be prevented or lessened by the diagnosed existence of an earlier stage of the condition does NOT mean that the condition is, as you said, “largely preventable.” No, it’s not. ONE form of diabetes (Type 2 adult onset) is sometimes delayable or even preventable from becoming the more serious full-blown form of the condition. Note from the very site you try to selectively quote that this cannot be done at all until pre-diabetes itself is diagnosed, that pre-diabetes is itself a serious and inherited early-stage form of diabetes. I think the fair-minded will find those facts compatible with what I said above about diabetes. Anyone crunching the numbers on the phrase “largely preventable” as related to diabetes would question your statement. “Largely” implies “to a major extent” and that’s just not true.

You claimed well beyond the realities there. And it sill begs the question of cost-effectiveness of prevention. For individuals that reward is high, but how does it quantify for population? Numbers, please.

A very rough sketch. Because you’d need to calculate lost productivity for those who were sick, plus the ripple effect through family and businesses affected by the illness.

Let’s say we start with a single case of malignant melanoma that might, diagnosed early, have been successfully treated for $1,000. Treatment alone for a metastasized cancer could easily run up bills of say, $200,000. Let’s say the patient is a head of family and makes 100k and by dying early his family loses 20 productive years at that amount. Let’s say the spouse couldn’t keep up with her career because they have kids and the patient needs help, so the spouse’s own 100k a year income is halved for the next five years. Let’s say both spouses were important to their employers and represented a major investment in training. More cost. At that point we’re in the low seven figures — all because a patient didn’t get a $500 check-up.

This is hardly an unrealistic scenario. When I see a statistic that includes all of that then I’ll be intrigued. Statistics are all about what you count, and what you choose not to count.

Sounds great Michael. But have you actually done the math? Have you added up the total cost of all that chump change? Have you use the incidence rates of these various afflictions in order to actually calculate whether all that extra preventative care is actually cost effective, or not?

As I said at the outset, I saw someone who sounded very knowledgeable (and FWIW seemed credible and nonpartisan) say that when you crunch the numbers, preventative care is a cost driver, not a cost saver.

I am happy to acknowledge that various forms of preventative care are inexpensive and can reveal serious and expensive health problems. But that doesn’t mean that in general it’s cost effective.

For example, if a given test costs $100, then it costs 1 million dollars to give the test to 10,000 people. Suppose the incidence rate is 1% and 100 people come up positive. Did detecting the malady save $1000 per patient in treatment costs? I don’t know. But this is a very rough sketch of how you would determine whether it was in fact cost effective.

You also can’t really blame companies for spending tons of money finding pills to make people skinny or get their hairline back. There is a demand for it, so they fill that demand.

How can both statements be true? You assert that research has no particular goal and that it does.

Also implied is that Pharma reacts to profit and that it doesn’t, that it would trade a business worth billions — treating cancer — for a business worth millions — curing cancer.

I’m not a conspiracy nut. I don’t think Mulder and Scully will discover that the government has a cure provided by aliens that it’s holding out on.

I just wonder by what logic the current system — which amounts, according to Exiled to requiring American consumers to spend hundreds of billions on medicine (defined broadly) in the hopes that a sufficiently large amount of that money will find its way to useful pharmaceutical research — can be the best system.

It’s not a question of blaming business for behaving like business. It’s the question of whether the business model makes the best sense for this sort of research.