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Mission: Possible

Once again, a foreign disaster has put the spotlight on America and our compassion for peoples of another nation.

Once again, Americans, from the person who donates online, to religious outreach programs, to organizations like the Red Cross, will mobilize, give, and save others.

And, once again, the United States Military will be called into action.

So far, approximately 10,000 troops from different branches of the armed service are being sent to Haiti.

Time and again, our military has shown that it is the most efficient, capable, well-structured organization on this planet.

And it is made completely of volunteers.

For all of the donations, rescue organizations, international aid programs, and government services provided for disaster relief around the world, none can match the effort and competence of our Military.

So the next time you hear some acne faced liberal Code-Pink stinkpalm punk protest outside of a recruiting office, tell 'em to go f*ck themselves.


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Comments (30)

Shawn: "So the next time... (Below threshold)
Justrand:

Shawn: "So the next time you hear some acne faced liberal Code-Pink stinkpalm punk protest outside of a recruiting office, tell 'em to go f*ck themselves."

NEXT time? Oops! Kinda been my S-O-P for years.

"And it is made completely ... (Below threshold)
bryanD:

"And it is made completely of volunteers.-Shawn

Factored in with the tone of the rest of your patronizing column, I won't even guess if the above sentence is self-absolution.

The neoconservative "keep me safe" meme is the creepiest thing since Heimat versus the November Criminals meets Petticoat Junction.

This is a projection of the meme.

I can't remember the book w... (Below threshold)
kevino:

I can't remember the book where I first read this, but found the quote:

There was a conference in France where a number of international engineers were taking part, including French and American. During a break one of the French engineers came back into the room saying, "Have you heard the latest dumb stunt Bush has done? He has sent an aircraft carrier to Indonesia to help the tsunami victims. What does he intended to do, bomb them?"

A Boeing engineer stood up and replied quietly: "Our carriers have three hospitals on board that can treat several hundred people; they are nuclear-powered and can supply emergency electrical power to shore facilities; they have three cafeterias with the capacity to feed 3,000 people three meals a day, they can produce several thousand gallons of fresh water from sea water each day, and they carry half a dozen helicopters for use in transporting victims and injured to and from their flight deck. We have eleven such ships; how many does France have?"

Sorry, I forgot to end the ... (Below threshold)
kevino:

Sorry, I forgot to end the blockquote.

Kevino - put (with no spac... (Below threshold)
JLawson:

Kevino - put (with no spaces) between the paragraphs and it'll format properly till you close the blockquote. For some reason, if you blockquote a section of text it'll cut off after the first para if you don't - but it'll still show up properly in preview.

Then there's the liberal response to your #3&4 -

Dumbass! Don't you know your html by now? If you can't even format a reply properly, why the f%$# should I even diginify your inane, stupid response with anything resembling a coherent answer? Your mother was a hamster, and your father smelled of elderberries! I fart in your general direction!

/liberal

Ahem. Sorry for that... ;)

For what it's worth - it IS rather odd how the US military has managed to become the primary source of initial disaster relief. Of course, when the tsunami hit Indonesia, we were there quickly... then the UN took over and...

UN turns a blind eye to reports of million-dollar aid fraud - World - smh.com.au

TSUNAMI reconstruction funds worth $US500 million are being lost to fraud and corruption because of the failure by the United Nations to implement its own anti-fraud measures.

This claim is made by the UN's former deputy director of investigations, Frank Montil, a former ASIO officer who for a decade was the deputy director of the UN's internal watchdog unit, set up to investigate fraud and corruption within the UN and its agencies.

In an exclusive interview with the Herald, Mr Montil said "the oil-for-food scandal taught them nothing". The fraud and corruption which had been occurring during the tsunami reconstruction period would come back to haunt the UN, which had wilfully ignored all the warning signs.
But the corruption and loss is tolerable because it's the UN, I guess. As far as I'm concerned, their record shows them to be pretty much useless.

If folks are looking for a charity to donate to - there's always the Red Cross. You can donate the Red Cross by texting the word "Haiti" to the number 90999.

There's also the United Methodist Comittee on Relief - they're 4-star rated by "Charity Navigator" who tracks the organizational efficiency and capacity, as well as income, outlay and expense breakdowns.

And yet we're constantly told that we're stingy. Well, when we run out of money we'll see just who the world turns to for help. Maybe we won't look so "bad" then!

AARGH! Kevinio -<... (Below threshold)
JLawson:

AARGH!

Kevinio -

Put
And a br
And a >

Between your paragraphs, and the blockquote formatting will look as it should.

I loves me the html this thing'll do - really I do...

Okay, one more time...... (Below threshold)
JLawson:

Okay, one more time...

>

Goes in front of a BR

and ends with a >> -

Put a pair of those between paragraphs to put an html break between paragraphs so a blockquote will format properly...

Oh, heck - just go here and look! LOL...

Man, it's fun trying to fig... (Below threshold)
JLawson:

Man, it's fun trying to figure out what this thing'll accept! LOL...

Hey bryanD, just so you won... (Below threshold)
GarandFan:

Hey bryanD, just so you won't feel ignored.

SHOVE IT UP YOUR STUPID FUCKING ASS!

Shawn declares: "For all of... (Below threshold)
Highlander:

Shawn declares: "For all of the donations, rescue organizations, international aid programs, and government services provided for disaster relief around the world, none can match the effort and competence of our Military."

Do you truly believe this shit, Shawn??

Costa Rica doesn't even have a military. How on earth does it get by?

Costa Rica is a wonderful c... (Below threshold)
Jay Tea:

Costa Rica is a wonderful country, Highlander. But from what you say, I presume that their efforts in helping the people of Haiti vastly outstrip that of the United States military?

Costa Rica gets by just fine on its own.

As does the United States.

But only one of those two is able to mount a rescue and recovery operation of this magnitude. And the main arm of that operation is the United States military.

J.

Hey bryanD and Highlander, ... (Below threshold)
epador:

Hey bryanD and Highlander, just so you won't feel ignored:

go f*ck yourselves!

JLawson, I believe you were... (Below threshold)

JLawson, I believe you were trying to say: <br>

The way to do that is to use &lt;. HTML prints <. Similarly &gt; (no space) prints >. (If you try to to type out &lt; telling someone how to do this, you need to type &amp;lt; for the ampersand to be printed correctly, rather than interpreted as an escape sequence.)

And allow me to add to the chorus of people telling bryanD to go f*ck himself.

Thanks, Jeff - that was ind... (Below threshold)
JLawson:

Thanks, Jeff - that was indeed what I was trying to do.

Shawn,I agree that... (Below threshold)
ryan a:

Shawn,

I agree that the US military should be recognized for its efforts in this an other international relief efforts. Absolutely.

For that reason I think that people should find a way to separate the members of the US military from the political leaders who decide how it can and should be utilized. While I do not always agree with how and why the US military is called into action, I am sure of the fact that many brave and honorable men and women fill the ranks of our military.

There is a huge difference between the policy makers and those who are expected to carry those policies out. I wish more people in the US would consider that idea when talking about our military and its role in foreign policy.

Time and again, our military has shown that it is the most efficient, capable, well-structured organization on this planet.

Clearly our military is well organized and able to accomplish many pretty amazing things. It all matters how it is supported and, ultimately, to what ends it is employed.

I have an ideological/philosophical question for you and anyone else here...and this is a serious and sincere question. It is also just a little off topic, but still related to some larger issues.

So, when discussion about health care in the US comes up, many political pundits argue that the "government" is incapable of running such a complex system without screwing it up. However, isn't the US military an example of a well-run government organization??? If we can find a way to fund and maintain a well-organized military, why can't we find a way to fund and maintain a well-organized and efficient health care system?

Note: I am not arguing for "free" health care, FYI. I am arguing that if we are able to fund the world's strongest military, why can't we do the same with health care?

Why are so many conservatives supportive of the military, yet so skeptical of "the government"? Last time I checked, the military IS a part of the US government.

Why isn't it possible for us to build a health care system? Doesn't the US military have a pretty decent health care system? How does that work, and why can't something similar be expanded to the rest of the citizenry? Is this a matter of priorities? I am by no means a big proponent of "more government" or any of that--but I am wondering about this question and why we cannot, as a nation, find a way to create an acceptable health care system. Seems to me that if we have the ability to create this high tech and well-run military then we should be able to do something about the health of all of our citizens.

To me this shows that we are clearly capable of creating efficient organizations...but we do not always have the political will or interest to create certain kinds.

Last time I checked, the... (Below threshold)
John Irving:

Last time I checked, the military IS a part of the US government.

When did you check, 19pi^i? Because at no part of our history has the military been a part of the U.S. government, they are and always have been subordinate to it. The military cannot create or enact policy without an elected official directing them. This makes them distinctly different from actual government agencies which can and do enact policy with the force of law without said specific direction.

As you started out with a mistaken assumption, this makes the rest of your statement pretty much moot.

John,"When did you... (Below threshold)
ryan a:

John,

"When did you check, 19pi^i? Because at no part of our history has the military been a part of the U.S. government, they are and always have been subordinate to it."

What? Who do you think coordinates the military? Who do you think funds the military? Have you ever READ the constitution? The military is under the jurisdiction of the executive branch of government, as per Section 2 of Article II in the Constitution:

"The President shall be Commander in Chief of the Army and Navy of the United States, and of the Militia of the several States, when called into the actual Service of the United States;"

Do you think that the Department of Defense is NOT part of the government or something?

The US military is government funded, organized, coordinated, and commanded, period. It is most definitely a government institution. I am not sure how you could argue otherwise.

What, do you think that the military is some kind of Non-Governmental Organization??? Hardly.

So, my original question stands. If the government is able to fund and coordinate the most powerful military in the world, why can't we find a way to fund and organize an efficient health care system?

Next time, try actually addressing the substance of the issue.

"why can't we find a way... (Below threshold)
JLawson:

"why can't we find a way to fund and organize an efficient health care system?"

Because it's not vital to the country, Ryan, passionate pronouncements from the White House to the contrary. And the way Congress looks at it, it would cost a HELL of a lot more than the military. We're already broke and living on the credit of others - where's the money supposed to come from?

Realistically, Ryan, it'd be possible to provide a minimal level of health care pretty cheaply - simply slap a attendant account onto each unemployment or welfare benefits card that would allow people up to 8 visits to a Doc-in-the-box and 10 prescriptions a year from the generic Walgreens/Walmart $10/90 days formulary. Catastrophic stuff (like deep cuts, broken bones and the like) would be taken care of by ERs as they are at present. This would cost maybe $1000 per person covered. Make it so that portion of the account can't be used for anything OTHER than approved health care providers - this would cover stuff that nurse practicioners can do, coughs and colds and sicknesses that'll respond to time and a reasonable level of care.

This will handle a lot of the stuff that ERs are currently being used for. Cost? Less than $50 billion a year, and if you roll over the accounts and reuse what doesn't get expended, it costs even less as time goes on. My estimate, if the '45 million' number is right, is that by the fifth year you're looking at about $35 billion to keep people covered. Not everyone's going to use their entire account each year, after all.

But you'll notice that nothing so SIMPLE has ever been proposed. There's never a provision for tort reform, never provisions for allowing insurance companies to operate countrywide. Instead, what Congress proposes is an 'all or nothing' approach, funded by more taxes with a price tag that ranges from indefinitely high to downright catastrophic - and the current 'choice' we've got will go right out the window when the law of unexpected consequences kicks in.

Because you're asking people who couldn't run Cash for Clunkers right, who didn't foresee the effects of it, who can't even get TSA to operate without generating a level of customer aggravation that has some people actually HOPING to be hijacked so they can beat the snot out of someone - and keeps missing stuff anyway - to take control of the entire health care section of our economy.

For some reason, 'government' and 'efficient health care' just don't go together in my mind. And I spent 10 years active duty and 13 years reserve time using the military health care system - I'd MUCH rather use civilian insurance!

ryan a, either you or your ... (Below threshold)
John Irving:

ryan a, either you or your teacher failed basic government. The military is controlled by the government, as I stated. It is controlled precisely to prevent it from being a part of the government, as it is in many other countries. The President is the civilian Commander in Chief, not the top ranking military member.

You never served, did you? You'd understand the difference if you did. Since you fail to understand that basic difference, how can you possibly understand why a government controlled military and a government controlled health care system are two entirely different concepts, not even apples and oranges but apples and asteroids.

I'll sum it up for you. The FBI, the FDA, the EPA, etc., can all make decisions affecting citizens of the United States without the direction of an elected official. The military cannot.

And JLawson covers rather neatly why using the military system would not be too effective.

Jlawson,First of a... (Below threshold)
ryan a:

Jlawson,

First of all, thanks for taking the time to respond.

"Because it's not vital to the country, Ryan, passionate pronouncements from the White House to the contrary."

I suppose we disagree on this point. It seems to me that an EFFICIENT health care system is vital to the country, just as having a military is vital. It makes sense to me on many levels, especially long term. As it stands, we do have high quality medical and health care systems, but they are not equally accessible by everyone. Partly because our costs are extremely high. We have great doctors, but many people do not have enough money to actually see them.

Another part of the problem, in my opinion, is that insurance companies have too much of a say in the matter. Doctors should be making more of the decisions, not middlemen who have no idea what is the best medical option. Medical choices should be based more on sound medicine and less on economics and politics. Another problem, as you mention, has to do with all of the liability and medical malpractice issues, which inflate costs to insane levels.

"And the way Congress looks at it, it would cost a HELL of a lot more than the military. We're already broke and living on the credit of others - where's the money supposed to come from?"

Ya, well, congress has a nice way of inflating just about every budget. My argument is that the money would have to come from a reorganization of the ways in which our national finances are allocated at present. It seems to me that we do have enough actual funds to set up a reasonable health care system, but much of those funds are wasted and mismanaged.

I understand the fact that a lot of government is wasteful, and I completely agree with that. However, in my opinion if we are able to coordinate the #1 military in the world, then we clearly have the *ability* to create a functional health care system. I still argue that it comes down to a matter of political will. And, as you already stated, many people do not feel that health care is as much of a priority as other issues. I disagree.

"Realistically, Ryan, it'd be possible to provide a minimal level of health care pretty cheaply - simply slap an attendant account onto each unemployment or welfare benefits card that would allow people up to 8 visits to a Doc-in-the-box and 10 prescriptions a year from the generic Walgreens/Walmart $10/90 days formulary."

I think that's a solid idea. I do think that these sorts of clinics could be part of the solution to the problem--but I still think they have to be more focused on community health than business. I do not think that a business model should dominate health care, especially when there is considerable economic inequality here in the US.

I also think that a good measure of preventative health care would go a long way, and could actually save a lot of money in the long term. It would be a good idea instead of always treating the results all the time.

One more thing about the whole doc-in-the-box local clinic thing. What if there was a way to have communities be invested in them? Why should these simply be disconnected businesses? I am talking about creating local clinics that are co-ops in a sense, and community owned/funded (not socialized). Meaning that funds go from communities DIRECTLY to their local clinics. I think there should be some kind of connection or tie-in with communities and their health care, as opposed to the system that we have now where insurance companies and health care industries tell us what our options are.

And then major medical issues could be handled in hospitals and ERs, as you say.

The problem with the local co-op idea is that poor communities would have to be funded or subsidized. So this would bring up problems like we see with public schools, where certain districts get a lot more than others.

"Because you're asking people who couldn't run Cash for Clunkers right, who didn't foresee the effects of it, who can't even get TSA to operate without generating a level of customer aggravation that has some people actually HOPING to be hijacked so they can beat the snot out of someone - and keeps missing stuff anyway - to take control of the entire health care section of our economy."

lol No shit! I do not have a lot of confidence in many of our politicians, that's for sure. But that does not mean that I think that we cannot figure a way to deal with this issue. I do think that we need considerable reform (both parties).

I am not really arguing for some massive, centrally-planned health care system. I think that the Federal government could play an important role, but that state government and local community governments should have considerable power in all of this. Government exists at multiple levels, and I think that it would be possible to create a general national health care system that allows for decision making, planning, and control at the local level.

For me, government does not just exist in Washington, DC. Government exists at all levels, and we as the citizens are responsible for keeping it accountable.

"For some reason, 'government' and 'efficient health care' just don't go together in my mind. And I spent 10 years active duty and 13 years reserve time using the military health care system - I'd MUCH rather use civilian insurance!"

I can understand that. I have never been in the military, but I have heard mixed reviews about the health care provided. I'll have to take your word for it. Maybe part of the problem is that the health of the soldiers themselves is not really a top priority? Or is it more of a matter of inefficiency?

The problem is, I have run into lots of nonsense and inefficiency dealing with private insurance. Some good experiences, some not so good.

John,You're arguin... (Below threshold)
ryan a:

John,

You're arguing semantics. The US military is clearly NOT some NGO. It is clearly a government institution. I am not arguing that the military has any power when it comes to making political decisions. That was never my intent. My point was that if our government has the ability to create, maintain, and manage a large and complex organization like the military, then it seems plausible that it could find a way to deal with this health care issue.

"The military is controlled by the government, as I stated. It is controlled precisely to prevent it from being a part of the government, as it is in many other countries. The President is the civilian Commander in Chief, not the top ranking military member."

I understand the technicalities of the separation of powers, John. The military is PART of the US government not because it has anything to do with making policy decisions, but because it is funded, coordinated, and controlled by the US government. It is a government entity.

Or would you make the claim that the US military is somehow a nongovernmental institution?

"Since you fail to understand that basic difference, how can you possibly understand why a government controlled military and a government controlled health care system are two entirely different concepts, not even apples and oranges but apples and asteroids."

You're missing the point. My point is this: if the US government has the ABILITY to coordinate the #1 military in the world, it seems that it is POSSIBLE that it also has the ABILITY to organize some kind of rational and efficient health care system. It's not a very complicated point.

Many people argue that the government cannot do anything without screwing it up. But we are clearly able to organize a large military force that can accomplish many diverse objectives, from invasion to foreign aid. And if the government can do that, I do not understand why it cannot find a way to provide basic health care for all of its citizenry.

Again, this all boils down to priorities.

Ryan,While I will ... (Below threshold)
Shawn:

Ryan,

While I will agree with you that the Military is funded and controlled at the top by "the government," its success is not a byproduct of it.

The way you speak of its existence is that somehow it just sprang from the heads of state over a short period of time like some bureaucratic conjuration.

A standing U.S. military originated during the 1800's. It has be refined to its current organizational status born from decades of trial, error, discipline, strict standards, and people who are not interested in gaining political points and corrupt hand outs.

You want to wait around that long for elected corrupt lawyers to figure out how to form a stream-lined, fair, efficient, self-maintaining entity which will provide the most personal, compassionate, life-altering care a human being can require?

The Military is a tool of the government. One which has blossomed in spite of governmental oversight.

Social Security, Medicare, Medicaid, the Post Office: all broke and broken institutions, invented and unsuccessfully sustained for generations, sustained only through invented money and warped political interests.

The President may issue a broad strategy for what he wants the military to accomplish for a specific mission, but it is fully implemented by a command structure which has complete free reign in how it will reach that objective.

In this way, is unlike any other governmental resource.

That is why soldiers, who are sworn to uphold a certain standard of honor and selflessness, and not politicians, coordinate its responsibilities.

Health care can not be established and maintained with traits inherent to the military.

It is specious reasoning, and a hope which cannot be fulfilled.

-Shawn

Shawn,"While I wil... (Below threshold)
ryan a:

Shawn,

"While I will agree with you that the Military is funded and controlled at the top by "the government," its success is not a byproduct of it."

Good point. So where does the efficiency and success come from then? From the men and women who actively shape what that institution is? From the people who believe in what the institution is all about. Indeed. And why can't we find some way to create a health care system with a similar sense of purpose and political will?

"The way you speak of its existence is that somehow it just sprang from the heads of state over a short period of time like some bureaucratic conjuration."

That's not what I said at all.

"A standing U.S. military originated during the 1800's. It has be refined to its current organizational status born from decades of trial, error, discipline, strict standards, and people who are not interested in gaining political points and corrupt hand outs."

Hardly. The US military has had its share of internal politics, and you know it. Don't get all sappy and naive about this.

"You want to wait around that long for elected corrupt lawyers to figure out how to form a stream-lined, fair, efficient, self-maintaining entity which will provide the most personal, compassionate, life-altering care a human being can require?"

Ha. Now that's another good point! Personally, I don't want to wait around for a bunch of corrupt politicians--Democrat or Republican--to find a solution to this. But then, there is no reason why we have to simply accept the status quo.

Personally, I do not think that a national health care system has to be under absolute or direct Federal control. I think that we should have a system that allows for local control, investment, and participation. Federal level policies with state and local governance and control sound good to me.

"Social Security, Medicare, Medicaid, the Post Office: all broke and broken institutions, invented and unsuccessfully sustained for generations, sustained only through invented money and warped political interests."

We have plenty of broken institutions, and they are not all run by the government by any means. I argue that the current health care system, in which insurance companies have far too much power, is yet another broken system. It amazes me that people actually defend the current system, as if insurance companies actually give a damn about the health of Americans. They give a damn about profit, and if you have to deal with them that becomes really clear really quick.

Our health care system needs to be based upon something more than the ideas of Milton Friedman. At the same time, it needs something other than the mentality of the New Deal. At least we have something to work toward.

Again, there is no reason why we have to assume that we can't come up with something better.

"The President may issue a broad strategy for what he wants the military to accomplish for a specific mission, but it is fully implemented by a command structure which has complete free reign in how it will reach that objective."

Great. So why isn't it possible to have a medical/health organization with a similar purpose and ability to accomplish goals? Are we only able to organize ourselves for war? I find that argument lacking.

"That is why soldiers, who are sworn to uphold a certain standard of honor and selflessness, and not politicians, coordinate its responsibilities."

Ok. So, substitute doctors, nurses, surgeons, and other health care workers for soldiers. Why not? We certainly have plenty of medical workers, and plenty of new docs in training. I think that if we had the motivation then something of this sort would be possible.

"Health care can not be established and maintained with traits inherent to the military."

That's not what I am arguing. I AM arguing that health care COULD be established if Americans had a similar sense of belief and purpose about the goal though. This is not about mimicking the organizational structure of the military. This IS about realizing that we are often only limited by ideology and politics.

"It is specious reasoning, and a hope which cannot be fulfilled."

If it is specious reasoning to claim that Americans have the ABILITY to create and maintain an efficient and honorable health care system, so be it. But again I think that far too many people are limited by their own lack of imagination and willingness to challenge what is "possible."

As we all sit around cheerleading for our respective political camps, a whole lot of nothing gets done. I get pretty tired of it. How about you?

We have some of the best medical training in the world. Yet, there are plenty of Americans who cannot and do not have access to it. To me, that is a problem that should be solved. And it is something that I think COULD be solved, if only more people actually gave a damn.

We sure can muster an amazing political force when we're motivated by fear, can't we? We sure can accomplish incredible goals when we're put to war, can't we? But when it comes to finding a way to make sure that all US citizens are taken care of, for some reason it can't be done?

Why not?

"But when it comes to fi... (Below threshold)
JLawson:

"But when it comes to finding a way to make sure that all US citizens are taken care of, for some reason it can't be done? Why not?"

Why isn't it the government's job to make sure everyone over the age of 16 has cars? Or enough to eat? Or sufficient clothing? Or is at a weight appropriate to their height and age?

The cynical part of me, Ryan, snickers. Because you've been duped, and most thoroughly, into thinking it's somehow the government's responsibility to take care of everything for the population. That the problem with health care is that for-profit business entities are handling it, and that somehow if it were put into government hands everything would be better.

You posted above - "I am not really arguing for some massive, centrally-planned health care system. I think that the Federal government could play an important role, but that state government and local community governments should have considerable power in all of this. Government exists at multiple levels, and I think that it would be possible to create a general national health care system that allows for decision making, planning, and control at the local level."

What I proposed WOULD allow for local control - since the money would directly be tied to the need for it. It would be administered on the lowest level possible, which makes it pretty resistant to fiddling with by authorities higher in the food chain.

Which is why it'd be utterly unacceptable in Washington. There is no concept there of how to handle health care needs beyond a 'one size fits all' top-down massive organizational structure that'd consume an incredible quantity of resources simply to exist.

Which is the bleedin' point behind the push for it!

Think about it... who could provide health care in a more cost effective manner? Government, or private industry? Who has more of an incentive to provide health care in an efficient manner - government, or private industry?

Who would be able to provide health care at levels appropriate to need? A Washington-based massive bureaucracy? Or a local governmental office, maybe 100 people per state, which would monitor the medical accounts of folks on food stamps and unemployment to make sure they've got health care and watch for patterns of fraud?

You wrote - "I am talking about creating local clinics that are co-ops in a sense, and community owned/funded (not socialized). Meaning that funds go from communities DIRECTLY to their local clinics. I think there should be some kind of connection or tie-in with communities and their health care, as opposed to the system that we have now where insurance companies and health care industries tell us what our options are."

Why have a tie-in?

The reason why I like the Doc-in-the-Box idea is that they're ALREADY in place in many (if not most) WalMarts and in a lot of chain pharmacies and groceries. You don't get much more 'in the community' than that. Why reinvent the wheel? Why put in an entirely separate system, which would need to be constructed, staffed, have an additional logistics chain, which would require negotiations to be certified and get agreements with local pharmacies to get good prices - when one already exists? The clinics are in the stores, the people live locally, they know the community - what more would you want?

Would government be somehow more 'involved', without a serious reason to do so?

You said... "I do not think that a business model should dominate health care, especially when there is considerable economic inequality here in the US."

That, to put it mildly, is an idiotic attitude. Sorry - I'm not trying to be insulting - but think about the logic behind that statement for a moment.

What does' economic inequality' actually mean? That the surgeon makes more money than the garbage man? That the guy working at a convenience store part-time isn't bringing home the same dough as a network administrator on-call 24/7? That somehow, in order for there to be 'economic equality' everyone should be making the same money?

Seriously, I know what I think 'economic inequality' means, and I'm wondering if you see it the same way.

Now, ask yourself - what does 'economic inequality' have to do with whether health care is provided by a business? If the business was paid by the government to provide health care, (which is what the additional account to cover "Doc in the Box" cards would do) is the care provided somehow tainted by coming from a business, instead of a government clinic?

What is more important to you - having health care provided affordably and quickly and conveniently, or having it come from a source you consider to be... oh, I don't know... 'clean' from the taint of profit?

More soon - I think this is getting pretty long...

Ryan - You've put ... (Below threshold)
JLawson:

Ryan -

You've put a lot into your thinking, and I hope you'll consider these replies with the same diligence.

I also think that a good measure of preventative health care would go a long way, and could actually save a lot of money in the long term. It would be a good idea instead of always treating the results all the time.

Google up "preventive care doesn't lower costs" - and you'll see about the only folks pushing for preventive care are politicians. Doctors say it'd be nice if folks cut out smoking, watched their weight and exercised more - but that's common sense. Early detection of cancers and such are good things (my wife's an oncology research manager) but people don't think about going to doctors when they're well - and I've known people (as have you, I'm sure) who won't go to a doctor unless they're deathly ill.

Preventive care doesn't lower costs in the long run - it raises them considerably.

Counterintuitive, I know, but it's confirmed by studies. For example, let's take a fake disease... Wally's Dropsy, which can affect all males over the age of puberty, in which a certain (ahem) appendage can turn blue and fall off. Figure this dread disease will affect one person per 50,000, and gives about two weeks worth of progressing symptoms until the appendage detaches. Now, a technique has been discovered to avert this disease, it works in every case the disease is present, BUT can cause the problem in 5 out of 1000 if used when the problem isn't present. The treatment is fairly expensive, about $50k per case.

A test is developed that has a 5% false positive rate. (So out of 50,000 you'll have 2500 false positives.) The test itself costs $100.

At this point, some questions become apparent.

1. Is it better to test 50,000 people, spending $5 mil, and finding 2500 cases - then spending $125 million to give the procedure to all of them - then CAUSING between 12 and 13 additional cases, which again have to have the procedure when symptoms present...

2. Or is it better to NOT test, wait for an (ahem) appendage to turn blue enough for someone to worry about, and have them go to their doctor who'll get them lined up for the $50k special?

Better, of course, being pretty darn subjective at this point. It's undeniably cheaper to wait for something to turn blue, but is it better? Is it more effective? Is it more cost-effective to test, or not test?

Is it indicative of anything that the concept of preventive care seems to have been dropped from arguments for government health care?

You asked re military health care - "Maybe part of the problem is that the health of the soldiers themselves is not really a top priority? Or is it more of a matter of inefficiency?"

Trauma care in the military is first-rate. But you also have to consider the population the military health care system serves. It's young, it's fit, and it's pre-screened in pre-induction physicals to weed out as many health problems down the line as possible. So beyond trauma, there's not much trouble other than the usual respiratory stuff you'll see when you've got a lot of folks working together. You also have pretty good dental and optical benefits, but you're not going to have much choice in what's done, and it's not going to be done to your schedule. (Took me six months to get an appointment for a contact lens fitting, and six more weeks to get the lenses.) You can get what you NEED, but THEY decide what you need in regards to extras.

And some of the dental techs.... (shudder) I massively dislike going to the dentist to this day, even though the folks I go to are very good and careful.

But they don't really care about customer satisfaction - you're stuck with them (unless you go off the base).

And that's problematic all throughout layers of the government - they don't CARE. There's no worry about you going elsewhere for what they provide - if they're the sole provider (like car tags and driver's licences) you'll put up with it and pay your money when you're told to.

What businesses would continue to exist with the same level of customer satisfaction your local license office generates - if there's an alternative?

Businesses need customers to survive - and the customer needs (at the end of the day) to be not so pissed off they take their business elsewhere. Even not-for-profit businesses need money to keep going and doing not-for-profit work, and to get that money they've got to show some reasonable return for their work to the investors who supply them with funds. The investors are the customer - they want results. No results, and the money dries up.

They're responsible, accountable to the customers.

Government doesn't have to be accountable - at ANY level. You hear of fraud in Medicare, from $200 to $500 billion ANNUALLY. Can you imagine any business that'd let that amount of fraud continue? But there's no real push to stop it, because - and this is a very important point, so consider it carefully - they're not primarily responsible for efficient use of the money. So what if a third of it gets wasted - there's always more coming in each year. That's coming from you and me, directly and indirectly.

I don't know about you, but it seems to me when you've got wastage on that level, you're not going to be wasting less by suddenly massively increasing the size and scope of the program. If anything, we'll see it take an astronomical jump, and the program stagger on a few more years before totally imploding under the fraud.

The push for health care isn't designed to get health care to the masses, much as it's the stated purpose. You and I both realize that it can be done, and it can be done cheaply. It'd be government cheese compared to the steak of private insurance - but consider the folks buying insurance are ALSO paying taxes to get the others government cheese.

It's to get control - and it's already clear that they haven't a clue how to efficiently manage it if they DO get it.

JLawson,"Why isn't... (Below threshold)
ryan a:

JLawson,

"Why isn't it the government's job to make sure everyone over the age of 16 has cars? Or enough to eat? Or sufficient clothing? Or is at a weight appropriate to their height and age?"

Hell, at that rate, why do we even HAVE a government?

"The cynical part of me, Ryan, snickers. Because you've been duped, and most thoroughly, into thinking it's somehow the government's responsibility to take care of everything for the population."

Hardly. Advocating for some kind of national health care system does not mean that I think the govt should take care of anything and everything. Not by any means. Health care, to me, seems like a pretty reasonable national priority.

"That the problem with health care is that for-profit business entities are handling it, and that somehow if it were put into government hands everything would be better."

So should medical decisions be based upon the bottom line, or are there some other considerations that should be taken into account? Should profit drive the entire industry? The problem with insurance companies is that it is fundamentally against their interests to pay out claims. Not really a good model in my opinion.

And actually, I am not a big fan of many government-run organizations. The Social Security office and the DMV are great examples of bureaucratic waste--I'll take AAA over the DMV any day. That said, there is a big difference between the way that the Auto Club is run and the way that many HMOs are run. Also, our overall medical costs are far higher than they should be--and this is not simply because of the invisible hand of the market.

"Which is why it'd be utterly unacceptable in Washington. There is no concept there of how to handle health care needs beyond a 'one size fits all' top-down massive organizational structure that'd consume an incredible quantity of resources simply to exist."

So do you see the military as a similar kind of bureaucratic waste?

"The reason why I like the Doc-in-the-Box idea is that they're ALREADY in place in many (if not most) WalMarts and in a lot of chain pharmacies and groceries. You don't get much more 'in the community' than that. Why reinvent the wheel? Why put in an entirely separate system, which would need to be constructed, staffed, have an additional logistics chain, which would require negotiations to be certified and get agreements with local pharmacies to get good prices - when one already exists? The clinics are in the stores, the people live locally, they know the community - what more would you want?"

Look, I understand the argument for economic efficiency, trust me.

Personally, the idea of WalMart as a kind of community clinic sounds pretty horrible. But there are other chain clinics that are at least somewhat personal. I would prefer not to end up as just another product, but that's just me. I suppose that "community" means something more than going to the local big box store.

"That, to put it mildly, is an idiotic attitude. Sorry - I'm not trying to be insulting - but think about the logic behind that statement for a moment."

No offense taken. I am not overly sensitive about this kind of thing. Feel free to express yourself.

"What does' economic inequality' actually mean?"

Maybe I should have used a different term because that one seems to have set you off. By "economic inequality" I meant that some people have more money than others, to put it simply. And some people really do not have enough to pay for health insurance. So they do without. For example, health care in parts of rural Kentucky is pretty dismal, because people are so goddamn poor. We have plenty of people in that situation, but that's the extreme. We also have a lot of Americans who are working hard and just scraping by. That's what I mean by economic inequality. Wealth disparity. Use whatever term you want. I realize that it sounds like a 2 cent phrase, and I pretty much hate those.

"That somehow, in order for there to be 'economic equality' everyone should be making the same money?"

Nope. That's not what I am saying at all. Don't make assumptions and start putting words in my mouth. I AM saying that people who make less money should still be able to afford decent health care. That's all.

"Now, ask yourself - what does 'economic inequality' have to do with whether health care is provided by a business? If the business was paid by the government to provide health care, (which is what the additional account to cover "Doc in the Box" cards would do) is the care provided somehow tainted by coming from a business, instead of a government clinic?"

That's not the issue at all. I could actually care less about where the care ultimately comes from. The problem I have with the business model is that health care decisions are not always in the hands of the people who know what needs to be done--doctors. And that is a REAL problem to me. I certainly do not think that insurance companies should be making decisions that should be in the jurisdiction of doctors, etc. That's the issue I have with the business model.

I can't understand why you think the current model is so great. Do you have any issues with our health care system, or do you think it's just peachy? You've never run into problems with insurance companies?

"What is more important to you - having health care provided affordably and quickly and conveniently, or having it come from a source you consider to be... oh, I don't know... 'clean' from the taint of profit?"

I am not concerned about profit in some kind of Marxist sense. I am concerned about health care being driven and controlled by profit, despite ethics and morality. I do not see profit as something that "taints" health care...but I do see it as something that basically sets up a fundamental conflict of interest between insurance companies and clients/patients. That's a problem.

Anyway, thanks again for taking the time to respond. I always learn something from these kinds of exchanges, and I appreciate people who are able to discuss these sorts of issues with respect and civility.

"You've put a lot into your... (Below threshold)
ryan a:

"You've put a lot into your thinking, and I hope you'll consider these replies with the same diligence."

Thanks. I definitely do take the time to consider your replies, and I appreciate your opinions. I will add another reply tomorrow, because it's pretty late here and I am about to keel over.

Ryan - I know what you mean... (Below threshold)
JLawson:

Ryan - I know what you mean by the 'keel over' part. (grin) It's possible to disagree without being (terribly) disagreeable, which folks like BryanD and Steve Green seem to disregard in favor of their insults...

Let's see...

"By "economic inequality" I meant that some people have more money than others, to put it simply. And some people really do not have enough to pay for health insurance. So they do without. For example, health care in parts of rural Kentucky is pretty dismal, because people are so goddamn poor. We have plenty of people in that situation, but that's the extreme. We also have a lot of Americans who are working hard and just scraping by. That's what I mean by economic inequality. Wealth disparity. Use whatever term you want. I realize that it sounds like a 2 cent phrase, and I pretty much hate those."

Actually, it sounds more like a catch-phrase designed to short-circuit critical thinking. Yes, rural Kentucky is poor. Giving them doc-in-the-box cards would help, figuring out some way to improve the economic base there would help considerably more. WHY is that area poor? What's the reasons behind the poverty? What can be done to encourage businesses to move into the area? Health care wouldn't improve the economic situation, and when you look at the overall drain on the country to provide it, ('it' being a nationwide system) the overall outlook for the area might go down instead of up. Look at rural Tennessee and Georgia - things improved greatly when a Saturn plant was built in TN and things will improve in the area where a KIA plant was finished in 2009. (Of course, Saturn's gone away now... the plant was retooled, but currently isn't building anything as near as I could tell.) TN saw a boom for 20 years - GA will see that area grow also. Everyone benefits.

"The problem I have with the business model is that health care decisions are not always in the hands of the people who know what needs to be done--doctors. And that is a REAL problem to me. I certainly do not think that insurance companies should be making decisions that should be in the jurisdiction of doctors, etc. That's the issue I have with the business model."

So instead, it gets put in the hands of bureaucrats.

According to the American Medical Association's National Health Insurer Report Card for 2008, the government's health plan, Medicare, denied medical claims at nearly double the average for private insurers: Medicare denied 6.85% of claims. The highest private insurance denier was Aetna @ 6.8%, followed by Anthem Blue Cross @ 3.44, with an average denial rate of medical claims by private insurers of 3.88%

In its 2009 National Health Insurer Report Card, the AMA reports that Medicare denied only 4% of claims--a big improvement, but outpaced better still by the private insurers. The prior year's high private denier, Aetna, reduced denials to 1.81%--an astounding 75% improvement--with similar declines by all other private insurers, to average only 2.79%.

http://www.independent.org/blog/?p=4459
Looks like the insurance companies are approving more than the bureaucrats do - and after 23 years, I've got problems with bureaucrats! LOL...

I've been in the 'just scraping by' category - after I'd been in for 10 years I got out and tried to figure out how to be a civilian for 5 years, then a friend of mine was interested in the Reserves and asked me to go along. Long story short, it took me a while to get my feet under me and my head squared away, and there were months where the choice between food, utilities, rent, and insurance led me to choose 3 of the above because there wasn't money for 4. During that time, I developed an ulcer - and paid out of pocket for the treatment and prescriptions. I didn't think it was someone else's place to pay - despite being in a part-time minimum wage job. Finally said 'this sucks great big hairy donkey balls' and quit a job I enjoyed but didn't get paid enough at for something different. But the jobs have to be there - and the more money taken out of the economy by the government, the fewer jobs there are going to be. As it is, what we're seeing now re unemployment is (I'm afraid) just a taste of what's to come. We're at a point where the government's promised a whole lot of stuff and there's no way to pay for it.

If money were no object, I could see having a supplemental government-run health coverage program. But that's in a perfect world, and with infinite resources. Right now, the only thing we seem to have an infinite supply of is politicians who aren't looking at the bills we've already racked up and are quite willing to tax us all into oblivion so they can continue using the government credit card for whatever strikes their fancy.

This isn't sustainable. Adding in a health care entitlement is simply going to add to the debt. Sooner or later the bill always comes due, and I'm thinking it's going to be a lot sooner than we think.

Yes, rural Kentuck... (Below threshold)
ryan a:
Yes, rural Kentucky is poor. Giving them doc-in-the-box cards would help, figuring out some way to improve the economic base there would help considerably more.

Of course figuring out a way to improve the economic base would help more than anything. How could I disagree with that? In the mean time, what do we do about people who do not always have access to basics?

WHY is that area poor? What's the reasons behind the poverty? What can be done to encourage businesses to move into the area?

Now those are some questions that actually start addressing the larger issues that are behind these kinds of problems. Why is there so much poverty in places like rural KY? Marginalization is one factor (meaning that Kentucky is not necessarily the highest national priority, especially certain parts of Kentucky). So this is where politics and power come into play. Things re not always equal from place to place. Other states deal with this as well. Lack of jobs is another factor, along with a lack of alternatives to certain low-paying jobs. Education is a problem, and poor health is a problem. These are not isolated issues, and one factor can feed another. Of course, I don't think it helps to characterize any group of people as absolute victims, so there are of course many other factors involved here.

How can economic growth be encouraged in rural KY? Now that's the big question. Improve education? Improve overall health levels? Tourism? New industries?

Health care wouldn't improve the economic situation, and when you look at the overall drain on the country to provide it, ('it' being a nationwide system) the overall outlook for the area might go down instead of up.

Here I disagree with you. Improved health conditions in these types of places could most definitely affect and/or improve the economic situation. It seems to me that a healthier population would only increase the strength of the work force. Here I have to say that you are only looking at this from a limited economic standpoint--you can't forget how certain factors can feed back into the economy. If people are healthy, they are more able to contribute to improving their standards of living (at least that makes sense to me).

I do understand your point about the drain on the national economy. But these sorts of issues are all about costs and benefits. Some benefits are more immediate, while others take some time.

Look at rural Tennessee and Georgia - things improved greatly when a Saturn plant was built in TN and things will improve in the area where a KIA plant was finished in 2009.

Yep, jobs bring economic growth. But what happens when there are no auto plants? What happens when businesses are not opening in certain areas? What do we do about people who live in pretty dismal conditions? Keep telling them that they need to get jobs? Let them suffer? What obligations do we have to people who have a lot less than we do? Should they be helped by the State, by NGOs, by volunteers, by taxpayers?

Look, I understand the basic tenets behind economic development. The only problem is this: the benefits and results of economic development are not always shared equally. And economic development by no means eradicates poverty. It can, but there is no guarantee. International development projects suffer these kinds of results all the time. So there has to be something more. One of the problems with development is that there is no formula or clear solution, since what "works" in one place may or may not work in another.

So instead, it gets put in the hands of bureaucrats.

Actually, I was thinking that more of the control should be in the hands of doctors, who should be supported by Federal guidelines and/or mandates. I do not think that insurance companies should be deciding whether or not I need certain kinds of care.

Actually, I am not sure which side is worse. Clearly you have had more experience with government health care, so I will take your word for it with that. I can say that I think that our current health care system could use some changes. At the same time, don't mistake me as some dogmatic supporter of the bill that is being drafted at present. I am particularly against the idea that the government will *mandate* insurance coverage.

I hear you about being in the just scraping by category. The only reason I finally have insurance these days is because I decided to go back to school, so I at least have decent basic coverage now. I certainly do not expect someone else to pay for my health...but I do think that my tax dollars should go toward a health care system that I can use and access. Why not? And I do think that we as a nation generate enough income to provide basic health services for people who are in need. But our budget and many of the programs where we put so much $$$ need some serious overhauls (Social Security, Medicare, Medicaid, etc). One other serious issue is the fact that our health care costs are often pretty inflated.

As it is, what we're seeing now re unemployment is (I'm afraid) just a taste of what's to come. We're at a point where the government's promised a whole lot of stuff and there's no way to pay for it.

I agree with you on this. The situation is looking pretty grim. But I am not going to pretend that the current admin is the only one at fault. In my opinion there is plenty of blame to go around in both parties. But then, I am not a big fan of either side.

If money were no object, I could see having a supplemental government-run health coverage program. But that's in a perfect world, and with infinite resources.

I agree with you. And I also agree that NOW is probably not the time to introduce more MASSIVE spending legislation.

Right now, the only thing we seem to have an infinite supply of is politicians who aren't looking at the bills we've already racked up and are quite willing to tax us all into oblivion so they can continue using the government credit card for whatever strikes their fancy.

Don't we ALWAYS have an infinite supply of politicians? Can't we sell THEM off to some other nation who needs some supplementary windbags? Maybe that will generate some revenue for my health care program...

This isn't sustainable. Adding in a health care entitlement is simply going to add to the debt. Sooner or later the bill always comes due, and I'm thinking it's going to be a lot sooner than we think.

This is where I agree with you 100 percent. While I do think that we need some serious changes, I do not think that NOW is exactly the right time to be pushing for it. I think that by rushing into all of this our politicians are going to create some larger problems down the line. A lack of funds is just one of them.

"Don't we ALWAYS have an... (Below threshold)
JLawson:

"Don't we ALWAYS have an infinite supply of politicians? Can't we sell THEM off to some other nation who needs some supplementary windbags? Maybe that will generate some revenue for my health care program..."

Nah, ours are faulty - they can't add 2 and 2 and get anything less than $50 billion. We'd end up having to pay the other countries to take them, and then they'd get pissed at us for exporting shoddy goods!

"I think that by rushing into all of this our politicians are going to create some larger problems down the line. A lack of funds is just one of them."

Lack of funds, inflation, increased unemployment, lowered productivity, higher taxes - looks like we're in for an interesting time to be sure!




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