Why ObamaCare Can't Work

[Trumplestiltskin 5,791]

The fallacy though is that the market won't ever "free" in the fullest sense of the word when corporations have international reach.

Certainly the consumer in the developed nation can choose to boycott companies that they feel operate unethically in developing countries, but the reality is that relatively few people do that, and are quite content to continue buying those goods and services either not knowing and/or not caring about whether the 3rd world is exploited so that they can enjoy them.

Its economic colonialism.

You're always going to dealing with governments, which is why, for example, google can get away with infringing the human rights of Chinese citizens by collaborating with the communist government by censoring internet content, something that would be abhorrent to people here.

[mawilson 2,133]

Certainly the consumer in the developed nation can choose to boycott companies that they feel operate unethically in developing countries, but the reality is that relatively few people do that, and are quite content to continue buying those goods and services either not knowing and/or not caring about whether the 3rd world is exploited so that they can enjoy them.

But... what you call "exploitation", they call "enrichment". If no-one's forcing them to participate in

the trials, then it's a fair exchange. You might not want to risk your health for $50, but don't call it

"exploitation" just because a 3rd-world person places a different value on his health (or indeed his life.)

[Trumplestiltskin 5,791]

If you're given experimental drugs in hospital without your knowledge, let alone consent or any recompense, what would you call it?

Drug trials are only a small part of what of what I'm talking about - its just one example of how private interests do business in that part of the world.

Read up on the Nestle baby milk scandal.

[mawilson 2,133]

If you're given experimental drugs in hospital without your knowledge, let alone consent or any recompense, what would you call it?

I don't know - a favour?

[mRx 16]

The fallacy though is that the market won't ever "free" in the fullest sense of the word when corporations have international reach.

Unlike political borders, which in the scientific sense are entirely arbitrary, economics knows no borders. Most of these problems you ascribe to the market, are really problems associated with foreign corruptable governments.

So, your assertion that a free-market provides for economic colonialism and unparalleled tyranny, you are ultimately assigning blame in the wrong direction. As I've proved in this thread, and as you continue to give examples of (particularily with Monsanto, and Chinese/Google censorship), are that governments are the source of such coerced decisions enplaced upon their people.

Which in any case, it's ridiculous to think that we need more government in order to counteract existing government. It's like preparing to go out in stormy weather by dousing yourself with buckets of water. It's silly, and empirically useless.

And with any other situation that you may deem "exploitation", if it is a voluntarily agreed upon, mutually beneficially exchange, who's to stand in the way of people of bettering themselves? The only thing intervention can serve to do on this situation is to make people less better than they would've been, had they been permitted to act in accordance with their own values.

It's funny how government intervention always creates more of the problem that they try to solve.

-Minimum wage laws designed to decrease poverty, actually increase unemployment and subsequent poverty.

-Drug laws create thriving abundant markets for government-denounced plants.

-Medicare/Medicade/HMOs designed to lower costs of healthcare, increase costs across the board for everyone.

-Anti-Discrimination Laws decrease employment of the affected individuals as employers are terrified of lawsuits resulting from thousands of pages of confusing regulations.

-Price controls completely distort markets and create unnecessary shortages and rotting surpluses while people starve.

I can go on and on....

[Trumplestiltskin 5,791]

Yes but again if you accept that you're always going to be dealing with governments then you have to accept that the relationship between those governments and private corporations is and will always be a symbiotic one.

The fact that exploitation of the 3rd world occurs, essentially for our benefit proves what I said earlier about corruption. Deregulating the economy in this country doesn't address that issue at all - and it can't for that matter when these companies are only legally bound to obey the local laws of the countries they operate in.

The fact that these things are facilitated by corrupt governments is important, but it certainly doesn't absolve corporations from responsibility for unethical behavior.

So really then the only standard that matters in a practical sense is the most corrupt government and legal system.

[mRx 16]

To be clear, we've defined this exploitation as "a coerced imposition of force over voluntary exchanges", I assume that's a fair estimate, and you'd agree.

Therefore, this exploitation can be sourced directly on the company or corporation--as in the supposed cases of the Chinese milk incident and the non-voluntary drug tests in India--or, by government decree--as in the cases of government/corporation monopolized grants.

There is a fundamental difference between the two. Other things being equal, one is correctable by the voluntary exchange economy, and the other is not.

Voluntary markets tend to make relatively quick work of fraudulent behavior (which is for our purposes, synonymous with "exploitation".) Of course, that's not to say it doesn't occur. But in an entrepreneurship-fostered free market, fraudulence seems to be a sure fire strategy for shoring up a prospective business. Frankly, it's more profitable to be legitimate. If this were untrue, then Wal-Mart would advertise 1 cent prices on everything, and then once you've swiped your VISA, you notice a charge of $100. Sure, they could realize a small exploitative profit, but their company image would be forever scarred. There are exoribant disincentives to run a fraudulent enterprise.

The government, foreign or domestic, OTOH, faces no market pressure whatsoever. They can force people to make certain exchanges, either by elimination of competion, or fear of reprisal. Granted, certain businesses have taken advantage of this partnership. These companies are the ones that cannot realize a profit in a system of voluntary exchange. For if they could, there would be no need to invest in the government.

I do understand that government exists, and has an inalienable symbiosis with these "weaker" companies. However, that's no excuse to blame the free-market. In no way does it foster an "unparelled tyranny", as I hope I've proved.

To be clear, some companies may commit abhorrent and fraudulent acts in western nations and impoverished nations, but the market punishes this, whilst the government reinforces it.

[doodlebugg 10]

Why Obamacare Can't Work: The Calculation Argument

by Gabriel E. Vidal

Contrary to Obama's suggestion that knowledge of clinical effectiveness and cost effectiveness can be obtained and disseminated, there is no rational way to evaluate cost effectiveness outside of the free market. Central health planners cannot compare and recommend the best option between two different combinations of drugs, hospitals, and physicians to treat a particular ailment. It is not just a matter of figuring out which combination offers better outcomes and lower costs. In fact, the bureaucrat actually needs prices to make that comparison! This is also why Obama's ideas on payment reform to change how Medicare pays providers, and knowledge reform to investigate which treatments are most cost effective will never work and will increase costs and reduce quality. We have explored this argument in detail here.

I totally disagree here. I work for a large healthcare institution and years ago we installed computer programs that analyze each operation and computed how to proceed in order to get the most cost-efficient result without sacrificing quality of care. This was years ago...probably 15 years ago or so. The author of this article is trying to tell us that it can't be done? It's already been done on a smaller scale. Just need to kick it up another notch for it to be country-wide.

Obama also proposes to reduce the cost of health care by upgrading medical records from paper to electronic. While the benefits of health information technology (HIT) are undeniable, the industry is nowhere near the level of development required to have a material impact in productivity and quality of care. It is truly in its infancy. We have different manufacturers with different systems, and different silos of solutions to particular problems even within the same manufacturer — silos that at best communicate clumsily with each other and at worst make the physician's access to meaningful timely clinical information a nightmare.

Billions of dollars have already been invested in HIT. Some systems have worked, while others have not. Billions more will need to be allocated until the best systems are adopted. But the idea that somehow a government agency with no shareholders at risk will help us better coordinate the allocation of capital and the experimentation necessary to develop these solutions is laughable, especially when one of its agents, the Department of Veterans Affairs, in all likelihood has the record for the most expensive failed HIT experiment to date, the $467 million computer system at its Bay Pines hospital in Florida.

The true drive behind government's interest in electronic medical records is the desire to acquire as much clinical and cost information as possible to further control care delivery and health resources. But this is a futile effort as we have seen above. In addition, the effort runs counter to the logical problem that computer systems at millions of local provider-patient levels are capable of generating more data than can be processed expeditiously and meaningfully by a central control agency and its computer system. Any information produced by this central planner will be erroneous and old by the time it is used to guide central bureaucratic decision making.

This is ridiculously pessimistic. We already have electronic medical records in our facilities. I can go to any doctor in our network and they will know what test I had done in 1983. Would it be hard and costly to install this technology nationwide? Sure but nothing is impossible and no one ever said it would be easy. We've taken over multiple healthcare institutions, all with different software systems and have overcome this hurdle. Why can't the government? And I don't get how the author thinks the info would be erroneous and old by the time it's used. The info is live. Realtime.

Any sensible insurance reform should separate these risks and only cover uncontrollable risks, allow individual underwriting (the practice of insurance companies assessing each individual's pricing and eligibility) move away from community rating (the practice of offering the same price to large groups of individuals regardless of each individual's age, sex, health status, and risk level) so that healthy people pay lower premiums and sick people pay higher premiums, exactly the current model for life insurance. In other words, we should allow and encourage "cherry-picking," not ban it.

Wow! So a retired couple with multiple health issues and a low-fixed income should pay more to stay alive than a healthy young person who has a higher income? Why not just wrangle the sick, shoot 'em and get it over with. I mean why bother to make pretend we care at all?

[Tahoma 2,292]

Why Obamacare Can't Work: The Calculation Argument

by Gabriel E. Vidal

Contrary to Obama's suggestion that knowledge of clinical effectiveness and cost effectiveness can be obtained and disseminated, there is no rational way to evaluate cost effectiveness outside of the free market. Central health planners cannot compare and recommend the best option between two different combinations of drugs, hospitals, and physicians to treat a particular ailment. It is not just a matter of figuring out which combination offers better outcomes and lower costs. In fact, the bureaucrat actually needs prices to make that comparison! This is also why Obama's ideas on payment reform to change how Medicare pays providers, and knowledge reform to investigate which treatments are most cost effective will never work and will increase costs and reduce quality. We have explored this argument in detail here.

I totally disagree here. I work for a large healthcare institution and years ago we installed computer programs that analyze each operation and computed how to proceed in order to get the most cost-efficient result without sacrificing quality of care. This was years ago...probably 15 years ago or so. The author of this article is trying to tell us that it can't be done? It's already been done on a smaller scale. Just need to kick it up another notch for it to be country-wide.

Obama also proposes to reduce the cost of health care by upgrading medical records from paper to electronic. While the benefits of health information technology (HIT) are undeniable, the industry is nowhere near the level of development required to have a material impact in productivity and quality of care. It is truly in its infancy. We have different manufacturers with different systems, and different silos of solutions to particular problems even within the same manufacturer — silos that at best communicate clumsily with each other and at worst make the physician's access to meaningful timely clinical information a nightmare.

Billions of dollars have already been invested in HIT. Some systems have worked, while others have not. Billions more will need to be allocated until the best systems are adopted. But the idea that somehow a government agency with no shareholders at risk will help us better coordinate the allocation of capital and the experimentation necessary to develop these solutions is laughable, especially when one of its agents, the Department of Veterans Affairs, in all likelihood has the record for the most expensive failed HIT experiment to date, the $467 million computer system at its Bay Pines hospital in Florida.

The true drive behind government's interest in electronic medical records is the desire to acquire as much clinical and cost information as possible to further control care delivery and health resources. But this is a futile effort as we have seen above. In addition, the effort runs counter to the logical problem that computer systems at millions of local provider-patient levels are capable of generating more data than can be processed expeditiously and meaningfully by a central control agency and its computer system. Any information produced by this central planner will be erroneous and old by the time it is used to guide central bureaucratic decision making.

This is ridiculously pessimistic. We already have electronic medical records in our facilities. I can go to any doctor in our network and they will know what test I had done in 1983. Would it be hard and costly to install this technology nationwide? Sure but nothing is impossible and no one ever said it would be easy. We've taken over multiple healthcare institutions, all with different software systems and have overcome this hurdle. Why can't the government? And I don't get how the author thinks the info would be erroneous and old by the time it's used. The info is live. Realtime.

Any sensible insurance reform should separate these risks and only cover uncontrollable risks, allow individual underwriting (the practice of insurance companies assessing each individual's pricing and eligibility) move away from community rating (the practice of offering the same price to large groups of individuals regardless of each individual's age, sex, health status, and risk level) so that healthy people pay lower premiums and sick people pay higher premiums, exactly the current model for life insurance. In other words, we should allow and encourage "cherry-picking," not ban it.

Wow! So a retired couple with multiple health issues and a low-fixed income should pay more to stay alive than a healthy young person who has a higher income? Why not just wrangle the sick, shoot 'em and get it over with. I mean why bother to make pretend we care at all?

The free market doesn't care if you live or if you die, and neither do the insurance companies.

[mawilson 2,133]

The free market doesn't care if you live or if you die, and neither do the insurance companies.

Sure they do... they can only keep taking your money while you're alive.

[mRx 16]

The free market doesn't care if you live or if you die

And the DC bureaucrats in plush marble buildings do?

Please...

[Tahoma 2,292]

The free market doesn't care if you live or if you die

And the DC bureaucrats in plush marble buildings do?

Please...

I'd much rather have a DC bureaucrat between me and my health care than I would a CIGNA bureaucrat.

[Tahoma 2,292]

The free market doesn't care if you live or if you die, and neither do the insurance companies.

Sure they do... they can only keep taking your money while you're alive.

Funny how those health insurance corporations suddenly don't want your monthly health insurance premium payments when you get really sick and it starts costing them big bucks. Recission anyone?

[Trumplestiltskin 5,791]

To be clear, we've defined this exploitation as "a coerced imposition of force over voluntary exchanges", I assume that's a fair estimate, and you'd agree.

Therefore, this exploitation can be sourced directly on the company or corporation--as in the supposed cases of the Chinese milk incident and the non-voluntary drug tests in India--or, by government decree--as in the cases of government/corporation monopolized grants.

There is a fundamental difference between the two. Other things being equal, one is correctable by the voluntary exchange economy, and the other is not.

Voluntary markets tend to make relatively quick work of fraudulent behavior (which is for our purposes, synonymous with "exploitation".) Of course, that's not to say it doesn't occur. But in an entrepreneurship-fostered free market, fraudulence seems to be a sure fire strategy for shoring up a prospective business. Frankly, it's more profitable to be legitimate. If this were untrue, then Wal-Mart would advertise 1 cent prices on everything, and then once you've swiped your VISA, you notice a charge of $100. Sure, they could realize a small exploitative profit, but their company image would be forever scarred. There are exoribant disincentives to run a fraudulent enterprise.

The government, foreign or domestic, OTOH, faces no market pressure whatsoever. They can force people to make certain exchanges, either by elimination of competion, or fear of reprisal. Granted, certain businesses have taken advantage of this partnership. These companies are the ones that cannot realize a profit in a system of voluntary exchange. For if they could, there would be no need to invest in the government.

I do understand that government exists, and has an inalienable symbiosis with these "weaker" companies. However, that's no excuse to blame the free-market. In no way does it foster an "unparelled tyranny", as I hope I've proved.

To be clear, some companies may commit abhorrent and fraudulent acts in western nations and impoverished nations, but the market punishes this, whilst the government reinforces it.

But all you're saying here is that in an idealised set of theoretical circumstances that its in a companies best interest to behave ethically.

[mRx 16]

To be clear, we've defined this exploitation as "a coerced imposition of force over voluntary exchanges", I assume that's a fair estimate, and you'd agree.

Therefore, this exploitation can be sourced directly on the company or corporation--as in the supposed cases of the Chinese milk incident and the non-voluntary drug tests in India--or, by government decree--as in the cases of government/corporation monopolized grants.

There is a fundamental difference between the two. Other things being equal, one is correctable by the voluntary exchange economy, and the other is not.

Voluntary markets tend to make relatively quick work of fraudulent behavior (which is for our purposes, synonymous with "exploitation".) Of course, that's not to say it doesn't occur. But in an entrepreneurship-fostered free market, fraudulence seems to be a sure fire strategy for shoring up a prospective business. Frankly, it's more profitable to be legitimate. If this were untrue, then Wal-Mart would advertise 1 cent prices on everything, and then once you've swiped your VISA, you notice a charge of $100. Sure, they could realize a small exploitative profit, but their company image would be forever scarred. There are exoribant disincentives to run a fraudulent enterprise.

The government, foreign or domestic, OTOH, faces no market pressure whatsoever. They can force people to make certain exchanges, either by elimination of competion, or fear of reprisal. Granted, certain businesses have taken advantage of this partnership. These companies are the ones that cannot realize a profit in a system of voluntary exchange. For if they could, there would be no need to invest in the government.

I do understand that government exists, and has an inalienable symbiosis with these "weaker" companies. However, that's no excuse to blame the free-market. In no way does it foster an "unparelled tyranny", as I hope I've proved.

To be clear, some companies may commit abhorrent and fraudulent acts in western nations and impoverished nations, but the market punishes this, whilst the government reinforces it.

But all you're saying here is that in an idealised set of theoretical circumstances that its in a companies best interest to behave ethically.

No, I'm saying that the free-market is what occurs naturally in an economic environment without coercive intervention, in which it behooves companies to best serve consumers.

It's not some pie-in-the-sky theory.