Today I spoke with a man who attended the Michele Bachmann's Tea Party rally near the capitol in Washington DC. He was an honest man. With honest concerns. Most of which were based on faulty information. He told me his thoughts, and I listened.
He had traveled to Washington DC from Tennessee, along with his mother and 86 year old father (which he proudly told to everyone in sight). They had come to DC the day before and had taken in the World War II Memorial, the Lincoln Memorial (his Dad's favorite), and of course, the Bachmann Rally today. He was proud of the service his Dad gave in the second world war, and his own 17 years of service in the Tennessee National Guard. He was proud of his life of labor as a wood cutter. He was proud to be an American. He told me there were "100,000 people at the rally" (best estimates were about 10,000). [Note: New estimates are about 5,000 attendees]
He said he was in DC to "stop healthcare." His basis of opposition - that "he didn't believe anyone else should have to pay for his health care." That's it. That's how he saw the entire health care debate. [I didn't mention that we already pay for the health care of others through increased insurance premiums.]
On Afghanistan, he called it "Obama's Vietnam." He felt that when General McChrystal came asking for 40,000 more troops Obama's only response should have been, "I'll give you 100,000, now go get them." He felt that "it's been two months" [since McChrystal's initial report] and Obama needed to do something now. Again, that's it. He saw the entire decision-making process about Afghanistan to be simply a matter of saturating the area with hundreds of thousands of troops because the general wanted them. He did understand that bin Laden and al qaeda are in the mountainous border region between Afghanistan and Pakistan, and that Pakistan wasn't doing its job (and he even understood why it was so difficult for Pakistan to do so). But to him it all came down to some variation of "fish or cut bait," with his preferred action to be "fish...and do it with lots of poles."
So why am I telling this story? Mainly to draw out the following take-home points.
1) There are real people with real concerns out there.
2) Much of that concern is based on misinformation.
3) Details aren't that relevant, what matters is the big picture message.
4) These are the people that the White House and the Congress need to reach.
So, how does the WH and Congress reach out to average, every day, honest Americans who base their feelings on their gut and the simple messages (even if the messages are often based on incorrect details)?
First, politicians need to stop talking only to themselves. They need to start listening better to the people. And by people I mean to real people like the guy I spoke with today, not the professional instigators with lobbyist talking points. Not other Congressman who come armed with nothing but their party's political talking points. And not the pundits, who mostly don't know diddly but play like they are informed on TV. And when I say listen, I mean listen. Not stand quietly while someone talks and then respond with their own prepackaged talking points. Listen. Ask questions. Learn. Think about what really matters to the people, even if they mess up a few details or mime some talking points they heard on their favorite cable propaganda station.
Second, ensure that the misinformation is corrected in people's minds. Put the facts online so people can fact check for themselves, but remember that many people rely more on word of mouth at church and in their neighborhoods and just don't trust anything politicians say. So find a way to get the facts out there.
Third, speak to the people. Tell them why health care reform 1) will not do what they most fear it will do, and 2) will benefit them and their families and their children. Tell them why it isn't wise to "just send 100,000 troops when the general asks for 40,000," for example, because 100,000 troops (or a million) won't help us reach our goals because x, y and z also need to be fixed. Oh, and tell them what are goal(s) actually are in Afghanistan. Tell them why dealing with climate change is important to them and to their grandchildren. And if you aren't ready to make a decision, tell them why it will take a little longer.
Fourth, keep the minority party honest. Not surprisingly, the minority party tends to think that their best route to winning back seats is to keep the majority party from getting anything accomplished. They often lie. Don't let them. Call them out for lies. There is plenty of room for honest ideological differences, but our elected officials are elected to represent our interests, not their own reelection interests. And lying serves no one's interests but the liars.
Fifth, "It's the Economy, Stupid." The state of the economy, real or perceived, is the driving force behind much of the angst right now. It matters not that the economy tanked last year, well before Obama was elected, the perception is that he needs to fix it...and he needs to fix it fast. Fiscal responsibility is the common thread for everyone no matter to which party they belong. Health care, climate change, finance reform, and other major legislative pursuits actually should improve the economy in the long run, but people tend to have a very short time horizon, and even shorter memories of how we got here. So make the tough decisions, and follow rule 3 above.
I learned a lot from my conversation today with an honest man. We should listen to each other more often.
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Comments: 127
I completely agree that there are real people with real concerns involved.
So we need to be able to address these concerns on a level to which each of us can relate. We need to relate on the gut level.
People that can be fooled so easily and completely are really to be pitied not hated.
Now certified liars like linda ,maryland,carol ,etc , that's a different story
Now bachman is indeed a world class moron and if Minnesota reelects her then her constituents are also.
I also wonder if you can petition for a recall of your congressperson on mental deficiency grounds?
You know crazy.
Just because they are in congress doesn't make them special.
Is that better?
***No refusal for pre-existing conditions beginning in 2013.
***Tort reform is not exclusive for "Real" medical errors.
At this hour that is my limit because they are bellowing about funding abortions on the House floor right now and it is distracting.
See you tomorrow!
For example, the simple picture is to just sign off on whatever number of troops is requested by the generals. But the big picture would understand that to a general, more troops is almost always going to be the first request ("when you have a hammer, every problem looks like a nail"). The big picture would understand that relationships with neighboring countries matter a lot. The big picture would understand that you can't "kill all the bad guys," you need to get most of them to go back to living their lives with some home of raising their children to adulthood. The big picture would understand that there are a million other factors that need to be considered, not just troop strength.
The general's job is to give his best military assessment.
The president's job is to deal with the big picture.
So somehow our elected officials have to be able to listen to us, and be honest with us.
Which I guess means we have to be honest with them first.
I don't know that we can. People react to their gut. We need to appeal to their gut. Allay fears, even when the fears are irrational or based on misconceptions.
This may sount trite, but it is not meant that way.
Not only do I not think it sounds trite, I think you've nailed it, Elizabeth.
Peace!
If fixed news didn't say it then it ain't so.
The really lamentable thing is how the 20% 'ers on both ends cynically manipulate the realities to serve their ends, aided and abetted by the media and the 24 hour news cycle trying to fill dead air.
Exactly. And they are being used as pawns.
Story is a powerful way to communicate and make ideas stick. I also like your four take-home points and five pieces of advice at the end. Very well written.
David K, I liked your post and your comments. Good work. I think if someone could find a way to get the FOX trouble makers off the air, a lot of people could actually hear the truth instead of a constant stream of lies and misinformation.
To actually hear a US Senator cite the Declaration of Independence and call it the Constitution is sure telling! That's exactly the kind of idiotic people we seem to have serving in Congress. And he was right up there with the Queen of Comedy at the so-called Tea Party today, exhibiting his stupidity. I wonder how many of the crowd knew he had it all wrong.
For instance, with the climate control bill, in the US Senate; has yet to have a "financial impact statement" done.
You are sooo right that they need to LISTEN to us, the people they represent.
Part of the missing info is if it would cost jobs, etc.
From what the AP news article I saw on AOL, the "potential costs" was not finished at the time the article was written.
One part that was missing was the cost to companies of implementing this legislation.
What is the "CBO?"
You may think you are being objective, but you are not.
I happen to be diametrically opposed to you, politically, so it's easy to spot your bias.
It's natural, it's human, we all do it.
Even legislators.
What WE the People cannot lose sight of is that no matter what happens this is OUR country, and we have to decide which direction we want to go.
Clearly, the recent elections, the tea parties, the flood of calls to Congress, indicate something.
And if the politicians are paying attention, they'll understand what that is.
I hold onto hope for 2010, and the return to a balance of power in D.C.
You might be surprised to know I don't want a completely one-sided Republican rule. Our form of government is ill-served by such.
I believe what I have highlighted in this article is:
1) Real people are out there
2) Facts aren't always what they appear to be
3) No one is listening
Another outstanding post. You are setting a high standard for our expectations. :-)
Those three points are political truths that shape everything we experience in the legislative process. In the best of theoretical representative democracies, the Congress would be the best qualified to create new laws for the benefit of all. But what Congress listens to is more the money than the real people out here and neither Congress nor the public seems to have a good grasp of the facts. Congress is lamentably unprepared for their task even if their "hearts" were in the right place.
on first reading that is such a Pure and libertarian viewpoint. But then when you look at it more closely, you start thinking of counter-examples. It sort of assumes, we all have enough money for our medical needs. But 700,000 americans, on average, go bankrupt due to medical costs every year, so obviously, we don't all have those buckets of $ when something bad goes down.
Assume that Amanda Sue develops Lupus at age 18, and mom works in a diner and dad is an an unemployed truck driverand there is zero health insurance. If the Lupus goes badly, it's not as if Amanda Sue can be taken to an emergency room and will be admitted to intensive care. If the doctors conclude that she is imminent danger of death, yeah they will take her in. If not, she will be sent home. She will be sent home every time until she actually IS in imminent danger of death- and by that time it will cost tens of thousands of dollars to treat her and she might die anyway.
Just sayin', it sounds great to reduce a complexity into a sound bite, but if you reflect on it too much, it is nonsense. And I am left suspecting that if this gentleman's granddaughter happened to be Amanda Sue, it might be an eye opener for him and he might change his tune.
There clearly is a disconnect. The guy was I would say about 60-odd years old, his dad was 86 years old and mother probably about the same. He was genuine and honest in his feelings that no one should have to pay for anyone else's health care. But:
1) He, and we, already do. Insurance company premiums are set to cover the cost of everyone who needs care but isn't insured. They do this so they can still make their profit goals each year even if something occurs that results in a lot of claims.
2) It is likely that both he and his parents collect social security and have medicare/medicaid, which is "government-run health care."
3) As veterans, they should both get VA medical coverage.
4) And of course there are many other "government hand outs" that both he and his parents are likely benefiting from.
Etc.
Which is why I decided that the details get lost in the theory. People will not be able, or not even care, to know about the details of any particular bill. What they will base their attitudes on is a simplified talking point. That's probably okay if it is an accurate reflection of reality, but not so much if it is a false premise.
1) It is unwise for Congress to pass such a huge measure without even making an effort to be bipartisan.
2) It is dishonest to continue to claim 'if you like what you have you can keep' when that capability is absent from the legislation in it's totality.
3) CBO cost estimates appear falsely low given they reflect only 5 years of full program vs 10 (although the estimate is for the next calendar 10 years).
4) Nowhere near enough time has been set aside for debate on this specific House bill (general debate about health care in general doesn't really cunt) before a vote.
5) AFAIK , no Constitutional Authority has been identified for this measure.
6) Keep the majority honest and transparent. A lot of work needed here.
7) No one really believes that these Health care and climate change fiascos will improve the economy.
8) Transferring costs is NOT the same as reducing costs. These bills do nothing to reduce actual costs.
9) The complexity of this 2000 page bill exceeds the ability of ANY leading Democrat to explain it. Without that coherent explanation, it shouldn't be supported.
10) Simply stating the problem over and over does NOT suggest the adoption of any of the current Democratic bills nor establish that they will actually solve anything.
Actually, I stated my take-home points.
1) It is unwise for Congress to pass such a huge measure without even making an effort to be bipartisan.
Efforts have been made. In fact, probably more than ever. Being bipartisan means opening the door, it doesn't mean the other side has to walk through it. In this case the minority party has been given ample opportunity and has flatly refused to participate in the governing of this country. Apparently they feel that standing in the way of meaningful legislation will give them short-term political benefits, which seem to be more important to them than actually doing their jobs.
2) It is dishonest to continue to claim 'if you like what you have you can keep' when that capability is absent from the legislation in it's totality.
Your statement is false. None of the bills being considered require you to change insurance.
3) CBO cost estimates appear falsely low given they reflect only 5 years of full program vs 10 (although the estimate is for the next calendar 10 years).
The CBO cost estimates are the CBO cost estimates. Your assessment that they are low is based not on fact but on your ideologically biased interpretation. Of course, the bill is still being debated, so estimates will change dependent on what changes are being made in the bill. Here is where the minority party is falling down on the job. If they have questions or want changes, they should be sitting down like adult lawmakers and discussing them, not whining in the streets and pushing falsehoods.
4) Nowhere near enough time has been set aside for debate on this specific House bill (general debate about health care in general doesn't really cunt) before a vote.
Your logic doesn't make sense. The bill is there to be debated. The issues have been debated for months. If the minority party wanted to contribute it has had ample time to do so. Frankly, it has refused to contribute on purely political calculus. Rather self-serving, and pretty embarrassing.
5) AFAIK , no Constitutional Authority has been identified for this measure.
You are incorrect. Congress is charged by the Constitution to write laws. They are trying to write a law. AKA, they are doing their jobs. Or at least the majority party is trying to do its job. Apparently the minority party has decided that reelection is more important than doing its job.
6) Keep the majority honest and transparent. A lot of work needed here.
One must get their own glass house in order before throwing stones. Death panels, anyone?
7) No one really believes that these Health care and climate change fiascos will improve the economy.
That is incorrect. Most believe that they will in the long run improve the economy. Your statement is akin to the horse shoe trade denying that the horseless carriage will ever improve transportation.
8) Transferring costs is NOT the same as reducing costs. These bills do nothing to reduce actual costs.
How do you know? And you do know that the cost of insurance premiums has increased at many times the rate of inflation every year for the last decade, right? So obviously the current system is already not working. Seems like trying something new is in order.
9) The complexity of this 2000 page bill exceeds the ability of ANY leading Democrat to explain it. Without that coherent explanation, it shouldn't be supported.
Here is a list of some articles, many of which summarize it quite well. See the short summary and detailed summary. And by the way, each Congressman and Senator has a staff that knows how to write and read actual legal bills, which isn't surprising given that these people are lawmakers, so they are used to drafting actual laws. Go figure.
10) Simply stating the problem over and over does NOT suggest the adoption of any of the current Democratic bills nor establish that they will actually solve anything.
I can't discern what meaning you intended from this statement.
In short, the list is not a list of "take-home" points because they really aren't related much at all to this post. If you want to use these as your own take-home points then you are free to do so in your own posts, but I would suggest providing a little bit more support for them since most of them don't make a whole lot of sense.
Did you have a comment related to the actual article?
The republicans have shown no intention to meet democrats on anything. "Bipartisan" to republicans means their way - period.
2) It is dishonest to continue to claim 'if you like what you have you can keep' when that capability is absent from the legislation in it's totality.
Actually, the opposite is true. If I have employer based insurance, I would be unable to access the public option. I would have to keep the employer based plan.
3) CBO cost estimates appear falsely low given they reflect only 5 years of full program vs 10 (although the estimate is for the next calendar 10 years).
Disease management costs are going to rise, regardless of the reforms. I have addressed this with you before. Until citizens decide to become healthy en masse disease management costs will grow. I proposed taxing those things that make us sick and injured. You said that is unconstitutional, but offered no alternative. Your view of government is incapable of addressing (at least) one of the nation's most pressing problems. Any response (for the fifth time)?
4) Nowhere near enough time has been set aside for debate on this specific House bill (general debate about health care in general doesn't really cunt) before a vote.
This issue has been around for close to a century. Debate is not the issue - delay is the only motive. Republicans have shown no effort toward good faith problem solving - and neither have you, for that matter.
5) AFAIK , no Constitutional Authority has been identified for this measure.
So, challenge it in the courts.
6) Keep the majority honest and transparent. A lot of work needed here.
Meaningless sound-byte.
7) No one really believes that these Health care and climate change fiascos will improve the economy.
If Americans became healthy, it would improve the economy. No doubt. But you don't like my proposal, so suggest one of your own - for the sixth time. Re: climate change - you should consider 1. what will happen to the economy if carbon emissions are not addressed, and 2. what will happen to the economy as China, Japan, and Europe become leaders in renewable energy technology and manufacturing. You must really like trade deficits.
8) Transferring costs is NOT the same as reducing costs. These bills do nothing to reduce actual costs.
Agreed!! Nothing will reduce costs until citizens actually care about their health (health care). But short of a massive enlightenment experience, that is not likely to take place. So I suggest disincenting things that make us sick and injured, and incenting things that make us healthy. You have rejected that, but offer no alternative. Your political ideology is inept.
9) The complexity of this 2000 page bill exceeds the ability of ANY leading Democrat to explain it. Without that coherent explanation, it shouldn't be supported.
Another meaningless sound-byte. It has been explained over and over, in detail, but you have to want to understand it before it will begin to make sense.
10) Simply stating the problem over and over does NOT suggest the adoption of any of the current Democratic bills nor establish that they will actually solve anything.
I told you what I thought would effectively address the American health care issue. For more on that, read Andrew Weil, M.D.'s, new book, Why our health matters. So far, you have had no alternative, even though you initially agreed with Dr. Weil's position. So that leaves your ideological position - lacking.
Listening to folks you know are misinformed would be only for the purpose of establishing a relationship. Otherwise, there is no chance of being heard yourself. Did you attempt to correct this man's misinformed opinions - or did you just listen?
Second, ensure that the misinformation is corrected in people's minds.
It won't make any difference to ideologues. They're not interested in accurate information. They only "want their country back". I think the only reason to discuss these things with ideologues at all is to expose them before someone, who may be undecided or non-committal. That's all.
Third, speak to the people. Tell them why....
What makes you think they will listen. Did the fellow you talked with?
Fourth, keep the minority party honest. Not surprisingly, the minority party tends to think that their best route to winning back seats is to keep the majority party from getting anything accomplished.
Yep. Democrats are going to rise or fall on their ability to bring about the change that was campaigned on in 2008. It's as if the majority has believed that the minority is its constituency. They have not acted like a majority party.
Fifth, "It's the Economy, Stupid." The state of the economy, real or perceived, is the driving force behind much of the angst right now. It matters not that the economy tanked last year, well before Obama was elected, the perception is that he needs to fix it...and he needs to fix it fast.
"Details aren't that relevant, what matters is the big picture message."
So what's the "big picture message" that says the economy depends on energy, healthcare, honest business practices on Wall Street, trade deficits, etc., etc., etc.
Somehow, I think that the message has to include some form of this: Americans have been trained to be "con-sumers" instead of citizens. Your buddy at the Bachmann rally seems to settle for simplistic answers - which are not solutions at all. I think he would benefit from some challenge to his simplistic outlook - e.g., oh, and if the general gets 40K troops, what does he do with them when the taliban simply retreats to Pakistan - to bide its time, while this occupation costs the taxpayer $billions/month? Are the American troops supposed to guard the Afganhi border? Are they supposed to fight a drug war there? What's the role? What's the definition of "victory"? Would it not be better to withdraw the American military, build up intelligence and special forces, and - above all - use that money to become energy independent, thereby cutting off important funding sources to the taliban, al qaeda, and other terrorist groups?
How would this fellow respond to these complications?
Listening to folks you know are misinformed would be only for the purpose of establishing a relationship. Otherwise, there is no chance of being heard yourself. Did you attempt to correct this man's misinformed opinions - or did you just listen?
Other than asking a few questions designed to get deeper, I didn't make any attempt to correct the misinformation. I was more interested in listening to what was behind his words. And yes, one needs to establish a relationship, which I would define as a common language for communication, before any real dialogue can occur. Otherwise it becomes two people talking at each other. Something we've all experienced here on Gather.
It won't make any difference to ideologues. They're not interested in accurate information. They only "want their country back". I think the only reason to discuss these things with ideologues at all is to expose them before someone, who may be undecided or non-committal. That's all.
I would agree that ideologues have staked out positions from which there is no return. To "change ones mind" is to admit error, something that isn't possible for many. But I don't think that most Americans are really ideologues. I think most of us just want to live our lives and tend to be influenced politically by the values we grew up with and those of our neighbors. Which makes us all, and some more then others, amenable to mimetic pressures.
What makes you think they will listen. Did the fellow you talked with?
No, they won't always listen. But communication is the beginning of any dialogue. Otherwise we're just talking at each other. As for the guy I was talking to, I actually do believe he was listening to me. As I've already said, I made no attempt to correct his misconceptions, but we did begin to establish a dialogue in which each of us actually heard what the other was saying. Again, it must begin somewhere.
Yep. Democrats are going to rise or fall on their ability to bring about the change that was campaigned on in 2008. It's as if the majority has believed that the minority is its constituency. They have not acted like a majority party.
I don't think it's that easy. Certainly the Democrats are the majority because the majority of the populace felt a need for change. But the reality is that the majority of the populace actually are not too comfortable with change, or at least significant change. We get scared whenever we get too far out from our comfort zones, and many have narrower comfort zones than others. I think the majority should learn from history, which shows that thinking 100% of the nation backs what 53% of the nation voted for is a mistake. The majority has the responsibility to govern for all Americans, not just the ones that voted Democratic in the last elections. The Republicans screwed that up big time, and now they are the minority.
That doesn't mean that the constituency is the minority party itself. It is the 46% that voted for the other guy. And the guy I spoke with yesterday is one of those 46%.
So what's the "big picture message" that says the economy depends on energy, healthcare, honest business practices on Wall Street, trade deficits, etc., etc., etc.
Alas, I wish it were so easy to identify the big picture message, but I think the message will actually be different for different people. Some will focus on health care, others on Af-Pak, others on the economy. Some will want more detail than others. I think my point was that most people are not political junkies like many of us on Gather. They just don't have the time, nor the inclination, to get into the nuts and bolts. So health care is "no one else should have to pay for my health care" rather than the intricacies of the bill.
How would this fellow respond to these complications?
While his "fish or cut bait" thinking would seem to suggest otherwise, he was aware of at least of the complications in Af-Pak. They just didn't to figure very prominently in the development of his attitude on the subject. Hence my comment that the details aren't always going to be very relevant.
I obviously don't know the answers. If I did I would be knocking on the front gate of the White House to offer them. But it did strike me that we often think of those with different viewpoints as "them" when in fact what we should be thinking is that we all really want the same things - to raise our kids in peace and safety and to have access to the opportunities that this country offers. We just don't always see the same route of getting there.
Let me make one point clear though. I in no way suggest that people should base their opinions and attitudes on false information. And I abhor those who intentionally mislead and deceive. We may reach different conclusions but we all must start with the same facts.
Could be - for most. But I think it is incumbent on citizens to be informed, and not so susceptible to the manipulations of "those who intentionally mislead and deceive."
"We may reach different conclusions but we all must start with the same facts."
Yes - and wasn't this guy at a Bachmann rally?
I agree, wholeheartedly. We can be informed on different levels, but there is no good reason to be misinformed as virtually everything these days is online and fact checked.
Yes - and wasn't this guy at a Bachmann rally?
Yes. I'm assuming you believe that the rally is a source of misinformation and not of information.
A Bachmann rally, at least.
Me too. The thing that disturbs me about the misinformation campaign, which has been pretty egregious just like the one back in the 1990s with the Clinton health care bit, is that it puts political pressure on our representatives in Congress to drop whatever they are doing and duck.
Thomas Jefferson at one point was quoted on his conviction that an educated electorate is essential for the government to function well. Uh oh, we do not have an educated electorate. We have a sound bite electorate, many of whom decline to vote if it is raining, then turn around and rant about something that is not happening and is not even being planned because they saw it on their email or heard somebody whispering darkly at Church or at breakfast at Shoney's.
It's not a good basis for public policy.
This past week I had two extremely educated and accomplished people relate to me what I knew to be misinformation. This was not a matter of differing interpretations, but of them believing as fact things that had been documented as being false. So it isn't just about the ability to understand. I think it has more to do with the willingness to understand. We feel comfortable within our own frameworks.
This is especially true among people who label themselves as conservatives. Conservatism is by definition the "inclination to maintain the existing or traditional order." Abraham Lincoln (you had to know I would have a Lincoln quote for this) said:
“What is conservatism? Is it not adherence to the old and tried, against the new and untried”
The problem is that things change, so why should it be expected that "old and tried" will still work (assuming it ever worked). There were 2.5 million people in the US at the time of the Declaration of Independence (not to be confused with the Constitution, as some minority leaders apparently do). Today we have about 300 million of us. The world has nearly 7 billion. Yes, times change whether we want it to or not.
It is always educational to read your articles.
Your “honest man” is one that reflects the value that created and sustained this country. I think your five points should be addressed. I will take liberty here and rearrange the order.
“Fourth, keep the minority party honest.” It is disappointing that you only feel that the “minority party” needs to be kept honest. I believe that both parties need to be honest. Is it possible that the majority party is willing to spend tax dollars because they believe that will keep then in power? Each party should describe some metrics that we can use to measure if their promises actually deliver something that will improve our health. These metrics would included in the law and be used as triggers to require revisions or revoking the law.
“Third, speak to the people. Tell them why health care reform” How much of the legislation will actually change the health of us rather than simply shift who pays for what and who decides on what is paid for. I regularly hear that the majority of health issues are lifestyle related and yet how much have we heard about lifestyle and personal health choices?
“First, politicians need to stop talking only to themselves. They need to start listening better to the people.” It seems your “honest man” was talking about personal choices and personal responsibility, where does that fit into the “health care reform” discussion?
“Second, ensure that the misinformation is corrected in people's minds.” If you desire the facts to be on line, who been the most resistant to putting the actual legislation on line even for a few days before voting on it? Who was it said he would post any bill for 5 days before signing? Both can do.
“Fifth, "It's the Economy, Stupid."” I have heard many from the Administration claim that “health care” is a drag on the economy so it is about stimulating the economy. Are they suggesting that medical care was a major cause of the economic down turn?
I wonder if your “honest man” based some of his reservations on government’s past performance and their lack of accountability. We may like complaining about the insurance companies, but they are accountable, how would you make the government accountable?
“Fourth, keep the minority party honest.” It is disappointing that you only feel that the “minority party” needs to be kept honest. I believe that both parties need to be honest.
I agree. Both parties need to be honest. And the minority party generally is freer with the "truth" than the majority party. But as I've documented recently, the Republican party seems to have institutionalized making stuff up in recent years. I've documented just a small part of it myself. The blatant dishonesty by the talking heads on the right have far outweighed anything the left has been doing.
“Third, speak to the people. Tell them why health care reform” How much of the legislation will actually change the health of us rather than simply shift who pays for what and who decides on what is paid for. I regularly hear that the majority of health issues are lifestyle related and yet how much have we heard about lifestyle and personal health choices?
That is my point. It needs to be communicated better why health care reform is needed and why it will be better for all Americans.
“First, politicians need to stop talking only to themselves. They need to start listening better to the people.” It seems your “honest man” was talking about personal choices and personal responsibility, where does that fit into the “health care reform” discussion?
Actually, his attitudes toward personal choices and responsibility do not seem inconsistent with health care reform. Right now the insurance companies make a lot of choices for us. Is that consistent with his philosophy?
“Second, ensure that the misinformation is corrected in people's minds.” If you desire the facts to be on line, who been the most resistant to putting the actual legislation on line even for a few days before voting on it? Who was it said he would post any bill for 5 days before signing? Both can do.
Read my earlier comments in this string. The "post any bill" is both a canard and a deflection from responsibility. It presumes that a "final bill" can be created before the minority party provides any input so they can simply shoot holes in it without taking responsibility for contributing to its development. That entire concept is so cynical and ludicrous that it makes me want to cut of Boehner from his sessions in the tanning salon he seems to live at. The minority party has had more than ample opportunity to contribute, and has in fact had provisions they like included in the draft legislation. So complaining that the "didn't have any time to read it" is not only disingenuous, it is dishonest.
“Fifth, "It's the Economy, Stupid."” I have heard many from the Administration claim that “health care” is a drag on the economy so it is about stimulating the economy. Are they suggesting that medical care was a major cause of the economic down turn?
Your conclusion is a non sequitur. Health care costs have been increasing annually at many times the rate of inflation. Why? Health care costs will continue to increase and the percentage of GDP for health care issues will always get bigger without any change. Do you think that the disproportionate increases in costs with decreases in coverage and/or company-paid coverage is good for the economy?
I wonder if your “honest man” based some of his reservations on government’s past performance and their lack of accountability.
From my conversation I saw no indication that this is the case. He didn't mention "getting screwed by the government" or anything about poor performance. In fact, the "government-run" health care system we have now actually works better than the non-government run system.
We may like complaining about the insurance companies, but they are accountable, how would you make the government accountable?
How exactly is the private insurance industry held accountable? Can you give an example?
I have posted many times that until Americans begin to actually care for their health (health care), the costs of "disease management" are going to rise. This is Andrew Weil, M.D.'s, insight - not mine (though I agree with it).
I have also posted many times (see above) that American consumers do not appear to be massively interested in lifestyle changes, though fitness programs and gyms seem to be growing somewhat. So - absent some great enlightenment experience among Americans, I think lifestyles should be influenced by incentives and disincentives.
I have suggested that the things that make us sick and injured be significantly taxed. Tobacco, junk food, alcohol (and othe drugs, if they are ever legalized), hand guns and ammo, and wreckless driving should be taxed to the max. On the other hand, organic foods should be subsidized instead of high fructose corn syrup. The most unhealthy food should not be the cheapest.
Right wing ideologues have criticized this approach as "unconstitutional", but have not offered any alternative suggestion, as I noted above. That leaves me to assert that right wing ideology is inept re: solutions to the most pressing problems this nation faces. Of course, it is a right wing proverb that government should be so small that one would be capable of drowning it in a bathtub. Response? Nothing, so far.
Duane B. wrote an article re: the self-serving motivations of anti-smoking campaigns, which use photos of diseased lungs and such. The research on that approach is mixed, but the motivations of those, who author those approaches is undeterminable. In any case, taxing tobacco products has been shown to be an effective deterrent to youth initiation. So, I would be interested in Duane's view of my suggestion that those products that make us sick and injured should be significantly taxed (10%). The revenue could be targeted to medicare. If Duane doesn't agree, he will have to offer some alternative - because the costs of disease management is going to grow, regardless of the current reforms under consideration. And - I agree with Duane - disease management is not health care.
Who do you think should be explaining why “health care reform” is needed, Pelosi, Reid, maybe Obama or do you think it should be done by the Republicans (the minority party) or John Boehner?
“Right now the insurance companies make a lot of choices for us.” That is where I disagree. I don’t know your “honest man”, but my best guess is that he makes his own choices in lifestyle not his insurance company. I suspect that if he is buying insurance there is a contract about what will be covered and all the insurance company does is work at enforcing that contract. We have had our insurance reject claims over the years the majority of the times it proved to be an error of the hospital whether billing for something that wasn’t provided, coding the treatment wrong, or even charging more than was agreed upon before the treatment. Who makes the choices in your lifestyle/your health?
“The minority party has had more than ample opportunity to contribute, and has in fact had provisions they like included in the draft legislation.” I have always thought I was naïve, but if you believe that the politics in Congress (in any legislature) is pure and open without the people in power manipulating the system to get done what they want then I may have found someone that I am a little more worldly than. Do you honestly believe that Pelosi wants to hear anything about “health care reform” without a government pays included and she hasn’t done all she can to the exclusion of open discussion than you aren’t even watching MSNBC. It is hard for me to imagine that you believe that Pelosi is open to all ideas and isn’t working the system for her point view.
I heard a Democrat Congressman say that this “health care reform” has been a hundred years in the making, after that hundred years why can’t we have three days to read the final bill before a vote?
Everyone is complaining about the increasing costs of medical care and how terrible it is that it is such a high percentage of the GDP, of individuals’ incomes. We can stop the cost rise by simply putting a cap on all medical spending, no more for new medical treatment, no more training for medical professionals (after graduation), no more diagnostics. Where do you think the cost is coming from? Out of a couple of trillion dollars do you think the rise is due to the pay of insurance CEOs? When I was little I went to the county hospital and stayed in 30 person ward there was one doctor and a couple of nurses on for the ward, they used ether for my anesthetic, and the medical bill was paid by my parents, now we have the best medical treatment in the world, it is paid by the insurance companies. If you want to stop the cost of medical care start with identifying the costs before trying to control how it is paid. The fastest grows job sector in this recession is medical care, do you think “health care reform” will stop that?
I appreciate your work at “documenting” the dishonesties of the Republicans, and hope you don’t think this is disparaging those efforts. After reading your article I didn’t find any attributed quotes or any information demonstrating inaccuracies. I was taught that documenting was capturing factual information. Your article on “Growing Dishonesty” seemed more of a list of your personal grievances.
The insruance companies are regulated, if they violate laws they are prosecutable, if people don't like what they are doing they can be sued, individuals within the insurance companies are legally libel, those that buy the policies can change companies, if the complaints by people to the state regualtors are sufficeint the insurance company's right to do business in a state can be revoked. Which one of those don't you feel is a means of accountability? How many of those do feel would apply to the govenremnt under the proposed legislation?
The weakness I see in taxing products like cigarettes are that it is simply adds cost to what they want to do. As for the changes in smoking habits, what came first was changes in the work place, long before there increases in cigarette taxes. In Michigan which is more discouraging to smoking, paying $1 for a cigarette or standing out in the winter cold and snow to smoke it?
If you want to stop people from doing something then why don’t you just try and get a law that bans them? Ban cigarettes, fatty foods, sugar drinks, guns, ammunition, alcohol, and whatever else you thing people shouldn’t have a choice in? I would be interested in how the “designated driver” approach affected the number of car accidents related to drinking?
If I believe that people should have the right to choose anything legal. And they should be allowed to reap whatever the consequences are. People’s health is determined by lifestyle, even thought the Congress doesn’t feel that way. I see no problem with people having a juicy double cheeseburger with all the trimmings. However, if they take it to the extreme by eating multiples for a couple of meals a day and not expending the energy to burn off the calories then they are most likely making a personal lifestyle choice that will affect their health.
As for the organic foods, what I have heard is that they are no more nutritious and a bit more expensive than the ones that are grown using government approved chemicals.
It is too bad that you seem to focus on who has the ideas rather than how well the ideas work. As best I can tell that for all the years that DC banned guns there were still an inordinate number of murders with guns. I doubt that all of those using the guns were ideologues, but I am sure that they were all criminals and didn’t care what the law said.
You may want to consider that lifestyle is based on behaviors, and people establish their own behaviors. Let me offer you an idea I have learned about addressing human behavior. Identify the behavior, understand the consequence (personal and immediate), develop positive triggers, and develop a way for the person to monitor their performance. Also habit leads attitude, so if you are willing to work on the habits then you will see the attitudes change.
All parties should explain their viewpoints honestly and as adults. Obviously.
If I believe that people should have the right to choose anything legal.
Agreed. Does that include abortion in your mind?
Lifestyle
I'll let Steve readdress your comments to his. But I will add that there are societal reasons for incentivizing or disincentivizing certain behaviors. We give mortgage interest deductions to incentivize home ownership. We give investment tax breaks to incentivize investment. So why not tax to disincentivize smoking, given that smoking creates costs not only to the smoker but to the society as a whole?
It is too bad that you seem to focus on who has the ideas rather than how well the ideas work.
I'm not sure who this comment was directed to, but I have never said anything to suggest that an idea is good only if it comes from one arbitrary group or another. On the contrary, I have a long track record of promoting honesty and innovation by anyone who is honest and innovative. From what I've seen from Steve's comments, the same is true for him. So I'm not sure where you arrived at this statement.
You may want to consider that lifestyle is based on behaviors, and people establish their own behaviors.
True, but see your comment in your following sentence, in particular:
...develop positive triggers...
positive triggers would include the incentives and disincentives that Steve has mentioned, wouldn't it?
“All parties should explain their viewpoints honestly and as adults. Obviously.” The only ones you have named as not meeting your expectations have been the minority party and John Boehner.
“Agreed. Does that include abortion in your mind?” It is a legal choice. If the body aborted or caused a premature birth in the third trimester our medical care people would do everything possible to save the baby, and most likely be successful, that causes me a real personal sorrow. However, in the Congress’s infinite wisdom they make it legal so I accept it. I do wish the mothers, especially at that point, were more accepting of adoption as an option. I do think that tuba ligations and vasectomies should be strongly encouraged. I think they would be a much more effective alternative to multiple abortions or unwanted children. Just as I don’t believe the government should pay people to smoke or drink, I don’t believe the government should pay for abortions of convenience.
With regards to tax incentives, I think that is a false method of distorting the market place. I think that people who buy homes don’t need the incentive; their decision is based on the value a home provides not whether they are reducing their taxable income by 20% of the annual interest payment on a loan. As for investment incentives it distorts the market place. Look at what those incentives have done in Michigan, they gave hundreds of millions in tax incentives and the businesses still went under. I am one of those who believe you only value what you pay so everyone should pay taxes and own a bit of the government spending. Taxes have one purpose, to provide the politician with money to spend. The idea that raising the taxes on cigarettes encourages someone addicted to nicotine to stop is a delusion. Talk to some who is making minimum wage and is smoking a $5/pack of cigarettes a day, they bemoan the price and keep smoking. If you want to truly talk about helping people stop smoking then analyze why they smoke and then try to figure out what to do to change it. Raising taxes on cigarettes is a lazy answer.
“I'm not sure who this comment was directed to, but I have never said anything to suggest that an idea is good only if it comes from one arbitrary group or another.” The comment was directed at anyone that labels an idea bad by attacking the source. When people dismiss ideas by saying they are from a “liberal” or a “neo-con”, a “leftwing” or “right wing” or Republican or Democrat, they are attacking the source and not thinking about the idea. It is much easier and lazy to do that, condemn/belittle/dismiss rather that discuss. It is the precursor to what I call ideological bigotry.
The price of anything is not a trigger it is a consequence. A trigger is more like when the phone rings and the behavior is to answer it. A healthy eating trigger is to start your day by eating, the behavior is to make it an apple, and the consequence is that it tastes good. Healthy lifestyle is to make eating and activity choices that create a healthy body, good blood and system numbers, a consequence is paying more for insurance it you don’t get the good numbers and payless for insurance if you do get the good numbers.
You asked me a question about insurance company accountability. Do you think what I listed as means of holding them accountable are credible?
Actually, that's a strength. Cost is a deterrent, and in any case, you should contribute to paying for the treatments you are going to need.
"As for the changes in smoking habits, what came first was changes in the work place, long before there increases in cigarette taxes."
Taxes have proven an effective deterrent to youth smoking. Perhaps, you have some data re: work place changes being an effective deterrent.
"If you want to stop people from doing something then why don’t you just try and get a law that bans them...."
That might be your alternative suggestion, but it is not mine. And I would not support bans.
"If I believe that people should have the right to choose anything legal. And they should be allowed to reap whatever the consequences are."
And part of the consequences are the costs of their medical treatment. They should have to pay a greater amount because they represent a greater risk. Why should I have to subsidize their medical treatments through higher insurance premiums and higher medicare taxes?
"As for the organic foods, what I have heard is that they are no more nutritious and a bit more expensive than the ones that are grown using government approved chemicals."
Yes, I'm sure you have heard that. I know you're not one for looking into research that much, so what you have "heard" will suffice - for you. But if you're ever curious, you might check out who does the studies that suggest those results. (Hint: industry also has tried numerous times to render the organic label meaningless via loopholes that would compromise organic processes).
"...for all the years that DC banned guns...."
Banning things is your idea - not mine. Let's keep that straight. Gun violence - do you know how much that costs nationally in emergency room expenses? Who do you think should pay for that?
"I doubt that all of those using the guns were ideologues, but I am sure that they were all criminals and didn’t care what the law said."
That's why my suggestion keeps it out of the legal arena. You seem to keep getting confused on that point.
"You may want to consider that lifestyle is based on behaviors, and people establish their own behaviors."
Actually, that's what I started with.
"Let me offer you an idea I have learned about addressing human behavior...."
Interesting. Your suggestion assumes motivation to change, which is exactly what is missing in a majority of the American public. My suggestion provides motivation to change, which has been demonstrated and is known to be effective. I understand it runs counter to your ideological aversion to taxes.
Exactly. The question to Duane is why does he support incentives for those things that make us sick and injured. Why does he not support incentives that would promote health? Apparently, he thinks that all of us should pay for the irresponsible decisions of some via higher insurance premiums and higher medicare taxes. Strange, for a "conservative", don't you think?
The fantasy of the free market. I guess you never heard of K-Street.
"The idea that raising the taxes on cigarettes encourages someone addicted to nicotine to stop is a delusion."
I guess that's why the American Medical Association supports tobacco taxes.
"If you want to truly talk about helping people stop smoking then analyze why they smoke and then try to figure out what to do to change it. Raising taxes on cigarettes is a lazy answer."
You seem to have a bad habit of assuming that these things have not been studied. They have been. Taxes have been shown to be an effective deterrent. I have for that research to keep getting in the way of your beliefs. The "lazy answer" is to just think that all of this national health problem is going to change by itself. That's why your political ideology is impotent with regard to one of the major threats to this nation's economic security.
"The comment was directed at anyone that labels an idea bad by attacking the source."
I have addressed this issue in detail. Critics of my suggestion are "conservatives" (or think they are). It is not out of bounds to note that those of that strange "conservative" ideology offer nothing as an alternative, and are apparently incapable of dealing with data, which runs counter to their beliefs. The "conservative" ideology does not work on a national level, and the issue of health care - disease management shows that clearly.
"The price of anything is not a trigger it is a consequence."
I was a clinician, treating addictions for 30 years. I understand triggers and consequences. Taxes are neither triggers nor consequences. They are a context.
"Healthy lifestyle is to make eating and activity choices that create a healthy body, good blood and system numbers, a consequence is paying more for insurance it you don’t get the good numbers and payless for insurance if you do get the good numbers."
Show me an insurance company that bases your premiums on your lab values. I'd like to see that. Btw, that would be a helluva lot more "intrusive" than generic taxes on products known to make people sick.
I have done some compression of your comments to minimize space and yet allow for referral to the original remarks, let me know if you feel this is not appropriate.
“Taxes…effective deterrent… smoking.” The question was which changed first the work environment or the increase in taxes.
“… your alternative suggestion… I would not support bans.” The question was why don’t you support it?
“I know you're not one for looking into research…studies that suggest those results.” Test me; give a link.
“They should have to pay a greater amount because they represent a greater risk” If you believe that then why raise taxes rather than promote insurance fees based on lifestyle impact on personal health?
“Critics of my suggestion are "conservatives" (or think they are).” Would you classify me as a “conservative” because I disagree with your approach or as a “liberal” because I offer an alternative approach?
” …"conservative" ideology offer nothing as an alternative, and are apparently incapable of dealing with data…counter to their beliefs.” Incapable of dealing with data is an interesting charge, first is trust in the data. The US medical care is denigrated for the baby death rate when compared to other countries, but is the data used accurate? In the US a baby death is counted it there was a spark of life, in Germany a baby must weigh at least a pound, in France it must be born after 26 weeks. (Richmond Times link below) What data do we use, the most inclusive or most exclusive? In the US “we (the general public)”/doctors encourage woman to carry babies as long as possible, is that true in all other countries we are compared to? Is the data accurate measure?
You can claim I disregard data, but I ask is that data simply showing a statistical relationship or is it measuring biological mechanism? What data has been generated that shows taxes stopped smoking and it wasn’t the workplace consequences? What are the criteria used for gathering data? Data isn’t simply numbers that we should put blind faith in, what the number represents (what is being measured, the accuracy of the data gathering, the reproducibility) and whether the interpretation of the data can be verified have a lot to do with the value of the data. You feel I ignore data, no I just want it credible and comparable.
http://www2.timesdispatch.com/rtd/news/opinion/op_ed/article/ED-HINKLE11_20090910-191206/291895/
“My suggestion…your ideological aversion to taxes.” The problem I have with taxes is they are impersonal. When you buy cigarettes the tax is hidden in the price of the cigarettes not a separate burden that the individual can influence. They can decide not to buy, but based on your experience (I was a clinician, treating addictions for 30 years.) have you ever heard of an addict deciding to stop purchasing their “drug” of choice based on price?
“The question to Duane is why does he support incentives for those things that make us sick and injured.” I believe in incentivizing good behaviors, I don’t believe that taxes are an effective incentive/disincentive. I believe that behavior is a personal decision and that the incentives/disincentives (consequences) need to be personal and immediate, and something the person can recognize and control. My view on effecting healthy behavior is providing the tools and mechanism for the individual working with their medical care provider to develop the preferred behaviors, the metrics to monitor their performance, and the triggers for those behaviors.
“The fantasy of the free market....” I think this comment is for a remark you wanted to hear. I simply said taxes are an ineffective way of distorting the market, particularly in addressing personal lifestyle behaviors.
“The "lazy answer" is to just think that all of this national health problem is going to change by itself.” The “lazy answer” is that a single government action can solve what is a personal choice. The idea of a tax being the way to make people change their behaviors takes the responsibility away from the only person that can make the changes and transfers it to the government. Based on your experience does the addict change when they blame the addiction on their parents, their peers, the government, their doctor, or is when they take responsibilities for their actions? If you believe that the size of the government tax on cigarettes is the way to change peoples’ behavior then you are turning over responsibility of their smoking to the government by saying the government can stop smoking by finding the tax level that will make it prohibitive.
“Show me an insurance company that bases your premiums on your lab values.” In Michigan it is the state regulators that decide what the insurance companies how much and for what they can charge.
I don't have to justify supporting something that was not my suggestion. My suggestion was clear. If you want to make a case for bans, that's your option.
"Test me; give a link."
Just refer to your article about anti-smoking ads. You make a number of ideological proclamations that are not supported by evidence - only by political belief. Regarding the relative health of organic foods/products, the results you have "heard" refer to studies that do not take many variables into account, e.g., pesticides, fertilizers, and antibiotics. Look it up.
"If you believe that then why raise taxes rather than promote insurance fees based on lifestyle impact on personal health?"
Good question. First, it is not a matter of just "raising taxes". The taxes raised are selective, so you have a choice re: whether you pay them or not. Second, raising selected taxes does not invade privacy. Raising insurance premiums based on individual health records is a significant invasion of privacy, and I doubt you would be able to affect it.
"Would you classify me as a “conservative” because I disagree with your approach or as a “liberal” because I offer an alternative approach?"
Your comments indicate you oppose government action on this issue, and you especially oppose taxes. That says to me you're a so-called "conservative." But your suggestion that people's privacy should be invaded to obtain their health records so that their insurance premiums can be determined - well, that just seems totalitarian.
"The problem I have with taxes is they are impersonal."
Exactly the point!!! They are referenced on products that make people sick and injured.
"When you buy cigarettes the tax is hidden in the price of the cigarettes not a separate burden that the individual can influence."
Yep. The individual can influence the cost by deciding not to buy.
"...have you ever heard of an addict deciding to stop purchasing their “drug” of choice based on price?"
Absolutely. It is common for rising prices of addictive substances to be one of the variables that influence an addict to stop using. Not only was this my experience professionally, it is supported by research.
"...first is trust in the data."
The American Medical Association trusts the data and supports tobacco taxes. Generally, I look to professional scientific organizations for "literature reviews". Those organizations regularly review research and summarize it with their positions. Note - professional scientific organizations only take positions when the evidence is compelling.
"I believe in incentivizing good behaviors, I don’t believe that taxes are an effective incentive/disincentive. I believe...."
I believe - I don't believe - I believe.... Is it any wonder that that you are seen as an ideologue. No matter how many times I tell you that the evidence does not support your "beliefs", and that the American Medical Association does not support your "beliefs", you keep referring to your "beliefs" as the alpha and the omega.
"I believe that behavior is a personal decision and that the incentives/disincentives (consequences) need to be personal and immediate, and something the person can recognize and control. My view on effecting healthy behavior is providing the tools and mechanism for the individual working with their medical care provider to develop the preferred behaviors, the metrics to monitor their performance, and the triggers for those behaviors."
Treatments already exist for individuals to effectively deal with their addictive and unhealthy behavior. That is not the issue. The issue is that we have a national emergency (one of several). The United States is a nation. It has an economy. The whole is greater than the sum of its parts. A nation is not just a conglomeration of individuals. A nation has to have an answer to the failing health of its citizens. Otherwise, the nation's economy is going to tank (further). Second, it is a well know clinical fact that individuals enter treatment when the net losses/gains of addictive/unhealthy behavior shift, such that the losses outweigh the gains. That is not something individuals "decide" about. That is the result of shifts in the environment (context) of their pathology. Those shifts have been, and have been proven to be rising costs, of which taxes represents one form. You may not like those facts, but you don't get to choose what the facts are.
"I simply said taxes are an ineffective way of distorting the market, particularly in addressing personal lifestyle behaviors."
The market is already distorted in favor of those things that make us sick and injured. Tobacco and corn subsidies make these products artificially cheap. But I see you avoid answering my most pressing question: why should I pay the same as someone, who represents a more serious risk? I take excellent care of myself. I eat healthy, exercise regularly and vigorously, and I don't take risks that would result in injury. My medical costs for someone my age are very low. So why do I pay the same as everyone else?
"The 'lazy answer' is that a single government action can solve what is a personal choice."
No one said anything about a "single government action" being THE answer to an individual's addictions and unhealthy choices. Taxes on products that make us sick and injured is one variable - a significant one. There is no doubt people will continue to be addicted and practice unhealthy behavior. Your absolutiist view of this is not warranted. The relative incidence of those behaviors will decrease, along with medical costs. The other part of this, though, is something that you keep missing. Revenue from these taxes will pay for the medical treatments these people are going to be more likely to need and use. They end up paying for their own treatment - as a group. Why would you oppose that, other than your ideological and reactionary aversion to taxes?
"The idea of a tax being the way to make people change their behaviors takes the responsibility away from the only person that can make the changes and transfers it to the government."
You keep distorting this thing. A tax takes away no responsibility from anyone. It shifts the context in which that individual makes choices, and accepts responsibility for them. It is no different than an intervention with an alcoholic, in which a family tells the alcoholic that there will be sanctions to their continued drinking. An employer can tell an addict that there will be sanctions to continued using. A public, via the voice of its government, can stop "enabling" the unhealthy and addictive behavior of many of its citizens. They may still be unhealthy, but it won't be as easy. That's all.
"Based on your experience does the addict change when they blame the addiction on their parents, their peers, the government, their doctor, or is when they take responsibilities for their actions?"
Taxes doesn't change responsibility. It changes context in which decisions are made and responsibilities are accepted. Stop distorting this issue.
"If you believe that the size of the government tax on cigarettes is the way to change peoples’ behavior then you are turning over responsibility of their smoking to the government by saying the government can stop smoking by finding the tax level that will make it prohibitive."
I've answered that time and time again. It is a variable, and it will diminish use and decrease medical costs. It is not absolute, and it will not end disease or medical costs. People will still have to make their own decisions. I have no problem with making the decision to be sick more difficult. Especially for youth. Why do you? And taxes do no transfer responsibility to government - the transfer responsibility to the individual. If you're going to smoke, eat junk, use handguns, and speed, then you're going to help pay for the catastrophes you're helping to create. Again - you keep avoiding this question - why should I pay for another person's bad decisions?
"In Michigan it is the state regulators that decide what the insurance companies how much and for what they can charge."
That doesn't answer the privacy issue that you proposed - basing insurance premiums on individual lab results of individual patients. Show me where THAT is being practiced!!!
“I don't have to justify ...” You surely don’t, I was simply trying to learn from your reasoning.
“only by political belief.” I am not sure what constitutes political belief, but what I say is based on experience and thinking through the question.
“.. taxes does not invade privacy.” If you noticed, my approach was between the individual and their medical care provider.
“…you especially oppose taxes.” No, if you recall I said I believe everyone should pay taxes (own part of the government spending).
“… products that make people sick and injured.” NO, the products you want to tax don’t make people sick, it is the abuse not the use that does.
“…rising prices of addictive substances …to stop using.” That surprises me, since I have heard that people turn to prostitution, to robbery, to selling drugs, to forfeiting their families to support their addictions. Now I learn it is simply a matter of price that will cause them to stop. So your data/experience indicates that by simply legalizing “meth”, “crack cocaine” etc. and raising the tax on it we will end peoples’ addictions (with few exceptions). Wow, that changes my whole perception of addictions.
“I believe - I don't believe - I believe...” When I say “I believe” it is to make plain that I rely on no one else to justify what I am thinking, that whatever I say rises or falls on the logic I used, and that I invite whomever to challenge my logic by telling me what I have failed to understand and why. I claim no expertise on any subject.
“A nation is not just a conglomeration of individuals.” I believe what has distinguished the US from all other countries through our history is that the individual has mattered most and not the state. I believe in the individual and their right to choose, not that the state is smarter and should make the choices for the individual.
“A nation has to have an answer to the failing health of its citizens.” Our medical care system is better than it ever has been, with room for improvement. You seem to see our health as bad with a single cause, I see our health being the best in my life time and that each person’s health is related to their lifestyle choices. I focus on quality of living not life span. I believe the person should be the decider of what is quality of living (as long as it doesn’t infringe on the rights of others as established in our legal system) for them. If a person chooses to eat poorly because that gives them legal pleasure then why should I say they have to eat brussels sprouts because it is better for them than a double cheeseburger?
“The market is already distorted in favor…Tobacco and corn subsidies make these products artificially cheap.”You make my point; tax incentives of any nature distort the market. Look at the tax actions for ethanol. I repeat, every person should pay taxes and taxes should not be modified in an effort to drive behaviors.
“No one said anything about a "single government action" …” Taxes is the only solution you have offered or defended.
“Revenue from these taxes will pay for the medical treatments ...” That sure isn’t the experience in Michigan.
“That doesn't answer the privacy issue that you proposed - basing insurance premiums on individual lab results of individual patients.” My approach would be based on the medical care provider certifying that there was a plan of action that and that the person’s health was not related to lifestyle choices. The Federal Disabilities act does allow for personal responsibility, if a person has a treatable condition such as high BP and they don’t treat it they can be terminate by their employer based on safety concerns. Why can’t that approach be used for medical insurance fees?
Thanks for that admission. What I say is based evidence and expert opinion, e.g., the American Medical Association.
"If you noticed, my approach was between the individual and their medical care provider."
Actually, you suggested that insurance premiums should be based on an individual's lab results. That's not just between a patient and provider.
"...if you recall I said I believe everyone should pay taxes (own part of the government spending)."
Alright. But tell me - why should I own as much govenment spending on treatment for lung cancer caused by smoking. Or why should I own as much government spending on treatment for diabetes?
"NO, the products you want to tax don’t make people sick, it is the abuse not the use that does."
Research suggests something different, but I accept that your personal experience and thinking guide what you believe reality to be. I might suggest, however, that you actually study the nature of addiction. It might influence your thinking on this issue. Second, even if what you say here were true, moderation would only bring a moderate tax, now wouldn't it?
"I learn it is simply a matter of price that will cause them to stop."
You have a very bad habit of jumping to all kinds of conclusions re: what I am saying, when I've never said any of the kinds of things you claim I've said. It may surprise you to know that that constitutes a logical fallacy, and it reflects on your thought process. And since your thought process is one of your primary ways of deciding what you believe, you should take particular note about it.
"When I say 'I believe' it is to make plain that I rely on no one else to justify what I am thinking, that whatever I say rises or falls on the logic I used, and that I invite whomever to challenge my logic by telling me what I have failed to understand and why. I claim no expertise on any subject."
Again, thanks for the admission. Two suggestions: 1. check out what the American Medical Association says on the subject; 2. study logic - because your argument, as noted above, has a logical fallacy in it.
"I believe what has distinguished the US from all other countries through our history is that the individual has mattered most and not the state."
Yep - that is your political ideology. Again, thanks for the admission. You would agree with Grover Norquist that government should be so small that you could drown it in a bathtub? If so, I will remind you how well that worked in the wake of Katrina.
"I believe in the individual and their right to choose, not that the state is smarter and should make the choices for the individual."
You insist on distortion. So be it. But taxes on products that contribute to disease and injury do not constitute the state making choices for individuals.
"Our medical care system is better than it ever has been, with room for improvement."
I encourage you to read Andrew Weil, M.D.'s book, Why Our Health Matters.
"If a person chooses to eat poorly because that gives them legal pleasure then why should I say they have to eat brussels sprouts because it is better for them than a double cheeseburger?"
There's that nasty habit of yours again - going off on things I never said. But you never answer my question. Why should I have to pay as much for someone's medical treatment, who decides to make eating cheeseburgers a lifestyle?
"My approach would be based on the medical care provider certifying that there was a plan of action that and that the person’s health was not related to lifestyle choices."
Yes, and your approach is open to all kinds of fraud and abuse, in addition to invasion of privacy. That's exactly why I favor a tax. It does not rely a doctor certifying anything, or determining whether a specific medical condition is related to lifestyle. Ever think a patient might distort the facts of their lifestyle to their doctor? Lab results are what they are, but they don't indicate causes.
"...if a person has a treatable condition such as high BP and they don’t treat it they can be terminate by their employer based on safety concerns."
Exactly why invasion of privacy is such a crucial variable in this discussion. You want to extend drug testing to all aspects of a persons health - at what point do you draw the line. What medical conditions would be grounds for termination? A person might be diagnosed with cancer. Because that becomes a liability to the company's insurance plan, would the be terminated? (I have seen this attempted, btw) And, of course, actual termination is not the only way to "terminate" people. But you may not know that, since you only rely on your own experience and thought process to set your beliefs.
One more thought on this. I believe that for a system to work, there has to be working relationships among four components of society: individual, family, community and state. None are any more important than the other - the working relationships are what matters. That is based on decades of experience as a mental health provider, a thorough knowledge of systems theory and application. Without working relationships among all levels, each component suffers. That is not a political view - it is a pragmatic understanding of what works and what doesn't work.
And yes - I am an expert in this area.
"You make my point; tax incentives of any nature distort the market. Look at the tax actions for ethanol. I repeat, every person should pay taxes and taxes should not be modified in an effort to drive behaviors"
I might not have anything against a flat tax, but what are you going to tax flatly? Income? Every product? Everything equally? Transactions? Estates? How do you decide what to tax? Carbon emissions? Deciding what to tax is a different thing than deciding on the amount. And a flat tax does not address my concern. If I am living a healthy lifestyle (and I am), I should not have to pay as much in a medical system as someone, who does not life a healthy lifestyle.
"Taxes is the only solution you have offered or defended."
The only thing I've mentioned, perhaps, in this article. But you will recall your post on anti-smoking ads. I supported the public service ads you were so critical of. I also have referred to Dr. Weil's book a number of times, and have recommended it. It is full of other measures, directed not only at government, but at the medical institutions and professions. I think I also mentioned subsidies for organic food, especially produce. And even though I have not mentioned it here, I would like to see tax credits for gym memberships. I also support taxing products that make us sick and injured - that's just what I've focused on in this article. Why do you take such an "absolutist", black and white view of things so consistently?
“What I say is based evidence and expert opinion….” I could use some description of the why so I could learn. Being told that is what someone else says doesn’t help me think.
“why should I own as much government…?” I have found that when an individual has to pay for something it has greater value, by paying government people are more attentive to how their money is spent.
“Research suggests something different,” I would be interested in reading this research because, what I have learn and what government regulations are based on is the concept of dose, quantity vs time. There surely are single dose killers, but few of those leave addicts behind. As yet I haven’t heard a single cigarette or one every other month causes irreparable damage, does data show otherwise?
“check out what the American Medical Association says on the subject;” I must admit I lean toward the AMA being a political organization rather than a consensus expert organization. My best guess is the bulk of the AMA budget is spent on activities in DC rather than on development of scientific findings. Based on the current political issue of “health care reform” there seems to be a lack of unanimity of their members.
“You would agree with Grover Norquist that government …drown it in a bathtub?” NO, I believe that government has a very important role in society, I believe in government regulations and their enforcement. However, I do not believe that they employ people individually or as a group that are smarter than all individuals or the general population. I do believe that just as individuals and private companies need to be accountable so does government.
“You insist on distortion.” Can you be more specific about what I have distorted?
“Why should I have to pay as much for someone's medical treatment…?” I don’t think so, that is why I have suggested that rather than a tax that abusers and conscientious users would have to pay on foods you don’t feel are healthy that the individual have their medical care insurance/bills be adjust based on their lifestyle impact on their health.
“…all kinds of fraud and abuse, in addition to invasion of privacy.” Your confidence in current patient privacy may not be as great as you want to believe. As best I can tell insurance companies get a detail accounting of all treatments each patient has done that they pay for. As an example if they pay for Metformin they will know and it is reasonable to believe that the patient has Type II diabetes. If it is Lipitor then best guess is a cholesterol problem.
Does your logic say that we shouldn’t try something because it is open to fraud and abuse? Then what should we do with programs that have an established history of fraud and abuse in the Billions of dollars such as Medicare/Medicaid, Social security?
“You want to extend drug testing...” I have said nothing about drug testing. I simply offer what the government and the courts have established.
“What medical conditions would be grounds for termination?” The case was a truck driver with untreated high BP that was sufficient to cause him to pass out while driving. You may feel that was an invasion of privacy, but it seems his infringement on public safety was deemed a greater concern.
“A person might be diagnosed with cancer...would the be terminated?”You seem to straying into areas I never mentioned. The issue was privacy related to adjusting policy holders’ lifestyle practices impacting their health, no place have I suggested any type of termination from insurance coverage.
“I might not have anything against a flat tax, but what are you going to tax flatly?” As best I can recall I never said anything about flat tax, only commented on manipulation of taxes to induce desired activities. I don’t oppose income, sales, or property taxes, or fee for services, or penalties for violations of the laws as revenue generators.
You do realize you're contradicting yourself here. "Think" about it. Also, you have a great way of dismissing expert opinion: "Being told what someone else says...." That's a great one!!!
"I have found that when an individual has to pay for something it has greater value, by paying government people are more attentive to how their money is spent."
Well, you're making my argument for me. If people are paying government (10% tax) when they buy cheeseburgers and chewing tobacco, they'll pay more attention to how their money is spent - both by themselves, and by government.
"As yet I haven’t heard a single cigarette or one every other month causes irreparable damage, does data show otherwise?"
Yes - well show me a "single dose" smoker, and you will have made your point. If you're interested in reading research on addiction, there is a huge body of work. You shouldn't have any trouble finding sources.
"I must admit I lean toward the AMA being a political organization rather than a consensus expert organization."
Of course, what else are you going to say? They disagree with your political ideology so they are political. Ever heard of JAMA? How many scientific journals do you suppose the AMA publishes?
"Based on the current political issue of 'health care reform' there seems to be a lack of unanimity of their members."
Yes, yes - a doctor I knew ridiculed the CDC and the WHO last fall, when H1N1 was being described as a pandemic. Turns out the research was right - as it generally tends to be. There is a difference between "unanimity" and "research". "Think" about it.
"I believe that government has a very important role in society, I believe in government regulations and their enforcement."
Yes, so do I - looking out for the "national interest" - things like the national economy, the national security. Those are the reasons for "regulations and their enforcement."
"However, I do not believe that they employ people individually or as a group that are smarter than all individuals or the general population."
Neither do individuals, who work for government. That's why they hold hearings - listen to experts.
"I have suggested that rather than a tax that abusers and conscientious users would have to pay on foods you don’t feel are healthy that the individual have their medical care insurance/bills be adjust based on their lifestyle impact on their health."
First, it has nothing to do with what "I feel" is healthy or not. Again, you dismiss research, evidence, science as just something that people have "feelings" about. That may be true for you, but it is utter nonsense.
Second, tying insurance premiums to individual health records - you mean like tying interest rates to individual credit histories? Insurance companies would have a field day with that. No - keep it simple. Just apply taxes to those things known to have a negative effect on the population's health, in general. Take the revenue and fund medicare with it.
"Your confidence in current patient privacy may not be as great as you want to believe."
You have a point. And I'd like to change that. There is absolutely no reason for insurance companies to have so much detailed information about patients. Let's get that insurance "bureaucrat" out of doctor-patient relationship!!!
"Does your logic say that we shouldn’t try something because it is open to fraud and abuse?"
No. We should fund enforcement.
"The case was a truck driver...."
There are other solutions to such cases. You don't have to make individual medical records "public" in order to address such situations. As a clinician, I had patients, from time to time, that presented a risk of pubic danger. I didn't have to disclose private health information to deal with it.
"You seem to straying into areas I never mentioned. The issue was privacy related to adjusting policy holders’ lifestyle practices impacting their health, no place have I suggested any type of termination from insurance coverage."
No. I mentioned it, because I've seen it happen. Once you disclose private health information - "confidential" information - you cannot control where it goes or how it is used.
"As best I can recall I never said anything about flat tax, only commented on manipulation of taxes to induce desired activities. I don’t oppose income, sales, or property taxes, or fee for services, or penalties for violations of the laws as revenue generators."
Well, that will have to be where you and I disagree. I think taxing products that have a known negative impact on public health is legitimate. All products and services are not equal. Government has a role in addressing national problems. Taxes are a tool.
“you have a great way of dismissing expert opinion:” I had a couple of teachers who said to learn you need to think through it and make it your own. I have heard we retain 10% of what read, 20% of what we hear, and 70-80% of what we do. In a high school science class we had to do experiments, gather data, to prove certain laws of physics. Doing those experiments was learning how the experts thought and developed those laws. That caused me to learn not memorize. This approach frustrated many teachers in school, but in work it was encouraged by the teachers my employer provided. You may feel that wanting to understand and learn the logic of experts is dismissing them, I feel it is the best way to learn, retain, and make it my own.
“If people are paying …they'll pay more attention to how their money is spent ...” NO, it just means it is more expensive. The point is if you don’t pay for something (no taxes) then it has no value. How much you pay may have an influence but it doesn’t change the attitude. You give a kid candy and they want more, you give a kid toys and they want more, make the kid pay and they have to choose. An addict has already chosen.
“well show me a "single dose" smoker” I had my only cigarette at 6 or 8, I had a few cigarillos at 22, none since.
“Ever heard of JAMA?” I have, do they do the research or do they report the research of others?
“a doctor I knew ridiculed the CDC and the WHO last fall, when H1N1 was being described as a pandemic.” I must admit my doctor doesn’t seem to feel that H1N1 is the equivalent of the influenza of near 100 years ago or even as severe to the public as the annual influenza’s. So is it a “pandemic” or is it milder than the annual flu (compare severest consequence)?
“listen to experts” Is an expert based on a set of academic credentials, proven superior performance, or what criteria?
“Again, you dismiss research, evidence, science as just something that people have "feelings" about.” NO, research has meaning that establishes explanations of specific predictors of future actions that are verifiable. I do not believe that statistical relationships are something to base public policy on. There are many studies of a 1000 people where one show people drinking so much coffee has a health problem while another study of a similar size population shows a health benefit. Neither describes any biological mechanism for their finding, but there are claims of good or bad health simply on the statistics. It comes down to which statistics you like and which population you choose. The proverbial “rocket scientist” wouldn’t use statistical relationships to send a man to the moon so why should we use it for public policy.
“tying insurance premiums to individual health records …” I had said it was about personal lifestyles on health and the choices the individual makes. Though I will admit I believe someone like Evil Knievel should pay a higher premium.
“…no reason for insurance companies to have so much detailed information …” Do you feel the insurance companies should simply write a blank check to the doctors and hospitals and never ask what it is spent on? I don’t my medical bill errors have been from the hospitals and doctors billing, I feel they should have at least accountability on the money they charge.
“You don't have to make individual medical records "public...” It only became public when the patient went to court.
“Taxes are a tool.” They are a good tool for gathering money. Ask any person wanting to reduce CO2 emissions whether the oil depletion allowance is a good tool, or ask any corn buyer if tax incentives for ethanol is good, or ask the Michigan Legislators if tax incentives for businesses to keep jobs here is working?
No - when you dismiss professional scientific organizations, like the AMA, as primarily political - that is dismissing experts. experts know things you don't, and in most instances, experts know what questions are important and which ones are not. You seem to find virtue in second-guessing expert opinion. I think it's fine to study an issue to the best of your ability in order to understand it. It's another thing entirely to pretend that you'll ever have the same level of understanding as a professional scientific organization.
"How much you pay may have an influence but it doesn’t change the attitude."
Well, with regard to youth smoking, research does not support your belief. Sorry.
"An addict has already chosen."
The "choice" to end an addiction is a complicated and extremely difficult one. People, who make that choice, do so most often in response to a change in the context of the addiction. Higher cost is one such change that is known to have an influence. Absent such influences, addicts generally do not "choose" to end an addiction.
"I had my only cigarette at 6 or 8, I had a few cigarillos at 22, none since."
Would you have described yourself as "a smoker"? I think not.
"I have (heard of JAMA), do they do the research or do they report the research of others?"
They publish research. They review it. They have standards that studies must meet in order to be published. They know the trends in research. They know what the body of research (evidence) supports. The AMA publishes several scientific journals. You think they don't know medicine?
"So is it a 'pandemic' or is it milder than the annual flu (compare severest consequence)?"
It is a pandemic. The severity of the disease really depends on whether you are in a high risk category. Pregnant women and women with young children are not feeling as calm about H1N1 as your physician's apparent attitude warrants.
"Is an expert based on a set of academic credentials, proven superior performance, or what criteria?"
I have said I look to professional scientific organizations. They know what the most up-to-date research indicates, and if they take a position, it is because the evidence is compelling.
"...research has meaning that establishes explanations of specific predictors of future actions that are verifiable. I do not believe that statistical relationships are something to base public policy on."
An incredible proportion of scientific research is based on statistics, which is valid for large numbers of events - a characteristic that is particularly useful in addressing a public, with a large number of individuals. Statistics is a very useful tool to advise public policy.
"It comes down to which statistics you like and which population you choose."
That's how the media sometimes portrays it - and how laymen often interpret it. That's exactly why expert opinion is important. Expert, in the body of professional scientific organizations, know which statistics matter, which populations are pertinent.
"The proverbial 'rocket scientist' wouldn’t use statistical relationships to send a man to the moon so why should we use it for public policy."
Please - study scientific method. The calculations used to send a man to the moon have been verified over and over and over via the same scientific method that advise public policy (if there ever is one) re: climate change, for example.
"Do you feel the insurance companies should simply write a blank check to the doctors and hospitals and never ask what it is spent on?"
Do you feel accountants have to have individual financial information on specific customers in order to audit a bank?
"I don’t my medical bill errors have been from the hospitals and doctors billing, I feel they should have at least accountability on the money they charge."
Surely, you review your own hospital/doctor bills, don't you?
"I had said it was about personal lifestyles on health and the choices the individual makes."
Yep - that's what you said. I disagree with how you'd approach it. I think it should be tied impersonally to products that are know to make people sice and injured. You avoid alot of complications that way.
"It only became public when the patient went to court."
Yep - that's how it's supposed to work. But like I said, in the real world, once confidential records leave a provider's office, there is no control over what happens to them. I don't care how many bright red stamps are used to indicate that the records are private, confidential medical records, not authorized to be forwarded beyond the specific recipient to whom they have been sent. It happens.
"They are a good tool for gathering money."
Good!!! Medicare needs money.
"Ask any person wanting to reduce CO2 emissions whether the oil depletion allowance is a good tool, or ask any corn buyer if tax incentives for ethanol is good, or ask the Michigan Legislators if tax incentives for businesses to keep jobs here is working?"
Taxes represent a tool. That is a separate fact from whether that tool is used well. Citing examples where you feel that tool has been used poorly is beside the point. Taxing tobacco, alcohol, (drugs if they are ever legalized), handguns and ammo, and adding a surcharge to moving traffic violations will work to diminish disease and injury, and it will create a fund for medical treatments of the remaining disease and injury.
Finally - I will remind you that disease management costs are going to continue to rise unless citizens - in large numbers - begin to take better care of their health. That is a national problem - a national emergency. While you may not want government to have the power to address a national emergency, I sure as hell don't want insurance companies to have that power - especially with a profit motive.
“No - when you dismiss professional scientific organizations, like the AMA, as primarily political” I don’t recall you describing how or why they came to their position, it seems you simply said they support your position. Why should I accept their position without knowing how they got there?
I believe that each person should participate in developing their own position on any activity whether it is political, medical treatment, personal relationship, if a religious choice.
“Higher cost is one such change that is known to have an influence.” And yet the only solution you promote is higher taxes.
“Would you have described yourself as "a smoker"? I think not.” When you said ““well show me a "single dose" smoker”” that seemed to mean that smoking a single cigarette was a single dose. How are you defining single dose; a whole pack or a whole carton? It gets back to research; why trust a research that prefers to change the parameters to fit the outcome they want rather than establish parameters before the research begins?
“Well, with regard to youth smoking, research does not support your belief.” How many kids do you think bought their first or even second taste of their drug of choice? My best guess is that those first tastes were gifts from a peers or family members. If so, then price doesn’t seem to be the issue. I lean toward the environment (peers, family) being the most significant factor in initial and continued use by children.
“The severity of the disease really depends on whether you are in a high risk category.” Are you saying this is an epidemic only for those at risk demographic or is a pandemic any virus that spread around the world, such as the flues that occur every year? If it the later then it would seem that we have a pandemic every flu season.
“they take a position, it is because the evidence is compelling.” So you don’t believe that they take positions simply because it benefits their members? The AMA support for the law passed to raise the payments to Medicare by hundreds of billions of dollar was not about politics but purely science based.
“Statistics is a very useful tool ...” It is a tool not the research. A statistical relationship is not a proof of anything unless there is a physical, chemical, biological prediction of the occurrence the data verifies.
“That's exactly why expert opinion is important.” Are you sure you meant “opinion’?
“The calculations used to send a man to the moon have been verified …” My best guess is that were physical laws such as that of gravity that were used in sending a man to the moon. What is the physical law that says drinking coffee is good or bad health?
“Do you feel accountants have to have individual financial information on specific customers in order to audit a bank” Your example doesn’t seem to fit as the auditor isn’t paying any bills. I would say that the accounting department that is paying a company’s bills should know what the company is buying.
“Surely, you review your own hospital/doctor bills, don't you?” Now you know how I know the rejects were due to the hospital errors.
“That is a national problem - a national emergency.”That is where we disagree you feel it is a national problem and is up to the nation to solve, I feel it is the individuals’ choices and only that individual can truly solve it. Using you experience; is it the addict or a national solution that stops the addiction? I know that the addict needs help, but without the addict making the choice can the addiction be eliminated?
Does the American Medical Association know anything about medical research? One would think, since the AMA publishes ten or eleven research journals.
"Why should I accept their position without knowing how they got there?"
Do you accept that anyone knows anything about anything that you don't? Do you really think you would know more about medicine than the American Medical Association? Would they really have to justify to you how they arrived at a position they cleary take? You're actually beginning to sound just argumentative.
"I believe that each person should participate in developing their own position on any activity...."
Sure. And part of developing that position is finding out what experts think about it. You don't do that. You just seem content with your own "beliefs".
"And yet the only solution you promote is higher taxes."
I think I answered that a couple of exchanges back. I answered that in many ways, actually.
"When you said 'well show me a 'single dose' smoker' that seemed to mean that smoking a single cigarette was a single dose."
What I meant is that you can't show me a single dose smoker, because there is no such thing. Smokers smoke several cigarettes per day - a pack, two packs, or more. You know this - you're splitting hairs to be argumentative. "Oh no," you'll say. "I'm just trying to learn...."
"...why trust a research that prefers to change the parameters to fit the outcome they want rather than establish parameters before the research begins?"
That's pretty absurd. Any other ridiculous charges?
"How many kids.... My best guess...price doesn’t seem to be.... I lean toward....
I'm sure you believe you're thinking things through, but what you're actually doing is making things up. But go do a study - have it repeated by qualified peers. See if you hypothesis is supported by anything, other than your own leanings.
"Are you saying this is an epidemic only for those at risk demographic or is a pandemic...?"
Pandemic
"So you don’t believe that they take positions simply because it benefits their members?"
Depends on the issue. You think that's the only reason they take a position? What would AMA member benefit have to do with raising taxes on tobacco - or any other product that makes the general population sick or injured?
"My best guess is that were physical laws...."
And do you think physical laws are ever verified - or do you think someone like Einstein just thinks them up, and they just "make sense"?
"It is a tool not the research. A statistical relationship is not a proof of anything unless there is a physical, chemical, biological prediction of the occurrence the data verifies."
It make sense that you don't look to science to help in the formation of your "beliefs". You don't have a clue about how science functions. Statistical relationships are the verification - by definition. If data is not statistically significant, an hypothesis is not supported. And btw, nothing is ever proved in science. Something is supported by evidence or it is not. That's all. Even gravity continues to be studied.
"What is the physical law that says drinking coffee is good or bad health?"
Physics is not biology or physiology. You have to use the appropriate branch of science when asking such a question.
"Your example doesn’t seem to fit as the auditor isn’t paying any bills."
No, but the auditor is performing a task in service of accountability. That was your question. An insurance bureaucrat has no place in the doctor-patient relationship. The accounting function is the same.
"Now you know how I know the rejects were due to the hospital errors."
Then, obviously, you don't need an insurance company bureaucrat doing that for you.
"That is where we disagree you feel it is a national problem and is up to the nation to solve, I feel it is the individuals’ choices and only that individual can truly solve it."
You're right - we really do disagree about it. The nation's economy is significantly affected by the failure of our disease management system. Waiting for individual citizens to all have an enlightening moment, in which they all realize that they are all partly responsible for the health of the national economy - well, this is why I believe your political philosophy is inept.
"...is it the addict or a national solution that stops the addiction?"
The addict responds to contexts. When it becomes more costly to maintain an addiction than to continue it, addicts often (not always) seek treatment. Affecting the context is something governments can do at all levels - and they do. So do families, employers and governments all affect the context.
I believe almost everyone knows more about something than I do and many much more about everything. I am at best normal in my mental capacities. What I try to stress, is that rather than simply defer to someone else what I should say or accept I want to try to learn from their reasoning, how they got there, so I can defend the point of view rather keep saying someone else said.
“You just seem content with your own "beliefs".” I am never content, that is why I am asking how others got to their conclusions and that is why I describe why I take my position. I want people to cause me to think.
“You know this - you're splitting hairs to be argumentative.” You call it splitting hairs and yet that is the principle of laws such as the “health care reform”. The letter of the law is what lasts so everyone doesn’t say what they want it to be and would know what to expect. How many AMA members mean a single dose when they say a single dose?
“do you think someone like Einstein just thinks them up, and they just "make sense"?” Yes, his concepts weren’t laws until several scientists verified them. Every physical law started as a concept/idea, and then through experiments it is verified before it became an acceptable law of science.
“No, but the auditor is performing a task in service of accountability. That was your question.” I am not sure you understand the function of an auditor; it is to verify that practices conform to protocols/laws. They have nothing to do with payments. Insurance companies are paying the bills.
“An insurance bureaucrat has no place in the doctor-patient relationship.” At best the “public option” is simply trading private insurance bureaucrats for government ones. It seems that Medicare only pays for certain treatments and will deny those not covered, that seems like the insurance companies. Oh, if the politicians think they need money for something else they simply write a new that cuts hundreds of billions from Medicare and let the patients pick up the difference. At least with my insurance company I know from year to yeas what they will cover.
“The nation's economy is significantly affected by the failure of our disease management system.” What disease, personal lifestyle choices or pandemics?
Problem is that you never seem to reach a point where reasonable explanations suffice.
"...that is why I am asking how others got to their conclusions...."
And when it's been explained, you find something else to question - something more peripheral to the issue.
"The letter of the law is what lasts so everyone doesn’t say what they want it to be and would know what to expect. How many AMA members mean a single dose when they say a single dose?"
I have no idea what your point is, or what it is you're asking.
"(Einstein's) concepts weren’t laws until several scientists verified them."
Very good. Verification is synonymous with science. Verification is done through repeated observation and/or experimentation.
"I am not sure you understand the function of an auditor; it is to verify that practices conform to protocols/laws. They have nothing to do with payments. Insurance companies are paying the bills."
No. I understand this very well. The insurance company's relationship is with the policy holder - not the doctor or hospital. If they make direct payments to doctors/hospitals, it is a matter of convenience. But it is you, who has the relationship with the insurance company. In recent years, managed care practice has distorted this, and that is the point where I disagree with you. The insurance company does not belong in the doctor/patient relationship. Those lines need clarification. The insurance company's role with the doctor/hospital is nothing more than an auditor's role.
"At best the 'public option' is simply trading private insurance bureaucrats for government ones.
Over my career, especially in later years, I spent untold hours on the phone with insurance clerks, trying to "justify" treatments. Not once did I ever have to talk with a government clerk for such a purpose. Not once. Your belief here is absolutely and totally false.
"It seems that Medicare only pays for certain treatments and will deny those not covered, that seems like the insurance companies."
It seems...it seems...it seems.... Again, your beliefs are contradicted by my experience. Off hand, I don't recall one time that Medicare denied payment for any treatment. There may be other complaints agains Medicare, but that's not one of them.
"...if the politicians think they need money for something else they simply write a new that cuts hundreds of billions from Medicare and let the patients pick up the difference."
That's a legitimate criticism - or at least I agree with it. Even I would not favor the taxes I propose, unless it is absolutely locked down that the revenue would be used exclusively - no if's, and's or but's - for Medicare and/or the public option program (whatever that ends up being).
"At least with my insurance company I know from year to yeas what they will cover."
You're living in a fantasy, if you think that's true. What they cover can change at any time. How much they charge can change at any time. Whether they cover you at all can change at any time. Since you like to ask questions, maybe this is the area you should be focusing on. I think some of the answers may shock you.
"What disease, personal lifestyle choices or pandemics?"
Disease management system (aka "health care system", which it is not. It is a "disease management system). It costs the economy 16+% GDP. That is growing, and will continue to grow. It is a national problem. You have no means of addressing it, except hoping people will "wake up" and begin to take care of their health - or opening medical records to the insurance companies, so that they can charge premiums on lab results, like the credit card companies charge interest rates on credit histories. That will not result in people getting healthier (on average). It will result in higher costs and greater insurance industry profits.
“Problem is that you never seem to reach a point where reasonable explanations suffice.” I have learned there is one of two reasons for a person is not grasping the others points of discussion (not necessarily agreeing), lack of ability (that has proven very rare) or the position isn’t frame properly for the situation. The latter can be slowed by the presenter being unwilling to approach the discussion in new ways or the audience is unwilling to consider a new perspective. Most likely I simply in this discussion I lack the ability to accept the idea that taxes is the sole way for a person to alter the choices they make.
“I have no idea what your point is, or what it is you're asking.” “Splitting hairs” is the equivalent of adhering to the “letter of the law”, you seem to feel that “splitting hairs” is simply an inconvenience for an answer to your challenge. That suggests you wouldn’t adhere to the “letter of the law” if it weren’t inconvenient. You might even prefer researchers that changes the experiment until they get the answer they want.
“The insurance company's relationship is with the policy holder - not the doctor or hospital.” Let me offer an example that we received in the mail today. Both my wife and I have annual physicals which include routine blood work that our family doctor requests. Today we received a bill (rejected by the insurance company) for $500 over the normal cost of the blood work. Upon review of the rejected bill we found that the charge was for a hospital physician reviewing the analysis, (the lab is a side business of the hospital). As part of our annual physical out doctor reviews the lab work and discuss the results with us. In this case the blood profiles were with the normal parameters. The insurance company was correct in rejecting the charge and after talking with them they are pursuing it be removed. If the insurance company would simply pay every bill without knowing what it was for, in this case they hospital would have been paid for charging for work that was at best never requested and even worse work that was never done. Do you think the “public options” should blindly pay every bill submitted (especially when you are so opposed to fraud and abuse)?
It is me and my doctors that decide on my care not the insurance company, they simply manage the payments and conformance to our contract.
“Your belief here is absolutely and totally false.” Which belief, I have offered many?
“Off hand, I don't recall one time that Medicare denied payment for any treatment.” I am glad you have had such a good experience.
“It costs the economy 16+% GDP.” I am curious why paying 16+% of GDP is so bad. What else should we be spending on? When medical care was “affordable” we paid the bulk of our earning on food, shelter, clothes and transportation. Today the shelter is much much bigger but we are encouraged to pay a higher portion of our income on it, food is better and less expensive than ever, clothing lasts longer but more is spent on style that need, transportations is cheaper than ever, and medical treatment provides treatments that were never conceived when it was “affordable”.
When I was young there was not medical treatment that could cost a million dollars and today that doesn’t surprise anyone. Why shouldn’t we pay more for medical care that is so superior to what we have ever had? Why should we expect that the percentage paid for health care be shrinking when the cost of all other necessities is shrinking?
And that was never said, even though you insist on continuing to "strawman" that point.
"'Splitting hairs' is the equivalent of adhering to the 'letter of the law', you seem to feel that 'splitting hairs' is simply an inconvenience for an answer to your challenge."
Actually, my "splitting hairs" comment has nothing to do with law or any "challenge". It has to do with your apparent ignornance of what addiction or habitual use of a substance is - by definition.
"You might even prefer researchers that changes the experiment until they get the answer they want."
More ignorance of scientific method.
"Let me offer an example that we received in the mail today. Both my wife and I have annual physicals...."
I understand how the situation is. That's why I challenge it. Are you telling me that you are not capable of understanding a hospital bill? A doctor's bill? Why do you need an insurance company to check your charges?
"Do you think the 'public options' should blindly pay every bill submitted (especially when you are so opposed to fraud and abuse)?"
Actually, what I think is that insurance companies and government programs (Medicare, VA, public option) should require patients to validate the charges before paying, and that the check sent to doctors and hosptals should be co-signed by the patient.
"It is me and my doctors that decide on my care not the insurance company, they simply manage the payments and conformance to our contract."
Either you're living in a fantasy, or you've been extremely lucky. Insurance companies are notorious for denying payment - even for treatments they have certified. They look for loopholes. I know. I personally had to fight my insurance company for two years before they paid for a treatment they had "pre-certified". I also spent hundreds of hours on the telephone with insurance clerks trying to justify certifications for services to my patients.
"Which belief, I have offered many?"
You're going to have to refer back to the previous comments. It is true, you have offered many beliefs. In fact, that's about all you've offered.
"I am glad you have had such a good experience."
You should do a study. Interview at least thirty doctors. Compare the following: Did they spend more time on the phone with insurance companies or with medicare? Were their charges denied more by insurance companies or by medicare? Let me know what you find out.
"I am curious why paying 16+% of GDP is so bad. What else should we be spending on?"
You continue to impress me with how little you understand about this issue. Don't ask this question too loudly in public settings or social gatherings.
But the main thing is that your question completely misses the point - the original point of my suggestion that taxes should be used in reference to those products that make us sick and injured.
"When medical care was 'affordable' we paid the bulk of our earning on...."
At the time you're referencing, people went to hosptals to die - not be "treated". Life expenctancy was what? 55?
"...food is better and less expensive than ever...."
No doubt, another of your beliefs. "Food" today is very poor quality. Do you not read anything?
"When I was young there was not medical treatment that could cost a million dollars and today that doesn’t surprise anyone. Why shouldn’t we pay more for medical care that is so superior to what we have ever had?"
Here's the point. I started with it, but you seem to have become totally confused. Andrew Weil, M.D. has said that regardless of the "reforms" enacted, health care costs (actually, disease management costs) are going to continue to rise, given the current health of the average citizen. What is needed, Dr. Weil says, is a healthier public, and a medical infrastructure that is at least as interested in preventive medicine as remedial treatments. Treatments do not have to be so expensive, either, according to Dr. Weil, and he asserts that medical training has to begin teaching doctors new methods, outside the pharmaceutical and surgical arenas. My suggestion - to tax those products that make people sick and injured (as well as incentivizing products/activity that contributes to health) - is designed exactly to bring down those rising disease management costs (16+% GDP). So to answer your question - why shouldn't we be paying that much for disease management - the answer is simple: because we don't have to.
In my limited experience a “strawman” is offer to trigger or focus a discussion and once then discussion has begun then the “strawman” is replaced by specifics. Your “strawman” seems to be a one trick pony, tax.
You asked for an example of a “single dose smoker”, I gave one, you didn’t accept it so you complained about “splitting hairs”. “What I meant … a single dose smoker, because there is no such thing.” .So it is what you mean and not what you say that I should respond to?
“Are you telling me that you are not capable of understanding a hospital bill?” The bills we get are simply a general reference to what was done and a gross amount. The detailed and coded bill is sent to insurance company. When they find exceptions to the coverage they let us know and we do the research to determine what the problem is.
It would be interesting if the hospitals and government would apply Deming’s statistical approach to removing errors (as the Japanese did for cars) or the Six Sigma approach to improving their systems.
“should require patients to validate the charges before paying, …” I like that approach and would even offer as a consequence a onetime reduction in their insurance premium for each error the patient found (say 1% paid by the billing organization).
“Insurance companies are notorious for denying payment - even for treatments they have certified.” Denying payment is normally after the treatment has been given. Did you have to wait the two years for the treatment?
“In fact, that's about all you've offered.” Why shouldn’t I offer what I believe? When I say I believe something, I take full responsibility for what I have said and place no blame or responsibility to others what I say or do.
As good as you feel Medicare is, have you ever wondered why there are more and more doctors who are not accepting Medicare patients?
When people use % of GDP they are placing it in relative terms. A rise in medical cost relative to GDP can be due to the medical care cost rising (for many reasons) or it can be other elements (such as food) are going down.
“"Food" today is very poor quality. Do you not read anything?” If food is of such poor quality, medical care is so dismal, and peoples lifestyles are so damaging, I can’t figure out why we are living longer, growing taller and more robust, and why we are so much more active in our later years.
Are any of Dr Weil’s issues being addressed in the “health care reform”? If the legislation that has passed the House isn’t addressing those issues of Dr. Weil’s then why should we expect the cost of medical care even be slowed? I would be very supportive of legislation that addressed the health issues, hospital performance reporting, medical program/treatment effectiveness reporting, even tort reform, and all of the points Dr. Weil raises.
“So to answer your question …: because we don't have to.” There are a lot of things in life that we don’t have to do but we choose to.
The reality is there are 4 elements to medical care; quality of care, access to care, improving care, and cost of care. Choose 3 out of the 4 you cannot control all four. There are 3 elements to personal health; lifestyle, genetics, and medical care. As of today there are only 2 that each person has influence over.
Response:
Duane: "As yet I haven’t heard a single cigarette or one every other month causes irreparable damage, does data show otherwise?"
Steve: "Yes - well show me a 'single dose' smoker, and you will have made your point. If you're interested in reading research on addiction, there is a huge body of work."
Duane: "I had my only cigarette at 6 or 8, I had a few cigarillos at 22, none since."
Steve: "Would you have described yourself as 'a smoker'? I think not."
Duane: "When you said 'well show me a 'single dose' smoker' that seemed to mean that smoking a single cigarette was a single dose. How are you defining single dose...."
NOTE: The important definition is not "single dose", but "smoker". Do you think that a single cigarette, or even a few cigarettes, defines one as being a "smoker"?
Of course, a single episode of smoking is highly unlikely, by itself, to pose serious health risks. But that is not the point, is it? The point is addiction, which your focus on "single dose" completely ignores. That is "splitting hairs" in order to avoid the real point - over 400,000 people die in this country annually, due to tobacco products. Single dose had nothing to do with it, because by definition, addicts are chronic users.
Now, what other irrelevant "question" do you have about this otherwise very straight-forward phenomenon?
I'm not commenting on how things are presently. I'm commenting on what needs to change. If you do not get an itemized bill from your doctor/hospital, you need to ask for one.
"Did you have to wait the two years for the treatment?"
No. The treatment was "pre-certified", which means "authorized". It was after the fact that the insurance company denied payment for the treatment they authorized. It is a very common shell-game the industry plays.
"Why shouldn’t I offer what I believe?"
I don't care if you state your beliefs. It's when you dismiss research, or attribute ill motivations to researchers, when research results contradict your beliefs - that's the problem. In other words, you have quite a bit of unjustified confidence in your opinions.
"...have you ever wondered why there are more and more doctors who are not accepting Medicare patients?"
I know exactly why doctors refuse to take medicare, and it has nothing to do with the issue being discussed. It has to do with reimbursement rates.
"A rise in medical cost relative to GDP can be due to the medical care cost rising (for many reasons) or it can be other elements (such as food) are going down."
So, you're saying that health care costs aren't really rising? - that it's just a mirage, relative to dropping food prices (which haven't been dropping, btw)?
"If food is of such poor quality..."
Here we go. These little sound-bytes have been around for at least a decade. Do you ever read anything?
Food is full of harmones and antibiotics, and treated with artificial fertilizers and pesticides. When was the last time you ate a real tomato?
"...medical care is so dismal..."
Actually, I didn't say that. I said it is expensive, and increasingly so. I said it is biased toward pharmaceuticals and surgery, when other preventive measures and less expensive treatments are as effective. I said that a preventive approach is warranted because it is less expensive. I said that "health care" is preferable to "disease management". Why do you misrepresent as rhetorical technique?
"...and peoples lifestyles are so damaging,"
I guess you don't "believe" in the incidence of heart disease, cancer, obesity, diabetes, asthama, etc.
"I can’t figure out why we are living longer,"
Treatments are advanced (and expensive), and life expectancy statistics are skewed by improved infant mortality rates.
"...growing taller and more robust..."
Growth harmones in the food supply.
"...and why we are so much more active in our later years."
Those, who have taken some reasonable care of themselves, that is. I haven't checked lately on the stats for joint replacements, open heart surgeries, etc. Have you?
I mentioned Dr. Weil's view of this above. Are you disagreeing with his assessement of the status of our disease management system?