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Hrms. I'm not 100% convinced, but the points you guys bring up is why my post originally hedged my bets and said the area was somewhat murky.

Frex, the power you reference says:

Venomous Bloodfang wrote:
Hit: 1[W] + Strength, Dexterity, or Constitution damage + 2d6 necrotic damage. You regain hit points equal to twice the necrotic damage you dealt.

It would seem like all of the damage is necrotic, although the second line explicitly calling out the necrotic damage seems weirdly worded in that case ...

More generally, I *think* the errata that changed Vulnerability/Resistance to how they currently work with re: to greater than one damage type also changed how powers with more than one damage type worked. I'll try to look it up when I get home ...

I fully admit I could be wrong though! So maybe you shouldn't listen to the bug headed guy. :P

Galdor the Great wrote:

2. Are there any mechanical advantages specific to the wizard class for having a high dexterity or widsom other than those listed below?

- DEX: bonus to Wand of Accuracy
- WIS: bonus to Ord of Imposition and push distance for Thunderwave

3. If a Deva uses the Radiant Power feat [PHB2 p.188], does the power acquire the Radiant keyword for purposes of damage resistance & vulnerability? If so, would a foe's Radiant resistance work only against the +2 radiant damage granted by the Radiant Power feat or against the total amount of damage caused by the power used?

Thank you.

2. Off the top of my head: None really, if you want to really delve down to Wizard-specific benefits. There may be a Wizard feat or two that has a Dex or Wis prereq, but the class itself largely doesn't use those scores.

More generally, of course, Dex affects your Init and many skills, while Wis gives Will defense and, again, many skills. On top of that, lots of feats will feature one or both as prereqs; not all will be feats Wizards are interested in, but at least some are.

3. Firstly, Resistance and Vulnerability key of damage types, not keywords, so whether or not the Radiant keyword is added by the feat is tangential to the question; a creature with Radiant Resistance/Vulnerability is always affected if the damage is typed as Radiant.

As to the second part, the rules don't really support the concept of "X blah damage and Y bleh damage"; by default damage is generally considered to have ALL of the types of its constituent parts. Notice that a creature can only utilize its Resistance if it is Resistant to ALL of the damage types a source of damage possesses.

Thus, any applicable Radiant Resistance would apply to all of the damage from the attack, not just the bonus Radiant damage provided by the feat. It seems like a bum deal, but unless you are turning otherwise untyped attacks into Radiant attacks and then using them on Radiant Resistant creatures, you should never actually make your attack more Resistible.

Some people happen to enjoy infinite oregano in their food, I'll have you know!

pres man wrote:

Problem is, you are talking to the wrong people here. You need to go and talk to people like Rep. Frank. If you see some more of that video of him talking while walking he tells the interviewer that he is doing more to get to a single payer by pushing the government option then those people that are pushing for a single payer directly. So please go clear things up with Rep. Frank and others like him. Once everyone understands it on both sides, then things will be good.

Lol, point taken. I'll certainly concede that in many ways the Democrats have badly bungled how the entire health care reform package has been sold. Sadly, perhaps, message discipline has never been a trait for my "side".

Part of the problem, I think, is talked about here. I want single-payer, I've admitted it many times. It is understandable that some may see me saying that the current reform isn't single-payer but that I still favor it and assume I'm simply lying. I'd call that cynical, but it isn't wholly irrational.

Another part is, in some ways, that he IS doing work towards single-payer by advancing the public option. It isn't that the public option will lead to single-payer, but if it is popular and successful it would certainly make it easier for single-payer to pass someday. Of course, if it is a terrible idea that crashes and burns, it'll make single-payer dead in this country for at least a generation or two, if not more.

If I were the one selling the reform I'd hammer on the eight points which I posted earlier, since those are the ones that will affect the most people. The other changes will have far more beneficial affects on people's lives, but only for a much smaller share of the population, and predominantly among a share that isn't known for being very politically active. I suppose, however, that you advocate for legislation with the politicians you have, not the politicians you want, right?

The idea that health care in the socialized countries is less than what we receive here is laughable, as is the idea that the government bureaucracies are more inefficient or expensive. From the link I gave in my last post:

Five Myths About Health Care in the Rest of the World wrote:

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Go read the link, you'll like it.

pres, thanks for the transcript (although of course, I didn't see it until I got home anyway). My response would be that you're misconstruing what is being said here. Eliminating employer based health care does not have anything to do with the creation of a single payer system. A system could exist (and does, if I understand Switzerland's system correctly) where no one receives health insurance from their employer but still purchases private health insurance for themselves.

Employer based health care is a really bad idea, and we only have it by accident. Weaning ourselves off of this system is important, but people are naturally attached to a system so rooted in our system. This is wholly tangential to single payer though.

Glad I could clear that up. :)

Regarding wait times, even they aren't inherent to government health care. Try this link out.

Here's a little taste:

Five Myths About Health Care in the Rest of the World wrote:
In Japan, waiting times are so short that most patients don’t bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. “Why don’t you just drop by?” the receptionist said. That same afternoon, I was in the surgeon’s office. Dr. Nakamichi recommended an operation. “When could we do it?” I asked. The doctor checked his computer and said, “Tomorrow would be pretty difficult. Perhaps some day next week?”

Have I mentioned we pay 50% more per person than the Japanese do? And they have universal coverage? And better outcomes?

I mentioned earlier about how one of the more quixotic effects of our terrible health care system is that it is sometimes better to bankrupt yourself so that you can qualify for health care: This story reflects that precisely.

Jeremy Mac Donald wrote:

This whole thing seems like foolishness. If Catholic hospitals are a major player in the system then write something into the legislation exempting them from having to provide abortions. In fact even that is probably not necessary.

As it stands no system is going to have it so that every hospital can provide every service - thats just not possible even for things that are not political hot potatoes. If one needs a service that hospital X does not provide then you go to hospital Y. If these hospitals don't hire people capable of doing abortions and don't install the facilities for doing them then people who want abortions will go to places that do in fact have such facilities. Same deal with cancer if hospital X does not have a cancer ward then people have to use hospital Y.

This whole thing is wholly tangential to current health care reforms, but that said:

The whole problem is in some areas of America, finding a place that will perform abortions can be very difficult to do. South Dakota, for example, only has one in the entire state.

That said, the government is not allowed to spend any public money on providing abortions, and nothing in the current health care reform would change that status of that law.

pres man wrote:
My guess is the thinking is due to statements like this.

Sorry pres, youtube is blocked here at work (shh, don't tell on me.) Transcript? Description? Anyone?

I'll try to remember to watch this when I get home and see if I can respond for you ...

Aberzombie wrote:

Once again, for your reading pleasure:

The History of the Public Option

My zomblee friend, I'm not sure that it is much of a secret that the public option is a compromise between what most liberals truly would like with what conservatives want. Our system is broken and we want reform, even if that means having to accept something other than the best possible outcome. Don't let the perfect become the enemy of the good, and all that.

The larger the pool of payees into an insurance system the better. Think of the Fire Department. Everyone pays taxes to supply their Fire Department, even though most people will never have a house burn down on them. The "free" money from those people helps make sure the Fire Department has enough money to handle the property of those people who do have fires. The larger the base of people paying into the system, the more risk can be diluted and spread over all of them.

Patrick Curtin wrote:

I'll be obligated. I'll have no choice. My employer will drop me like a hot potato once a public option is available. Ah well, I'll have more money for Paizo goodies, right? Why worry about tomorrrow when people are sick today! I've got a gold card with a $20,000 credit limit, as long as I can pay the minimum I can live like a king! ... For a while ...

Also, I LIVE in Massachusetts. I see on the ground what is going on in this state. That article you linked misrepresented the numbers. The $88 mil cost is the annual increase. There's also a lot of unintended consequences. Our state is being kept afloat by stimulus money, a federal 'bailout' if you will. We still had to increase our sales tax by 25%. Almost everyone my age or younger has left the state for states down South. Many business have fled as well. Tax revenues are down despite massive tax hikes. Yet I am stuck here because of family healthcare issues. Ironic, no?

Again, I'd say don't go away. But anyhow, even IF your employer drops your job based health care, that still doesn't mean you'll be forced onto the public option. It's an option, one of many plans that will be available through the public exchanges. You will still be 100% free to choose a private plan if you would so want. Would a chart help? Have a chart.

As for the Massachusetts angle, I would assume the Bostonian journalists also live there as well. Most states (all of them?) are being kept afloat because of Federal stimulus money, as tax revenues are down everywhere (recessions suck, ya know?) I wouldn't expect Massachusetts to be any more immune to those macroeconomic trends than any other state.

pres man wrote:
David Marks wrote:
Sorry David, I wasn't as clear as I could have been. I mean if you don't want the public option in the plan, then you are being told to shut up, even if you want other things that are in the plan. Hopefully that clears up the confusion.

Your posts do seem to confuse me more than others pres. I think it is your short stature and inexplicable hammer wielding that does it. :P

Thanks for the clarification. :)

From the Demonization thread:

pres man wrote:

Which just happen to be national issues ...

And actually I do not. I often times like some of the Dems ideas, but not all of them. Unfortunately in politics you either get the whole thing or nothing. Take the healthcare debate. I support the idea of covering all americans but I don't want to see a government insurance program. Instead I want to see mandatory issurance. The National Dems don't want that idea, either take the government insurance or shut up. It is not me who is not open.

Pres, I believe current health care reform does have a mandate for health care insurance (I assume that is what you were saying). I'm not sure where you have the idea that you take the government insurance or shut up; the current proposal simply creates a public health insurance plan that those buying health care on the individual market can choose. There will be many (MANY!) more private insurance plans, and they will cover many (MANY!) more individuals.

Kirth Gersen wrote:

Have those "geniuses" in Washington decided that a Swiss-style system (private care, privately managed but held to a government-mandated system of uniform regulation) cannot work? If the Dems have taken that off the table (as maybe a workable compromise), then more fool them. One party is as bad as the other.

While the Swiss system is currently completely private, with government mandates and regulations, my understanding is that at its outset, it looked much like the current proposals in Congress, including a public health insurance plan. It was only recently that they dismantled their public plan when it became obvious it was no longer needed.

Kirth Gersen wrote:

Have those "geniuses" in Washington decided that a Swiss-style system (private care, privately managed but held to a government-mandated system of uniform regulation) cannot work? If the Dems have taken that off the table (as maybe a workable compromise), then more fool them. One party is as bad as the other.

While the Swiss system is currently completely private, with government mandates and regulations, my understanding is that at its outset, it looked much like the current proposals in Congress, including a public health insurance plan. It was only recently that they dismantled their public plan when it became obvious it was no longer needed.

Edit: This post, and my last one, rightly belong in the health care thread, and not this one. I'm going to copy them over, pres and Kirth, and will try to only post future responses here.

pres man wrote:

Which just happen to be national issues ...

And actually I do not. I often times like some of the Dems ideas, but not all of them. Unfortunately in politics you either get the whole thing or nothing. Take the healthcare debate. I support the idea of covering all americans but I don't want to see a government insurance program. Instead I want to see mandatory issurance. The National Dems don't want that idea, either take the government insurance or shut up. It is not me who is not open.

Pres, I believe current health care reform does have a mandate for health care insurance (I assume that is what you were saying). I'm not sure where you have the idea that you take the government insurance or shut up; the current proposal simply creates a public health insurance plan that those buying health care on the individual market can choose. There will be many (MANY!) more private insurance plans, and they will cover many (MANY!) more individuals.

David Fryer wrote:

Never mind of course that, as was mentioned earlier in the thread, that 60% of those who are currently uninsured are already eligable for coverage under existing government insurance programs, and that, according to the President, another 6% would not be covered because of the immigration status. Of those that are left, many of those are uninsured by choice because they believe they have better things to spend ther money on. Also ignore the fact that for all the stated efficency of Medicare, it is millions, if not billions, of dollars in debt right now.

While some people may go without health insurance by choice, I'm sure many more choose to go without simply because our individual insurance market is horribly, horrendously broken.

Anyway, we already guarantee treatment at an ER, which is terribly expensive, inflicting even more financial damage on those who are already having trouble, as well as costing the hospitals money for treatment they never get payment for. Mandatory health insurance would help alleviate both of these issues, and the increased risk pool would help drive down the costs for those who already have insurance. Seems like a good deal to me. (obviously, duh)

Patrick, I accept that in some arguments the sides have to agree to disagree. No hard feelings chum, as far as health care debates go, you're relatively rational compared to others on the "anti" side I've talked with. Perhaps it is because you at least recognize that some measure of reform is needed, even if you don't quite like the current proposals.

A few things (hopefully you're still reading):

First, several insurance companies ARE non-profit. A good public option would grant us more than simple non-profit status though. Because it would automatically conform to all of the regulations currently being proposed (I've listed them before, will re-list at request) it will give a competitive incentive to the other private insurance plans to also institute the regulations. What does this mean? It means less will have to be spent on enforcing the new regulations, since the private insurance companies will have an incentive to adopt them.

Second, this quote:

Patrick Curtin wrote:
EDIT: I also think that if Congress and President Obama feel their health insurance will be so great that they should be obligated to participate in it, giving up the nice plan they enjoy as a perk ATM. But, we know how that goes.

suggests you STILL aren't really getting what the current health care proposals are about.

First, no one will be obligated to participate in the public health plan. It will simply be an option (note how it is always called the public option?) along with many (MANY!) more private plans. Anyone in the public option will be so because they chose to be there, for whatever reason.

Second, the option is there only for people buying health care in the individual insurance market (the health care exchange being proposed). People who get employer based health care won't have it open to them, and other than having their health care regulated (again, eight points, listed earlier) won't see any effect here.

Finally, I've seen some talk about Massachusetts thrown around here. This link dispels some of the characterizations of how the system is currently doing. For those who don't want to bother clicking, here's the tl;dr for you.

It worked. It has been a success. If national health-care reform has a similar effect, it will be wildly successful.

pres man wrote:

Sorry for the confusion, it wasn't a comparison. It was a response to the claim "I'm not sure I've ever seen a median or mode reported for any real world purposes." I was pointing out a place where it is used in a real world purpose. Again, sorry for the confusion.

Ah, ok then. Yes, good point, housing prices hadn't occurred to me as such an instance.

pres man wrote:

I think the US allows greater access to much more expensive procedures then some of the other countries. This will of course in flat the average cost.

Perhaps, perhaps not. If we do though, why don't we see better results than countries that supposedly do not? I'd say part of this goes into why some kind of comparative effectiveness study is a good thing, and something that will hopefully be set up.

Secondly, do you think the inflation from expensive procedures theoretically unavailable in other countries makes up for the population of people who don't have any access to health care and thus deflate the average by spending $0 on it? Recall that the other countries we're talking about do not have any citizens not covered, so no one spends $0 on health care a year ...

pres man wrote:

Except without the mandatory health insurance for everyone, forcing companies to take on additional risk is a pretty bad idea. Like I said, the mandatory insurance for adults is something Obama can't publicly support without seeming as either a flip-flopper or a liar. In either case, he'll lose whatever political capital he has remaining.

The bills under review now require mandatory health insurance. As for whether or not Obama has called for it, I'm not sure, but he's largely not the one writing the bills in Congress either. I'm confused as to what you're trying to say here.

More thoughts on tort reform.

Part II (I posted Part I earlier) and Part III.

Aberzombie wrote:

I found this piece by Charles Krauthammer to be interesting.

Let’s Be Honest about Death Counseling

I read that this morning in the paper. Wow, does that guy give bad advice.

Warning to everyone: don't write a living will and just assume doctors won't follow it, as Mr. Krauthammer seems to imply. If you have a legitimate signed and notarized living will, doctors WILL follow it. This isn't a toy to play around with.

Secondly though, we can see the gradual changing of the death panel lie here. Sure, they may not be death panels NOW. But maybe they'll be death panels later, am I right? Of course, the doctor has no reason to favor one kind of end result or another; they are being paid for providing couseling, not for advising you to deny treatment. He's just pulling things from nowhere.

Patrick Curtin wrote:

And I understand your point David, and I recognize that the way Americans receive health care is flawed. We just have differing ideas on what is the best way to go about fixing it. I join these debates to learn things and challenge my assumptions. Since starting in on trying to keep up with the debates, I have been made aware of the co-op model of health care insurance...

...Government bureaucracies may start small and lean, but they never stay that way. Waste and bloat come over time with them like cats having kittens. Also, there is the real underlying issue of how to pay for all this. Government is not some separate entity sitting on a dragon hoard of gold. Government is you and me. The money it collects comes from us, or it borrows it from other governments. We are running our country like a college kid with a pre-approved gold card. The bill comes due sometime, but instead of our parents having to pay it, our children will. I find that horrific. Leveraging our needs on the backs of our children is a scummy way to do business.

Unfortunately, we have no options when it comes to government, except to vote every two years. Even then, if you live in a state antithetical to your politics, you're shouting into the storm. Especially if you support a third-party, which is frequently mocked as foolish. But at least we have some semblance of choice, which is more than most governments around the world can say ...

The problem with co-ops is that they will largely lack the ability of a public option to use market leverage to bargain for lower prices. The big problem, though, is that the co-op idea was designed to be a compromise between those advocating the public option and those against. Ignore that the public option itself was designed to be a compromise between those advocating single-payer and those against. Instead, notice that when support for the public option began to waver, already those against reform began pushing against it. Those against the public option will fight any co-op just as vigorously.

Secondly, however, I'm not sure why you're so anti-government here Patrick. Non-governmental bureaucracies can also be largely inefficient and bloated. Do you know how the hospital and your insurance currently handles payments? A single-payer or socialized system could seriously streamline that entire process and largely reduce all of that inefficiency.

Strict assumption that government bureaucracy = bad means sometimes having to accept substandard solutions to satisfy your preconceived ideals.

Mandor wrote:

So you couldn't find any actual votes? Which means your statement "they consistently vote against all proposals to control spending!" is not true.

Liberal republicans generally represented more liberal constituencies where the only way for a republican to get elected is to be a centrist. They got voted out, along with other republicans, because the republican party did a great job of angering voters with the Iraq war and the culture of corruption.

The Blue Dogs are going to be in a similar situation in '10. As democrats in more conservative districts they will be facing their constituents' anger over out-of-control deficit spending and the culture of corruption.

I'm not sure I know of anywhere where committee votes are tracked and tallied; if you do I'll try and track down the actual votes for you. As is, I'm happy to take their words on what they oppose at face value. Unless you're trying to imply they criticized it in public and voted for it in private?

As to your second point, that is mostly what I was saying. If health care reform is defeated, their conservative voters will "thank" the Blue Dogs for their efforts by replacing them with Republicans. To stay in office, their best bet is to get a bill out so that public opinion of Democrats is high going into the next election.

pres man wrote:

See if we did that in the US, maybe dropped in a few regulations about how people with pre-existing conditions have to be taken on (perhaps randomly assigned to various insurance companies like car insurance is done for some high libility folks), and make it harder to lose their insurance, that would solve most problems.

See, this is the thing pres. The regulations you say might solve most problems? Yeah, those are totally in the bill that everyone is protesting! I've posted them at least once, maybe twice in this thread.

Under the bill currently being considered, we'll be transitioning to something similar to what the Swiss have, with mandatory regulated private insurance for most people. Not my first choice, but far and beyond better than what we have now.

pres man wrote:

I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?

Sickle-cell isn't real?

Sadly, it is. But I don't think it is something specific to America. I'm sure any country that has a sizable African population has to deal with sickle-cell. Based on some quick Googling + Wikipedia-ing, I would estimate that Britain has 1/6th our population, but 1/5th our cases of sickle-cell, which would make me think sickle-cell has a heavier per-capita burden on them than it does us.

pres man wrote:

Sure. Though, there may be some truth to racism and how medicine is done. I think studies have shown that minorities often get worse care. Of course some of that may also be issues of socio-economic things as well. Sometimes it is hard to separate the two, especially since minorities groups are often in lower socio-economic groups.

Sorry I wasn't clearer. The racist medicine part was an accusation I heard recently that health care reform would lead to disproportionate treatment of blacks at the expense of whites. Because Congress hates white people or something, I suppose. Obviously this idea belongs in the list of absurd fairy tales I listed it with.

You are correct that, even after factoring socio-economic effects, racial minorities do perform worse in health care outcomes, which is a separate matter from what I was thinking of.

pres man wrote:
David Marks wrote:

Look at the housing market. It often has the average home price and the median home price for a given market. That is because a single $10 million home can throw of the average if most of the other homes are in the $60-$100 thousand range.

Arglbarl. I hate it when the board eats a post. ><

Well, I had a lot written out here, but the short of it is: the housing market and the health care market are two different things, with their values measured differently for several reasons. Basically, your comparison doesn't hold.

I do get that extremely high numbers can inflate an average, just as extremely low numbers can deflate it. Are you trying to say you think that is going on here?

Thurgon wrote:

So I would put forth that creating jobs in the right sectors would likely do more for healthcare coverage then any current plan in the house or senate.

Creating jobs also inceases the tax income for the government and thus long term reduces the debt.

Morning everyone. Here comes another couple of posts from me! :)

Thurgon, this is totally the wrong way to go about trying to fix health care. We want less of a link between your job and your health care, not more. The fact that when you lose your job, you also lose your health care makes things like the recession we are slowly crawling out of all the more painful for everyone involved. It hobbles our domestic companies (automakers, anyone?) versus international competition. And it makes self-employment a risky business for many people.

Less job-reliant health care, please.

Sigh, I can't help myself. I was going to let someone else talk for a while, but then I mosey on over to one of my favorite political sites and what is article #1?

Tort Reform Unlikely to Cut Health Care Costs

That link is for you Patrick! :)

Stebehil wrote:

Well, I found this little secret quite a while ago ;-) And I don´t read newspapers covered with headlines half a page high, as well. I just think that many people can´t be bothered with thinking for themselves, rather feeding on some regurgitated stuff fed to them.

I don´t think the media is the root of the problem, rather, a willing accomplice in the name of a "good story". I thought that my post was clear enough to show that I mainly blame the political caste nowadays.

The current federal minister (or is secretary?) of family affairs is introducing a law which allows a federal police institution to block websites from viewing. Officially, this aims at the abomination that is child porn - it goes without saying that this should be fought will full force. But once an instrument is introduced that can be used to block websites, going from blocking illegal content to blocking unwanted but legal content is only a small step. What´s more, Sweden has had four years of experience with this kind of blocking. The Swedish police states that the blocking of websites has done nothing to reduce the amount of this stuff produced, while a German child protection society just checked a list of 20 websites allegedly containing that stuff, and had 16 of them offline within a few days, by simply notifiying the ISP. It is already illegal to post that stuff anyway, of course, so there is no need for this kind of law.

But this minister will have this law, no matter how much it is shown that this law is completely superfluous and potentially harmful. She fights critics with basest ad-hominem attacks, alledging that the critics support child porn.

That is what I call inept politicians. I´m not sure if that minister is indeed so stubborn that she believes her own BS, or if she consciously lies to the populace to introduce a censorship tool. Guess which party my vote does not go to...


Here in America the panic at the sexualization of children is quite rampant. I'm sorry to see that it is also spreading throughout at least some parts of Europe. Do you guys have problems with ... I can't believe I ever have to type this ... sexting?

Over here we've been arresting teenagers and throwing them in jail/putting them on lifetime sexual predator lists because they have been making and distributing "child pornography". By taking pictures of themselves naked. Sigh.

Oof. We need some kind of multi-quote option here, to avoid me having to post a half-dozen replies to posts that went up while I was gone. Sorry for the flood guys.

Loztastic wrote:

How does it work over there for "social health" issues?

Say I was a heroin addict (which i'm not). Over here, I could walk into a clinic and ask to be put on a programme - there is currently a wait (a couple of weeks), but after that time i'd see the nurse (who would take bloods for BBV's and LFT's) and do an analysis of what I'm taking. once the results came back (again, about a week) I'd be in to see the doctor - who would perscribe a programme of Methadone, Subutex (if i was strong enough) or Naltraxone (if i was brave enough and strong enough). I could tghen apply for funding to do either a residential detox or a residential rehab - however the money IS very limited, only a few people a year in each city get to go

many prisons also have a rehab wing - run more like a rehab unit than a prison. more or less isolated from the rest of the prison, volutary transfers only to the unit, and for people serving long sentences for drug/alcohol related crime

... I'm guessing over there means America? I'm under the impression that these kinds of clinics are largely on the decline throughout America. As is we can barely get Needle Exchanges going without people wringing their hands over promoting drug use. On top of that, Methadone clinics have a bad case of NIMBY.

Sadly, both political parties are still committed to plunging us head first off the Drug War cliff. There are some rumblings on the left (and in libertarian circles as well) but not much traction on a national level, at least not yet.

But our completely twisted Drug War policies probably should be spun into their own thread, rather than cluttering up this one.

Patrick Curtin wrote:

I think this distills down the issue I have with government taking over health care system. I personally would rather have a business in control than a government bureaucracy. I don't think the government will be trying to get rid of me by curing me, I think they will be making as much paperwork as they can to justify their existance. They will want patients in the system, as this will make them look busy. Insurance companies have a large bureaucracy, but it is profit driven. Underperforming employees at least can be fired, unlike government bureaucrats. Government bureaucrats are almost immune to firing, and they manage to accrue more and more benefits as they go.

I think we can reform the insurance model without constructing yet another massive government bureaucracy that siphons tax money into their pockets via pay and benefits. There are better ways to reform what's wrong than tossing it into the government sector. making non-profit co-ops like the Group Health Cooperative in Seattle that handles 600K members might be an option. I'd rather give a one-time start up disbursement of cash to establish some national cooperatives than have to pay for more bureaucrats.

I guess to some level I can understand your point Patrick, but doesn't it bother you that the reason those under performing employees are fired is because they aren't efficient enough in denying coverage to people who need it?

A private company exists to make a profit. This means they ARE very efficient. But a private health care insurance company makes a profit by getting lots of people who don't use health care to buy insurance while making sure no sick people need their services. And they've been getting better and better at making sure that if there is any way they can deny you coverage, they will.

Isn't it a problem that if you are sick and don't have insurance, then your best option is to actually bankrupt yourself so you can get Medicaid? I hate being the stereotypical "bleeding heart liberal" here, but isn't there a moral component to seeing that people can get the health care they need?

We already insist that hospitals treat any emergency cases that walk through their doors, even if they can't pay. This is a very inefficient way of seeing that everyone can receive health care, and is no replacement at all for people with long lasting emergencies, like cancer or HIV. Why is it so unreasonable to try and make the above requirement more both cheaper and more useful, by moving this care from the ER to actual doctor's offices?

David Fryer wrote:
Not to mention that the majority of countries that are usually listed in these examples have small and relatively homogenous populations. Neither Japan, or Switzerland has anywhere near the size of population or cultural and genetic diversity found in the United States. It's like comparing apples to watermelons.

I'm not sure why size of population or cultural/genetic diversity (and I'm not even sure I buy the genetic diversity argument) matter. We're looking at per capita spending; why should more people mean that we spend more per person for poorer results? Why is American culture (or genetics?) so inferior compared to other countries that utilize socialized or single-payer health care systems?

pres man wrote:

I imagine you take the data that you are using to calculate the average, put it in numeric order and figure out the middle value, and there is the median. How is that so much harder than taking all the values, adding them together and then dividing by the population?

Not really. No one actually has a list of how much each (of the 300+ million) people in the US spent on health care for the year. It isn't as easy as just looking at the same data, sorting it, and then taking the middle value.

Averages are MUCH easier to construct than medians or modes when dealing with real world fuzzy statistics. I'm not sure I've ever seen a median or mode reported for any real world purposes.

pres man wrote:

Supports the idea that Dems are not being totally truthful. This lack of honesty is part of the reason so many distrust what is being pushed through. If you have to lie about it, there must be something wrong, is what alot of people think.

Death panels. Forced euthanasia. Racist medicine. Eugenics.

If you have to lie about it, there must be something wrong. Right?

Mandor wrote:

I must have missed something. What spending controls did they vote against?

I remember them lying down and playing dead with the Stimulus and the Omnibus bills which massively added to our debt. They rolled over for the Cap and Trade bill. It looks like they finally became active recently with healthcare and the federal reserve's refusal to open their books because they are afraid of getting voted out of office next year. Until then, I didn't know they existed.

Here are two links discussing Blue Dogs complaining in the same breath about A) the cost of health care reform and B) proposals for lowering health care reform.

Secondly, it seems to me the Blue Dogs either seriously misunderstand the structure of politics or don't really care about getting voted back into office. If health care reform fails, expect the next election or two to be very bad for the Democrats. Being on the margins as is, Blue Dogs are going to be exactly who get picked off in such a case, just as the liberal Republicans were almost voted to extinction in '06 and '08 elections.

Jeremy Mac Donald wrote:

Well its worth pointing out that a system without enough checks and balances is generally even worse. The last thing one needs for stability is a country that goes from the extreme right to the extreme left every 4 years.

For all its flaws America does have a pretty good political system. Checks and balances are insanely frustrating but, at the end of the day, the American political parties absolutely need to figure out where the exact center of the political spectrum is and then array themselves on that centre and then over to whichever side (right or left) they represent. Winner grabs the centre and either party that fails to do that starts loosing elections.

That said I think one of the reasons things seem particularly contentious in America these days is that the centre has shrunk. I suspect in Britain and Canada you have a centre thats roughly 40% of the population with the right and left each taking up around 30% of the population while America's centre is more like 20% of the population with the right and left being closer to 40% each. Hence you have two powerful blocks trying to sway a small group in the middle and very much opposed to the other side. In other states you have this massive group in the middle and smaller groups on each side trying to sway the middle group to see things more like they do.

I'm not sure I can honestly agree Jeremy. Perhaps the reason America possesses such strong fringes on the left and the right is because both sides know they can propose anything they want and the gridlock built into our system will prevent them from ever having to actually back up the claims they make. I know many liberal politicians have slowly been backing away from liberal positions suddenly since Obama has won and there has actually been a chance they will have to actually deliver on some of their claims.

Consider that we have more veto points in our system than nearly any other Western nation (maybe more than any Western nation?) Our Senate is built explicitly to give disproportionate power to smaller states.

Did you know the "Gang of Six" that are currently holding up health care reform in our Senate represent only 2.74 percent of America's population? That is less than New Jersey, and less than 1/5th of California. What is good to let less than 3% determine the fate of the other 97%?

America has gotten plenty of things right, but we get a lot wrong too. I suppose it is like that everywhere, but that shouldn't stop us from calling out the problems when we see them.

I haven't finished reading it yet, but this (10 Reasons to Support Reform) was given to me today and I thought it would be of interest to anyone still following this thread.

I love this cartoon as an example of old-timey politics.

Sound like modern day right vs left talking points? Why yes. Yes they do.

b j wrote:

One thing I would like to point out is insurance companies aren't the people setting the prices for services, doctors and hospitals are. I worked in the business office of a hospital, so trust me when I say they are VERY profit oriented. Nothing changes if we add 48 million people to the mix, and that is why the AMA is on board for the current plan, 48 million new customers.

Everyone throws out the amount spent on health care, but most studies show we spend more simply because we charge more. We charge more because we are capitalists. Again, nothing changes. The hospitals with the worst problems financially are the ones MOST dependent on medicare and medicaid. They subsist, never expanding or improving. Our whole system will be that way. Take away the profits for drug companies and we have no new drugs.

Also, most of those 48 million added won't pay a thing into the system, because they for the most part pay little in taxes. So we take a financial hit from the loss of private insurance, then throw in massive increase in patients, and we are set for total system failure. We need reform, but not massive overnight changes with no clear way to pay for or support them.

And herein lies one problem. In a normal market, the prices of goods or services are determined by how much they are worth to the customers. I want bread, but only for $X dollars. If no one is willing to give me bread at the price I'm willing to pay, I can just do without bread.

Health care isn't the same. When you need treatment to avoid death, or (even worse) to avoid your child's death, no amount of money will even be too much. You will mortgage your home, you will sell your car, you will give everything you have. How can prices possibly be rationally determined by a free market in such a situation?

Again though (and I feel like a broken record saying this again) these are reasons for a socialized or single-payer system, both of which are NOT even possibilities with the current proposed reform. People get hung up on the idea of a public option, but fail to realize that the proposed public option is VERY tiny and limited under most plans currently proposed. Few would qualify for it, and I think current estimates are only around 10% total enrollment in the public option in 10 years. That means the other 90% of the population would still have private insurance.

The real jewels of the current reforms are the exchanges and the insurance reforms (I listed them earlier, will re-list if requested).

The public option provides many valuable things (it is estimated to reduce costs close to $1000 a person, and will result in a less expensive insurance regulatory body) but as some have reluctantly admitted, it isn't all of health reform. Both sides focus on it and lose sight of the bigger picture. That said, if talk of dropping it energizes reform proponents enough to get it added in and passed, I'm a fairly happy person.

pres man wrote:

I would be interested in seeing the median spent on health care as opposed to the average.

As you can guess, that piece of data is a bit harder to find than the average. From here, though, I get a few things though:

  • A recent study found that 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance.
  • Over the last decade, employer-sponsored health insurance premiums have increased 119 percent.
  • Employees have seen their share of job-based coverage increase at nearly the same rate during this period jumping from $1,543 to $3,354.

Lots of businesses are feeling the pain of increasing health care costs; I don't think I've seen any evidence suggesting the problem here is that a few are choosing to spend far more in health cost insurance than others (assuming that is what you were suggesting?)

Patrick Curtin wrote:

Yes, but studies have shown that the actual cost when you add up the defensive CYA medicine and other factors is more like 5-10% Link

Would trial lawyers agree to a cut in their share of judgements in good faith, since everyone is being asked to sacrifice? Say, only getting 10% of any judgement payout rather than 33%?

I looked through the wiki and didn't quite see your number (although see my next section below).

Can't speak for the lawyers (don't even know any) but I wouldn't wholly opposed to that. Maybe we could tax medical malpractice payouts and use them to fund universal health care! (Kidding, kidding ... mostly)

Patrick Curtin wrote:

There could also be variables to the equation. I looked for the CBO's information, but wasn't able to find it. A link would be helpful. This >article< in the NY Times seems to indicate Texas had a positive jump in health care quality after instituting tort reform. Perhaps costs in Texas stayed up even though more people were being seen since there were so many more doctors? I don't know the answer to that.
http://www.justice.org/cps/rde/xchg/justice/hs.xsl/8681.htm wrote:
The Congressional Budget Office called the evidence of defensive medicine “not conclusive,” and summarized, “On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.”i Researchers at Dartmouth College echoed these conclusions, saying, “The fact that we see very little evidence of widespread physician exodus or dramatic increases in the use of defensive medicine in response to increases in state malpractice premiums places the more dire predictions of malpractice alarmists in doubt.”

I believe this data is found here (PDF) but I can't claim I've actually been brave enough to download it and dive in.

Patrick Curtin wrote:

Why do so many doctors feel like tort reform is an essential part of health reform if it wouldn't make a difference? I would imagine that they are the folks on the 'cutting edge', pun intended. No one is advocating wiping away damage judgements all together, but a cap on what can be asked for in a suit is surely not all that whacky if we are asking for such a major reform of the health care system.

Well, I think seeing as doctors have to deal with medical malpractice on a daily basis, and likely fear it (since it could lead to the loss of their license, after all). For the same reason I'd say take the above quote with a grain of salt, seeing as it comes from a law organization. Still, the CBO is vaguely reliable so ...

I'm not sure I believe simply working in medicine gives you very deep insight into the medical industry either, although I'll admit it likely gives you some. Edit: I wanted to say this the first time but forgot (doh!) While I'm sure doctors would like tort reform, the AMA still backs the health care reform currently on the table. So they obviously think there is something to be gained for themselves here. I suppose it's tangential to the point here, but wanted to point it out.

To be honest, were it me and you negotiating what kind of health care reform gets passed, I'd likely agree to trade you your tort reform for a strong public option and some good exchanges. More's the pity that we are not.

Patrick Curtin wrote:

I will peruse this article. Thanks for the link.

For the record, I haven't read the book the article talks about; all my info on it comes second hand.

Patrick Curtin wrote:

Well, this is a staggering number. However, it is not any different for folks with other types of health systems. This >Article< by the UK newspaper the Telegraph details how an estimated 72,000 preventable deaths occur in the NHS system annually, but that the incidents were underreported by the system itself. Considering the population difference, I believe that the UK actually has a higher per capita preventable death rate, if you trust the Telegraph's information.

Also, there are limits to what car insurance will pay for accidents, including death-related ones. Why shouldn't malpractice have a system of similar caps?

Without reading the study they are referencing it's hard to say. The two numbers I gave were for two specific forms of "preventable death". What were they counting in that study? What I wanted to point out though, is that with the number of potential medical malpractice cases out there, the number brought to try is extremely low, not to imply that our system was deadlier than others.

Bill Dunn wrote:

Thurgon wrote:
4) There are many reforms that could be undertaken before it becomes needed for a complete government take over. Try them first before putting all our healthcare in one very risky government controlled try.
Complete government takeover isn't even on the table.

And to build on Bill's response, what we are trying to pass ARE the reforms that can be undertaken before a complete government take over is needed.

If these reforms don't pass the system will remain badly broken, and the problem will get worse. Fighting health care reform now just means the battle will come back at a later date. Next time the proposed changes may not be so restricted.

David Reutimann wrote:

This was what I was talking about:

I had thought that might be what you meant, but since it didn't reference any actual protesters I wasn't sure. Thanks for clarifying.

David Reutimann wrote:

That is true, but unfortunately such behavior has existed on both sides. For example, one side is talking about forced euthanasia, death panels, etc, while the other side is talking about astroturf, rent-a-mobs, opposition being only motivated by racism, Nazis, the Ku Klux Klan, and so on. It seems that both sides have been reading rule #12 in Rules for Radicals.
The fact that no side can seem to get past the rhetoric and the hyperbole is more a function of the fact that each side feels that they have been personally attacked by the other and less by the fact that there is not common ground to be had.

I don't really think any of the things you listed violate either of the things I was complaining about re: the protests. After all, there was much more evidence of astroturfing or rent-a-mobs than there ever was for death panels or forced euthanasia. But I'd prefer this thread not get dragged off course into a which side is the bigger ass argument (although we know it was you guys! :P)

pres man wrote:
And there is people like my wife's father. Had something like 4 heart surgeries over the span of 12 years. He was a smoker. And even during the last time when he was dying and the hospital staff said that continuing treatment was probably a bad idea, was still willing to do so when the family decided to at least try mainly to avoid the guilt of not doing so. This family wasn't insanely rich. That is the problem with anecdotes. There are always enough on both sides, that it doesn't actually prove anything.

I think it was actually on a libertarian site that I first read "The plural of anecdote is not data." Which is why I must again point out that statistically, America pays more than anyone else yet receives worse health care (or at best, equivalent). This isn't anecdotal; I don't think I've even seen anyone try to explicitly refute the data.

I'll repeat. We pay more, for less. Quite a bit more. This should bother you, since in this case that less results in lots of suffering and misery. Not talking about instances where insurance screws someone. I'm talking about instances where lack of insurance screws someone. Why is it America is the only industrialized nation great enough to bankrupt citizens for getting sick?

David Reutimann wrote:
Actually, I was more interested in what the individual posters would take away from it. You're right, Chuck Grassley is negotiating in bad faith. However, it could be argured that that is part and parcel of being a politician. (Yes, I have been told many times that I'm a cynic.) I guess I'm just curious (and cynical again) if the template through which protestors will be portrayed will change now that the ideology of the protestors is changing.

I suppose you could say it's part of being a politician, but I surely don't like it. Another example would be with all the talk of the "death" of the public option, I've already seen a few right-leaning publications talking about how the next possible option, a co-op, is still not acceptable. What would be acceptable? I suspect nothing, but by making it seem like one more compromise would get their approval any chance at reform can be slowly eroded away and torn apart. Sigh and sigh again.

As for the protesters, I went and re-read the link, but couldn't find anything about protesters. What protesters are you talking about?

My problems with the current spate of anti-reform protesters were twofold. One, they weren't actually protesting anything that existed. Death panels, forced euthanasia, socialized medicine, etc. None of that was proposed or has ever existed as possible reform, but they were still outraged about it.

Second, protesting outside is fine, and using signs or slogans that are tasteless or offensive isn't even a problem. But the threats of physical violence and the shouting down of dissenting opinions, the refusal to let anyone try to explain that what they were protesting didn't even exist, was wholly uncalled for.

David Fryer wrote:
David Marks wrote:
amethal wrote:
David Marks wrote:
Athas.org is still up and running.
Doesn't seem to be.
Give it a day or two. I know a few other people who can't reach them currently ... it seems likely they've changed IPs and that it hasn't propagated to all DNS servers yet. I promise you they are still up (I double checked just now!)
It's not working for me either.

Well, not sure what to say. The problem does seem to be what I said, but of course it could be working in the opposite direction (they are down, some people just haven't gotten the message). Here is a rpg.net thread discussing whether or not they are or are not actually dead.

David Reutimann wrote:
Submitted for consideration, without comment.

Since you didn't leave a comment, I don't know what you wanted us to give us with your link. What you gave me, however, was this:

The link wrote:
Senate Finance Committee ranking member Chuck Grassley admitting that he probably wouldn’t vote for any type of bill -- even if he got everything he wanted in it.

That goes back to arguing in bad faith, something I briefly talked about earlier. The left wants health care reform. The right doesn't. Their position isn't that there are some reforms they want to see that are different from the left's; they simply want no reform to be passed at all.

Which in itself wouldn't be so bad except instead of saying so they pretend that there are concessions that will convince them to accept some amount of reform. But somehow that support just never seems to materialize, even after they get everything they want.


Bill Dunn wrote:

When the Labour government created NHS, it had a massive majority and had swept into power in a wartime election, turfing out a wartime icon of a Prime Minister. There was no way the Conservatives could claim, with any real credibility, that Labour did not have a mandate. That's pretty much a perfect storm for getting BIG things done, even over vested interests.

By comparison, though Obama did win handily and the Democrats widened their majorities including setting up a potentially filibuster free supermajority in the Senate, the American system is designed to gridlock. Bicameral legislature, executive branch involved in approving legislation, huge regional disparities in political views within the same party, weak central party authority and discipline. The status quo is hard to dislodge.

Agree 100%. Perhaps 1000%. America's government was designed to be inefficient and very prone to maintaining the status quo, due to the needs of the Founding Fathers at the time.

Things were different then, and the way we solved the problems of the time (creating this inertia driven system of government) are preventing us from solving our problems now. To say it is insanely frustrating doesn't even begin to describe it.

Anyone looking for some anecdotal about how borked American health care is can look here for a rather large collection of some examples of what, exactly, we've gotten wrong.

Kirth Gersen wrote:
So, having read every post, I now realize something: for Americans, health care is not the issue under debate. It's just more of the same old "us" vs. "them" Republican vs. Democrat crap. Anyone in favor is obviously a communist. Anyone opposed is obviously a right-wing extemist. There are no Americans anymore; just two mutually antagonistic camps, always happy to cut off a nose to spite the face.

That is an uncomfortably close description of what it's like over here. Sigh.

amethal wrote:
David Marks wrote:
Athas.org is still up and running.
Doesn't seem to be.

Give it a day or two. I know a few other people who can't reach them currently ... it seems likely they've changed IPs and that it hasn't propagated to all DNS servers yet. I promise you they are still up (I double checked just now!)

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