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The profit motive and medicine


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#21 Brant Gaede

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Posted 10 October 2009 - 09:59 PM



Improper assumptions of fact that create mistakes in logical conclusions:

Chris:

"At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall."

This is not only inaccurate, but immoral even if it were accurate.


Fact: One million dollars spent on correctional education prevents about 600 crimes, while the same money invested in incarceration prevents prevents 350 crimes.

http://www.ceanation...ime-control.pdf

What is your basis for calling it immoral?



Chris:

On page 30 to 32, the tables are from 1994. The "study" is restricted to, apparently, three states and riddled with leaps of bureaucratic bullshit. Ohio California and the Department of Education are the sources.

C'mon Chris. There is not even what I required of my freshman rhetoric/debate students which was what precise statistical analysis was used.

You cannot seriously base what you said on this. It proves nothing.

Adam


If the figures are valid then the incarcerations are too short?

--Brant

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#22 Chris Grieb

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Posted 11 October 2009 - 03:28 AM

It should be noted that health insurance did not really arrive in the United States until the wage-price controls of World War II. Businesses provided health insurance because they could not raise wages.

The wage-price controls did stop inflation because the cause of inflation was what the US government was doing to the money supply. With the advent of World War II health insurance became a "right". The state cause a problem and then provides a worst solution.



#23 Merlin Jetton

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Posted 11 October 2009 - 06:01 AM

My question is, if individual capitalism (as opposed to social capitalism) is so good, as the proponents of Objectivism claim, then why has the healthcare system got into such bad shape in the US?

The U.S. healthcare system is not the result of "individual capitalism", but largely one of massive government intervention. As Chris Grieb says, tax policy has played a huge role. Also, about half of all medical care spending is by Medicare and Medicaid. To call that system "individual capitalism" is absurd.

#24 general semanticist

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Posted 11 October 2009 - 06:03 AM

Government is coercion, produces nothing and should be limited as the Founders intended to protecting the rights of individuals. Unfortunately the sophistry and power lust of men has construed the Constitution to their own misguided purposes where the kind of evil intentions you attribute to those who seek profit actually are more appropriately attributed to those who have priorities above the freedom of the individuals whose rights are violated and who are enslaved by the laws politicians legislate.

I'm sorry but I find this statement very melodramatic. Government IS coercion? Government produces NOTHING? I hate bureaucracy as much as the next guy but getting rid of bureaucracy is different than getting rid of government altogether. The sentiment in Objectivism is that government is bad but I don't think the idea of government is so bad - it's much of the actual practice that sucks. I would say the political/economic goals of Objectivism are totally unrealistic and it will never happen in a million years. I used to be somewhat of a fanatic about General Semantics and thought it could save the world but I eventually realized that there is no panacea for all our problems. I admire your determination none the less. :)
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#25 general semanticist

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Posted 11 October 2009 - 06:11 AM

The U.S. healthcare system is not the result of "individual capitalism", but largely one of massive government intervention. As Chris Grieb says, tax policy has played a huge role. Also, about half of all medical care spending is by Medicare and Medicaid. To call that system "individual capitalism" is absurd.

Well, compared to many other countries like Canada, UK, France, etc. the US healthcare has been run like a business as opposed to a public service. There are private clinics starting up in Canada now - the government is losing the battle to stop them. We are evolving into a 2-tiered system where if you want special treatment you can pay for it yourself, if not, stand in line. :)
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#26 BaalChatzaf

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Posted 11 October 2009 - 07:32 AM

Well, compared to many other countries like Canada, UK, France, etc. the US healthcare has been run like a business as opposed to a public service. There are private clinics starting up in Canada now - the government is losing the battle to stop them. We are evolving into a 2-tiered system where if you want special treatment you can pay for it yourself, if not, stand in line. :)


And a badly run business at that. Government should not try to run anything and certainly it should not try to run anything as a business. Do you know what a camel is. It is a horse designed by government. Government is essentially parasitic and incompetent. It is even worse in democracies. In democracies the worst impulse of the Mob becomes a blunt instrument in the hands of the governors.

Ba'al Chatzaf

Edited by BaalChatzaf, 11 October 2009 - 07:35 AM.

אויב מיין באָבע האט בייצים זי וואָלט זיין מיין זיידע

#27 BaalChatzaf

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Posted 11 October 2009 - 07:42 AM

Because of the current controversy going on in the US about healthcare I thought it would be timely to ask this question. United States has historically been the best example of individual capitalism in the world and this included medicine. My question is, if individual capitalism (as opposed to social capitalism) is so good, as the proponents of Objectivism claim, then why has the healthcare system got into such bad shape in the US? My position is that the profit motive cannot solve all of mankind's problems - there are some issues that are better dealt with by other means.


Perhaps the profit motive is insufficient to produce the best system, but one thing would help. And that is to apply sound engineering principle to the provision of health services. Also analyzing the rules to eliminate counter productive and perverse incentives would go a long way toward cutting costs. For example, Medicare pays doctors for doing tests. As a result many more tests than are necessary are prescribed by doctors. Not only that, over testing becomes the norm and a conscientious physician who is loath to prescribe unnecessary tests runs the risk of legal damages in a lawsuit that might follow from a bad outcome. Etc. Etc. Etc.

Having the government run the system is dangerous. The government acts on the false premise that medical care is a right, rather than a service which can be purchased voluntarily. Medical care is not a right, for it it were, then the burden of providing it becomes an act of tyranny and enslavement. If I have the right to X then someone has the duty to provide X for me. That is slavery plain and simple.

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#28 Michael Stuart Kelly

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Posted 11 October 2009 - 07:59 AM

I have lived in an emerging third world country where government run health care involved a lot of corruption. I can't say it doesn't work. It does, but in a half-assed kind of manner. For instance, I had a complicated broken arm set beautifully in a São Paulo hospital, but for the physical therapy, they only had a slot for 6 months down the road after the operation. After 30 days, if you don't do the physical therapy, your arm movement locks at a certain point. I had to do that part myself under my own instruction. I got it wrong, my arm would not open all the way and it took years of forcing it to get it to work right.

Still, I blame myself. At least I was advised that I needed to do it. I am grateful my arm was set. There was no need to offer physical therapy for free since I was mobile after that. But offering physical therapy in the manner it was offered was a joke. People would have been paid to give me this service long after it wouldn't work.

For basic emergency room kind of treatment, I have no problem living in a society where folks are concerned about providing this to anyone who needs it. This is only common sense. But even then, I don't want a civil servant worried about his coffee break or interoffice politics sewing my split leg back up.

Believe it or not, churches have done an excellent job of providing this basic emergency-room care. So I say let them run with this ball and let anyone interested in forming a group to provide this care study what they do.

As for advanced cancer treatment, state-of-the-art organ transplants, brain surgery, etc., to me the government running the health care industry is dangerous because of the illusion covering reality. I definitely don't want a civil servant worried about his coffee break or interoffice politics using powerful invasive technology or harsh drugs on me. And I want the hand that cuts any possible tumor in my brain to be steady.

Those who clamor for government run health care usually blank this out, so they deserve what they get if and when they get it. If they cannot imagine this by simple common sense, reality will remind them eventually.

People would do better to imagine ways to care for the uninsured, if that is their real concern, rather than trying to level the entire medical profession down to all professionals being government employees.

Michael

Know thyself...


#29 Ninth Doctor

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Posted 11 October 2009 - 03:26 PM

GS: "why has the healthcare system got into such bad shape in the US?"

I’d invite you to check that premise, and define better what you mean by your statement. I say it’s the equivalent of the claim that global warming is a crisis, government officials/candidates and MSM assert it, but this hardly makes a case. Manufactured crises are their bread and butter. If you can (or choose to) afford to join boutique medical practice in the U.S., can you not get the best medical care in human history? Free enterprise in medicine does still exist in the U.S., though only a small minority avail themselves of it in its pure form. Free market advocates fear that Obamacare is a trojan horse that, after a couple iterations of subsequent reforms, will destroy what freedom is left.

I’ve met Canadians who describe horror stories similar to what MSK relates above, people with knee and eye problems who had to go the US to get prompt treatment because the wait involved in Canada guaranteed they’d never walk/see again. Analogous horror stories emerge from HMO’s and Medicare in the U.S., though here we have an army of lawyers (for better and worse) to provide a counterweight.
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#30 Christopher

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Posted 11 October 2009 - 03:27 PM



Improper assumptions of fact that create mistakes in logical conclusions:

Chris:

"At the same time, we know that social programs geared toward education and anti-drug awareness/facilities actually reduces crime and saves money overall."

This is not only inaccurate, but immoral even if it were accurate.


Fact: One million dollars spent on correctional education prevents about 600 crimes, while the same money invested in incarceration prevents prevents 350 crimes.

http://www.ceanation...ime-control.pdf

What is your basis for calling it immoral?



Chris:

On page 30 to 32, the tables are from 1994. The "study" is restricted to, apparently, three states and riddled with leaps of bureaucratic bullshit. Ohio California and the Department of Education are the sources.

C'mon Chris. There is not even what I required of my freshman rhetoric/debate students which was what precise statistical analysis was used.

You cannot seriously base what you said on this. It proves nothing.

Adam


I didn't spend too much time looking it over, I just pulled the first link off an internet search. I consider my assertion to be nearly self-evident in today's society, and I don't want to waste a lot of time trying to convince you. If you're interested, here are a few more links I found:

http://www.crimeredu...eoffice.gov.uk/
http://www.eoionline...ction-Jul02.pdf
http://www.all4ed.or...vingFutures.pdf
http://educationalis...ation_in_prison
http://www.ceanation...educesCrime.pdf
http://www.econ.berk...oretti/lm46.pdf

Hope they help.

#31 general semanticist

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Posted 11 October 2009 - 03:56 PM

GS: "why has the healthcare system got into such bad shape in the US?"

I'd invite you to check that premise, and define better what you mean by your statement. I say it's the equivalent of the claim that global warming is a crisis, government officials/candidates and MSM assert it, but this hardly makes a case. Manufactured crises are their bread and butter. If you can (or choose to) afford to join boutique medical practice in the U.S., can you not get the best medical care in human history? Free enterprise in medicine does still exist in the U.S., though only a small minority avail themselves of it in its pure form. Free market advocates fear that Obamacare is a trojan horse that, after a couple iterations of subsequent reforms, will destroy what freedom is left.

I've met Canadians who describe horror stories similar to what MSK relates above, people with knee and eye problems who had to go the US to get prompt treatment because the wait involved in Canada guaranteed they'd never walk/see again. Analogous horror stories emerge from HMO's and Medicare in the U.S., though here we have an army of lawyers (for better and worse) to provide a counterweight.

I think what I meant by "bad shape" the sky-rocketing costs of it. It is unsustainable and this is why the healthcare reform cannot be put off much longer. Pretty well every country in the world struggles with healthcare but of course everyone has a different opinion about how to fix it. There is so much talk about 'freedom' in this forum but it's all very vague about how it will work. As usual, the devil is in the details.
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#32 Ninth Doctor

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Posted 11 October 2009 - 04:55 PM

Costs as a percentage of GDP? Of the Federal Budget? The ageing of the baby boomers goes a long way towards explaining both. They’re counting on Medicare, they haven’t saved for future medical needs (or sufficiently for retirement), thus bankruptcy of the U.S. government looms. This will have catastrophic consequences. Faced with similar fiscal challenges, the Roman Empire sent out the legions to conquer/enslave the Dacians. Unthinkable for the U.S.

Why aren’t the baby boomers ready? One could criticize the culture of that generation, but its simple enough to note they’ve been convinced they can count on Medicare. Never mind that its an unfunded liability, the next generation will pay in the needed taxes, somehow. Sounds like something out of Atlas Shrugged. And the baby boomers will have the votes to make it so. Until reality intervenes.

To keep this short, doing more of what doesn’t work, doesn’t work. Including more government intervention in the free market.

Here’s a good recent Thomas Sowell article:

http://www.capmag.co...cle.asp?ID=5643
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#33 Christopher

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Posted 12 October 2009 - 06:20 PM

Adam,

We can disagree about crime reduction through education. I'm interested though why you think education to prevent crimes is immoral. If it saves more money in law enforcement than it costs to run the program, and if the benefits are a more stable and peaceful society in which individuals can flourish, it would seem to be more protective and indicitive of a pro-human rights position than against it. Thoughts?

#34 Selene

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Posted 12 October 2009 - 09:41 PM

Adam,

We can disagree about crime reduction through education. I'm interested though why you think education to prevent crimes is immoral. If it saves more money in law enforcement than it costs to run the program, and if the benefits are a more stable and peaceful society in which individuals can flourish, it would seem to be more protective and indicitive of a pro-human rights position than against it. Thoughts?


In a completely limited government, it would be closer to moral, if:

First, any moneys allocated from the budget would have an automatic sunset provision which would terminate the program unless clear and convincing evidence was presented that the program met that standard.

The premise of transferring the wealth of one citizen to experiment with a "what if" of another for a social experiment is immoral. To use it to keep citizens more safe you have to prove it.

Adam
"Extremism in the defense of liberty is no vice..and moderation in the pursuit of justice is no virtue."

#35 jts

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Posted 28 March 2012 - 07:42 AM

One could argue that it is the profit motive that drives the costs of healthcare up for when there is money to be made then decisions get based on maximizing earnings and not providing the most sensible healthcare. Heart by-pass surgery is a good example. There is little evidence that it prolongs your life while there is much evidence that changing your diet and lifestyle does. There is even evidence that artheroslcerosis can be reversed with proper supplements but there is no money to be made in these treatments so the medical establishment ignores and tries to discredit them instead.

That describes what happens in the unfree government controlled doctoring business.

There are 2 categories of people that doctors have difficulty making money out of: healthy people and dead people. So in an unfree market (where competition from alternative ideas is illegal or discouraged), the most profitable deal for doctors is to have people live as long as possible but in a state of bad health. Then what doctors do is essentially torture people (with cut, poison, burn) until they run out of money. It is important to get all their money before they die. If government pays for it, that's even better. The correct dose of a drug is the dose that makes the most money; too high and the patient dies (no more profit); too low and the patient recovers (no more profit). That's in an unfree market.

But in a free market, it's a different deal. In a free market, doctors are in the business of putting themselves out of business. They are in the business of helping people to get well and to stay well. And the doctor who is the most effective in putting himself out of business (helping people to get well and to stay well) is the doctor who gets the most business. And any doctor who is not in the the business of putting himself out of business (not in the business of helping people to get well and to stay well) won't get any business and will be put out of business. In a free market, a doctor won't be able to stay in business unless he is doing his best to put himself out of business, in competition against other doctors who are doing the same. This process continued, eventually there would be little business for doctors and few doctors and little need for doctors and they would have competitive prices and we wouldn't be talking about the high cost of health care.

I will give a little example to illustrate the difference between a doctor in an unfree market and a doctor in a free market (even tho he was not actually in a free market). A man in France had polyps in his nose. He had them removed by surgery. They grew back. He had them removed again by surgery. They grew back again. He had them removed by surgery 18 times. They grew back 18 times. At this point he figured enough is enough, and enough is too much, and too much is enough. So he crossed the Atlantic Ocean and went to the legendary Dr. Herbert Shelton in Texas. Dr. Shelton explained -why- the polyps were growing back. The causes were removed. The polyps disappeared on their own without surgery and without treatment of any kind. The Frenchman was so grateful that he arranged a special meeting with Dr. Shelton to thank him. Dr. Vetrano acted as a translator because Shelton didn't understand French and the Frenchman didn't understand English. During the meeting, the Frenchman shook Shelton's hand several times and demonstrated several times how easily he could breathe thru his nose and he promised that everyone in France would hear of Dr. Shelton.

For the surgeon, the most profitable course of action was to do as many surgeries as possible and to hell with the root causes. Shelton acted like a free market doctor (and consequently got in trouble with the law many times) and tried to put himself out of business. Shelton did not get any repeat business from the Frenchman. In a free market, all doctors would be like Shelton and some would be better than Shelton and they would be competing to do the best job of getting people well and to stay well and at the lowest price.

#36 Merlin Jetton

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Posted 28 March 2012 - 08:00 AM

There are 2 categories of people that doctors have difficulty making money out of: healthy people and dead people. So in an unfree market (where competition from alternative ideas is illegal or discouraged), the most profitable deal for doctors is to have people live as long as possible but in a state of bad health. Then what doctors do is essentially torture people (with cut, poison, burn) until they run out of money. It is important to get all their money before they die. If government pays for it, that's even better. The correct dose of a drug is the dose that makes the most money; too high and the patient dies (no more profit); too low and the patient recovers (no more profit). That's in an unfree market.

Beautifully said. It also describes hospitals, non-profit or for-profit.

#37 Brant Gaede

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Posted 28 March 2012 - 08:30 AM

Police are reactive, not, generally proactive. Same as with medicine. In that sense, only, docs are like cops.

--Brant

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