Comments on: I’m Back

By: Jeannette

Jeannette — Fri, 25 Sep 2009 11:37:41 +0000

I do believe you are one of the few in our age bracket that actually think that there IS a sense of entitlement in today’s society as well as agreeing that people should be held responsible for their own sustainable medical care which doesn’t involve a crisis or chronic treatment. I am of the mindset that there is no accountability anymore nor a sense of EARNED pride. People are most certainly full of pride, but they have done nothing to be proud of. To those out there whining about not finding a “fulfilling” job- TOUGH! Whoever said life would be enjoyable, fair, entertaining, rewarding and make you rich LIED! that is the exception to the rule. it’s a lofty goal, but rarely attainable. You want food, shelter, clothing and some spending cash? you have to make some sacrifices- being content in your employment may be that sacrifice. Thank you for allowing me to see that I am not the only 30-38 year old out there that thinks this way. It is an “old school” thought process and i like it… I like it just fine…
PL: Of course there’s a sense of entitlement. You should see it in law. These little wind up dolls think they’re entitled to respect because they graduated from law school with some horseshit honor or clerkship under their belts. “Get in line, you little shit, and shut the fuck up. You’re nothing until you’ve handled real stress and demonstrated you can think on your feet. Stuff the law in this brief and shut the fuck up.”

By: Evil Conservative

Evil Conservative — Mon, 07 Sep 2009 15:32:47 +0000

Goldhill article:
“Indeed, I suspect that our collective search for villains–for someone to blame–has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care–from doctors to insurers to pharmaceutical companies–work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that–most important–remove consumers from our irreplaceable role as the ultimate ensurer of value.”
Paragraph of the Year.
My main and very minor critique is that “the new tests and treatments” are offered a section but that’s still glossed over. The article shows Lasik procedure prices going down and I’ve heard of analogies with plastic surgery, but even the most neurotic people concerned about their appearance can wait to have those elective procedures.
The new treatments and new tests for life-and-death matters are awesome. Some real next-level shit. It’s that whole American capitalist innovation thing. This next-level shit is expensive as hell and everyone demands it because 1) no one takes short cuts on medical care – used car, yes; medical care, never 2) it’s financed by insurance companies or the government.
Elite Education article:
“Yet it is precisely that opportunity that an elite education takes away. How can I be a schoolteacher–wouldn’t that be a waste of my expensive education? Wouldn’t I be squandering the opportunities my parents worked so hard to provide? What will my friends think? How will I face my classmates at our 20th reunion, when they’re all rich lawyers or important people in New York? And the question that lies behind all these: Isn’t it beneath me? So a whole universe of possibility closes, and you miss your true calling.”
And this neurosis has taken grip over the entire nation as thousands of colleges are outrageously overpriced and saddling kids with high five-figure and low six-figure debts plus a sense of self as overinflated as their GPA’s.
PL: No argument with either paragraph here. But I think we gave up on following true callings long ago. There’s a giant unspoken recognition among people who can see where we’re headed that one’s best move is to grab as much as he can as quick as he can, put it in a safely diversified portfolio and get the hell the hell out of the game. The complaints about your generation having entitlement complexes are only half true. A lot of you are shrewder at a younger age than people in my generation were, due to the information you’ve had at your fingertips from a very early age. And I think you’ve noticed that (a) office work has become such a soulless, demeaning slog that accepting it as a foregone reality for 40 years of your life is basically a form of passive suicide and (b) its economic rewards are getting smaller and smaller every day.
I don’t think it’s all an entitlement mindset. I think a lot of you are just rationally assessing the situation for what it is and reacting to it. The question remains, “What;s your option?” Only so many of you can become entrepreneurs. What happens to the rest will be interesting.

By: Major Pearson

Major Pearson — Thu, 03 Sep 2009 11:11:22 +0000

You are missing the point in BigCity’s comment.
If a patient is brought in on a stretcher, is the ER doc supposed to say, “Sorry buddy, cash up front or those bullets stay in?” The truth is they won’t and they can’t say that.
Health Insurance companies were initially created by doctors unhappy with not getting paid. Did you think they always existed?
People will not pay their bill. The reason for that is simple; you come into a doctors office sick. You feel terrible, and sure, 500 bucks to get fixed sounds fine. Then, when the bill comes, you are feeling fine, and you actually get angry. “I feel fine. That doctor didn’t do much, all he did was give me some pills and tell me to rest. I could have done that on my own.”
I know this will happen because it happened before.
Know how the government can really lower healthcare costs? This is a long-term solution, so of course it won’t happen without significant local pushing, but oddly enough, grants to fund and create after-school programs. Programs like this allow children a safe place and can supplement their education. Little Tommy can’t go out to play with his friends anymore, because his mother is working and is afraid something will happen. As a result, he’s at home, watching television and eating potato chips, lowering the median age of obesity with every bite. Think costs are high now? Just wait.
PL: I got that point. Hence my recommendation that the direct purchase structure only be used for emergency and chronic care. The guy with the bullets in him of course gets care. But who needs an insurer in the game for preventative care? It’s a TPA that does nothing but ad administrative costs and encourage overuse of services.
I agree with you on the education thing, but that’s never going to happen. The average American doesn’t want to be responsible for his own health care. They want someone else to do it for them. It’s too hard for them to think about. And they’d rather spend the money on a flat screen TV, or a down payment on a Hummer. We’ve been trained by Madison Avenue to only want what’s tactile and flashy, or involves gratuitous immediate enjoyment (”I’m going to Disneyworld!”).
Frankly, the people who could get health care and instead use the money to buy home entertainment systems or cars they can’t afford ought to get no treatment. Darwinism ought to be allowed to work its magic on their genes.

By: Jack

Jack — Thu, 03 Sep 2009 10:31:02 +0000

Good to have you back. I was starting to suffer from withdraw symptoms.
PL: So am I. I’m getting fucking killed with business shit now. Take time off and you get sooo far behind the eight ball.
And not the good kind of eight ball.

By: Nick

Nick — Thu, 03 Sep 2009 09:16:57 +0000

I hope this posts! I have tried three times, dammit! Anyway, not sure if you read this, but it seems relavent given our current situation.
http://www.theamericanscholar.org/the-disadvantages-of-an-elite-education/
PL: Dude, I haven’t had a chance to read this, but I encourage others to do so and comment. I’ll offer my comment later.

By: Jay

Jay — Wed, 02 Sep 2009 22:43:35 +0000

That article by Mr. Goldhill was fantastic. It should be mandatory reading for all of Congress. I wish I had read it before your last post; maybe my comments would have been more intelligent. Great to have you back.
PL: Amazing. It ought to be dropped from airplanes on the cities and handed out at every town hall on health care.
Don’t worry about your comments being intelligent or not. Most of the ones I write here are furious back of the envelope things. I read one or two a month later and often say to myself, “What the fuck was I thinking there?”

By: gen

gen — Wed, 02 Sep 2009 21:39:34 +0000

do you know tucker max in real life? like drink together and stuff? coz i thought maybe you’re slingblade. :D
PL: I have had a drink with him, and spoken to him many times. Slingblade? I’ve been alleged to be dead and accused of being a professional writer moonlighting, but that’s the first time that suggestion’s been made.

By: New Diarist

New Diarist — Wed, 02 Sep 2009 12:48:44 +0000

Pay for preventive health care out of pocket. Great idea. Except what is “preventive” health care? I have to see a cardiologist, and endocrinologist, and an internist every 6 months. The combined full fare charge for these visits would cost me $1500/year. Even if they reduced their fees to $100 per visit (HAH!), that’s still $600/year.
Tell me how someone making $30,000/year with 3 kids is going to pay for school physicals, dental appointments, and a physical for herself at $100 a pop, cash on the barrelhead?
New Diarist
PL: You’re missing an important piece of my point. The reason the cost of services is so inflated is the insurers’ involvement. They pay low reimbursements, so the providers jack up the price many multiples to make their margins. If we adopted a direct pay preventative care structure, the price would have to drop back to a reasonable level individuals who aren’t merely reimbursing providers at a nickels-on-the-dollar rate could pay.
And as to your seeing a cardiologist and endocrinologist so frequently, it’s clear you’re talking about a chronic/emergency situation, which would be covered by the chronic/emergency insurance I proposed.
I think we can agree, the guy seeing his GP because he wants antibiotics for a bad sinus infection ought to pay out of pocket and not even be allowed to attempt to submit his bill to insurance. Same with the overprotective parent whose kid skins his knee. Insurance should be used for serious issues only, like the ones you describe.

By: hhgfhgfh

hhgfhgfh — Wed, 02 Sep 2009 05:15:39 +0000

Hey tb!
Don’t rock the boat, asshole!
PL:No rocking there. No worries.

By: hoovdizzle

hoovdizzle — Tue, 01 Sep 2009 10:26:13 +0000

glad to hear you’re still fighting the good fight. keep a thumb on it.
PL: I know no other way to go. Damn writing thing. Can’t stop.