“In my opinion one of the biggest problems with our credit crunch and high foreclosure rate is bank reliance on FICO scores. FICO scores do a good job of reporting an individuals past history of repayment of debt. The biggest problem is the scores do...

Many moons ago, when I was knee high to a grasshopper, I used to sit on the front porch with my pappy, Rufus head resting on pappy’s outstretched legs while his tail in a slow metronome wagged back and forth, Goof Ball, our cat purring on my lap, Benny Goodman in the background magically coming from the radio, and I would question and listen to what the old man said.

One night, as the thunder heads rolled closer obliterating the stars, and the lightning flashes competed with the lightning bugs, pappy got a bit sick and tired of the stand I was taking. In his knuckle rapping voice he said this:

“You know R. Paul, if somebody disagrees with you, you really ought to listen to what he has to say, you may learn something.”

I only bring this up to point out that in my comment you refused to read, I gave an Internet link to the O'Neil & O'Neil paper that does not require the magic 5 dollar fee you feel we all should pay. It required an academic affiliation, and the usual full name and E-Mail address. I did not have to fudge the information, after all I did teach at the University of Rochester School of Medicine. I am sure that others with real or imagined academic credentials will be able to access this paper. As I do not wish to subject you or others to my verbiage, the link can be found here.

I really do looks forward discussing this paper with you, at 43 pages, and 4 pages of references, it ought to be a fun bone experience…

The problem immediately jumps out at you: attempts at cost containment should not lead to a decrease in quality of health care. And thus my question to Steve Verdon (above) revolved around the issue of Quality Assurance (is the ”widget” you are delivering of the highest quality), and Evidence Based Medicine (prove to me that the “widget” is of high quality, and indeed not defective).

In the U.S. health care is financed by the Government (Medicaid, S-CHIP), Medicare, Veteran Administration etc), Private Health Insurance (employer provided with employee self pay contributions, or total self pay contributions), and out of pocket on a need basis. The latter group is the uninsured (estimated at 16% of the population), and if you wish, the underinsured (estimated at 35% of the population).

A bit sparse, but the above sets the table. To ensure Quality Assurance, you need an extensive data base, preferable as all encompassing as possible, and somebody to maintain it. You need an entity to investigate malfeasance, you need an entity to define why health care is more expensive in region A than in region B, and why 4 times more back surgeries are done in city X than in city Y. That can only be done by the Federal Government, and those that argue the market place is self correcting, are opening the door to the chicken coop to the foxes, and inviting the vulture capitalist to the feast…

Evidence Based Medicine is just simply defining what works best, and excluding what is ineffective, or may actually be harmful. This has to be done by a totally independent body, financial players (Insurance Companies, for profit and non profit hospitals etc) have to be excluded. They have to be able to say this back operation cannot be entertained unless these conditions are meet, and they have to be the intellectual policemen.

Within the above frame work I favor single pay, government sponsored, Health Insurance. Everybody, young and old pays in, everybody, rich or poor gets the same treatment. Do not cry socialism, you are still able to chose your own physician, he or she is able to recommend a specialist, and you may wish to chose your own specialist. That my friend, is impossible in many of today’s “free market” insurance plans. It does not preclude that an individual can purchase selected insurance, as is available I many EU countries.

Is my choice going to happen, of course not. The French on finding a dead body, are fond of saying “find the women”. In the U.S., the hard boiled cop will say “follow the money trail”. There is just too much money to be made in American Health Care to seek a reduction in the escalating cost; that the increase is greater than any other industrialized nation assuredly is of no concern to those who profit. In the U.S. there is just too much money floating around to worry about health care outcomes (Quality Assurance), and whether our system damages our and future generations (Evidence Based Medicine).

Gasp, a comment by R. Paul Miller, MD whose children affectionately roll the ‘R’ as the say Our Paul, posted without any links. They will provided on request, or if challenged.

Who are you quoting there, because it sure is not me. But feel free to laugh all you want, but pardon me for finding your last comment incoherent nonsense.

Which I thought was an elegant solution to the rising cost of Health Care...

Paul, you only confirm my opinion that you are mendacious with claiming that was "my solution" or suggested solution to the problem.

And the O'Neil & O'Neil paper can be had by spending $5 here.

Once again, I'm not going to read the rest of your post since you once again failed to use the site's search function, nor engage the actual positions I've laid out.

We got a bigger recession than you expected.

Your argument twists a lot of ways, but you seem to be trying for this one:

No get got the recession we predicted, only the lack of the stimulus we didn't want, made it worse.

May I LOL? Tell me again how "worst since the Great Depression" was overblown, and we should only expect a "typical" recession.

And I've presented solutions before on this site. It isn't my fault you're too lazy to use the search function. Steve Verdon (June 11, 2009 | 12:27 pm)

It was when you blessed me with the F crown, that you had this to say:

First off precluding people prior conditions also lowers premiums. Including them would drive up premiums. That is precisely the point of how administrative costs, even higher ones, can keep premiums lower and thus create value for customers of a private insurance company.

Which I thought was an elegant solution to the rising cost of Health Care, especially if we coupled it with one of your previous suggestions to lower the cost of health care by excluding pregnancy and obstetrical benefits from insurance coverage. Yes, a brilliant formulation: exclude those that may be “high” costs individuals, and medical insurance rates will go down.

It strikes me that you have an inability to grasp health care data. When presented with comparative data, such as the OECD studies, you fail to examine or comment on the data, and instead come back with a post implying that the OECD countries are going broke. When comparing Canadian and U.S. Health Care you selectively quote a study by June E. O’Neill and Dave M. O’Neill which as referenced is not available on line or through library services to your readership. As strange as it may be, the O’Neill paper, as quoted by yourself , is part of a large survey paper on Health Care; the paper presents other studies which clearly point to the benefit of government sponsored by health care.

Turns out I read OTB for its unique conservative/libertarian perspective, and the fact that the comments by the readership often contain thoughtful links to information that are challenging. In turn I try to broaden the conversation either through criticism, questions, or pertinent links. One of the questions I posed in the past was this:

Do you believe that Insurance Companies can deliver a better “product” than a government single payer system? If yes, explain in terms of Quality Assurance and Evidence Based Medicine.

Steve’s answer was

This is a very large question that would require a very lengthy reply, so not going to answer it here. My general position though, is that I'd prefer a market based mechanism so that we can get whatever cost minimization mechanisms come with the market vs. government where such mechanisms are dubious at best. That doesn't mean there is no role for government, I just don't see any government run program that does it right.
Posted by Steve Verdon | May 13, 2009 | 03:41 pm |

As a physician I favor the quality of medical care, and its equal and equitable distribution to all Americans; that surely is not happening today. Steve shows no interest in the quality of health care, and views the distribution of medical care through plutocratic economic models. That we would disagree is predictable.

Psssst… For those who were frustrated by the inability to access the study by June E. O’Neill and Dave M. O’Neill it can be found here. I do look forward in discussing this paper with Steve in the future.

I think you just reinforced my comment. Yes, bigger and faster.

Let me see, so far we have virtually nothing spent...and the economy is still in the tank...so bigger? Bond markets, interest rates and inflation fears be damned.

Faster, maybe, bigger? No. Why not have the Administration get the current slated spending spent then see if we need more.

You got the Roubini future, and no, the stimulus wasn't big enough to "reverse" it. For that, as the joke goes, you'd need a BIGGER stimulus.

You are ignoring the fact that so little of the stimulus has been spent. To claim that BIGGER stimulus is necessary given this fact is indeed tortured logic...or the logic of one who ignores reality.

I think you just reinforced my comment. Yes, bigger and faster.

But instead of reversing the economic decline, the Obama economy has gotten worse. Obama's proposed fix certainly did not work and may have made the problem worse.

That is tortured logic.

No it is counter-intuitive. Like when, during a boom, that the stock market goes up when the unemployment rate comes in a bit higher than expected. The Fed can hold off on a rate increase in such a case, since such a report would provide weak evidence that the economy is not growing too fast to raise the possibility of higher inflation.

In the case we are in now, if the quantitative easing and the increased spending have the effect of increasing the interest rate, then it could put off the recovery and/or make the recession worse. I'm not saying this is the case, but that would be one way the story could work.

You got the Roubini future, and no, the stimulus wasn't big enough to "reverse" it. For that, as the joke goes, you'd need a BIGGER stimulus.

You are ignoring the fact that so little of the stimulus has been spent. To claim that BIGGER stimulus is necessary given this fact is indeed tortured logic...or the logic of one who ignores reality.

I think some parsimony should be shown and that's the value of a federal system. Solve the problem in the states with the largest problem first as a pilot program before launching into an inevitably half-baked national plan.

Now having claimed to have a competent understanding of economics, but having shown none, Obama wants to fix a healhcare system that works.

When economists themselves cannot come to an agreement about the best way to fix the economy, I don't fault Obama so much for taking the course he has taken. The healthcare system works for some, but not for many.

That would certainly explain the soaring stock market...

1. The stock market is not the economy.
2. Beware sucker's rallies during a recession.

Are you willing to bet your life on Obama Care?

As opposed to someone who has no health insurance and has the ER as his "doctor" and then can get his finances wiped out or others who are at the mercy of some HMO bureaucrat who may hold their insured lives in his grubby, greedy hands? Oh look, hyperbole works both ways...

But instead of reversing the economic decline, the Obama economy has gotten worse.

That would certainly explain the soaring stock market...