Silversea Water Cooler: Part 3, Welcome!

[UKCruiseJeff]

Jeff, I do think that would be the most economically efficient way to provide all citizens with access to basic health care. But it's a huge can of worms, and certainly could create other issues. I doubt it would be a panacea.

 

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It does seem like the only solution. The downside is the obvious one and that is that if one had a free choice one wouldn't choose to start from here. A federally funded scheme would end up excruiatingly expensive as the sole supplier would presumably be the private sector.

 

Mind you our NHS doesn't appear to enjoy any real economic advantages it seems with being publicly owned.

[jpalbny]

Yup...who knew health care could be this complicated? ;)

 

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[UKCruiseJeff]

Thanks so much for taking the trouble with that lengthy post .....

 

I guess we have ended up with a system that we are told that all envy, but I only find that people envy the idea and philosphy underscoring the NHS but those that understand it knows it is failing.

 

In my position I am so concerned about protecting ourselves from finding we need urgent treatment that might be delayed in the NHS, that until a few years ago I was paying excruiating premiums for private health care insurance with a very high excess (£5k) that would cover us for serious urgent conditions including anything that might be considered pre-exisitng. But now the premiums were so high we are essentially self-insuring. We are keeping a specific fund for possible future needs and will simply hope it is enough.

 

Some other European countries seem to do so much better than us.

[TLCOhio]

Oh, healthcare...will try to give some background. I recommend "The Social Transformation of American Medicine" by Paul Starr if anyone is interested. Great read.

Insurance works best if everybody pays, including healthy people who have no use for it. The healthy non-users subsidize the sicker insured people who use more than they pay in premiums. But, convincing healthy people to pay for something they don't need is tricky.

Single payor? Got me how it would look. I work for the VA which is a single-payor system and I love it, but we are not without problems.

The most qualified candidate to be the single-payor IMO has to be the federal government. They are big enough to absorb the risk, and have taxing authority to raise the money needed to run healthcare. I don't think we'll solve the problems associated with health care in the USA until we uncouple profit from payment. But those who feel that this will stifle innovation have a valid point that I can't answer...unless the NIH expands its grant programs substantially. And given their current state of disarray, who would trust them with such a responsibility?

 

I am so concerned about protecting ourselves from finding we need urgent treatment that might be delayed in the NHS, that until a few years ago I was paying excruiating premiums for private health care insurance with a very high excess (£5k) that would cover us for serious urgent conditions including anything that might be considered pre-exisitng. But now the premiums were so high we are essentially self-insuring. We are keeping a specific fund for possible future needs and will simply hope it is enough. Some other European countries seem to do so much better than us.

 

Appreciate these thoughtful and additional details, background and comments from both J.P. and Jeff. Yes, it is very involved and complicated, whether here or in the UK.

 

Our large local library did not have that one book by Paul Starr. BUT, I read more about this author, his background, views, suggestions, etc. While he is a Pulitzer Prize-winning author, he also edits one of the top liberal magazines in the U.S. and was an advisor to Bill Clinton in the 1990's during their healthcare efforts at that time. While it seems that this Princeton professor raises very good questions, I am not 100% sure he is "middle-of-the-road" in providing analysis on these questions. BUT, part of the discussion and learning process is to read more, ask good questions, seek added info, etc.

 

Agree that "profit" and money are a key part of the debate. Whether it be the salaries and costs for insurance companies, or hospitals, there is also the questions as to the "profit" or salaries that go to doctors. Sorry to be a little blunt. There is a big difference in salaries paid for doctors, especially for the specialists in certain areas of medicine, here in the United States . . . versus . . . what the pay scales are in many parts of Europe. This doctor salary subject always gets "sensitive" as we all love OUR personal doctors and view that they are worth it.

 

The VA is another interesting area/question. As I re-call back in the 1960's and 1970's, it was more of a system designed to take care of "service-related" injuries and problems, etc. That's absolutely merited and due to those veterans so were injured and harmed during their military service. BUT, then things expanded in the V.A. to be viewed/shifted that any and all veterans should get free health care whether service-related or not. Am I some correct in my memory and about this evolutions of health care expectations in the V.A.?

 

Finally, with life insurance, as an example, you pay more if you are a male, a smoker, are over-weight, have bad heath habits, etc. That's consider legitimate and fair with this type of insurance due to the actual cost factors. BUT, with health insurance, there are no penalties to those who do not follow medical advice or engage in more risky/bad life habits. Right? Should there be more "incentives" to encourage and reward better health habits? AND, how much should the healthy young pay extra to subsidize those older and less healthy who require much higher levels of medical costs?Lots of questions and challenges!! Not easy or "fair" to make all parts of our society.

 

THANKS for the great sharing and added background from both sides of the Atlantic! Look forward to keep learning more. Just did last weekend two different TV programs talking about some of these questions, including the failure of plans from both political parties to ignore the challenge of fixing the soaring health care cost curve.

 

Enjoy! Terry in Ohio

 

AFRICA?!!?: Lots of interesting and dramatic pictures can be seen from this live/blog at:

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Now at 33,412 views for this visual sharing including Cape Town, along South Africa’s coast, Mozambique, Victoria Falls/Zambia and Botswana's famed Okavango Delta area.

[UKCruiseJeff]

Hi Terry,

 

The earnings of doctors in the UK once qualified and experienced is now extremely high. Further their NHS contracts entitle them to undertake private work during what would in every other "industry" be considered to be normal working hours as long as they complete their contractual hours. They can do this on NHS premises and using NHS facilities although private patients would be expected to pay for the facilities. I would be surprised if there is much of a differential between what American doctors earn than those in the UK. We also have a system whereby there is now an incentive for newly qualified doctors to seek work abroad often in places like Oz. Not only will they earn more but they will avoid paying their fees loans which they accumulated during their medical studies which will eventually be picked up by the rest of us through taxation.

 

With resepct to insurance, in the EU it is now illegal to charge different insurance rates depending on gender.

 

http://www.bbc.co.uk/news/business-12608777

[Lois R]

Did someone say something about a CIRCUS? You would be giving a circus a bad name:eek:.......it is UNreal

what is going on:loudcry:......I am not just talking about Healthcare but ALL THE OTHER STUFF:eek:........OMG........

I am no prude honestly, but these guys are just..........omg........I can't say it on here because I would be banned.

 

JP....maybe you missed my question a few weeks ago but I asked for your thoughts about The Health care issue.......

Thought you and Chris would have more insight than the regular person........I just think both parties should work

together but what do I know?

 

As for the other "CRAP"......I can't recall so much of it in such a short period of time......in my lifetime of voting

anyway..........it is really, really crazy and flame me if you like.....but this guy thinks he should be on Mt Rushmore?

And the new guy he hired...........all I can say is OMG.

 

Thanks for letting me vent.

[UKCruiseJeff]

Lois, wouldn't you prefer it that he were on Mt Rushmore than sitting in The Oval Office? :)

 

Can you Americans clarify something for me. I've seen on other threads the regular new usage of "Ecole de Chef" as though it were some indication of either quality or qualifications or recognition. As far as I am aware it is just a part of the Relais scheme of having some of their affiliated fee-paying member properties having a chef's table with some offering to show punters how to cook ie literally "cooks school".

 

Are these one and the same thing that people are referring to or is there something in the US that confers some extra special prestige or extra qualification or recognition to the "Ecole de Chef" title that I am unable to find when I google? I'm clearly confused.

 

Thanks/

[Lois R]

Jeff, Mt Rushmore needs no other people on it.......and the Oval Office? Needs major help.:mad:

 

Can't help you with the Chef thing.......I know there are different levels of Chefs but have never even heard of that one.

[UKCruiseJeff]

Jeff, Mt Rushmore needs no other people on it.......and the Oval Office? Needs major help.:mad:

 

Can't help you with the Chef thing.......I know there are different levels of Chefs but have never even heard of that one.

 

Extraordinary reading .....

 

http://www.newyorker.com/news/ryan-lizza/anthony-scaramucci-called-me-to-unload-about-white-house-leakers-reince-priebus-and-steve-bannon

[Lois R]

Extraordinary reading .....

 

http://www.newyorker.com/news/ryan-lizza/anthony-scaramucci-called-me-to-unload-about-white-house-leakers-reince-priebus-and-steve-bannon

 

That has been in the news for 2 days now.......and today Priebus is out........gone from the White House.

[UKCruiseJeff]

That has been in the news for 2 days now.......and today Priebus is out........gone from the White House.

 

Yes, I've been following it.

 

It rather feels not just that the lunatics have taken over the asylum, but the lunatics are now replacing all the sane staff who managed with relative sanity, with other lunatics. And what happened at that meeting that has caused them to be so ballistic.

 

It is extremely concerning and hasn't been funny for some time.

[Lois R]

Yes, I've been following it.

 

It rather feels not just that the lunatics have taken over the asylum, but the lunatics are now replacing all the sane staff who managed with relative sanity, with other lunatics. And what happened at that meeting that has caused them to be so ballistic.

 

It is extremely concerning and hasn't been funny for some time.

 

I agree 1000.00%........it has not been funny to me EVER............

[spinnaker2]

JP.

Thank you for a synopsis of health care in the USA.

DS who is a veteran of army has not used VA benefits.

He's considering now having just been billed 160k for three level cervical fusion.

 

And you are right.

To quote Trump, who knew health care could be so complicated.

:-)

[UKCruiseJeff]

I agree 1000.00%........it has not been funny to me EVER............

 

What I think really worries me, is that I guess I'm not the only one who has reached an age when you realise how quickly it has all sped by and one hates the inevitability of being in possibly the last quartile. Up until recently my thoughts were only rather morbid on the subject. A depressing awful subject over which I have no control. It ends the same for all of us.

 

Lately however I have found myself realising that I had caught myself subconsciously thinking how lucky I am not to be a youngster. What a p**s poor place we are leaving to them, if that is what is really on my mind.

 

Ah well. I guess some more medicine (Armagnac) is beckoning ......

 

Let us all in the Cooler shut and lock the door, pull the blinds down and turn the Cooler neon sign outside off and have a "lock in". All drinks for the rest of this sesssion are on the house. And s*d "auld lang syne". We must collectively keep each others' pecker (Brit version) up!

 

;)

[mysty]

If I may weigh in here. Respectfully I would suggest that those of us in the last quartile of our lives are not completely responsible for the world as it stands. it is indeed a mess of epic proportions and we may have contributed but we are not solely responsible. Once again I raise the flag that critical thinking is missing. Not just among the more aged of us. The younger folk voting are not schooled in thinking for themselves and they buy into sound bites. If we could escape the madness I think we would all leave the island. Unfortunately we cannot. We are not all responsible for the mess and we are all responsible for doing our part to fix it.

[UKCruiseJeff]

M, I'd like to draw some comfort from those thoughts, but it is unavoidable that it is our generation that collectively bring those that follow us "on". Of course what they then do, we have no control over and that much I agree with.

Today, my local paper was celebrating the "graduation ceremonies" of all our local education establishments. When I read further they were referring to largely about 11 year olds leaving their primary school. All were dressed up in gowns and mortar boards and received passing out scrolls which was photographed. Evidently an increased number of graduates passed this year with honours. Also evidently, no one failed, and as the man from Lake Wobegone would undoubtedly say each graduate was cleverer than average.

 

At this point I felt like a martian who had visited world from another planet.

[mysty]

i don't disagree with you Jeff. In a lot of ways our generation and the next have created monsters. Not monsters in the scary, deadly aspect. Monsters in the sense that reasonable expectations for intellectual pursuit, use of the native language, aspirations for success and civic responsibilities have not been ingrained. A breed of "special snowflakes" have been raised. No disagreement there. And you are not alone in your feeling of being from another planet. I just think that we all have a responsibility to address this in whatever arena we can. I don't think withdrawing and hoping that the world won't implode is the way to go. We all have a circle of influence. Not necessarily large but maybe effective. Should we not at least try?

[jpalbny]

Hi from a super brief layover in Detroit! Love the conversation so far. Terry has the history of VA correct AFAIK. Have not worked there that long, only about 25y between school and real work. So I didn't live through that part of its history firsthand.

 

Terry, Paul Starr's political leanings aside...I love the book for its history. Fascinating. We used it as a textbook for a Health Policy class I took in the late 1990s for my MPH program. We also did a big project to pick apart why health care reform failed under the Clintons.

 

Off to SFO shortly. Later!

 

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[UKCruiseJeff]

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[UKCruiseJeff]

M,

 

Isn't the optimism delusion ie we can make a difference just that ... a delusion in order that we don't face the terrible truth that none of us Coolers can or will make the slightest difference. It is in a way similar to those that believe in a further life after death. It is the only way of coping with the terrible reality. The same solutions are provided by the nonsense promises of religion. The truth is that it is all random, and whilst it is true that a handful of people in the world have the power and resources to trash the world it seems that none of them could change the world to "goodness". Each bit of premeditated good thought that produces a good action is always followed by random consequences.

 

Fatalism has more going for it than the notion of control. We can improve on our personal luck odds but wider control becomes exponentially random through the laws of unintended or unwanted or unexpected consequences. And that I guess is what makes life fascinating as well as frustrating. I don't think this is pessimism, more realism.

[mysty]

J...I understand what you are saying. And I agree that we have limited control over the events, outcomes, direction of the world. I do, however, believe that we can influence a very limited aspect of the world we live in. I cannot accept that we are doomed to a world where the evil thrives. I know that I will have very little impact on how our future unfolds. It is not realistic for me to expect otherwise. I have to count on the wisdom, goodness and civility of my fellow earthlings that we will find a way through the crap! Otherwise, there is no hope and we might as well all just acquiesce to the ugly. Not the way I want to live my life. Call me a Pollyanna. I can't move on with any other viewpoint. Optimism may be an illusion and a panacea but the alternative is not at all conducive to a joyful life. Life is just too damn short!

[jpalbny]

 

JP....maybe you missed my question a few weeks ago but I asked for your thoughts about The Health care issue.......

Thought you and Chris would have more insight than the regular person........I just think both parties should work

together but what do I know?

 

 

Lois, I didn't miss your question. I had to think about whether to wade in. It's so politically charged. And I don't know more about it, per se. Just a different perspective.

 

Intriguing analogy with health insurance costing the same whether you have bad habits or not, vs life insurance costing more if you smoke, etc. However, it's not always that way. It's an epiphenomenon of health insurance most often being sold to a group, vs life insurance being sold to an individual. If you buy group life insurance, which is offered through some employers, it is not individually priced based on your bad habits.

 

Some health insurance plans subsidize gym memberships. It's a start.

 

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[UKCruiseJeff]

J...I understand what you are saying. And I agree that we have limited control over the events, outcomes, direction of the world. I do, however, believe that we can influence a very limited aspect of the world we live in. I cannot accept that we are doomed to a world where the evil thrives. I know that I will have very little impact on how our future unfolds. It is not realistic for me to expect otherwise. I have to count on the wisdom, goodness and civility of my fellow earthlings that we will find a way through the crap! Otherwise, there is no hope and we might as well all just acquiesce to the ugly. Not the way I want to live my life. Call me a Pollyanna. I can't move on with any other viewpoint. Optimism may be an illusion and a panacea but the alternative is not at all conducive to a joyful life. Life is just too damn short!

 

M,

 

I think we have found our way onto that man's Epicurus island in the book. Those two blue chairs under the tree.... No one else understands but you do. I do so miss intelligent argument with other old men even if one of them is a female! :D Can you imagine what a time we'd have if we could conspire a nightly table on some ship where we could both cook and eat and argue. Lovely!

 

I was a long time ago taken on by a large corporation. They said they were looking for people with Phd's or (British) Masters degrees when in reality they were looking for an east-end lad who was expelled from school but knew how to sell. After my rather extensive training I found myself selling mainframe computers to a variety of businesses. The corporation by now had started to make the "best personal business computer" of it's time. The teenager who wrote the operating system wanted the corporation to buy his small business for a measly small sum. It seemed to some of us who were selling "heavy metal" ie mainframes and moved into the new business, that the personal computer was a vending machine for software and the cash was in the software not the hardware. Hardware get's cheaper every year, but the software expanded in line with the improvement of storage and processors we felt. We were ignored. Thankfully. If we had succeeded and the software guy lost and sold up to us then the world would not have the Bill Gates billions being recycled into goodness and probably millions of lives that might have been lost through the unforgiving nature of malaria. A ludicrously well staffed and clever corporation of several hundred thousand of the worlds best graduates managed not to secure it's own future and a single man who dropped out of school and because of that he and his wife has changed and possibly saved the life of millions. Now, even though he does not work, he is the world's richest man. The chances of that outcome was I suggest in the millions to one against. It happened through fate irrespective of "good judgement" except that is for one man's.

 

I still resolutely conclude that we can try but the outcome has more to do with good unintended and unforseen consequences than what we do. Except that is if you are for example Bill Gates. He is one, we were several hundred thousand.

[mysty]

Thanks J for giving me the second blue chair! :) It would be nirvana to "conspire a nightly table on some ship where we could both cook and eat and argue" .Although you would need to do the cooking! And yes, I agree that the engines of goodness are few and far between. I am not yet ready to believe that we have exhausted those engines. Intended or unintended, I need to believe that there is hope.

[UKCruiseJeff]

Thanks J for giving me the second blue chair! :) It would be nirvana to "conspire a nightly table on some ship where we could both cook and eat and argue" .Although you would need to do the cooking! And yes, I agree that the engines of goodness are few and far between. I am not yet ready to believe that we have exhausted those engines. Intended or unintended, I need to believe that there is hope.

 

There is always hope. Hope is the fuel of optimists. A lack of hope is the fuel of pessimists. Realism is the fuel of depressives. I am an optimistic pessimistic realist. :D

 

What is in the larder? :D