Dude and Dude: Health Insurance

My husband is certain that the only reason they have implemented a weight loss pool (put in $10 and if you lose the most weight, you get all the cash) is because they are planning to also implement an "unhealthy tax." If you are obese, you are driving up the costs for everyone else, so your insurance rates are higher. The only way to get good rates is by maintaining a healthy weight, not smoking, and not drinking. I believe they very well might do this. It *almost* sounds like a good idea. In practice, not so much.

See, the unhealthy pool will be offered only the high deductible plan. They will pay ungodly rates for it too. All of which buys them nothing if they actually get sick. I know. We're on it this year. The healthy pool will still have their rates go up, but it will look like such a bargain compared to the unhealthy pool, that people will try to get on it. Which leaves a bunch of people in top physical condition who have little need of a doctor. Meanwhile, they are paying more than they are now, so the insurance companies are only getting richer, and yet, they get to claim that they are battling the obesity epidemic by helping people adopt healthy lifestyles. Which brings in even more customers.

And now, to the question and answer part of the discussion... Do you think there is any form of socialized medicine that can work, or is it flawed right from the beginning? It seems that countries that try to maintain a low tax rate while providing such services ultimately fail. And people can point to places like Sweden where the tax rate is high but the health care system is failing, and say that it is flawed too, but I find that argument weak. Theirs is not collapsing in such a way that it cannot be fixed without readjusting their entire view of socialism. Theirs is better described as "problematic."

Also, I know that they are saying they have enough flu shots on hand for everyone who wants one, but I also know that viruses mutate. Why are we not hearing more about the "bird flu" and do you consider it to be a threat?

... coming anytime soon, it would be political death to any party that allowed it to happen. It won't need to happen at the political level anyway, because, as you've pointed out, private industry is already implementing it, under the pressure of trying to avoid being "bankrupted" by health insurance premiums. Remember, in this climate you don't have to actually go bankrupt to go bust - all you have to do is show a quarterly report that fails to meet market expectations, and your investors abandon you to Chapter 11.

I operate on the "parasite theory" of social systems. That is, there is no such thing as a perfect system. And it's not only pointless but ultimately deadly to try to identify and enforce one, Mr. Bush, Ms. Clinton. Each one functions well only until the point that the parasites learn to manipulate it. Once the parasites have learned this, the social system must change, or it will be brought down.

Socialized medicine, for instance, works only so long as customers are willing to curtail their use of the system (i.e. knowing enough about their health to go to the doctor only for scheduled checkups and issues not treatable at home), and providers are willing to curtail their reward expectations. Each customer that goes to the physician for a hangnail ("why not? It's free.") is a parasite. Each physician who wonders aloud how come he's working so many hours for so little money is a parasite. Enough parasites, and socialized medicine comes crashing down. As in New Zealand, England, and elsewhere.

A similar combination of parasites (Viagra and the social forces that have allowed its acceptance; the obesity epidemic, due to the worship of McDonald's; physicians who abandon primary care for specialties for which he can charge more and work less) is at work on the American system. Which is about to collapse under their weight. Somebody should be paying attention - because it is this sort of thing that spawns terrorists. Not to mention revolutions. The shooting kind.

We are not hearing more about "bird flu" because it is not yet a large enough epidemic to permit the news outlets to make money covering the story. Viruses do mutate, but they don't usually mutate so rapidly that a vaccine developed for a particular strain in a particular year will suddenly lose effectiveness. Even with viruses, most of the mutations that occur will actually make the virus less virulent, if they don't destroy it outright. This year's vaccine should be ok for this year. There will have to be a new one for next year.

For more on the bird flu, go here.

I did not mean to imply a government imposed tax on the unhealthy. I meant, as you said, a privatized system that more or less becomes the accepted norm of corporations, and thus becomes the law of the land. And while I 99% agree with you that political parties would never do it, lately, stranger things have become law. So that 1% is holding out.

I think your parasite theory is accurate. I also attribute the ability of certain nations with a higher tax rate to having fewer problems as an example of how to counter this. There is no way to completely eradicate the parasites. Instead, you must work to minimize their effects. I think such a system takes abuse into account, and budgets for it. In a system where the tax rate is low, there just isn't as much give in the budget. The ones like Sweden will find that they have more parasites, but they are better equipped to deal with it. As you've said, they haven't learned to manipulate it, which is why it isn't the crashing failure that other socialized health care systems are.

In the end, it's all a wash on a large scale. Each system leaves you to pay huge amounts of money for acceptable healthcare. But on an individual level, the results are very different. The democratic system leave some unable to meet that high cost. The low tax rate socialist system leaves some waiting too long for appropriate health care or seeking a higher cost alternative. The high tax rate systems make people seek treatment for frivilous health concerns, thus putting a strain on the larger cities, but the budget has room to accomodate more doctors. And please don't think that I am suggesting the US switch. God, what a disaster that would be.

I figured the media would tie into your answer somewhere. And I do agree with that assessment. I meant more on a scientific level than a reporting level. I knew that receiving ANY type of flu shot would usually make the symptoms more bearable, even if the virus had mutated. And I suppose I knew that most of the mutations wouldn't take hold. It just makes sense that they wouldn't. But I suppose I gave too much weight to the one freakish mutation that might be quite dangerous, and how much of an impact it would have. I'll be the first person to admit that the cellular level stuff was NOT my strength.

And for the record, I asked about the "bird flu" because you brought up the topic of health care, and it's not often I have a chance to pick a scientist's brain. NOT because I am terrified of it. I take the approach that if there is a pandemic of anything and my number is up, there isn't a lot I can do about it. It's a "take proper precautions and get over it" kind of attitude.

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The Swedes, as I understand the matter, are a special case. Theirs is a relatively small population, and that population is almost completely Swedish, so that members of the population strongly self-identify with each other and the nation. Swedes, like other Germanic peoples, are far more accepting of both governmental and social strictures than are Americans - so they will accept taxes and behavior restrictions imposed by government and (critically important) will put heavy social pressure on everybody else to do likewise. Listen to Garrison Keillor's News from Lake Wobegon (same principles apply to Swedes as to Norwegians, and Danes) ... No way the average American would tolerate the neighbors "snooping" on their personal practices. Yet it is precisely this "snooping" that keeps the parasites at bay enough to allow things like socialized medicine to function. Thus, I would argue that the Swedes actually have fewer parasites than other nations.

The virus vaccine situation is complicated. Viruses are wierd, because part of the way they mutate is by "stealing" DNA from other creatures. If a bird flu virus should happen to "steal" a piece of DNA that includes genes encoding for the machinery to allow the bird flu virus to pass from human to human, all hell would break loose. This apparently is what happened during the famous, and deadly, 1918-19 influenza pandemic.

Fortunately, such events are rare. But they are also unpredictable.

And unfortunately, it's not true that "any" vaccine will be better than none. Viruses occur in "families", and vaccines tend to retain some effectiveness only for viruses belonging to the family of the original target. The current "bird flu" belongs to a family that has not previously impacted humans. Thus, there will be little or no natural immunity, and vaccines effective against other virus families will likely be of little value. This is why so much weight is placed on news reports reporting the "strain(s)" of active influenza virus from any particular year, and whether they belong to known or new "families" or strain groups. The more closely related an emerging flu virus is to a known strain or family, the less is the risk of a major outbreak to humans.

Very interesting all around. Thanks for the info.

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