Big Gulp, Meet Big Brother

[ApatheticNoMore]

Maybe what is considered nutritionally healthy always has an element of trendy to it. Was reading on the history of bread the other day (looking inside this book on Amazon). If we eat bread at all nowdays, we value homemade or artisan (ha!) bread. But machine manufactured bread was originally considered far more hygenic and thus healthy than homemade bread (think fear of infectious disease in an age before antibiotics). And contrary to the current emphasis on whole grains in mid last century enriched white bread was just considered super healthy. It is ENRICHED with all these essential vitamins and builds strong, bones, and muscles and is what you *should* feed your kids so they can grow up strong, don't you know?

Also in the old days people ate a LOT of bread. They averaged from the turn of the 20th century to the 1960s, 6-8 slices of bread a person a day! Wow. I don't know about you, but to modern lower carb sensibilities that seems like a LOT of bread!! And they weren't fat! Of course they were likely more active, and they weren't eating corn syrup or drinking large sodas (although they did eat sugar - sugar consumption was never that low I don't think), and they certainly weren't eating modern high omega 6 fats (those and trans fats are truly modern in being so widespread).

http://www.amazon.com/White-Bread-So...dp/0807044679/

No, I don't think we will ever reach a day when empty big gulp calories, with no evolutionary history at all in the human diet (I mean you can debate to what extent primitive people ate say grains, but you can't debate they were eating coca cola!) will be considered health food. And I like to think nutrition progresses and that we have a better idea about it now etc.. But it's quite possible being fat won't be seen as so bad in retrospect (some people say so now), it is even possible that sugar won't be seen as so bad in retrospect (although evidence points to it as quite bad now). When the whole state of the planet hangs in balance I'll go with the best scientific evidence we have now, and I'll go all in, but what you personally put in your mouth ...

And now back to your regularly scheduled healthcare debate.

[bae]

Health care shouldn't be for profit any more than police and fire protection, ...

I'm always curious what is meant by "not for profit" in this sort of case. Should food be "not for profit"? Housing? Education? Clothing? Transportation? Electricity, water, telephone service, Internet access?

Let's look at public safety.

Policemen clearly get paid for their time, above minimum wage, at a rate hopefully reflective of their years of training and the demands of the profession. Police management get paid as well. The companies that make police cars get paid for their products, and presumably make some profit on the manufacture of the car. The companies that make police uniforms and guns similarly make a profit. The fellow selling the land upon which the police station is built, the contractor who built the structure, the suppliers of bricks and cement all made a profit.

So which specific "profit" is the problem?

Perhaps you are thinking of a scenario in which someone like Omni Consumer Products buys the police force and runs it, and then charges the city a "profit" for its management services, which is billed to the taxpayer? Now, if they are delivering superior service at a lower overall cost to the taxpayer because of their management expertise, what's the problem with them being compensated (as "profit") for their efforts? If they are delivering an inferior product, with artificially-high prices, and bilking the taxpayer for the costs, and pocketing the money while sitting on a tropical beach, well, that's a different story.

I suspect in some areas the police unions would get upset at the competition for the unearned public dollar though :-)

[JaneV2.0]

The problem is not physicians getting paid for their services, the problem is adding for-profit entities like insurance companies into the mix that are answerable foremost to their shareholders and that pay their CEOs billions to keep costs down by denying care. We could look at countries who do health care more efficiently than we do (all of them, apparently). Those few who allow for-profit agencies into the mix do so under strict regulations. I haven't seen anything good come of privatizing functions traditionally performed by state agencies, but I could have missed one, I guess. (I tried to buy a pint of brandy yesterday. Hahaha. Washington insider humor.)

I'm mystified at how people are supposed to pay for basic--let alone catastrophic--medical care at current laissez-faire rates, pay off staggering college debts (a relatively new and again, profit-driven phenomenon), save hundreds of thousands to pay for their SS-free retirements--all while working at $14 an hour jobs. If they're lucky enough to have one of the few jobs that hasn't been gleefully off-shored by the "job creators."

"Now, if they are delivering superior service at a lower overall cost to the taxpayer because of their management expertise, what's the problem with them being compensated (as "profit") for their efforts?"

In my experience, a little profit is never enough with these people. If they were happy with small, consistent profit margins and a high-quality product, I would take your point. But those pesky shareholders and greedy CEOs are never satisfied, it seems.

[JaneV2.0]

...
The other down side is that a lot of people with this vision don't seem to take a realistic look at what it really costs to accomplish. While I'm all for caring for anyone who needs it, I don't want to bankrupt the country to do it. People lose sight of the possibility that exponentially increased debt could ultimately cause more pain and suffering in different, but possibly much broader, ways than a lack of universal healthcare. It's a risk I see as very real and one I'm not comfortable taking.
...

Our national health care costs are about double what civilized countries pay out. Surely we can do as well as they do, if not better, if we set our minds to it.
http://www.nytimes.com/2012/03/06/he...are-costs.html (Thoughtful article on just this subject)

[bae]

In my experience, a little profit is never enough with these people.

How profitable are they?

Health South, a Big Evil Hospital Company, that my mother has sued multiple times: Profit Margin: 8.4%, Return on Assets: 10.24%

United Medical, a Very Large Medical Insurance Company: Profit Margin: 5.0%, Return on Assets: 7.75%

Apple, an Earth-friendly hipster company: Profit Margin: 27.13%, Return on Assets: 25.84%

Starbucks: Profit Margin: 10.56%, Return on Assets: 13.45%

[ApatheticNoMore]

Health South, a Big Evil Hospital Company, that my mother has sued multiple times: Profit Margin: 8.4%, Return on Assets: 10.24%

There can be ways that these companies are ridiculously inefficient that doesn't show up as profit. Like if your pour massive amounts into new machinery used by almost noone or fancy new hospital wings. But how could any hosptial do that and stay competitive? Oligopoly and 3rd party payers so noone really sees the cost (whatever costs you see on your bill will certainly have no relationship to anything).

[peggy]

I'm always curious what is meant by "not for profit" in this sort of case. Should food be "not for profit"? Housing? Education? Clothing? Transportation? Electricity, water, telephone service, Internet access?

Let's look at public safety.

Policemen clearly get paid for their time, above minimum wage, at a rate hopefully reflective of their years of training and the demands of the profession. Police management get paid as well. The companies that make police cars get paid for their products, and presumably make some profit on the manufacture of the car. The companies that make police uniforms and guns similarly make a profit. The fellow selling the land upon which the police station is built, the contractor who built the structure, the suppliers of bricks and cement all made a profit.

So which specific "profit" is the problem?

Perhaps you are thinking of a scenario in which someone like Omni Consumer Products buys the police force and runs it, and then charges the city a "profit" for its management services, which is billed to the taxpayer? Now, if they are delivering superior service at a lower overall cost to the taxpayer because of their management expertise, what's the problem with them being compensated (as "profit") for their efforts? If they are delivering an inferior product, with artificially-high prices, and bilking the taxpayer for the costs, and pocketing the money while sitting on a tropical beach, well, that's a different story.

I suspect in some areas the police unions would get upset at the competition for the unearned public dollar though :-)

Glad you asked bae, cause this is something lots of folks get confused with. Non profit doesn't mean free. It doesn't mean people work for free. Everyone makes a very good living, but the 'investment' element is removed. With the police force, all the police and management make good livings, with benefits, but a corporation doesn't own the police force with the expectation of making a profit. Yes, some small towns (and large) use it as such, but they aren't supposed to write tickets to profit. And with universal health care, all the doctors and nurses and administrators get a very good salary. But the hospital isn't owned by a big corporation who expects a huge return on investment by kicking folks out whose insurance runs out, or ordering all kinds of unnecessary tests to run that insurance out.
Again, non profit does not mean free. A common misunderstanding.

[bae]

I don't misunderstand that at all.

But I'm curious where the line between acceptable and unacceptable "profit" is.

In your reply, you seem to indicate it is to be found around here:

"but a corporation doesn't own the police force with the expectation of making a profit."
"But the hospital isn't owned by a big corporation who expects a huge return on investment "

"the 'investment' element is removed".

That is, the ownership of the capital required for the enterprise is the issue. You seem OK with profit for labor.

[ApatheticNoMore]

I'm mystified at how people are supposed to pay for basic--let alone catastrophic--medical care at current laissez-faire rates, pay off staggering college debts (a relatively new and again, profit-driven phenomenon), save hundreds of thousands to pay for their SS-free retirements--

with zero return on their investment apparently, or really if your are investing in index funds there's no return lately. So add to that on top of a 40 hour (ha, if your lucky!) work week and commuting, become investment experts in their free time (you know in between parenting and keeping a house etc.), so they can eek more than 0% return out of their investments, for their SS-free retirement. Personal responsibility might be code for being, well at least a multi-millionaire (but preferably a billioinaire you know), what you aren't there yet? What have you been doing grasshoppering your whole life away?

[JaneV2.0]

Layers and layers of profits add up, I guess.

One article I read asserted that medical insurance profits had tripled over the last ten years--while the economy faltered.

According to this article last year in the NYT http://www.nytimes.com/2011/05/14/bu.../14health.html :

"The nation’s major health insurers are barreling into a third year of record profits, enriched in recent months by a lingering recessionary mind-set among Americans who are postponing or forgoing medical care."

As far as medical insurers go, I can't use the analogy of a leech because leeches can provide medical benefits.