Steely_D wrote: 
A friend of mine is significantly involved at KP.  There is thankfully, some evolution on delivery, distribution of HC, as well as cost control.

Several other issues you raise deserve a more insightful commentary than I can offer.  Thanks for raising them.

 ScottN wrote: 
Well, that very much depends on the setup.

In antiquated, obsolete Fee For Service medicine, where a doctor gets paid for everything they do to the patient, it's in the doctor's financial interest to over-order and - in truth - not cure the patient. They make more money that way. That's capitalism.

The movement in programs like Kaiser Permanente and others is prepayment. This means that, with a fixed amount of money coming in, it's in the financial interests of the company that they physicians 1) keep the members healthy 2) don't waste premiums dollars which means 2a) don't screw up and create lawsuits. Weirdly, this means that the financial goal of the patient (don't pay a lot) matches up with the company (don't let the member get sick, because that drains the coffers). Declining the necessary service is a bad thing for the member: it generates more illness, more visits to try to get the service, and more lawsuits that a legitimate necessary service wasn't provided.

Note that this is separate from giving people what they think they want because they saw it on TV. It requires a good knowledge of what people really need, what tests are useful, what likely results are - and to be good communicators so the patient doesn't think they're being cheated. 

 miamizsun wrote: 
You've built up what you may think is a rather robust logical argument, but I think there are some holes in it.

Regarding the bolded text above, Ordinary peoples' ability to judge the professional competence of experts (doctors, bridge designers, etc. etc.)  is dubious at best. How many centuries before scientific reasoning came along did we put up with things like bloodletting, burning witches for disease and crop failure, etc?

Scientific method and knowledge gives us (in theory) the ability to judge if someone is competent at their job, but few consumers possess it in the requisite degree to make an informed judgement.

Look at how many people willingly give their money to quacks like Andrew Wakefield, or "Alternative" medicine practicioners of homeopathy, etc.

Even when it comes to traditional practitioners, how is one to judge reliably whether the failure of a therapy, or some other unwanted outcome is attributable to the competence of the practitioner? If a doctor sets your broken nose improperly, and you go to complain, they could tell you you did not follow their post treatment instructions carefully, or insist that the radiologist screwed up, or some other clever excuse. Most people assume that a certain aura surrounds people with "MD" appended to their name, and would not be likely to pursue this. Online review sites can potentially help somewhat in making it easier to detect patterns of complaints, but these comments and reviews are unvetted, so we don't know how reliable they may be.

There are ways that incompetent practitioners can continue to practice. If the state medical board (a regulating agency which presumably you as a libertarian/nonaggression principle supporter are not in favor of) suspends a practitioners' license to practice in one state, they can simply move to another. Even if they get decertified in every state, they can do what Wakefield has done, i.e. become an "unfrocked" doctor, i.e. a "service provider" or "consultant". Your options 1, 2, and 3 may be the only ones in your idyllic utopia based on non-aggression, but in the real world there is at least one other.
 

 ScottN wrote: 
a philosophical concept

the real problem is when you or i can't disagree or say no to bad business (or just bad ideas period)

we notice some doctor/hospital is ripping us off and simply say no thanks and go trade with another doctor/hospital with reasonable prices and service

sooner rather than later the doctor/hospital that is overcharging will start to suffer

in today's world he's got three options

1) he can go out of business but that isn't good for anyone involved, especially him and his employees

2) he can lower his fees to something reasonable that people can afford and hope that his business recovers

3) he can try and buy political favor, some lawmaker who will make a rule that you must do business his way or face state aggression

number 3 is the problem we have today

state interference on behalf of a lobby

shouldn't our leaders have our best interest at heart?

we can say what we want about politics but lobbying is still bribery

look at all the profit that doctors and insurance companies are making now

you think they have they have lobbies?

how many lobbyists do you and i have?

i don't have one do you?

to be fair i don't think the doctor lobby is as powerful as the insurance industry

 Red_Dragon wrote: 
And for as long as possible.  Like health care insurance and some other venues, there is an inherent conflict of interest when it is in the financial best interest of a service provider, to lessen, cheapen or decline the service provided.

 Steely_D wrote: 
think of capitalism as a tool

it can be great when used properly

when in corrupt hands not so much

 Red_Dragon wrote: 
i think that problem is relative

in other words the govt corrections complex in almost 10 times as large and they're engaged in the same act of bribery/lobbying

i agree that we have way too many non-violent people in cages

because bad govt

i say we go with freedom and stuff

 Red_Dragon wrote: 
Yep. Capitalism means profit. It is neither ethical nor moral - it's dispassionately driven by the bottom line.
It's not inherently evil for the owners of prisons to want more people incarcerated - it's just business. 

 miamizsun wrote: 
It means a lot to inmates. The private prison lobby spends a lot of money to make sure silly things like weed remain illegal because their bottom line is based on locking up as many people as possible.

 Red_Dragon wrote: 
ownership doesn't mean much to inmates (or in my eyes)

bureaucracy is bureaucracy whether it's govt or govt cronyism

we need to lower the incarceration rate/prison population

Very good news.

(...) Management & Training Corp., the private contractor that operates the center for the U.S. Bureau of Prisons, said about 2,000 inmates became disruptive Friday because they're upset with medical services and refused to perform work duties.

MTC spokesman Issa Arnita said in a statement that prisons officials have begun moving the inmates and that the process would continue into next week.

Arnita said prison administrators met with inmates Friday to address their concerns but that the prisoners "breached" their housing units and reached the recreation yard. The Valley Morning Star reports fires were set inside three of the prison's 10 housing units.

Authorities say about 800 to 900 other inmates are not participating in the disturbance. The inmates being held at the facility, which is in far South Texas more than 200 miles south of San Antonio, are described as "low-level" offenders who are primarily immigrants in the U.S. illegally.

"Correctional officers used non-lethal force, tear gas, to attempt to control the unruly offenders," Arnita said in the statement.

No inmate breached two perimeter security fences, and there's no danger to the public, he said.

The large Kevlar tents that make up the facility were described in a 2014 report by the American Civil Liberties Union as not "only foul, cramped and depressing, but also overcrowded." (...)

Is prison contagious? | Science/AAAS | News
Tipping point. Simulation shows how longer sentences for some may drive up rates of imprisonment for many.

Incarceration in the United States is frequently described as an epidemic, with per capita rates nearly quadrupling in the past 30 years. African-Americans appear to be particularly susceptible: In 2011, they were six times more likely than whites to be incarcerated, making up 38% of the 1.6 million Americans behind bars while accounting for only 13% of the U.S. population. Now, a computer simulation originally developed to track infectious disease suggests the longer prison sentences that blacks often receive may accelerate the rate of “infection.”

Social scientists have long observed that imprisonment behaves like a contagious disease, says Kristian Lum, a statistician at Virginia Polytechnic Institute and State University in Blacksburg. Studies show that those close to an incarcerated person are more likely to become imprisoned themselves. They could be driven to crime by poverty or stress resulting from the jailed person's absence, or become inured to violence through more frequent exposure to criminals. Children whose parents or older relatives are in prison may act out in ways that land them in jail, too. Even if the prisoner's friends and family don't commit more crime, or more violent types of crime, they may attract more attention from the police and be more likely to be arrested for minor infractions. (...)

Segregation by Incarceration
America’s New Apartheid
by GARRY LEECH

Many people associate the mass imprisonment of a population with authoritarian regimes. Consequently, many Americans are surprised when they learn that the country that incarcerates more of its own citizens than any other is the United States. With 2.3 million prisoners, the “land of the free” has more people in prison than China, which has a population four times the size of the United States. A hugely disproportionate percentage of those incarcerated are African-Americans as Washington’s war on drugs constitutes the latest incarnation of racist policies that have existed since the country’s founding.

The United States has a long and ongoing history of implementing policies ensuring that Blacks are segregated from whites, both physically and in terms of experiencing different rights. While still a British colony, the white settlers, having exterminated much of the indigenous population, imported Black slaves from Africa to work the plantations and to serve as domestic servants. Upon achieving independence from Britain, the new “democracy” with its “Bill of Rights” immediately made evident its hypocrisy to the benefit of privileged white males by continuing the practice of slavery and only allowing white male property owners to vote. In short, there was no “independence” for Blacks.

Our history classes celebrate that white hero Abraham Lincoln’s freeing of the slaves while ignoring the fact that most nations in the Americas had abolished slavery almost half a century before the United States. In fact, only two countries—Brazil and the Spanish colony of Cuba—maintained slavery longer than the “land of the free.” That celebrated champion of freedom, Thomas Jefferson, only freed his slaves upon his death, when he no longer had a need to exploit them. In fact, slavery wasn’t abolished until almost one hundred years after independence. And when slavery was finally abolished in the United States in 1865, blacks still remained second-class citizens under a system of apartheid in which a series of Jim Crow laws kept African-Americans segregated from whites.

It wasn’t until the mid-1960s, one hundred years after the abolition of slavery and almost two hundred years after independence, that officially-sanctioned segregation eventually ended and all Blacks in the United States finally obtained the right to vote and to equal access to public schools and other public spaces. But the US government soon found another tool for implementing social control over Blacks in order to segregate them from the general white population: the war on drugs. In 1971, President Richard Nixon declared illegal drugs to be “public enemy number one.” During the next two years, drug arrests and incarceration rates increased significantly, with a disproportionate number of those targeted being African-Americans.

In 1986, President Ronald Reagan intensified the war on drugs by declaring that illegal drugs constituted a threat to national security. That same year, Congress passed the Anti-Drug Abuse Act with very little debate, establishing harsher and mandatory prison sentences for crack and powder cocaine. But the mandatory sentences for crack were much harsher than those for powder cocaine. Consequently, a conviction for selling 500 grams of powder cocaine resulted in a five-year mandatory sentence, whereas only five grams of crack cocaine would trigger the same five-year sentence. In other words, a conviction for possession of crack resulted in a prison sentence 100 times longer than a conviction for the equivalent amount of powder cocaine. Essentially, Congress imposed disparate sentencing laws for basically the same drug, since both crack and powder cocaine are derived from the coca plant. Furthermore, crack became the only drug that carried a mandatory sentence for first offenders.

A quarter of America’s 2.3 million prisoners are in jail for non-violent drug offenses—more than the total number of prisoners in the European Union. In 1980, there were 41,000 imprisoned drug offenders but that number had skyrocketed to more than half a million by 2011, according to The Sentencing Project, a non-profit organization that analyzes the US criminal system. The race and class bias of the 1986 sentencing laws soon became apparent as the ratio of Blacks who were imprisoned compared to whites increased dramatically. Because crack was much cheaper than powder cocaine it became popular in poor urban neighborhoods, many of which were Black. In contrast, most of the principal users of powder cocaine were middle- and upper-class whites living in relatively wealthy suburban neighborhoods. Black neighborhoods have also endured the militaristic presence of heavily-armed police narcotics squads carrying out “zero tolerance” drug policies. And so, while record numbers of low-level urban drug dealers and users are being sent to prison, most middle and upper class white suburban dealers and users remain free to indulge their habits with little police harassment.

By the late 1990s, despite constituting only 13 percent of the nation’s drug users, Blacks represented 58 percent of imprisoned drug offenders. Furthermore, the majority of these offenders were low-level dealers or users; in fact, statistics released by the United States Sentencing Commission showed that only 11 percent of federal drug offenders were high-level dealers. This rate of incarceration contributed to a social breakdown in many poor inner-city neighborhoods. The number of Black children growing up fatherless skyrocketed, with 70 percent living in single-parent homes without their biological father at the beginning of the 21st century compared to only 14 percent twenty years earlier.

In 2010, Congress finally addressed the 100:1 sentencing disparity between crack and powder cocaine by reducing it to an 18:1 ratio and eliminating mandatory prison terms for crack possession. While an improvement, the new sentencing laws still disproportionately impact Blacks and, because they are not retroactive, thousands of drug offenders convicted under the old laws remain incarcerated. (...)

Why For-Profit Prisons House More Inmates Of Color : Code Switch : NPR

A new study by a UC-Berkeley graduate student has surprised a number of experts in the criminology field. Its main finding: Private prisons are packed with young people of color.

The concept of racial disparities behind bars is not exactly a new one. Study after report after working group has found a version of the same conclusion. The Sentencing Project estimates 1 in 3 black men will spend time behind bars during their lifetime, compared with 1 in 6 Latino men and 1 in 17 white men. Arrest rates for marijuana possession are four times as high for black Americans as for white. Black men spend an average of 20 percent longer behind bars in federal prisons than their white peers for the same crimes.

These reports and thousands of others have the cumulative effect of portraying a criminal justice system that disproportionately incarcerates black Americans and people of color in general.

Sociology Ph.D. student Christopher Petrella's finding in "The Color of Corporate Corrections," however, tackles a different beast.

Beyond the historical overrepresentation of people of color in county jails and federal and state prisons, Petrella found, people of color "are further overrepresented in private prisons contracted by departments of correction in Arizona, California and Texas."

This would mean that the racial disparities in private prisons housing state inmates are even greater than in publicly run prisons. His paper sets out to explain why — a question that starts with race but that takes him down a surprising path. (...)

The Science of Solitary Confinement | Science | Smithsonian
Research tells us that isolation is an ineffective rehabilitation strategy and leaves lasting psychological damage

Picture MetLife Stadium, the New Jersey venue that hosted the Super Bowl earlier this month. It seats 82,556 people in total, making it the largest stadium in the NFL.

Imagine the crowd it takes to fill that enormous stadium. That, give or take a thousand, is the number of men and women held in solitary confinement in prisons across the U.S.

Although the practice has been largely discontinued in most countries, it's become increasingly routine over the past few decades within the American prison system. Once employed largely as a short-term punishment, it's now regularly used as way of disciplining prisoners indefinitely, isolating them during ongoing investigations, coercing them into cooperating with interrogations and even separating them from perceived threats within the prison population at their request.

As the number of prisoners in solitary has exploded, psychologists and neuroscientists have attempted to understand the ways in which a complete lack of human contact changes us over the long term. According to a panel of scientists that recently spoke at the American Association for the Advancement of Science's annual meeting in Chicago, research tells us that solitary is both ineffective as a rehabilitation technique and indelibly harmful to the mental health of those detained.

"The United States, in many ways, is an outlier in the world," said Craig Haney, a psychologist at UC Santa Cruz who's spent the last few decades studying the mental effects of the prison system, especially solitary confinement. "We really are the only country that resorts regularly, and on a long-term basis, to this form of punitive confinement. Ironically, we spend very little time analyzing the effects of it."

Exact numbers are hard to come by, but based on a wide swath of censuses, it's estimated that between 80,000 and 81,000 prisoners are in some form of solitary confinement nationwide. In contrast to stereotypes of isolated prisoners as the most dangerous criminals, Haney estimates that a third of isolated prisoners are mentally ill, and a disproportionate are minorities, partly because alleged gang membership is grounds for placing a prisoner in solitary indefinitely. (...)

helenofjoy wrote: 

The money has already been allocated and divied up amongst the big boys. Jaywalking? A doobie? Loitering?

We've got contracts to fulfill and need to create crime.
http://www. huffingtonpost. com/2012/02/14/private-prisons-buying-state-prisons_n_1272143. html

"Corrections Corporation of America, the nation's largest operator of for-profit prisons, has sent letters recently to 48 states offering to buy up their prisons as a remedy for "challenging corrections budgets. " In exchange, the company is asking for a 20-year management contract, plus an assurance that the prison would remain at least 90 percent full, according to a copy of the letter obtained by The Huffington Post. "
"

https://www. google. com/search? q=cca&ie=utf-8&oe=utf-8&aq=t&rls=org. mozilla:en-US:official&client=firefox-a#q=cca+state+deals&rls=org. mozilla:en-US:official

 RichardPrins wrote: 
I cannot even imagine a solution without dismantling our present systems ... and what about the money?

Guards May Be Responsible for Half of Prison Sexual Assaults - ProPublica