Healthcare & rationing

[TDPerk]

(after all, I've been blowing sunshine up Obama's holy hole right from the first post, right?)

That's all I've read of you so far.

Are you sure you're not just repeating GOP lies?

= Naive

Yes. I agree you're naive.

Try to respond to some other comments as well, you're great entertainment as well.

[Maui]

(after all, I've been blowing sunshine up Obama's holy hole right from the first post, right?)

That's all I've read of you so far.

Thats right, I keep forgetting about your reading skills. Go back to post 1 and try again.

Try to respond to some other comments as well, you're great entertainment as well.

I think I've done a pretty good job responding to them, considering this board does not provide those of my persuasion much backup. OTOH, you seem to be missing much of what I have wrote.

But I am trying to work done tonight as well, so this will have to be it for now. Goodnight.

[TDPerk]

Thats right, I keep for getting about your reading skills. Go back to post 1 and try again.

Just did, and yes, you've had Obama's hand up your back since post 1.

I think I've done a pretty good job responding to them, considering this board does not provide those of my persuasion much backup.

A) You haven't actually responded to them. The nature of sovereign immunity, for example, remains the same.

B) So you admit you're in the tank. That's big of you.

But I am trying to work done tonight as well, so this will have to be it for now. Goodnight.

Brave, brave Sir Robin...

See if you can be more substantive tomorrow.

When you have time.

[Maui]

A) You haven't actually responded to them. The nature of sovereign immunity, for example, remains the same.

Just because you don't agree with my responses doesn't mean I didn't respond to them. I've addressed this issue at least 3 times now. I've got a novel idea-- why not respond to my response!

Brave, brave Sir Robin...

LOL. I'm chicken because I don't have all night to waste with you?

See if you can be more substantive tomorrow.

LOL. I think I've been the only one linking to the raw data here. (Some others have linked to op-eds). What comment have you made tonight that didn't come from the talking point memo?

When you have time.

Dude, this is fun, but seriously? Play time is over. I really do have to work. Talk to you tomorrow.

[MSimon]

Isn't the GOP version of healthcare reform to make it illegal to sue?

Nope. Just limits on unquatifiable losses i.e. pain and suffering. The love of a child. The loss of a loving spouse. etc. That is lottery ticket litigation.

Is it unfair? Probably. Is it less unfair (higher insurance costs and fewer doctors for all) than the other options. Probably.

I can't think of a perfect system that is workable in practice. Humans are involved. Which is why I like engineering. More quantifiable stuff. None the less we need a system that puts individuals in control.

So here is what I propose.

1. Insurance be made portable - company to company and across state lines.

2. MSAs that roll over. Complimented with catastrophic coverage with varying levels of deductibles.

What is this going to do? Competition for low cost procedures. If the MSAs are set at $2K and the average rolled over per year is $1K then it is likely that most procedures under $10K or $20K that are not dire emergencies will be shopped around.

3. Put a cap on non-quantifiable damages.

Individuals decide what they want to spend on health care.

No spending - inferior care at best.

[MSimon]

Look guys. It would be good to stop the name calling.

TD. No need for harsh words. Just keep asking "what is the difference between sovereign immunity and a contract?"

Maui. I know. I know. We should all treat each other like brothers. And if it costs nothing I'm all for it. But if there are costs borne by unrelated people there is a formula for the break even point.

http://en.wikipedia.org/wiki/Kin_selection

Socialism may work in Sweden where every one is a Johansson. It is not going to be well accepted in America where kinship groups are small (relatively). People will do more for their kin than they will for a stranger. Sad but true facts of life.

Generally it is better to design in IP-67 connectors than complain about the rain. Reality is what it is. There is no New Socialist Man. Neither is Libertarian Man on the horizon.

Americans for the most part are descendants of misfits and people who generally don't fit in well with pecking orders. The distrust of government is genetic. Overall I'd say that was a good attitude.

===

My other prescription. We can enlarge the social safety net by making the country more profitable. Drilling more oil and gas here and now would be a good stopgap measure. Until something better comes along.

[ravingdave]

Dave,

I think the answer to the question you pose is catastrophic insurance coupled with MSAs. And MSAs should be allowed to accumulate allowing you to by insurance with higher deductibles as time goes on. That would give you price shopping in procedures costing under $10,000 or so.

It would also help if there were price lists.

A Very reasonable idea. Unfortunately, it doesn't seem to be part of the debate by the majority party in Washington.


David

[TallDave]

Is debt from the aftermath of car accidents a huge part of defaults? Would it be even if car insurance was not required?

They result in a legal liability which the plaintiffs know they often have no hope in recovering given the defendants' limited funds. The end result was a lot of the time there was no finanical remedy for the injured. Thus mandates were reasonable.

Your point about government helping out when the uninsured need medical care is part of my original point-- rather than ask taxpayers for that $ to make up for an uninsured person's bill, why not ensure everyone is contributing up front?

Besides being terribly coercive, because a lot of those people can't afford insurance anyway. That's why they're on Medicaid or asking for private charity. If someone is poor and ill, they either die or someone else pays the bill.

Nor do they want a corporate board doing the same. Guess what? It's part of insurance public or private.

In fact it is not. You make a contract with a private insurer. The government simply decides. This is one reason why we spend so much more on health care.

This is a point of factual confusion. The U.S. has, by far, the best medical care in the world. We have the best cancer survival rates (in some cases, 4 or 5 times better than socialized systems).
...
Breast cancer deaths per 100,000

You're confusing survival rates with cancer rates. The medical system has little effect on the latter.

A heck of a lot of people think this is part of our problem. Too much focus on costly "defensive" medicine

A common misconception. As it turns out, preventative medicine is also costly and inefficient, because generally 99% of the people never get that disease anyway. What is effective is lifestyle changes -- but the gov't cannot force free people to live healthier.

And there's where the perspective comes in. How much money, with sharply deteriorating returns, should we throw at preventing an outcome that cannot, in the end, be prevented?

As much as we choose. You have no right to make that decision for me or anyone else.

What good is all the extra money if we have to throw such a huge chunk of our "wealth" down the healthcare toilet?

As opposed to what? We are free people and we will spend whatever percentage of GDP we choose on healthcare. What is a much better chance of beating cancer worth? A lot, to most people.

It's arrogant, myopic and, in many cases, dangerous to think that just because we've done a lot of things right over the course of our history, that we can do no wrong.

What's arrogant, myopic and dangerous is to discard the free market for gov't control in the face of all the historical evidence for such a proposition.

As M Simon points out, a lot of the problem is we are disconnected from costs because insurance insulates us from cost decisions. This is very very expensive. It would be better if more people made cost/benefit decisions.

OTOH, health care costs are going to keep rising right up until the point we achieve functional immortality anyway, because every day someone invents a new treatment. We might someday spend 50% or more of GDP on health care. And why not? As long as everything else we already consume fits into the other half of an ever-rising GDP, we might as well spend the rest on prolonging life.

[tomclarke]

What's arrogant, myopic and dangerous is to discard the free market for gov't control in the face of all the historical evidence for such a proposition.

...snip...

We might someday spend 50% or more of GDP on health care. And why not? As long as everything else we already consume fits into the other half of an ever-rising GDP, we might as well spend the rest on prolonging life.

I am fascinated by the arguments about free markets. In simple, relatively static, systems, economics actually works as billed (perfect information, agents act optimally). There is a continuum between this state of informed nirvana and the type of "progress" made under evolutionary pressure.

My view is that in complex global systems free markets are much closer to evolutionary survival of the fittest than to an intelligently optimal solution.

Now this is not an argument against free markets necessarily. Evolution is an extraordinarily powerful optimising tool. But there is no guarantee that it gives good results and indeed it works through periodic catastrophy (sometimes at species level).

We can choose how much regulation and what type of regulation to give our markets. The ideal of transparency does not wash. Unless you prohibit certain transactions, to slow the system down and make it more manageable. You can guarantee that devious ways will be found to evade transparency for local (though not global) advantage. So we have real choices to make. Wrapping this up in terms of "government interference" is ideologically convenient, but obscures the issue. which is: "what types of enforcable regulation do we want for our markets".

Some people simply say no regulation. It is attractive, and possibly would end up being optimal in a sufficiently simple or stationary world. But where change is rapid we can see clearly from the animal kindowm how much survival of the fittest leads to enhanced survival, and how much to profitless arm's wars, intra-species reproductive competition (e.g. peacock's tails) etc.

end of ideological rant.

Now, this 50% "spare" income. I know it is not 50% now, but it must be 20% at least. Is this consistent with the argument that spending say 10% of GDP on AGW prevention measures will remove all competitive advantage? I can't see any difference except the ideological one of who mandates the resource diversion...

[TallDave]

My view is that in complex global systems free markets are much closer to evolutionary survival of the fittest than to an intelligently optimal solution.

Those that make correct decisions survive. The "intelligently optimal solution" is incalculable and in any case would never be perfectly implemented even if it could be known. Free markets are the best we can do in a world of limited information and flawed humans.

Some people simply say no regulation

No serious free marketer says that. At the very least, government must intervene to prevent monopolies.

<Is this consistent with the argument that spending say 10% of GDP on AGW prevention measures will remove all competitive advantage?

Shrug. If you want to spend your money on AGW prevention, no one is stopping you. Most people seem to prefer health care.

The difference in terms of competitive advantage, of course, is that we can sell the health care treatments we develop. AGW prevention is just broken windows: it doesn't address any real problem. Additonally, AGW prevention is mandated and adds to the bottom-line cost of everything else.

[tomclarke]

The difference in terms of competitive advantage, of course, is that we can sell the health care treatments we develop. AGW prevention is just broken windows: it doesn't address any real problem. Additonally, AGW prevention is mandated and adds to the bottom-line cost of everything else.

Equally, if renewables are subsidised versus carbon fuels with a cash-neutral carbon tax, the new technologies developed can be sold.

I don't buy the bottom-line cost. Healthcare is pretty basic, and governments give up plans in adversity easier than people give up health. The issue is that the US health system uses lots of resources. People cannot choose "cheap, efficient, slightly worse" healthcare if they want to. There are too many monopolistic issues in the system. So saying "the inefficiency is Ok, because people can choose it or not" is not fair.

Best wishes, Tom

[vankirkc]

I know I'm going to get flamed for saying this, but I think the argument for 'free markets' in healthcare is a bit delusional.

For a free market to lead to the optimal outcome there has to be some elasticity of demand. I would argue that there is none for life saving procedures and medicines, which represent the bulk of healthcare expense. Nobody comparison shops for the best deal for their heart transplant surgery. It just isn't done. If you need to have your arm sewn back on, are you really going to shop around for a couple weeks to find the best provider? Of course not.

I think the U.S. ought to take the route laid out by Japan, who have mandatory insurance AND price controls for healthcare related expenses (birth and optics aren't considered to be 'healthcare' issues). As a user of the system, I can attest that it works quite well, analysis shows it costs 1/3rd per capita of what is currently being spent in the U.S., and Japanese life expectancy is among the highest in the world.

The chicken littles in the forum, and on the right, would have you believe that implementing public healthcare will suddenly make it impossible to receive additional care outside the system. That's patently false in Japan. There are private hospitals here if you want to avail yourself of them.

It's all more reactionary smoke and mirrors to protect the fat insurance companies' profits. Business as usual in Washington.

[Skipjack]

I live in a country with universal healthcare. You pay 25% of your income (a tad more as a non self employed person) into the system. For that you get a pension when you retire (usually at age 65 with roughly 75% of what you earned the last few years) and you get full coverage health care. The only things not covered by this are glasses (contact lenses are though) and porcellain or gold fillings as well as more elaborate dental procedures that are not a necessity (e.g. dentures are covered, but only the cheapest version, from what I understand, I dont need those yet, so I dont really understand the details here).
Children are automatically insured with their parents, spouses are insured with their husbands.
You dont pay more if you have a preexisting condition. E.g. I had a heart attack at the age of 33 due to me working through a flu once. I do have to take rather expensive medication ever since, but I dont have to pay any more than my partner does, who does not have that condition. And quite honestly I dont see why I should. I never did anything wrong to provoque this illness.

Now our system is not all great and shiny and it does have issues. E.g. it is managed by politicians who are idiots and have no idea about medicine. Therefore they make stupid rules. Workers there are overpaid. The management is bad and money is not reinvested but rather is shifted from one person to the next. In return they pay the doctors that do the actual work comparably little money. In addition there is a lot of abuse. Drug addicts, alcoholics and other lowlifes that have never worked anything in their lives abuse the system wherever they can. Plus we have a lot of immigrants that get full coverage without having worked here for very long. They bring their illnesses from Afrika and Asia and we pay their treatment (e.g. HIV, which is very expensive). All that is a problem.
In return you are comparably safe for comparably little money. Still the system is hurting really bad right now.

----
In the US, there is the other extreme. you can pay up to 800 USD a month for full coverage (more if you are self employed) and those 800 USD wont buy you any retirement yet. Now, of course if you are making 100k or more a year, you are much better of in the US, but that should only apply to a small fraction of the population.
The average income per working capita here is roughly 3000 USD a month (I assume it is about the same in the US). 800 USD would be ~27% and that for the health insurance only. In addition to this (unless you are insured with BCBS ), your insurance will cover much less than the health insurance here does (there is more things they dont cover than what they do cover).
If you have any preexisting conditions or are just plain simply old, you pay even more, if you get any insurance at all.
Plus, if you are sick for a prolonged period of time and because of that loose your job, your health insurance is gone too. Actually you will not only loose coverage for yourself, but for your entire family.
Now what happens when that happens to a guy? He is out of a job and has an enormous healthcare bill to pay, because, say, he worked himself to a hearth attack. Now he can either file bankrupthy and noone gets any money, or he can do what a lot of americans do. Find any reason (and that could include a nurse looking at his weener while making the wrong face) and then file a malpractice suit and sue the shit out of the people that just saved his life. Most of these lawsuits are settled out of court, so the doctor does not get into danger of loosing his license. The patient does not have to pay the bill and even gets some money to take home with him. The result is that noone wants to be an MD anymore in the US. Now they have to import their MDs from India and god knows where...
Really awesome system that is! But hey, it seems to be what some people here want, for whatever reason. I assume that these people make a lot more than 70k a year, or otherwise the system wont pay of.

I am looking very closely at the two systems since I am considering moving to the US.

In my personal opinion a mix of both systems would be good. Ours is not perfect, but darn sure neither is yours...

[Maui]

1. Insurance be made portable - company to company and across state lines.

Agreed. Not sure what you meant to be included in "portable", but I also think that if any employer contributes to a company a health plan that they should be required to offer the amount they contribute as a voucher that employees can take elsewhere.

Despite all the fans of capitalism and benefits of an open market here defending the current system, the reality is that a large percentage of the population has no practical choice for health insurance. My employer provides an HMO. I cannot afford a grand a month to buy insurance elsewhere.

2. MSAs that roll over. Complimented with catastrophic coverage with varying levels of deductibles.

Agreed.

3. Put a cap on non-quantifiable damages.

I disagree there. I think tort reform should instead focus on penalizing those that bring frivolous suits such as with the English rule system

While I agree with the fact that there is way too much money currently being wasted on lawsuits and malpractice insurance, I also think the threat of a huge punitive lawsuit needs to be there because otherwise there are going to be some cases where it would be cheaper for an offender to be sued and lose than to address the problem. Sure, there will be cases where excessive punitive damages are awarded but the court needs to have the power to match the penalty to the offense. Anyway, excessive punitive damages that can be appealed.

Also-- punitive damages should not go to the plaintiff. I think this would help discourage lawsuits that overlook who might have actually been responsible in order to go after deep pockets.

Individuals decide what they want to spend on health care.

No spending - inferior care at best.

I agree in regards to the choice on how much to spend, but I also disagree on the no spending part. I'm not saying the care needs to be good, but it shouldn't be inferior. A) If the program is truly inferior, we're probably getting back in a situation where other people's money is going to be used when the person has a medical problem. B) Basic human decency. If your house is on fire and you call 911, they don't look up what you pay in property taxes to decide whether to send the inferior firemen or the elites. We should ensure all children have acceptable education. Similarly all people should have acceptable healthcare.

[ravingdave]

Look guys. It would be good to stop the name calling.

TD. No need for harsh words. Just keep asking "what is the difference between sovereign immunity and a contract?"

Maui. I know. I know. We should all treat each other like brothers. And if it costs nothing I'm all for it. But if there are costs borne by unrelated people there is a formula for the break even point.

http://en.wikipedia.org/wiki/Kin_selection

Socialism may work in Sweden where every one is a Johansson. It is not going to be well accepted in America where kinship groups are small (relatively). People will do more for their kin than they will for a stranger. Sad but true facts of life.

Generally it is better to design in IP-67 connectors than complain about the rain. Reality is what it is. There is no New Socialist Man. Neither is Libertarian Man on the horizon.

Americans for the most part are descendants of misfits and people who generally don't fit in well with pecking orders. The distrust of government is genetic. Overall I'd say that was a good attitude.

===

My other prescription. We can enlarge the social safety net by making the country more profitable. Drilling more oil and gas here and now would be a good stopgap measure. Until something better comes along.

Very astute post. With such a sharply honed intellect, it makes me wonder why you don't agree with me more often.


David