Can I assume, then, that you think medicare has been a failure?
Well, the question isn't whether Medicare has been a failure compared to doing nothing for senior health care; rather, the question should be whether Medicare has been a failure compared to what might have been done with the same resources under a different system.
Since Medicare was created, it's hard to argue that health care costs haven't exploded, which is what happens every time the government moves into an industry the way it did with Medicare. There is suddenly an enormously larger pool of money available for providers, bureaucrats and crooks, and the predictable result is vastly increased levels of inefficiency, fraud and corruption.
By an objective standard, Medicare has been a failure because it has taken a much larger health care spend than any other country in the world and failed to translate it into increased longevity. If that's not failure I don't know what would be.
It is easy to say that Medicare has been a success because it has provided a minimum level of health care to millions of seniors, but when you look at the cost and look at how disconnected the actual cost of the program has been from the initial estimates of the program's cost when it was enacted, it looks less successful.
To me, the question with a program like Medicare shouldn't be whether we could have done worse--we clearly could have done worse; instead, the question should be how much better could we have done, and when every government in the developed world is producing greater longevity at a lower per capita cost, it's hard to say the program has been anything but a failure, and bear in mind that I am saying the program has been a failure even when compared to other government-run systems around the world--that's like saying a turtle is so slow that he came in last place in a turtle race.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
MT, you are acknowledging that other countries are be doing a better job. That says a lot because most of them have some form of single payer system. So the question may form as to what should be the best way to deliver health care to everyone.
Last edited by lazyboy on Wed Apr 18, 2012 5:15 pm, edited 1 time in total.
Inside of me there are two dogs. One is mean and evil and the other is good and they fight each other all the time. When asked which one wins I answer, the one I feed the most.�
lazyboy wrote:
MT, you are acknowledging that other countries are be doing a better job. That says a lot because most of them have some form of single payer system. So the question may form as to what should be the best way to deliver health care to everyone.
Oh sure. In every turtle race there will be a winner.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
I've been listening to the V-50 lecture series, which is very interesting but is definitely an idealistic libertarian take on the problems of the world. J. Stuart Snelson, the lecturer for the 60 hour series, is a great speaker and a really sharp guy and he has some interesting things to say (the series was recorded in 1977 and Snelson passed away this past December).
One of the many amusing observations he makes is that the reason there are traffic jams is because the private sector makes the cars (which means there will always be plenty of supply relative to demand), while the government makes the roads (which means that there will never be enough supply relative to demand).
I thought about that comment as I was reading the posts above about health care and related issues. In the health care setting, there is the bizarre countercurrent of health care providers constantly complaining about low reimbursement rates for medical services, while overall the cost of care continues to increase dramatically. You would think that if reimbursement rates were that low, and a significant part of most health care practices depended on government reimbursement, then overall costs wouldn't be rising that dramatically. The fact that overall health care costs are rising as reimbursement rates are either staying the same or falling suggests that there is something badly broken about the Medicare system. A dynamic like that doesn't even make any sense, unless you accept the premise that gaming the Medicare reimbursement system is more important for doctors to master than providing effective medical treatment.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
It would seem that some countries that have single payer also have cost containment.
The system is being gamed here but maybe not in other countries.
Why is that?
What could we do to improve our system?
Last edited by lazyboy on Thu Apr 19, 2012 1:34 am, edited 1 time in total.
Inside of me there are two dogs. One is mean and evil and the other is good and they fight each other all the time. When asked which one wins I answer, the one I feed the most.�
lazyboy wrote:
It would seem that some countries that have single payer also have cost containment.
The system is being gamed here but maybe not in other countries.
Why is that?
What could we do to improve our system?
As long as you have regulatory capture, you are going to have a system that is designed around maximizing insurance company profits. That's the basic problem, IMHO.
One thing that would improve our system would be to find a way to convince people to live healthier lifestyles, but that too runs into regulatory capture of a different type--i.e., media outlets are hesitant to run pieces that are too critical of certain practices such as eating fast food and sugary breakfast cereals because they represent so much advertising revenue.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
The conflict, then, would seem to be between regulatory capture and insurance company profits and you won't have one without the other, at least in this set up. To say that one exists purely as good guy and the other purely as villain is unrealistic. And if you had less of one than the other you might run into more abuses of one type or another. There's probably a better way, structurally, to set it up. I agree that focusing on healthier lifestyles is a way out.
I still think single payer seems to be the superior solution as long as there exists the freedom to take an alternative route. Coercion doesn't have to be part of the plan. There are far too may people without adequate health insurance and it's not getting better. I have medicare and I'm not complaining. I also pay out of pocket for alternative practitioners. Can you have a form of socialized medecine and also maximize freedom of choice? I don't see that they are mutually exclusive. Again, there are examples of other countries that seem to have better numbers and, I think, also some freedom of choice. I haven't heard of a purely private model of health care working anywhere in the world.
Inside of me there are two dogs. One is mean and evil and the other is good and they fight each other all the time. When asked which one wins I answer, the one I feed the most.�
lazyboy wrote:
The conflict, then, would seem to be between regulatory capture and insurance company profits and you won't have one without the other, at least in this set up. To say that one exists purely as good guy and the other purely as villain is unrealistic. And if you had less of one than the other you might run into more abuses of one type or another. There's probably a better way, structurally, to set it up. I agree that focusing on healthier lifestyles is a way out.
I still think single payer seems to be the superior solution as long as there exists the freedom to take an alternative route. Coercion doesn't have to be part of the plan. There are far too may people without adequate health insurance and it's not getting better. I have medicare and I'm not complaining. I also pay out of pocket for alternative practitioners. Can you have a form of socialized medecine and also maximize freedom of choice? I don't see that they are mutually exclusive. Again, there are examples of other countries that seem to have better numbers and, I think, also some freedom of choice. I haven't heard of a purely private model of health care working anywhere in the world.
I think the good guys are the producers--i.e., the doctors and nurses. The villains are the people who take the value created by the doctors and nurses and try to get a piece of the action without adding any value to the overall health care delivery system.
In this formulation, the villains are the government and a portion of the insurance industry.
I don't really have an answer to what would work. I can only observe what we have learned doesn't work.
As a suggested approach, perhaps the government could provide coverage for everyone that only kicks in when a person hits $50,000 or so in medical expenses in a given year. The insurance industry would provide coverage for medical expenses between $5,000 and $50,000, and there would be a premium for this coverage. Everyone would be responsible for self-insuring the first $5,000 of annual expenses, and this should keep the premiums on the $5,000-$50,000 coverage pretty low.
It's sort of like the current HSA/HDHP setup, except the government would pay everything over $50,000 in annual expenses. Since few people have expenses in excess of $50,000 per year, the government would actually be providing health care to a relatively small population of sick/injured people, premiums would be lower, and people would be able to negotiate and shop for the first $5,000 in annual spending. Since most families are going to average $5,000-$15,000 in healthcare expenses per year, this arrangement would provide a meaningful insurance component, while also allowing a premium structure that isn't outrageously expensive.
In the setup I am proposing, insurance rates would be set by age band, and if you are in that age band you would pay the premium for that age band, regardless of your own health situation, and anyone who wanted to buy insurance could buy it without answering any health questions.
I don't have an answer to the problem of waiting until you get sick to buy insurance, and I agree that this is a thorny problem. Maybe provide that for people who choose not to buy insurance and later get sick and have bills they cannot afford to pay, they become indentured servants to the state and once their health improves enough they are moved to a labor camp where they work off their medical bills. The longest stay in the camp would be two years, since the largest bill would be $45,000, since the government pays everything over $50,000, and the first $5,000 wouldn't have been paid by insurance in any case. That comes out to working off about $22,500 per year, which is probably about right. I have to think that this arrangement would be a strong incentive to maintain health insurance, and I wouldn't have a problem if the government subsidized the cost of coverage for poor or disabled people.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
MediumTex wrote:By an objective standard, Medicare has been a failure because it has taken a much larger health care spend than any other country in the world and failed to translate it into increased longevity. If that's not failure I don't know what would be.
Seems like an unfair standard. That would be like saying higher auto insurance costs are a failure because the increased expenses haven't translated into longer-lasting cars.
Longevity tends to be a function of other factors beyond healthcare (DNA, diet, environment, obesity, stress, sleep, wars, etc). And Western healthcare, in general, tends to treat the symptoms, after they appear (heart disease, cancer, alzheimer's). Even the best hospitals in the world can only do so much for people once their symptoms appear.
On average, Japanese live five years longer than we do, but I wouldn't say that those five years of increased life expectancy are entirely due to their healthcare reforms. More likely the Japanese just don't become obese like we do.
There is a strong correlation between income per capita and life expectancy. Beyond income per capita and other exogenous factors, there's only so long you can stretch a human's life.
See: http://www.bit.ly/gI9IgP
(Click the "PLAY" button, or drag slider, to see life-expectancy trends over time)
In the United States, we throw a lot of money at post-symptom healthcare, but we don't see much ROI anymore.
After a certain point it comes down to quality of life — and some would argue that the very idea of extending one's life expectancy beyond their own natural timeline can often lead to a lower quality of life.
Last edited by Gumby on Thu Apr 19, 2012 8:25 am, edited 1 time in total.
Nothing I say should be construed as advice or expertise. I am only sharing opinions which may or may not be applicable in any given case.
Three issues with your proposed idea to have people pay off medical debts they incurred due to lack of insurance:
One, wouldn't such a system violate current interpretations of US law as regards peonage, debt bondage, and indentured servitude (United States v Reynolds, 235 U.S. 133, 1914) i.e. that indentured servitude in payment of a debt is illegal?
Two, a large percentage of the nation's healthcare spending is incurred providing medical care for people in their last twelve months of life. This sytem would be unable to collect on that because you can't make someone work to pay back a debt when they are dead (or permanently disabled by a terminal illness until they end up dying).
Three, this is a complete political non-starter even if the above two objections didn't exist; as unpopular as the individual mandate is (even among many people who otherwise like what the PPACA does), do you really think what amounts to "buy health insurance or you could be sold into indentured servitude" would be any more acceptable to most Americans? The whole plan (to me anyway) has chilling overtones of slavery and of "Arbeit Macht Frei" and this would no doubt be pointed out by the idea's opponents if anyone tried to get something like this enacted as a law.
Last edited by D1984 on Thu Apr 19, 2012 8:46 am, edited 1 time in total.
MediumTex wrote:In the health care setting, there is the bizarre countercurrent of health care providers constantly complaining about low reimbursement rates for medical services, while overall the cost of care continues to increase dramatically. You would think that if reimbursement rates were that low, and a significant part of most health care practices depended on government reimbursement, then overall costs wouldn't be rising that dramatically. The fact that overall health care costs are rising as reimbursement rates are either staying the same or falling suggests that there is something badly broken about the Medicare system. A dynamic like that doesn't even make any sense, unless you accept the premise that gaming the Medicare reimbursement system is more important for doctors to master than providing effective medical treatment.
Isn't at least some of this due to EMTALA and cost shifting (that occurs for reasons in addition to EMTALA)?
"Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.
Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked."
Source: http://www.cbsnews.com/video/watch/?id=6754650n
The video shows how all this money is spent, why it is spent, and how little good it does.
In other words, people tend to die when they die. We just spend most of our healthcare money trying to extend that time by a few more weeks.
Last edited by Gumby on Thu Apr 19, 2012 8:41 am, edited 1 time in total.
Nothing I say should be construed as advice or expertise. I am only sharing opinions which may or may not be applicable in any given case.
Three issues with your proposed idea to have people pay off medical debts they incurred due to lack of insurance:
One, wouldn't such a system violate current interpretations of US law as regards peonage, debt bondage, and indentured servitude (United States v Reynolds, 235 U.S. 133, 1914) i.e. that indentured servitude in payment of a debt is illegal?
Two, a large percentage of the nation's healthcare spending is incurred providing medical care for people in their last twelve months of life. This sytem would be unable to collect on that because you can't make someone work to pay back a debt when they are dead (or permanently disabled by a terminal illness until they end up dying).
Three, this is a complete political non-starter even if the above two objections didn't exist; as unpopular as the individual mandate is (even among many people who otherwise like what the PPACA does), do you really think what amounts to "buy health insurance or you could be sold into indentured servitude" would be any more acceptable to most Americans? The whole plan (to me anyway) has chilling overtones of slavery and of "Arbeit Macht Frei" and this would no doubt be pointed out by the idea's opponents if anyone tried to get something like this enacted as a law.
The labor camp idea was sort of "A Modest Proposal"-style tongue in cheek suggestion.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
MediumTex wrote:By an objective standard, Medicare has been a failure because it has taken a much larger health care spend than any other country in the world and failed to translate it into increased longevity. If that's not failure I don't know what would be.
Seems like an unfair standard. That would be like saying higher auto insurance costs are a failure because the increased expenses haven't translated into longer-lasting cars.
I think that a better analogy would be to look at whether extended automobile warranties have translated into longer lasting cars.
The more basic point I would make about Medicare is simply that it is staggeringly inefficient and the people who make the most money off of the system are those who have mastered the many different ways of subtly defrauding the system through billing practices and other gaming opportunities.
I'm not saying I want to let all the old people die, I'm just saying that the current system looks like a gigantic money pit that doesn't seem to be leading to better health outcomes for those within the system.
I understand the point about the last 12 months of life making up a lot of the overall spending during one's life, but to me this is also one of the flaws in the program. If doctors weren't getting paid for all of that expensive but futile care, they wouldn't do a lot of it.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
To me, this issue is one where we have a conflict between two important points:
A free market is likely to provide the greatest level of service at the lowest possible price. With >50% of healthcare spending coming from government, we're nowhere close to having this.
Once you have a free market, some people will not be able to participate in the health care system at the market price. Regardless of how ill-advised their decisions may have been to get them to this point, it makes us uncomfortable to leave people without the opportunity to receive medical care.
First, a few obvious ways that you could resurrect a free market in healthcare:
Freedom to buy insurance policies across state lines. If your state foolishly mandates "insurance" coverage for things like fertility treatments, you should be able to purchase a lower-cost option that operates under the laws of another state. The effect here should be huge.
Remove protectionist import restrictions. These policies allow other countries to get far cheaper prices for the same drugs than the United States does. The end result is that we subsidize drug research for the entire planet. This is unbelievably expensive. It needs to end.
Instead of trying to kill HDHP and HSA a la Obamacare, actively encourage them. HDHPs are what insurance is supposed to look like. Enough with treating "insurance" like a pre-paid health plan. Get price sensitivity back into the game.
Price transparency. Published price lists help provide consumers with the information that they need in order to make decisions. This dovetails with the idea of heightened price sensitivity.
Now it's down to those who will still be unable (or unwilling) to participate in the health care system at the market price. For this, I would try to borrow ideas from Singapore's healthcare model. These are the basic components:
Medisave - There are no "social insurance" programs like Medicare or Social Security but rather "mandated savings" programs where your payroll deductions go into an account. One of these accounts (Medisave) can be used for medical expenses.
Medishield - There are a number of public and private options for catastrophic insurance coverage. These are actual insurance programs designed for major, unexpected events like accidents or serious illnesses. The "Medishield" program is the public one.
Medifund - Provides subsidies to the 10% or so who are too poor to afford medical coverage. Can't be "borrowed" from and never disperses principal. Only interest from the fund can be spent.
In other words, people wind up saving (and spending) mostly their own money. Price lists are required to be published so you have greatly enhanced price sensitivity. Insurance is used like insurance, not like a pre-paid health plan. Those who still truly can't afford to pay receive a subsidy to provide for their medical needs. Decisions about care are largely left up to patients and doctors.
In the final analysis, Singapore's government spends about 1/7th per capita what the US government does for healthcare and citizens there enjoy very good health outcomes. I find plenty not to like about their system as well so there's still lots of nuance here. But there are many interesting ideas in their system that reveal how we might allow truly free healthcare markets to finally emerge in the United States.
MediumTex wrote:The more basic point I would make about Medicare is simply that it is staggeringly inefficient and the people who make the most money off of the system are those who have mastered the many different ways of subtly defrauding the system through billing practices and other gaming opportunities.
I'm not saying I want to let all the old people die, I'm just saying that the current system looks like a gigantic money pit that doesn't seem to be leading to better health outcomes for those within the system.
I understand the point about the last 12 months of life making up a lot of the overall spending during one's life, but to me this is also one of the flaws in the program. If doctors weren't getting paid for all of that expensive but futile care, they wouldn't do a lot of it.
You're spot on. The 60-minutes segment showed how the end-of-life healthcare system is set up to reward extra care. The best course of treatment for the last two months of life is to make people more comfortable in their own homes. But, overwhelmingly, most people are admitted into expensive hospitals that are designed to suck money out of the government and insurance (via unnecessary tests, procedures and diagnostics). Unfortunately, these hospitals don't make as much if their beds aren't full of sick and dying patients.
Last edited by Gumby on Thu Apr 19, 2012 10:00 am, edited 1 time in total.
Nothing I say should be construed as advice or expertise. I am only sharing opinions which may or may not be applicable in any given case.
Utilization (excessive), and insurance coverage that goes far beyond the traditional definition of insurance are important issues with regard to health care costs. Fraud is a politician's favorite target in describing ways to cut costs without decreasing service, but the only way likely to be successful at cutting costs is through rationing of care, either by self selection and market forces, or government mandate.
There was a great article in the WSJ on how doctors die that I think you may find interesting:
6 Iron wrote:
Utilization (excessive), and insurance coverage that goes far beyond the traditional definition of insurance are important issues with regard to health care costs. Fraud is a politician's favorite target in describing ways to cut costs without decreasing service, but the only way likely to be successful at cutting costs is through rationing of care, either by self selection and market forces, or government mandate.
There was a great article in the WSJ on how doctors die that I think you may find interesting:
Thanks, 6 Iron, that's a wonderfully sane and instructive article.
Inside of me there are two dogs. One is mean and evil and the other is good and they fight each other all the time. When asked which one wins I answer, the one I feed the most.�
lazyboy wrote:
The conflict, then, would seem to be between regulatory capture and insurance company profits and you won't have one without the other, at least in this set up. To say that one exists purely as good guy and the other purely as villain is unrealistic. And if you had less of one than the other you might run into more abuses of one type or another. There's probably a better way, structurally, to set it up. I agree that focusing on healthier lifestyles is a way out.
The best way would be to set an individual mandate for a nationally-shared risk pool, end Medicare as a single-payer (switch to vouchers or grants) and rely on competitive consumer-driven health care, nonprofit co-ops, minimal but catastrophobic insurance coverage, etc. just as it was before WWII wage controls, Medicare & HMO's ruined the industry.
But seriously, rational intelligence is the first casualty of politics. I suspect America will have to collapse before the greedy sicknesscare-industrial complex gives up its pork.
MG
Last edited by MachineGhost on Sat Apr 21, 2012 6:55 am, edited 1 time in total.
"All generous minds have a horror of what are commonly called 'Facts'. They are the brute beasts of the intellectual domain." -- Thomas Hobbes
Disclaimer: I am not a broker, dealer, investment advisor, physician, theologian or prophet. I should not be considered as legally permitted to render such advice!
The market for healthcare is decidedly different than markets for food, clothing, and housing, which the article tries to compare it to. Also, as a side note, I'd be surprised if the writers of the article didn't also see the gov't subsidizing food, clothing and housing as massive manipulation and morally bankrupt at the first chance they get if we chose that model.
The main point is the existance of commonly observed "market failures." To start out, I know many, including yourself, don't believe in such a thing, so I'll give you the benefit of the doubt and refer to them as "market inefficiencies." Even you and libertarians could probably imagine yourself as a consumer who wants to buy a product like a swiss army knife, you know a lot about it, have plenty of time and options from which to buy them, you don't rely on someone else's conflicted interest in advising you on the purchase, there's no externalities associated like 100 tons of CO2 going into the atmosphere, etc... this is a very efficient purchase. Most purchases in the economy fall into this category to one degree or another, and even if they don't, many aren't life-or-death decisions. You and I probably feel very comfortable trying to identify and obtain the most value out of the market, and the sellers in the market know that most of their customers are like us, so they actually work to provide that value.
Now, food, clothing and shelter, being necessities, are often subsidized by government for what we see as "moral" reasons as the article points out. It's not that these are "inefficient markets," but simply that people can quickly suffer if they can't afford the products of these markets. Overall, though, while we do want some basic level of regulated safety in those markets, we're perfectly fine going shopping for exactly what we want, needing little/no advice on what we need, and engaging the great markets that will respond to people that know what they want.
But once you add some of those "Market inefficiencies," suppliers in the market work less and less hard to produce real value, and more and more hard to fool the buyer. We discuss on this forum how this works in finance all the time... most of us are disgusted by it. Most people don't know macroeconomics, investing, tax, retirement planning, etc. This would be bad enough, left alone, in terms of adding inefficiencies to the market, but compounded to that is the fact that the market tends to exploit this lack of knowledge for the supplier's benefit. "Informational assymetry" and the "principal-agent problems" tend to allways fall in favor of the agent & the informed.
Healthcare falls much, much more into this market model. I'm not talking laser eye surgery shopped for weeks in advance online (which the market probably responds wonderfully to), but the purchasing of both health insurance and trusting of a doctor in emergency situations, as well as advisory situations (not suggesting doctors are dishonest so much as consumers being in a horrible spot to negotiate/bargain). I would have no idea where to start if an insurance company gave me a choice of what emergencies to cover vs what not to cover in a pricing model they decide. I'd also be in a horrible position to bargain at the hospital if I broke my arm. I literally know next to nothing about insurance OR surgery, so I'm in NO position to have an equal seat at the bargaining table, which always falls in favor, like I suggested before, of the most informed... aka, the supplier.
Lastly, even if I WAS good at bargaining for insurance and dissecting my doctor's medical advice for flaws in service-level, it would still leave us with a system (in a fully free-market) that didn't truly behave like an insurance system. For instance, if you are diagnosed with a disease or condition, you have two choices in a free market system:
1) Stay with your current insurance provider, no matter how crappy the service
2) Shop for new insurance but at an exhorbitant rate, now that they know your risk profile
Some would say this is how things should operate, but isn't this almost defeating the purpose of insurance to begin with, and creating a truly awful marketplace for private insurance? Any market with that kind of rigidity is bound to be just a piss-poor market.
I love the way the market works when two parties come together with equal knowledge on a product/service and work together... and it's not that it has to be perfect lest the gov't to take it over, but overall both the insurance and health service side of healthcare are truly horrible markets to try to be a discerning customer in, and the insurance side especially takes full advantage of their superior bargaining power & knowledge in this situation to a point where seldom is their time spent on trying to improve service vs avoid covering people that might get sick.
So, no, healthcare is nothing like food, clothing and shelter, other than it's a necessity. It's actually a severely flawed market.
Last edited by moda0306 on Thu Apr 26, 2012 2:43 pm, edited 1 time in total.
"Men did not make the earth. It is the value of the improvements only, and not the earth itself, that is individual property. Every proprietor owes to the community a ground rent for the land which he holds."
moda0306 wrote:
So, no, healthcare is nothing like food, clothing and shelter, other than it's a necessity. It's actually a severely flawed market.
True, it's a severely flawed market, but that is because healthcare doesn't operate anywhere near a free market anymore because of extensive government interference (like Ted Kennedy's unmitigated HMO disaster, a response to a so-called "market failure" that was really just previous government interference). If there is no escape hatch, any market will become dysfunctional and flawed as consumers have no competing alternatives to choose from. Remember the Soviet Union? Normally, an extralegal "black market" would crop up to profit from the opportunity to solve such consumers problems, but since healthcare is so tight-fisted controlled by governments, there is not the legal freedom ("Rule of Law") to do so on a wide basis. We can take care of the "moral hazards", etc. in the free market with appropriate regulation, but that would still pale in comparison to the number of people the FDA kills each year.
I don't equate insurance with healthcare. The presupposition that insurance is necessary really has to be delineated between true insurance and a group co-op. In a real free market, insurance would act as the former and not as the latter as it does currently (which is why premiums continue to rise, as everyone is paying a pro-rated share of the co-op's previous year's medical expenses [that aren't limited to just major medical]).
True healthcare has to start with self-responsibility. Socialism is the exact opposite. Once you believe the government "owes" you material comforts, its not a huge leap to become lazy in your lifestyle, eating habits, etc.. Heck, I'd go so far as to say the decline in traditional American values is inversely correlated to America's expanding waistlines!
Essentially, it comes down to what kind of market would you rather have: a market like the current healthcare market where the heavy hand of government controls 99% of everything through a smargasbord of three-lettered agencies, where there is no price transparency, "insurance" co-ops divorce people from self-responsibility as costs spiral ever upwards, or a lightly regulated, competitive market like the dietary supplement market where the exact opposite conditions prevail? We need a DHSEA for the entire economy, not just healthcare. I won't hold my breath.
MG
[Edit: Mod cleaning up Kennedy reference]
Last edited by MachineGhost on Sat Apr 28, 2012 1:51 pm, edited 1 time in total.
"All generous minds have a horror of what are commonly called 'Facts'. They are the brute beasts of the intellectual domain." -- Thomas Hobbes
Disclaimer: I am not a broker, dealer, investment advisor, physician, theologian or prophet. I should not be considered as legally permitted to render such advice!
As I pointed out, the market would be horribly flawed even in a purely free market system.
Also, some may call asking for gov't to engage in healthcare as a handout... others would look at the gov't backing land deeds as "private property" of only certain classes of individuals as being a handout.
Myself... well I'm ok with the gov't both engaging in a social safety net and deeding real property to aid the private sector in engaging in economic activity. Don't think that private property operates outside of gov't to a great degree in our modern society... it's as much a social construct as natural right, and it's secured by gov't say-so at every turn, whether explicitly or implicitly. The land your house was built on, the house itself, your car, etc, etc... you may have worked for them, but the gov't backing private property is the glue holding it all together, and much of the property that's been allocated to individuals wasn't done on merit but on influence. Real wealth was handed out. That's decidedly socialist in nature... or crony-capitalist, to be more specific.
Do you really think people get fat because they think someone else will pay for their heart problems? Even private insurance doesn't take the time to ask you about your exact eating habits... it's hard for me to believe that they would if the gov't was totally out of the system. No, private health insurance in a gov't-free system is likely to be a horrible market to interact with because of informational assymetry and the agent/principal problems.
I find it odd that you think the gov't controls 99% of the system. Tell that to the multi-billionaires in the health insurance industry in our country that they don't have in Europe. If that's the case, though, and the gov't has their heel on everything, let's just get a medicare-for-all system going and let the private sector do what it's actually good at, and quit acting like it will ever provide us with a good health insurance system, when I've already illustrated that the market for health insurance is predisposed to deliver horrible service because people are in absolutely no position to efficiently shop for it and hold insurance companies accountable when they actually need them.
Last edited by moda0306 on Fri Apr 27, 2012 2:51 pm, edited 1 time in total.
"Men did not make the earth. It is the value of the improvements only, and not the earth itself, that is individual property. Every proprietor owes to the community a ground rent for the land which he holds."
moda0306 wrote:
As I pointed out, the market would be horribly flawed even in a purely free market system.
This talk of "market failures" is nothing more than what you guess will happen if the government releases its grip on the >50% of healthcare spending that it currently controls. Well I "guess" that a free healthcare market would behave... like pretty much every other market known to man. You're conjuring up "information asymmetry" special cases that likely don't exist.
Speaking of information asymmetry, what do I know about automobiles? The vast majority of the population has not the first clue what goes into putting a car together. The car manufacturers know everything and the consumers know barely anything at all. When you look at it this way, the "asymmetry of information" looks immense. The deck looks to be utterly stacked against the consumer in every way.
Yet we "clueless consumers" get along just fine. The job of the market is to convey this information via profit, loss, and the pricing system. The weak offerings are destroyed by the strong offerings and even a quite uneducated consumer bumbles Mr. Magoo-like into a market of high quality automobiles.
I'm surprised that you so casually brush off procedures like laser eye surgery. It's no coincidence that these procedures are generally not covered by 3rd-party payers and thus enjoy an experience much closer to what you'd find in a free market. Note that their costs fall over time, just like what you'd expect in a free market while other procedures rapidly rise in cost over time. No government subsidies or other general tomfoolery to stand in the way.
What do I know about getting my eyeball lasered? Absolutely nothing! Yet the market provides a menu of miraculous procedures that fall in cost over time. The price system is what dismantles this "informational asymmetry".
I probably wasn't very clear, but I meant "knowledge about the product" in quite a different way. When you buy a car, you know you want a few things: Powerful engine, decent handling, nice interior, comfortable seats... and you can tell those in about one test drive.
There's a few other things you're not so sure about: Safety, gas mileage, reliability... a few big ones that probably cover the vast majority of your concerns. Now we have gov't regulations around safety levels, as well as how to report gas mileage on a universal basis, and reliability can be "bought" via a warranty, as well as guessed based on past history of the brand.
So there's a huge amount about vehicles that you do know in terms of how you want the package delivered that the private sector is very good at delivering, because they know you know what the difference is between a smooth and rough engine, leather and cloth seats. They react remarkably well to things that they know their customers can tell the difference between, easily. However, the Pinto managed to sneak in an explosive gas tank because most customers didn't notice that.
Regarding eye surgery, first off, you have all the time in the world to shop for it. Insurance is for more severe conditions and/or emergencies (I'd assume we agree on this). I'm in no position to bargain for most types of surgeries like I would with laser surgery. First off, they're often much more complex & expensive. Secondly, you're often either working through insurance, or in an emergency situation (or incredibly sick).
I see these as completely different in nature, and the private sector knows that and reacts differently to them.
"Men did not make the earth. It is the value of the improvements only, and not the earth itself, that is individual property. Every proprietor owes to the community a ground rent for the land which he holds."
moda0306 wrote:
As I pointed out, the market would be horribly flawed even in a purely free market system.
This talk of "market failures" is nothing more than what you guess will happen if the government releases its grip on the >50% of healthcare spending that it currently controls. Well I "guess" that a free healthcare market would behave... like pretty much every other market known to man. You're conjuring up "information asymmetry" special cases that likely don't exist.
Speaking of information asymmetry, what do I know about automobiles? The vast majority of the population has not the first clue what goes into putting a car together. The car manufacturers know everything and the consumers know barely anything at all. When you look at it this way, the "asymmetry of information" looks immense. The deck looks to be utterly stacked against the consumer in every way.
Yet we "clueless consumers" get along just fine. The job of the market is to convey this information via profit, loss, and the pricing system. The weak offerings are destroyed by the strong offerings and even a quite uneducated consumer bumbles Mr. Magoo-like into a market of high quality automobiles.
I'm surprised that you so casually brush off procedures like laser eye surgery. It's no coincidence that these procedures are generally not covered by 3rd-party payers and thus enjoy an experience much closer to what you'd find in a free market. Note that their costs fall over time, just like what you'd expect in a free market while other procedures rapidly rise in cost over time. No government subsidies or other general tomfoolery to stand in the way.
What do I know about getting my eyeball lasered? Absolutely nothing! Yet the market provides a menu of miraculous procedures that fall in cost over time. The price system is what dismantles this "informational asymmetry".
Pet medicine is also a great example of what unregulated medicine might look like for humans.
I often have the feeling when I take my pet to the vet that I wished I could go to a doctor's office like that when I was sick. It just seems like a much simpler experience and vets and their staffs just seem nicer than the people who treat humans.
U.S. healthcare is like a tree that has become completely overgrown with parasitic vines, shrubs and moss. You can barely even tell that it was just a tree to start with. At this point in the game, it's hard to even imagine what the health care tree might look like without all of the leeches, and that is why I offer veterinary medicine as an example of what human medicine might look like if you took away all of the insurance companies, governmental programs, and plaintiffs attorneys.
Q: “Do you have funny shaped balloons?”
A: “Not unless round is funny.”
