Gyroscopic Investing

Ad Orientem wrote:

Libertarian666 wrote: There is a very simple solution to this problem. Everyone gets unlimited, high quality, free health care at the government's expense!

Just like all the other free high quality services from the government...

As much as I dislike government programs there is an argument to be made for a single payer system like almost every other country in the industrialized world has adopted in some form. Even Justice Antoni Scalia said as much in his dissenting opinion in the Obamacare case. Indeed a hybrid system that guarantees a minimal level of care while allowing for private health insurance and care such as exists in many countries might have been the best way to go. The issue is not whether to ration health care or not. Rationing is what we do when there is a limited supply of something that everyone wants or needs. The question is on what basis will we do the rationing?

Our current system rations health care primarily on the basis of ability to pay. In the modern world this strikes me as morally dubious. Pure socialized systems (i.e. Canada) ration exclusively on the basis of need as determined by the state. While ensuring basic care this system also condemns citizens to dependence on a government agency that often combines the efficiency of the Post Office with the compassion of the IRS. Hybrid systems (i.e. Costa Rica, Great Britain and France) have elements of both and the problems attendant to both. No system is perfect. But I am VERY RELUCTANTLY coming round to the pov that the pure capitalist approach is economically untenable (take a look at the rate charts for the last 25 years) and immoral.

Our current system is broken beyond repair. Where to go is an open question with me. But I no longer believe that tinkering with the tax code or just getting the government out if it is the answer.

Ad Orientem wrote: Our current system rations health care primarily on the basis of ability to pay. In the modern world this strikes me as morally dubious. Pure socialized systems (i.e. Canada) ration exclusively on the basis of need as determined by the state. While ensuring basic care this system also condemns citizens to dependence on a government agency that often combines the efficiency of the Post Office with the compassion of the IRS. Hybrid systems (i.e. Costa Rica, Great Britain and France) have elements of both and the problems attendant to both. No system is perfect. But I am VERY RELUCTANTLY coming round to the pov that the pure capitalist approach is economically untenable (take a look at the rate charts for the last 25 years) and immoral.

Our current system is broken beyond repair. Where to go is an open question with me. But I no longer believe that tinkering with the tax code or just getting the government out if it is the answer.

Libertarian666 wrote:

Ad Orientem wrote: Our current system rations health care primarily on the basis of ability to pay. In the modern world this strikes me as morally dubious. Pure socialized systems (i.e. Canada) ration exclusively on the basis of need as determined by the state. While ensuring basic care this system also condemns citizens to dependence on a government agency that often combines the efficiency of the Post Office with the compassion of the IRS. Hybrid systems (i.e. Costa Rica, Great Britain and France) have elements of both and the problems attendant to both. No system is perfect. But I am VERY RELUCTANTLY coming round to the pov that the pure capitalist approach is economically untenable (take a look at the rate charts for the last 25 years) and immoral.

Our current system is broken beyond repair. Where to go is an open question with me. But I no longer believe that tinkering with the tax code or just getting the government out if it is the answer.

The current (pre-Obamacare) system could hardly be farther from "pure capitalist". Let me name just a few government interferences in the market for health care:

1. The licensing & prescription rules that limit competition in provision of medical services
2. The tax incentives to buy health insurance through one's employer
3. Medicare
4. The federal prohibition against selling health insurance across state lines

The free-market solution is to repeal all of those and every other type of government interference in health care.

Not that there is the slightest chance that will happen before the current system collapses into a heap of rubble, of course.

MediumTex wrote: I have always thought that best analog when it came to thinking about health care and the government's role was the military and military spending.

Think of the military as a single payer effort using taxpayer dollars to prevent foreign threats from destabilizing society and threatening the personal safety of the citizenry.

In the case of health care, we are trying to protect ourselves from threats to our personal safety that come in the form of illness and injury.

If the government is going to spend money to protect us from political threats, why not spend money to protect us from biological and accident-related threats?

A single payer system could make sense in the same way that a single payer military makes sense (the irony in that statement is intended).

If we did go to a single payer system, I think that the health care industry would have no one to blame but itself.  You can only screw people around for so long before they start turning to the government for help, no matter how flawed the government's solutions are.

Ad Orientem wrote:

MediumTex wrote: I have always thought that best analog when it came to thinking about health care and the government's role was the military and military spending.

Think of the military as a single payer effort using taxpayer dollars to prevent foreign threats from destabilizing society and threatening the personal safety of the citizenry.

In the case of health care, we are trying to protect ourselves from threats to our personal safety that come in the form of illness and injury.

If the government is going to spend money to protect us from political threats, why not spend money to protect us from biological and accident-related threats?

A single payer system could make sense in the same way that a single payer military makes sense (the irony in that statement is intended).

If we did go to a single payer system, I think that the health care industry would have no one to blame but itself.  You can only screw people around for so long before they start turning to the government for help, no matter how flawed the government's solutions are.

+1

It's also worth noting that most of the same people who bleat about socialism in health care insist year after year on throwing hundreds of billions of dollars at the armed forces, which also run one of the world's most successful government run health care systems.

The licensing & prescription rules that limit competition in provision of medical services

The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.

[...]

Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family

[...]

“In the U.S., we like to consider health care a free market,”? said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”?But it is a very weird market, riddled with market failures.”?

Consider this:

Consumers, the patients, do not see prices until after a service is provided, if they see them at all. And there is little quality data on hospitals and doctors to help determine good value, aside from surveys conducted by popular Web sites and magazines. Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.

Even doctors often do not know the costs of the tests and procedures they prescribe. When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. “It’s impossible for me to think about cost,”? he said. “If you go to the supermarket and there are no prices, how can you make intelligent decisions?”?

[...]

And yet, Ms. Yapalater recalled, she did not ask her doctors about the cost of her colonoscopy because it was covered by insurance and because “if a doctor says you need it, you don’t ask.”? In many other countries, price lists of common procedures are publicly available in every clinic and office. Here, it can be nearly impossible to find out.

Pointedstick wrote: I don't think anyone's arguing for a world without credentials or standards or safety inspections, but there's no magic in having the government assume these roles. After all, the government is just an organization made up of the same kinds of people who do these kinds of safety certification in the private sector, and very successfully, I might add. Look up the Underwriters Laboratories.

smurff wrote: Libertarian666 wrote:

The licensing & prescription rules that limit competition in provision of medical services

A few months ago there were reports of people getting injections of industrial-grade silicone to make their butts look grotesquely large.  They developed infections that required hospital stays, assuming they survived.  Others were left disfigured in a way beyond the intended enhancement.  Last month a British woman who showed up in Philadelphia lost both of her hands, both lower legs, and both buttocks. The butt-injectors were totally unlicensed, with no medical training or even healthcare experience.

You can say it was the victims' own fault for doing something so vain and stupid, but without some sort of regulation and competency- based licensing, we would all be reduced to trying to figure out whether the person claiming to be a cardiac surgeon who is about to replace an aortic valve is a real trained surgeon, or just another butt injector.