Giving Away Your Bargaining Chips
I'm starting to get very pessimistic about the prospect of meaningful health care reform ever happening. We have a popular Democratic President who was elected less than a year ago with a mandate to reform health care and a very clear plan for doing so. We have large Democratic majorities in both houses, including a soon-to-be 60 seat majority in the Senate. The public is massively in favor of comprehensive health care reform. And yet, the Democrats seem to lack the will to even get a meaningful bill out of committee. Ezra Klein reports that the Senate Finance Committee has now dropped the public option from its bill and scaled back the bill significantly. The new plan is relies on government-seeded health care "co-ops" to provide more options to consumers. Remarkably, the plan still contains a mandate to buy coverage (along with subsidies for those who can't afford the cost).
Ezra concludes that while the new bill is far less than he would have hoped for, it would still incrementally improve the overall health care landscape in this country.
I'm sure that's true, but there's a massive opportunity cost to doing health care reform this way. First, from a political perspective, there will never be a more favorable climate for passing health care reform. The stars are aligned right now. The Democrats control all branches of government and have significant popular support. And with wide scale unemployment and lack of job security, many people are either uninsured or desperate for a system in which they don't have to constantly worry about losing their health care coverage. As time goes by and the next election nears, it will only get harder to pass meaningful reform.
Second, when you try to do health care reform piecemeal, you end up sacrificing the bargaining chips you need to get everyone on board. To take the most obvious example, the public option is incredibly unpopular with insurance companies. They know that the existence of a public option will eat into their profits and force them to be more competitive. Indeed, that's the entire point. On the other hand, insurance companies love the idea of an individual mandate. If everyone has to buy insurance, that means more customers for them, and a bigger risk pool.
By including a mandate but not a public option, the Finance Committee is essentially giving away our biggest bargaining chip with insurance companies. Once a mandate is in place, the insurance companies will have what they want and will simply devote all their lobbying efforts to killing any future attempts to create a public option. It's just bad strategy.
And frankly, it's bad politics as well. Mandates will be easy to demagogue. People don't like being told they have to buy something, even if there are lots of exceptions and subsidies. If the law is ever passed, Republicans will run ads highlighting the fines and penalties in the law for those who don't buy insurance. These attacks will be much easier to defend against if the bill also gives people an inexpensive, reliable public option. People like choices, and a great many of them would prefer the option of being insured by the government, knowing that the government won't deny them coverage because of a pre-existing condition or rescind their policy without warning based on some trivial omission in their application.
Moreover, if you have a mandate without a public option, it means that 100% of the subsidies the government is paying out to help people buy coverage go directly to the insurance companies. This amounts to a massive give-away of taxpayer money. Again, the insurance companies get to have their cake and eat it too. They get a whole bunch of new paying customers and no new competition to keep them honest and control costs.
I really think the Obama administration is being too cautious on this. They need to take the helm and really, forcefully make the case for the inclusion of a public option. If the public option doesn't happen now, it's not going to happen.
Ezra concludes that while the new bill is far less than he would have hoped for, it would still incrementally improve the overall health care landscape in this country.
I'm sure that's true, but there's a massive opportunity cost to doing health care reform this way. First, from a political perspective, there will never be a more favorable climate for passing health care reform. The stars are aligned right now. The Democrats control all branches of government and have significant popular support. And with wide scale unemployment and lack of job security, many people are either uninsured or desperate for a system in which they don't have to constantly worry about losing their health care coverage. As time goes by and the next election nears, it will only get harder to pass meaningful reform.
Second, when you try to do health care reform piecemeal, you end up sacrificing the bargaining chips you need to get everyone on board. To take the most obvious example, the public option is incredibly unpopular with insurance companies. They know that the existence of a public option will eat into their profits and force them to be more competitive. Indeed, that's the entire point. On the other hand, insurance companies love the idea of an individual mandate. If everyone has to buy insurance, that means more customers for them, and a bigger risk pool.
By including a mandate but not a public option, the Finance Committee is essentially giving away our biggest bargaining chip with insurance companies. Once a mandate is in place, the insurance companies will have what they want and will simply devote all their lobbying efforts to killing any future attempts to create a public option. It's just bad strategy.
And frankly, it's bad politics as well. Mandates will be easy to demagogue. People don't like being told they have to buy something, even if there are lots of exceptions and subsidies. If the law is ever passed, Republicans will run ads highlighting the fines and penalties in the law for those who don't buy insurance. These attacks will be much easier to defend against if the bill also gives people an inexpensive, reliable public option. People like choices, and a great many of them would prefer the option of being insured by the government, knowing that the government won't deny them coverage because of a pre-existing condition or rescind their policy without warning based on some trivial omission in their application.
Moreover, if you have a mandate without a public option, it means that 100% of the subsidies the government is paying out to help people buy coverage go directly to the insurance companies. This amounts to a massive give-away of taxpayer money. Again, the insurance companies get to have their cake and eat it too. They get a whole bunch of new paying customers and no new competition to keep them honest and control costs.
I really think the Obama administration is being too cautious on this. They need to take the helm and really, forcefully make the case for the inclusion of a public option. If the public option doesn't happen now, it's not going to happen.
posted by A.L. at 9:00 AM
69 Comments:
If the public option doesn't happen now, it's not going to happen.
I hope you're right.
I also think that you overstate the public's appetite for health care reform:
http://www.nytimes.com/2009/06/18/us/politics/18poll.html?pagewanted=print
"A distinct gulf exists between Mr. Obama’s overall standing and how some of his key initiatives are viewed, with fewer than half of Americans saying they approve of how he has handled health care and the effort to save General Motors and Chrysler."
Now, who knows, maybe the American public are disappointed in Obama's health care proposal because it doesn't go far enough and they want more government involvement, but I think that's just Democratic daydreaming.
I don't know Colin. The WSJ/NBC poll showed a whopping 76% of people favored a public option.
http://www.huffingtonpost.com/2009/06/17/obama-boost-new-poll-show_n_217175.html
I agree, it's looking bad right now.
What I don't understand is the posture of the Blue Dog and New Democrat members of Congress. Don't they know Republican policies are unpopular? Yet they are acting like Republicans. One Democratic member of the House (!) said he didn't like reconciliation-as-a-way-of-passing-legislation in the Senate. Since when did House members get interested in the procedures of the other chamber?
Certainly I'd like to see something stronger from the Senate, but the House did release its plan today, with a pretty good public option included.
I think the real muscle on the public option is going to be in conference. The House is likely to pass one, the Senate not. It'll get resolved there, one way or the other.
FWIW, I do think the Obama team understands the mechanisms of getting bills passed pretty well. You can do a lot in conference once you've got a bill past both houses. You can also never get a bill out of commitee. I'd prefer the former, even if we don't like the Senate sausage for the time being.
Anonymous Liberal,
The reason for your pessimism is something has good cause. When a faction of very few (AMA Lobby) can exert its influence to the detriment of the citizens of this country, one has to wonder how Madison ever envisioned that our current form of government could have controlled the effects of factionalism he speaks of in Federal paper #10.
Our elected officials follow the money during every day of their elected lives with the exception of campaign time.
It is not the people, but the structure of the offices of our government that is the problem.
Changing the people only goes so far. Seperating politicians interest in money must be a priority if politicians are ever to create meaningful legislation to the benefit of the people.
http://voxvocisrespublica.blogspot.com/
My guess is that your disappointment is more than just the lack of action of healthcare initiatives.
That's interesting AL. I frankly suspect that the American public is not terrible well informed on the health care debate, which would explain the conflicting poll data.
That said, if you really want the public option for the simple reason of promoting competition, there is a far simpler way to achieve this: allow people to buy insurance across state lines and ignore state mandates. The federal government can do this with its power to regulate interstate commerce. More competition means lower prices.
This seems to work fairly well with any other number of necessities such as food and clothing, why not health care?
Oh, and expanding competition would be far, far cheaper too. In fact, I don't think it would cost the feds anything.
This of course assumes that your true interest is in promoting competition and not simply expanding government's involvement in health care.
This seems to work fairly well with any other number of necessities such as food and clothing, why not health care?
This won't work for any number of reasons. First, the only reason this would result in lower insurance prices is because insurance companies would all set up shop in the state that was the most willing to gut all regulations. Companies setting up shop in these states could offer cheaper policies, but only because they would be offering much less coverage and would have much greater flexibility to cherry pick the healthy and drop the sick. These companies would syphon off the cheap to insure people (the young and healthy), taking them out of the risk pool, thereby increasing costs to everyone else and forcing every other insurer to cut back their coverage. The result would be a massive under-insurance problem where people's policy wouldn't provide enough protection and would disincentivize preventative care.
And these are just some of the problems. There are many others. There are two basic problems with treating health insurance like other forms of insurance. First, everyone needs it. With home or car insurance, you can avoid the need for them by not driving or not owning a home. But you can't just choose not to live. Second, unlike car or home insurance, descriminating by risk factors is morally problematic. If a car insurer doesn't want to insure a reckless driver (or charges them extortionary rates) that's fine. It makes sense. Don't be reckless. But should a health insurer be able to turn down a diabetic (or charge extortionary rates)? It is in the interest of health insurers NOT to insure people who are likely to require lots of care. So who is left to cover these people? The private system, without HEAVY regulation, will never do so. There are already millions of people who can't get insurance. If you deregulate in order to foster "competition," you'll just free insurers to dump their least profitable customers and greatly increase the number of uninsured.
I tend to disagree that something is better than nothing. I believe half-way measures might very well make the situation worse by doing little to improve breadth of coverage and at the same time making coverage more expensive, especially in the long run. Once the insurance companies realize how easy it is to run over the members of congress, they'll push their advantage to the max.
Moreover, if you have a mandate without a public option, it means that 100% of the subsidies the government is paying out to help people buy coverage go directly to the insurance companies. This amounts to a massive give-away of taxpayer money.
I believe this is, as they say, a feature and not a bug.
You seem very certain of the outcome that allowing the purchase of insurance across state lines would produce. I would note, however, that we don't see what you described for other types of insurance. You can buy auto insurance even if you are a high-risk driver. Sure, it will cost you a lot more, but you can get it.
Same with life insurance. I was able to find life insurance on the internets for $75,000 of coverage for an 80 year old man. Granted, it cost $400/mo, but you can get it.
So this notion that huge numbers of people would simply be denied coverage seems rather implausible when insurance companies are plainly willing to insure people with high levels of risk for other types of policies.
You seem to acknowledge this when you state "But should a health insurer be able to turn down a diabetic (or charge extortionary rates)?"
Of course we have no idea what constitutes "extortionary", which is in the eye of the beholder, but it certainly makes sense that those who require more care should pay more.
The real solution, therefore, is to control costs. The best way to do this is through competition, which works brilliantly everywhere it is tried.
To do this we need to break away from the insurance model towards a fee for service model. Insurance should be used for unforeseen and serious events. In health care this would mean cancer and the like. This is why auto insurance doesn't cover oil changes.
By moving away from having many routine procedures covered by insurance we will encourage people to shop around and health care providers compete for their business. Indeed, this is the case with procedures that are not covered by insurance such as Lasik and cosmetic surgery, where we see little of the cost inflation that we find more broadly in health care.
In addition to competition it seems that expanding supply would help, given that it usually produces lower prices. There are many barriers in the health care world that are probably unnecessary. My girlfriend for example received her degree in physical therapy from a university in Spain. When she moved to Colorado she had to get licensed there, which included taking 3 semesters of classes at the local college including on topics such as Colorado geology and history. It would have been 4 semesters but she tested out of Spanish which gave her more credits.
Even after all that she still can't practice in other states such as California. (fortunately DC accepts licenses from other states) Now think about those types of barriers across the board, which limits the supply of people who can provide care.
Seems to me the best approach is for government to stop subsidizing the ridiculous model that ties insurance to employment -- an artifact of WWII wage controls -- and focus on expanding competition by eliminating barriers.
Time after time we see that the marketplace works with higher quality and lowered prices while government underperforms and comes in over-budget (take a look at cost projections for Medicare from decades past and see how wildly optimistic they were). This would seem to suggest a certain approach.
Sell it to Red State, Colin. We don't buy it here.
"Time after time we see that the marketplace works with higher quality and lowered prices while government underperforms and comes in over-budget"
Lies, lies, and damned lies. Show me where private health insurance provides higher quality and lower costs over Medicare. You can't show me because it doesn't.
Absolutely right, Colin. We have a window of opportunity here while corporations have no need to offer incentives for employees (where are they gonna go, Cuba?) to slam the door on health insurance.
It's a perfect time, after 60-some years of driving up the cost of health care, for the door to be slammed shut and eliminate this subsidy. When people have the choice between bankruptcy and death (and, given the state of the for-profit medicine business, probably first one, then the other in a lot of cases) they'll have the opportunity to display their principles by either dying cheaply or taking their family's future with them -- and then dying.
The spectacular success of the competitive model in so many fields, except for the internet, the military, the space program, and development of integrated circuits is sure impressive -- we'd be discussing this subject over a party-line telephone call without massive government programs.
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This seems to work fairly well with any other number of necessities such as food and clothing, why not health care?
Simply because no amount of competition outside of a public option would help my GF since she has a "prio condition" (which is completely gone and likely will never appear again). Your idea would just mean she could get rejected by more companies then now..
Same with life insurance. I was able to find life insurance on the internets for $75,000 of coverage for an 80 year old man. Granted, it cost $400/mo, but you can get it
400 dollars is half my monthly income and more then most people pay for rent here. Not to mention LIFE insurance isn't HEALTH insurance.
So this notion that huge numbers of people would simply be denied coverage seems rather implausible when insurance companies are plainly willing to insure people with high levels of risk for other types of policies.
Meanwhile my GF cannot currently get health insurance at ALL. When she was in her teens she developed a very low platelet count for years but has since recovered. Her platelet count has been perfectly fine for the last +6 years yet health insurance providers don't want to touch her with a 10 foot pole. Since there's always a risk that her disease could make a comeback..
The real solution, therefore, is to control costs. The best way to do this is through competition, which works brilliantly everywhere it is tried.
Really? I know a lot of internet subscribers that'd disagree with you on that one. Competition could only work if there really is TRUE competition which in today's markets is very very rare.
To do this we need to break away from the insurance model towards a fee for service model. Insurance should be used for unforeseen and serious events. In health care this would mean cancer and the like. This is why auto insurance doesn't cover oil changes.
Your comparison is extremely flawed and it amazes me that you don't even realize it. Car insurance providers cover car ACCIDENTs not blown engines or anything else that could be a result of poor maintence (unless said poor maintence results in an accident and then they only cover the accident part). That being said health insurance would be more like insurance for the engine in which case providing oil changes would potentially lower costs by preventing complete engine or even car replacements. Cancer is best treated when caught early (cheaper and much higher chance of survival) yet you're seriously aurging that we shouldn't bother trying to catch it early cause it's not a big deal yet.
By moving away from having many routine procedures covered by insurance we will encourage people to shop around and health care providers compete for their business. Indeed, this is the case with procedures that are not covered by insurance such as Lasik and cosmetic surgery, where we see little of the cost inflation that we find more broadly in health care.
Meanwhile in the real world that would mean fewer people engaging in pre-emptive medicine. So instead of catching stuff early when it's cheap to treat we'd be catching stuff when it's late in and not only would the cost of treatment be much higher but more people would be dying.
I frankly suspect that the American public is not terrible well informed on the health care debate
Not like you, presumably.
I recall some blisteringly sharp reasoning on the global supremacy of the American health-care system and cross-national health outcomes in an earlier discussion.
Oh, and expanding competition would be far, far cheaper too. In fact, I don't think it would cost the feds anything.
This of course assumes that your true interest is in promoting competition and not simply expanding government's involvement in health care.
Oh indeed. Competition is a great thing. Would that there actually were some. So here's a free-market thought: why not just let a public option compete with the private insurance carriers? Of course, knowing all you do about the health-care debate, you're no doubt well aware that so long as the government and Congress don't simultaneously enact side-measures to protect and coddle the competition-terrified insurance companies, the public-insurance option would freaking trounce the private insurance companies. And lead to billions in cost savings for Americans.
Colin,
There are number of false assumptions and claims in your response, but let me briefly address a few of them.
First, just because even really bad drivers can still get car insurance doesn't mean sick people can get health insurance. Insurance is about making money. In order for it to be worthwhile to insure someone, the insurer has to be able to make more in premiums that that person is likely to cost in payouts. Even terrible drivers don't get in accidents ALL the time. So at some rate, it makes sense to insure them. Health care is different. First, it's super expensive, so even a relatively small risk translates into high premiums. Second, with a lot of conditions, it is a virtually certainty that a known amount of health care costs will be incurred per year. To use the car insurance analogy, there is a 100% chance the person will get in a few accidents every year. It's like asking a auto insurer to cover a blind driver. The rates would be higher than the out of pocket costs. These people are uninsurable.
Second, I really recoiled at this:
it certainly makes sense that those who require more care should pay more
Really? This makes sense in the realm of car insurance, where you can choose to be a more careful driver.
But health conditions aren't like that. Why should those who happen to come down with an illness or cancer or whatever be bankrupted? In what moral universe is that okay?
In no other developed country are people punished financially for having the bad luck of having health issues. It makes no moral sense, especially when the whole point of insurance is to pool risk.
The problem is that with health care, unlike car insurance, people are more risky to cover based on things that are 1) not their fault, and 2) easy to spot.
Should insurance companies be able to charge black people more because statistics show they are, on the whole, more prone to diabetes and kidney disease? Should people who've fought off cancer be denied coverage because cancer often comes back?
None of this makes any sense and it's one of the many reasons why "the market" can't effectively solve our health care problems. Health insurance is fundamentally and qualitatively different than other forms of insurance.
One final point, your discussion of elective procedures is not instructive. Costs are controllable by market forces in the elective procedure area precisely because the procedures are elective (i.e. not necessary). When you need a heart transplant, you're not going to shop around for price. With necessary care, there is always an expert intermediary (the doctor) who tells you what you need. And because you need it, you do it. Price doesn't factor in. That's why market forces will never work to contain cost in health care the way they do with respect to consumer goods.
This entire discussion has left me terribly depressed. The prima donnas in the Senate (Democrats and Republicans) are going to make sure we have nothing that even approaches universal health care.
One must ask oneself "why" isn't it happening. The Democrats could have the "will" but it is being bought. Follow the money on this. Everyone Democratic officeholder that has insurance as a result of holding federal office is a hypocrite for opposing the same plan for the people he/she represents. Let's talk about their coverage. We should have their coverage. If it is good enough for them it is good enough for us. That is the issue.
Three points about “health care reform”:
First, no one is talking about how many Americans are ALREADY on Federal health care, with the government as payer. These would include ALL US military and their families, ALL retired US military and their families, ALL federal employees and their families, active and retired whether Executive, Legislative, or Judicial branches, ALL Medicare and Medicaid recipients, ALL Federal prisoners.
Toss in ALL state and local government employees, and it’s a heck of a large number. NO ONE IS TOTALLING THIS CROWD!
If you put the UNINSURED on ONE side, and the GOVERNMENTALLY INSURED on the other, who’s left? Let’s see the numbers!
Second, the President has already endorsed the Federal Direct Student Loan Program, originated and operated by civil servants in the Department of Education. This is because it’s simpler, cheaper, and probably fairer. The parallels with single payer health insurance are PALPABLE, but NO ONE is talking about them. Why not?
Third, and very important, SENATORS AND CONGRESSMEN receive VERY GENEROUS health care benefits, and are not taxed for them, and they’re paid for BY THE GOVERNMENT, and WHO ARE THEY to deny similar benefits to others? Are they THAT MUCH BETTER THAN WE ARE??
It is important to keep mentioning all three points, especially the last, because we need to open the OVERTON WINDOW to a wider public discussion! Check it out! Get with it!!
Bob Knisely
Right on. Some of the best healthcare in the US is provided by the UC system. So you can include students and employees (past and present) of the UC system as well.
Further, (private) health insurance for all employees of all govt contractors (think DOD) is also taxpayer paid.
Finally, it's always amazing that "Invisible handers" always compare govt options with perfect free markets, rather than the govt subsidized, pro-business regulated, oligopolistic, imperfect markets of the real world.
Lies, lies, and damned lies. Show me where private health insurance provides higher quality and lower costs over Medicare. You can't show me because it doesn't.
Medicare, of course, is headed for a fiscal reckoning as Obama keeps telling us. So, sure, Medicare is great, except for the fact that it is going bankrupt. Also, since the reimbursement rate is terrible fewer doctors are taking Medicare patients.
So other than the fact that it is unsustainable and doctors hate it, it's a great program.
So here's a free-market thought: why not just let a public option compete with the private insurance carriers? Of course, knowing all you do about the health-care debate, you're no doubt well aware that so long as the government and Congress don't simultaneously enact side-measures to protect and coddle the competition-terrified insurance companies, the public-insurance option would freaking trounce the private insurance companies. And lead to billions in cost savings for Americans.
Ridiculous. Public options aren't true competition as they do not have to turn a profit or even break even. Just look at Amtrak and the US Postal service.
AL,
A few points:
But health conditions aren't like that. Why should those who happen to come down with an illness or cancer or whatever be bankrupted? In what moral universe is that okay?
The reality is that health care is rationed everywhere in the world. Move to a government system and it changes nothing. Governments deny and ration care. That isn't even debatable.
I really don't get your outrage. In my model health care is a function of your ability to pay or obtain insurance. In your preferred model government bureaucrat would decide who gets treated. This isn't scare mongering on my part, it's just reality.
As an example I had a Norwegian friend whose grandmother needed an operation (hip replacement or some such if I recall). The public hospital would treat her for free, but she would have to be on a waiting list for a considerable time (9 months I think). She checked with a private hospital and she could have had the procedure done the next week -- of course she would have had to pay for it.
Rationing and trade-offs exist in either model. At least mine has the virtue of offering some hope of cost containment which would enable more people to get care.
One final point, your discussion of elective procedures is not instructive. Costs are controllable by market forces in the elective procedure area precisely because the procedures are elective (i.e. not necessary). When you need a heart transplant, you're not going to shop around for price. With necessary care, there is always an expert intermediary (the doctor) who tells you what you need. And because you need it, you do it. Price doesn't factor in. That's why market forces will never work to contain cost in health care the way they do with respect to consumer goods.
This is demonstrably not true. You can get heart transplants in India for much cheaper than the US:
http://www.medical-tourism-india.com/heart_surgery_india.htm
There is a whole medical tourism field. There is no reason that people can't shop around for health care just like they shop for everything else.
It's a perfect time, after 60-some years of driving up the cost of health care, for the door to be slammed shut and eliminate this subsidy. When people have the choice between bankruptcy and death (and, given the state of the for-profit medicine business, probably first one, then the other in a lot of cases) they'll have the opportunity to display their principles by either dying cheaply or taking their family's future with them -- and then dying.
Idiocy. The insurance model is the very thing that is driving costs up. When someone else is footing the bill costs go up. My model would bring costs down and encourage people to shop around like they do everything else.
The spectacular success of the competitive model in so many fields, except for the internet, the military, the space program, and development of integrated circuits is sure impressive -- we'd be discussing this subject over a party-line telephone call without massive government programs.
Well, the military is a public good, do I don't see what your point is there. Public goods, by definition, aren't subject to competition. Health care, in contrast, is a private good.
Simply because no amount of competition outside of a public option would help my GF since she has a "prio condition" (which is completely gone and likely will never appear again). Your idea would just mean she could get rejected by more companies then now..
This is more evidence of why we need to abandon the insurance model and move towards fee for service. Currently, your GF needs insurance to get care. I believe that we should move towards a system in which you pay for what you get, with insurance reserved for catastrophic events such as cancer.
400 dollars is half my monthly income and more then most people pay for rent here. Not to mention LIFE insurance isn't HEALTH insurance.
You completely missed the point which is that high risk individuals can obtain insurance in other areas.
Really? I know a lot of internet subscribers that'd disagree with you on that one. Competition could only work if there really is TRUE competition which in today's markets is very very rare.
There is very little competition generally in internet subscription, so this actually makes my point. We need more competition, not less. We can promote competition by allowing people to buy across state lines which would expand choice and drive down costs.
Your comparison is extremely flawed and it amazes me that you don't even realize it. Car insurance providers cover car ACCIDENTs not blown engines or anything else that could be a result of poor maintence (unless said poor maintence results in an accident and then they only cover the accident part). That being said health insurance would be more like insurance for the engine in which case providing oil changes would potentially lower costs by preventing complete engine or even car replacements. Cancer is best treated when caught early (cheaper and much higher chance of survival) yet you're seriously aurging that we shouldn't bother trying to catch it early cause it's not a big deal yet.
This is nonsensical. Who is saying that we shouldn't try to catch cancer early? All I am saying is that health insurance should only be used for unforeseen catastrophic events such as cancer. I really have no idea what you are getting at here.
Meanwhile in the real world that would mean fewer people engaging in pre-emptive medicine. So instead of catching stuff early when it's cheap to treat we'd be catching stuff when it's late in and not only would the cost of treatment be much higher but more people would be dying.
Huh? Why would people stop engaging in pre-emptive medicine? Because they would suddenly stop caring about whether they detect an illness early that could kill them? Does that seem at all rational or likely? Are you really thinking this one through?
Colin,
A company doesn't need to turn a profit to be competitive.
If you want to eliminate insurance, the best way to do that would be to support a single-payer system, putting all the insurance companies out of business (I'll hold your hat while you convince Congress to do that) -- and then, when medical care begins to suffer, you'll have your chance to allow people to opt out by creating the new model.
If you are correct in your predictions about how things would work, that should be duck soup, as, after 10 years of single-payer, everybody will see the decline.
If you are correct, the public option would inevitably result in single-payer, so, by your own logic, you should be supporting it.
Bribery is the only explanation. That or some other form of corruption.
A company doesn't need to turn a profit to be competitive.
It needs to at least break even to stay in business. Existing public options such as the US Postal Service and Amtrak do not do this.
If you want to eliminate insurance, the best way to do that would be to support a single-payer system, putting all the insurance companies out of business (I'll hold your hat while you convince Congress to do that) -- and then, when medical care begins to suffer, you'll have your chance to allow people to opt out by creating the new model.
This is a bizarre remedy. So we should move to your model so that people can suffer and eventually adopt my prefer model? No thanks, I would rather skip the pain and suffering and just move to my preferred model immediately.
Colin,
Perhaps your problem is your "facts". For example, the USPS actually was profitable for 5 of the last several years.
You imagine that you could eliminate insurance as we know it, move to a "pay as you go" scheme (apparently by magic) and this would not involve suffering?
No matter how we cut the cost of medical care, doctors, health care companies, and at least some segment of the public at large will suffer.
If we imagine, erroneously, that it's malpractice insurance that costs so much, and place limitations on malpractice awards, people will suffer. Lawyers too.
Going to a pay-as-you-go system will transfer the pain onto the backs of the poor, which, judging by your comments so far, you are perfectly happy with. Of course, over the course of time, your theory that this would cut the cost of care means that, in the long run -- if your theory is correct, which is by no means certain, as health care is not like crude oil -- doctors and health-care company executives would face a less-profitable future, but meanwhile, there would be a great deal of suffering.
I think there's a more satisfactory symmetry to making the people who have become wealthy off the health-care boom bear the brunt of the suffering to fix the problem, but that's just me.
Colin, there are all sorts of fatal problems with your "plan" (i.e. a pure fee for service model), but I'll limit myself to just the most obvious. First, this is easily the simplest system (because it's no system), so the obvious first question is: why does no countries use this system. There are many reasons.
The most fundamental problem is that when you don't cover routine care, many people just won't pay for it on their own. People generally don't like going to the doctor and if they have to pay out thousands of dollars for routine check ups and tests (like mammograms, prostate tests, etc.), they won't do it. They'll only go to the doctor when they are really sick. This is essentially what happens now with the uninsured. The result is an incredibly inefficient system (both in terms of costs and health outcomes). Medical problems are much more expensive and more difficult to treat if they are not discovered until they're acute.
There are literally no health care policy experts or medical professionals who believe that a fee-for-service model is workable. It is a libertarian pipe dream that even libertarians wouldn't really want if they magically got their wish. The reason the insurance model sprung up in the first place is precisely because a fee for service model is unworkable, unjust, and counterproductive.
This is more evidence of why we need to abandon the insurance model and move towards fee for service. Currently, your GF needs insurance to get care. I believe that we should move towards a system in which you pay for what you get, with insurance reserved for catastrophic events such as cancer.
Under your plan we'd be getting the exact same "healthcare" as we're getting now which is NONE. It's like you cannot comprehend that people who work hard don't always get rewarded financially and that it takes a lot of luck to get anywhere in that aspect.
You completely missed the point which is that high risk individuals can obtain insurance in other areas.
Yes and you completely missed the point where I told you my GF cannot get coverage at all due to having Idiopathic thrombocytopenic purpura when she was young.
There is very little competition generally in internet subscription, so this actually makes my point. We need more competition, not less. We can promote competition by allowing people to buy across state lines which would expand choice and drive down costs.
So you think magically you're going to create competition despite your precious "free market" not really being free or a fair market at all? I'd like to point out that insurance =/= healthcare provider. The only possible competition in insurance companies that pop up will be more then offset by the fact that there's limited choices when it comes to seeing a doctor (around here there's one hospital and the next closest is 40ish miles away). Since you're advocating a system where most of the healthcare costs come out of pocket there's little chance of a true freemarket solution (due to the severe lack of choice). AL has already destroyed you on this subject in an earlier post though so I leave the rest to him.
This is nonsensical. Who is saying that we shouldn't try to catch cancer early? All I am saying is that health insurance should only be used for unforeseen catastrophic events such as cancer. I really have no idea what you are getting at here.
You are and the fact that you cannot see that you are advocating such a thing is so rediculous it's not even funny anymore. When you start forcing people to pay out of pocket for preventive medicince (cancer screening etc) there will be a drop in people who engage in such. The direct result is more people waiting till they are really sick before going to the doctor which directly results in higher costs of treatment and mortality rates. This is exactly what's happening with the millions of uninsured already because well they are already paying the way you want everyone to..
Huh? Why would people stop engaging in pre-emptive medicine? Because they would suddenly stop caring about whether they detect an illness early that could kill them? Does that seem at all rational or likely? Are you really thinking this one through?
This is already happening with the millions of uninsured right this very moment. When it comes down to spending thousands ruining your life and losing your job or hoping for the best most people are going to be forced into the hope for the best since they have NOTHING to fall back on (especially when they have kids). Seriously this is the whole reason why the healthcare system is such a fracking mess in this country.
You're not advocating anything resembling a health care system. What you're advocating is a system where everyone is on their own unless their problem reaches some magical "Serious" thresh hold set by you. Your ignorance leads me to believe you've been eating out of a silver spoon your whole life.
Colin, why is it that the top 10 countries in the WHO ranking all have public options *and* spend far less per capita than the U.S., which comes in at #37?
http://www.photius.com/rankings/healthranks.html
Perhaps your problem is your "facts". For example, the USPS actually was profitable for 5 of the last several years.
Still doesn't change the fact that in the years that they don't make a profit that the taxpayer picks up the tab.
You imagine that you could eliminate insurance as we know it, move to a "pay as you go" scheme (apparently by magic) and this would not involve suffering?
No, I'm sure it would. Any change would. I just believe that it would produce more harm than good. Also my solution isn't magic, I simply propose that we stop subsidizing insurance, which again is a silly artifact of WWII price controls.
No matter how we cut the cost of medical care, doctors, health care companies, and at least some segment of the public at large will suffer.
If we imagine, erroneously, that it's malpractice insurance that costs so much, and place limitations on malpractice awards, people will suffer. Lawyers too.
Well, yes. When you introduce competition it exerts downward pressure on prices and people lose money -- that's the nature of the free market. I see it as a virtue, however, and not a problem.
Going to a pay-as-you-go system will transfer the pain onto the backs of the poor, which, judging by your comments so far, you are perfectly happy with.
Why would this harm the poor? Because they hate lowered prices?
Of course, over the course of time, your theory that this would cut the cost of care means that, in the long run -- if your theory is correct, which is by no means certain, as health care is not like crude oil -- doctors and health-care company executives would face a less-profitable future, but meanwhile, there would be a great deal of suffering.
No, I think that prices would be reduced in the short-term as well. Everywhere we find competition the impact on prices tends to be pretty immediate.
I think there's a more satisfactory symmetry to making the people who have become wealthy off the health-care boom bear the brunt of the suffering to fix the problem, but that's just me.
I see, so then, what -- only doctors, health care professionals and drug companies will pay for the cost of government health care? Does that make any sense?
Actually, people like Colin do not see healthcare as a public or moral issue, and do believe that if you get bankrupted by an illness, or die from one because you cannot pay for treatment, that's just your tough luck. No one in this life should get anything that they cannot pay for, and everyone should get as much as they can pay for.
It's called "personal responsibility" and I do not want to live in their world. Not even if I'm one of the ones that can pay.
First, this is easily the simplest system (because it's no system), so the obvious first question is: why does no countries use this system. There are many reasons.
Perhaps the biggest reason for this is more rooted in political science than a study of effective health care policy. People tend to like getting free stuff from the government. Getting something at someone else's expense is politically popular. This is particularly true when the free item is available to everyone. The only notable reform of social programs in recent memory was welfare, which was received by a minority of the population and paid for by the majority.
The most fundamental problem is that when you don't cover routine care, many people just won't pay for it on their own. People generally don't like going to the doctor and if they have to pay out thousands of dollars for routine check ups and tests (like mammograms, prostate tests, etc.), they won't do it. They'll only go to the doctor when they are really sick. This is essentially what happens now with the uninsured. The result is an incredibly inefficient system (both in terms of costs and health outcomes). Medical problems are much more expensive and more difficult to treat if they are not discovered until they're acute.
I simply don't believe this. You think that people are willing to pay $30 for an oil change but won't pay for a health checkup?
Mammograms cost between $50-150 (http://www.cancer.gov/cancertopics/factsheet/detection/screening-mammograms), and that's with insurance companies picking up the tab (which is frequently mandated by law). If people actually shopped around I would be willing to be a fair chunk of change that amount would go down.
There are literally no health care policy experts or medical professionals who believe that a fee-for-service model is workable.
This just isn't true. What do you think health savings accounts are, if not an attempt to persuade people to pay for items out of their own pocket -- fee for service -- with the exception of catastrophic events? This is actually very much part of the mainstream and even part of US law. Now, HSAs have some big flaws and do not represent my health care ideal. But your accusation that my thinking is out of mainstream thought is simply not true. And again, I never said that insurance should be dispensed with entirely and there is an appropriate role for it for catastrophic events.
This is at least the second time in which you have proven to be objectively wrong in your statements (the bit about not shopping for a heart transplant being the other). The fact that you are objectively wrong should humble you at least somewhat and prompt a rethink of some of your assumptions.
Under your plan we'd be getting the exact same "healthcare" as we're getting now which is NONE. It's like you cannot comprehend that people who work hard don't always get rewarded financially and that it takes a lot of luck to get anywhere in that aspect.
Who is "we"? Certainly you are not referring to the United States, where there is plenty of health care. Indeed, it is a massive industry.
Yes and you completely missed the point where I told you my GF cannot get coverage at all due to having Idiopathic thrombocytopenic purpura when she was young.
No, actually I addressed that by saying that it was further evidence of the flaws of relying exclusively on insurance.
So you think magically you're going to create competition despite your precious "free market" not really being free or a fair market at all? I'd like to point out that insurance =/= healthcare provider. The only possible competition in insurance companies that pop up will be more then offset by the fact that there's limited choices when it comes to seeing a doctor (around here there's one hospital and the next closest is 40ish miles away). Since you're advocating a system where most of the healthcare costs come out of pocket there's little chance of a true freemarket solution (due to the severe lack of choice). AL has already destroyed you on this subject in an earlier post though so I leave the rest to him.
Why would there be a lack of choice? Would hospitals and doctors suddenly disappear? This makes little sense.
You are and the fact that you cannot see that you are advocating such a thing is so rediculous it's not even funny anymore. When you start forcing people to pay out of pocket for preventive medicince (cancer screening etc) there will be a drop in people who engage in such. The direct result is more people waiting till they are really sick before going to the doctor which directly results in higher costs of treatment and mortality rates. This is exactly what's happening with the millions of uninsured already because well they are already paying the way you want everyone to.
Sigh. Seriously, do you even read my arguments? My whole point is that with more competition -- by eliminating health insurance for routine procedures -- that health care costs would diminish and the poor and everyone else would be able to get care. In fact, the free market already offers solutions for sick people that lack insurance as is described here:
http://www.time.com/time/specials/packages/article/0,28804,1903873_1903925_1903791-1,00.html
This can be done for screenings and other preventative treatments as well.
This is already happening with the millions of uninsured right this very moment. When it comes down to spending thousands ruining your life and losing your job or hoping for the best most people are going to be forced into the hope for the best since they have NOTHING to fall back on (especially when they have kids). Seriously this is the whole reason why the healthcare system is such a fracking mess in this country.
Again, drive down costs and more people can afford care. Healthcare is a mess because it is bureaucratic and unresponsive to the consumer, which is a product of an over-reliance on insurance. Further, there is no reason that insurance should be linked to employment, which the current system promotes through the tax code.
Colin, why is it that the top 10 countries in the WHO ranking all have public options *and* spend far less per capita than the U.S., which comes in at #37?
If you are asking me to defend the current approach I will not. In fact I advocate radical change.
Actually, people like Colin do not see healthcare as a public or moral issue, and do believe that if you get bankrupted by an illness, or die from one because you cannot pay for treatment, that's just your tough luck. No one in this life should get anything that they cannot pay for, and everyone should get as much as they can pay for.
No, not at all. I believe that we need to make health care cheaper so that more people can get it.
Government-run health care where everyone gets all the treatment they need or want is a fantasy. It has literally never occurred, and never will. You face finite resources under either the state-run or free market model, which is why state-run systems are forced to either deny treatment to people or place them on a waiting list. They do not have unlimited resources.
At least my proposed system offers the hope of cost containment and increased quality.
BTW, does anyone here not wonder why TennCare is such a mess?
Colin,
Forgive me, but I simply don't share your faith in the effectiveness of the law of supply and demand where a) the demand in question is inelastic and b) the supply isn't fungible.
In shorter words, I don't see why prices would drop like a rock if people stopped buying.
Even if prices dropped dramatically, just what do you think this would do to health care suppliers? Apparently, you somehow believe they'd make up the difference by the increased demand for appendectomies and the like.
I know 'the plural of anecdote is not data' but sometimes it helps to bring the discussion out of the theoretical clouds someone like Colin has kicked it into. So, a couple of personal stories:
About 7 years ago a foot problem I'd had for years suddenly got infected. At the time my wife and I had no insurance, we hadn't gotten on to Medicaid yet.
I can say the infection was not in any way 'my fault' and was so unexpected that when I complained to my GP on Saturday that a problem was starting, he thought it was nothing to worry about, but scheduled an appointment for me for the foot doctor for the next Friday.
On Friday it was "Go home, pack a bag, and meet me at the hospital AT ONCE!" Apparently the infection had gotten so bad that another day or two and I'd have been one-legged.
I would have had no way to pay for this treatment, and would have simply had to declare a bankruptcy I could never have hoped to have been discharged from.
Fortunately the Hospital was known for good doctors and incompetent staff, and there were several uncorrected problems during my stay -- one urinal and one waste basket for two patients who were not particularly mobile -- and the urinal remaining unemptied -- an 'emergency call button' that was disconnected -- and remained so for three days after
I'd complained. (And a feeling that, had it been my roommate who had complained -- I had a couple -- they would have been ignored. The difference, sadly, was that I have white skin.)
This culminated in -- at my first 'clinic check-up' -- an example of negligence that almost left me with my other leg broken. (A 150-lb bench was carelessly unsecured in front of where I was sitting and when someone sat on it, it collapsed against my leg. I an still not sure how it only scraped my leg instead of breaking it.)
So I 'settled' on a 'you don't sue me, I won't sue you' basis. If I hadn't, the bill would have been more than my wife or I had ever earned in a year of generally low-to-moderate paid work before her disability kept either of us from working.
Cut it in half, cut it by two thirds by the magical savings Colin suggests, assume it had happened when my wife was still working, but, as wasa true, we couldn't afford to extend her health coverage to cover me, or assume that ther was no insurance -- and we still would have had to choose between being bankrupt or me losing my foot -- and conceivably my life if I had waited a little longer before being forced to risk the bankruptcy.
And my problem was settled with an operation and just a little follow-up care (a cane, pain-killers, and we paid a nurse from the hospital to stop by and change my bandages for a few weeks). Imagine if it had become something needing chronic follow-up care -- and how likely I would have been able to find someone to treat me if the case against me had gone forward. (Hospitals are required to treat emergencies, but that's as far as it goes -- in the US.)
Meanwhile, my sister-in-law lives in Canada, just over the border in the Far West. She has just had a minor recurrence of her ovarian cancer that was, when it first occurred, treated promptly, efficiently, and at no charge to her or to my wife's family. Her wife -- not sure if they have had the ceremony, but they were together 19 years ago when I met my wife -- recently was treated for breast cancer -- fortunately it was caught early.
My sister-in-law is a self-employed artist and caterer. Had she lived a few miles south of where she was, I can easily imagine her delaying treatment because of the cost -- particularly in Colin's system -- until the only relevant choice would have been 'style of casket.'
I should have mentioned that, afaik, my sister-in-law, while a long-time resident of Canada, is still an American citizen, and that, again afaik, had my foot infection occurred while I was visiting her, I would have received the same operation, probably better hospital care -- it couldn't have been worse -- and would have owed nothing and might have even gotten the visiting nurse without paying her myself.
...We have a popular Democratic President who was elected less than a year ago with a mandate to reform health care and a very clear plan for doing so.... A.L. at 9:00 AM
What planet was that? During the campaign, Obama announced the weakest health care proposals of any, even denying the necessity of a mandate, i.e. universal coverage.
It should be clear even to the thickest OFB that you got what you voted for. By-the-way, how's them wars ending for ya?
Colin said...You can buy auto insurance even if you are a high-risk driver....
Yup, through a state pool which is the equivalent to single payer.
Colin said...So, sure, Medicare is great, except for the fact that it is going bankrupt...
Nope, just need greater funding to update for higher medical cost. Kinda like having to pay higher premiums to your private company except that your private for–profit insurance company then pays higher bonuses for denying coverage to needy customers.
Mike
[Colin, why is it that the top 10 countries in the WHO ranking all have public options *and* spend far less per capita than the U.S., which comes in at #37?]
If you are asking me to defend the current approach I will not. In fact I advocate radical change.
No. I'm asking why a public option can't be part of the solution given that it has gotten the job done cheaply and effectively in other countries. Since you favor "radical change," why not go with something that has been proven to work elsewhere?
Meanwhile, my sister-in-law lives in Canada, just over the border in the Far West. She has just had a minor recurrence of her ovarian cancer that was, when it first occurred, treated promptly, efficiently, and at no charge to her or to my wife's family. Her wife -- not sure if they have had the ceremony, but they were together 19 years ago when I met my wife -- recently was treated for breast cancer -- fortunately it was caught early.
My sister-in-law is a self-employed artist and caterer. Had she lived a few miles south of where she was, I can easily imagine her delaying treatment because of the cost -- particularly in Colin's system -- until the only relevant choice would have been 'style of casket.'
Ridiculous. I actually specifically said that insurance should remain for events such as cancer.
Even if prices dropped dramatically, just what do you think this would do to health care suppliers? Apparently, you somehow believe they'd make up the difference by the increased demand for appendectomies and the like.
I think that they would have to become more efficient. Demand for food is also inelastic, yet in real terms prices have been on a steady downward decline.
No. I'm asking why a public option can't be part of the solution given that it has gotten the job done cheaply and effectively in other countries. Since you favor "radical change," why not go with something that has been proven to work elsewhere?
Well, I beg to differ about whether they are truly more effective. I believe, for example, that cancer survival rates tend to be higher in the US than many of those countries.
Without giving too elaborate of a response I simply think that we can do better than those systems, which aren't exactly problem-free (e.g. funding in the UK, wait times in Canada).
Indeed, our own experiences with government-run health care in the US -- TennCare, Medicare RomneyCare in MA -- have encountered considerable problems. I don't see how expanding government interference would change this.
Colin,
Since you are so enamored of businesses free of the taint of government, but think agriculture is a model, I take it that you've never heard of "agricultural subsidies" or "food stamps", which tend to make your comparison to the food industry questionable.
While the modern factory farms are very efficient, I doubt very much health care consumers would care to be treated like the material in the food chain. Ever visit a factory hog farm?
While demand for a certain amount of calories, protein, and other compounds is inelastic, there's another slight flaw in your analogy. If you need an appendectomy, but, to save money, decide on two tonsillectomies, you might begin to comprehend the problem -- before you die.
Also, food is fungible, which health care is not.
Perhaps if you swallowed your fatuous belief in the magical cure of the "free market" for all ills, financial or political, and exposed yourself to a tiny bit of real economics, you'd come to understand the inanity of your position. I know, it's unlikely, but ignorance isn't incurable.
Colin said...our own experiences with government-run health care in the US ... have encountered considerable problems.....
Nope, they haven't. Medicare is a well-run program that provides better care at lower cost than any HMO or PPO. In fact, you have your facts bassackwards: it is private insurance that is failing consumers by failing to cover all Americans at a reasonable cost.
When United Healthcare's CEO William McGuire get a $1 Billion bonus, it only shows what a fraud private insurance is. Private companies make profits by receiving premiums not providing care. Medicare has operating costs 25% lower than your inefficient private carriers.
Mike
Medicare is a well-run program that provides better care at lower cost than any HMO or PPO.
If it is so well run then why do doctors try to avoid patients that have Medicare? And why is it headed for bankruptcy? Are these the hallmarks of an effective insurance program?
Since you are so enamored of businesses free of the taint of government, but think agriculture is a model, I take it that you've never heard of "agricultural subsidies" or "food stamps", which tend to make your comparison to the food industry questionable.
I am familiar. Subsidies are not the reason that food is cheap. In fact, when New Zealand slashed its dairy subsidies the result was higher incomes for farmers and increased output:
http://newfarm.rodaleinstitute.org/features/0303/newzealand_subsidies.shtml
Australia is a big agriculture exporter and relies very little on subsidies.
While the modern factory farms are very efficient, I doubt very much health care consumers would care to be treated like the material in the food chain. Ever visit a factory hog farm?
Factory hog farms are a product of government subsidies:
http://www.splicetoday.com/consume/the-pork-spending-we-should-worry-about
While demand for a certain amount of calories, protein, and other compounds is inelastic, there's another slight flaw in your analogy. If you need an appendectomy, but, to save money, decide on two tonsillectomies, you might begin to comprehend the problem -- before you die.
No, but you can shop around for the best price. A heart transplant is 1/4 the cost in India that it is here. We need more competition to drive prices down even further.
Perhaps if you swallowed your fatuous belief in the magical cure of the "free market" for all ills, financial or political, and exposed yourself to a tiny bit of real economics, you'd come to understand the inanity of your position. I know, it's unlikely, but ignorance isn't incurable.
Through the subsidy discussion you have shown to be the one who is unaware and deeply ignorant.
Colin,
When you were cherry picking data for evidence that lowering subsidies might lower the cost of food, and stumbled across New Zealand, you should have looked at their health care system.
The question isn't whether subsidies affect the price of food (they do, they've been used for millenia for that precise purpose), the question is whether your argument that health care is like agriculture is ridiculous.
You might ask yourself why your examples (Australia, New Zealand) are two countries with extremely low population densities and an abundance of fertile land, and whether those examples really mean anything for the rest of the world.
As for the fungibility of health care, I can see the scenario right now. Guy comes in with a heart attack. As they're prepping him for emergency angiogram, he moans, "no, please! Just get me to the airport. I can get a transplant in Mumbai for less than you'll charge for angioplasty."
I regret that I can't take you seriously anymore. I don't see how anyone can.
Colin said...If it is so well run then why do doctors try to avoid patients that have Medicare? And why is it headed for bankruptcy?....
Actually, my doctors tell me they prefer to deal with Medicare because payments are quicker and entail less paperwork. Also, there is no later denial of coverage that for-profit companies are well-known for committing in order to screw policyholders.
Medicare is in no way headed for bankruptcy. Are you simply a hack working for some health care lobby group? Government programs don't go bankrupt. Congress simply budgets more money for them. It's capitalist entities that go bankrupt like Enron, World Com and numerous others that spent more on bonuses for poor executives than customer care. Grow up to the real world.
Mike
Actually, my doctors tell me they prefer to deal with Medicare because payments are quicker and entail less paperwork.
While your anecdote is impressive, the evidence remains to the contrary:
http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html
Medicare is in no way headed for bankruptcy.
Nope, sorry, that's just not true:
http://minnesota.publicradio.org/display/web/2007/04/26/midday1/
You might ask yourself why your examples (Australia, New Zealand) are two countries with extremely low population densities and an abundance of fertile land, and whether those examples really mean anything for the rest of the world.
Then forget NZ and just look at the US. A handful of crops receive the lion's share of subsidies:
http://www.card.iastate.edu/iowa_ag_review/fall_01/concentration.aspx
Most of U.S. agriculture receives little or no subsidies, with 60 percent of the value of U.S. agricultural production receiving a 3 percent subsidy share in 1999.
Yet even here prices have declined. Bananas are pretty cheap despite not receiving subsidies and being imported from Central America.
As for the fungibility of health care, I can see the scenario right now. Guy comes in with a heart attack. As they're prepping him for emergency angiogram, he moans, "no, please! Just get me to the airport. I can get a transplant in Mumbai for less than you'll charge for angioplasty."
What an absurd example. For emergency and catastrophic care insurance makes sense. For most health care interactions it does not and people should pay out of pocket.
This post has been removed by the author.
For all those interested in an economic analysis of why the normal laws of supply and demand do not quite work in health care, take a look at this.
Colin:
If you think the example is ridiculous, it was your own example. Or maybe you don't think that needing a heart transplant is pretty catastrophic, and probably fairly urgent.
If it was urgent care that you couldn't shop around for then hospitals in India wouldn't be offering their services for it. By definition you are wrong.
Well, I beg to differ about whether they are truly more effective. I believe, for example, that cancer survival rates tend to be higher in the US than many of those countries.
Colin, can you come up with something other than anecdotes and what you "believe"? Like, um, statistics? Here's a start:
Life expectancy, best to worst:
(in years)
France 80.87 (rank = 5)
Sweden 80.63 (rank = 7)
Iceland 80.43 (rank = 9)
Canada 80.34 (rank = 10)
Italy 79.94 (rank = 11)
Spain 79.78 (rank = 14)
U.K. 78.7 (rank = 26)
U.S. 78.06 (rank = 30)
Source: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
Infant mortality, best to worst
(in deaths per 1000 births)
Sweden 2.75 (rank 221)
Iceland 2.9 (rank 195)
France 4.2 (rank 184)
Spain 4.2 (rank 183)
U.K. 4.8 (rank 174)
Canada 4.8 (rank 173)
Italy 5.0 (rank 171)
Cuba (!) 5.1 (rank 168)
U.S. 6.3 (rank 163)
Source: http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate_(2005)
How can there possibly be any doubt about the effectiveness of the health-care systems in countries like France, Italy, and Canada with statistics like these? The U.S. spends gobs more money, leaves 50 million uninsured, yet can't even produce a superior infant mortality rate to Cuba's!
Cancer survival rates take into account only those patients who receive treatment. A better measure is
Deaths from cancer, best to worst:
(per 100,000)
U.K. 253.5 (rank 16)
Sweden 268.2 (rank 14)
France 286.1 (rank 12)
U.S. 321.9 (rank 9)
Italy 418 (rank 2)
[other countries not given]
Source: http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer
I would really like to know how you can defend these hard statistics without resorting to what you "believe." This is a reality-based community.
Colin said..yadayada....4:19 PM
Sorry, pally, but industry planted news articles are not evidence of anything but slanted stories from lobbyists like you.
Your claims are silly and patently false.
No one wants to deal with a company that will rescind coverage in the midst of treatment leaving the hospital and doctors left without recompense. No federal government agency or can go ‛bankrupt' as long as it is funded by government.
The current American system of private insurance has let the American people down in terms of coverage and results.
Facts speak far louder than spin.
Mike
Michael,
Do you really believe that life expectancy is a good proxy for health care? If you rank the US states and the District of Columbia the life expectancy for residents of DC is 10 years less than the first ranked state (Hawaii). Is this attributable to the health care systems in each state? Or do demographics play a role?
Facts speak far louder than spin.
Of which you have offered up none at all, while dismissing those to the contrary as spin without any evidence.
Do you really believe that life expectancy is a good proxy for health care?
Of course it is. Or do you think everyone in France, Spain, Italy, Canada, and the U.K. just happens to have great genes, but that U.S. residents, who share much of the same gene pool, don't? If the DC/Hawaii contrast you mention is valid (you offer no statistics to support it), it is surely a function of access to health care (DC is made up of a large, urban-poor underclass with no coverage), which makes the issue of universality so important. Would your "plan" come close to offering universal coverage?
I notice you've said nothing about infant mortality. Do you believe that's not a good index of the quality of health care?
Here are the facts, which are beyond dispute:
Countries with public health care systems (France, Italy, Sweden, Canada, etc.) spend far less per capita than the U.S. currently does and achieve just as good or better results in many rankings of well-being. They also cover all their citizens, while our system leaves out 50 million.
Occam's razor would suggest a public plan as the best solution. Put aside your anti-government ideology for a moment and just look at the facts. It doesn't take a rocket scientist.
Well, if you want the stats, here you go:
http://en.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy
You then say that the difference between Hawaii and DC is surely one of access to health care, but offer up no evidence.
It is a fact that US states operate under similar health care systems (with some exceptions, with TN and MA implementing some semi-universal coverage measures). Yet outcomes vary from state to state.
It's interesting to me that people in North Dakota have a life expectancy of 79.8 years while Norwegians have a life expectancy of 79.78. Does that mean that North Dakota's system is marginally superior to Norway?
Coincidentally, or perhaps not, North Dakota has more immigrants per capita from Norway than any other state.
As for infant mortality, I find that statistic not at all surprising. I imagine that it has a lot to do with habits of the mother during pregnancy. I would imagine that the poor and less educated take worse care of their unborn children. A population with poorer and less educated people will probably compare worse to a more educated population.
To me a more convincing study would compare people with similar education and income levels across countries, where health care systems are the only real differing variable, and then compare outcomes. My suspicion is that the differences would be much less pronounced.
Colin said...Of which you have offered up none at all....
Au contraire, chum; I offered the facts that medicare is better than for profit insurance that denies coverage in order to enrich CEOs. Indeed, testimony to congress has shown that your corporations have engaged in outright fraud:
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html?hpid=topnews
while other have shown that the results for the American consumer have provided worse benefits to the consumer at twice the price of single-payer nations. Your silly spin has gone nowhere against the utter failure of the American healthcare system.
Mike
As for infant mortality, I find that statistic not at all surprising. I imagine that it has a lot to do with habits of the mother during pregnancy. I would imagine that the poor and less educated take worse care of their unborn children. A population with poorer and less educated people will probably compare worse to a more educated population.
You're tying yourself in knots, Colin.
So now the U.S. population is "poorer and less educated" than that of Cuba? Bermuda? Slovenia? Spain? Portugal? Greece? All rank ahead of the U.S. in infant mortality.
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate_(2005)
It couldn't have anything to do with the fact that all these countries have free, universal health care, could it?
Au contraire, chum; I offered the facts that medicare is better than for profit insurance that denies coverage in order to enrich CEOs.
No, that's not a fact, that's an opinion.
Well, at least you have given up the life expectancy as proxy of health care system argument.
Regarding infant mortality yes, I still think that demographics play a role. Now, the US population as a whole is richer than all of those countries you cited. But there are differing fertility rates. Spain, for example, has a fertility rate of 1.37. The US, meanwhile, has a fertility rate of 2.12, which is unusually high for a developed country. Indeed, I believe the OECD average is 1.65.
The US rate is even bigger than Cuba, which at 1.60 is ranked as #179 in the world for fertility (maybe people don't want to bring more children into the worker's paradise?).
You might want to take a look at this publication:
http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf
It says:
Maternal education has long been considered an important factor in fertility and maternal and infant health and has been shown to have a profound effect on the number of births and the risk of adverse birth outcome. Women with higher educational attainment are more likely to desire and give birth to fewer children, and are less likely to engage in behaviors detrimental to health and pregnancy.
So we have a situation where the least educated -- who are the most risky population -- are also giving birth to the most children in a country with an unusually high fertility rate.
Seems to me that the apparent answer is that we have people in more risky demographics having more kids than equivalent demographics in other countries.
Or, yeah, maybe we should simply adopt the Cuban health care model.
Colin said... No, that's not a fact, that's an opinion.
Perhaps you were unable to click so here's another that mentions the same facts about health care insurance providers: http://www.nytimes.com/2009/06/29/opinion/29mon1.html?ref=opinion
And an article on exorbitant pay to CEOs:
http://rawstory.com/news/2008/Despite_economic_slowdown_defense_contractors_and_0414.html
Insurance companies are cheating their customers by taking premium and denying coverage with false rationalizations. Even a lobbyist hack cannot hide the evidence.
Mike
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