quote:How many people here are happy with their car insurance?
(raises hand)
The fact that it's mandated and largely comoditized means that insurance companies are forced to compete on price and service. It's not all roses, but it's a way better situation than we have with health insurance.
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I should think that if it wasn't legally mandated, the competition on price and service would create far cheaper and better options for consumers.
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What about the prospect of fewer people paying for insurance would increase competition on price? Because in a strict supply and demand model you'd be right, but in an insurance model, the larger pool of consumers drives the cost down. If people weren't required to carry insurance, the pool of insured people would include fewer people, but at a higher risk of making claims, partly because there would be uninsured people driving, but also because higher risk drivers would be more likely to seek insurance, especially older people and younger people. Insurers would also have the option of seeking out and accepting only low risk drivers, pushing the marginal or high risk customers either into no insurance, or higher premiums they are less likely to be able to pay. The existence of these populations of high risk drivers in the insurance system means that the prices for insurance for low risk drivers goes down, but if you eliminated the requirement, insurers would have less competition for high risk customers, and the rates for low risk customers would go up as a result. Smaller pool of customers = finding ways to capitalize on a smaller market.
It's similar to the health insurance problem, The main difference being that low risk driving customers are more likely to have car insurance than low risk medical insurance customers are- the effect of removing one tier of the market is to destabilize it, raising prices and lowering overall coverage.
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MrSquicky: if you don't like car insurance (or home insurance, or life insurance, or business insurance, or numerous other insurance markets that certainly seem to function quite well), perhaps you'd consider all the "club" memberships out there. The same "counterargument" seems to apply from a naive perspective for every business that derives most of its income from ongoing membership fees.
But strangely, people voluntarily and frequently participate in such businesses. The businesses, and the insurance companies, do have incentives to provide the services they've promised, because they still have the possibility of ongoing income, and the PR damage from displeasing a consumer for a legitimate reason can be huge.
Of course, that doesn't apply to health insurance now, because we don't have anything like a free market in health insurance right now. Instead, the government makes it so job-bundled health insurance is discounted relative to unbundled health insurance (and I bet they thought making health insurance "cheaper" was a good idea), meaning that people don't really have the option to switch health insurance when it doesn't deal with their problems, unless it becomes so bad they're willing to switch jobs as well -- assuming that's even a reasonable option.
I don't think just removing those subsidies of job-bundled health insurance would be enough, though that's a very important step. There are other barriers to health insurance portability that need to be addressed (and could be in a fairly straightforward manner), such as preexisting conditions and group eligibility, but they're very addressable in a way consistent with a free market.
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quote: You think car insurance functions perfectly well?
How many people here are happy with their car insurance?
I've got no reason to complain about mine...yet. Then again, the last time I needed it was 9, almost 10, years ago.
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I love my car insurance. I think it is government run too- USAA. I know you have to be military or a military brat to get it.
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I have USAA as well. It's not run by the government though. It was started by army officers to self-insure themselves because they were considered "high risk" by conventional insurance companies.
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quote:Originally posted by fugu13: MrSquicky: if you don't like car insurance (or home insurance, or life insurance, or business insurance, or numerous other insurance markets that certainly seem to function quite well), perhaps you'd consider all the "club" memberships out there. The same "counterargument" seems to apply from a naive perspective for every business that derives most of its income from ongoing membership fees.
But strangely, people voluntarily and frequently participate in such businesses. The businesses, and the insurance companies, do have incentives to provide the services they've promised, because they still have the possibility of ongoing income, and the PR damage from displeasing a consumer for a legitimate reason can be huge.
Of course, that doesn't apply to health insurance now, because we don't have anything like a free market in health insurance right now. Instead, the government makes it so job-bundled health insurance is discounted relative to unbundled health insurance (and I bet they thought making health insurance "cheaper" was a good idea), meaning that people don't really have the option to switch health insurance when it doesn't deal with their problems, unless it becomes so bad they're willing to switch jobs as well -- assuming that's even a reasonable option.
I don't think just removing those subsidies of job-bundled health insurance would be enough, though that's a very important step. There are other barriers to health insurance portability that need to be addressed (and could be in a fairly straightforward manner), such as preexisting conditions and group eligibility, but they're very addressable in a way consistent with a free market.
What do you think of the Wyden-Bennett Healthy Americans Act? I think it does a better job of solving the portability/security issues you point out than do any of the other House or Senate bills.
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quote:Originally posted by fugu13: MrSquicky: if you don't like car insurance (or home insurance, or life insurance, or business insurance, or numerous other insurance markets that certainly seem to function quite well), perhaps you'd consider all the "club" memberships out there. The same "counterargument" seems to apply from a naive perspective for every business that derives most of its income from ongoing membership fees.
As you subsequently addressed, health insurance is a different animal in terms of both how it has been handled and gummed up by government involvement, as well as how it has been allowed to run itself into the ground through lack of regulation.
A lot of other types of insurance offer a more approximately static model for the insured. Any house can burn, and anyone can have a car accident, with relatively slight statistical variance. But a 60 year old is not twice as likely as a 20 year old to have a heart attack, or get cancer, it's closer to 50 or 100 times as likely (offhand guess)- and health insurance offers an array of statistical variances so wide, we can hardly expect a for-profit business not to seek an advantage by over-insuring the young, and discouraging the elderly from seeking care.
It comes down to some of the simplest of tactics, like allowing providers to send their hospital bills directly to patients in the mail so they will be frightened by the amounts being paid. Lend as much weight as you prefer to this anecdotal perspective, but following my father's last ride in an ambulance after an episode of insulin induced psychosis, the 6,000 dollar medical bill that arrived at our house embarrassed him, and he has subsequently refused ambulances despite having needed them. I don't have access to a stat on that if one exists, but it at least happened once.
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quote: You think car insurance functions perfectly well?
How many people here are happy with their car insurance?
I've got no reason to complain about mine...yet. Then again, the last time I needed it was 9, almost 10, years ago.
My only quibble was that my premiums were twice those of all my sisters and my parents, despite mine being the only perfect driving record in the family, and me being the only member of the family never to be in any accidents. I got maybe 200 bucks off for good grades in high school, but it was still a marked difference in rates, even after my older sister totaled a car, and I drove for 8 years with nothing more than a parking ticket.
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quote:as well as how it has been allowed to run itself into the ground through lack of regulation.
Lack of regulation doesn't make a free market. In any business, if companies are given significant advantages unrelated to their ability to provide services, this results in a perverse market.
And, of course, health insurance has constantly been one of the most regulated businesses in existence.
And if you've been paying attention to what I've said here and elsewhere, you'd know there's a fairly simple answer (several, actually, but I'll just list one I currently like) to the "differences in risk" assessment: have the government use simple criteria to divide the population into large groups. Any insurance company that insures more than N members of a group must insure anyone in the group.
(As an aside, your characterization is wrong. Such differences in risk exist in several of the markets listed. Some businesses are hundreds of times more likely to go out of business than others, for instance, and your assessment of the variance in car accident probabilities is incorrect, if one considers the same variables the car insurance industry does).
Senoj: I haven't had time to look through the bill yet, but I'll try to find some.
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quote:Originally posted by fugu13: Senoj: I haven't had time to look through the bill yet, but I'll try to find some.
Even if you only have a chance to look at the wikipedia entry I would be interested in your impressions. Or anyone else's, for that matter. To me it seems a much more rational approach than the bills being pushed by Democratic leadership. Or the Republican-favored bill (Coburn-Ryan Patient's Choice Act, which cribs liberally from Wyden's bill, but strips some of the most important (IMO) sections).
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It's definitely better than what we have now but I don't see anything about pre-existing conditions or portability.
I don't like the religious exemption. Mandating coverage is a tax and we don't grant religious exeptions for other taxes. I worry that we'll see a lot of young, healthy people discovering that they have a religious objection to healthcare which will end up making the program cost more for everyone else.*
*EDIT: Unless the opt-out is only for care, not for payment.
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Because the Act would shift the tax benefit from an employer to the employee, it would effectively solve the portability problem (with the caveat that because it is administered in state groups, moving from one state to another might result in policy change).
Also, according to Sen. Wyden's summary:
quote:Previous and existing health problems, occupation, genetic information, gender and age could no longer be used to determine eligibility or the price paid for insurance.
I don't have an issue with the religious exemption. I think it's unlikely that many people would use that as a loophole, but perhaps I'm hopelessly naive.
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quote: I love my car insurance. I think it is government run too- USAA. I know you have to be military or a military brat to get it.
short commercial....I had to use my USAA insurance recently...and it was first class service. They paid me the full retail price for my SUV quickly, with no change in my rate at all. Another great side benefit is when GEICO or anyone else calls and asks me who my insurance company is, I tell them USAA, and they say Thank You and hang up!!
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DarkKnight, when I first got insurance on turning 18, I figured I would probably go with USA. But I wanted to be responsible and do some price shopping. They often asked me who my current insurer was and when I said USAA, they said, why are you calling us?
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I guess ex post facto I'll just dump some interesting information in here even though it's no longer contesting anybody :/
quote:BETHESDA, MD – A comprehensive data set of all new chemical entities approved between 1982 and 2003 shows that Europe is pulling further ahead of the United States in pharmaceutical research productivity.
The study, "Global Drug Discovery: Europe Is Ahead," was published in Health Affairs.
While the U.S. share of approved new drugs did increase in between 1993 and 2003, as compared to the previous decade, that simply reflected the fact that the pharmaceutical industry poured more of its research dollars into American labs, said study author Donald Light, a professor of psychiatry at the University of Medicine and Dentistry of New Jersey.
Over both decades, the U.S. share of approved new drugs lagged behind its share of research funding.
On a dollar-for-dollar basis, Europe was more productive than the United States in discovering new drugs, and the European productivity advantage was greater in the period from 1993 to 2003 than it had been in the period from 1982 to 1992.
Japan outstripped both Europe and the United States in pharmaceutical research productivity over those 20 years.
quote:
"Congressional leaders and others concerned about high prices of new patented drugs will be heartened by this analysis, because lower European prices seem to be no deterrent to strong research productivity," Light wrote.
He cites previous research showing that pharmaceutical companies are able to recover research costs and make a "good profit" at European prices, and he rejects the notion that Europeans are "free-riding" on American pharmaceutical research investments.
Apparently, a government research institution can afford to put more money into pure research due to the fact that it is not constrained by the need for short-term profits nor is it competing for cash out of the budget against large-scale advertising.
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quote:Originally posted by fugu13: Except there are markets that objection appears to apply to that function perfectly well without being run by the government, such as car insurance.
If you don't have car insurance, in theory you can't drive. Car insurance is insurance for something you can choose to do. It's not as though you can be barred from living if you don't have health insurance. The cost of caring for the uninsured in the health care industry exists. The cost of repairing the cars of uninsured drivers only exists insofar as the uninsured drive, and non-car-insured people drive far less commonly than non-heath-insured people live.
Added: That is to say, car insurance may function well in the market of prospective drivers, but that doesn't inherently make it a good model for health insurance.
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quote:Originally posted by twinky: If you don't have car insurance, in theory you can't drive. Car insurance is insurance for something you can choose to do. It's not as though you can be barred from living if you don't have health insurance.
If you don't have car insurance, and you drive, in theory you should pay for any damage you cause. Similarly, if you don't have health insurance and you get sick you should, in theory, pay for your own medical costs.
In practice neither of those things happen because society absorbs the costs, particularly for those who would be financially devastated by facing the consequences of their misfortunes/bad decisions (automotive or health-wise). In the case of health care, both because of the relative size of the costs and because of the relative lack of control over getting sick, it makes sense for a fair society (particularly a wealthy one) to absorb more of those costs.
But I see the difference between the two as one of degree, not one of kind.
<edit>Rereading I see your point more clearly. You can chose not to drive. If you don't drive you will never find yourself in a situation where you are liable for an accident. No matter what, you might find yourself in a situation where you are responsible for a health-care situation. I retract most of what I said.
However, you are still able to exercise some degree of control. Making good health decisions doesn't eliminate the possibility of finding oneself liable for health-care costs, but it makes it much more unlikely. You can't get to zero (like with driving), but you can get closer. I think the tension between holding people responsible for their poor health decisions and recognizing that some illness is unavoidable is a worthwhile discussion to have, and one that has been notably absent from all the dialog I've seen in the current push. One of the reasons I like the Wyden-Bennett bill is because it preserves individual autonomy and responsibility to a much greater degree than do the other Democrat-sponsored bills.</edit>
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I'm not sure where I see an objection in there. All that means is that if someone can't afford health insurance without assistance, we should make sure they can afford it. A subsidy I have repeatedly come out in favor of. Where in what you said is anything that would make a private health insurance market not a reasonable (and even desirable) method of making sure people have access to care?
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Also, the comment about everyone needing health care applies quite well to numerous other things we don't expect the government to provide directly for everyone. Such as food and shelter.
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quote:Originally posted by fugu13: Also, the comment about everyone needing health care applies quite well to numerous other things we don't expect the government to provide directly for everyone. Such as food and shelter.
Those are very poor analogies for several reasons.
First off, while everyone needs food and shelter, no one need a 5000 sqft house or $30/lb filet mignon. In developed countries, the fraction of the food and housing market that goes to meet basic human needs is relatively small so the market forces of supply and demand can work reasonably well. The same is can not be said of health care. With very few exceptions, health care is not a luxury and the difference between expensive treatments and inexpensive treatments is not a matter of aesthetics. While many people choose to go without preventative health care, there are long term consequences to those choices that can have severe impact on the persons length and quality of life as well as the over all cost of health care for the community.
Second, as a community (through the government) we do have programs like food stamps, housing vouchers, homeless shelters, food kitchens to make sure that every person has their basic food and housing needs met. We don't expect that the community pay for those who want huge houses or gourmet meals, but we do pay to make sure everyone has access to the basics.
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quote:Originally posted by fugu13: Also, the comment about everyone needing health care applies quite well to numerous other things we don't expect the government to provide directly for everyone. Such as food and shelter.
Not really.
quote:The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?” For that matter, when you have to pay for your own health care, does your consumption really become more efficient?
heath care is very very different from food and shelter.
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There has been little substance in any of Obama's promises. He's going to give everyone healthcare, create green jobs for all, save the environment, end the war and bring peace and harmony to the world. He's still in campaign mode. He's had the most prime time conferences of any president in the same period and people are beginning to see through the empty promises. "Change you can believe in"....what does that mean? Anything you want it to. The problem is reality is sinking in accross the country and more and more people are losing "Hope" in his empty promises. We didn't elect an accomplished leader, we elected a community organizer. Community organizers almost always fail to improve their communities but are effective at rallying support for their own economic and political power. One only needs to look to South Side Chicago to see our president's accomplishments as a community organizer.
Maybe it'll help hone down your general statements a little. I mean, really?
quote:"...create green jobs for all, save the environment, end the war and bring peace and harmony to the world."
No wonder you don't like him so much. You seem to think he's promised to save the world single-handily.
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quote:Originally posted by fugu13: Also, the comment about everyone needing health care applies quite well to numerous other things we don't expect the government to provide directly for everyone. Such as food and shelter.
Those are very poor analogies for several reasons.
First off, while everyone needs food and shelter, no one need a 5000 sqft house or $30/lb filet mignon. In developed countries, the fraction of the food and housing market that goes to meet basic human needs is relatively small so the market forces of supply and demand can work reasonably well. The same is can not be said of health care. With very few exceptions, health care is not a luxury and the difference between expensive treatments and inexpensive treatments is not a matter of aesthetics. While many people choose to go without preventative health care, there are long term consequences to those choices that can have severe impact on the persons length and quality of life as well as the over all cost of health care for the community.
Second, as a community (through the government) we do have programs like food stamps, housing vouchers, homeless shelters, food kitchens to make sure that every person has their basic food and housing needs met. We don't expect that the community pay for those who want huge houses or gourmet meals, but we do pay to make sure everyone has access to the basics.
I agree with your first point. Your second point doesn't really go against the analogy, and, in any case, fugu has said he is for subsidies- my understanding is that stamps and vouchers are instances of such.
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If he didn't have to go through Congress to achieve those aims, I imagine he would have already done it all by now.
I only blame Obama for part of what I think should have been done by now and hasn't been. I blame another small part on Democrats not being able to get their act together. But mostly I blame obstructionist Republicans who are more concerned with political positioning than with the actual welfare of the nation.
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quote:Originally posted by fugu13: I'm not sure where I see an objection in there. All that means is that if someone can't afford health insurance without assistance, we should make sure they can afford it. A subsidy I have repeatedly come out in favor of. Where in what you said is anything that would make a private health insurance market not a reasonable (and even desirable) method of making sure people have access to care?
The fact that the market insurance model works for car insurance doesn't imply that it will work in other dissimilar markets. It doesn't imply that it won't work, but that's hardly an argument for doing it.
The best way to evaluate proposed health care reforms is to compare the effects of similar reforms on the health care systems of other countries, not to compare the proposed reforms to unrelated industries.
quote:Originally posted by SenojRetep: However, you are still able to exercise some degree of control. Making good health decisions doesn't eliminate the possibility of finding oneself liable for health-care costs, but it makes it much more unlikely. You can't get to zero (like with driving), but you can get closer. I think the tension between holding people responsible for their poor health decisions and recognizing that some illness is unavoidable is a worthwhile discussion to have, and one that has been notably absent from all the dialog I've seen in the current push. One of the reasons I like the Wyden-Bennett bill is because it preserves individual autonomy and responsibility to a much greater degree than do the other Democrat-sponsored bills.
I think having everyone covered is a precondition for holding that discussion. As it is now, the people least able to make responsible health choices are also the people most likely to be uninsured -- that is, the poor.
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Maybe it'll help hone down your general statements a little. I mean, really?
quote:"...create green jobs for all, save the environment, end the war and bring peace and harmony to the world."
No wonder you don't like him so much. You seem to think he's promised to save the world single-handily.
Very insightful. I didn't realize he made FIVE HUNDRED promises during his campaign...wow. What I find very insightful are the 40 the site indicates he has kept: No. 15: Create a foreclosure prevention fund for homeowners - He created the "fund" but is it getting to the people? Is this new government program working to stem forclosures? No. 33: Establish a credit card bill of rights -- like this on. No. 36: Expand loan programs for small businesses --- again, created another government program. How are small businesses doing, are they opening or closing up shop? No. 40: Extend and index the 2007 Alternative Minimum Tax patch - "If you reach a certain minimum income level, you have to pay this tax regardless of your deductions and exemptions." In other words, he raised taxes. No. 58: Expand eligibility for State Children's Health Insurance Fund (SCHIP) - yep you can make 80k a year and get govt healthcare for your kids. No. 76: Expand funding to train primary care providers and public health practitioners - ok, student loan program. No. 77: Increase funding to expand community based prevention programs - not suprising a community organizer would throw money at community organizations. I'm sure they're non-partisan like ACORN. No. 88: Sign the UN Convention on the Rights of Persons with Disabilities - ok, I'm sure disabled children in China will be safe now. No. 125: Direct military leaders to end war in Iraq - On "my first day in office, I would give the military a new mission: ending this war" BO - I'm quite sure the objective of any war is to end it by winning. We're still there, good thing he restated the end objective of war is to end the war. No. 134: Send two additional brigades to Afghanistan - Fitting, expand another war. No. 174: Give a speech at a major Islamic forum in the first 100 days of his administration - Did a lot of good. I can sure tell Iran likes us now but you can't blame a guy for trying...speeches are all he knows. No. 222: Grant Americans unrestricted rights to visit family and send money to Cuba - Lets help out our communist comrades to the south. No. 224: Restore funding for the Byrne Justice Assistance Grant (Byrne/JAG) program - Economic stimulus money for crime prevention programs. No. 225: Establish an Energy Partnership for the Americas - Ok, uh we have a free market but I'm sure we're going to convince Venezuala to stop drilling for oil and put up wind turbines. No. 239: Release presidential records - He reduced the timeframe for record releases of OUTGOING presidents. Gives him more ammo to continue blaming Bush. No. 241: Require new hires to sign a form affirming their hiring was not due to political affiliation or contributions. - Uh, ok, unless you're a white house Czar. No. 278: Remove more brush, small trees and vegetation that fuel wildfires - great idea, maybe California will stop burning if the environmentalists don't challenge in court...wait, they already have. Go delta smelt. No. 290: Push for enactment of Matthew Shepard Act, which expands hate crime law to include sexual orientation and other factors - If you commit a crime make sure it's against a white christian male or you'll get the book thrown at you. No. 307: Create a White House Office on Urban Policy - Community organizing the inner city from the white house. No. 327: Support increased funding for the NEA - Funny, the White house was in a conference call with the Non-partisan NEA recently calling on them to create art to push the president's policies. Wow, propoganda at work. Isn't that a tax exempt violation of law? http://www.washingtontimes.com/weblogs/watercooler/2009/aug/27/art-obamas-sake-nea-pushes-white-house-agenda/ No. 332: Add another Space Shuttle flight - One more flight before the shuttle is cancelled. I'm sure this will stimulate the economy. No. 334: Use the private sector to improve spaceflight - Wasteful programs like this should be private sector...the government should only run healthcare, autos, banks and energy. No. 345: Enhance earth mapping - Ok, whatever. No. 346: Appoint an assistant to the president for science and technology policy - Another Czar Holdren.. Great Guy http://www.foxnews.com/politics/2009/07/21/obamas-science-czar-considered-forced-abortions-sterilization-population-growth/ No. 356: Establish special crime programs for the New Orleans area - Throw more money at the epitome of Liberal power failures, maybe Detroit and South Side Chi Town will get some help...Blemish on the record of Democratic power. No. 359: Rebuild schools in New Orleans No. 371: Fund a major expansion of AmeriCorps - Brown Shirts No. 391: Appoint the nation's first Chief Technology Officer - Yeah, an IT Czar...didn't they consider this: http://www.computerworld.com/s/article/9137294/Bill_giving_Obama_power_to_shut_Web_takes_on_new_tone I know, from right wing Computer World magazine. No. 411: Work to overturn Ledbetter vs. Goodyear - I thought we had a separation of powers? The president is working to overturn the Supreme Court? Wow, what a great guy. No. 421: Appoint an American Indian policy adviser - Indian Czar, it's time to community organize the Native Americans. There has to be a few million votes there if we promise them gov't hand outs. No. 427: Ban lobbyist gifts to executive employees - But they can be hired by Obama. No. 452: Weatherize 1 million homes per year - (low income homes). I just replace my windows and upgraded my attic insulation, glad my tax dollars will pay for someone elses home improvements. No. 458: Invest in all types of alternative energy - Green Jobs...solar, wind and bio. No. 459: Enact tax credit for consumers for plug-in hybrid cars - Govt gives $7000 to help people buy cars they otherwise do not want. No. 480: Support high-speed rail - good idea No. 498: Provide grants to encourage energy-efficient building codes - "Give federal money to states that enact building codes the federal govt wants. Will create a competitive grant program to award those states and localities that take the first steps in implementing new building codes that prioritize energy efficiency, and provide a federal match for those states with leading-edge public benefits funds that support energy efficiency retrofits of existing buildings." States rights are undermined by federal dollars. I've seen this before....raise your drinking age and lower your speed limits or you'll lose federal funding for roads. No. 502: Get his daughters a puppy - The world is saved. He spent longer making this decision than any so far. No. 503: Appoint at least one Republican to the cabinet - Kinda reminds me of the statement, token black guy. No. 507: Extend unemployment insurance benefits and temporarily suspend taxes on these benefits - this has run out. No. 513: Reverse restrictions on stem cell research. - OK
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Before you think of replying with anything to any part of that, remember: you will be replying to Malanthrop, a man who strenuously resists correction or tact to an absurd degree.
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Getting back to subjects related to health care . . .
First, the reason I brought those particular other markets up was because of the assertion that a free market does not make much sense for health care for a particular reason -- a reason that applied to all of those markets. Come to think of it, I could also bring up the relatively free market for many kinds of health care that exists in Canada. The mentions of food and shelter were just asides.
However, some of the objections to them were not as substantial as they seem. There are many parts of health care that are more optional than is being suggested: for instance, the availability of personal trainers.
And yes, twinky, it would be good to compare this reform to existing ones. This reform would keep health insurance tied to employers, absent the small possibility a "public option" is included in the bill, that would still be intended to cover a relatively small percentage of people.
In contrast, a requirement that people obtain insurance meeting certain minimal conditions combined with subsidies for poorer people, elimination of pre-existing conditions clauses, elimination of the employer insurance subsidies, and mandatory all-group coverage when covering more than a minimal number of people would far more resemble the single payer systems in several other countries that deliver better results than the US currently does. Additionally, it would be likely to draw upon the efficiencies that we have strong evidence are created in any market with properly allocated rights, information availability, and low transaction costs.
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Please don't feed the troll. This has been a more or less interesting debate and I'd hate to see that change.
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To keep things focused, I'm just going to respond to one bit:
quote:Originally posted by fugu13: In contrast, a requirement that people obtain insurance meeting certain minimal conditions combined with subsidies for poorer people, elimination of pre-existing conditions clauses, elimination of the employer insurance subsidies, and mandatory all-group coverage when covering more than a minimal number of people would far more resemble the single payer systems in several other countries that deliver better results than the US currently does.
Has anyone actually objected to this type of reform in this thread?
Added: And when the crap did you pass my postcount? Posts: 10886 | Registered: Feb 2000
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Given that it involves private insurance companies doing all the insurance providing, I'm pretty sure all the people objecting to private insurance as a way of providing health care are objecting to that type of reform.
And it appears I passed your post count at least a year or two ago Posts: 15770 | Registered: Dec 2001
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I meant to say objected specifically to this proposal, rather than a blanket objection to a bill without a public option or a bill that isn't a wholesale move to single-payer/universal health care.
I certainly agree that your proposal would be far superior to your system as it currently stands, and it seems reasonable that a comparatively incremental approach to reform would have a better chance of success than a wholesale changeover (not that the current bills contain the latter).
I'm not convinced it would stop insurance companies from dumping high risk/high load members; these people would be dumped down (or held at) the minimum coverage level rather than being cut off completely. Depending on the minimum coverage level for catastrophic or chronic care, that might not make a very big dent in health-related bankruptcies unless the proportion of people who are currently dumped due to preexisting conditions (as opposed to some other excuse) makes up the lion's share of the dumping.
Posts: 10886 | Registered: Feb 2000
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Your objection can be dealt with in two ways: make the minimum required insurance level include most of the basic care options considered essential, and don't let companies price discriminate within groups. An insurance company can't kick a person down in coverage if they're required to cover the group the person is a part of at the same price for anyone who chooses to purchase.
Posts: 15770 | Registered: Dec 2001
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quote:There are many parts of health care that are more optional than is being suggested: for instance, the availability of personal trainers.
I've never even heard of a health insurance plan that covered personal trainers but that is beside the point. Optional is a loaded word. Setting a broken leg is "optional", even if it means being crippled for the rest of your life. Taking antibiotics for sepsis if optional, even if it means you die in a few days. What do you consider "optional medical care"? Are annual physicals "optional"? How about high blood pressure medication? mamograms?, anti-depressants?, well baby check ups?, immunizations? hip replacement surgery? pain killers?
Studies do in fact show that people use less health care if they have to pay for it. The problem is that it isn't luxury items they are going with out like personal trainers and cosmetic surgery. Those items make up only a miniscule fraction of health care costs. When people have to pay more for medical care, they cut back on preventative treatments that would in the long run save money system wide and result in better health outcomes. That is a large part of why the US pays twice as much as other developed countries for health care and yet has worse outcomes.
Consider for example emergency medicine. If someone is having a stroke or a heart attack, getting treatment fast is critical and can make an enormous impact on both the cost of treatment and the success of treatment. The fastest treatment comes if you call the paramedics and an ambulance. That's true even if a friend can drive you to the hospital in under a minute because ambulance patients get treated faster in emergency rooms than walk ins. But an ambulance ride costs thousands of dollars and you can't be certain it will make a difference so most people I know simply would not call 911 or an ambulance unless they had no other options.
Financial considerations do not lead people to make wiser user of medical care over the long run. Every study that has looked at it has found the same thing.
Posts: 12591 | Registered: Jan 2000
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"But the fact that some geniuses were laughed at does not imply that all who are laughed at are geniuses. They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown." - Carl Sagan
Posts: 3275 | Registered: May 2007
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That statement doesn't apply to me directly, it's obvious it applies to conservatives in general at this time, in our country.
Posts: 1495 | Registered: Mar 2009
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quote:Originally posted by fugu13: Your objection can be dealt with in two ways: make the minimum required insurance level include most of the basic care options considered essential, and don't let companies price discriminate within groups. An insurance company can't kick a person down in coverage if they're required to cover the group the person is a part of at the same price for anyone who chooses to purchase.
Given the system as it exists in the US now, if I lived there I imagine I'd consider that a satisfactory reform, if coupled with your original proposal.
Posts: 10886 | Registered: Feb 2000
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quote:Originally posted by The Rabbit: Financial considerations do not lead people to make wiser user of medical care over the long run. Every study that has looked at it has found the same thing.
^
Listen to this.
This is true. People get less-wise care, then they later incur absurd costs within a broken care system.
Posts: 15421 | Registered: Aug 2005
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quote: Has anyone actually objected to this type of reform in this thread?
Several people have stated they want single payer, which is not exactly saying they object to those ideas but single payer does make them irrelevant
Posts: 1918 | Registered: Mar 2005
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quote:Originally posted by fugu13: In contrast, a requirement that people obtain insurance meeting certain minimal conditions combined with subsidies for poorer people, elimination of pre-existing conditions clauses, elimination of the employer insurance subsidies, and mandatory all-group coverage when covering more than a minimal number of people would far more resemble the single payer systems in several other countries that deliver better results than the US currently does.
I actually would object to the elimination of the employer subsidies. You'd charge more to the people who were responsible and doing what they should have been all along. I'm all for the rest of it (again, without the conflict of interest of a government plan), but that part I find a bit insulting.
Posts: 2283 | Registered: Dec 2003
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The largest problems with our health care system are because of the employer subsidies. Because employer-subsidized health care is so much cheaper, other health care providers than the one available through your employer basically can't compete for your health care.
This means people have to switch jobs if they want to switch health care, and many people have health care plans that do not effectively meet their needs. This means that health insurance companies have very little incentive to meet the needs of insured people, and a lot of incentive to meet the needs of companies (which frequently don't line up).
Not removing subsidized employer health care is the largest factor influencing insurance companies to ignore the wishes of health consumers.
Also, it doesn't charge more to people who have been responsible in the least. If a company isn't paying a large chunk of health care dollars, those dollars go back into the compensation pot (almost certainly as salary).
Subsidies are tempting. They always sound like they're making things cheaper. But not only are they always taking money from someone else in order to make it cheaper for the subsidized person, they can restructure a market in a way that harms everyone, and they frequently do, something seen over and over again.
Posts: 15770 | Registered: Dec 2001
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