quote:The problem of people with no insurance is a very real problem--which is why I'm in support of high-deductible catastrophic care, made affordable to those who can't afford it.
The problem with high-deductible catastrophic care, is that it turns out to be penny wise and pound foolish. No matter how logical it sounds, making patients pay deductibles at all is one of the key reasons the US health care system is so much less cost effective than any other system. This has been shown by study after study. When people have to pay out of pocket for routine health care, the skimp where they shouldn't. And its pretty hard to blame that on the patients since that is precisely what deductibles are intended to make people do. That saves insurances companies in the short run and since in todays economy, people rarely keep the same insurance for more than a decade, the long term costs are most likely to get passed on to some other company.
But in the long run, it costs us all because people don't get diagnosed early when treatment is least expensive and most effective. Just think about something like high blood pressure. If people don't get regular check up, they aren't going to find out they have a blood pressure problem until it gets serious. That makes them far more likely to have a catastrophic very costly illness, like a stroke. Over the long run, regular physicals and high blood pressure drugs cost so much less than a stroke, a system that encourages people to skimp on routine care but covers major illnesses is going to end up costing more and being less effective.
I'm fed up with all the side issues and distractions. Big government vs small government, federal vs. local are all beside the point. I think what very nearly every American wants is high quality affordable health care, we only disagree about how to get that.
The plane fact is that the US market driven system is doing a worse job of that than any of the "socialized" approaches out there. And you know what, Canadian, Norwegians, Danes, Germans and the rest don't seem to be struggling under horrible oppression in exchange. Certainly not anything that is worth the 3-5 years of life we loose and 2-3 grand extra we each pay per capita annually for medical care.
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quote:Originally posted by The Rabbit: I'm fed up with all the side issues and distractions. Big government vs small government, federal vs. local are all beside the point. I think what very nearly every American wants is high quality affordable health care, we only disagree about how to get that.
The plane fact is that the US market driven system is doing a worse job of that than any of the "socialized" approaches out there. And you know what, Canadian, Norwegians, Danes, Germans and the rest don't seem to be struggling under horrible oppression in exchange. Certainly not anything that is worth the 3-5 years of life we loose and 2-3 grand extra we each pay per capita annually for medical care.
quote:Originally posted by TomDavidson: Neither. It's also worth noting that you sort of missed part of his point: that while the "country" of China may be over 3000 years old, its government is younger than our own. In fact, as he notes, the American government is older than almost all the other governments on Earth.
Also surprisingly incorrect the current Chinese government is the successor of one of two competing schools of Chinese philosphical political thought, Legalism as supposed by Mo Tzu and Han Fei Tzu or Confucianism via Confucius and his disciples with government switching between which one is predominant both of which predate American Parliamentary democracy and on a cultural political basis have outlasted it in total age, with the current and recent governments of China only currently different interpretations of long lasting schools of thought underlying basic principles of government, including Maoism as simply a reinterpretation of Moism (from Mo Tzu).
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I think I know where your line of argument is coming from, a more clear and basic line of reasoning being, "the CPP did not in fact bring a new form of government, but merely a change in the people at the top and among the village bureaucrats. Therefore, the current state of affairs is less a new form of government than merely just a new Chinese dynasty."
Personally, I am not unsympathetic to this view. However, rather than quibble, the more relevant question might be, what relationship does age of government have to do with an efficient or optimal health-care system?
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Blayne Bradley
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Because Malanthrope brought it up?
And yes that would be a good clarification of my argument.
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Mal jumps down many rabbit holes. It is not necessary for you to follow him. Especially when it appears that his main pattern is: bring up as many random anecdotes and tangents as possible to get a rise out of people and confuse the issue
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Blayne Bradley
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Well in theory yes, but I just read half way through 'The Chinese Machiavelli' and I wanted an excuse to show off.
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The only reason healthcare was passed is they realize this is their one and only chance. Even if it didn't pass, they would still be voted out of office in November. Pelosi understands that this is their one and only chance to control all branches of government. Even if they didn't pass healthcare, Pelosi, Reid and Obama know they will lose complete power in a few months. Liberalism is about feelings, not logic. They aren't representing the people, they have an agenda. Watch out for what else they will try to ram through prior to November. Cap and trade and amnesty are next. Elections are close in this country. Amnesty will create 20 million new voters. Of course, they'll vote for the party that legalized them.
The most dangerous enemy a man can face is the one who knows he's already dead. The Democrats know they are going to lose power in the fall. Watch out for what they will try to do in the meantime.
posted
I'm all for amnesty (and even more radical loosening of immigration restrictions. Free flow of labor is the way free markets are supposed to work, right?), and cap and trade (though I think some of the concessions in the current cap-and-trade proposal are no good. I'm all for straight up auctioning of credits). Of course, people want to ignore the real effects they have in the world (air pollution), even when their favorite tool (free markets) are being proposed to internalize the external costs.
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Current "liberalism" isn't classical liberalism. The American people have become keen to what liberalism means today. "Liberal" has become an epithet. That's why they are now calling themselves, "progressive". The polar opposite of a liberal is the libertarian...funny how they share the same root word. Liberals were once libertarian. The people didn't change, they redefined the word. In the 1930's, the American people realized Progressives were socialists and that word fell out of favor. ACORN is going bankrupt....they'll change their name. ACORN can't receive federal dollars so the same people will form a new tax free organization with the same agenda under a new name.
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That was nowhere near an answer. You don't know what liberalism is. You don't know what "classical liberalism" is (terrible characterization, by the way) and you don't know what it is today.
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quote: The plane fact is that the US market driven system is doing a worse job of that than any of the "socialized" approaches out there.
We do not have a 'market' driven system as the markets as designed differently in each state and health insurance companies are not allowed to compete across state lines. The 'market' is whatever the state politicians decide they want it to be and is not driven by what the end consumers want. You cannot call it a market driven system if the government is the one calling the shots.
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quote:We do not have a 'market' driven system as the markets as designed differently in each state and health insurance companies are not allowed to compete across state lines. The 'market' is whatever the state politicians decide they want it to be and is not driven by what the end consumers want.
But any way you look at it, the US system is much more market driven than any other system in the world, and its both more expensive and less effective.
You can hypothesize that if the US health care market were truly a free market, it would be even better than the "socialized" systems. But since no true free markets for health care exist anywhere in the world, that is pure conjecture. We could try the experiment and see how it turns out, but that is an extremely risky proposition since 1. failure would mean lots of human suffering, 2. we have proven alternatives and 3. all the preliminary data suggests that the freer the market the worse it is for providing efficient effective health care.
Give me one reason that we should try a true free market health care system rather than the alternatives that have proven efficient and effective around the world. What would make that worth gambling human lives?
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quote: But any way you look at it, the US system is much more market driven than any other system in the world, and its both more expensive and less effective.
I don't know how all of the rest of the world's health systems work, but we are not using any market forces at all. The governments, federal and state, make certain mandates and restrictions and those laws and regulations are what 'runs' health care. We do spend more than other countries and as I have pointed out many times, with links, the reason is because we choose to do more testing and overtreatment than other countries do.
quote: Give me one reason that we should try a true free market health care system rather than the alternatives that have proven efficient and effective around the world.
Allowing health insurance companies to compete across state lines, like virtually every other business can, will lower costs and provide much better choices.
quote: What would make that worth gambling human lives?
Giving the government more control than they have already seems much riskier than allowing people to choose the health care insurer that they feel is best for them. How would allowing companies to compete across state lines be so risky?
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quote: But any way you look at it, the US system is much more market driven than any other system in the world, and its both more expensive and less effective.
I don't know how all of the rest of the world's health systems work, but we are not using any market forces at all.
...
Look at what you just wrote VERY CAREFULLY and then confirm for us that you actually believe this.
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If market forces aren't at all in play, why do health insurance companies and hospitals advertise?
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quote: Look at what you just wrote VERY CAREFULLY and then confirm for us that you actually believe this.
quote:If market forces aren't at all in play, why do health insurance companies and hospitals advertise?
I see what you are saying. I wrote that quickly. How about this....The government (federal and state) has created 50 different markets, and in each market the government decides the services to be marketed. The health care 'market' is vastly different than say the car insurance market. Health care is controlled by politics and interest groups, and the end user has little input. The government (federal and state) has created a mess and now they want more control over it. Why not remove them from your health insurance and allow people to buy the health insurance they want instead of what politicians and special interest groups think they need? I am not saying zero regulation as I know that is the next straw you will reach for. The question remains...Why is competition across state lines such a bad thing?
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quote: Why not remove them from your health insurance and allow people to buy the health insurance they want instead of what politicians and special interest groups think they need? I am not saying zero regulation as I know that is the next straw you will reach for.
This is why people are responding to your point with some befuddlement. You are against regulation, and in favor of an unregulated market. Fine- wrongheaded in my opinion, but fine. But you are in favor of *some* regulation. Well I think the internal flaw in your position is that you show no faith in the government to regulate only when necessary, and yet you admit that some regulation *is* necessary. Essentially this is the Republican credo that government doesn't work, full stop, but that it is necessary to some extent. Well, then, where exactly are we? Because we have a system that is loosely based on the idea that the markets should drive themselves, but that *some* government regulation is necessary. But you yourself admit that government is *not* good at deciding how much that necessary amount really is, and in fact I think the present state of affairs bears that out, whether you believe the government does too much or not enough, it clearly isn't doing much that has been very effective thus far.
So you want to dial back a failing strategy to a more tolerable level, but with the same built in flaw, while at the same time ignoring the measurable and real successes of systems where the opposite approach has been taken. You can plead ignorance about them, and you have, but they are still there, and they are still relevant to the discussion whether you have anything to say about them or not. There is no test case for the other approach- there is no working system, certainly none in the developed world, that relies on *less* regulation than the United States has now- not to mention less effective regulation, which is the key point here.
But right now where you are is basically a weak admission that the current system isn't working, and a proposal that we sort of make it work a little better- despite the looming presence of hundreds of millions of dollars in the political spectrum that has been keeping it the way it is, or making it worse, for 30 years. That's the thing I think your side of the argument chooses to ignore, and which is the death blow to it. The government taking a hands off, "sensible" approach to regulation is right out. And that's because a market driven system bleeds money and corruption. You want to attract sharks- put blood in the water, and see who gets elected. It won't be people into "sensible" regulation, it will be people into making lots of money and getting re-elected, and then getting "consultancy" jobs after their terms. But if we regulate more heavily and more actively, the built in incentive for washington to become an arm of the corporate interests is diminished. You think the Republicans are fighting this so hard because they believe it won't work? If they believed it wouldn't work, they'd let the dems do it. They don't seem to care whether whatever happens bankrupts us or not. They've been bought.
quote:. The government (federal and state) has created a mess and now they want more control over it. Why not remove them from your health insurance and allow people to buy the health insurance they want instead of what politicians and special interest groups think they need?
Because, as has been exhaustively detailed over the course of this and other threads, it is the actuarial non-social models and the lack of regulation pertaining to these affairs that ensure that the system remains inefficient, neglectful, and prone to poor sustainability through sustained double-digit inflation.
quote:I am not saying zero regulation as I know that is the next straw you will reach for. The question remains...Why is competition across state lines such a bad thing?
For the same reason why 'competition across state lines' was such a terrible, terrible idea for industries like credit card companies. With something like health insurance, you effectively allow the weakest chain to dictate levels of corporate maneuverability around the rights of ALL states. In the case of credit cards, the major ones literally all moved to the state with the most nonexistent usury regulation, allowing them to reap the most exploitable circumstance and apply it to their actions in the rest of the 49 states.
In addition, if some states take it upon themselves to apply decent regulation and others remain malfunctioning cesspits of broken healthcare (see: south dakota, etc) then that creates longitudinal issues where you have geriatric exodus to the states that are in any way decent at maintaining a health support net. Were they hypothetically to be strained to the point of needing additional revenue just to keep it functional, people would point to it and make wildly disproportionate claims about how the system obviously 'doesn't work' as they would do in all of the states that only manage to pass middling and promptly defunded institutions of health care support.
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quote:Originally posted by malanthrop: The only reason healthcare was passed is they realize this is their one and only chance. Even if it didn't pass, they would still be voted out of office in November. Pelosi understands that this is their one and only chance to control all branches of government. Even if they didn't pass healthcare, Pelosi, Reid and Obama know they will lose complete power in a few months. Liberalism is about feelings, not logic. They aren't representing the people, they have an agenda. Watch out for what else they will try to ram through prior to November. Cap and trade and amnesty are next. Elections are close in this country. Amnesty will create 20 million new voters. Of course, they'll vote for the party that legalized them.
The most dangerous enemy a man can face is the one who knows he's already dead. The Democrats know they are going to lose power in the fall. Watch out for what they will try to do in the meantime.
From your lips to God's ears.
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quote:I don't know how all of the rest of the world's health systems work, but we are not using any market forces at all.
This is simply not true. For example, market forces are at work when insurance companies compete for contracts with large employers or individuals search for a plan. They are at work when companies offer employees different packages with different benefits and prices. They are at work every time a patient makes a copay for a service. In fact, the justification given for copays, deductibles and the employee contribution to premiums is a 100% market based.
As kate said earlier, if there were no market forces at work, why would hospitals and pharmaceutical companies advertise?
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quote:Originally posted by Orincoro: [QUOTE] You think the Republicans are fighting this so hard because they believe it won't work? If they believed it wouldn't work, they'd let the dems do it. They don't seem to care whether whatever happens bankrupts us or not. They've been bought.
Ok thats fine. If republicans eventually gain control of the house/senate and pass tort reform and dems fight it, would you still stick by the accusation you have made above?
You could argue the Dems have been bought by lawyers and unions just as easily.
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quote: You are against regulation, and in favor of an unregulated market.
I am against the regulations that greedy self serving politicians have currently, or before this current bill, set in place. I am not in favor of a totally unregulated free for all.
quote: But you are in favor of *some* regulation. Well I think the internal flaw in your position is that you show no faith in the government to regulate only when necessary, and yet you admit that some regulation *is* necessary.
Your first lines are contradictary. The government (federal and state) has gotten out of control with 'mandates' for this and that when most of it is not necessary. We are trying to reform health insurance so why shouldn't we try to reform these mandates? Government doesn't change easily and this new bill doesn't address some of the major problems we are having with health insurance.
quote: Essentially this is the Republican credo that government doesn't work, full stop, but that it is necessary to some extent.
Was your opinion of the effectiveness of government the same when Bush was in office? I am not speaking for all Republicans but by and large, politicians attempt to spend as much as they can because that is how they can show their voters that they are working for them. They place all kinds of mandates on health insurance carriers so they can show the people how they are protecting them.
quote: Well, then, where exactly are we? Because we have a system that is loosely based on the idea that the markets should drive themselves, but that *some* government regulation is necessary.
Your initial assumptions are flawed. We do not have 'a' system. We have 50 different systems. The health care insurance I have now cannot be sold in any other state except this one. It's misleading to say there is *some* government regulation. The government dictates and mandates what will be sold in their state. People with health insurance must pay for all those mandates no matter if they will ever use them or not. For example, in my state, chiropracters are mandated to be included in every health insurance policy. I will never use a chiropracter so why I am being forced to have it covered? Many states mandate that nurse midwives be covered. If someone never wanted children, why is that coverage forced upon them?
quote: But you yourself admit that government is *not* good at deciding how much that necessary amount really is, and in fact I think the present state of affairs bears that out, whether you believe the government does too much or not enough, it clearly isn't doing much that has been very effective thus far.
So if you agree that the government is doing a poor job so far, why would you want to give the government 100% control over health care?
quote: So you want to dial back a failing strategy to a more tolerable level, but with the same built in flaw, while at the same time ignoring the measurable and real successes of systems where the opposite approach has been taken.
I don't understand your position of wanting the government to take over when you agree that the current system, run by rules, regulations and mandates from the government (federal and state), is not effective.
quote: But right now where you are is basically a weak admission that the current system isn't working
Where I am is a strong admission that the current system isn't working.
quote: and a proposal that we sort of make it work a little better- despite the looming presence of hundreds of millions of dollars in the political spectrum that has been keeping it the way it is, or making it worse, for 30 years.
The proposed system will make it work much much worse.
quote: That's the thing I think your side of the argument chooses to ignore, and which is the death blow to it
Your side is embracing the painful expensive demise of the health care system that your side helped set up. Remember when HMO's were the answer? (Thanks, Ted Kennedy). Your side is taking a bad system and making it much much worse by terrible legislation.
quote: The government taking a hands off, "sensible" approach to regulation is right out. And that's because a market driven system bleeds money and corruption. You want to attract sharks- put blood in the water, and see who gets elected. It won't be people into "sensible" regulation, it will be people into making lots of money and getting re-elected, and then getting "consultancy" jobs after their terms. But if we regulate more heavily and more actively, the built in incentive for washington to become an arm of the corporate interests is diminished.
Why would washington need to become an arm of corporate interest when washington will be in total control of those same corporate interests? The power would totally transfer to the people who you are admitting cannot be trusted with that power. Corruption would skyrocket even faster as the same politicians who created the mess are now given total control over the mess. The 'end user' will cease to have any input into their own health care needs.
quote: You think the Republicans are fighting this so hard because they believe it won't work? If they believed it wouldn't work, they'd let the dems do it. They don't seem to care whether whatever happens bankrupts us or not. They've been bought.
Just like the Democrats allowed Bush to pass every single item he wanted, and never voiced an opposition? Your assertion makes no sense whatsoever especially when Reid inserts items that cannot be repealed. If my congressperson said "I'm not going to fight against bad legislation" I would never ever vote for them again. That is why they are in Washington. And honestly....you really want to go down the road of Republicans being bought? Democrats are owned every bit as much as Republicans. It would be a grand delusion to think otherwise.
quote: Because, as has been exhaustively detailed over the course of this and other threads, it is the actuarial non-social models and the lack of regulation pertaining to these affairs that ensure that the system remains inefficient, neglectful, and prone to poor sustainability through sustained double-digit inflation.
I do not want the current system. Although you might want to check out denial rates of Medicare vs private companies, how the actuarial non-social models are tablulated. Live birth rates and how the numbers were calculated were discussed, as well as not accounting for the diversity of the population. Take Norway for example, there are almost as many Norweigan Americans as there are Norweigans. What is Norway's non-white population? Is ethnicity irrelevant when determining life expectancy? Is Norway's culture and lifestyle different than America's? Do lifestyle choices have an impact on life expectancy?
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posted
Regarding your issues with Norway, it is not just Norway that has the improved life expectancies. You are looking at over 30 different countries, with different cultures and populations and life styles that all have better life expectancies. This has already been pointed out, looking at examples like Australia and diabetes in this thread.
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quote:Your side is taking a bad system and making it much much worse by terrible legislation.
yeah, you haven't exactly made a credible case so far as of yet that bypasses all of the hefty substantiation we provided for why the current system is not an improvement on the status quo, though you seem to have tacitly dropped the argument over whether or not the US was at the bottom of the list for the quality of healthcare when it comes to developed nations.
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quote: "Essentially this is the Republican credo that government doesn't work, full stop, but that it is necessary to some extent."
Was your opinion of the effectiveness of government the same when Bush was in office? I am not speaking for all Republicans but by and large, politicians attempt to spend as much as they can because that is how they can show their voters that they are working for them. They place all kinds of mandates on health insurance carriers so they can show the people how they are protecting them.
My opinion of the effectiveness of *Bush's* government was somewhat independent from my opinion of the effectiveness of government overall. I found Bush's particular brand of governance all the harder to swallow in that it came from someone claiming not to be in favor of the kind of spending he was doing- that and I thought the particular ways he spent money were bat**** stupid.
quote: Your initial assumptions are flawed. We do not have 'a' system. We have 50 different systems. The health care insurance I have now cannot be sold in any other state except this one.
Please afford me the charity I have shown you in trying to actually read what you have to say. I do not believe we have "one unified system." I was characterizing the overall state of health care in our country and calling that a "system." I was not assuming it actually was a system in every specific sense of the word. This is an ongoing problem for you, and I think it's not my fault.
quote: So if you agree that the government is doing a poor job so far, why would you want to give the government 100% control over health care?
Yeah, pretty much. Maybe not 100%. I would still like many facets of our health care system (read above for my use of: "system"), such as elective medical care, to be governed more by market forces. However I am of the opinion that control of the health care system by the government places ultimate control of the system in the hands of the voters. I think that's a sight better than where that control currently lies. The government does a passably good job of controlling other aspects of our nation, and where it doesn't I am heartened by our ability, through democracy, to effect change.
quote: I don't understand your position of wanting the government to take over when you agree that the current system, run by rules, regulations and mandates from the government (federal and state), is not effective.
Well that's easy. As has been said ad infinitum in this thread an elsewhere, I think managing a health care system (read above for my use of "system" once again), through ad hoc regulation of a nominally capital market is ineffective. I think social medicine systems around the world show us how a government can do things better. Honestly, do you look at every failed action of the government and dismiss the idea of increasing the government's involvement because their mere involvement thus far proves their lack of potential to be effective? They have been involved in an ineffective way. I want them involved in an effective way. I think that it is possible.
quote: Your side is embracing the painful expensive demise of the health care system that your side helped set up. Remember when HMO's were the answer? (Thanks, Ted Kennedy). Your side is taking a bad system and making it much much worse by terrible legislation.
Now I think we're getting somewhere. You're right. This bill isn't good enough, not by a long shot. The system "we" (and it long before I could ever vote), helped set up sucks ass. Times change. A black man is President. I am with you- we need to go a lot further, and it's a shame the conservatives can't see past their own noses on this one, or are too busy pointing out the wrongs of sadly deceased people who legislated in a different era, when the economy was not in crisis due in significant part to the health care system's failings.
quote: Just like the Democrats allowed Bush to pass every single item he wanted, and never voiced an opposition?
No, that isn't how things were, nor how they should have been. But then, the democrats never formed an unbreakable coalition against new legislation in a time of national crisis, for the sole purpose of wrecking Bush's reputation. Not that I don't think they didn't want to. It's just that democrats like to think for themselves, so it makes doing such a thing a lot harder for us.
quote: Democrats are owned every bit as much as Republicans.
No, I don't think so. I think your clambering for the false equivalency, which is pushed hard by the republicans, admits a defeat you aren't ready to face here. Not all sides of this debate are equally wrong, and not all political parties are equally corrupt, morally or ethically, or intellectually, or otherwise. The republicans, today, are far worse. That is my opinion, and it is not a crazy one nor delusional, nor do I put such stock in it that I will be as offended by your rebuke as you will probably be by mine.
I do not think you are delusional or stupid, or lying. I think you are misinformed, and wrong. I think your hysterics are a disproportionate, but understandable, reaction to the situation you have been placed in, and I find that unfortunate. I find so much about your camp to be unfortunate, I can't even tell you.
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Ever since Bush became a public disappointment I have seen a dramatic uptick in equivalence arguments. The over/under of the likelihood of "Democrats are just as bad" appearing in these sorts of discussions is .. well.
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quote:Your initial assumptions are flawed. We do not have 'a' system. We have 50 different systems. The health care insurance I have now cannot be sold in any other state except this one.
Assuming you could buy insurance across state lines, what makes you believe insurance companies would opt out of their business model of picking cherries and dropping lemons?
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posted
They would still do their best to play that game. However, the larger the market, the less is a company's ability to do so. There are costs of reputation as well as gains of money in dropping people; and reputation is an insurance company's stock in trade. When there are more companies in a single market, then a customer's cost of switching is less; consequently they lose more customers per unit reputation lost. Therefore it becomes more costly to drop people, and they will not drop as many.
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KOM: But insurance companies simply have packages for each state, and I would surprised if the differences were really that large. If anything I would expect them to be even more tailor made to do what I described in my previous post.
And I can't believe I'm using any information from Bill O'Reilly. But here is a pretty telling map of the market.
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posted
So, just for clarification, what is the sum of arguments as to why health care cannot reasonably be turned into a competitive market? Going through ~500 posts with arguments embedded in internet yelling isn't making this very clear - could someone please neatly explain this?
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Blayne Bradley
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posted
Do you consider misinformation and "Because I think so" an argument?
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quote: The republicans, today, are far worse. That is my opinion, and it is not a crazy one nor delusional, nor do I put such stock in it that I will be as offended by your rebuke as you will probably be by mine.
You are entitled to your opinion.
quote: I think your hysterics are a disproportionate, but understandable, reaction to the situation you have been placed in, and I find that unfortunate. I find so much about your camp to be unfortunate, I can't even tell you.
I wasn't being hysterical but thank you for pitying the unfortunate people who disagree with your point of view.
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I think that the big reason why capitalism and health care don't mix well is the nature of preventative medicine. If you have to pay for your own treatment, you put it off until it is serious. Tied to that, because of the actuarial model, you don't really want to find out what could be wrong with you, because then you will be denied coverage. I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
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posted
Healthcare is the only market where any random individual could end up requiring services that cost a large multiple of their annual salary. Even with housing, there is a ability to market to every income level, so that someone making very little can rent out a one-room studio while someone who is wealthy may buy a large estate.
With healthcare, the large estate may be the only option regardless of the income level of the customer. There's no studio apartment version of open heart surgery or chemotherapy. I think this makes healthcare an inherently market-unfriendly enterprise. The invisible hand just can't function with so many disparate interests, varying income levels, and the rigid care requirements presented by many medical conditions.
I think the closest we can get to a real market-based healthcare system is some form of what we're doing now - a mandate to purchase insurance coupled with a requirement to not reject any customers for purposes other than non-payment. I don't think we're provided the best implementation of this approach, and I think a single-payer system would be preferable, but it's a vast improvement from the status quo and it provides a foundation from which we can drive improvements.
Posts: 3275 | Registered: May 2007
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quote:I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
Mine does. Annual checkups, teeth cleanings, routine lab work is all free to me, not even a copay. Maintenance pills, including birth control, is cheap - I pay $10 for a four-month supply. They track my health for me, allow me to track all my appointments and prescriptions online, and they harass me into getting a well being check up once year. There is a small subsidy for gym memberships and discounts on reputable diet plans.
There is a higher charge for emergency services and for other things, but as far as supporting preventative things to make me a cheaper patient for them in the long run, I think Kaiser does a pretty good job.
Posts: 26077 | Registered: Mar 2000
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quote: I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
My plan provides for a free, no copay, yearly physical.
Posts: 1918 | Registered: Mar 2005
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posted
A single annual physical isn't particularly ground-breaking. My own insurance -- which I think is fairly proactive when it comes to preventative care -- is more along Kat's model.
Posts: 37449 | Registered: May 1999
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quote: I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
My plan provides for a free, no copay, yearly physical.
my plan doesn't. And I know plenty of people in the same boat as me.
Anecdotal evidence to the rescue!
Posts: 8741 | Registered: Apr 2001
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posted
My insurance doesn't AFAIK, but I recently changed insurance. Old ones never did. For my yearly exam, which I needed for birth control, I would have had to pay the full charge- I am healthy an never actually met my deductible. Since I didn't have a couple hundred bucks, I just went to a local essentially free clinic (charged $29 for outside lab expenses).
Posts: 2223 | Registered: Mar 2008
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quote:Originally posted by DarkKnight: I wasn't being hysterical but thank you for pitying the unfortunate people who disagree with your point of view.
No, I don't pity you, especially. You're ignorant because you want to be, which is despicable, and laughable considering what you are actually trying to argue (because you've gotta love an answer to a basic question about European systems being: "I don't know anything about them, but listen to what I have to say about why they won't work"). Your fault, completely. Still unfortunate though.
Posts: 9912 | Registered: Nov 2005
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posted
Why Free Markets won't work with Health System:
1) Supply and Demand. This is the basic of all Free Market ideals. However, when my wife or child are ill my demand for health care is infinite. As anyone who plays with math knows, dealing with infinite numbers messes up everything.
2) It is less expensive to deal with small things than large. Yet most small things can be ignored. So when I get a cough I don't spend my money going to the doctor--but if it leads to pneumonia, that gets expensive.
3) The majority of health insurance is paid for in whole or in majority not by the consumer, but by their employer. This means that the insurance company does not need to satisfy the needs of the individual consumer, but the needs of the human resource department of that person's employer. Cutting costs by denying coverage or limiting health options allows a lower cost to the employer, which looks good on the Human Resource people's efficiency report. If they can do a two tier system where upper management gets prime care and the rest get semi-adequate care--that is the best savings for the employer and the best option for the insurance company.
4) The provider of the services in question do not need to please their patients as much as they need to please the insurance companies who are paying them. This dissonance of who is the priority is not appreciated by the service providers, or the service consumers.
5) Companies provide health care for two reasons. Originally to cover work related injuries and keep their employees healthy enough to continue working. More recently its been as a employment motivator and perk. Work for us and get this great insurance.
However, the cost of insurance is increasing faster than the profits of almost all companies. This means they must spend more and more of their budget on this perk.
To slow this down they are forced to provide less and less services--adding co-pays and deductibles that actually create a lowering of their employees spendable income.
This demoralizes and dis-insents the workers. The companies are spending more money to create the opposite outcome than the one they desire.
Posts: 1941 | Registered: Feb 2003
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quote:I imagine it is possible for a health insurance company to come up with plans that would favor preventative medicine, but right now, most plans do not.
Mine does. Annual checkups, teeth cleanings, routine lab work is all free to me, not even a copay. Maintenance pills, including birth control, is cheap - I pay $10 for a four-month supply. They track my health for me, allow me to track all my appointments and prescriptions online, and they harass me into getting a well being check up once year. There is a small subsidy for gym memberships and discounts on reputable diet plans.
There is a higher charge for emergency services and for other things, but as far as supporting preventative things to make me a cheaper patient for them in the long run, I think Kaiser does a pretty good job.
Kaiser is what I have as well, as they started in and are based in California. In many ways I think they are the future of American medicine, but comparing them to most health insurance is comparing apples to rutabagas -- they're not remotely comparable. Kaiser pays their doctors a salary, not a per-service charge. They own the labs, radiology departments, etc. -- they're not contracting with outside agencies (with few exceptions). In those cases (like emergencies) that Kaiser is paying outside people, they are a huge PITA.
That said, I think the Kaiser model is a good one, and I'm glad it is growing.
Posts: 32919 | Registered: Mar 2003
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quote:Originally posted by Darth_Mauve: 2) It is less expensive to deal with small things than large. Yet most small things can be ignored. So when I get a cough I don't spend my money going to the doctor--but if it leads to pneumonia, that gets expensive.
I think my issue with this one is that most of the time, an otherwise healthy adult is just going to have the cough. If they take it easy and eat right, it's going to go away never having been more than a cough. So why send everyone to the doctor with a cough if most of them just need to lie down and eat some soup? So that tiny percentage doesn't get pneumonia? Let's just send the folks with risk factors for pneumonia to the doctor with a cough.
The rest of your points are pretty valid, though I would balance the HR part against the benefit of having someone who gets paid to weed through insurance co. fine print all day figure out what the best value is on a plan doing it for me. Plus, we'll never be able to match individually the collective bargaining power of a large employer negotiating price. Even though I want to see at least one layer of government run care available to everyone, I still see a place for a good employer-provided option in the future.
Posts: 2283 | Registered: Dec 2003
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quote:Kaiser is what I have as well, as they started in and are based in California. In many ways I think they are the future of American medicine, but comparing them to most health insurance is comparing apples to rutabagas -- they're not remotely comparable. Kaiser pays their doctors a salary, not a per-service charge. They own the labs, radiology departments, etc. -- they're not contracting with outside agencies (with few exceptions). In those cases (like emergencies) that Kaiser is paying outside people, they are a huge PITA.
That said, I think the Kaiser model is a good one, and I'm glad it is growing.
The Kaiser system is an excellent model. We were using them as the standard for care back in the late 70s when I was a debater. They are the exception to what I said about insurance companies looking only at minimizing short term costs. Not only do they cover preventative care, they have done a lot of research to determine what types of preventative have the biggest pay off and they do an excellent job of eliminating unnecessary and over treatment.
Unfortunately, Kaiser doesn't get the full pay back for their preventative approach because people change jobs and health coverage too often. Its also unfortunate that few if any of the HMOs that are supposedly modeled after Kaiser actually function nearly as well. I suspect thats because they overlook some critical aspect of the Kaiser system, but I won't speculate about what that aspect might be.
Posts: 12591 | Registered: Jan 2000
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posted
I actually would consider a universal health care system. But this clunky behemoth that actually raises costs while not addressing some of the most pertinent problems? I'm not sure.
Posts: 241 | Registered: Nov 2009
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