quote:Originally posted by fugu13: Requiring coverage is the least part of what one might argue prevents there from being a free market in that arrangement.
It's really not a 'free market' arrangement. I should quote wikipedia: a free market is a market in which there is no economic intervention and regulation by the state, except to enforce private contracts and the ownership of property. This becoming a new revisionistic definition of a 'free market solution' would give most libertarians hives.
Iit's blatantly redefining 'free market' at convenience, for the sake of language framing it for appeal. Not that this doesn't tend to work, of course ('fair tax,' anyone?), but ..
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I would venture that it would naturally lead to single payer in the U.S., and as a stepping stone it's an excellent idea for a managed proposal for initially universal coverage.
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quote:It's really not a 'free market' arrangement. I should quote wikipedia: a free market is a market in which there is no economic intervention and regulation by the state, except to enforce private contracts and the ownership of property. This becoming a new revisionistic definition of a 'free market solution' would give most libertarians hives.
Iit's blatantly redefining 'free market' at convenience, for the sake of language framing it for appeal. Not that this doesn't tend to work, of course ('fair tax,' anyone?), but ..
I didn't say it was purely a free market solution. By the definition given on Wikipedia, there is no free market in anything in the United States (or any other place on earth). (Not that Wikipedia's definition is especially good, since it misses several things that have been important in what free markets mean as they are discussed in the literature that defines them.) Since that makes it a quite useless definition for the purposes of analyzing actual systems that exist, another definition is needed if one actually wants to discuss the free markets (aware that this is a fuzzy and relative distinction) and the non-free markets that really do abound in the real world.
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Requiring coverage is one thing. A bill that "requires" coverage but the fines to the employers that don't offer it are less than the current cost of healthcare to the employer while the bill skyrockets the costs of healthcare....
Roadmap to single payer. Structure is in place. Foot in the door politics. The Obama healthcare bill didn't institute single payer. It killed private healthcare...intentionally. The American people don't want single payer but they do want "reform". Obama will destroy the current system to get single payer down the road. "Stimulus" money went to government employment. This administration were good students of Alinsky. It's easier to destroy the current system than it is to pass single payer. Once the private system is destroyed,....we'll have no choice. Only the government will be left standing.
If you want to put Americans to work, slash taxes. On one hand they call the expiration of the Bush tax cuts a "tax reduction" for the wealthy if renewed. Is denying an increase a reduction? Liberals operate on the assumption that the people's money belongs to the government first. Not increasing taxes is somehow a "tax break". Tax "credits" to people that pay no taxes aren't called an expense. Who's paying the child tax credit to the welfare mother who lives in government housing and feeds her kids on food stamps? That check is a "tax break".....really?
quote:Originally posted by fugu13: I didn't say it was purely a free market solution. By the definition given on Wikipedia, there is no free market in anything in the United States (or any other place on earth).
Welcome to the ideal that is the free market. "Free market solutions," by definition, don't include a taxed, required government involvement. They involve the absence of that. That's it.
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quote:Originally posted by malanthrop: The Obama healthcare bill didn't institute single payer. It killed private healthcare...intentionally. The American people don't want single payer but they do want "reform"
"Killed private healthcare" is the most asinine apprehension of the healthcare reform bill I have yet heard.
Oh god, private healthcare is dead! Yet I still go to the same hospitals and still somehow magically get health coverage from Cigna.
Shut up or quit being clueless.
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quote: "Killed private healthcare" is the most asinine apprehension of the healthcare reform bill I have yet heard.
This version of health care reform will, over the next few years, dramatically change private health care in many intended, and unintended, ways.
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Usually the unintended effects of an action are not included in the term 'reform'. Of course it's possible to argue that the unintended effects will be good; but generally speaking, when you tinker with a complex system there are many more ways of screwing it up than there are of improving it.
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quote:Originally posted by King of Men: Usually the unintended effects of an action are not included in the term 'reform'.
I'm not sure I can agree with that. I think that reform always has to lead to unintended consequences, it is pretty much a law (as in The Law of Unintended Consequences). Consequently, if you don't want any unintended consequences then it means you don't want any reform.
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quote:Welcome to the ideal that is the free market. "Free market solutions," by definition, don't include a taxed, required government involvement. They involve the absence of that. That's it.
Welcome to what people who don't think about it think the free market is. While I am not saying my proposed system is entirely free market, it is far more grounded in the realities of how free markets have been discussed by the great thinkers of that scholarship. For instance, the description you just gave obviates things like "courts" and "police", both of which are absolutely essential to a functioning free market of any size. Ultimately and broadly, free markets are about allowing free exchange within some sort of system of property rights: in my proposed system, the property rights are defined over large groups and periodically reissued using an auction mechanism, but given the market failures associated with allocating them in other ways, I would definitely contend that is one of the most free market ways to do it. A system with a market failure isn't a free market that doesn't work, it isn't a free market -- and there's nothing unusual about that definition in any of the actual economic literature.
If I'm changing the definition on people who mucked up the more basic definitions in the first place, good.
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Here's an experiment. Find ten to twenty reasonably persuasivepeople who consider themselves advocates who argue in favor of a 'free market' ideology, such as Advocates for Self-Government or whatever, or even just your average run of the mill arguin' internet Libertarians. Describe your system to them without first describing it as a 'free market yet universal' proposal. Use this post:
quote:Remove healthcare from employers entirely. Create Very Large Groups (millions of groups, at minimum) that are easy to discover based on demographic information and overlap heavily. Have insurance companies bid on offering standardized insurance to those groups, and then be able to offer whatever additional options they want. Any health care company insuring more than some small number (a few thousands) of a group be required to offer their plans at similar rates to everyone in the group. Have insurance be required, with an accompanying progressive tax (ideally folded into the general tax program, but whatever) that is used to subsidize those with difficulty affording insurance (possibly they would also be members of a special group with a sort of "automatic insurance" they don't have to explicitly purchase, to simplify things).
At the end, ask them if they consider this system, wherein coverage is mandated by the government and progressive taxes are used to provide it to the people who aren't well off enough to provide it for themselves, a 'free market solution' to our healthcare system's woes.
I will do the same. Note their replies.
This without even informing them that they have 'mucked up more basic definitions,' but if you would like to subsequently thereupon inform them that this is actually a free market proposal and if they don't think so they have the term wrong, you're welcome to see where that gets you.
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I'm not sure I see why this essentially semantic debate is such a big deal, Samp.
As far as I'm concerned, fugu's point is well taken: the "free market" fundamentalists you're talking about are operating under a shared delusion -- that there's some sort of "natural" economy that was there before government started making the rules. I see no reason to take their definition as preferred, given the false presupposition behind it.
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Not preferred, but when people hear economists talk about the advantages of the free market without knowing that they mean something different by "free market" they think that their idea of "natural" economy works and has the support of those economists.
Like the confusion with the idea of the deficit.
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quote:Originally posted by Destineer: I'm not sure I see why this essentially semantic debate is such a big deal, Samp.
If the language framing of the proposal is really, really divorced from what freemarketeers think of as free-market solutions and proposals, then the proposal's packaging can backfire as being dishonest. Mainly though it deserves to be noted that calling it free market, in my opinion, doesn't make any sense. It isn't proposing deregulation or removal of government impediments from the healthcare system, it's proposing the opposite.
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quote:Originally posted by malanthrop: The Obama healthcare bill didn't institute single payer. It killed private healthcare...intentionally. The American people don't want single payer but they do want "reform"
"Killed private healthcare" is the most asinine apprehension of the healthcare reform bill I have yet heard.
Oh god, private healthcare is dead! Yet I still go to the same hospitals and still somehow magically get health coverage from Cigna.
Shut up or quit being clueless.
It's only a matter of time. “We don’t want to be the first one to drop benefits, but we would be the fast second.”
quote:If the language framing of the proposal is really, really divorced from what freemarketeers think of as free-market solutions and proposals, then the proposal's packaging can backfire as being dishonest. Mainly though it deserves to be noted that calling it free market, in my opinion, doesn't make any sense. It isn't proposing deregulation or removal of government impediments from the healthcare system, it's proposing the opposite.
And if I had been writing in this thread to argue a proposition to the small, small percentage of people who are courts+police free marketers, that might matter. I made an offhand remark because I supported a system I feel is maximally free market, given the constraints on any health care market and a minimal aversion to suffering, that is also universal, in a discussion about current and more socialist approaches, and then when requested, I described the system. You're imagining a pulpit that doesn't exist.
And yes, I do think a lot of more free market people would be on board with such a system. It has similar elements to many of the proposals bandied about by somewhat more libertarian members of Congress, while being generally superior to their plans.
It is also likely to be superior to single payer, since there is a strong incentive for insurance providers to compete, yet it has pretty much all the strengths of single payer.
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quote:And yes, I do think a lot of more free market people would be on board with such a system. It has similar elements to many of the proposals bandied about by somewhat more libertarian members of Congress, while being generally superior to their plans.
Of course, Obama's plan was itself very similar to plans the Repubs had put forward in previous years.
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It would lack the larger risk pool of a single payer system, though. Wouldn't that be a pretty significant drawback?
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Remember, the groups would be at least a few million in size (often larger), and would be picked in ways largely orthogonal to health (geographic location, for instance). Risk pools that size should be pretty much indistinguishable from the riskiness of the entire population. What's more, the ways in which they weren't orthogonal (heavily polluting cities, for instance) would provide additional incentive for individuals to preserve collective health.
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quote:Originally posted by fugu13: And yes, I do think a lot of more free market people would be on board with such a system. It has similar elements to many of the proposals bandied about by somewhat more libertarian members of Congress, while being generally superior to their plans.
Do you think any Republicans, with the possible exception of senators from Maine, would have voted for this plan?
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quote:Originally posted by fugu13: Remember, the groups would be at least a few million in size (often larger), and would be picked in ways largely orthogonal to health (geographic location, for instance). Risk pools that size should be pretty much indistinguishable from the riskiness of the entire population. What's more, the ways in which they weren't orthogonal (heavily polluting cities, for instance) would provide additional incentive for individuals to preserve collective health.
I'd be interested to see any sources you might have handy on risk pool size vs. riskiness. It's not something I have more than a cursory knowledge of, so I'm willing to take your word on it.
I am a little skeptical, though, regarding orthogonality. It seems like certain regions could be skewed more heavily towards being older, for example. I also don't really think the incentives towards collective health would work out. We already have some pretty strong incentives for that now, and it doesn't seem to be having much effect.
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quote:I am a little skeptical, though, regarding orthogonality. It seems like certain regions could be skewed more heavily towards being older, for example.
Sure. I don't think that's a problem; quite the opposite. Remember, part of the point of this plan is to preserve incentives as much as is possible to do so while simultaneously ameliorating market failures.
quote:We already have some pretty strong incentives for that now, and it doesn't seem to be having much effect.
Could you give some examples?
quote:I'd be interested to see any sources you might have handy on risk pool size vs. riskiness. It's not something I have more than a cursory knowledge of, so I'm willing to take your word on it.
A million people is a substantial percentage of the entire US population. Unless selected for in a way with substantial bias, the risk pool will not be extraordinarily different from the risk of the entire nation -- and, as I point out above, the ways in which it is different will be an overall good effect, not a bad one.
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Before I respond, can I ask you to clarify how these groups would be organized? The way you described it in the post summarizing your plan doesn't really make sense to me, primarily this part:
quote:Create Very Large Groups (millions of groups, at minimum) that are easy to discover based on demographic information and overlap heavily.
In this context, what does "easy to discover" mean? And in what sense would they overlap?
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Oops, I typo'd for "millions of people" -- no wonder the confusion. I only mean several hundred, maybe a thousand groups, with extreme overlap.
By "easy to discover" I mean all sorts of things. The groups could be by geographic area living in, by geographic area born in, by time of year born, by day of week born, you get the idea.
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I definitely envision the federal government; I want many of the groups to cross state boundaries.
Though actually, there could be some interesting effects if the states got to add to the requirements of the insurance offered within them (but were restricted to making those changes go into effect at the times of re-bidding). It would make things more complicated for the insurance companies, but not prohibitively so, if kept within reason.
The problem would be if states started doing the things that kept inter-state insurance walled citadels right now. My suspicion is that differences in the coverage mandated are not the main sticking point (and thus could be safely set by the states), but differences in organizational requirements are a major sticking point. I'd have to look into that more.
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To answer your earlier question, it seems to me that the incentives for collective health are largely the same under your plan as the incentives we have now. The benefits of being healthy, and having other people be healthy seem really obvious. Additionally, keeping other people healthy will tend to lower your own medical costs. We still largely eat too much, and exercise too little. I just don't see what added incentive your plan would provide (or specifically what it would incentivize).
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quote:To answer your earlier question, it seems to me that the incentives for collective health are largely the same under your plan as the incentives we have now. The benefits of being healthy, and having other people be healthy seem really obvious. Additionally, keeping other people healthy will tend to lower your own medical costs. We still largely eat too much, and exercise too little. I just don't see what added incentive your plan would provide (or specifically what it would incentivize).
If the people in an area are part of the same group, every bit the health of the area improves, the lower the cost of insurance for everyone.
That effect is basically swamped right now by business considerations and the variance of the smaller populations being insured as part of the same group; an entire area will have a much lower variance, and the business considerations angle will be largely gone.
That's the more obvious effect, but the really big effect is a less obvious one: you'll be able to improve your insurance rates, sometimes substantially by moving to healthier areas. Healthier areas are healthier for a variety of reasons, many of them relating to the environment and social effects that promote healthiness. The positive effects of moving to such areas are potentially quite large for many individuals.
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Granting, for a moment, that people would actually move significant distances to lower their rates, wouldn't this create feedback loops in less healthy areas, leaving the riskiest people all in the same groups (and shrinking the risk pools to boot)? Bearing in mind, these people would also be the ones least likely to be able to afford expensive rates, because they'd also be the ones least likely to be able to afford to move.
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quote:Granting, for a moment, that people would actually move significant distances to lower their rates, wouldn't this create feedback loops in less healthy areas, leaving the riskiest people all in the same groups (and shrinking the risk pools to boot)? Bearing in mind, these people would also be the ones least likely to be able to afford expensive rates, because they'd also be the ones least likely to be able to afford to move.
I think part of the insulation on this would be that most people aren't going to move to lower rates in the short term -- but if someone is moving anyways, considerations of health insurance will be high.
The truly poor would have subsidized health insurance under the plan, so I don't envision the mobility problems hurting their total effective income. I am somewhat worried about the "lots of unhealthy people in one spot" effect, but I suspect increased mobility effects might more than make up for it in overall welfare.
I believe the general availability and separation from employers of health insurance would help lower the overall mobility barrier some, too, as the cost to employ a marginal employee would drop drastically -- often by more than a quarter of the overall costs of employing that person.
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I was actually pretty happy to think 'horray, we can stop talking about O'Donnell now!' but this forum was ahead of the curve.
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quote:The truly poor would have subsidized health insurance under the plan, so I don't envision the mobility problems hurting their total effective income. I am somewhat worried about the "lots of unhealthy people in one spot" effect, but I suspect increased mobility effects might more than make up for it in overall welfare.
I'd kind of been assuming that subsidization would be a necessary component in this, but it's good to hear it. How do you envision the subsidizing working? Would the federal government tax the insurance companies, then credit those companies insuring lower-income pools, or something similar?
Also, how do you see increased mobility (I assume this means between groups?) improving overall welfare?
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quote:I'd kind of been assuming that subsidization would be a necessary component in this, but it's good to hear it. How do you envision the subsidizing working? Would the federal government tax the insurance companies, then credit those companies insuring lower-income pools, or something similar?
Part of the income tax. I don't see a reason to try to create silos of taxation; it creates all sorts of silly bookkeeping, and is frequently filled with unintentional consequences. Of course, I'd also drastically simplify the income tax system
quote:Also, how do you see increased mobility (I assume this means between groups?) improving overall welfare?
I mean mobility between jobs and between locales (of course, that usually entails a job change), primarily. If there are fewer costs to to hiring a new person, more people can be hired in more locations, resulting in one kind of improvement. Further, if people find it lower costing to move between places, they're more likely to take an optimal job. For instance, there's a lot of evidence that a substantial proportion of the lowered welfare in the current recession comes from people being unable to move to take jobs, due to the prohibitively high cost of dispensing with their current residence.
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quote:Part of the income tax. I don't see a reason to try to create silos of taxation; it creates all sorts of silly bookkeeping, and is frequently filled with unintentional consequences. Of course, I'd also drastically simplify the income tax system
I think the benefit to going at it from the end of the insurance companies is that it wouldn't be possible for individuals to take the tax credit (or whatever) and just skip getting the coverage. I imagine it'd lower enforcement costs quite a bit. It could possibly also make a nice incentive for companies to take on poorer and riskier groups.
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quote:I think the benefit to going at it from the end of the insurance companies is that it wouldn't be possible for individuals to take the tax credit (or whatever) and just skip getting the coverage. I imagine it'd lower enforcement costs quite a bit. It could possibly also make a nice incentive for companies to take on poorer and riskier groups.
I don't see what the difficulty is of requiring anyone getting the tax credit to notify their company, and then requiring every company to file information on all the people who have notified them about getting the credit. The company has no reason to lie, because they get no benefit from lying. The person has reason not to lie, because if they are on the benefit list but not the insurance list, the government comes after them.
Distributing straight to the insurance company would be acceptable to me as well. I don't want the money collected from insurance companies, though, as that adds needless complication when we already have a good way of collecting money progressively (and depending on how the money is collected from companies, could end up penalizing companies differentially, or even being effectively a regressive tax).
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quote:Originally posted by fugu13: Requiring coverage is the least part of what one might argue prevents there from being a free market in that arrangement.
It's really not a 'free market' arrangement. I should quote wikipedia: a free market is a market in which there is no economic intervention and regulation by the state, except to enforce private contracts and the ownership of property. This becoming a new revisionistic definition of a 'free market solution' would give most libertarians hives.
Iit's blatantly redefining 'free market' at convenience, for the sake of language framing it for appeal. Not that this doesn't tend to work, of course ('fair tax,' anyone?), but ..
This administration has undermined the fundamentals of the free market. Wonder why the wealthy aren't investing? It might have something to do with the fact that this administration has undermined the basis of our economy....contracts.
General motors was taken away from the stockholders and given to the unions. Salary contracts for executives were invalidated and the government determined executive compensation. "Predatory Lenders" are under attack for forcing the borrower to stick to the terms of their contractual agreement. Banks are under attack for forclosing under the terms of the contract.
The economy will freeze when the government intervenes in contracts at a whim. The victim of "predatory lending" signed a contract. Elderly Americans lost their 401k's when the government handed over their wealth to the union.
Contracts are no longer contracts. Laws are no longer laws. Illegal aliens are no longer illegal and lenders are now considered predators. The economy cannot flourish in a lawless environment. If you can't count on law and a contract, what can you count on?
quote:Originally posted by malanthrop: Wonder why the wealthy aren't investing?
My 401k was at 11% as of yesterday. Anyone not investing right now is doing it wrong.
quote: "Predatory Lenders" are under attack for forcing the borrower to stick to the terms of their contractual agreement.
I was confused on this one at first, too. Apparently, these are places that weren't charging Prime +1 for interest. These were places charging credit card interest on home loans. The companies I've worked for aren't evil, so I hadn't heard of such a thing.
If you truely feel contract is everything and caveat emptor is the highest rule of the land, than I can see that not mattering. But to me, people are really only free to choose the best path for them and their families when the paths to ruin are as carefully marked as possible.
My credit union does what it can to offer home buying classes and responsible credit classes, but we're only serving 30,000 or so people in a city of 170,000. How many people who honestly just don't know better because their families have always been bad with money are missing out on this vital information that could change their lives for the better just because our ads don't reach them?
I'm conservative enough to want people to be responsible for their actions but realistic enough to want help to be available so they can tell good choices from bad.
quote: Banks are under attack for forclosing under the terms of the contract.
Actually, they're under attack for foreclosing under conditions not in the terms of the contract. And possibly in illegal ways.
And in my world, the bigger ones are still under attack for taking tax money, giving out huge bonuses, making profits, and not lending at the same rate as banks that didn't take TARP funds. They made a mistake and still managed to punish the consumer and reward themselves. I'm sticking with "evil".
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quote:I don't see what the difficulty is of requiring anyone getting the tax credit to notify their company, and then requiring every company to file information on all the people who have notified them about getting the credit.
Ahh, I see. That does sound like it could work.
I don't have a lot more to add. Your proposal sounds like a strong model - a great deal better than what we currently have.
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quote:Part of the income tax. I don't see a reason to try to create silos of taxation; it creates all sorts of silly bookkeeping, and is frequently filled with unintentional consequences.
What do you mean by 'silos of taxation'? I'm getting an image of big cylindrical buildings filled with shredded tax forms, but that's probably not it. Posts: 10645 | Registered: Jul 2004
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Separate taxation systems that function over separate areas of focus. In this case, the silo would be taxing insurance companies in order to fund the insurance rebates. It sounds like it makes sense, but it really doesn't. The point of the insurance rebates is so wealthier people can subsidize poorer -- and the most effective way to target that is with the income tax system.
Not that having taxes other than income taxes isn't sometimes appropriate. For instance, I like gasoline/carbon taxes, because they deal with a serious specific externality (really a whole host of externalities) in a definitely welfare-improving way. I don't like the idea of setting aside the revenues for transportation or other accounting silliness, though.
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