I saw some talking head on the cable teevee news making a specious comparison between health insurance and auto insurance. If we just treated health insurance more like auto insurance, he said, we’d have more competition in the health insurance market. We’d have little lizards on the television marketing insurance to us at low, low prices.
Problem is that our bodies are not cars and our policy goals with health insurance are different than those for auto insurance. By and large, we’re content to let people suck it up and go without a car if they can’t afford one (or if they can’t afford to insure it). It’s less common for us to tell people to suck it up and die if they can’t afford to keep their bodies in working order.
And that leads to the second point. As a policy matter, I don’t think we’ve ever decided whether we want people insured against accidents or the unexpected or for maintenance (or, probably, a little of both.) If the person doesn’t change the oil and the car breaks down, well that’s just what you get dummy. Change the damn oil. If someone has a lemon of a car – and it’s known to be a lemon – an insurance company isn’t going to insure against repairs. The person is expected to repair it at his or her own expense, buy another car that’s not a money pit, or do without.
You can’t do that with your body. We don’t have a lot of sympathy for the folks who don’t change the oil – they don’t exercise, they eat junk, they smoke, and they sit on the couch. Just like a car, you’re body is going to break down. But, even for these folks, we’re not quite willing to just let them die if they can’t afford the inevitable repairs.
We’re more sympathetic to those who bought a lemon – their bodies develop problems through no real fault of the owner. Some defects are unknown and unknowable in advance, but others can probably be calculated with sufficient information, genetic testing perhaps. If an insurer can determine that a potential insured is probably a lemon in advance, can we really expect them to insure against future maintenance that’s not so much unknown risk as strong probability?
With health insurance, we haven’t really decided whether we are spreading the danger of unknown risks (who is going to get hit by a careless driver? We know it’s somebody, we just don’t know who exactly). Or, are we spreading the cost of health care from the unhealthy to the healthy. Or, are we spreading the cost of health care from the poor to the rich?
The spreading and managing of risks, the impact of which can be estimated at the group level but the individual level of which is unknown, is typically what “insurance” is. The other policy choices – having the healthy subsidize the unhealthy or the rich subsidize the poor strike me as different animals even if they are perfectly valid policies. But, I think we have to know exactly what we’re trying to accomplish before we can design a system that is effective in meeting our goals.
Exactly. This is precisely why I believe the current national “debate” over this topic is little more than politicial grandstanding and theatre. After watching a major portion of the Professor Barack show yesterday, I realized that most of the people in that room were discussing policies and talking points that were almost completely unrelated to the underlying problem.
Look at it in terms of a casino: If you were a health insurance company, you’d want to mostly play craps and blackjack at the casino because the odds of winning are better if you consistently follow certain methodologies. Now, what if the government stepped in and said “Hey, Mr. Health Insurer, we are going to force you to put 50% of your premium dollars on Black 17 once a day.” Don’t like that analogy? Put it in terms of the stock market. “Mr. Health insurer, we realize that you like to make consistent return on your VAST investment, but it’s just not fair to the other companies on the exchange that you are unwilling to bet your money on them. They are undercapitalized, poorly managed and have huge systemic problems, but we’re going to force you to invest anyway. Oh, you refuse? That’s ok, we’ll just go to good old Mr. Taxpayer and force him to do it instead. Afterall, we know what’s best for them….”
I realize these examples are cartoonish at best, but if you take off all of the window dressing, they basically fairly represent what is going on.
It struck me yesterday as I watched much of the Health care debate that for the ‘conservatives’, everything is a matter of supply side economics,and freedom, and profit vs. the needs of people.’Liberals’ start with defining peoples’ needs.I really understood graphically what ‘trickle down ‘ means. This is not a new insight,but re-proven,and it’s the contrast between humanism ( the individual is our measuring stick) and an econonomic model , let competition(‘fair vs unfair’ isn’t a concept) determine the worthy and the unworthy).
That’s why I don’t see much room for bipartisanship agreement. That was clear about how each side would handle pre-existing conditions.The conservatives would isolate those with existing maladies into their own group ( so they wouldnt ruin the profit mandate) and have them pay according to the norm of that group,which would require very high premiums,whereas the more liberal Dems would spread the risk and lower premiums for all.
So yes, I can see how automobile insurance and health insurance are the same,if we look at choice defined only by risk and profit with profit for someone else being the measure of success. That comparison model will continue to be used,no matter how many Dougs take time to explain how autos and people arent the same..It’s basic truth for an entire political party.
Lou,
Doug and I had this very discussion yesterday to a degree, and basically what we decided was that disconnecting the two and having an apples-to-apples debate was the equivalent of inventing a magic wand. There is no reconciliation that can really happen between humanism and profits. Humanism is a purely emotional mechanism and profit a purely mathematical one. Health insurance companies are not in business to fix sick people. Doctors are. Health insurance companies exist as a purely profit motivated entity with a biproduct of providing defrayed medical costs to their customers. That’s it. If you try to to insert a humanist angle to the equation, everything falls apart.
That is why the intellectual argument mandates the removal of antitrust exemptions and many other regulations just to set a baseline standard of care in the U.S. We don’t know what our medical market is capable of doing because we haven’t seen it in a state of equillibrium for almost 70 years. A lot has happened since then. Trying to force a square peg into a round hole is NOT going to produce the results that anybody wants, and that is the modus operandi that is typically the stuff of Washington politics.
I don’t care much about the profitability of insurance companies. Like any other business, they are a means to an end and not an end in themselves. A free market in widgets is the best means to efficiently supply the most widgets to people who need or want them.
Like I mentioned, as a country, we don’t really have a good sense of what particular itch the health insurers are supposed to scratch. But, whatever it is, they’re not quite getting at it. If there is a better way to finance the health needs of the country – and there are a number of reason why health care is not like supplying widgets – then I’m happy to go that better way even if the health insurers find they no longer have a viable business model. But, at the same time, the “better way” is going to have to account for the fact that the people currently providing health insurance aren’t going to want to do it out of the goodness of their collective hearts.
(Andrew’s comment slipped in while I was writing that last one.)
We should distinguish between what we want health insurance to do (ideally) and what it is likely to do if we go a certain direction. In this latter sense, the analogy to car insurance is vital and points to a rarely-understood point: if you insure a ton of stuff– particularly stuff that people have some/considerable discretion over– then you will get the very problems we see today with health care and health insurance.
To avoid these practical problems, health insurance should cover (only) catastrophic and preventative care. The former is easy to see, with analogies to ANY other form of insurance; that’s what insurance does. The latter exists to some extent and would evolve further without the vast subsidies and regulations we see in health care/insurance.
To get to the “should” stuff, you could have targeted subsidies to lower-income folk that would cause modest trouble, but not nearly the problems we have today.
The Dems ignore market processes and thus, are asking for a lot more of the poison we’ve already ingested. The GOP lacks political power– and either lacks political imagination to see the solutions &/or the political will to make difficult arguments to the general public.
My Ole Daddy allus told me, “Son, when a man tells you that the other side is all about Emotion, an’ his side is all about Mathematical certainty, try to notice how happy he looks when he’s walkin’ away with your wallet.
I appreciate the way President Obama likened catosthropic health insurance to house insurance. That is, a 2,000 dollar catosthropic insurance policy won’t pay for any medical treatment,but it would keep you from losing your house to debt,if you had a catosthropic health problem. This the ‘professorial Obama’ that some people call him,sometimes derisively.
Some comparisons are confusing and others are enlightening.Probably depends on one’s belief system.
Andrew,
I’ve always credited the humanism movement,starting in Europe with the Renaissance, for our democratic , grassroots traditions and our respect for constitutional secular government ,and that every man can succeed if given a chance.
OK, say people with a certain pre-existing condition can function well at home and at work if they have access to various RX products that would amount to $5,000 per month if they went to the pharmacy on their own without insurance, but without the meds they would decline into disability pretty quickly. If you group all these people together in a pool by themselves, what would their premiums have to be to maintain access to the medicines? The pre-existing pool won’t work for them because I don’t think most in the group would be able to afford the premiums the insurance company would have to charge to cover the bill and make a sufficient profit to make offering the insurance worthwhile. Only by spreading the risk widely can these costs be affordable and therefore, the people continue to be functioning well.
This is not a made up example, this is the cost of meds for at least one disease that I am aware of. And, no, it is not behavior-related, so don’t go there.
Too bad the discussions the our elected officials are having are not as thoughtful and though provoking as those posted here.
My Daddy always told me that when one admonishes you for not having compassion, he’s setting you up to pick your pocket.
@Mike – yeah, because there’s no difference between taxes for Medicaid that keep the poor from dying in the street and street crime.
Seriously, take off your libertarian blinders and look at the real world.
The “Daddy always told me” was a red herring anyway. I discussed how one might provide subsidies for the lower and lower-middle income classes within a much more free-market system. Those who have ears, let them hear.
To go with another analogy on this (difficult) issue (only): some GOP’ers are the Tin Man; most of the rest of the GOP’ers are the Lion; and most Dems are the Scarecrow.
There is a market solution to future pre-existing conditions; there is a relatively low-cost political solution to those with current pre-existing conditions. Check out this blog post from awhile back: http://schansblog.blogspot.com/2009/08/solideasy-market-based-solution-to-pre.html
Peter, I am looking at the real world. There are those who wish to use government as an instrument of plunder. You may call this ‘robin hood’ action ‘justice’ or ‘compassion’, or ‘belonging to a society’, or any number of other things. It’s just lying though to call it anything other than theft. Real world, no window dressing.
The real distinction between libertarians and liberals on this issue is that libertarians believe the ends do not justify the means, while liberals do.
Mike Kole posted:
“The real distinction between libertarians and liberals on this issue is that libertarians believe the ends do not justify the means, while liberals do.”
I would say that depends on who happens to be in charge any given time period..Reconciliation ,for example, as a means to pass a bill, is seen a threat or as common sense,depending wholly on which side uses it and for what purpose.And do ‘real libertarians’ carry a card like liberals are assumed to?
But isnt the ‘real problem’ how we view individuals as investors vs how we view individuals as consumers or patients? When investors organize they become corporate and when consumers or workers organize they unionize or form into consumer awareness groups.
The consumer/patients are always seen as problems to be controlled and investors are seen as white knights who must not have restrictions.
Investors are never seen,or have never been seen in recent years, as a problem to be controlled.A case in point were these 20s investor guys at the gym Ive mentioned a couple times who were flipping houses every several months with the goal of retiring by 30 yrs old.That was a Eureka moment for me.Why in the H were these guys allowed to do that with my money?
The individual as consumer or patient has no rights except what the insurance companies,in this example, allow because the profit mandate is what is seen as stable,not health care or protections from tainted food. It’s always a matter of let the private sector figure it out without ‘government interference’ Well, they have figured it out:that’s why we have catastrophic insurance policies offered as a solution for insurances companies,and we wait to see if anything trickles down to the patient. Maybe, at least ,they wont lose their house if there is a family health emergency,but expecting medical bills to be paid may be asking too much from insurance.They maye not be able to afford it.
What standing do individuals as patients or consumers have in the libertarian-ordered world? Isn’t the investor class designated as the de facto controlers of everyone else’s money? If so, when is a consumer or patient ever going to be able to step to the front of the line?
I ask you,Mike Kole,because you always give an honest,straight forward response.
I don’t think that stands up for most libertarians. There are some who are basically anarchists, but most concede that government should have sufficient resources to, say, operate courts and a police force. But, if taxation or redistribution is theft, the government couldn’t morally do that. Why should the government be allowed to steal from *me* to enforce *your* contracts or other property rights?
See, I figured that, in a lot of ways, libertarianism was just the best means to an end: a free society is ultimately happier and wealthier than societies governed in other ways. But, looking around the world, I have cause to question that assumption. There are other countries with happier populations. We might still be the wealthiest country, but if that wealth ends up mostly concentrated in the hands of a few ultra-rich individuals, that doesn’t speak much for the condition of the society as a whole.
“It’s just lying though to call it anything other than theft. Real world, no window dressing. ”
Mike, I can’t think of any other way to describe this argument than that it’s idiotic. By which I mean profoundly stupid. First of all, words have meanings, and the meaning of theft is quite different from that of taxation. (For that matter, to touch on another bit of libertarian illiteracy, we *do* live in a democracy.)
Leaving aside the plain meaning of the words, it’s exceedingly silly to think that taxation is illegitimate. It is enshrined in our constitution and has been since the beginning (although income taxes were added later). It is the basis of *all* functioning societies, without exception.
Really, there’s not much else to say on this subject.
“It’s just lying though to call it anything other than theft. Real world, no window dressing.”
It is called theft when government money goes to the poor and middle class. When it goes to corporations and their shareholders, it’s called capitalism.
Yes Peter and Chad.
Okay, just for the record, let’s try it this way: my ole Daddy never told me “Emotionalism Always Wins!” Nor did he say that everyone who ever mentioned Profit was out to pick my pocket. What he did tell me was that people who dismiss all ethical concerns as “emotional” while insisting that profit taking is the disinterested application of accepted formulae to an unambiguous universe are very likely to be at least as emotionally attached to their resultant profits as they accused others of being.
In other words, it is fallacious to imagine that you have dispelled all ethical argument by asserting you don’t share the ethics in question; this is the human condition, whether we like it or not. And it’s a bit puzzling, at least, to express a preference for one group stealing you blind over another.
“Logic without emotion is a useless and rotting log, which merely blends in with all the rest of the moss. Emotion without logic is a wild, rampant, and dangerous beast.
You must have both.
Logic is the bullet. Make sure it is strong, clean, bright, and true. Emotion is the pistol. A bullet will not go far unless fired for a decent and confident pistol, carried with conviction.
Logic is the steering wheel. With it you can find the proper roads and avoid accidents.
Emotion is the gas pedal. Without it you will never get where you are headed. Just make sure your wheel is working, or you’ll only head into a ditch, and unfortunately you may bring someone with you.”
Samuel Thomas Poling
http://www.rationalresponders.com/logical_fallacy_lesson_8_appeal_to_emotion
If you believe in evolution, then emotions have been selcted “in” as a benefit to the survival of the species. If you believe in creation, then emotions are a God/Goddess given gift. The same can be said for logic. You can ascribe for yourself how much of each should be used in combination. :)
Chad- It may be how the Republican Party defines capitalism, but to me, theft is theft, regardless of the recipient, regardless of the reasons.
It’s some kind of twisted ethics that demands an unethical act in order to solve a problem.
Not to be labor a point,but hopefully just to clarify..I have never understood how a libertarian based society of any kind, would work.The libertarian definition seems to vary person to person,but the consistency is that government would not intervene,only to allow.
When there is freedom from government than there is defacto control from self-appointed power bases.In past generations it could have been the church or now it could be corporate conglomerates.But its always some entity with already considerable power,who seeks more…So it may sound like double talk to many,but I have come to the conclusion that ‘freedom’ has to be defined and enforced,by government,and I by ‘government’ I mean constitutionally enacted law by those elected,which is ‘the people’, another name for ‘the government’.
We have had a ‘survival of the fittest’ type economy,which has now nearly collapsed due to what some have called ‘free market’ .So the most common explanation of figuring out what happened seems to be ‘who to scapegoat?’
So when do consumers and patients come to the head of the line for our publically created and accessible wealth?
My answer is: Never,without government intervention on their behalf. How would others answer that question,especially a libertarian who can see himself as a patient or consumer?
Comment from above: I would never try to separate reason from emotion.We can judge it others but not so much in oursleves,and that’s where it most counts to judge.
Calling taxation “theft” (or any related words) is a little disengenuous, I’m thinking.
Certainly, one can take issue with the total amount of taxation, or the concept of taxing everything that moves (or doesn’t), or how the taxes are redistributed, but each taxpayer gets some kind of return of the monies paid to the various taxing entities. But, it isn’t theft, larceny, burglary or robbery.
I’m more curious about the other side of the equation, Mike: in what sense do you acknowledge there is, or even can be, “a problem” with our healthcare system?
@Lou, I favor a voluntary society. My belief is that when an action is worth undertaking, people will lead at the opportunity. The best examples I can offer lie with the military service. For centuries, armies and especially navies were staffed by impressment. You! Over there! Drop everything, get on the ship. Of course, that isn’t an American experience. So, contrast the reactions to WW2 and Vietnam. In the former case, Americans rushed to enlist to fight the Japanese. In the latter, young men burned draft cards. One can immediately judge the validity and justice of either war on the basis of enlistment. Any action worth doing does not require compulsion. People enlisting in WW2 knew the risks involved, and enlisted anyhow, in huge numbers. They did not need to be compelled to enlist. Vietnam? How abut our current wars? While the draft isn’t active, we keep hearing that recruitment is off. That tells me a lot, too.
No different with health care. Anybody who wants to can voluntarily step up and fund health care solutions for those who can’t afford it. I don’t see a whole lot of voluntary action, though. I do see a lot of effort to compel people to participate in a variety of ways.
@VG- Not theft? Voluntary taxation? Those are the nice words included in the tax code, but withhold your participation, and see which orange uniform you’ll wear, and which cell you’ll occupy in federal prison. Go ahead! Run the experiment!
Again, anything else is window dressing, and that is what is disingenuous. What you are essentially saying on the ‘return’ is that if you are mugged in the street, and the mugger drops a $20, you’d go and pick it up. Well, so would I, but I’d hardly see that as a ‘return on investment.
User fees are positively fair taxation. Gas taxes? Perfect. Pump the gas, pay the tax, the money goes into the roads. Perfect.
If I may, D. Riley, I think the first and biggest problem is simply referring to our health care market as a “system.” It is a dynamic market just like any other; metals, crops, cars or toys. Calling it a “system” implies that somehow it was strategically developed as a whole to conquer a common problem. However, it actually developed organically (and in a very fragmented fashion) to solve a staggeringly massive series of small problems. Markets are comprised of both providers and consumers…and just like in any other market, some people consume more than others and some providers charge more for their goods than others. This is why this debate is so complicated and unending. The Democrats think it’s possible to train thousands and thousands of independent, dissimilar market providers and consumers into one giant happy flow of cash and care. It’s the geopolitical version of herding cats…and nobody seems to want to recognize it for what it is.
Except that a number of other countries have developed health care systems through government intervention that, by and large, the citizens of those countries seem to like very much and which seem to provide levels of care that are at least comparable to those provided in the U.S. but cost a lot less.
It can be done but there are reasons – not necessarily persuasive to me – why we may not want to do it. One reason, which Mike offers, is that taxation is theft. If that’s the case, then we are also funding our national defense through theft. In for a penny, in for a pound.
And, for what it’s worth, I think we need a national defense, and I don’t think it could be adequately funded through user fees or voluntary contributions. So, “theft” it is.
Doug,
So essentially you are suggesting that because France can do it, so can we? The whole premise breaks down immediately based on sheer size and volume….not to mention the other inequities such as the quality of care many of us already enjoy (and will be pissed if we are forced to do without for the “general welfare”). If what you are suggesting is true, then the logical next step would be to scrap a Federal health care plan and let the States each develop their own. The size and scope would be much closer to a realistic match with the models to which you think we should aspire.
As I understand the way France does things, a plan is mandated by the government through expert advice. When they want a railroad system they ask rail experts to submit a plan,and then each region in France has input.When they do health care they start with what the service will provide and then they mandate that it be provided.Then the national care system pays what ever the program is.
Efficient in USA doesnt mean efficient for the consumer,it means efficient to make profit. Efficient health care would mandate adequate personnel but adequate profit might mean getting rid of personnel. The French familes I keep in contact with are horrified by the haphazard nature of our american health care system.There is no way to predict the level of service,except and if they need health care while in the States they hope they are somewhere where they can get adequate treatment. But whatever care they get here ,they know the French system will cover everything.They just submit their bills.
I was never in hospital in France but I spent a week in hospital In Berlin,Germany for a week in 1998.I remember being told that if I were Jewish everything would be free. My total bill after a week in the hosptial was something over $2,000,but less than $3,000.That was for everything they did including my stay in hospital. A German friend paid my bill so I could be dismissed, since they dont accept American insurance unless it is specifially written for Europe.Dealing with american health insurance ,I was told, was impossible because there are no standards.
That’s where I learned some first hand German,like when I asked for water the orderly told me in German ‘Darf nicht wasser haben’ If you’re told ‘darf nicht’ it means NO WAY,and don’t ask again…I also remember that the names on the doors of the various rooms the words took 3 lines of print .It was like a language maze.Although I speak good French,my German was mimimal.Fortunately English is commonly spoken …in Berlin,especially.
The French are reluctant to speak English even if they are fluent.I had known a Frenchman for several years and we always spoke French and then I heard him once speak fluent English to an American who didnt speak French and he explained that he spoke English to someone who doesnt speak French,but since I speak French there is no need to speak English..typical French thinking..
My knowledge on almost any level is anecdotal ,but still, I think it gives insights into different ways of thinking and doing things.
The state experiments might work if each state was more of a closed economic system like between countries. Otherwise arbitrage would probably make the state health systems ineffective.
But I’m not sure why we don’t think the Canadian, French, Japanese, British, Australian, or whoever’s health systems are scalable.
That’s an easy one, Doug. Those countries actually practice strict immigration control. We don’t.
I have to call BS on the whole argument that the US is too ethically diverse to support universal health care. I just visited Canada last week, and I was amazed by the ethic diversity I saw. In one office I visited, 1 out of the 5 people there were what I would consider “traditional” Canadian. The other 4 spanned the globe on their ancestry.
I’m not sure if that was your point, exactly, Andrew, but I have heard the argument before that, for example, the Japanese have a homogeneous ethnic pool, so they are easier to insure.
My daughter studied one summer in France and one summer in Italy in the “90s. She had to see a doctor in each country for her pre-existing condition. The care was just fine, no problems, although a couple of protocols were different. In France she was able to handle the bill with money she had brought. In Italy she went back for a recheck, and there was more of a bill for tests and we ended up wiring money, about $200 to a hospital. Never able to get our insurance involved, so I don’t know what would have happened if the bill was more. The Italian doctor even faxed a test result to her doctor here so he could “consult”. In both places she had to buy meds at a pharmacy. The meds that cost $80 here at home cost her less than $10 in both those countries.
Doug- So, if we can be wrong in one area of funding governing, we should (not merely can) be wrong in another? This is supposed to be compelling?
We funded this country previously by issuing debt. People and other countries bought bonds as a safe investment. The nation gained cash up front, investors made a small, safe profit later. Also, we’ve sold war bonds through our history. We can certainly do these things today, if people believe in it.
Just think- if you don’t support the wars in Iraq or Afghanistan, you might not have to pay for them, if we had voluntary taxation. You know, the real deal. But now, everything goes into the meat grinder. As you say- in for a penny, in for a pound. It’s as a good a reason as any to be out altogether. To paraphrase Jefferson, ‘nothing more unjust than forcing one to fund something they don’t support’.
Alas, Republicans do this too. I don’t know how many times I’ve heard alleged fiscal conservatives throw up their hands and say, ‘if their side gets welfare and other assistance, then we get ours via corporate assistance’. As you say- in for a penny… Look where that gets us.
I don’t suppose I can respond to this very well because I don’t agree with the premise that taxation is theft, any more than I agree that the death penalty is murder. The government is not a person and different standards apply. The older I get, the more I tend to agree with Hobbes’ notion that government is Leviathan. In its absence, individuals would be beset by many more lesser predators that, collectively, do far more damage than does the government. Absent involuntary taxation, I don’t think the government can effectively keep the lesser predators at bay.
Does that mean I think government should have absolute authority or be able to confiscate 100% of my property? No. As with most things, there is a balance to be struck. It’s messy, not precise or simple. One primary goal would be to make government’s ability to abuse me as limited as possible while still being effective at preventing private actors from using violence or other kinds of leverage to coerce me.
Jason,
Homogeny has nothing to do with it. Actual number of people is the point. We have no idea how many people are in our country. We have a series of guesses based on flawed assumptions and old data. The 2010 census should help, but that’s not a cure-all for the problem. We also have no idea how many of these people will react upon learning that their every health care need and desire will be satisfied by Washington DC. We can assume they will react in a fashion not unlike the way college freshmen respond to a sudden and simultaneous dose of bad influences and absence of any and all parental control.
Here’s the long and short of it: Most people have NO idea how health insurance actually works. The layman’s impression of its function is basically that you put a little money in, and get a lot of benefit out…like some sort of fantastic slot machine that just keeps on hitting the jackpot. Put a little in, cash out whenever you feel like it. Unfortunately, this isn’t how insurance works at all. It no more follows this pattern than a Magic 8-Ball actually reads your mind and tells the future. It’s preposterous. Why is there some assumption out there that the cash actually exists to cover every human in our country? If that was the case, then it would be a better deal for most people (let’s say, 75% of them :) to stick with the “system” as it is right now and NOT try to spread their premium dollars over a wider base of individuals for what would logically have to be thinner coverage. I understand that Americans overpay for a lot of health-related services, but we also overpay for cars, houses and restaurant dining. But remember, prices are only supported by the willingness of the market to bear them.
“Arbitrage would probably make the state health systems ineffective.”
Huh? How so?
“But I’m not sure why we don’t think the Canadian, French, Japanese, British, Australian, or whoever’s health systems are scalable.”
Why is it a no-brainer that they would be scalable? Why is it preferable to try one grand, federal experiment rather than 50 different state-based approaches? Was it a mistake to move toward decentralization with welfare in the mid-1990s?
If we’re going to get scalable, let’s replicate Singapore’s system.
Andrew said, “I understand that Americans overpay for a lot of health-related services, but we also overpay for cars, houses and restaurant dining. But remember, prices are only supported by the willingness of the market to bear them.”
The difference, of course, is that the penalties for opting out of cars, houses and dining out are minor in comparison to opting out of health care where the potential “penalty” is death.
Another difference is that health care and health insurance are much more heavily subsidized, leading to the much higher costs of provision.
What would an oil change cost if car insurance covered 90% of its cost to consumers?
Off the top of my head, a business owner could locate just over a state line, profiting from the market of a state with healthier citizens who spent less overall on health care (and had more to spend on other things) while avoiding having to contribute to such things through taxes or employment regulations in his or her chosen state.
Screw it. I give. This thread has taken a tack where no matter what rational, logical point I may illustrate, I just keep getting beaten over the head with the whole “it’s sooooo inhumane for (certain) people to pay for their medicine and treatment” routine.
I’ll leave you with this: Right now, most Americans don’t pull their own weight with respect to taxes. Period. It’s probably not going to get any better if a “health care system” is crammed up our collective rectum.
Andrew – As rational as your argument may be that some people should just be allowed to die due to not being able to afford health insurance, you come across as sociopathic in your lack of empathy for the pain and struggles of those who are suffering or will suffer as a result of high prices, being under insured or lacking insurance.
We recoil in disgust when such a lack of empathy is shown by a murderer. I find it nearly equally as disgusting when exhibited by those who seek profits and claim that any emotional response is invalid.
Practically, those effects would probably not be that significant– and in any case, could be more bad than good. For example, it might keep a state from doing stupid things– like competition tends to do. In any case, this rationale would set the table for nationalizing anything– from welfare policy to state-based regs and taxes. I don’t think you want to go there…
MIke Kole posted:Lou, I favor a voluntary society. My belief is that when an action is worth undertaking, people will lead at the opportunity”
I don’t disagree with that,but people get involved for their own reasons,which vary widley. My family has been a military family for several generations, but maybe that’s because each generation has its wars. My brother joined the Navy in peacetime but ended up on the USS Wisconsin in the first Iraqi war firing 5-inch shells into Iraq. .But he joined for economic reasons when he joined: education and training along with tradition.Peacetime military offers personal incentives for people to join,but then when there is need they’re there to be called.He retired from Navy at 42,after 25+ yrs, with a life long pension.(thats probably more widley accepted than a teacher retiring at 60 with a lifelong pension!)Then he went to school paid for by military benefits and became a long distance semi driver.
This is just one antecdote but I think typical.And my father enlisted in the Navy in 1942 ‘for the duration’ when I was 6 months old. He said he saw ‘the writing on the wall’ but also he couldnt get a job at that time. Economy had been and was still very bad.
If something is voluntary,then there has to be incentives for personal benefit ,but also rules for what you have to offer.To say capitalism(profit mandates) is all we need to fix a societal issues is blind,naive belief;there has to be some kind of written or understood pre-issued mutually binding contract( it seems to me).It’s just common sense. When one joins the military everything is spelled out for both sides.
Mary, A note about your daughters experience seeing a doctor in Europe. I can speak more clearly about France,but I think European countries are more like each other than any one is like in the States. And Europoeans who have visited me on home exchanges to the USA are ‘horrified’ by what they see as an inefficient American system. It’s ironic that these ‘socialist Europeans’ see their system as the efficient one.
I forgot one of my perscription drugs once and was able to buy it over the counter for $7 in France. It was what my co-pay would have been with my insurance in the States.Pharmacists can perscribe persciption drugs in France,and they ask questions about why you need it, as a doctor would. In the time I was in Mexico I could buy penicillin in the drugstore.Many do home remedies.
One difference I found in Europe was that the nurse will lay the medication on the stand next to your bed and she assumes you will take it whereas in an American hospital the nurse stands there and watches you take it..First day I waited for the nurse to come back to hand it to me. I was also amused at the doctors in Berlin when they consulted each other.One talked and the others listened at attention and nodded..Yet they all were wearing jeans and sneakers and a white smock…typical German doctor’s attire.Reminded me of a Laugh-In skit at time.
Eric – Who were you responding to in your last message? I’m a bit confused. ;)
Eric was talking to me and my musings about jurisdictional arbitrage (if I’m even using that term correctly.) I might be off base on that one, but I’m working from the general premise that it will be an uneven playing field where some of the players (or playing pieces, I suppose) can move freely across borders with few constraints while the state-based health care regulations are confined to the geographic area of the state.
Andrew – I might disagree with you on some of the particulars, but for my part, I would not shy away from the notion that some folks are going to have to die. I can think of a scenario where we pour gobs of our economic resources into marginal health cases and have little to show for it at the end. If we the people don’t take a rational view of what can and cannot reasonably be done to help people, politically this will never work. Tough choices have to be made and they won’t be if every time Grandma Millie dies from cancer, some politician catches hell for it.
Doug/Andrew – I fail to see how wanting to live is irrational or unreasonable.
The naysayers, some of whom claim that they are only speaking rationally, have emotional responses to the debate that they are not aware of or somehow consider their own feelings more noble. A lot of the opposition seems scared in a selfish way of their own benefits being cut. No admission of this on their part, only the claim that their arguments are dispassionate.
I also find it hypocritical on some naysayers part that they’re worried about the costs of this plan, but were cheerleaders for two wars that have cost us billions and thousands of lives and which we got into largely because of emotional reasons (fear, anger, revenge, greed).
What gets me the most about this debate is that we have examples around the world of how health care systems can work, effectively, for entire countries. Yes, our country is different, but I don’t think our country is so different that some modifications can’t be made to those examples to fit here.
As a teenager, I went on a trip to Spain. One of the young women in our group sprained her ankle. We took her to a nearby clinic/urgent care where there was absolutely no paperwork for her to be treated that I can remember, where the only reason she was asked her name was so they knew how to refer to her, where she was seen quickly with little wait and where she didn’t have to pay one red cent for her treatment. Purely from a stress standpoint, this experience was light years better than any experience I’ve ever had here in the states. I’d be more than willing to pay a significant amount more in taxes to have a system that gave everyone this same experience.
It’s perfectly rational for an individual to want to live. It might not be rational for a society to direct its resources to keeping that individual alive. Just taking an extreme to illustrate the point, if it’s going to cost $10 million to keep the person alive for another day, if the person has that kind of money, it might be rational for him or her to spend it on the extra day of life. It wouldn’t be rational for a government or an insurer to spend that much money to keep the person alive for that amount of time. On the other hand, it would be unforgivable for a government or health insurer to refuse to spend $1 to keep the person alive for another 20 years even if the person didn’t have a dollar.
As the time period grows longer and the price tag grows smaller, the line becomes more and more difficult to draw. Even more so because the cost and outcomes are usually probabilities and not certainties.