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Phaedrus said...
Universal Healthcare like every other kind of socialism saps the strength of innovation. There is no drive to improve such a system and it stagnates. Bread was 'universaly available' in the Soviet system as well. No hunger there ever right? Since it would be complete insanity for a government to try to provide the absolute best in medical technology and new therapy to every citizen - instant bankruptcy, what the people end up getting is the affordable mediocre medical treatment that won't stress the system.
It is only by opening it up to capitalism and the free market that the best things become available at all, and then those things eventually become cheaper and everyone benefits.
You are right when you say that democracy and the public good benefit by better health. You are wrong in thinking that can be achieved by declaring healthcare a universal right. It is the same as pretending that poverty could be eliminated if we took everyones money away and gave it back to everyone equally: causing productivity and economic growth to completely disintergrate. Canada's best doctors go the same place their best actors go. There's a very good reason for that.
coralhei said...
1. Note that I am not terribly uptight about keeping the discussion on the original topic. I wish universal health care were on the South Dakota ballot. South Dakota may lack the population necessary to create a statewide risk pool... although we already have the high-risk pool sponsored by the state to serve those good citizens whom the free market refuses to serve, so maybe we could cover everyone.
2. Phaedrus raises the red flag on declaring health care a right. Erin and I don't have to go that far. We can look at the matter purely in pragmatic terms. The private system isn't doing what Phaedrus says it should. Where are the absolute best technologies and therapies that the free market should be making cheaper and available to everyone? Health care costs are going up much faster than inflation. Fewer and fewer people can afford basic health care (like pre-natal check-ups, well-baby doctor visits, etc.). What good are the "absolute best" medical technologies and therapies if they drive families into bankruptcy even when they seek basic care for medical emergencies? Maybe "affordable mediocre medical treatment that won't stress the system" wouldn't be so bad.
By the way, Phaedrus makes analogies to the bread shortages in the Soviet Union. Why not make a better analogy, directly to the Soviet Union's universal health care system? Russians had better access to health care and better health outcomes under the Soviet system than they do under today's mafia-capitalism.
Phaedrus's analogy to the failure of food distribution in the USSR misses the point. Food distribution under the free market system works because we can make genuine free market choices. We have the time to decide which loaf of bread we want for supper, which bakery we want to buy from, or even whether we want to bake it ourselves. I can get all the information I need about bread costs and bread options from the bakery ads in the paper and by trying the bread from different bakeries each week to decide which bread best serves my needs. I don't need a complex insurance policy to obtain bread (and I don't get charged extra if I walk into a bakery to buy bread out-of-pocket). Take the preceding four sentences, try substituting "health care" for "bread" and "hospital" for "bakery," and you'll see the failure of Phaedrus's faith in the free market to provide health care.
Hospital patients cannot get the time or information they need to make genuine free market decisions about their health care. The doctors and nurses administering the care cannot tell the patient how much the shots and pills and procedures they are offering cost. When a man stumbles into the ER on a Saturday night with an appendicitis, the only people who can tell him how much the procedure will cost, the business office staff, are all at home sleeping and won't be in until Monday morning. South Dakota passes a law requiring hospitals to post their charges, but we only get a list of median charges for up to 25 most common general procedures, with no practical breakdown of specific charges within each procedure that a patient might reasonably be able to minimize through wise choices (assuming the patient is not unconscious, in labor, vomiting blood, terrified of dying, or experiencing some other distraction that might hamper her or his responsible free-market decision-making). The free market cannot work in a situation where real choice and information are not available.
I love the free market. I wish it worked all the time. But it doesn't. And when it doesn't, Adam Smith says government needs to step in and get the job done. Health care does not allow genuine free market decision-making. The free market is pricing more and more people out of health care. Universal health care might not get us the best erectile-dysfunction treatments, but it would get shots and check-ups to everyone who wants them and stop half of all bankruptcies to boot. When the free market can lower my health insurance premiums -- or heck, just limit the premium increases to the rate of my wage increases -- give me a call. Until then, I vote for universal health care, not because it's a right, but because it gets the job done better.
RIP Quincy Jones
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Probably one of the greatest music producers EVER! I have to tell you, I
have been beside myself, I get it, he was old, but everything you listened
to deca...
5 hours ago
Since receiving Erin's comment in the voter thread, I started hashing out an essay on the subject myself. I'll link it here when it's done.
ReplyDeleteAnyway, in response to the Adam Smith comment... is Universal Health Care the only solution? Yes, the free market isn't doing the job here (details in my forthcoming essay)... but couldn't the solution be merely to regulate hospital prices rather than all-out insurance? Like electricity... the gov doesn't let Excel charge whatever they want (California deregulated utilities and it was a mess). Why not treat health care as another utility? Consumers still purchase it on their own and take responsibility for their own health... but the government makes sure that (like electricity and water) it's afforable for everyone.
When I last heard that Adam Smith comment at my college econ class, it was in the chapter about government regulations... not entitlements.
Oh, and by the way... the abortion legislation isn't unconstitutional. It was ruled that way in Roe v Wade, by the dubious interpretation that the 14th amendment guarantees a right to privacy. The exact sentence the justices referred to in their decision reads as follows:
ReplyDeleteNo State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall
any State deprive any person of life, liberty, or property, without
due process of law; nor deny to any person within its jurisdiction
the equal protection of the laws.
"liberty" being the word they focused on.
However, the word privacy doesn't occur a single time in any of the the amendments, and to me a plain reading of this sentence absolutely does not support a right privacy, much less a right to have an abortion. South Dakota's case may very well be struck down by the US Supreme Court... but as goes the moral of Mr. Smith Goes to Washington, "Lost causes are the only causes worth fighting for."
Roe v Wade was a case of judge activism and a political agenda... not constitutionality.
On privacy:
ReplyDelete"The makers of our Constitution . . . conferred, as against the government, the right to be let alone--the most comprehensive of rights and the right most valued by civilized men."
--Justice Louis D. Brandeis (1928)
Considering the level of disagreement in the current Supreme Court I don't understand the point of quoting a singe justice from 1928. Especially when he is wrong :) Privacy just like every right we have is limited. I don't think it is a stretch to say that commiting what some citizens (not myself) believe to be murder could possibly be protected as being a personal choice! What was wrong in Roe v Wade wasn't so much the decision anyway, it was the fact that the court made a decision at all. There is nothing in the constitution that defines when life begins. As such it was the purvue of the people to legislate though the democratic process laws concerning it that could be changed over time as the need arose or to ammend the constitution. It was far, far beyond the courts power to make that decision because it felt that there was a need.
ReplyDelete(sorry about already diverging from the topic Cory!)
The mess that happened during California deregulating energy was caused only in a very small part by corporate greed. More of it was caused by destructive price controls, inadequate maintanance of the power generation infrastructure, non-existance of adequate power generation within the state.
ReplyDeleteI find it fascinating that David would contemplate the CA electricity crisis in the same paragraph that he suggests that heathcare could be helped though price regulations. Price regulation would only compound the problem just like it did in CA. The solution regarding high healthcare prices is actually to shift more of the burden back to the consumer. If the risk to insurance companies declined, so would the premiums. I have a high deductable policy in combination with an HSA. My premium is $10/month with a deductable of $1,700 but after a couple years I will have enough in my HSA (wich becomes an investment for retirement if it isn't used) to pay for the entire deductable.
The free market can work for healthcare. Just because it isn't right now doesn't mean we throw the baby out with the bathwater. It just means we need to fix the market.
CAH said...Where are the absolute best technologies and therapies that the free market should be making cheaper and available to everyone?
ReplyDeleteAnswer: how much did an X-ray cost 15 years ago? How much did an MRI cost when they first became available? there are countless treatments that are constantly entering the market and old treatments that do become cheaper. If a patient benefits more from the MRI, that is what we give them. The cost of healthcare restricted only to the treatments in use in 1986 would not be racing upward at all (and if universal healthcare had been implemented back then it is entirely likely the current treatments would be the same as back then.)
You will have to point me to some evidence that USSR universal healthcare was anything but abysmal. Unless you are comparing their previous system to the their current system, the availability and outcomes have never been anything to be proud of.
The free market works poorly inside the ER... Making market decisions at least requires the consciousness of the buyer after all...although the misuse of the ER is another matter entirely and that has caused the closure of ERs making healthcare completely unavailable because hospitals could not afford to keep them open for illegal aliens to use at will. (buy that's another issue)I simply want to point out that however poorly it works inside the ER, it works just fine before people get there.
So how about we compromise--we offer universal healthcare that covers only treatments that were around in 1986.
$10 a month with a $1700 deductible? Holy cow -- where do we sign up? Our current HSA policy is $280 a month with a $7500 family deductible.
ReplyDeleteBy the way, our plan is an HSA plan as well, but our impression is that HSAs are just another so to wealthy people who have big chunks of disposable income to invest. Or maybe we folks toward the bottom of the middle class are just too dumb to invest our money wisely or to figure out how to make money in the first place and thus deserve all of our troubles. (Use abortion laws to punish women for getting raped; use the health care system to punish the poo for not being better capitalists; sounds consistent to me.)
Shift more burden to the consumer: actually, I could go that direction. David once suggested that health insurance is really a form of gambling and that we could thus justify banning it the same way we ban other forms of gambling. I would like to think that if we were to ban health insurance, we would see prices go down, since individuals could not afford to indulge in extra tests and longer stays in the hospital. But I've become more cautious of that idea given that under the current system, hospitals charge the uninsured more than the insured.
But either way, free market forces aren't working. Even conscious patients cannot get the information they need to make truly informed purchasing decisions in the hospital. I was perfectly conscious throughout the decision-making process for taking my wife to he hospital, helping her give birth, and then deciding what treatments would be given to our daughter when she was born with possible pneumonia. Not one of the doctors or nurses around us could tell us what the procedures or medicines or even the diapers they were using would cost us. They hardly ever asked us what we wanted them to do. It seems the only time at which I might have had a choice was right when the baby emerged from the womb, when I could have looked at our daughter's unhealthy color and weak limbs and said, "Oh, actually, I think she'll get over that on her own. Skip the ICU; we'll just take her home, thanks." Actually, at the hospital in Sioux Falls, we wouldn't even have had that option. The hospital would not have let us choose to end care and leave the hospital with our baby until at the very least we had watched three safety videos. In so many ways, free-market choice is not a viable option in the health care system, even for perfectly conscious, rational patients like Phaedrus and David.
Say, Phaedrus, $10 a month -- that's not through your employer, is it? Given your position that we should shift more health care costs to the consumer, I'm sure you wouldn't leave it to your boss to pay for even part of your health insurance... would you? Again, hook me up with your insurance agent. I'll trade in my $280/month family policy, paid for entirely out of my pocket, in a heartbeat.
ReplyDelete"Use abortion laws to punish women for getting raped"
ReplyDeleteUnder the proposed law, a rape victim is perfectly capable of taking the morning-after pill. (What rape victim wouldn't do that as quickly as possible? Do they suddenly come to their senses 10 days after the fact?)
Making rape a legitimate excuse for getting an abortion would mean that courts would be flooded in supposed date-rape instances. Logistically, making rape/incest a legal exception would be a nightmare. The law as proposed makes the most sense for people who consider casual abortions to be an act of irresponsibility.
"use the health care system to punish the poo for not being better capitalists; sounds consistent to me."
Not me. I think that health care, like electricity and water, should be affordable to everyone. But I do not believe that we are entitled to it, and it encourages irresponsibility for the state to pick up the meth addict, put him in the ER until he's back to full health, and release him back into society to go back to his old ways.
Regulation is the answer. Not state-funded health care.
Hopefully it is obvious I mean "the poor," not "the poo." How embarrassing! :-)
ReplyDeleteAs I've stated before, Erin and I do not have to argue and are not arguing from the entitlement position. We are arguing from the affordability position. And unless Phaedrus's agent can come through for us, health care under the faux-free market is getting less affordable, not more.
ReplyDeleteDavid, is your world really so filled with meth addicts and irresponsible, lying women? What about working parents who don't drink, don't do drugs, and wouldn't consider filing false charges in court against anyone, but who, golly gee, still find health care and health insurance beyond their budget? What's their problem? Not saying the prayer of Jabez enough?
ReplyDelete"David, is your world really so filled with meth addicts and irresponsible, lying women? What about working parents who don't drink, don't do drugs, and wouldn't consider filing false charges in court against anyone, but who, golly gee, still find health care and health insurance beyond their budget? What's their problem? Not saying the prayer of Jabez enough?"
ReplyDeleteDoesn't my regulation solution make health insurance affordable?
I mean essentially the solutions offered by state-sponsored health boils down to two things: (A) government lowers the reimbursement doctors receive, and then (B) the government pays it.
I think part (A) is the solution we're looking for all by itself. Your thoughts?
David: The solution isn't to try to make health insurance affordable, it is to make health care more affordable - keep your eye on the ball - regulating prices never makes prices cheaper.
ReplyDeleteCory: Yes the insurance is through my employer, but it is only for myself, not a family plan, and it covers at 80% once the deductable is met. That way it is nicely useless for the regular medical bills the way insurance should be but saves me from disaster should I get hit hard. HSA's aren't a sop to the wealthy, they are far too limited. They are a great benefit that returns a lot of control to people like me. Don't you get some employer contribution to your insurance at all?
take a look here, you should be able to find something better than what your describing: http://www.ehealthinsurance.com/
Thanks for the info, Phaedrus. I'm still wondering: wouldn't it be more consistent with what you were saying earlier to tell you emploer "Thanks but no thanks" and assume complete responsibility for yourown health care costs? I think employer-paid health insurance is a great benefit, but does an employer have any obligation to provide it?
ReplyDeleteMy employer, Montrose School District, does offer a health plan. Were I to take individual coverage, I would lose $1440 from my annual pay of just under $30K and pay an additional monthly premium of just $39 a month. The plan has a mere $500 deductible, geared toward the older members of the staff, many of home are the second income of their household and take hold the job mostly to pay for the health plan. Were I to enroll myself plus my wife and daughter, we would pay a monthly premium of over $1000. We get paid twice monthly, so every other check would go straight to the insurance company, leaving me with just over $1000 a month in take-home pay. That's why we have opted for a private plan that provides much less coverage at a monthly premium we can still just barely afford. So obviously, my interest in universal health care is far from altruistic. I want to help others, but I also want not to go broke. (So why am I sitting here blogging instead of working? Hmmm....)
"David: The solution isn't to try to make health insurance affordable, it is to make health care more affordable - keep your eye on the ball - regulating prices never makes prices cheaper."
ReplyDeleteWell... I need a little more explanation behind this.
Let's say doctors currently charge $100 to remove a mole. And let's say that the government (if given the say so) would regulate that price to $40 per mole removal.
If this were the case, it seems pretty obvious that health care would be more affordable for uninsureds. And it also seems obvious that health insurance companies would pay less in claims... therefore the free market to drive down premiums to a sensible level.
If we can make it a law that water stays at a nice low price, we can make it a law that physicals, prescription drugs, and surgeries stay at a nice low price, too. And it sure seems to me that that would solve all our problems. Cory and I are looking for a practical solution (rather than an all-out entitlement), and I don't see any the disadvantage to this one.
Please correct my logic where I am wrong. Stating that "regulating prices never makes prices cheaper" makes no sense to me without some further explanation.
David's quote: "Under the proposed law, a rape victim is perfectly capable of taking the morning-after pill. (What rape victim wouldn't do that as quickly as possible? Do they suddenly come to their senses 10 days after the fact?)"
ReplyDeleteOh my, I don’t even know where to start with this one. Here goes:
1. This law does NOT ensure that Plan B is available throughout the state. Current state law states that pharmacies are not required to provide Plan B and if a pharmacist is opposed to distributing Plan B, s/he is not legally required to do so. If you live in a small town in South Dakota with a very limited number of pharmacists (and that's a fairly likely possibility in SD), it’s entirely likely that you have zero access to Plan B.
Also, Plan B must be taken within 72 hours of unprotected sex in order to be effective, so the 14-day clause in the abortion ban is virtually meaningless.
Also, Plan B is available from behind the pharmacy counter without a prescription only to people 18 years or older (proved with a photo ID). It's available to women under 18 only with a prescription.
2. At the very worst, this statement strikes me as misogynist. At its best, it reveals a lack of understanding of the effects of rape and a lack of appreciation for the myriad rape situations that may inhibit a woman (or a young girl) from reporting a rape and seeking out emergency contraception.
Two rape situations with which I am personally well-acquainted: One was a 14-year-old girl raped by a neighbor. She was so frightened and convinced it was her fault that she didn’t tell anyone about it until she was in college. Another was a 12-year-old girl seduced by a much older man. Mom and Dad found out about it, filed charges against the man, and moved to another city. Daughter came to believe she was worth nothing more than a sexual object for the pleasure of men and acted accordingly. At 14, she became involved again with a much older man. When Mom and Dad found out this time, they blamed the daughter, daughter never got the help she needed, and nothing happened to the man. Thank God no pregnancies resulted from either of these cases.
I relate these two situations to you, David, to demonstrate that rape cases are incredibly complex and individual situations. There are any number of reasons why a woman (or man, for that matter) would not report a rape within 10 days. Rape is an act that is incredibly traumatic and destructive to the victim. Quite frankly, yes, it takes 10 days or much longer for some victims to "come to their senses," as you so flippantly put it.
(Cory, my apologies that this comment is off-topic, but I couldn't pass it up.)
It seems as though there are pretty much 3 opinions on the matter of abortion:
ReplyDelete1) All abortion is wrong because a fetus is fully human at conception.
2) Casual abortions are wrong because they are irresponsible. But when sex isn't consensual it's ok for the mother to have the option of getting an abortion.
3) A woman has the right to choose whether or not to terminate her pregnancy no matter the cause for that pregnancy (usually up until X number of weeks, after which the unborn child is clearly human).
The law passed by the SD legislature most clearly reflects mindset 1. I am of mindset 2. I don't know where you and Cory are...
However, as my friend Phil Assmus convinced me last night (which changed my stance on the tobacco tax), you have to vote on the law that's presented, not your ideal law. True, I wish there was more leniency for cases of rape and incest. There is a little bit, as I mentioned, with the day-after pill... but not a whole lot, as you point out. (And yes, I was embarrassingly flippant in my portrayal of a rape victim.)
However my (our?) ideal law isn't on the ballot. And given position #1 or position #3, I find position #1 to be closer to my position (#2), and better for society.
I don't see any sense in voting no on a law just because it's not my ideal one. A voter should compare the status quo to the hypothetical status quo post were the law to pass.
Just finished my essay on health care. I decided just to link it rather than copy/paste the whole thing into a comment on your blog.
ReplyDeleteI'd love to hear feedback from all of you (either here or on the discussion page of the essay).
Interesting that Phil has been able to convince David to step away from his usual idealism and vote for an imperfect law just in time to suit David's political desires. But Referred Law 6 is less than ideal: it won't work. If passed, it will likely face an immediate court challenge and thus not go into effect for 2-3 years while the courts (and high-priced lawyers) hash it out. It will save no babies during that time, and unless there are significant changes on the Supreme Court, it will be declared unconstitutional and save no babies ever. Plus, it is based on a patronizing, arguably misogynist view of women as untrustworthy and unequal creatures whom the state must protect from their own inability to make wise choices for themselves (or, alternately and more radically, whom the state can mandate to serve the needs of another person without compensation, a.k.a. slavery). No solvency, dangerous moral foundation -- talk about "less than ideal"!
ReplyDeleteDavid's "it's not perfect, but it's what's before us" position is sounds like this approach to buying a computer: I want a reliable laptop for under a thousand dollars with wireless, widescreen, and enough memory to play Civ IV fast. The salesman in front of me is offering a refurbished laptop for $2000 with no wireless, an 8" screen, 128 MB RAM (Civ IV takes at least 512MB), pirated OS software with plenty of bugs, and a battery that will explode. Plus, the salesman is clearly distorting the truth. Buy the laptop, David says. I say reject the sales pitch and try to get a computer that will really work.
"Interesting that Phil has been able to convince David to step away from his usual idealism and vote for an imperfect law just in time to suit David's political desires."
ReplyDeleteHuh? I still think the tobacco tax is unjust. I don't like the idea of a certain class of citizens paying more in taxes. However, what Phil pointed out is that through Medicare/Medicaid smokers use a disproportionate amount of government dollars... To which my argument was that we are then using one bad idea (state-sponsored health care) to support another bad idea (tobacco tax). But since I can't vote to get rid of Medicare/Medicaid, I have to consider the tobacco tax in full consideration of that system... in which case, yes, they should pay more to make up for extra money they take out.
But how does this suit my political desires? I still think both are bad.
"But Referred Law 6 is less than ideal: it won't work. If passed, it will likely face an immediate court challenge and thus not go into effect for 2-3 years while the courts (and high-priced lawyers) hash it out. It will save no babies during that time, and unless there are significant changes on the Supreme Court, it will be declared unconstitutional and save no babies ever."
As mentioned earlier, I don't think that it's unconstitutional. It has a chance (in my mind, a good chance) of winning those court cases, and then correcting a deep moral flaw in our society. One could mount a pre-civil war argument with your exact same reasoning about why abolitionists should be content to keep slavery. I see casual abortion as a moral wrong nearly as great as slavery. Lawyers and courts aside, what do you and Erin really think about it?
"Plus, it is based on a patronizing, arguably misogynist view of women as untrustworthy and unequal creatures whom the state must protect from their own inability to make wise choices for themselves (or, alternately and more radically, whom the state can mandate to serve the needs of another person without compensation, a.k.a. slavery). No solvency, dangerous moral foundation -- talk about "less than ideal"!"
This smells like hyperbole. Certainly there is nothing in the text of the proposed law that says women are untrustworthy... and roughly 800 abortions Vs a population of 800,000 South Dakotans suggests that number of women seeking abortions are a very very small minority. Passing a law against those 800 says nothing about disrespecting the other 400,000 females.
Should murder be completely legal? Can't we trust society to make wise decisions about when to kill or not to kill another adult? Sorry, but humans are fallen creatures. They cannot be expected to act wisely.
"David's "it's not perfect, but it's what's before us" position is sounds like this approach to buying a computer: I want a reliable laptop for under a thousand dollars with wireless, widescreen, and enough memory to play Civ IV fast. The salesman in front of me is offering a refurbished laptop for $2000 with no wireless, an 8" screen, 128 MB RAM (Civ IV takes at least 512MB), pirated OS software with plenty of bugs, and a battery that will explode. Plus, the salesman is clearly distorting the truth. Buy the laptop, David says. I say reject the sales pitch and try to get a computer that will really work."
Ok. So tell me what sort of abortion law "really works"... how much different would it be from the one that's proposed? The status quo doesn't work at all... there are about 800 casual abortions a year, which is outrageous. In my mind, that's like a computer that doesn't boot up at all and punches you in the face three times a day. So with only two options here, I'll take pirated MS-DOS.
[trying to get back on topic] Hey, what do you guys think about my regulation idea on health care, though?
ReplyDeleteA little more support for universal health care from Dr. John Geyman, University of Washington... (I'll get to your essay, David, don't worry!)
ReplyDeleteDavid: Its basic economics that when you artificially restrict the price you cut out the portion of the market that is unwilling to supply the product at that price. Government price caps have historicly been the cause of supply shortages that later result in a severe price jump as soon as the government removes the cap (which it has to eventually unless it takes over supplying the product as in water)
ReplyDeleteThe other alternative is that a substitute product is found by the consumers that can't get the original product and normal market forces over-ride the price cap and the price of the substitute jumps up with the increase demand. Then the government in its great wisdom will probably just stick another price limit on the alternative and the whole process repeats itself.
The government can force a hospital to give an MRI for $50 if it likes....but the cost for a hospital to own and operate the equipment means that quite rapidly no hospital would offer the procedure.
Price caps are a rapid way to mess up a market situation that we have already established does not work very well. I would much rather have the government push hospitals to fully inform patients about the costs of procedures. It's wrong that nobody would tell CAH how much something was going to cost him before he got the bill.
I have also always been very much for voucher programs and it seems that an employer should be providing some pre-tax voucher support to any employee that does not want to participate in the jobs group medical plan. Somehow I don't think that the school only contributes $1440 a year towards the premium cost of that individual plan if it only costs $39 a month out of a teacher's pocket. Maybe I'm wrong though.
Sounds like Phaedrus knows his economics. By the way, Phasedrus is right: my employer's contribution to individual health plan is surely more than $1440 a year. The school has an interest in maintaining a larger pool, so it does not return the full amount of its contribution to me when I decline the school's coverage and seek my own insurance. Plus, I'm grandfathered in; new hires since 2003 don't even get the choice. So a new teacher offered a job has one more restriction placed on her free-market choice: once she takes the job at my school, she gives up her freedom to pick a health insurance policy that suits her needs -- or, more accurately, she can decline coverage and buy a private policy, but the school gives her no extra compensation. Some choice.
ReplyDelete"So a new teacher offered a job has one more restriction placed on her free-market choice: once she takes the job at my school, she gives up her freedom to pick a health insurance policy that suits her needs -- or, more accurately, she can decline coverage and buy a private policy, but the school gives her no extra compensation. Some choice."
ReplyDeleteAnd as found in my essay, that's also one of my chief concerns with universal health care... the government forces on every citizen an enormous purchasing decision.
I am actually ok being uninsured, I don't freak myself out with ghastly motor accident or terminal illness scenarios. But when something as ancient and as common as a healthy birth requires one to take out a second mortgage on their home... the pricing structure is seriously screwed up.
Phaedrus: I have taken some econ myself, and I don't think that regulation automatically triggers the disadvantages you suggest.
ReplyDeleteFirst of all, I'm not advocating that procedures are priced at such a level that hospitals lose money. The price for getting an MRI should be based on the cost of the equipment (which may also need to be regulated... medical equipment is another racket, and so are pharmaceuticals), and the average number of times used in a year, with a decent cut included for the hospital, too.
"Decent" cut, not an "outrageous" cut. Hospitals right now have gross inefficiencies, from a ridiculously high nurse-to-patient ratio to complimentary valet service. These inefficiencies come from over-priced services... and I'm suggesting that we use regulation to bring that down to normal-priced services.
For one counter-example to your scenario, consider Medicare. Medicare reimburses hospitals less than private health insurance or uninsured patients... and yet hospitals aren't coming to any economic catastrophe. The Medicare levels were established based one usual and customaries across the nation... and while there are some mistakes in the fee schedule, the concept seems to work just fine.
If we were to merely pass a law saying that hospitals collected Medicare-level reimbursement from every Tom, Dick, and Harry, I think hospitals would still be in fine shape. Which seems a lot easier (and more fair) than requiring the additional step of putting every citizen on Medicare.
Medicare reimburses hospitals less than private health insurance or uninsured patients... and yet hospitals aren't coming to any economic catastrophe.
ReplyDeleteLOL - medicare works??
Medicare is an economic catastrophy. what has been said about social security for the future is already happening in the Medicare system and it is already putting more and more pressure on state budgets. It's a bankrupt beurocracy that survives by devouring bigger chunks every year. You would honestly allow the government to determine what profit was outrageous and base prices on what current prices were at the time - completely ignoring any changes in the market and effectively fixing the price. Hospitals lose money because of medicare. The reimbursement often does not actually cover the cost and they just eat it. Your argument is no more legitimate than the more recent critisism of the oil industry making "obscene" profits. Overly high nurse to patient ratio's? Tell that to a hospital after a multimillion dollar lawsuit. Speaking of which nobody has mentioned one of the forces that creat these "obscene" charges - litigation. Is everyone here in favor of restricting "obscene" profits in lawsuits? thats one of the few places I'll climb on board.
you were awake in those classes David?
"Medicare is an economic catastrophy. what has been said about social security for the future is already happening in the Medicare system and it is already putting more and more pressure on state budgets. It's a bankrupt beurocracy that survives by devouring bigger chunks every year."
ReplyDeleteSo it's a failure on the government side? You'll get no objection from me. But the hospitals themselves aren't having an economic catastrophe from the money they receive from Medicare... they're fattening up and shopping for new belts to hold their pants on. Complimentary valet service?
"Speaking of which nobody has mentioned one of the forces that creat these "obscene" charges - litigation."
I can see you didn't read my essay. It was right there, in bold.
In case anyone is interested, my brother Michael (second year in medical school) offered some insights on my essay, as well.
ReplyDeletewell david, I read your essay now. You understand some of the problems but I don't think you have hit a solution. I don't believe that there is so much overpricing in the medical sector as you seem to believe. Hospitals and Insurance don't dictate whatever price they feel like, there is enough competition to keep that from happening, and there are pleanty of hospitals that have financial difficulty. I think the primary thing that we need to change is societies attitudes towards health. It is a societal good, however it is not a societal right. If we are ever going to get a handle on the cost we have to be willing to allow more suffering where it is not affordable. This is similar to Cory's stance of abortion law. Allowing abortion to reduce the numbers. Stop feeling like we should save everyone and more people will be better off. Make Insurance be a failsafe, not a catch-all.
ReplyDelete1. no premiums under $1000
2. mandatory medical savings accounts
3. no Medicare
"1. no premiums under $1000"
ReplyDeleteDo you mean "no deductibles under $1000"?
......um..yeah $1000 deductables, sorry, neural blue screen of death....
ReplyDeletePhaedrus: "I don't believe that there is so much overpricing in the medical sector as you seem to believe."
ReplyDelete5% of the total spent on health care in 2004 was fradulent ($60 billion).
That's when a hospital jacks rates so high as to be illegal.
David. fraudulent medical cost is also creating false claims for insurance companies or Medicare. Since we're tossing off links
ReplyDeleteFRAUD I know this kind of stuff does drive up premiums but I still don't see any evidence that hospitals overpricing is a significant factor in high medical cost....that's like blaming ENRON for the California energy debacle, just the victims kicking the most obvious target.
"I know this kind of stuff does drive up premiums but I still don't see any evidence that hospitals overpricing is a significant factor in high medical cost....that's like blaming ENRON for the California energy debacle, just the victims kicking the most obvious target."
ReplyDeleteOk...
So do you think that hospital prices are (A) too high or (B) affordable?
If (B), then do you think health care premiums are (A) too high or (B) afforable?
If you answered (A) for either question, please tell me what you think caused prices to escalate? If you answer (B) to both, there probably isn't any point to continue the discussion...
I personally answer (A) to both and I think that there is a causal link between high hospital prices and unaffordable premiums. True it's not the only factor, but probably the most substantial one.
When I said I don't think overpricing is significant, I mean I don't think hospitals are taking excessive profit, If they were charging only enough to break even I don't believe prices would drop much at all. Yes I do think prices are much higher than they should be. This has to do with the structure of health insurance and Medicare; the effects of litigation and malpractice liability; and American demographics.
ReplyDeleteWhen I said I don't think overpricing is significant, I mean I don't think hospitals are taking excessive profit, If they were charging only enough to break even I don't believe prices would drop much at all. Yes I do think prices are much higher than they should be. This has to do with the structure of health insurance and Medicare; the effects of litigation and malpractice liability; and American demographics.
ReplyDeleteI think I see what you're saying... correct me if I'm wrong, but it seems to be:
"Hospital pricing is higher that it theoretically could/should be... but the reason it's higher isn't because the hospitals themselves want a higher profit, but because they have to pay malpractice premiums. So yes, the prices are higher but that 'extra' money is going to malpractice insurance not the hospital's treasure trove."
(You also listed "the structure of health insurance and Medicare" and "American demographics" as causes of higher prices... but I don't understand the link there. Please explain?)
Regarding malpractice... the money has to stop somewhere. Hospitals might be raising prices to pass money through to malpractice insurers. But I'm pretty sure that the malpractice insurers aren't just arbitrarily raising their premiums to collect a pot of gold. They're raising premiums because of an increase in lawsuits. So ultimately the money gets passed through to lawyers and plaintiffs. This means that your contention really boils down to the connection that the 'extra' money in hospital prices ends up in the pockets of plaintiffs and their lawyers. The reason I have to pay $1000 for a night in the hospital rather than $200, is because $800 is going to people suing the hospital.
I think malpractice litigation is a contributing factor, but the local hospital's complimentary valet service seems to suggest that there are some other things in the works. How much of that $1000 is going to the guy who parked my car, donations to the local symphony, billboard ads, and other non-essentials like that?