How To Kill Private Insurance (And Kill Us All)
Kaus says:
It's seemed to me that the Obama administration has made a mistake in the framing of the health care issue: 'We'll raise your taxes and in exchange we're going to cut your treatments.' I mean, how could that not have widespread appeal? It's pain/pain!
Here's Mickey with Robert Wright (who looks like he could use a nap) on Bloggingheads:
Untie health care from jobs! Untie health care from jobs!
And, P.S., when government "takes care" of you, that means the rest of us are paying for you. Health care is not a right. It's expensive because it's valuable. Making private insurance compete with government will mean the value goes down. There's really no way around it.
I like this WSJ article (my summary)
Healthcare Reform Myths
Parsing the Health Reform Arguments
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One of the myths: If you like your current plan you can keep it.
You can keep your current plan if it is still offered and the company is still around. This is not a silly consideration. Proponents have learned from the Hillary Care proposal in the 1990's that radical transformation does not sell. The current plan provides a framework to take away freedoms one at a time, to minimize resistance, and obscure the ultimate goal.
A century of monopoly by the Post Office shows us how much Congress likes competition to one of its high-cost, inefficient activities. (Private insurance likely will disappear or be made to conform to government rules, standards, limitations, and costs. -ag)
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Henry Stern at InsureBlog examines the Massachusetts Health program that is the darling of Washington. Here is a part:
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insureblog.blogspot.com/2009/07/mass-cuts.html
Mass can't pay for the plan by themselves. They need Washington to pick funds from the national money tree to pay for this program.
Much of the rest of the $115 million in savings, $32 million, comes from slowing payments to the managed-care health insurance companies that won bids to offer insurance through the Commonwealth Care program. Regulators said that by slowing enrollment growth, the companies would receive less money than they had banked on when they submitted their bids earlier this year.
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Andrew_M_Garland at July 5, 2009 11:53 AM
Thanks for that, Andrew -- and I think this is key:
"One of the myths: If you like your current plan you can keep it.
You can keep your current plan if it is still offered and the company is still around. This is not a silly consideration. "
People just don't realize this -- and don't realize that once we break the system we currently have, there's no going back.
I've said this before -- I have an HMO. Kaiser. At 45, I could get health insurance through them for $145, but I choose to pay $339, for the utmost in care (unlimited lifetime $ for care, in case I get cancer, etc.). At this time, when I'm struggling financially due to the downturn in papers, $339 isn't chicken feed. But I value my health and value good health care and being protected in the worse case scenario, so it's a good investment.
Amy Alkon at July 5, 2009 1:06 PM
We can all agree there needs to be changes though, right?
When I lost my healthcare because of job loss, I couldn't actually get other healthcare (aside from expensive cobra, which doesn't last forever) because of pre-existing conditions. It's looking like I'm going to be diagnosed with a life long (and potentially fatal) disease that will make it very hard, and maybe impossible, for me to find insurance again if I lose my current job supplied insurance. I could always just go with disability, but why should I soak up money from the system when I am willing/can pay? I'd like to have options other than a) pay completely out of pocket b) pay $2k a month and still have to pay for all of my medication or tests out of pocket c) ride off of the tax payers dime. (The 2k figure was what I would've paid in Cobra, not regular insurance since they didn't even want to cover me at all).
Stacy at July 5, 2009 5:12 PM
To answer MK's 'safety net' question..
I suspect that it's because that framing argues for subsidies, not wholesale reform of the healthcare market. For instance, it could be accomplished by extending the covered populations of the current MediCare/Aid regimes.
IMO it's a more sensible approach, for similar reasons to those that endorse the argument that the current model of reforms should be tested on the existing Medicare system. That is, if we purportedly know enough about which populations need assistance, and know which methodologies to apply, then it should be easy to verify this using the existing system.
Such a model had been advanced by a group from Harvard during the Clinton administration, when they were promoting their own reforms. IIRC this was estimated at about 20 Billion annually and would have covered both 'gap' households and people like Stacy who legitimately couldn't obtain private insurance on their own.
Now it's likely that the costs would have been considerably more even back then. But what their analysis did demonstrate was that the 'crisis' facing healthcare could have been satisfactorily addressed with far less drastic intervention in the market, and in the practice of medicine.
But I suspect that many advocates of a National Healthcare regime see drastic intervention as its primary benefit.
Jack at July 5, 2009 7:00 PM
Stacy -
If the entire system we had was not a government-approved monopoly created for the sole purpose of employing paper-pushing morons whose only qualification is that they don't drool on the paperwork before they decline coverage or payment, then maybe you wouldn't have the problem you have.
However, if you put the healthcare system in the hands of the government, the paperwork will never get done because it will get covered in drool.
Which means that instead of being denied, you'll just never get approved instead.
I fail to see how that is an improvement.
brian at July 5, 2009 7:03 PM
The best argument against single payer healthcare I've heard is Japan. I was going to live there for awhile so I did a lot of research. If an almost completely homogenous and fairly healthy society can't do it (and neither doctors nor patients like it all, they all go to “international hospitals” where they can pay for their care but get the attention they need), I don't think we can.
Also, it certainly doesn’t seem fair that someone like me, who got something through sheer genetic ill-luck, can’t get healthcare individually but someone who purposely (or rather, lazily) got diabetes can.
Stacy at July 5, 2009 7:22 PM
"It's expensive because it's valuable."
Quibble: water and oxygen are valuable (try and go a few days without them), but plentiful, so they are inexpensive to the point of free.
By contrast, medical care is expensive because you are bidding for a rather limited supply of items: the brains of smart people. Getting smart people to train for 15 years to provide you with round the clock access to their state of the art scientific knowledge is expensive because of all the other things those people could do. To convince them to be medical care specialists, rather than business owners or poets, you have to outbid each of those other alternatives.
But if you want dumber people with less training to be your medical care providers, yes, it will cost you much, much less for medical care.
Spartee at July 5, 2009 7:29 PM
Spartee -
Thing to remember - the shortage of "smart people" in the medical field is artificial.
There are high barriers to entry that have nothing to do with intellect or money. The state licensing boards determine how many doctors may enter a given practice. They don't just give licenses to any qualifying doctor.
These artificial barriers are much like the building and electrical codes - designed to steer business to connected (read: union) entities and away from otherwise qualified people. There's nothing wrong with the standards, don't misunderstand me. But when you set up a process by which the only way someone can demonstrate mastery of the standards is to be an apprentice and then a journeyman after finishing school, and the only way to get an apprenticeship in many cases is to be connected (i.e. union or family) to someone already established.
Limiting competition is good for profit, but ultimately harms the consumer.
brian at July 5, 2009 9:40 PM
> if you want dumber people with
> less training to be your medical
> care providers, yes, it will cost
> you much, much less
I've often wondered about making a special bargain with people who whine about the high costs of modern medicine. (Hi, Brian!)
If you could pay a 1967 price for your insurance and medical treatments, and receive a 1967 standard of care, would you do it?
We can't actually run the experiment, y'know, because it would be completely fucking immoral. People expect rocket-science-style precision when they're getting medical care; newest materials, most advanced technique, most thoughtful research, etc.
And not only that, when people get sick, they think they deserve to be pampered. They want the whole society to turn real polite 'n compassionate in a hurry.
And if any of these things don't happen in the right order at the perfect time, they want the right to sue.
So, yeah, care costs more than it did a few years ago.
Crid [CommentCrid@gmail.com] at July 5, 2009 9:40 PM
...Well, or you could go my route. I've basically just donated myself to a medical school's clinical studies department so I can get all that rocket-science stuff. Of course, if they wind up killing me, no one can sue. I wonder if that's a big part of it, at least I've heard from doctors that their insurance is one of their biggest overheads.
For people with general ailments though, I honestly wonder why more people don't consider a nurse practitioner.
Stacy at July 5, 2009 10:52 PM
"Thing to remember - the shortage of "smart people" in the medical field is artificial.
There are high barriers to entry that have nothing to do with intellect or money. The state licensing boards determine how many doctors may enter a given practice. They don't just give licenses to any qualifying doctor."
Are you claiming that if 50 people pass the state certification standards in a given year, only 25 will get a license, to protect profits? I have never heard that claim.
Spartee at July 6, 2009 1:55 PM
Spartee, that is in essence what I am claiming.
Basically, the system that produces "doctors" is pretty much the same as the one that produces "electricians" and "plumbers".
You go to school, you take a position as a journeyman/intern, you take a further position as an apprentice/resident, and then you are allowed to take the licensing exam.
Only after all of that are you allowed to actually enter private practice.
And who determines when you are "ready" for the next step? The same people who administer the tests and produce the licenses.
And they all answer to the union.
brian at July 6, 2009 4:18 PM
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