Eat The Poor
Why The Atlantic's Megan McArdle opposes national health care:
I know, most of you have already figured out why I oppose national health care. In a nutshell, I hate the poor and want them to die so that all my rich friends can use their bodies as mulch for their diamond ranches. But y'all keep asking, so here goes the longer explanation.Basically, for me, it all boils down to public choice theory. Once we've got a comprehensive national health care plan, what are the government's incentives? I think they're bad, for the same reason the TSA is bad. I'm afraid that instead of Security Theater, we'll get Health Care Theater, where the government goes to elaborate lengths to convince us that we're getting the best possible health care, without actually providing it.
That's not just verbal theatrics. Agencies like Britain's NICE are a case in point. As long as people don't know that there are cancer treatments they're not getting, they're happy. Once they find out, satisfaction plunges. But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.
So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure. Innovation benefits future constituents who aren't voting now. Producing it is very expensive. On the other hand, cutting costs pleases voters this instant. This is, fundamentally, what cries to "use the government's negotiating power" with drug companies is about. Advocates of such a policy spend a lot of time arguing about whether pharmaceutical companies do, or do not, spend too much on marketing. This is besides the point. The government is not going to price to some unknowable socially optimal amount of pharma market power. It is going to price to what the voters want, which is to spend as little as possible right now.
It's not that I think that private companies wouldn't like to cut innovation. But in the presence of even rudimentary competition, they can't. Monopolies are not innovative, whether they are public or private.
Megan sucks for supporting the bailout of Wall Street companies. This is better.
Jeff at July 29, 2009 9:28 AM
I know the insurance companies have my best interests in mind and only want the best health outcomes for me. That's why they turn down as much as they can, shortchange providers on a regular basis, and kick people out of the plan after the fact for fictitious and irrelevant reasons.
I know Healthcare Theater and at the moment, it's the private insurance companies playing that game.
I also know that the VA system has been highly applauded for being based on a system that gives incentives to keep a patient healthy in the long run: http://www.longtermcarelink.net/article-2008-3-5.htm
And finally, there are several different possible ways a government health care system could take. Check out the Ron Wyden plan that has bipartisan support and doesn't seem to have the problems that McArdle fears.
jerry at July 29, 2009 9:35 AM
Jerry -
You're joking, right? The same VA that has been under assault for being an almost complete failure for returning veterans?
And there is NO form a government health care system can take that I will ever find acceptable. Giving the government control over life and death is unwise at best, fatal at worst.
Keep in mind that any government plan has as its central tenet that government is more efficient then private industry. Also keep in mind that the success of any government plan requires that the government be, on balance, smarter than the average citizen.
Both of those are patently false.
The best solution is to keep the government as far from healthcare as possible.
brian at July 29, 2009 9:48 AM
Hi, Brian!
Crid [CridComment@gmail] at July 29, 2009 9:50 AM
Like I said, Crid - never post on another relationship thread. You don't have the right.
brian at July 29, 2009 9:53 AM
By that I mean, a guys whose government allows protection from creditors such that "they'll eventually get their money" ought to be careful what he wishes for.
Crid [CridComment@gmail] at July 29, 2009 9:55 AM
One, your continued deliberate misinterpretation of that sentence fragment is making my fist itch.
Two, I didn't ask for the system to be set up the way it is. If I had my druthers, it would all disappear in a ball of fire.
brian at July 29, 2009 10:06 AM
As Megan points out the pharmaceutical companies are in it for the next big drug.
The large pharma companies have gotten out of a lot of base drug/vaccine research and sales. Remember the vaccine shortage in 2004? Basically only two companies manufacture the yearly vaccine and one was shut down for contamination of the vaccine.
Then you have any number of smaller companies that do acetaminophen, aspirin and cold medicine knockoffs as private label/generic for stores. The smalls probably aren't doing research, and big pharma can't really compete on the generic stuff for price.
If government had even more control, I don't think it would do anything good for the advancement of medicine.
Jim P. at July 29, 2009 10:10 AM
"Mulch for a diamond ranch"... damn, why didn't I think of that first?
Jerry, I think the answer to your conundrum is that a lot of us (not everyone, but a lot of people) are trapped into a specific plan according to where they work. When that happens, you're right, the incentive to provide better service decreases. What market pressure remains depends on how willing the company is to go out and shop for other plans on behalf of its employees. Some companies will do that, and some won't. I work for a large company that self-insures because they could not find anything that management considered satisfactory for their employees. That decision effectively took about a half million people out of the insurance market.
So the first answer, as we've said here before, is to uncouple insurance from employment. And the way to do that is to give privately purchased insurance the same tax treatment that employer-paid insurance gets. Then, the individual consumer can shop for insurance instead of being stuck with their employer's plan, and insurers will feel a lot more competitive pressure, kind of like what's happened with auto insurers over the last twenty years or so. A side benefit will be an increase in entrepeneurship -- I know several people who would like to start their own businesses and have credible ideas for doing so, but they have to stay with their current employment for insurance reasons.
The second thing, which doesn't get talked about much: Us voters have to start being smarter about who gets appointed to state insurance commissions, and demanding good government from them. In most states, insurance regulations are a pastiche of favortism, patronage, and hometown protectionism. It's very expensive for insurers to do business nationwide because of the myriad regulatory regimes they have to deal with. We need to lean on state insurance commissions to clean up their acts, and start forming inter-stae groups to standardize rules, regs, and paperwork.
Cousin Dave at July 29, 2009 10:20 AM
Brian, you should learn to read and use the google and cleanup your attitude and respect your betters.
The VA does not treat returning vets.
Next.
jerry at July 29, 2009 10:44 AM
Cousin Dave, and Amy,
Here's Ron Wyden's plan, I think he's been listening to us.
http://www.npr.org/templates/story/story.php?storyId=106979677
jerry at July 29, 2009 10:47 AM
And the way to do that is to give privately purchased insurance the same tax treatment that employer-paid insurance gets. Then, the individual consumer can shop for insurance instead of being stuck with their employer's plan,
My company is in the 500-1K employee class. The way they work it is that you are required to have health insurance. They pay for the insurance by giving you extra money (not taxed) as part of your "paycheck". It is enough to cover a single person (and depending on which plan maybe a spouse), and for families they will have a relatively small amount out of pocket to pay for kids and spouse.
If you have external insurance (military retirees, employees insured by spouses coverage) you used to get the extra money in your pocket. But with the advent of the Medical Savings Accounts (MSA) -- if you don't take the company insurance -- that money goes to the MSA.
Here's the rub -- if I didn't use all the MSA money in a given year, it doesn't accumulate and carry over, it disappears. I can't use the MSA to pay for a private plan.
The plan is borderline that I've considered getting my own self paying plan. But I'm stuck with the employer plan or totally out of pocket.
Jim P. at July 29, 2009 10:51 AM
Soak the rich, and pay for national health care. Limit expenditures to 10 percent of GDP; outlaw malpractice lawsuits (binding arb, only); and embrace euthanasia for terminally ill aged.
No, life is not fair. The rich will pay more, and might even get the same level of care at the middle-class. Cry me a river. Boo-hoo.
Next topic?
i-holier-than-thou at July 29, 2009 11:10 AM
Jerry - if I considered you my better, I might respect you. Hell, if I considered you my equal, I might.
Yeah, the Army might run Walter Reed, but the VA is responsible for it.
My father and grandfather have had acceptable experiences with the VA. However, the plural of anecdote is not data. I never had any trouble with Anthem, either (when I had them) but plenty of people get into massive battles to get simple shit dealt with.
Anything private business can do badly, government can do worse. This is an axiom.
brian at July 29, 2009 11:16 AM
Yes Jerry, private insurance companies can be selfish assholes in it for the money. Apparently, you think the government is more noble? In heart/intention maybe but reality is quite different. Think about this though, where can you go now if an insurance company screws you over on care? The courts. Now they're far far from perfect but with publicity, luck, and cash you have a shot at justice or compensation. Do you really think with the government in control you'll have much of an appeals process?
You'll excuse me if I'm not too much of a fan of the VA when they weren't too keen in looking after my WW2 vet grandfather after his stroke. The man got blown up off a ship in the pacific and shed blood on Guadalcanal but fuck him if he needs medical care. He was lucky he had the assets to cover a lot of the costs and my mother made sure she was in control until that cash ran out and he was stuck with Oregon running things.
Though I'll give my senator Wyden respect for trying for an alternative I'm not real optimistic.
Sio at July 29, 2009 11:20 AM
Brian, me? I was talking about Crid! I would never think to ask you to consider me your equal or better. I think way too differently than you, and we all know how you feel about that!
Sio, do I think the government is more noble? Answer 1: Than private insurers who engage in capitation and love it?
Sio, do I think the government is more noble? Answer 2: Did you even read about Wyden's plan? What part of the government being noble plays any sort of role in it?
jerry at July 29, 2009 12:24 PM
Sio, I'm sorry, I didn't mean capitation, I meant rescission:
http://www.pri.org/health/ira-glass-health-insurance1517.html
jerry at July 29, 2009 12:28 PM
Doesn't matter either way, Jerry. Any plan that any politician comes up with is going to involve more government, not less.
We have the screwed up system we do now because of government. What makes you think that government will finally get it right this time, when no government in the history of man ever has?
brian at July 29, 2009 12:55 PM
Can't be done; they can't afford it.
After we balance the budget and pay off the debt we can talk about additional spending.
Congress's national health care proposals resemble its cap and trade proposals: they'd bankrupt us without accomplishing their stated purpose.
Pseudonym at July 29, 2009 1:28 PM
Jerry said: "Sio, do I think the government is more noble? Answer 1: Than private insurers who engage in capitation and love it?
Sio, do I think the government is more noble? Answer 2: Did you even read about Wyden's plan? What part of the government being noble plays any sort of role in it?"
Point 2: First, yes I know the basics of Wyden's plan. My response was to your assertion about government run care being better than private, not Wyden's plan. As I said above at the end, his idea has potential and far better than the current big plan being floated. Still, the devil is in the details. How much government regulation of the marketplace, how much on the subsidies? I'm not optimistic for much the same reasons mentioned in your linked article about it. Its not controlling enough for many in Congress/Exec branch.
Point 1:
I already covered this previously. Yes they're often dirty and underhanded. Big surprise. Welcome to humanity. I suspect we won't ever agree on this but I have no idea how you can believe that a bureaucrat in DC or Salem or Sacramento will have any more nobility to help people than businesses will. A bureaucrat will put policy before patient just as much as a money grubbing private insurer. The difference is, the private company will often have profit as a powerful motive to do the right thing. Bad press gets out, their services aren't what they say they are, they'll lose business.
If Uncle Sam controls it all, who will you complain to? Your local health commissar? Yeah because bureaucrats are oh so more understanding and without political/personal agendas and bias. Oh, but you can go to the press! Fight the system! Yeah, I'm skeptical given how bought off the vaunted 4th estate has shown themselves to be lately.
Sio at July 29, 2009 2:21 PM
Everyone is dancing around the obvious fact.
A government run medical system is all about population control. They want to keep it small and therefore, "manageable".
Oh, what a coincidence, the baby boomer generation is starting to reach retirement age in large numbers. Just think of how much "money" the fedgov would save if most of them died off around the age of 65. How could the fedgov make that happen?
Why, let's nationalize the medical system!
What happens next?
"Well, Mr(s). so and so, we have an acute shortage of (pick one-heart, breast cancer, prostate cancer, etc.) treatment and medicine right now. The best we can do for the moment is give you pain killers. It's only a two year wait to see our gov. "health care" physician, I'm sure you'll be OK until then."
This might just coincide with the people who run this country behind the scenes fluoridating the water (big-time cancer causing agent) and spraying chem-trails in American skies. Lots of people getting cancer these days, more so per capita than in the past. Must be another one of those amazing coincidences........
SM777 at July 29, 2009 5:07 PM
sm777-
That is exactly what we need. We need more old folks to be euthanized. They cost tons to keep alive, for little gain to themselves and none to society at large.
Anyway, I think all this posturing about "private" health care is baloney.
Take Amy Alkon, who bills herself as self-employed, hustling for a book deal when not hustling cookware, and "45" years old.
Okay, so now maybe she can afford healh insurance, with a big deductible.
In 10 years, that monthly health insurance bill is going to run towards a grand, unless she has any medical problems, in which case it will be higher, with a larger deductible.
Brave Amy, self-employed and still single, and still hustling books deals and cookware, will start to reassess. Too late to maryy a rich guy, and a blog is like no money.....
After all, medical care is not a luxury, or chosen, it is necessity, Amy will reason. "No one choses to have ovarian cancer, it just happens," she will say. "And when my back went out, you think I wanted that to happen?"
Amy wonders how to make the gap from 55 to 65 years old, and to the safety of publicly funded Medicare.
There are no libertarians over age 65, when it comes to health care.
Those old biddies want hundreds of thousands of dollars spent on them, and tons of personal care up the ying-yang. The heaviest users of our health care systems are old ladies, and you can bet the contentious Amy Alkon will be using her canes and (publicly financed) Medicare with the best of them.
Oh brave old world, so full of predictable outcomes.
i-holier-than-thou at July 29, 2009 5:38 PM
Boy, the trolls are really out tonight.
Cousin Dave at July 29, 2009 6:50 PM
> Boy, the trolls are really
> out tonight.
Hey, I just got home!
> your continued deliberate
> misinterpretation
Naw, babe! I'm all about context.... Hostess Amy has saved our discussion onto a high speed "computer disk" so that every can reflect carefully on each other's meaning!
> Two, I didn't ask for the system
> to be set up the way it is.
Two, nobody said you did. Civilization is full of "systems" to which good people cohere, whether they had a hand in design or not. That's the point about emergency care: No one's going to ask, you're just going to get it. And then you'll them that "they'll eventually"....
And by the way, let's say a bike accident did drop you into a long-term coma. Would you presume the debt for your care had been excused?
Y'know, in fifty years of living, I don't think I've ever incurred or attempted to incur a single debt with the phrase TEGTM.
Crid [CridComment@gmail] at July 29, 2009 7:14 PM
Whooops-seee. Here it is! That's one on me... Sorry!
Crid [CridComment@gmail] at July 29, 2009 7:17 PM
No, i-holier-than-thou, that is not what we need. But that is what was planned for us years ago.
We need to get rid of most of the fedgov. When voting doesn't do the job (rigged elections by the two halves of the dictator party) then the founders of this country recommended another method..................
SM777 at July 29, 2009 7:35 PM
Does Health Insurance Make You Fat?
Quote:
What interesting times we live in.
My own humble proposal: since "soak the rich" doesn't work (there aren't enough rich, and they're not rich enough) we should instead "soak the statists". Carry out a national referendum on nationalized health care, and keep track of who votes "yea". Tax those people extra, and divvy up the proceeds into medical vouchers for everyone. Re-vote yearly.
Pseudonym at July 30, 2009 7:41 AM
I decry, in the strongest terms, crid's arch tone.
Jeff at July 30, 2009 8:25 AM
> private insurance increases BMI
> by 1.3 points
No. You mean they correlate, right?
> I decry, in the strongest terms
Yet somehow, you find yourself aroused as well... A wisp of feeling, like a cleansing summer breeze, that puts a spring in your step and a song in your heart.
Crid [CridComment@gmail] at July 30, 2009 8:57 AM
That quote is from the paper itself. I'm cautiously optimistic that the authors and reviewers know the difference between correlation and causation, but not enough to bet on it.
Pseudonym at July 30, 2009 12:12 PM
> That quote is from the paper itself.
Right. I think the paper is bullshitting you.
Crid [CridComment@gmail] at July 30, 2009 2:58 PM
I think that depends on what the definition of "is" is.
Pseudonym at July 30, 2009 5:47 PM
So, you're thinking, "we've got a problem with [insert issue here]. I know, we'll ask government to solve it!".
Now you have two problems.
Rod at July 30, 2009 9:22 PM
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