Whole Health
From the WSJ, Whole Foods' John Mackey's alternative to Obamacare. Eight points:
• Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.
• Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.
• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.
• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.
• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.
• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?
• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.
• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
Many promoters of health-care reform believe that people have an intrinsic ethical right to health care--to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?
Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America
Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.
Dont know about the tort reform, hack doctors deserve to be run out of the medical profesion even if by way of a lawsuit
lujlp at August 12, 2009 3:10 AM
See. CEOs should run this place like a privately owned company/non-profit. Not politicians.
Gretchen at August 12, 2009 5:29 AM
The "Personal Health Account" is basically a way for them to work around the post-WWII tax oddity that makes health insurance a business tax deduction/work benefit rather than an individual purchase/deduction.
It's a way for a company to duplicate private money - and encourage the same prudent behavior people take with their own money.
See - no need for fancy ideas.
If we didn't have this odd quirk - which Mackey points out - then we would simply decide how best to spend our individual funds on health care, among many other expenses.
No need for fancy ideas - other than the free market.
Ben-David at August 12, 2009 5:42 AM
luljp - Tort reform is needed because of legal shenanigans such as John Edwards engaged in to make his millions. He took doctors to court over children with medical issues (such as Cerebral Palsy) which are so poorly understood that there is no proving what caused them, then using emotional appeals to win huge settlements against doctors who probably had done nothing wrong.
WayneB at August 12, 2009 6:38 AM
Abolish all of the HMOs and let the insurance companies themselves do what they were intended to do in the first place.
Flynne at August 12, 2009 7:14 AM
There's a lot to like in those proposals.
In the long run, the only way for health care reform to be sustainable is for most people to pay in to the system more than they take out. If we can lower costs enough to make that viable, we can transition to a high-deductible HSA-based approach for everyone but the poor, who can receive health care vouchers (like food stamps). We can lower costs by stopping the government from artificially inflating costs.
We need a level playing field so that consumers can make informed health care purchasing decisions. The current system, and Congress's proposed "reforms", obfuscate instead of clarify. Reform should remove barriers not add them.
We can't soak the rich, and we can't soak the rich plus the middle class. We can't afford to pay 10% or more of our GDP (more than half of the federal budget!) for a government-run system that will accomplish less, cost more and worsen care for millions.
Pseudonym at August 12, 2009 7:43 AM
My dad has an HSA (he's in CA and has had it for several years). Paying the deductible can be a pain if you have an ongoing health problem and have to pay it all in a couple of months, but I think he really likes it despite that. I know it's been great for my brothers, who are young and don't have any problems.
I don't know how different we are than Canada regarding wait lines anyways. When I lived in LA I had to wait 9 months to have a tumor out. By that time I had two tumors. My HMO didn't want to pay for the surgery if it was just a cyst (which the doctor told them it wasn't, and tests showed it was spreading), so they put it off as long as possible. My husband got sent home from an ER with an appendix on the cusp of bursting and rotting intestines, his doctor sent him back the next day and ordered them to operate or the doctor would report them. While my friend in Canada got a bad eye infection and walked into an ER and got treatment, and went to a specialist two days later. I've never had that turnaround.
On the other hand, I know someone from the UK who had a dangerous pregnancy and was ordered to stay in a hospital for 5 months. She couldn’t get a second opinion or go home with a nurse, that was just the way it was.
Stacy at August 12, 2009 8:46 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/12/whole_health.html#comment-1662346">comment from StacyStacy, dunno which HMO you have, but it sounds like a crappy one, and how could you sit by while they waited nine months to schedule surgery for your tumor. I would have fried somebody's ear off on the telephone early on.
Amy Alkon at August 12, 2009 8:51 AM
Stacy, I agree with Amy - My wife had a tumor in her abdomen (she had a biopsy and they still could not determine what it was) and the doctor scheduled surgery within a couple of weeks. It turned out to be a product of endometriosis, rather than malignant tumor, but it was done and out almost immediately. She also had a ganglion cyst in her wrist several years earlier, and that was also automatically covered.
WayneB at August 12, 2009 9:03 AM
We need the English Law of Costs.
It lets anyone sue without government imposed liability limits; it ends almost all frivolous lawsuits; and, it's been tested and shown to work in practical cases for about 400 years. That's a cool feature.
Jeff at August 12, 2009 9:07 AM
Oh yeah. I'm shopping at Whole Foods, now. Mackey gets it. I support people who support individual liberty. I hope you do, too.
Jeff at August 12, 2009 9:09 AM
THose eight proposals all sound like they'd make more money for the insurance companies, so that's great...
And Amy, I'm sure you would have fried someones ear off, but that doesn't change the fact that insurance companies sometimes screw people over, really badly, not just delaying procedures but canceling peoples' insurance when they get sick.
Clinky at August 12, 2009 9:10 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/12/whole_health.html#comment-1662358">comment from ClinkyAnd Amy, I'm sure you would have fried someones ear off, but that doesn't change the fact that insurance companies sometimes screw people over, really badly
This is why it's important to maintain a free-market system. When it's just the government, you won't have a choice. I chose Kaiser because it seemed to be a good HMO. I CHOSE it.
Amy Alkon at August 12, 2009 9:18 AM
Clinky, I don't see anyone advocating eliminating insurance regulators. The proposals are exactly that, proposals on how the current situation can be improved.
More money in your HSA has nothing to do with making more money for insurance companies. Nor does tort reform. Nor does making costs transparent. Nor, in fact, does any of them.
So, you don't like the situation where insurance companies can make bad decisions, but you can still go to the government or the law for redress. I'm sure you'll love the situation where the government makes bad decisions and you have nowhere to go.
MarkD at August 12, 2009 9:25 AM
"I chose Kaiser because it seemed to be a good HMO. I CHOSE it."
This is the part I like about the suggestion to remove state laws that keep this or that compabny out of their markets. We don't have Kaiser in Washington. I grew up with it in California, and my parents still have it, and they love it still after all these decades.
Jim at August 12, 2009 9:39 AM
If a claim was denied in bad faith, you can always go to the Department of Insurance of your particular state (California www.departmentofinsurance.ca.gov)to open a claim on the insurance company.
I realize it is a government agency, and for several reasons you may want to avoid such an option, however, insurance companies can get fined and audited for the claims made against them, especially if they were discovered to be in bad faith. Usually it just takes one letter from the DOI to get them to pay out.
I've helped several of my friends via this route when I was unable to get the insurance company rep on the other line to understand how insurance works.
I was an insurance broker (not healthcare) for 10 years, licensed. I now work in insurance risk management. I can tell you, the people that are on the phones when you call to discuss claims aren't the ones you need to be speaking with. Sometimes a letter from the DOI will get the job done.
(You can go to the DOI for any claim related to insurance - property, liability, auto....)
I got a friends auto insurance claim payout (when his car was totalled) increased by 1/3 because the insurance company wasnt giving him what his vehcile was valued at - they werent using the right location code. Over and over we went explaining this to the adjuster. No dice. One letter to the DOI. Check was in the mail.
Just some food for thought.
Feebie at August 12, 2009 9:48 AM
Amy, while what you say sounds good in theory, I think many people ignore the law of intended consequences. While in a vacuum, health care shouldn't be right, but we don't live in a vacuum.
The ability for people to have access to primary care directly effects your health and your wallet. A person with no health insurance or a high deductible plan is much less likely to go to the doctor for a sinus infection or bronchitis. So instead being treated with antibiotics, they continue to spread the infection. In the worst cases, they end up in the ER where we all know the costs for treating people is exorbitant. And that is relatively mild. What about the diabetic who doesn't receive ongoing treatment, you guessed it, ER. Not only that, but eventually that person will have their limbs amputated and end up where, LT disability and yup, Medicare. Again, now add up the costs of this person's ER visits, disability, and health care (prosthetic, wheel chairs, special equipment, etc.) and compare that to the cost of insuring them up front and keeping them healthy.
So you don't want the government to regulate health insurance? And what if Kaiser decides that once you get cancer they are going to drop you? What do you do then? I tell you, you go bankrupt because now with a preexisting condition, you won't get insurance from anyone.
So unless we are going to stop treating people who can't pay in emergency rooms, drop disability, and get rid of Medicare, I still maintain it is cheaper in the long term to make sure everyone has access to adequate health care.
Mark at August 12, 2009 9:49 AM
One small correction, in California - HMO's, PPO's have a separate department:
http://www.hmohelp.ca.gov/
Some states have a separate department. Some states don't.
Feebie at August 12, 2009 9:59 AM
I was with Kaiser, I was only 18 and just on my own, I still trusted doctors/insurance companies and just figured there was a reason I had to wait. Not that I didn't call and try to beg for something earlier, I did, but it wasn't the corporate office. I did leave messages at my board, or whomever the council is that decides these things. The reason it was so long is because they wanted 3 ultrasounds to prove it was growing, and the wait was about 6 weeks each for those, and then there was the wait for the surgery itself. If they had taken the word of my specialist and the first test (3 months after treatment) then it would have been down 9 months earlier.
However, even now there's always a wait for things. It's never good to hear "Oh no! I think you have a brain tumor, now wait 4-6 weeks for an MRI". It wasn't until I moved out of CA that I realized what better care I could get in other places. I just moved from Seattle and I feel I got amazing care there, hardly anyone in the ERs and specialist care within 1-2 weeks.
Stacy at August 12, 2009 10:01 AM
And Mark, almost all Insurance is *regulated* by the government in one way or another, but they are an outside entity as it stands now. Their regulations in part are necessary, but they over-reach and create huge expenses which is then passed on to the consumer via premiums or non-participation in some states.
Texas has a lot of weird regulations on insurance (healthcare, workers comp, specifically). Many companies choose not to write insurance there. As bad as it sounds, these regulations don't make it cost effective to do business there - and thereby reducing a multi-state insurers potential pool of risk. The larger the pool, the better they are able to transfer risk and make a profit.
Feebie at August 12, 2009 10:10 AM
Feebie, I understand that there are regulations now, and I'm always for streamlining/fixing, but many here are advocating for complete deregulation. I guess my main point, is I believe by leaving people under-insured or with no insurance at all, we end up paying a much a higher price through our government social nets.
Mark at August 12, 2009 10:19 AM
Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.
We need the English Law of Costs.
Or alternatively a cap on the amount the lawyer makes. If you cap the amount the plaintiff can get, you have effectively limited forcing individuals and business to correct the error of their ways.
You also have restricted the ability of plaintiff to live on the award. For example the case of a "healthy", well paid 25 year old that has "minor" surgery and something goes wrong -- he is now debilitated that he can no longer work. A $1M cap is not really that much money if the life expectancy is another 50 years.
But if you were to cap the lawyer at $100K or one-third the award, the incentive to go for $25M is still there, but if the offer comes in at $10M -- it wouldn't make much difference to the lawyer.
Jim P. at August 12, 2009 10:28 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/12/whole_health.html#comment-1662374">comment from StacyHowever, even now there's always a wait for things.
There are problems in every business and those who get served are those who figure out how to make things work for them. You need to get the specialist to speak out for you in a case like this.
Amy Alkon at August 12, 2009 10:36 AM
"Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?"
I sometimes wonder if the doctors truly know. It was funny yet sad when I went to a doc laster year for an ear checkup. I paid cash and thus apparently got a 40-50% discount. They said they'd have billed insurance for 400+ and I paid about $240 for a test/doc consult. Took two of them about 5 minutes to figure out how to print out my "receipt" with itemized list of services I paid for. "We can do that but most people don't ask for it...". Sorry, I'd like to know what exactly I'm paying for.
Worst was I wish I'd gone to them a year earlier as the last clinic I went to charged me over $300 for what amounted to nothing really getting done.
Sio at August 12, 2009 11:00 AM
When workers compensation was deregulated (I want to say early ninties) things went quite well. It became more affordable to mom & pop businesses.
The only ones who didn't do well was (in California, cuz I'm more familar with it) the State Fund here. They dropped their rates so low in an effort to compete and with their high risk placements (firefighters, football players, cliff hangers...type jobs) and them being the government and basically running fat on everything - they went belly up - and took Calfiornia tax payers right along with them.
The politician in California that really knows his stuff with insurance (specifically work comp) but insurance in general and has a lot of great things to say is Tom McClintock (R).
Erika at August 12, 2009 11:01 AM
Mark:
Huh? Who has advocated for deregulation of insurance?
Reducing and simplifying regulation perhaps. Reducing the number of required coverages, definitely.
brian at August 12, 2009 11:24 AM
"The ability for people to have access to primary care directly effects your health and your wallet. A person with no health insurance or a high deductible plan is much less likely to go to the doctor for a sinus infection or bronchitis. So instead being treated with antibiotics, they continue to spread the infection. In the worst cases, they end up in the ER where we all know the costs for treating people is exorbitant. And that is relatively mild. What about the diabetic who doesn't receive ongoing treatment, you guessed it, ER. Not only that, but eventually that person will have their limbs amputated and end up where, LT disability and yup, Medicare. Again, now add up the costs of this person's ER visits, disability, and health care (prosthetic, wheel chairs, special equipment, etc.) and compare that to the cost of insuring them up front and keeping them healthy."
There are serveal things wrong with your scenario here. First, most sinus infections and bronchitis are viral infections and not baterial infections. Antibiotics only work against bacterial infections and are not indicated for about 90 oercent of what you are talking about. In fact, treating them with antibiotics leads to antibiotic resistance where it now takes stronger and more expensive antibiotics to deal with the mutated bacteria that are becoming more and more common so early over treatment of minor illness is leading to major complications. Eventually we will run out of them and then what will we do?
The other big problem is, according to most of the medical professions that I know, 90 percent of what is wrong with people under the age of 70 or so is a result of poor lifestyle choices, mainly smoking, drinking and obesity. I for one don't want to spent my time subsidizing or paying for insurance for those people. Nor do I want to subsidize illegal aliens. Without consequences, most people have no motive to change their lifestyle to fix these things(or go home) That is what you and I picking up the tab will do, remove all individual responsibility which is rare enough already these days.
Isabel1130 at August 12, 2009 11:32 AM
My company switched to high deductible HSA this year. So far it has worked great for everyone involved. Cheaper for the company, no out of pocket expenses for me.
Tort reform is desperately needed but will not happen when about half of the people in congress are lawyers.
As to it being a way of getting rid of bad Drs, There are way better ways of getting rid of bad Drs. that doesn't take years and a dozen lawsuits. The problem right now is frivolous lawsuits are too common. There is no disincentive to suing anyone in America, all you have to do is find a lawyer who is bored or sees profit in the gamble.
Joe at August 12, 2009 12:31 PM
I had an HSA linked to a PPO and loved it. My deductible was 2200 per year, but I was able to set aside that much plus a little match from company. The unused money rolled over year to year. Now that I have a major medical issue, I have quite a few bucks set aside for the max out of pocket
ron at August 12, 2009 2:00 PM
If you google Kaiser. I think a lot of diff states have it. In Alaska you can get it. Rates are waaaaay better than the employee sponsored plan offered at work. The coverage is better as well.
Melody at August 12, 2009 4:13 PM
Amy, you missed my point(and for the record I usually agree with you on most things). No matter how somebody arrives to where they need expensive health care, you are already paying for it. Whether it is an uninsured hard working person like my Uncle or the illegal immigrant, the government and charities are already paying for people who can't pay their ER bills. Wouldn't it be quite a bit cheaper if you could head off even a fraction of those with effective primary care? Like I said, the only way your argument makes financial sense is if we dismantle the entire social safety net, and since you know that isn't going to happen, we need to look at this realistically.
Mark at August 12, 2009 4:20 PM
Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.
This strikes me as the best of many bad options.
So what you have to wait sometimes for treatment. In Kaiser Permanente, they ration, and some treatments are not offered, and complaints are bound into binding arbitration. Same thing.
Some snobs fear they will be trated just like anybody else. Too bad.
I want national health insurance, and I want to whack rich people with consumption taxes to pay for it.
i-holier-than-thou at August 12, 2009 4:23 PM
I forgot, yes I realize my analogies were bad regarding the antibiotics, I was at work and typing to quick. But the essence of the analogies remain. Let's substitute in strep and bacterial meningitis. Also, I do work in health care on the supplier side. My job will be directly impacted by potential Medicare reimbursement cuts.
Mark at August 12, 2009 4:34 PM
And I want everyone who believes in Marxism to die.
Let's see who gets their wish first.
brian at August 12, 2009 4:38 PM
To my knowledge Kaiser Permanente does not provide insurance in Alaska. Kaiser Foundation Family does. It's more of a literature and resource type outfit.
Again, to the best of my knowledge, you can't actually purchase insurance from them (KFF).
Either way, Kaiser Foundation Family a separate company from Kaiser Permanente and I can't find online where they have locations in Alaska.
Feebie at August 12, 2009 4:38 PM
i-holier (or he who suffers from pervasive narcissistic personality disorder).
Duuuuddddeee, what the HELL are you talking 'bout?
So by your (faulty) reasoning if I don't have a car, and other people (who work their asses off) have nice cars... and clearly a car is not a right, then I can still force everyone have their cars confiscated and sold and then have shitty cars purchased for everyone so we all can have cars?
WTF?
>>Some snobs fear they will be trated just like >>anybody else. Too bad.
>>I want national health insurance, and I want to >>whack rich people with consumption taxes to pay >>for it.
When you were a child, were rich people unnecessarily mean to you or something? Did they throw hot coals at you? Seriously. What's the malfunction on that end?
Feebie at August 12, 2009 4:48 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/08/12/whole_health.html#comment-1662439">comment from i-holier-than-thouI want national health insurance, and I want to whack rich people with consumption taxes to pay for it.
Or you could just earn a living and buy your own. Health care is very valuable to me, so I pay for it, and choose to have the top plan.
Should we buy you lunch, too?
Amy Alkon at August 12, 2009 4:56 PM
"Wouldn't it be quite a bit cheaper if you could head off even a fraction of those with effective primary care?"
Actually it wouldn't So called preventitive care cost major bucks in this country and some studies seem to indicate that little of it actually does much good. For example, cancer, and heart disease really dont seem to respond to early medical intervention or so called preventative care. The only thing many of the tests do is catch it earlier so they end up treating it longer. Few people with agressive cancers are actually cured. That is why they measure cancer by five year survival rates, not "cures". For heart diease, nothing works like giving up cigarettes or not smoking in the first place. Clean water and food have added way more to the average life span in civilized countries than all of the so called preventitive care which has added a matter of months or weeks to the average life span. See http://content.nejm.org/cgi/content/full/358/7/661
Isabel1130 at August 12, 2009 5:22 PM
I always tell people there is no avaoiding death and theyd better get used to it
lujlp at August 12, 2009 6:21 PM
Let us not forget. Healthcare in the U.S. is currently rationed. Healthcare everywhere is rationed. As is any other commodity. We are simply debating the means by which it is rationed. Currently, your healthcare is rationed based upon your insurance company's whims or the size of your bank account.
Whatever at August 12, 2009 10:11 PM
"Wouldn't it be quite a bit cheaper if you could head off even a fraction of those with effective primary care?"
While your hard-working-but-uninsured uncle may be an exception, many of the uninsured run up ER bills for no good reason. The primary care folks rightly want nothing to do with them.
Not because they can't pay, but because their health issues are not treatable by primary care or anywhere else. Read the last few months of an urban ER blog like Crasspollination. Many if not most of the uninsured who go through ERs fall into several categories:
- Lifestyle problems. Examples: problems due to extreme obesity, alcoholism, etc.
- Drug-addicts: Faking pain to get free narcotics. This is so frequent that it inspired the name of the blog I mention above.
- Attention-seeking. Example: a pregnant woman who show up weekly with "abdominal pain", but really only want a free ultrasound of her baby. Or (an example I personally know of), the lonely old lady who calls the medical hotline every day to have someone to talk to.
None of these will be helped by primary care. All of them should be turned away, but federal law (huh? why?) prohibits it.
bradley13 at August 12, 2009 10:46 PM
None of these will be helped by primary care. All of them should be turned away, but federal law (huh? why?) prohibits it.
Yep, the solution, is to permit ERs to turn people away. That would definitely help control costs.
Whatever at August 12, 2009 10:53 PM
Until we let emergency rooms turn down people, we have no true market in health care. If we want a market, we have to permit caregivers to simply not treat those who can't pay. Like how those who don't have enough money can't buy a car. As long as someone, somewhere must treat an ill person, we don't have a true market.
My modest proposal: let those who can't pay die or suffer whatever consequences of their bad choices or misfortunes.
Get rid of special pricing for insurance companies. Get rid of insurance. Cash on the barrelhead. Let people negotiate price directly with their physicians for all services.
A true, libertarian, market-based solution!
Whatever at August 12, 2009 11:04 PM
> A true, libertarian, market-
> based solution!
If people want to buy & sell insurance, they should be permitted to do so. That's libertarian.
If people want to move to nations where people without cash in their pockets are turned away from medical care, I can recommend some.
__________________
You know how to tell the difference on a blog between someone who's being thoughtfully contrarian and someone who's just had too many drinks?
Me neither.
Crid [CridComment @ gmail] at August 12, 2009 11:33 PM
You know how to tell the difference on a blog between someone who's being thoughtfully contrarian and someone who's just had too many drinks?
It's a tough call, especially when the person is a n00b on the blog. Homophonic typos are a cue I look for.
Whatever at August 12, 2009 11:48 PM
Where do these douchebag trolls come from?
There is a big difference between an ER turning away someone with a critical injury for lack of insurance, and an ER turning away someone with no injury at all.
And if you think this specific problem will be solved by letting the government ration care, you're out of your mind.
Oh, and I love how the liars who want government to tell people when to die say "care is already rationed in the US".
Care is NOT rationed in the US. A market does not "ration" anything. A functioning market would increase supply to meet demand. We don't HAVE a functioning market in medicine, because laws and guilds prevent an increase in supply.
And "universal" health care won't do a fucking thing to change that simple fact.
But of course, all the liars on the left (just got through listening to ANOTHER one on the radio. I guess since he's from Yale we're just supposed to believe him.) expect us to buy their shit sandwich because they've wrapped it up so nicely.
Doesn't change the fact that their answer to all our questions is still "eat shit and die."
brian at August 13, 2009 5:07 AM
We don't HAVE a functioning market in medicine
Yes! Absolutely.
For us to have a functioning market, both parties must be able to either accept or walk away from the deal. The fact that hospitals are compelled to treat people means they can't walk away from the deal some times but are forced to dole out treatment to those who cannot pay. These suckers need to be allowed to suffer or die or whatever if we are to have a market.
Markets also need price transparency. We don't have that in health care either. What a patient is billed is often not explained up front by either the hospital or if he has it, his insurance company. It's also not usually possible to compare costs between different providers.
Markets also rely on the ability of people on both sides of the negotiation to make informed decisions. The informational advantage is vastly in favor of the doctor in terms of medical knowledge. And the doctor has no real knowledge of that patient's propensity to sue him.
Proponents of a real health care marketplace need to explain how these problems can be solved.
Oh, and I love how the liars who want government to tell people when to die say "care is already rationed in the US".
Health care absolutely is rationed. Your insurance provider decides what treatments you get, if you have one. If you don't have one, your wallet says what you can afford, up to a point (even the indigent get some sort of care, usually via an ER). If you're poor, Medicaid says what treatments you get. If you're old, Medicare does. The point is that unless you are fabulously wealthy, your treatment options are limited by some sort of governing body.
Care is NOT rationed in the US. A market does not "ration" anything. A functioning market would increase supply to meet demand. We don't HAVE a functioning market in medicine, because laws and guilds prevent an increase in supply.
Observe the convolutions here. 1. Care is not rationed. 2. A market does not ration. 3. We don't have a market.
See the problem?
Whatever at August 13, 2009 8:57 AM
We don't have a properly functioning market, but we have a market.
Care is rationed if you put yourself into a rationing system. If cash is your limiting factor, that's not rationing. 60" plasma televisions aren't rationed, they're expensive. There is a huge difference between the two.
Simple. See, you seem to think that there's some aversion to any subsidy of any kind. There isn't. But it needs to be reasonable. We should not have an ambulance sent to pick up a woman with a headache so she can go to the ER to get a subsidized aspirin because she's too much of a piece of shit to go to CVS and spend $3 for a bottle of Bayer's.
1) Complete transparency. The doctor gives you costs up front. You get the opportunity to comparison shop - quality versus cost like we do for everything else.
2) Reign in the guilds. The AMA presently limits the number of medical professionals that the educational system can turn out in a given year. This is done to create an artificial shortage and keep prices elevated.
We don't have a limit on the number of plumbers, electricians or HVAC installers that can come out of the technical schools. When there's too many, there's no more jobs, and people stop getting those educations.
Let anyone who can pass the tests and get the education become doctors, nurses, etc. When there's too many, then there won't be any more jobs.
I don't know why this is so difficult. But I can tell you that the reason none of it is ever proposed by the idiots in Washington is that it does nothing to increase their control over the day-to-day lives of average Americans.
brian at August 13, 2009 9:31 AM
John Mackey's Whole Foods solution has some terrific ideas, but it does not address consumer protections such as dropping coverage for seriously ill people, or denial of coverage due to pre-existing conditions, or the fact that insurance right now is tied to one's job (or one's spouse's job).
My old employer offered an HSA but my understanding at the time was that the money did not roll over from one year to the next. It was use it or lose it, that year.
The point that no one has a "right" to health care is an ugly but necessary debate.
Our free-market society is predicated on the notion that individuals are responsible for obtaining their own health care and employment, with an unspoken assumption that JOBS AND HEALTH CARE ARE READILY AVAILABLE.
I still don't know if health care should a right of the individual, or some sort of obligation on the part of society to provide for its members. Does a mentally disabled adult have the "right" to be looked after? Or is it just indecent for the rest of us to leave such a person to his or her own devices? (Had to sustain this argument in the Tenderloin, I must admit...)
Mackey's also hinting that Americans who are fat deserve their own fate, and he's got a rather self-serving plug at the end encouraging people to eat more vegetarian food, like they sell at Whole Paycheck! What a surprise! I'm not overweight, never have been, but I think it's flippant to blithely blame all our health-care economic woes on all those fat rib-gobbling smokers out there... plenty of folks have other conditions like lupus or myasthenia gravis (two women of my own acquaintance), and I don't think their conditions are "self-inflicted" through lifestyle.
vi at August 17, 2009 8:01 AM
"Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them."
This, to you, is a desirable outcome?
"I think many people ignore the law of intended consequences."
Yes they do - which is why we don't want this bloated bill which no one understands. Mr. Mackey's suggestions would be a good start at reform. What the government wants to do now is TRANSFORM.
alanstorm at August 18, 2009 11:58 AM
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