…Americans have come to expect their health insurance to subsidize the consumption of all medical care.

But when I hear lefties talking about socialized health care as obviously decent, and about themselves as obviously superior for believing in it, my heart breaks.

This is just not how the world works. When something means a lot to you, you'll have to earn it. We were put on this planet to strive.

If liberals were kind, they'd be spending their own money for care for the needy.

I used to go to church, so I know how this works: Baby Jesus will not be impressed with those who spend the money of third parties to care for the poor.

Toothpaste and dental floss should be covered by insurance!

...it's the foolishness of the man on the street that left all that fuel sitting out there.

Amen. I said something similar, elsewhere on the net, and was told that I was falling victim of a government conspiracy to turn me against my fellow citizens, thus giving more power to the government. Ohferchrissake. The eggheads in government aren't doing anything but trying to get votes. And the real dummies are the ones who keep voting for them.

I will throw in that, to an extent, the insurance companies did it to themselves, although I don't think they realized it at the time. Circa 1990, when inflation in the medical industry was really getting rolling, the insurance companies came in and told policyholders, "Go with our insurance, and we'll go to the doctors and and lean on them for better rates in return for volume." In other words, a buying club, a la Costco. Now, a buying club per se is not a bad thing. The trouble was, insurance companies, being in that business, didn't look at that as a separate function, and they co-mingled the buying-club aspect of routine care with the major-medical insurance function. When you're a hammer, etc. That created all kinds of cross-subsidies that no one could figure out, with exploitable holes that were quickly found by the marketplace (providers and consumers alike).

That created a double whammy. It had already been the case for a while that the billed cost of services had a tenuous connection to the cost of providing the service. (Most doctors are not great business people; the truth hurts but it is what it is.) Now the situation was compounded by the fact that what the consumer paid only had a tenuous connection to the billed cost. It made the market hugely inefficient. You know how economists say that pricing is information? Well, in medicine, nobody knows what the price is, so there is no information and nothing on which to base judgements.

I'm on a couple of long-term sustaining drugs. There's a funny thing that has been happening with these the last couple of years. It used to be that I knew in advance each month what I would have to pay; there were periodic increases, but it was pretty stable. Now? It's different every month. Sometimes drastically so, and nobody can explain why. I've asked both the pharmacy and the insurance company, and no one has an answer. And I know I'm not the only person experiencing this. My read: the whole system is breaking down. It's become negatively stable; as people react to seemingly random price changes, it gets more unstable. I wonder what's going to happen next. My fear is that, as price whipsawing breaks up the supply chain, a lot of useful and essential drugs are going to start disappearing from the market.

I think the link is broken.

I think what Schultz, et. al., is saying is similar to what Radwaste says and I say though in very different ways. It's wrong to use an insurance model for what seems to be a desire to offer a prepaid medical plan.

You can have an insurance model, or you can have a prepaid medical plan, or you can have something different, but you shouldn't claim one is the other.

On the other hand Amy, it's been a while since I was in an HMO, but the ones I was in were very centralized around one or two medical centers and their specific doctors and I would say those are structured more like prepaid medical plans than insurance. (But it's been quite some time and they may have changed.)

But the other way in which I think Schultz et. al. are wrong in relation to Obamacare is that a common complaint of the plans I have seen from the exchanges are very high deductible, a deductible so high, that for me it changes the game and makes the plan almost worthless except to consider it as catastrophic care. I may be spoiled in that regard, my former employer paid plans had very low deductibles or no deductibles per se in that everything was 80/20.

And yes, I have had some great medical plans from employers, those employers were often denoted by having large powerful unions or were employers (who like Kaiser Steel in the 40s) realized healthy employees (with healthy families) were awesome for productivity.

But now it's time to divorce health care from employers, and let employers get on with business and people get on with their lives.

Obamacare did one very good, very important thing: It eliminated lifetime maximums. When I bought insurance on the individual market years ago, I had a lifetime maximum of $500,000. Seems like a lot, but cancer will eat through that in a jiffy.

The elimination of these lifetime maximums is part of what's making health insurance more expensive now -- but it's all the "little" (maintenance) stuff, too. So, yes, most people would probably be better with health insurance acting as "catastrophic" (high deductible) coverage. I had that sort of plan years ago and found I was able to very easily negotiate huge discounts for routine care with my doctor's office if I promised cash up front.

The missing piece for me is: What do we do with people who have tragically expensive "maintenance" diseases (diabetes, for example)? We've already figured out that state-run high-risk pools aren't sustainable.

Cousin Dave, there's a doctor at HuffPo who writes an occasional blog on drug pricing.

http://www.huffingtonpost.com/david-belk/

I found him at this reddit ama.

http://www.reddit.com/r/IAmA/comments/1sbwz8/i_am_david_belk_im_a_doctor_who_has_spent_years/

I am David Belk. I'm a doctor who has spent years trying to untangle the mysteries of health care costs in the US and wrote a website exposing much of what I've discovered AMA!

"Obamacare did one very good, very important thing: It eliminated lifetime maximums."

Why would you believe that?
Medical care is a finite resource. This position essentially claims that an individual should be able to command the resources of the entire medical establishment, as with the sad case of the brain-dead youngster cited elsewhere on this blog (an example, not that specific case).

The February 2014 issue of Reason magazine, not yet available on-line unless you're a subscriber, has a good article outlining how it's not actually the cost of health care that's gone up; it's the price of health care - and why that distinction is important. If you don't already get Reason, subscribe - and get thee to a newsstand to pick up the February issue.

I largely go with Pirate Jo because I have always considered my "health insurance" as something of pre-paid care. When I had a broken arm I could and did pay for the treatment, but when bkood clots necessitated surgery and bypasses for both femoral arteries there was no way I could even pay for the ambulance ride. While I am sure my insurance provider put it down in the books as a loss for the year. I think of it as having paid into a fund for over thirty years before withdrawing from the fund.

But catastrophe-only proponents should bear in mind that that as I mentioned above for many even getting to a hospital can constitute a crippling expense. That ambulance ride I noted, with no on-board treatment, was billed at over $900 and I doubt there was any profit overall even so.

I have a great employer. Great employees, too, who figured out (with some help from HR, but as a collaborative effort let by a couple of motivated people) which of the handful of offered health care plans was the best deal given a set of situations. Situations like, 5 members of a family with one catastrophic car accident, a single person with a chronic disease, 2 healthy adults, etc etc. I switched to the one that was the best deal for me, which is basically a high-deductible ($3500) lower-per-month-cost plan with an HSA attached to it. (Same doctors/facilities in all plans, which simplified it a bit - it was purely a cost analysis.)

I got a new prescription at the end of the year. If I had gotten it filled in 2013, there would have been a $25 copay (the script would have told me the true cost, but it was just informational).
For reasons beyond my control, I ended up getting it filled Jan 2 instead. So, instead of being informational, it was a direct hit. The pharmacist told me if the script was for a slightly different dosage (e.g. range is 10-200, script was for non-generic 18, generic comes in 20, to give an idea of "slight difference"), the cost would be a quarter of the significant amount I paid. Do you think I will ask the doc about that, next visit? Yes, I will! Do you think I would have if it didn't directly hit my pocketbook? Maybe, but likely not.

That, right there, is the problem with health insurance. It's not even really a buying-club, but a buying club gone wrong. Everything in the store is one of two prices. Anything (gas grills, towels, wine) with a brand name is one price, and everything not brand-name is the other lower price. I am a logical person. I'd get the finest Cabernet, every single time.

Why would you believe that?
Medical care is a finite resource. This position essentially claims that an individual should be able to command the resources of the entire medical establishment, as with the sad case of the brain-dead youngster cited elsewhere on this blog (an example, not that specific case).

I get your point, but insurance isn't paying for the McMath case -- because she's dead. Her family has been crowdsourcing. Also ... a car accident, gun shot, a hit and run, cancer: all things that happen that can wipe out your lifetime maximum at age 25.

I CHOSE to pay more so *I* wouldn't have a lifetime maximum but I don't choose to pay more so people paying less can have it.

This type of plan generally wasn't available to those with preexisting conditions. I know because I got rejected for them when I was between jobs. I lucked out by getting a job with benefits, so it wasn't an issue for long. In the meantime, I had a plan with a 100k limit and a 10k deductible as a stop-gap. It was the only "yes" I got from an insurance company (thanks, United!), and it cost me $200 a month, but I took it. Because it was the responsible thing to do. Even at 25, I knew I wasn't invincible.

I am not defending Obamacare (it's a mess!), but simply pointing out that the system was broken for many people long before it. The bajillion dollar question is how to create a system that requires everyone to pay in BEFORE they need coverage, that covers everyone for life-wrecking emergencies, that has some semblance of competition, and that doesn't prevent people from being able to afford rent.

"not actually the cost of health care that's gone up; it's the price of health care - and why that distinction is important"

Yeah, that's a big part of the problem: almost no one in the medical industry really has a handle on what their costs are. I note that in a typical medical practice around here, the office manager is usually a relative of one of the partners. Sometimes that relative is a good manager, but more often it seems to be the otherwise-unemployable black sheep whom the rest of the family has pressured the doctor into hiring. The doctor's maximum expectations for that person are that they will show up for work most days, keep the appointment book, and not be too nasty to the patients. The doctors just pay bills as they come in, and hopefully they show a profit at the end of the month. Hospitals, truthfully, are not much better.

We have to be careful about going down the rathole of the labor theory of value here, but... in the real world, price has at least some relationship to cost. Selling below cost all the time won't work for obvious reasons. On the other hand, selling too far above cost leaves room for competitors to undercut you. But in the medical market, what's the relationship of price to cost? No one knows.

Even at 25, I knew I wasn't invincible.

I thought I was invincible then! I'm still trying to convince myself at 40. But that's a guy thing.

You're not wrong in your analysis of the problem sofar. But that's exactly where SS came from, make everyone pay in before they need the pay out. And that went so well...

I'm Australian, and we have a country wide free medical system paid for by a tax levy (about 1% per year) called Medicare. It's reasonably good but if you need a knee reconstruction look forward to a 18 month waiting list - and you won't know when that time is, you might get a call say a week before. If you can't work in the meantime, tough luck. It is effectively mandated catastrophic but "when it suits us" cover. Most people who can afford it buy private insurance to top this up to get access when it suits them. If you can't afford that, you can wait, except in dire circumstances (and no, pain does not count, you have to actually be getting worse or dying).

It's not the worst model in the world. It provides catastrophic cover for people who can't afford insurance relatively cheaply, while providing an incentive to be in a health pool if you can afford and need it. Unfortunately, the ACA manages to achieve nothing of the sort.

"But that's exactly where SS came from, make everyone pay in before they need the pay out. And that went so well..."

Well, the idea it was sold on -- saving for the future -- was fine. The problem is, SS was a sham from the beginning; it never actually worked that way. And people who don't understand the difference between an investment plan and a Ponzi scheme fell for it. Big time. When I lived in South Florida, I was stunned by how brazenly and openly pyramid schemes operated there. They advertised; they printed flyers; they rented rooms at the community center for meetings. The huge majority of Americans are innumerate; they cannot do basic arithmetic, much less understand concepts like geometrical progressions. Which is the way our supposed betters want it.