Romney Signs Mass. Health Care Law

Sigh…

BOSTON – Gov. Mitt Romney on Wednesday signed into law a landmark bill designed to guarantee virtually all Massachusetts residents have health insurance.
However, the governor vetoed a key portion of the bill — a $295-per-worker assessment on businesses that do not provide health insurance. Some critics have called that provision a tax on businesses.
The bill, intended to extend coverage to Massachusetts’ estimated 550,000 uninsured, is being touted as a national model, thrusting the state to the forefront of the national debate about how to provide near-universal health care coverage without creating a single government-controlled system.
It’s also a political coup for Romney as he weighs a potential run for the Republican presidential nomination in 2008. The bill could be a centerpiece of that campaign if Romney can credibly claim pushing through a groundbreaking health care reform package.
Romney used his line-item veto power to strike eight portions of the bill, most significantly the $295 fee. Administration officials say the fee could actually discourage registration for the new health program, since some employers might consider it cheaper to pay the fee than to insure workers.
“It’s a very small feature of this bill. It’s a very insignificant and unnecessary and, in some respects, counterproductive element of this bill,” Romney had told The Associated Press in an interview on Tuesday. “It applies to a tiny number of employers, and it raises a very small amount of money relative to the scale of this entire proposal. So I don’t think it’s necessary.”

This is a mistake, mostly because it doesn’t address the real problem at the heart of the health insurance issue. Frankly, this puts Romney off of my list for possible Presidential candidates in 2008.
A lot of people (mostly on the left though, as evidenced by Romney, some on the right too) make the mistake of thinking that the root problem of the health insurance issue is the fact that some people don’t have it (whether by choice or circumstance). That is not the root problem. The root problem is that health insurance is so expensive that all but a tiny minority of rich Americans must rely on their employer or their government to provide health care for them. If health care were more affordable it wouldn’t be the problem it is today, and providing it for those who truly cannot afford it for themselves wouldn’t be an insurmountable task.
We need to be approaching this problem differently. Rather than looking at ways we can provide health insurance for those who don’t have it (or force businsses to provide it) we should be looking at ways to fix the system so that citizens can afford to provide it for themselves and their families. Mandating health insurance doesn’t solve that problem. In fact, it makes it worse.
Health insurance companies have to be loving this legislation. Why? Because it forces every resident of Mass. to do business with them. These companies can now, collectively, raise prices with relative impunity. Granted, the insurance companies can’t get too carried away lest they face price caps from angry politicans (and wouldn’t that be a mess, mandated private insurance with a capped price), but I’d be willing to bet that in five years health insurance prices will be significantly higher in that state than they are now. Which, as I said, just makes the problem worse.
Nobody in Mass. is being made more responsible for their health choices. This is just another shift of the burden away from the individual and onto the collective. Nobody will shop around for their health care. Instead they’ll take what is convenient regardless of the cost and the same problems we have under the current pseudo-private system will continue under this new even-less-private system. All that’s happened is that we’ve moved one step closer to socialized medicine when we ought to be moving closer to individuals paying for their own health insurance and care.

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  • http://Array Tom_with_a_Dream

    Puzzle –

    Cold Turkey is the best solution for most addictions.  It’s the hardest, true, but it works.  Except for heroine and methadone, which doesn’t really have that stellar of a track record. 

    People only learn trough pain, you give them the lesson easily and hey won’t learn it.  Make it hurt, make them stretch and then they might get it on the first try.   

    We can’t ween ourselves off the politician’s lobbyest’s coattails.   We have to jump off all at once.

    And as for your distrust of the HSA notion, I am flabergasted that more people dont’ realize the beneifts.  Most of our medical costs can be quantified for a year; routine visits for a sickness or two per member of the household, a (single usually) ob/gyn visit, allergy shots are weekly, sports exams are yearly, dental is predictable, etc.

    Once you have these costs in hand, you withhold that much from you paycheck and have it placed in a "lockbox".  You go to the odctor, you submit your receipt, they send you the money.  And that money was removed BEFORE you taxable income was calcualted so oyu pay less taxes.  Duh!  

    Now it won’t cover deductibles if you are hit by a car, but you still come out ahead if you (correctly) assume you woin’t be hit by a car.  That deduct comes out of your pocket, after taxes.  Simple.  Why does America need to be sold on this concept? 

  • Tom_with_a_Dream

    As always, Rob, you have seen through the glitz-and-glam and are looking directly at the true problem.  Too bad you aren’t running for National office…

  • Puzzlefeet

    Oh please Rob, I am still connected to North Dakota.  I’ve been away for a year so don’t tell me I am out of touch with North Dakota.  I am more in touch with the health care facilities there than you know.

    And you’re missing my point, there is no shopping around when the shoppers are shopping with both hands tied behind their backs.  How are the clinics in Beulah, Dickinson New Salem competing when they are affiliated with the same clinic and the same hospital with the same billing procedures and the same costs.  That’s just plain bunk!

    And I’m not denigrating personal health care resposiblity, but you gloss over the serious problems with transparency and expect people in rural areas to have choices when they clearly don’t.  And Rob, you feel free to keep talking past me with that old "personal responsibility" tripe.

  • Bat One

    "HSAs are just a ruse to cost shift more and more to the individuals who can least afford to pay."

    Puzzlefeet,

    If my health concerns are not my responsiblity, whose are they?  Since when is personal responsibility "a crock" as you so quaintly put it? 

  • Puzzlefeet

    Once again, Rob, the question is how making people more responsible for their health choices when there is practically no information from which the consumer can choose.  They don’t how much a surgery is, they don’t know the quality of a particular hospital or a particular doctor.  How is a consumer of health care supposed to be more "responsible" when the information is not available to them.  Making people more responsible is just cost shifting to those who can least afford it especially when no quality and cost data is available.  Also, it will difficult if not impossible for those in rural areas to make "responsible" choices when there may be only one clinic or doctor in the area and certainly only one hospital. 

    I, for one am looking forward to watching the implementation of the Mass. plan to see how it works. 

  • Puzzlefeet

    When you say they shop around for health care, what does that mean?  Are the specialists they need at the Mayo, did they talk to their friends and ask what doctor they used for the hip replacement.  That’s not "shopping" cuz they still don’t know how successful that particular doctor is with that particular surgery and the cost of the surgery by that doctor as compared to another doctor. 

    You are putting the cart before the horse.  Doctors and hospitals are already screaming about privacy of their information.  Yet we want the consumers to make these so called "responsible choices" now when the quality and cost system is not even viable at this time.  Again, this is just a cost-shifting ruse for the worker.

    And as far as that rural area, that one clinic is probably affiliated with the hospital or clinic in Minot or Bismarck or Fargo. Most rural clinics are no longer independent and are satellite clinics of the larger  ones located in Bismarck, Grand Forks or Fargo.  That does not qualify as shopping around for the best deal as the cost will be the same because the bill will come from the same place.

  • Epicurus

    Mitt Romney never had my vote.  Not that my vote would ever sway the outcome of the vote in my current state of residence (in a Presidential election at least). 

  • http://mlkashinsky.com/ Marc

    Oh yeah Rob, and what happens if the doctor you negotiated with is on vacation?  Would you expect the on call doctor to honor that price? Or would you just wait for your doctor to return?

    Again, that is why we have insurance.  The insurance company has already negotiated the price of care for us.

    I guess in theory, if there were no insurance (and we all know how likely that is to occur) we could negotiate prices, but that wouldn’t work either simply because of what I stated previously, plus the fact you can’t negotiate for what you can’t plan for.  Everyone of us is different, and all heart attacks, car accidents etc. are not the same.  You can’t negotiate for every conceivable complication when you have no idea what the complications might be. 

  • Puzzlefeet

    Further Rob, you show me any existing plan or legislation that has been put forward that gives consumers access to easily digestible comparative and clincally based information on the quality and cists of different doctors and  hospitals as well as information on which medical procedures are and are necessary in particular circumstances.

    It doesn’t exist and there is no plan or legislation on the foreseeable horizon.  Yet you want to put "consumers in charge" and I ask in charge of what?  Not only are the consumers hands tied behind their backs, they’re blindfolded as well.  That’s some plan.  Again, it’s just a ruse.

  • http://mlkashinsky.com/ Marc

    All that’s happened is …..when we ought to be moving closer to individuals paying for their own health insurance and care.

    I’m confused isn’t that precisely what the MA law has done by requiring everyone to purchase health insurance?

    And if you have insurance, why would you shop around for care? The insurance company has already negotiated the lowest price for you. Of course you could go out of network for care, but than why would you have insurance?

  • robert108

    Marc: Once again, you start from a collectivist premise, and so all your conclusions follow from that.  Medical care is about individual businessmen, called doctors, selling their service to the public.  We are not a collectivist country, except where individuals can’t provide that function, like national defense.  Can’t you see the difference.  People don’t have options in healthcare because the govt has taken them away through treating healthcare as if it is a socialist collective function.  This is obscene in a free society. 

    I mean punishing someone who uses their freedom to say "no" to dictatorial insurance.  You know that.  Why do you pretend ignorance?  Forcing people is unAmerican, even if it benefits you personally.  If your dictatorial insurance plan was so great, you wouldn’t need to force people to participate in it.  So much for your "benefits" argument.  It’s not a benefit if people choose not to buy it when given the freedom to do so.  If you want to give people a choice, offer to reduce their taxes if they buy insurance.  You claim to "cure" the problem of excessive ER use with your plan, so give us a cost/benefit analysis that shows us how much less we would pay if we were all forced to pay for your health insurance.  That is the only valid argument in a free society. 

  • http://mlkashinsky.com/ Marc

    Rob, I just have to ask again, because I still want to know,

    How do you shop around for heart surgery when you are being rushed to the hospital in an ambulance? 

    How do you shop around to fix a broken leg, once you’ve broken it? 

    How do you shop around to health care when you’ve just been involved in an auto accident, and you have massive internal injuries.

    Inquiring minds want to know! 

  • robert108

    Marc: As usual for a leftie, you twist my words.  Even if good health practices reduced medical costs by 50%, it would be well worth it.  You use the usual leftie memes of "if it’s not perfect, let’s not do it", and the "all or nothing at all" rationalizing.  Public health care cost plenty, and most of that is because of bureaucracy and inefficiency.  Giving us more of it is just plain stupid.  Also, why should I subsidize the carelessness of others?  A safety net encourages risky behavior.

    Marc, you are just being dishonest that I said no one ever would get sick if they followed wise health practices;  I said that we shouldn’t have to pay for those who choose to live unwisely.  That is their responsibility.  They should receive the lowest level of healthcare if they have been careless with their health.

     

  • Puzzlefeet

    T-w-a-d, "cold turkey" only works with a support system in place.

    Also, make those medical calculations on a $8-$10 an hour job and how much do you have left to live on with a family. HSAs are just a ruse to cost shift more and more to the individuals who can least afford to pay.  Those with the most health needs will be left in employer based insurance raising those cost until the employer stops and those are left totally uninsured.  This is just a big-ass fraud on unsuspecting people under the guise of choice and personal responsibility.  What a crock!

  • The.Whistler

    Why are you asking me what I think.

    It’s your life, and your money.  Do what you want to do with your own health care. 

     

  • robert108

    Being responsible for your own healthcare, Marc, means, in the case of a heart attack, following a lifestyle to prevent it.  You alone have the responsibility for that.  If you have high cholesterol and high blood pressure, make lifestyle changes before you keel over.  Stop smoking, cut down on the butter and pastries, stuff like that.  We shouldn’t have to pay for your carelessness.  A safety net encourages risky behavior.

  • http://sayanythingblog.com/ likwidshoe

    Not that my vote would ever sway the outcome of the vote in my current state of residence…

    In what state do you reside?

  • http://mlkashinsky.com/ Marc

    but most Americans have an established relationship with a doctor/hospital.  You do your shopping around before those things happen. 

    And how is the ambulance driver going to know that?  And do you really think he’ll even give a damn?

    So Robert what you are saying is, that if everyone in the world practiced a healthy life style, then no one would ever get sick?  That heart attacks only happen to people who have not practiced a healthy life style? 

    What about cancer?  What lifestyle changes do we to make to prevent that?  What about alzheimer disease?  Just how do we prevent that?

    Did you ever think that the body might just wear out after constant use. Tell me Robert, just how do you prevent old age.   

    Why don’t you write a book Robert and tell everyone in the world how to not get sick.   

     

  • Puzzlefeet

    Rob, the problem remains you will throw the unprepared consumer out there and expect them to make "responsible choices" before there is a system set up that allows them to make the responsible choices.  That’s got failure written all over it.  Once again, this is not about people not being responsible for their health care.  I still don’t buy it but you have to sell it that way in order to sell us on HSA and all that crap. 

  • http://mlkashinsky.com/ Marc

    Evil might be a word to use for those who propose HSAs and HDHPs as a way to stem the rise in health care costs.  Those who go along with that dribble are simply misguided.

    Certainly HSAs will reduce an individuals health insurance cost in the short run, but it will do nothing to reduce health care costs, since health care costs are rising due to the aging of the population, i.e demand outstripping supply.

    And the fallacy that HSAs will enable people to negotiate prices is ludicrous, since the health insurance company policy, which enables you to have the HSA has already negotiated the lowest price.  I suppose you could go out of network, and negotiate a lower price (which would be unlikely), but then only a portion of that cost will go towards your deductible, reducing any cost benefit that may have been derived from a lower negotiated price. 

    What HSAs will accomplish is to shift more costs on to the sick, by taking money out of the insurance pool, designed to spread risk.  Eventually this will result in a lessening of the quality of health care in the US as healthcare provider are forced to carry the increased burden of the poor and the uninsured.

    HSA’s will benefit the healthy and the wealthy, by allowing them to shelter more money from income taxes exacerbating the problem even more.

    At least Massachusettes has done something to address personal responsibility by requiring everyone to purchase insurance.  How effective it will be still remains to be seen as the penalties are not very severe.

  • MIke Hitchinson

    perhaps mr romney should have made up an "imaginary enemy" and started a war. maybe he should have sat in the white house for almost 6 years and completetly IGNORED the daily invasion of our country by MEXICO. he should have offered us a HEALTH SAVINGS ACCOUNTS plan so americans can save their OWN money while illegals get these services for free and plunge the states they have invaded into further debt. how dare he offer an attempt to help americans with their health care services that THEIR tax dollars have paid for many times over. i hope he gives this idea up and comes up with a better use of american tax dollars. i mean after all israel getting BILLIONS of dollars to help fight a once a month suicide bomber or some kids throwing rocks is surely a better use of OUR money. maybe he should suggest we keep sending BILLIONS to africa to fight starvation and famine so the governments there can keep stealing it as millions continue to die. damn him for trying to do something for the taxpayers of MA doesn’t he know the proper way of running a government is to lie,cheat and steal while constantly talking about terrorism? i don’t blame you for threatening to NOT VOTE FOR HIM,i mean why change now? 

  • http://sayanythingblog.com/ likwidshoe

    I don’t see anything in MIke Hitchinson’s rambling and often off topic diatribe that tells us why this health care law is a good plan. Does anybody else?

  • http://www.themillerreport.com/ Dave W

    I second Epicurus.  I also wonder how a Republican can come to the conclusion that this fits within the montra of ‘limited government’?  All the supposed presidential candidates have said those 2 marvelous words, we already know that none of them are actually for limited government. 

    I saw Romney on Hardball and boy was he ‘almost’ convincing.  I know he was certainly snoballed into this debacle. 

  • Epicurus

    Cool medical news:

    Recent advances in MRI offer the potential of true three dimensional imaging of biological structures at the cellular resolution (less than 10 micron). The power of MRI in clinical settings has stimulated the development of contrast agents that can be approved for use in human subjects and currently provide data solely on anatomical features. It is the goal of this work to develop needed classes of biochemically activated MRI agents capable of reporting on the anatomical and physiological function of cellular processes in experimental animals. The complexes are designed to be responsive to an in vivo metabolic event and transmit this metabolic signal in the form of an image acquired by MRI. These new agents are important because they address needs ranging from long-term labeling of individual cells to the detection of gene expression within the cells of an organism.

    http://www.chem.northwestern.edu/~tmeade/NURes-MRI.htm

  • http://mlkashinsky.com/ Marc

    I think PF and I have pretty much said the same things, with some slightly different argument that reach the same conclusions. 

    Negotiating for health care would be like negotiating to have your house repaired before the hurricane hits.  How can the contractor know how much to charge until he knows how much damage there is? 

    Of course your entire community could negotiate with the contractor to fix all the houses in the community, and everybody would pitch in, but I think that’s what they call insurance, where everybody shares in the risk.

    And Robert I’ll bet your for mandatory auto insurance and garbage pickup in your community. 

  • Puzzlefeet

    Tom_with_a_dream, What are they using?  They are eligible for Medical Assistance and you and I are paying with our taxes.  Low income people don’t have cash tucked away, they are using it to pay rent, buy food, day care for the kids so they can go to work. 

    Then you write:  "the point of "Personal responsibilty" is to get the common man, who currently has not one scintilla (nice one) of information, to make his own decisions.  When he is forced to, only to discover the scarcity of info available, he will pitch a fit and, eventuall, that info will be brought out.  Then, and not until that fit is pitched, will the true problem (ie: Govt, insurance, etc) be identified and solved. " We have been pitching a fit over the cost of health insurance, but guess who has the bigger lobby, us or the health insurance and Pharma lobby?  Hmm….

    Then you write:  "If the price of strawberries goes up, we dont’ get that service.  We wait. "  If I wait to get my child to the doctor, not only will the child get sicker, I may lose my job, then what? And sometimes I have to have those strawberries, no matter the price, or my health may worsen and I may not be able to work, then what?

    Now as to your analogy of the milk and toilet paper.  We have been screaming about health care prices going up 8-20% a year.  Nothing has changed, it keeps going up.  And we cannot go without health insurance.  If you remember the only time that health costs actually reigned themselves in was right after the Hillary care threat, then the companies moved slower in the cost increases. 

    HSAs will not do this, the information is not available and will not be available so the only people who benefits from an HSA are the well-off and healthy people.

    so those are my comments.

  • http://mlkashinsky.com/ Tim

    All the healthy and wealthy love HSA’s.  They get to shield more money from taxes, and then get to puchase HDHP’s at much lower prices than a full comprehensive plan.  Then they’ll have more money to buy those fancy cars and flat panel TV’s, and they rationalize that as being good for the economy.

    They don’t really care about anyone else, as long as they willl benefit.  The sick, the poor and the elderly are just a drain on their incomes, and they would rather they just went away.  Of course they wouldn’t feel that way if their parents or loved ones were part of that crowd. 

  • Bat One

    Puzzlefeet,

    Ok, please explain what it is about HSA’s that youo perceive to be dishonest.  One of the reasons I set up my first company was to take advantage of an HSA and do so in a manner that was fully deductible to me, yet afforded me the coverage I felt that I  personally needed.  The HSA has done exactly what I expected.  Nothing dishonest there. 

  • robert108

    Epi: My sentiments exactly.

    Dave: Mit has lost my vote in ’08. 

  • Puzzlefeet

    BatOne, I said HSAs were a "crock", not personal responsibility.  HSAs do not equal personal responsiblity.

  • Epicurus

    Oh, and we’re just about to take the cover off the pool, though we could have done that 2-3 weeks ago. 

  • http://sayanythingblog.com/ likwidshoe

    Puzzlefeet said, This is just a big-ass fraud on unsuspecting people under the guise of choice and personal responsibility. What a crock!

    No. It’s not a "fraud". You may view them as the wrong approach, but fraud they are not.

  • http://sayanythingblog.com/ likwidshoe

    Puzzlefeet said, Ok, Lik, I’ll just use these words: Deception; wile; ruse; sham; trick.

    Those words are wrong as well Puzzlefeet.

    A question for you: why do you always assume the worst intentions when it comes to positions that Rob and I endorse?

  • http://sayanythingblog.com/ likwidshoe

    They get to shield more money from taxes, and then get to puchase HDHP’s at much lower prices than a full comprehensive plan. Then they’ll have more money to buy those fancy cars and flat panel TV’s, and they rationalize that as being good for the economy.

    Do you even pay attention to the arguments given?

    They don’t really care about anyone else, as long as they willl benefit. The sick, the poor and the elderly are just a drain on their incomes, and they would rather they just went away. Of course they wouldn’t feel that way if their parents or loved ones were part of that crowd.

    Oh. So anybody who endorses the HSA idea is just plain evil.

    Great argument.

  • Tim

    But Tom, what about all those that are sick now?  How will they benefit from and HSA?

  • http://sayanythingblog.com/ likwidshoe

    Marc said, Emotionalism!

    Gimme a break! The only reason you didn’t read my post, is "you can’t handle the truth."

    Look at your dripping condescension. Pretty rude of you to basically call me a liar. Not too classy.

    The truth is Marc, I am increasingly getting turned off to people who always assume that any disagreement I might have with them is because I am evil. If you can’t argue the merits or lack thereof about something as small as health savings accounts without assuming that your opponent has evil intentions, then you’re not worth my time. There are better pro and con arguments out there that don’t require heavy assumptions of my personal character.

    That’s not to say that I won’t occasionally jump into the ugly fray for the sport of it, just that it is getting old.

  • Puzzlefeet

    Lik, HSAs simply do not meet the needs of most low income individuals.  It certainly meets the needs of those with disposable income and higher incomes who can afford to put money in an account.  Marc’s comments above echo my sentiments exactly.  Instead of trying to figure out how to shift costs to those who can least afford to pay or have an account, why don’t we try to figure out how to control the spiraling costs of health care and prescription drugs. 

    HSAs do  not control the cost of health care in the least.  Nor does an HSA make us more responsible for our health care when we don’t have a scintilla of the information needed to make better health care choices nor is that information going to be available for the forseeable future. 

    Why in the world would you introduce a plan when the most important part of the plan is missing is beyond, unless its true intentions were never meant for those who needed it the most.  Also, Lik I am not questioning your intentions.  The position that employers are being put in trying to provide their employees with health care is getting more and more difficult each year.  That is why the union and the chamber of commerce are working on health care issues jointly.  Businesses know that in order to be more competetive with other countries with universal health coverage, we have do something different,  I just don’t believe that HSAs meet our dual needs.

    And I also know that the mesage to sell HSAs is "personal responsibility" and the line: "if we put you in charge of your health care, you’ll be more careful with it."  That line most of all is what I find offensive.  So that’s where I stand. 

    I’ll give you this, I’ll lay off the "evil" stuff if you and Rob lay off the "you just don’t get it" stuff.

  • Epicurus

    Let’s just say that is a deeply red state.  The GOP candidate for President would have to be caught screwing twelve dead howler monkeys before it would go for a Democratic candiate.  Indeed, the last time this state went Democratic was in 1976.

  • Puzzlefeet

    Ok, Lik, I’ll just use these words: Deception; wile; ruse; sham; trick.

  • robert108

    Marc: "Forcing people to buy health insurance" is the exact opposite of personal responsibility, don’t you know?  You are undoubtedly "pro-choice" on abortion, but when it comes to health insurance, it’s "no-choice" I guess.  Nice hypocrisy.  Forcing people has no place in a free country.  It’s wrong.

  • robert108

    Marc: By your own reasoning, the extra demand for health care by those who use more because it’s cheaper and is paid for by the taxpayers does contribute to the problem by, now get this:  increasing the demand!  The supply problem is due to govt handing over the regulation of medical care to the AMA.  They made the rules, and they wrote them to keep themselves in business by restricting the supply.  This is curable by returning health care to market forces.  The heavily bureaucratic, govt managed system is also a source of increased cost.  Othewise, the increased demand from the aging population would simply call forth an increased supply.  I don’t support mandatory anything, so you know where you can put that one.

    P: Punishing someone when they don’t do what you want is still dictatorial, with the usual leftie spin.  In your mind, the only people being forced here under your dictatorial plan will be the evil rich who just don’t want to contribute to your collectivist system.  You still haven’t addressed the issue of the govt forcing people to purchase something in a free society. 

  • http://sayanythingblog.com/ likwidshoe

    Evil might be a word to use for those who propose HSAs and HDHPs as a way to stem the rise in health care costs. Those who go along with that dribble are simply misguided.

    Oh. So either evil intentions or stupid.

    This is where I stopped reading your comment. Emotionalism has no place in this topic.

  • http://mlkashinsky.com/ Marc

    Oh, I guess I’ll respond. 

    You’re making an assumption that the store will simply not raise prices for milk and toilet paper simply because you complained alot.  On what basis do you make that assumption?  And if that is so easy, how come the oil companies don’t lower their gasoline prices just when the driving season hits?  Aren’t we complaining enough?

    And unlike toilet paper, where you can choose to use kleenex or napkins to circumvent the use of toilet paper, and maybe drive down the price of those commodities, what alternatives do you have when you’re in the emergency room with a broken leg and in a lot of pain.  Do you really think that you’ll say, ‘oh that’s too much money, I’m going to drive 100 miles to the next town where the doctor is cheaper’, or maybe you can just have your neighbor fix your leg.  And even worse what if you just had a heart attack.

    And then there is the case of the quality of health care.  PF is right the information is not available, and I don’t think it ever will be. 

    While there is information available on the likelihood of someone getting an infection in a hospital, or the likelihood that  a foreign body may be left in someone after an operation, anything that tries to measure mortality, or success of a procedure, is pretty much worthless, because, to date, no one has been able to figure out how to measure the condition of the patient, i.e. just how far progressed the disease is or the actual physical condition of the patient. 

    Some doctors and hospitals take the more difficult cases and thus will have a higher mortality rate than other hospitals.  Is it fair to penalize the doctors and hospitals for taking the more difficult cases.

    You just can’t equate health care to ordinary commodities, except as it applies to the laws of supply and demand.   Everyone one of us is different, and will react to treatments and medications uniquely. 

    Consumerism in health care is a misnomer, and to think that you can apply consumerism to health care like you can to the purchase of a car is simply inaccurate.  (How’s that for not being emotional)

  • Epicurus

    The first thing we need to do is to stop thinking that we need a healthcare "system." 

  • http://mlkashinsky.com/ Marc

    Emotionalism! <LOL> 

    Gimme a break!  The only reason you didn’t read my post, is "you can’t handle the truth." 

  • Puzzlefeet

    Robert 108, if you look closely a person will not be forced to buy the insurance, they can choose not to purchase but there will be consequences to their choice, what choice is all about after all.  Responsibility and consequences.

  • Tom_with_a_Dream

    Marc – Your arguments are valid.  I still disagree that the solution is to throw out hands up and give in, I still believe that with enough (and the right kind of) fit-pitching we will win.  But I’ll leave the analogies alone for awhile.  Got work to do anyway.

    Puzzle – Your arguements were ripped off from Marc.  Sure, they might be yours as well, but sinc eMarc already said them, for you to repeat them tells me you like the sound of your keybaord more than you desire to have a throughtful back-and-forth debate.

    Someone said – "We will be forced to pay for the poor’s health care unless everyone gets insurance."  When I read thiis I thought of the $295 fee required by the employer if they choose to skip insuring their people (I guess Romney vetoed it). 

    If the employer fails to insure thier poeple and if the people are too poor to buy the enforced insurance, then who pays their bills?  And even if the vetoed $295 fee is re-instated, how far with that $295 go?  Not very I think…. 

    Aren’t we still left with the health care costs being sky-high, regardless of who pays for it?  I’d like the cost of a quick office visit to a well-trained and highly schooled doctor to cost what hjis time is worth, puls the cost of his tools and those disposables he consumes during my visit, and that’s it.  To do that, we need to get the malpractice lawyers off their backs and we need the doctors to compete. 

    Marc, by the way, same solution for oil prices.  We need the suppliers to compete with all interested parties, including those who believe they can make Alaska profitable and safe for the six caribou (Who, incidently, want the pipline since it is heated!). That would also go a long way to toning down the world’s leading depots pain-in-the-butts (Middle East, Venezuela, etc).

  • Puzzlefeet

    Actually, Tom, my comments were a bit different from Marc’s comments.  I addressed your question "what are they using?" Marc didn’t.

    I addressed your "pitching a fit" argument by responding that consumers have been pitching a fit but that the insurance and Pharma lobbies have more juice.  Marc’s comments didn’t address the lobbying issue.

    I addressed your "strawberry" analogy from the employment side, Marc did not. I then addressed the "milk and toilet paper" analogy, and tied it to the increasing prices of health care with the Hillary care attempt.  Again, different from Marc’s comments.

    Finally Marc’s conclusion was that consumerism couldn’t be applied to health care since it can’t be compared to buying a car. My conclusion was different in that I concluded that HSA would benefit the healthy and the rich. 

    So you may think they were similar but we both took different aspects of the issue.  There was no "ripoff", you simply failed to read for content.

  • http://mlkashinsky.com/ Marc

    No Robert get this.  People use health care because they need health care. People don’t go to the doctor just for fun, like they might decide to go out for dinner.

    And get this: the population is aging, and as the body deteriorates, more things go wrong, and we need more care.  Maybe I should have been more specific.  Demand is increasing because we are living longer! 

    And punishing someone?  What are you talking about?  You mean making someone pay for a service they have benefitted from? 

    Is it fair for only certain people to support an infrastructure that everyone benefits from? 

    I know you support taxes for the military, and police protection. What’s the difference between those services and healthcare?

    We don’t always need them, but when we do, they’re all there, and we all pay for it.

     

  • robert108

    P:  No, forcing people is not personal responsibility.  It’s dictatorship, the opposite of personal responsibility.  Nice try at cherry-picking what I wrote.  It’s only personal responsibility if the person is free to choose whether to do it or not.  You also conveniently didn’t deal with the hypocrisy of "pro-choice" on baby-killing or the appropriateness of the use of govt force in a free society.  You just chose to ignore the major points I was making.  I understand, as a self-acknowledged "emotional" you are in the mode of "My mind is made up;  don’t confuse me with facts." mode.

  • Tom_with_a_Dream

    I re-read your (different from Marc’s) comments.  Here is where I think you stand:

    • It’s okay for the society to continue to pay for all health services of those who don’t have insurance.  (I would be happy to pay for those who genuinely need help, I just don’t believe the current system weeds them out effectively.)
    • Our fit-pitching is falling on deaf ears.  Probably true.  But why is that?  I think the govt’ should spend ourr money to solve the problem (lawyers and single competitor, etc) and not by "enrolling" everyone in the same flawed, and secretive system.
    • And you still believe that HSAs only help rich people.  I still disagree that they benefit people who are willing to give their money to priority based needs.  Meaning:  the spinners have to wait.  (For example, I still don’t have an iPod but I listen to my mp3 almost exclusively, burning 0.10c CDs for the car, even though I have a "upper-middle" income.)

    But I am not trying to pick a fight with you over this.  I believe that, given enough time, teh system will right itself, despite the politicians best efforts to be selfish….

  • Puzzlefeet

    Actually, Robert 108, it is personal responsibility having health insurance so the rest of us don’t have to pay for those who don’t and have to use our taxes for welfare health care. But nice try, though.

  • http://mlkashinsky.com/ Marc

    Just to clarify Tom, I don’t thing PF or I have ever said it is okay to pay for the health care of those who don’t have insurance.  I agree it is okay to help those who genuinely need help, but I DO NOT like paying for the care of those that can afford health insurance, but choose not to buy it.

    The only other point I want to make is that health care costs are not increasing because consumers don’t have "skin in the game" and demand too much service.  Health care costs are rising, as they are all over the world, because the population is aging and demand is increasing without a commensurate increase in supply.

    And as long as the supply lags behind demand, prices will continue to rise.  Certainly there are many things we can do to stem the increases, by relieving some of the administration burden, but the only way to reign in costs is to increase the supply, i.e. doctors, nurses, hospital beds etc.

    HSAs are great for reducing health insurance premiums, but they’re not going to reduce health care costs.  All they accomplish is to transfer more cost to the consumer, and take money out of the insurance pool which will force health care providers (doctors and hospitals) to absorb more of the cost of caring for the sick, which in the end will reduce the quality of health care available in the US. 

  • http://mlkashinsky.com/ Marc

    And when you think about it, do you really want to treat health care like we do other commodities?

    When my TBird got over 200,000 miles, it started costing me about $200 to $300 per month to keep it running.  I kept thinking I would get everything fixed, and I could get a few more miles out of it., but more things happened.  I decided it was cheaper to just buy a new car, and I sent the TBird to the junk yard.

    If we want to treat health care like a commoditiy then we should start thinking about limiting the amount of money we can spend on an individual to keep them alive.  After we’ve reached that limit then just send them to the junk yard, so to speak. 

  • Tom_with_a_Dream

    Maybe I misread your post.  I will re-read mine, Marcs, and yours, but not until later.  I have to be somewhere.  Can’t say I will reply, seems there will be nothing to reply to (I left Marcs comments alone too, nothing personal). 

    I’ll offer a pre-apology, in any case.

  • Tom_with_a_Dream

    I keep reading above that only the rich can use HSAs.  Why is that?  I’ll agree that the poor may not have disposable income to tuck away before they cash their$8/hr paycheck but what are they using when they get sick?

    I’d suggest that people who get sick (ie: everyone, eventually) should have cash (or some commodity) tucked away.  If the best way to do this is to remove it from the check before the Friday night bender, so be it.  

    I’d also suggest that people working $8/hr job (I’ll add "a single $8/hr job" since some are willing to break their back to make it work) should not be raising a family and trying to fund all that comes with such a family.

    the point of "Personal responsibilty" is to get the common man, who currently has not one scintilla (nice one) of information, to make his own decisions.  When he is forced to, only to discover the scarcity of info available, he will pitch a fit and, eventuall, that info will be brought out.  Then, and not until that fit is pitched, will the true problem (ie: Govt, insurance, etc) be identified and solved.  

    There is nothing explicitly wrong with having insurance, where the costs are shared across a large group of (mostly well) people.  That is statistical analysis is what has made Big Insurance (I wonder why we dont’ hear about them more…) so rich.  But there is something wrong when that insurance is so all-encompassing that we don’t bother to check the reciept when we grab our groceries. 

    Actually, I like that analogy.  The Supermarket in my town is the only one.  They moved in and the "The Acme" was closed and out moved out within a year and some.  Now we all shop there, regardless of price (go with me here…) btu we still check the price.  If the price of strawberries goes up, we dont’ get that service.  We wait.  

    But if the price of milk or toilet paper goes up in Feb (snow season), we still buy it (equate this to the broken leg in the ambulance) but not until pitching our fit to the GM.  And calling our neighbors, and writting a letter to the Mother Company.  Right?

    Next snow storm, what happens to milkand tp?  Nothing! 

    We need this with health care.  The Insurance comapneis can still take our collective money and assist with the overall prices (as far as I’m concerned) but we all need to be more involved so our voices get raised and the players are forced to respond to us.  

    The HSAs are a way to do this, while allowing us (all of us, not only the rich) to reduce our taxable income at April 15.   It’s called a tax incentive.  Govt’ gies incentives to encourage people to do what’s in their best interest (and it is supposed to give negative incentives for things that are not in our best interests, think cig. taxes).

    Comments? 

  • The.Whistler

  • http://mlkashinsky.com/ Marc

    Hey Whistler!  I wasn’t talking to you, and I don’t care what you think.

  • http://sayanythingblog.com robport

    I’ve been away for a year so don’t tell me I am out of touch with North Dakota.  I am more in touch with the health care facilities there than you know.

    You certainly haven’t displayed that here, unless you’re selectively accepting reality to more easily match it to your big-government, nanny-state views.

    And you’re missing my point, there is no shopping around when the shoppers are shopping with both hands tied behind their backs.  How are the clinics in Beulah, Dickinson New Salem competing when they are affiliated with the same clinic and the same hospital with the same billing procedures and the same costs.  That’s just plain bunk!

    It would help if you actually read my comments and then responded to my points.

    As I’ve said before, there is no competition now.  If we made people responsible for their own health care competition would grow.  Let’s not pretend that a massive shift in the way people pay for their health care would have no impact on the way that health care is provided. 

    And I’m not denigrating personal health care resposiblity, but you gloss over the serious problems with transparency and expect people in rural areas to have choices when they clearly don’t.  And Rob, you feel free to keep talking past me with that old "personal responsibility" tripe.

    Man, you really don’t like losing arguments do you?

    Serious problems with transparency?  Are you just making stuff up now?  Where are the problems with transparency?  As I’ve said before, we can mandate pricing practices if you want (though not prices).  I’d rather see that then mandating health insurance or socialized medicine.

    But health care is like any other business.   When people shop, businesses have to compete.  When they compete things like good customer service and comparitive shopping information spring into existence.  We don’t have those things now because nobody shops around.

    Are you following that, or are you going to keep pretending like nothing would change if we made people personally responsible for their own health insurance? 

    Further Rob, you show me any existing plan or legislation that has been put forward that gives consumers access to easily digestible comparative and clincally based information on the quality and cists of different doctors and  hospitals as well as information on which medical procedures are and are necessary in particular circumstances.

    Well, there’s none really.  But then, you are once again missing the point.  That stuff doesn’t exist because nobody shops around.  Honestly, what does it take to get you to read my comments and actually respond to the points I’m making?  Once people have a reason to shop around the means to do so will take shape.  It won’t need to be legislatively mandated (though, as I’ve said all along, if it makes you feel better we can do that) because it will just happen like it always happens in a free market.

    I ask in charge of what?  Not only are the consumers hands tied behind their backs, they’re blindfolded as well.  That’s some plan.  Again, it’s just a ruse.

    Right, consumers are blind now.  I want to open their eyes and empower them to make their own decisions.  You want to keep them subjugated by forcing them into our current system which a) doesn’t work and b) doesn’t hold them responsible for their own actions.

  • http://sayanythingblog.com robport

    Once again, Rob, the question is how making people more responsible for their health choices when there is practically no information from which the consumer can choose.  They don’t how much a surgery is, they don’t know the quality of a particular hospital or a particular doctor.  How is a consumer of health care supposed to be more "responsible" when the information is not available to them.

    But that is a problem easily fixed.  Mandate clear pricing for health care providers.  I’d rather see us do that then step closer to socialized medicine.

    Making people more responsible is just cost shifting to those who can least afford it especially when no quality and cost data is available.

    A typical big-government liberal response.  Making people responsible for their own decisions and actions is bad.  The government should, of course, seek to take care of everybody. 

    Also, it will difficult if not impossible for those in rural areas to make "responsible" choices when there may be only one clinic or doctor in the area and certainly only one hospital.

    I live in such a rural area.  We have one hospital and one clinic.  Yet people shop around anyway.  People routinely go to Bismarck, Grand Forks, Fargo…even as far as the Mayo clinic to get care.  Plus, once we’ve broken up the consumer complacency brought on by our current system by forcing people to shop around once they are responsible for their own health care more options will emerge due to more competition.

  • http://sayanythingblog.com robport

    How do you shop around for heart surgery when you are being rushed to the hospital in an ambulance?

    I don’t know about you, Marc, but most Americans have an established relationship with a doctor/hospital.  You do your shopping around before those things happen.    In an emergency situation away from home I would assume the decision would be made based on whatever is most convenient.

    But you’re talking about a very small percentage of overall health care.  This is a red herring.  You’re trying to say "Well someone who has been knocked unconscious can’t choose their hospital so obviously asking people to be responsible for their own health care is crap."

    That logic doesn’t follow. 

  • http://sayanythingblog.com robport

    Tom, I don’t think I’m electable.  I was, unfortunately, born without the ability to pander or kiss asses.

  • http://sayanythingblog.com robport

    You are putting the cart before the horse.  Doctors and hospitals are already screaming about privacy of their information.  Yet we want the consumers to make these so called "responsible choices" now when the quality and cost system is not even viable at this time.  Again, this is just a cost-shifting ruse for the worker.

    What hospitals have cried about making prices public?  That is not a violation of privacy, and again it is an issue that is easily solved.  Let’s mandate that health care providers hand out clear and concise price lists for their services.  Now, the hospitals won’t like this because they don’t like it getting around how much they mark up their goods and services, but so what?  This is about empowering individuals.

    And of course it is a cost-shifting move.  What I’m wondering is why you think it is anyone’s responsibility but the individual to provide health care? 

    That does not qualify as shopping around for the best deal as the cost will be the same because the bill will come from the same place.

    Which just shows how disconnected from realities in ND you are.  Yes, the clinics are owned by other hospitals.  But, these clinics still compete with the other clinics and hospitals in the area.  And you’re totally missing the point.

    If we make individuals responsible for their own health care they will shop around.  This will cause more clinics to open and compete for business and it would also make their billings and services easier to manage (though we can still mandate clear pricing practices if that’s what you want).

    Basically, what you’re trying to do is denigrate personal health care responsibility by saying that it "won’t work" in an environment where we don’t have personal health care responsibility.  That is a total canard, and I suspect you know it.

    But, feel free to keep talking past me with more libera, big-government, nanny-state tripe. 

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