Say Anything Blog

Now come on, Rob, they’re only paying twice the going rate for health insurance.  Have a heart.  :^)

That’s over $12k per person… You can buy quite a bit of health care coverage for $12k....

The article would have  creedence had it not been written by a lobbyist for the health insurance industry.

Adam Brackemyre lobbyist for

"The Council for Affordable Health Insurance (CAHI) is a research and advocacy association of insurance carriers active in the individual, small group, MSA and senior markets. CAHI’s membership includes insurance companies, small businesses, providers, nonprofit associations, actuaries, insurance brokers and individuals."

http://www.sourcewatch.org/index.php?title=Council_for_Affordable_Health_Insurance 

woof: Nice smear by association; very McCarthyesque.  How are those smaller entities going to get the ear of the humungous federal govt?  The info is either true or it’s not;  who wrote it isn’t the issue.

Not  a smaer. Just pointing out this guy has  a dog in the fight.

Rob said,

Socialized medicine, or any type of government-backed health care program for that matter, has never worked.

It seems that this isn’t true.  There are a lot of nations with socialized medicine ahead of the U.S. in the CIA factbook rankings for Infant Mortality and Life Expectancy.

One factor with infant mortality is that we aren’t exactly comparing apples and apples.  Many times a premie in the US is counted as a mortality when that same baby would not in another country (such as Canadia)

There are also factors such as Crack babies that aren’t really fair to blame on the US healthcare system.  

That being said I think Rob was referring to the fact that quality goes down ON AVERAGE while costs go up.  It’s conceivable that treatment for babies may not go down while they government health care plan doesn’t try to cure the terminally ill.

OK the real reason why I wanted to post this was to point out to any deadbeats in North Dakota that there’s a great subsidized health care plan in Vermont. 

Woof: "The article would have  creedence had it not been written by a lobbyist for the health insurance industry."  You denied he had credence because he was associated with some groups that represent free enterprise.  That’s smear by association.  You said nothing to dispute the truth of what he wrote.  That is a smear.

CV Rick: If socialism worked, then the most powerful nation on Earth would be a socialist country, like the Soviet Union.  Oh, wait!  They went broke.  Oh well.  Anything other than free enterprise produces long term shortages, high prices, or a combination of both.  Econ 101.  Separating the consumer of the service from the payer is inefficient.  Taxpayers can only pay so much, then they opt out.  It is also immoral to make people pay for something when they aren’t using it, especially when the payment is really confiscation. 

I would agree with Whistler that infant mortality isn’t a particularly good statistic to use for comparing medical systems. Neither is, for that matter, life expectancy. The problem is that other factors play a major role in life expectancy beyond medical care, such as lifestyle, nutritional habits, etc. In fact, medical care may be fairly far down in the list compared to the amount of stress, obesity, smoking, abstinence and other factors that reduce life expectancy.

To even suggest that Dirigo Health is anything close to a single payer system which would cover everyone is totally wrong.  The biggest problem is it is still a voluntary program

The way I understand Dirigo, it is simply the state of Maine, contracting with private insurance companies to offer health care at a guaranteed rate, and asking health care providers, doctors and hospitals, to try and control their costs better.  Yeah, that’ll work.

The only differences between what Dirigo offers and what we have now, is those within 300% of the poverty level are charged a rate which is subsidized by the state of Maine depending on their income level.  But if you’re already getting free health care, where is the incentive to start paying for it? 

As long as enrollment in health care is voluntary, costs will continue to be shifted to those who are already paying for it.  And HSAs, the answer suggested by the writer of the article, will do nothing to stop that. 

All HSAs will do is take money out of the current health care system, by removing more of the shared costs, eventually forcing even larger increases in all health insurance rates, HDHPs and standard health plans, somewhere down the road.

Right Marc, govt coercion is the only way!  Private citizens can’t be trusted to be responsible for themselves.  Big Brother govt will take care of us all.

On the other hand, anybody who attacks direct subsidization programs but supports our current indirect subsidization (where the more you make, the more gets subsidized) is plainly crackers.

Carrick:  IMO, subsidization is wrong, whether it is direct or indirect, when private enterprise would work better, which it almost always does.

You won’t get any argument from me about the current system being broken.  It just seems like moving to a government-backed solution would be more of the same, only worse.

When the people fear their government, there is tyranny; when the government fears the people, there is liberty.

-- Thomas Jefferson

Rob’s recently listened-to songs:

In my opinion the current system of hidden subsidization is completely hosed. By taking insurance benefits out pretax, you’ve created a vicious loop that protects everybody but the consumer. I think these are all points that Marc has made, but I think bears repeating.

The current system distorts the job market because it penalizes you for leaving your current employer. The insurance companies negotiate a "special rate," so that self-insured people end up paying much higher amounts for the same treatment. Doctors and hospitals benefit from the absence of oversight by insurance companies of what they bill and don’t bill.

There are certain things that having the individual be responsible for paying would help, like "why are you charging $5 per aspirin tablet?". (Good luck getting that rate reduced with our current system.) On the other hand, I’ll point out the obvious---most people are ill or they wouldn’t be seeking medical treatment. This means that they are usually at their near worst and least able to represent themselves. Further, if you need an immediate by-pass procedure, how can you refuse a doctor? How does privatization rectify this

Medical care is nearly a monopolistic enterprise, many communities have few choices as to which hospitals to go to and which doctors to use, especially for major operations. Most doctors don’t like doing boring" and low-return preventative medicine, but a healthy work for is in all of our best interests.

To give an idea how much it would cost, suppose we decided to pay for biannual checkups for each adult? I suspect in "real dollars" (rather than heavily jacked-up insurance-company medical-care cartel prices) it would cost about $50/visit. This works about to about $25 billion per year, to be compared to our net subsidization of about $250 billion (guess, anybody know the real number?). On the other hand, by keeping the population healthier, suppose we increased productivity by just 1%. This amounts to a increase in economy productivity of 125 billion dollars, a revenue return to the government of about $25 billion, but with more job creation and more wealth creation. So how is this not a good idea?

On the other hand, like Rob and Robert108 I am pretty much underwhelmed with the idea of government taking over all aspects of medical care. I happen to think that "big government" sucks when it comes to doing about anything that requires the slightest amount of flexibility. Katrina is not a Bush failure per se, it’s a failure of the model that Big Government can tuck us in bed and keep us safe like the big Nanny State we’ve come to know and love.

HSA’s work.  Bottom line.  They put the patient in charge of the money, with catastrophic coverage insuring the costs that are unassumable liabilities on behalf of the insured.  The insured pays for the expected, bugetable expenses and saves for them with tax incentives.  Insurance is not to pay your bills, insurance is to cover catastrophies.  People need to be responsible for themselves and budget for it.  This is a concept lost on most of the left. 

Carrick - Self insuring doesn’t work.  You can’t assume the liability for catastrophic medical expenses.  That’s what insurance is for.  But, buying large deductible, affordable coverage and budgeting for smaller expenses does. 

 You have a point in small communities about medical care being somewhat monopolistic.  This is a problem that small town america is trying to deal with.  Quality health care is a problem in small communities.  It takes a special physician to go into practice in several small communities.  One still needs to be reasonable close to a regional medical center.  In addition, the regional medical center needs to participate in most managed care networks to be affordable (which most do). 

Carrick: Couldn’t agree with you more.  BTW, Marc is the one in favor of compulsory insurance and a single-payer system.

Why is it the compulsory health insurance is considered coersion by the government, while compulsory auto insurance isn’t?

A lack of health insurnace, which results in someone not being treated for a highly infectious disease, can result in a lot more harm to society then one person without auto insurance.  Yet it seems most people on this list have no objection to mandatory auto insurance, but have an objection to mandatory health insurance.   The logic escapes me why that is.

Secondly, why is it whenever anyone discusses socialized medicine they only talk about Canada and the UK.  I admit, those systems are failed, and patterning a system solely after those two countries would not be good.  You need to take a look at the systems in the other industrialize countries before you can make a judgement on the effectiveness of so called socialized medicine.

Try googling the health care systems in Germany, the Netherlands, Switzerland, Japan, etc.  What you will find is there is very little government control over the health care system, and they are patternedrelatively close to the system we have in the US.  There are no waiting times, health outcomes are far better than in the US, and they do it for less than half the cost of the US.

The principal differences between those countries and the US, is on top of universal health care for all their citizens, they have a universal enrollment policy.  Everyone pays the same for health insurance, with credits to the poor, and insurance companies are not permitted to deny coverage because of pre-existing conditions. Everyone is guaranteed a minimum prescribed level of health care which they have to pay for.

Everyone pays their fair share!  No one gets a free ride, like in the US. What is so awful about that?  

If you object to paying for the health care of others, then you need to move somewhere else, because you are doing just that, if you currently purchase health insurance, or use the health care system, and pay for it directly yourself.

r108 said,

If socialism worked, then the most powerful nation on Earth would be a socialist country, like the Soviet Union.

Maybe power should be measured in freedoms and in the standard of living.  Don’t you think that bringing up the Soviet Union as your prime example of socialism is misleading?  Econ 101 should have taught you that political systems and economic systems aren’t tied directly.  Democracy and Socialism aren’t mutually exclusive.  Neither are despotism and capitalism.

CV Rick wrote, It seems that this isn’t true.  There are a lot of nations with socialized medicine ahead of the U.S....

Then why does the U.S. effectively subsidize their drugs?

...in the CIA factbook rankings for Infant Mortality and Life Expectancy.

The percentage difference is around .002%! Sometimes it is .003%! In other words: statistally irrelevant. And guess where the biggest differences abound? In the Democrat controlled inner cities where infant mortality is higher (because our "Great Society" programs pay welfare crack mothers to have babies and where life expectancy is lower.)

So how, again, are socialized health countries "ahead of the U.S."?

Maybe power should be measured in freedoms and in the standard of living.

Maybe it shouldn’t. Why would "freedoms" have such requirements as, "equitable wealth distribution"? You’re bringing your socialist requirements as an argument.

Marc said, The biggest problem is it is still a voluntary program

This is the typical liberal refrain. The problem is not that your ideas don’t work, it’s that we haven’t done enough of it yet. It’s why we hear cries of "more money!" everytime it is shown that government doesn’t work.

Why is it the compulsory health insurance is considered coersion by the government, while compulsory auto insurance isn’t?

If you don’t have car insurance and hurt somebody in an accident they’re taking something away from the party they hurt.

 on the other hand not having health insurance should be a personal thing.  If you decided not to have insurance and ultimately didn’t get medical treatment because of that you only have yourself to blame.

On the other hand that whole point breaks down when when the uninsured (but happy) person get’s sick and has the work done anyway.  They either stick the hospital with the bill or the taxpayer gets hosed. 

Ok, one last try, and I’ll shut up forever. Maybe

If you decided not to have [health] insurance and ultimately didn’t get medical treatment because of that you only have yourself to blame.

First off, in this country, you don’t need insurance to get treatment.  Just go to an emergency room.  You are required by law to be treated.

But, to use your example, what happens if you contract a contagious disease, don’t get treatment because of a lack of health insurance, and spread that disease, knowingly or unknowingly, throughout society?  Are you still the only one who gets hurt? 

And likwidshoe, who’s crying for more money?  I’m not! There is plenty of money available now, the bills do get paid  I just want those who don’t pay for their health care to pay for it.  Why are you against that?

Why should I have to pay for someone else’s health care?  Why should I have to be employed to have the opportunity to purchase affordable health insurance?  Why can’t I just buy the same insurance as government employees at the same price they pay? And why do I have to be healthy to purchase that insurance, or be required to pay 170% of the rate of everyone else, should I get sick?

I’m not talking about socialized medicine.  And while I do believe a single payer system, structured much like medicare, will produce better results, I would have no objection to the current system as it stands provided it were made compulsory, and everyone was allowed to purchase insurance at the same cost, or at a graduated scale based on age, with no exclusions due to pre existing conditions.

And you also ask,

Then why does the U.S. effectively subsidize their drugs?

That’s an excellent question.  We do that because are politicians are in the pockets of big pharma, and refuse to let us negotiate drug prices like they do in the rest of the industrialized world,

Of course if voluntary health insurance is your thing, and you don’t mind subsidizing the health care of those who refuse to pay for it, than you shouldn’t be objecting to the US subsidizing drugs to the rest of the world. 

I do, but I guess that is the definition of a socialism, so my ideas aren’t worth much.

BTW Rob, I hate not being able to preview my messages before posting.  

And likwidshoe, who’s crying for more money?  I’m not!

I didn’t say that you were.

I just want those who don’t pay for their health care to pay for it.  Why are you against that?

I’m not against that. Don’t put words into my mouth.

We do that because are politicians are in the pockets of big pharma, and refuse to let us negotiate drug prices like they do in the rest of the industrialized world...

Did you even read the link? It explains what tool those other countries use when they "negotiate". It’s a tool that "big pharma" wouldn’t endorse.

Of course if voluntary health insurance is your thing, and you don’t mind subsidizing the health care of those who refuse to pay for it, than you shouldn’t be objecting to the US subsidizing drugs to the rest of the world.

Doesn’t apply.

If you guys sit down and read through the other types of government programs out there, you’ll find that Marc is right---many of these programs do not qualify as "socialized medicine".  For example, the Swiss system (one of the most successful) is a  "consumer-driven" health care system, in other words, generally more free-market than our own system. It’s also no surprise that the purest socialized medicine systems work the poorest, and more free-market-like systems, like the Swiss system, work better.

If people keep themselves less healthy (as a group), it affects us as individuals, because of the lost productivity. Thus, we do have a vested interest in encouraging a healthy workforce. See my comments about the effectiveness of "investing" in preventative health care, as an example of the sort of reasoning I think should be applied.

I know that Robert108 and I probably disagree on this point, but I think because of the nearly monopolistic nature of the heatlh-care system, government oversight is needed. A model along the lines of local oversight of utility companies, where hospital and doctor’s rates were reviewed on a semi-anual level, taking into consideration local market conditions, would be the best approach, rather than a centralized FEMA link bureaucracy.

Marc, thank you for your input. I think we all appreciate them. Conservatives are a very skeptical bunch of folks for the most part. Generally this is a Good Thing.

Carrick, you make good points as always.

I agree that government oversight is needed, but I think you and I disagree as to the extent of that oversight.  I believe that doctors (nurses, pharmacists, etc.) should have to pass certain agreed-upon standards in order to practice their profession.  Above and beyond that, I don’t see much of a need for government involvement.  I know I’m being sort of general here, but my point is that we can agree on a certain amount of regulation.  Where I draw the line is government paying for health care.

Carlin’s point about HSA’s kind of got overlooked, but I think he’s right in that they work.  I also think they’re the way out of our current predicament.

HSA’s put the citizen in charge of making day-to-day medical decisions.  They can choose which doctor they see and which treatmetns they pursue.  And they can ask all those important questions, as you pointed out, like "Why did you just charge me $75 for the use of a pair of scissors?"

But HSA’s also require catastrophic coverage.  If you get really sick, you’re covered.  Cancer.  Broken legs.  Stuff like that.

It is the best of both worlds, as far as I’m concerned.  And HSA’s can even be set up so that employers can contribute to them just as employers now contribute to insurance plans.  The only difference is that the citizen, not some insurance company, gets to keep the money if it doesn’t need to be used for care.

Talk about a great incentive for preventitive health care.  You can bet many Americans are going to be taking their health more seriously if they know that they’ll get to keep the money in their HSA at some point if they don’t use it.  Or pass it on to their survivors.

When the people fear their government, there is tyranny; when the government fears the people, there is liberty.

-- Thomas Jefferson

Rob’s recently listened-to songs:

Folks it’s all about personal responsibility.  Driving a car brings with it a certain amount of responsibility.  Maintaining fiscal responsibility is part of being a grown up.  If you are going to drive a car with the potential to kill my family in an accident, by gawd you should be required to have proof of fiscal responsibility.  In healthcare, if you are indigent, the gubmint will take care of you.  In most states, if you are near the poverty level, you will have subsidizes medical care, it may not be as good as what you can go out and buy, but it is medical care, and it’s gonna cover miscellaneous up to catastrophic.  If you cannot qualify for employer sponsored group coverage or individually underwritten health insurance, you can qualify for state subsidized (in addition to it being insurance carrier subsidized) health insurance, guarantee issue. 

Yes likwid, I have read that link in the past, but have been unable to find a reference to that condition anywhere else.  I also find it hard to believe that countries like Germany, France, Canada, the UK etc could get away with violating patent laws, but if you can find corroborating evidence let me know.  I’ve been proven wrong many times.

CV Rick: I used the Soviet Union(hardly a bastion of freedom or quality of life for its citizens), because it was the longest-lasting socialist experiment.  Why else?  They had seventy years to get it right, starting just like Karl predicted, with a violent revolution(against an agrarian monarchy, not an industrialized capatalist system), and failed miserably, for entirely predictable reasons, if you know econ 101.  While it is technically true that economic systems and political systems are separate, in practice, a political system which involves personal freedom is necessary to maximize the performance of a free enterprise economic system.  That is just the way it works.  Russia today is having a problem with "capitalism" because they have no cultural background of individual independence. 

Marc: I don’t support compulsory anything. I believe I described the result in CA of effective enforcement of its compulsory auto insurance on the auto body repair industry, and ultimately, the consumer.  Prices of such repairs have gone through the roof, which is entirely predictable, as is the skyrocketing cost of health care with the present semi-socialized system.  The farther you get from the free enterprise system, the more problems you have.  The law of supply and demand is a cosmic one, and cannot be repealed.  The problem with socialism in general is the need for equality of outcome, which is not the human condition.  We get differential outcomes for many reasons, and that cannot be changed by a political or an economic system. 

Rob wrote:

"Look at Canada’s system. All inefficient, bureaucratic boondoggles."

Canadians live significantly longer than Americans, have lower infant  and child mortality, and do all this despite spending roughly one-half of what Americans spend.

Wow! Let’s all move to Canada.  Sounds like paradise.

"Talk about a great incentive for preventitive health care.  You can bet many Americans are going to be taking their health more seriously if they know that they’ll get to keep the money in their HSA at some point if they don’t use it.  Or pass it on to their survivors."

Rob,

I would assume then, that you would support the Bush administration’s proposals for Social Security reform for much the same reason?  Just asking.

PS  25 minuted til "24" everyone. 

Bat:  I don’t know about Rob, but I sure do!

I’d support the privatization of both medical care and pensions as well. 

BTW, infant mortality in developed nations has a lot more to do with behavior than medical care--as does longevity.  That said, Canadians do have a good reason to take care of themselves--they wait for months for heart surgeries.  The failure to exercise is downright lethal there, and people know it.

Braveheart said, Canadians live significantly longer than Americans...

Define "significantly".

...have lower infant and child mortality...

I don’t know about you, but I call less than a 2 death difference per 1,000 people statistically irrelevant. Additionally, America has more black people (12% versus Canada’s 2%). Blacks have nearly twice the infant mortality rate. Your biased citing of a statistic doesn’t take this and many other factors into account.

...and do all this despite spending roughly one-half of what Americans spend.

Uh yeah. Because we Americans help subsidize your system.

Robert Perry,

How unfortunate that you suggest the privatization of two areas which should neve have been anything but private in the firt place.

Robert 108,

There are times when I allow my intellectually playful side a chance to roam freely a bit.  Such as the exchange yesterday with Don Myers.  So far, the Social Security gambit has attracted only your attention, and I know from reading here that you take the private versus collectivist argument seriously.  Have patience.  Eventually, some liberal will find the bait too tempting to resist.

I trained a wild squirrel to come sit in my lap while I fed it peanuts, years ago.  Fattened up over a couple months like that, the squirrel was actually very tasty.

Bat: I got my conservative epiphany in ‘62 when I took my first econ course in college.  In that class, beginning econ, we figured out when SS would go broke, and that it was a pyramid scheme in the classic sense.  We figured out how to make it work, by what is now called privitazion.  Since then, the jacked up tax rate has put off the date of demise, but hasn’t changed anything as far as the underlying structure is concerned.  The Presiden’t plan is not big enough, but it is a step in the right direction.  It would also strengthen the Market tremendously.

Glad to see that you are a member of People Eating Tasty Animals.