American Politics: the Lost Generation

[Shryke]

I think TheKa acknowledges this.

If he did, he wouldn't be favoring "a truly free market" as a solution.

I'm not talking about right now, I'm saying period. The Health Care market exhibits so many properties that make it not function anything like an idealised Free Market, it's a fucking joke.

[Former Lord of Winterfell]

Which is why "allowing insurance companies to compete across state lines" accomplishes nothing. That is the problem with employer based coverage. Businesses offer health insurance in lieu of higher wages thanks to government incentives, but employees do not get to pick their provider.

But businesses have an obvious incentive to shop to get the most bang for their buck, so that still creates a competitive element. Plus, linking it to employment does have the virtue of limiting self-selection by individuals that might lead to the healthy and ill being segregated.

The idea that insurers don't compete for the business of employers isn't accurate even on its face.

[TheKassi]

The idea that insurers don't compete for the business of employers isn't accurate even on its face.

If this had any real truth to it, the "open up state lines" argument wouldn't exist. The entire notion is predicated on the concept that closed boarders keep insurance costs high do to lack of competition, and that opening up state lines will change all that.

The pool is stagnant because blocks of dozens and dozens if not hundreds or thousands of people, who all have very different opinions on what constitutes quality or acceptable cost, move far more slowly then individuals. That isn't going to change over night simply because you open up state lines.

You can not expect a system that fosters collective bargaining managed by an individual who is only accepting the responsibility to net themselves a tax break to play by the rules of a free market. Might as well expect fish to run.

[ThinkerX]

There's a fairly major difference between housing and health care, the main one being if you have a medical emergency you must pay for it.

*ONLY* if you can afford to do so. Or you can just live with it - I've known people who actually resorted to home remedies or sneaking over the border to cut costs way down.

There is no incentive for insurance or medical care costs to lower. None at all, because people will always get sick or have emergencies and need to be treated. Even if you have the ability to shop fro the cheapest health care package, you're still overpaying in this country.

No, again, you just do completely without. Ever hear of alternative medicine? A lot of people have been looking very hard into that as a direct result of high health costs in the normal system.

And so called 'health care reform' makes matters even worse. What the so called reform really does is forcibly transfer monies from people who have little money to people who have a lot. That is the *ONLY* thing it really does. It is a complete and utter rippoff.

Not only that, the people putting it forth are deliberately lying about the costs and how it is going to be paid for. Like I said - forty percent of the population of this country (give or take a few points) simply *cannot* afford to buy *any* health insurance package on their own. Fine, says the liers and their deluded supporters - we'll just subsidize that part and pay for it with taxes on the so called 'cadilac' plans. What these utter fools do not realize is that A) less than ten percent of the populace actually has the so called 'cadillac' plans and B) the minute that goes into effect there will be a mass exodus from those plans. Hence, with the government already starting to institute spending freezes across the board, and a giant shortfall in the already ficticious revenues for this program, the government is going to start aggressively looking for ways to deny those subsidies on any grounds they can come up with - regardless of their true merit, AND at the same time inisisting that people still pay for health insurance anyhow even if they do not have the ability to do so.

[Aemon Stark]

No, again, you just do completely without. Ever hear of alternative medicine? A lot of people have been looking very hard into that as a direct result of high health costs in the normal system.

Right. Let's treat acute appendicitis with acupuncture and chronic myeloid leukemia with a multivitamin.

And so called 'health care reform' makes matters even worse. What the so called reform really does is forcibly transfer monies from people who have little money to people who have a lot. That is the *ONLY* thing it really does. It is a complete and utter rippoff.

And it does this how...?

[Lord Mord]

Trisk,

I believe the rest of his post is designed to elaborate on the "ripoff" aspect. It's not bad enough that the planned reforms will "steal" from people (laughable concept where taxes are concerned, but not to ThinkerX), but worse, those same reforms will achieve none of their aims and only make everything much, much, worse.

I think he'd still be pissed at the idea of these reforms if they worked, because it'd be off the sweat of his brow, but he would at least have to concede that it wasn't the worst idea ever, because more people had health coverage. It's a "ripoff" because it literally (according to him) rips some people off explicitly, and then rips everybody off by selling us a bill of goods.

[sologdin]

he means that it's a payday for insurance companies, transfering the premiums of added insured persons into the custody of the industry; this also means that it's a payday for health care providers, because added insureds = more patients. the thesis is that the price will be borne by those persons least able to bear it; "forcibly" is the old libertarian saw about men-with-guns forcing compliance with statute (true enough--but the same applies to the market relations upon which libertarians jizz, though they ignore the identity of application, to their credibility's dire peril.)

the assessment is correct, except, as evident in the claim that this is the only thing that reform does, for the fairly callous disregard for the fact that many uninsured persons will be able to receive medical treatment.

[ThinkerX]

Sologdin was the only one who grasped what I was trying to say there, though Caspen got part of it.

I do dispute the the claim that the newly insured people will actually recieve treatment, though. The insurance companies are *NOT* there to help people, rather, they are in it for the money. They will, under this 'reform' scam gain *lots* of new customers who *have* to get insurance, making them a giant pile of money right off the bat. They will, at the same time, resort to every trick they can think of to avoid paying out when somebody actually tries to collect. Even if that person does collect, the insurance company will automatically raise their premiums, possibly to unaffordable levels. On top of that, I regard the subsidies as being completely unsustainable even in the short term (within one or two years), with a great many people being denied them - but those same people will *still* be legally required to obtain insurance they have no way of paying for.

Now...on another not quite related matter I've seen brought up repeatedly elsewhere but not even mentioned here:

there be a Treasury scheme in effect, through proposed regulatory changes, to convert 401K(s) to annuities (sp?). Under these changes, 401K fund managers will be 'encouraged' to invest heavily in treasuries...and the last few auctions of treasuries - at least the long term ones, anyhow - have been catastrophic failures. There have also been multiple allegations that the only reason these auctions have not been even worse is because the Fed and Treasury are playing number games.

[Former Lord of Winterfell]

If this had any real truth to it, the "open up state lines" argument wouldn't exist. The entire notion is predicated on the concept that closed boarders keep insurance costs high do to lack of competition, and that opening up state lines will change all that.

There are two issues. The first is that because each state has its own maze of regulations, there are significant administrative costs for insurers who might consider selling in other states. The effect is to sort of freeze insurers into the states in which they are located, which reduces the number of insurers competing for the business of employers in each state.

The second is that each state has its own array of mandated coverages that effectively prevent insurers from offering cost-effective policies to lower-income people. Maybe an unskilled worker isn't sufficiently productive to earn health insurance that includes mental health coverage, chiropractic, birth control, and acupuncture, but he/she would be able to afford a basic medical insurance policy if insurers were permitted to offer it.

The pool is stagnant because blocks of dozens and dozens if not hundreds or thousands of people, who all have very different opinions on what constitutes quality or acceptable cost, move far more slowly then individuals. That isn't going to change over night simply because you open up state lines.

Of course it won't change overnight. But employers -- who for obvious reasons always try to get the most bang for their buck, and do shop aggressively -- would have a bunch of difference insurers from whom to choose. What's the downside? At best, you could see significant cost savings as multiple insurers compete against each other for business. At worst, you'd see little change.

You can not expect a system that fosters collective bargaining managed by an individual who is only accepting the responsibility to net themselves a tax break to play by the rules of a free market. Might as well expect fish to run.

Are you saying that employers have no incentive to try to get the best deal for their employees at the best price? Employers are not required to offer insurance at all, and if they truly do "race to the bottom", none of them would offer it. But most offer it as part of a benefits package to attract and retain employees. Triskele pointed out that there are relatively few insurers in each state. They compete, but imagine how much more aggressively they'd have to compete against each other if other policies were fungible between states.

I'm not trying to suggest that there is literally no competition, but it's nothing like what a free market would be. So yes, some shopping around does occur, but they're shopping around amongst limited options which may even be colluding in some areas.

I think there's some truth in that, although the other "competitor" out there is the risk that employers drop insurance entirely. But that's why I think the elimination of state mandates and the antitrust exemption might improve things. Multi-state companies that really figure out how to do this stuff the most efficiently would be one aspect of improved cost control.

I'm saying that on top of that they would gravitate towards a market that catered to their low-risk credentials and would charge less. The low risk people all gravitating towards some state together leaves a mess for everyone else.

I understand your point, but I don't understand how you think that would actually happen. I mean, they wouldn't be gravitating towards a particular "market" -- they'd be gravitating towards particular policies, right? But if they're getting insurance through their employer, they're not going to be able to freely jump ship anyway. And unless you assume they'd all gravitate towards minimum coverage policies, how would they keep the high-cost folks out?

[The Progressive]

Sologdin was the only one who grasped what I was trying to say there, though Caspen got part of it.

I do dispute the the claim that the newly insured people will actually recieve treatment, though.

I'm curious ThinkerX as to how you and your family has been paying for medical services?

[DanteGabriel]

O Canada, why couldn't your government bureaucrat health care death panels have denied Sarah Palin some coverage years ago, and saved us all some trouble?

"We used to hustle over the border for health care we received in Canada," she said. "And I think now, isn't that ironic."

http://tpmlivewire.talkingpointsmemo.com/2010/03/palin-while-growing-up-my-family-would-seek-health-care-in-canada.php?ref=fbfp

[ThinkerX]

I'm curious ThinkerX as to how you and your family has been paying for medical services?

I have not been in to see a doctor in years. Last time I went to the emergency room was about a dozen years ago for a badly swollen hand. I got a soft cast, a prescription for ibuprofin, and a five hundred dollar bill for services rendered. At that point, I decided that unless it was truly crippling or life threatening, I'd just do without. I did walk into a clinic for an ear infection about five years ago. Two visits, one prescription and a two hundred dollar tab that time.

My daughter was on a state medical program for dependant minors when she moved in with me at the start of last year. I renewed it - because its basically free (for me) - but it also expires in another year or so. After that, she is on her own.

I hear way too many stories of medical ripoffs at all levels - insurance, hospital, and patient alike - to have any confidence in any sort of proposed reform. I hear stories of insurance companies refusing to pay out for technicalities or for no reason at all. I hear stories about how medi-whatever bills magically inflate to absurd levels when bucked on up the line. All this in small town Alaska, which makes me figure it scales up proportionally in more populated areas.

[Former Lord of Winterfell]

I have not been in to see a doctor in years. Last time I went to the emergency room was about a dozen years ago for a badly swollen hand. I got a soft cast, a prescription for ibuprofin, and a five hundred dollar bill for services rendered. At that point, I decided that unless it was truly crippling or life threatening, I'd just do without. I did walk into a clinic for an ear infection about five years ago. Two visits, one prescription and a two hundred dollar tab that time.

My daughter was on a state medical program for dependant minors when she moved in with me at the start of last year. I renewed it - because its basically free (for me) - but it also expires in another year or so. After that, she is on her own.

I hear way too many stories of medical ripoffs at all levels - insurance, hospital, and patient alike - to have any confidence in any sort of proposed reform. I hear stories of insurance companies refusing to pay out for technicalities or for no reason at all. I hear stories about how medi-whatever bills magically inflate to absurd levels when bucked on up the line. All this in small town Alaska, which makes me figure it scales up proportionally in more populated areas.

I don't doubt that ripoffs like that occur on occasion. But the reality is that for most people, their insurance actually pays the bills it is supposed to pay.

[The Progressive]

I have not been in to see a doctor in years. Last time I went to the emergency room was about a dozen years ago for a badly swollen hand. I got a soft cast, a prescription for ibuprofin, and a five hundred dollar bill for services rendered. At that point, I decided that unless it was truly crippling or life threatening, I'd just do without. I did walk into a clinic for an ear infection about five years ago. Two visits, one prescription and a two hundred dollar tab that time.

You feel no need to buy some sort of basic and/or catastrophic coverage? How would you be able to pay for some unforeseen medical emergencies that would cost tens if not hundred thousands of dollar?

My daughter was on a state medical program for dependant minors when she moved in with me at the start of last year. I renewed it - because its basically free (for me) - but it also expires in another year or so. After that, she is on her own.

It's free for you and your daughter because other taxpayers are subsidizing it.

[Stego]

Sarah Palin admits to crossing the border into Canada for free health care.

[Mad Monkey]

You could argue that Mrs. Palin's attitudes towards Canadian health-care system were shaped by her economic circumstances at the time and the difficulty of supporting a special needs child without a substantial income, and that the fact that her income has improved has allowed her to take a more mature, reasoned view of the health care reform issue and realize that the U.S. health care system as it stands now is far superior -- in most cases -- than the one that exists in Canada and other Communist dictatorships.

[DanteGabriel]

You could argue that Mrs. Palin's attitudes towards Canadian health-care system were shaped by her economic circumstances at the time and the difficulty of supporting a special needs child without a substantial income, and that the fact that her income has improved has allowed her to take a more mature, reasoned view of the health care reform issue and realize that the U.S. health care system as it stands now is far superior -- in most cases -- than the one that exists in Canada and other Communist dictatorships.

You could argue that, but you'd be laughed out of the building.

[Mad Monkey]

You could argue that, but you'd be laughed out of the building.

I didn't say I would argue that. I said that you could; I will be hooting and throwing feces! :D

[TrueMetis]

Sarah Palin admits to crossing the border into Canada for free health care.

I wonder if we can arrest her for this.

[Aemon Stark]

There are two issues. The first is that because each state has its own maze of regulations, there are significant administrative costs for insurers who might consider selling in other states. The effect is to sort of freeze insurers into the states in which they are located, which reduces the number of insurers competing for the business of employers in each state.

Simple solution: Single-payer public insurance. People can still purchase supplemental private coverage. That IS the solution to administrative costs. Why does the US tolerate such wasted money on accountants and (apologies to some present company) actuaries?

The second is that each state has its own array of mandated coverages that effectively prevent insurers from offering cost-effective policies to lower-income people. Maybe an unskilled worker isn't sufficiently productive to earn health insurance that includes mental health coverage, chiropractic, birth control, and acupuncture, but he/she would be able to afford a basic medical insurance policy if insurers were permitted to offer it.

Most cost-effective solution for everyone: Single-payer public insurance. No coverage of chiropractic, acupuncture, etc.

Of course it won't change overnight. But employers -- who for obvious reasons always try to get the most bang for their buck, and do shop aggressively -- would have a bunch of difference insurers from whom to choose. What's the downside? At best, you could see significant cost savings as multiple insurers compete against each other for business. At worst, you'd see little change.

there's some truth in that, although the other "competitor" out there is the risk that employers drop insurance entirely. But that's why I think the elimination of state mandates and the antitrust exemption might improve things. Multi-state companies that really figure out how to do this stuff the most efficiently would be one aspect of improved cost control.

Where are these cost savings going to come from? Competition does NOT lead to lower prices in and of itself, especially in health care where the claims do not follow a regular pattern, and whose size is related to exogenous factors like professional salaries, equipment costs, and a variety of other things. Where are the efficiencies to be gained? An enormous part of that "inefficiency" is not related to payouts to doctors or hospitals, but to the administrative costs directly.