Health Care Reform in the US

[I_luv_saber]

Originally Posted by Inquartata

So...when the polls indicate that the people have subsequently changed their minds about such a policy---as they appear to be doing on Obama's health care plan, coincidentally ---does that make the policy illegitimate? Or is the people's "will" locked as of the moment of the election?

They are still responsible to the people.

Most politicians, when realizing their constituents feel strong enough about an issue that they will not vote for him/her come reelection if he does not support it, suddenly start caring about what they want. Don't get me wrong, I hear what you're saying... I'm openly pretty cynical about politics and more importantly, politicians... but that same cynicism leads me to believe they will carry out the will of the people if they believe they will lose the people's support (i.e. if the people get loud enough). If not out of a sense of duty, then from a sense of covering one's ass. Even if they aren't up for reelection, they likely have ambitions of running SOME other office at some point.

Not to keep flogging a dead horse, but as I've said before: You'd be surprised what can happen when people start giving a damn.

[dcmdale]

Originally Posted by Inquartata

Yes, there are other contributors to cost. Yes, there are things such as patent protection which can offset to an extent certain contributors to cost, by conferring a sort of monopoly condition in a given market. But no, these do not make obvious additions to cost "irrelevant", by any means!

So, these manufacturers merely "want" to charge a price of X, rather than X plus, say, another $1000? Or another $10,000? Or another $1 billion? They are forgoing additional revenue which they could have simply by "wanting" to charge even more out of philanthropical feelings?

I don't think this is really what you meant to say, is it?

Not even outright protected monopolists can "charge whatever they want". Even they have cost and revenue curves which constrain the quantity they will supply and the price they will charge. At some point charging more will reduce their profit, not increase it---elasticity again. And the makers of these devices are not even outright monopolists...

Will wonders never cease? It seems that Inq is defending pernicious governmental regulation on enterprise and Jeff is advocating for a free market economy?!?

[jeff]

Oh, I dunno if that's the correct characterization - I'm saying that market forces are the reason expensive things are expensive, and Inq is incorrectly saying that it's due to government regulation. Both of us are taking positions that are descriptive, rather than prescriptive, but I'm right and he's wrong.

Inq: you do see the smiley, right?

[jeff]

Originally Posted by Inquartata

I...don't know. I was just struck by the number of articles about the high suicide rates amongst Canadian Inuits that had floated to the top of that Google search page

Obvious anti-Canada bias in Google....

Originally Posted by Inquartata

Yes, but that IMO is not a consequence of access to health care, because I believe that Native Americans already have universal care. ( I may be wrong. )

They do not. One of my long-term charities is a hospital serving the Navajo rez. The lack of medical services is shocking. Many problems go untreated.

Originally Posted by Inquartata

I think it's more to do with the nature of reservation life in general---unemployment, poverty, boredom, lack of opportunity---and maybe with an unfortunate genetic susceptibility to alcohol...

Agreed, and I think it's the same on both sides of the US-Canada border.

Originally Posted by Inquartata

So...when the polls indicate that the people have subsequently changed their minds about such a policy---as they appear to be doing on Obama's health care plan, coincidentally ---does that make the policy illegitimate? Or is the people's "will" locked as of the moment of the election?

And should support for health care "reform" drop below 50%, will it no longer be a "basic right"? Can we then oppose it without being uncaring inhuman barstids?

Well, we've backed away from "whatever an elected official does, we must have wanted" to "how long does a mandate last". There's no hard and fast rule on that, but it eventually becomes apparent, and we're nowhere near that.

I don't think we would be served by a President that rotates like a weathervane with every puff of breeze from a different quarter. That's hardly "leadership", and is not how historical precedent of officeholders works. Take his immediate predecessor ("I am the Decider"), who maintained an unpopular war when there were consequences to policy: people dying. It seems odd to suggest that the current administration shouldn't even bring a bill to a vote (nobody will die from that) because some polls are lower than they were.

Shall we use the Gallup poll or Zagats to decide on a day by day basis which way we'd like to go? Boy, would that be an opportunity for vote rigging and manipulation, too.

Originally Posted by Inquartata

You said that "we do not have a working ( just fine ) system", I believe. No?

"Not working"="broken", no?

No, of course not. The adjective "fine" modifying "working" means something.

Originally Posted by Inquartata

Gah! This library is so frustrating. Stupid wireless connection keeps locking up for minutes at a time. So I sit doing nothing waiting for pages to load. I'll never catch up at this rate!

Oh, well, it's time to head to practice anyway...

Imagine using that to vote your preference in a poll....

[dcmdale]

Originally Posted by jeff

Oh, I dunno if that's the correct characterization - I'm saying that market forces are the reason expensive things are expensive, and Inq is incorrectly saying that it's due to government regulation. Both of us are taking positions that are descriptive, rather than prescriptive, but I'm right and he's wrong.

Inq: you do see the smiley, right?

I was specifically referring to Inq's position on patents which he quite correctly identifies as a government granted limited monopoly, but then apparently defends and you, I think correctly, indicate that competition would force lower drug prices.

[jeff]

Ah. Well. I was on the Yugo:Lexus::cautery:harmonic scalpel bit and hadn't even remembered that part.... I think Inq and I both agree on and approve of patent rights and competition, but disagree on where the costs in healthcare originate.

[Inquartata]

Bleh, it just took me 10 minutes to find where I left off! This bodes ill...

Originally Posted by jeff

Hey! You didn't respond to a point I did make, about the mistaken claim that "baseline assumption that universal health care" involves the indefinite repeal of the laws of supply and demand. Were that the case then those countries would be expending vastly more on health care, but they don't. Therefore that line of reasoning is incorrect. QED.

No. They merely solve the problem by rationing rather than price.

Are you are advocating government rationing of health care in the US?

This is quite a new tack - to say that GDP figures for different countries are not comparable. Such comparisons appear all the time in economic papers and the press. For years we've accepted such comparisons as parts of our debates. If we're going to depart from such well-established practice, then I'm going to have to ask you to provide some justification rather than just say "well we can't compare the costs after all".

OK.

I wish I could take credit for the idea, but the possibility was actually suggested to me as I was watching a program on PBS...I think it was "Charlie Rose". ( I went so far as to write it down, but now I can't find the note. So I'll have to summarize.)

The man who was being interviewed said that for years electrical power usage in China had roughly tracked its GDP growth. Which makes sense when GDP growth is coming through industrialization: the greater your factory output, the more power you consume. But he said that recently, power use had stopped being a useful proxy for GDP growth. The interviewer asked what that might mean. The guest replied that it suggested that China was making up its GDP numbers...

This is certainly a possibility in countries whose accounting is not transparent. That started me thinking about ways in which GDP figures might turn out not to be closely comparable in other sorts of countries, from differing ways of measurement to different accounting methods to per capita variation to....

if in 20 years we're paying less and living longer and better, then I sure as heck will reverse my position on the relative merits of the two systems.

The problem, though, is that you probably will not have the chance to find out. I strongly suspect that we are going to change our system to one more closely resembling theirs, and comparisons of systems will then be impossible.

Though I'm sure this will not break your heart.

In the meantime, countries like Japan, Germany, Italy and Scandinavian states already have older populations and are facing our future demographic challenge today.

IMO, not enough to matter yet. Apart from Japan the differences are no more than a few percentage points. ( Assuming again that census figures are comparable and that they control for exogenous factors such as immigration. )

And ask yourself: What are the productivity growth rates of those countries with the largest aged populations? Are they sacrificing that to maintain high social program benefits? If so, it's only a matter of time until it catches up to them...

Let's go back to your Yugo and Lexus. Both are subject to the same regulations. One costs much more than the other. The same applies here. One surgical device is very expensive, the other is not.

Yes, so?

Who is arguing that the costs imposed by regulation will make the prices of disparate items equal?

Obviously there are other costs of producing goods, in addition to those imposed by regulation. These costs vary enormously by type of product. Did I say otherwise?

All I was in fact saying was that your claim that the price of good X is more expensive than the price of good Y simply because the maker of X "wants" to charge more is not correct. And that regulation imposes costs. It is not a nonissue in the escalating costs of healthcare...

I'm sorry, but this is just a red herring.

It's a red herring that you have imagined, then, because I never said that cost differences between various goods are SOLELY due to regulatory costs.

Or maybe it's a red straw man that smells like herring. ( smily )

The devices in question are more or less expensive due to the intellectual property to create them and the cost to manufacture them, not because the government makes it so.

Where did I say otherwise? I was answering your statement that "No government regulation involved in its price nor in the doctor's option to use one." That, and only that...

And the reason for their costs isn't the question, but rather the wasteful use of expensive equipment when less expensive would have done the same job.

Sorry---what question?

I answered that in the previous section.

Possibly. It will not be the first time I have lost track of one of the arguments in this thread. ( smily )

If government regulation raises the cost of health care it does not do so in this instance, which is purely an example of voluntary selection by practitioners to use extremely expensive equipment.

Sorry, but yes, it does. That it does not raise it by the full price of the device does not mean that it does not raise it at all. Nor does it mean that having the government or an insurer willing to pay for it without market-based restraints does not distort demand for it...

[Inquartata]

Originally Posted by Sins of the Fleche

I read in the newspaper (before anyone asks, the Raleigh News & Observer) today that Obama has suggested making cuts to Medicare and Medicaid as part of an effort to trim cost from the healthcare reform bill and ease its passage.

Now, this seems to me to be a counter-intuitive move. The government, in an effort to provide coverage to the uninsured, is going to slash the budgets of the already ailing Medicare and Medicaid programs, leaving those with them with an increasingly worthless plan.

Welcome to the wonderful world of politicians making economic policy.

And some cuts were already scheduled to occur in Medicare which the Administration wants to stop from happening---and indeed wants to spend several hundred billion dollars more on the things that were to have been cut. ( Oddly, this is not included in his assertions that health care reform will not involve any additional spending. Or maybe not so odd if one understands politics. )

Don't try to tell me that Medicare and Medicaid cover all, or even most, medical procedures or visits, or that they "can take the hit." They don't, and oftentimes, the unpaid portions of the bill are passed on to the patient or the hospital/physician has to simply forgive the debt.

Just about everyone I know who is on Medicare also has to have an additional policy to pay for the things Medicare refuses to cover...

Here's another example of what worries me about politicians making economic decisions. I saw an interview with Peter Orszag in which he was talking about moving "away from more care...toward better care". That is, the Administration wants to raise quality and to reduce quantity supplied. Fine. But how is this supposed to lower the price of care, as they insist their reforms will do? Increasing quality and reducing quantity supplied cannot reduce price. They are things which can only raise price! Increasing quality involves increasing costs, which will increase price. Reducing supply will also raise price, assuming that demand stays the same---but they envision increasing demand by some 50 million consumers! When demand rises and supply diminishes, what happens to price? Hint, Mr. Orszag: It does the opposite of "go down".

I sometimes wonder whether anyone in Washington understands even the barest fundamentals of economics.

[Inquartata]

Originally Posted by I_luv_saber

If you can't find numbers showing how many claims are filed in a year, how do you expect me to find numbers showing how many are denied unjustly?

Then maybe we should agree not to build arguments based on numbers which we can neither find nor even be sure exist?

So again, if, say, identity theft or mail fraud (or what have you) happens to an extremely small proportion of those who use the US Postal Service, does that mean we don't put laws in place making it illegal?

There ARE laws in place. Why is it that you think we need more, just to prosecute things that are already crimes?

So, I am to find numbers showing how many claims are unjustly denied, but you can't find find numbers showing this enormous number of claims?

Right. Because YOU are the one building an argument that "we need reform/more regulation" based on numbers that you can't even estimate reliably. You see?

Then we have a fundamental difference opinion on what a society should be.

Maybe, maybe not. All I'm saying is that I doubt that all of the anecdotally reported instances of abuse together add up to a large enough percentage of the total number of uses of medical insurance by the millions of people covered by policies to warrant the spending of large amounts of resources on additional regulation. Which regulation, by the way, will probably add still more to the price of health care, making the incentive to engage in abusive practices even greater...

any society that lets despicable acts happen to thousands of it's people because it's not considered a big enough problem, is a barbaric one.

How much more clearly can I say this? No one is "letting" anything happen! There are laws against abuses. If the abuses are proven, they are punished by existing laws. None of the abuses you have mentioned are legal! How then is anyone "getting away" with anything?

For you, I doubt that, even if I could pull numbers from a government organization that tracked the numbers of claims filed and claims denied, you would be convinced.

Of course not, because those aren't even the relevant numbers. What you need are the number of claims improperly denied with deliberate knowledge of the impropriety of the denial. Just the number of claims denied is not useful, unless you believe that there is no such thing as a claim which deserves to be denied...

Do you think that every single claim filed is necessarily valid and proper? That, for instance, no fraudulent or frivolous ones are ever made? That no unnecessary procedures or drugs are ever demanded by patients? That all patients comply properly with even prudent rules when making claims? That they always file all the right forms, always fill them out correctly, always get pre-approval for things their insurance requires, etc?

Should anything and everything the patient wants require that the insurer just shut up and pay for it? Is that the model you want to see embraced?

However, as has been pointed out many times before, we don't live in a completely cost/benefit world.

Meaning....what?

Some of the practices ARE legal, firstly.

Which ones?

As far as getting away with illegal acts, see below...

So...if someone "gets away" with a crime---that's the same as if the act is legal, as far as society is concerned?!

Occasionally someone commits a murder and is never caught. Does that mean that the laws against murder are somehow flawed? That more laws will ensure that all murders are solved and result in conviction and punishment?

I AM arguing that most of it ought to be illegal.

What "it"? Which acts are legal but should not be, exactly? The ones thus far presented anecdotally seem all to be already illegal...

I DO call their sometimes blatant breach of contract illegal (as well as some of the other discriminatory practices), and many times they do get away with it. This is because 1) The amazingly strong lobbying power, 2) Their legal power, and most importantly 3) The settlement tactic.

This is an aspect of every aspect of the law. OJ gets off on a double murder charge because he can afford top lawyers and investigators and jury analysts. John Doe goes to death row for the same crime because he cannot. Is it your contention that somehow the law ought to (1) Prevent a suspect from getting the best legal defense he can afford, or (2) The government should supply every suspect with a defense equal to what the wealthiest member of society could afford?

Regarding health insurance, is that your remedy? Prohibit a corporation that gets sued from defending itself beyond a certain level preferred by you, or force someone to pay for every plaintiff's case up to the same level the plaintiff can afford? And if the latter who is it that you want to pay? The taxpayer? The defendant?

You may not think it is, but that does not make it so. Do you have any proof of this assertion?

Proof that there are other options?

Proof that "do nothing more" is an option? That "make small changes to statutes" are an option? That "better law enforcement work" is an option? That using new technologies such as mitochondrial DNA testing is an option?

If a thing can be done, I think that makes it an option, no?

( confused emoticon here )

As far as my opinion on it, I can assure you it does not come from the media. Truthfully, I've never seen anything in the media damning insurance companies for the things I damn them for, but I don't watch TV much.

For the record, my point about our opinions about the prevalence of something being influenced by the media's over-presentation of it applied to murder, not to whether or not health insurers are scoundrels...

My opinion is formed from my personal experiences with insurance companies as well as the multiple experiences of others I've found who have gone through the same problem. I've found that I'm not the only one, and what's more, that it's happening to enough people to be a problem.

How many "experiences", total?

Have you investigated the accuracy of all of the ones that did not involve you personally?

For my part, if I had absolute personal knowledge of a number of abuses, but knew nothing about how many claims had been filed without incident by millions of patients against all of the insurers in existence, I hope I'd hesitate to extrapolate my personal experiences into a blanket conspiracy theory...especially if I lacked any real data on how widespread the alleged abuses actually were.

If I change it to "abuses should be allowed to happen since the cost will outweigh the benefit" will you feel better?

Hey, I can't help it if your standpoint sounds really bad when put in simple context!

Nope. Because that's a misrepresentation of my position, and I have said so enough times that I am pretty sure that you know it. ( smily )

Too long again. Stand by for part #!%*ing 2...

[Inquartata]

Part #$%&ing 2:

I am in favor of slight reformation through additional regulation and control.

What, specifically?

Or are you content just to hand the government a blank check and trust it to restrain itself?

I more than agree that excess regulation is not good. I don't agree that no regulation IS good.

Someone should design a Laffer curve of regulation. I think it would almost certainly show that we are already much too high up the slope.

I simply said it's quite a bit of a stretch to call some additional regulation 'total system reform', which it is.

Finally we agree! ( Read your sentence carefully! )

With an insurance company, I have signed a contract.

You have also neglected to answer the question! Naughty!

I'll pay you monthly while I'm healthy if you'll pay for my bills when I get sick (simplified, but about right, no?). When I get sick, the insurance company decides that (here's a common one) I must have had a preexisting condition that I did not disclose.

And what if you really did? No matter, they should be forced to pay first anyway, then hope to recover AFTER they prove fraud?

What if in fact you had a pre-existing condition but didn't know it? They should still have to pay, I suppose?

What your "additional regulation" seems to boil down to in the end is "Make the big bad corporation pay in all cases". Am I right?

I now have no way of paying my bills, nor any way of getting money TO pay the bills (I'm sick, remember?).

Ah...on what basis are we to accept the assumption that "sick" always and in all, or even most, cases means "unable to work"?

I know cancer patients who are still working. Don't you?

Your example is happenstance, and a poor analogy, IMO.

It's what you are expecting insurers to do, though: Pay first and try to recover later should there in fact turn out to have been fraud. IMO it's an unreasonable legal burden to foist onto anyone, and that is not changed by the fact that corporations are not well liked...

As noted, the difference in this case is that the insurer has an extremely unfair advantage not present in most situations.

Who was it in fencing who was told that he won a bout on his reputation, and replied "Go out and get yourself a reputation"?

We cannot truly ever "level the playing field" without resorting to totalitarianism, IMO.

Perhaps stiff fines, leading up to the revocation of their license to insure?

For what, doing what the law allows?

You can always work to change the law if you like. But that's not "a little additional regulation". That's making major changes to the way Western law works...

It's happened to far too many people to be considered "rare" in my mind.

Based on what numbers? ( I keep harping on this, because the statistics do matter, whether or not you want to accept it. )

If I have signed a contract stating that insurance is to pay me when something goes wrong, why is the status quo that it is okay to NOT pay me and assume I am guilty of negligence with no proof?

Heh. I will propose a compromise: We ask neither for the extreme I presented nor the one you presented, but instead leave things as they are.

Is it so much to ask that they must submit at least SOME proof of negligence or of fraud before denying a claim?

If that's in the contract, sure.

Generally that's the way it's done, too. They put an investigator onto you. I'm not sure what else it is that you want here...

Plenty of proof has been put forth that regulation (to an extent) works.

Well, THERE'S a statement that's not so broad that it's meaningless...

It's your turn to disprove that.

Careful, you are right on the verge of sounding like Fatfencer there...

For example?

One of his favorites was the spillover effects of pollution.

[Inquartata]

Originally Posted by erik_blank

I'm confused... What is his definition of laws and regulations? Are they not one and the same? It seems like Mr. Friedman is trying to suggest that instead of a set of laws that regulate business that we should have a set of laws to regulate business...

"Laws" are statutes made by legislatures. "Regulations" are administrative rules imposed by bureaucracies. The former are often used to create the power to make the latter, but they aren't the same things.

[Inquartata]

Originally Posted by thereom4

I would offer you a hug, but I'm afraid that you're going to ask me to provide you with evidence on why I think you need a hug.

Well I'll ask anyway. You need a hug Inq?

I don't know. Is this going to turn into an offshoot of the "Cleavage" thread?

[Inquartata]

Originally Posted by dcmdale

45% of the U.S. health care spending ($1 Trillion of the $2.4T) already comes from public sources (Medicare, Medicaid, and similar programs).

That's the low end of the range of estimates I've seen.

And even at that, it only covers 27.8% of the population.

But extending that model to more of the population is going to save money?

Meh.

[Hauptman]

Originally Posted by Inquartata

That's the low end of the range of estimates I've seen.

And even at that, it only covers 27.8% of the population.

But extending that model to more of the population is going to save money?

Meh.

Now you know better than that. There is nothing in that statistic to imply whether or not money would be saved. :P

The only issue relating to savings is whether gov't run healthcare can provide healthcare comparable to private insurance but at a lower cost.

If you take away the profit motive, and the fact that private healthcare spends significantly more money on overhead than gov't programs, then there is a reasonable argument that gov't run healthcare would be cheaper and offer savings.

[Hauptman]

IMHO, the key to changing healthcare in this country is to charge insurance rates based on weight.

Insurance companies have no problem charging extra for smokers, and motorcycle riders, and all sorts of "higher risk" behaviors that correlate to higher payouts by said insurance companies. So why not charge for people being overweight which clearly correlates to more health issues and higher healthcare costs?

If there has been a significant increase in health insurance rates over the last 20 years it clearly correlates with a significant increase in obesity and related health issues. I'd like to see this explored more.

[thereom4]

Originally Posted by Inquartata

I don't know. Is this going to turn into an offshoot of the "Cleavage" thread?

No. Let's just leave that thread where it is. Shall we?

[I_luv_saber]

Originally Posted by Inquartata

Then maybe we should agree not to build arguments based on numbers which we can neither find nor even be sure exist?

Agreed, since my argument is not reliant upon numbers. My argument rests on the fact that the crimes (or would-be crimes) are life altering enough that they need to be taken care of.

There ARE laws in place. Why is it that you think we need more, just to prosecute things that are already crimes?

1) As I said, some of them ARE NOT crimes. I'll address this below.

2) In part, more aggressive enforcement of the regulations that DO exist is necessary as well. More laws won't do anything without better enforcement and oversight.

Right. Because YOU are the one building an argument that "we need reform/more regulation" based on numbers that you can't even estimate reliably. You see?

Again, it was simply a part of my argument, not really what it rests on. It rests on the fact that the crimes are harmful enough that they must be prosecuted aggressively. A white collar crime that hurts people just as bad or worse than a blue collar crime should be prosecuted just as harshly.

As an aside, I'd also like to see white collar crimes punished by actual sentences, not just fines, where warranted. For example, if a person suffers significant health decline as the result of an unjust denial on the part of the insurance company, I'd like to see sentencing as opposed to simple fines, just as if a criminal had injured someone in a blue collar crime. Fines for serious crimes seem an awful lot like simply buying your way out of crimes.

Which regulation, by the way, will probably add still more to the price of health care, making the incentive to engage in abusive practices even greater...

Two words: Tort Reform.

How much more clearly can I say this? No one is "letting" anything happen! There are laws against abuses. If the abuses are proven, they are punished by existing laws. None of the abuses you have mentioned are legal! How then is anyone "getting away" with anything?

Waiting someone out in court via bureaucracy is not a crime. However, it still achieves the objective the insurers are looking for, which is to pay as little as possible, as late as possible, regardless of the fact it still can shatter lives forever. I call that getting away with it.

Do you think that every single claim filed is necessarily valid and proper? That, for instance, no fraudulent or frivolous ones are ever made? That no unnecessary procedures or drugs are ever demanded by patients? That all patients comply properly with even prudent rules when making claims? That they always file all the right forms, always fill them out correctly, always get pre-approval for things their insurance requires, etc?

Absolutely not. It certainly exists. What I see wrong with the situation is this:

A) I sign a contract with an insurer that says they pay for any medical bills I may incur if I pay them a monthly premium.

B) A year later, I'm found to have cancer.

C) They don't pay my medical bills saying that I must have had a preexisting condition I didn't tell them about hence the contract was unfair or that I had a great-great uncle who had cancer (who I may have not even known about) hence increased my risk, which they didn't know about, so the contract was unfair.

D) I go bankrupt paying for my medical bills and end up living on the government's dime.

Two problems here. First, the insurance companies CAN get away with this sort of thing. I've linked you to a support group with similar stories, and even included my own. Regardless if it's a common occurrence, IT HAPPENS. Don't ignore the elephant in the room because it's inconvenient!

Second, this ends up with more burden on taxpayers indirectly.

Some standard of proof or some way of increasing accountability is not too much to ask, IMO.

My argument rests on the fact that this life-shattering crime is bad enough that even a relatively small number of unprosecuted occurrences is too much. These are crimes the STATE needs to be prosecuting, and aggressively, not private parties.

Should anything and everything the patient wants require that the insurer just shut up and pay for it? Is that the model you want to see embraced?

They've signed a contract to pay for it. Now, if they want to investigate me for insurance fraud, have at it. Fair enough. But that they can, on a whim, cut off medication or other medical services because they "suspect" something, without any evidence, is wrong.

Meaning....what?

Meaning many laws, like it or not, are base on morality, liberty, and justice, not just cost/benefit. My assertion is that society's prerequisite for a law is more closely based on justice rather than simply frequency of occurrence.

Which ones?

Example was given above.

Occasionally someone commits a murder and is never caught. Does that mean that the laws against murder are somehow flawed? That more laws will ensure that all murders are solved and result in conviction and punishment?

The additional regulation and laws are to stop practices that are currently legal, but IMO should not be.

In the murder scenario, if we did not really spend many resources on prosecuting them, or on the homicide units that catch the culprits, do you not think there may be an increase in murders? Or maybe an increase in the number of unsolved/uncaptured murderers?

You're right. The laws don't do much if the state isn't bothered with enforcing them.

What "it"? Which acts are legal but should not be, exactly? The ones thus far presented anecdotally seem all to be already illegal...

Already been given an example of the most common. Basically, claims can be denied with no proof, and insurance companies can kick back and wait people out. I'd venture a guess that they make (or would, hypothetically) far more money NOT paying bills and paying lowball settlements, and taking the few hits they get when they are taken to court and they lose rather than if they pay the bills as they are supposed to, by contract.

So yes, it is their breach of contract is illegal, but the fact they can deny claims with no proof, or no accountability to any (as far as I know) organization IS legal.

Is it your contention that somehow the law ought to (1) Prevent a suspect from getting the best legal defense he can afford, or (2) The government should supply every suspect with a defense equal to what the wealthiest member of society could afford?

It is an inequality, however on that I would err on the side of liberty and say no, that would not be the best option. I'll elaborate below.

Regarding health insurance, is that your remedy? Prohibit a corporation that gets sued from defending itself beyond a certain level preferred by you, or force someone to pay for every plaintiff's case up to the same level the plaintiff can afford?

No, my remedy is that there must be SOME standard of denying claims. If not a direct payout followed by investigations, then accountability to a regulatory agency that oversees claims filed. A minimal standard of proof must be submitted in order for a claim to be denied. For example, in the case where they denied the claim of the pregnant client on the basis that she must have known an not disclosed this information, they must submit proof that she knew she was pregnant.

This is just an idea mind you, but as long as there is greater accountability on the side of insurance companies, I'm fine with the high-priced lawyers.

Proof that there are other options?

No, that it is NOT the runaway problem the media says it is. What leads you to believe this? The simple fact the media says it makes it a lie?

How many "experiences", total?

Have you investigated the accuracy of all of the ones that did not involve you personally?

In my personal case, I was obviously involved pretty thoroughly and I pretty clearly see it and call it as dirty pool.

In the cases of friends and family, the investigation was limited to my knowledge on the matter. Claims denied because insurance company claimed that the client must have had a preexisting condition, as far as I know they did not know. Of course no one can know for sure, but there was never any proof submitted, that I know.

In cases where insurance fraud was claimed, again, no proof was submitted.

Both cases the insurance companies (two different ones, Blue Cross and Kaiser, I believe) waited them out in court. I have known one case where the person who was denied actually had enough money to last through the legal siege tactic and won the case. He won the money he was entitled to by contract. The insurance company, as far as I know, was never fined or punished in any way for unjustly denying the claim.

Whether or not you believe these are entirely your prerogative, but you asked, so I told you .

For my part, if I had absolute personal knowledge of a number of abuses, but knew nothing about how many claims had been filed without incident by millions of patients against all of the insurers in existence, I hope I'd hesitate to extrapolate my personal experiences into a blanket conspiracy theory...especially if I lacked any real data on how widespread the alleged abuses actually were.

*shrug* Again, we have a difference of opinion. Your proof of necessary law seems to be: "It must happen to X percent of people before law is needed". Mine is: "If the act is harmful enough to a person or family, it should be a crime". Society seems to agree with the latter as well, since many laws are modeled this way (as you pointed out, murder is relatively rare).

[I_luv_saber]

Originally Posted by Inquartata

Nope. Because that's a misrepresentation of my position, and I have said so enough times that I am pretty sure that you know it.

I've read that you deny it, however by reading your posts as a whole, that's not what I see. What I see is that a requirement for law, for you, is that it must happen often enough, not that the act itself is harmful enough.

What, specifically?

I believe I addressed this in the previous post, so I'll skip it here in a vain attempt to fit this all in one post.

Finally we agree! ( Read your sentence carefully! )

It is A STRETCH, silly!

You have also neglected to answer the question! Naughty!

First of all, the naughty thing is really creepy . Secondly, I believe again I answered this in the previous post. If not, please specify where you'd like me to elaborate.

And what if you really did? No matter, they should be forced to pay first anyway, then hope to recover AFTER they prove fraud?

At the very least they should have to prove I've done wrongdoing! Why is it I am assumed to be guilty because they say so?

What if in fact you had a pre-existing condition but didn't know it? They should still have to pay, I suppose?

Yes, actually. That's pretty clear even in current contracts that that is the case. As long as I am disclosing, to the best of my knowledge, my current and past states of health, I am fulfilling my obligation. Fortunately, omniscience is not an obligation. Actually, this is true in most cases of contracts even outside of healthcare, as far as I know.

What your "additional regulation" seems to boil down to in the end is "Make the big bad corporation pay in all cases". Am I right?

"Make the big bad corporation pay what it should have been paying in the first place, but is trying to weasel out of" is a more apt description.

Ah...on what basis are we to accept the assumption that "sick" always and in all, or even most, cases means "unable to work"?

In cases where the bills are the highest, say a critical car wreck, or a shooting, you are often left unable to work for a time.

My argument is not that ALL claims get denied, just that expensive claims sometimes get denied with little or no basis.

I know cancer patients who are still working. Don't you?

Actually, no, however I've no doubt they exist. As I said, my assertion was never that all claims are denied, just that some claims are denied unjustly.

It's what you are expecting insurers to do, though: Pay first and try to recover later should there in fact turn out to have been fraud.

Fair enough. As I said, I'm open to other solutions to the problem, such as more accountability to a regulatory agency. Perhaps having to show at least some proof to, a court perhaps, before denying a claim. To first show that they have legal grounds before reneging on a contract.

Another solution might be that cases have to be resolved in a certain amount of time? Or perhaps that the insurance companies are entitled to a certain period of investigation before the pay out must be made? I'm open to other solutions.

We cannot truly ever "level the playing field" without resorting to totalitarianism, IMO.

To have a complete level playing field, yeah, that's probably a fair statement. But we can do our best to see that everyone gets a reasonably fair shake without resorting to that, IMO.

For what, doing what the law allows?

No, for breaking laws and regulation. It was posed as an idea for punishment in current and possible future laws.

You can always work to change the law if you like. But that's not "a little additional regulation". That's making major changes to the way Western law works...

I'd call it relatively little change compared to, say, socialized medicine, or a government option for insurance, wouldn't you? It's all relative, I suppose...

Based on what numbers? ( I keep harping on this, because the statistics do matter, whether or not you want to accept it. )

TO YOU, they matter. As I said, we have a difference in opinion on what matters in order for new laws or greater enforcement to be pursued. Murder is relatively rare, but we dedicate so many resources to it (compared to how much of an issue it really is for most people) because we consider it unjust, regardless of how rare it is. See what I mean? I, and apparently at least some part of society, feel that a large number of victims is not necessary for a law to be passed and for it to be pursued. The fact that it happens at all and is unjust is enough.

If that's in the contract, sure.

My point is this should not BE a contractual issue, this should be a legal prerequisite for denying a claim and possibly changing someone's life forever. That they must be accountable (to a court, a regulatory agency, whatever) for their actions BEFORE possibly ruining a life.

Generally that's the way it's done, too. They put an investigator onto you. I'm not sure what else it is that you want here...

For fraud, yes, this is generally the procedure, but AFAIK this is not the case for any other form of claim denial, and also AFAIK they are not responsible to any court or agency to prove they are justly denying a claim. In the case of fraud, they do so in order to prepare for a possible future suit, I don't think they must show they are justly denying a claim beforehand.

Careful, you are right on the verge of sounding like Fatfencer there...

First of all, NOT FUNNY!

Secondly, the proof has been put forth, you are refusing to accept it. But at what point can you simply just refute evidence on the basis of argument alone, without posing your own? That only holds so much water...

You asked me for proof that this happens. I posted what I felt was reasonably enough to show that it happens. You then asked for proof showing it happens *"enough". I have said that is not what my argument hinges on.

Again, all it boils down to in the end is we have different standards for when law and regulation is/is not necessary. My evidence has proven what I set out for it to prove, nothing more.

*Incidentally, I think we both have very, very different opinions on what constitutes "enough" (see previous paragraph regarding our different requirements for law to be necessary) and from that stems the disagreement.

One of his favorites was the spillover effects of pollution.

Care to elaborate? (I ask out of curiosity)

(Hey, I did it! With enough room left over even for this sentence! )

[jessicasimpson]

Originally Posted by Inquartata

Who was it in fencing who was told that he won a bout on his reputation, and replied "Go out and get yourself a reputation"?

That was me

[jeff]

Originally Posted by Inquartata

Bleh, it just took me 10 minutes to find where I left off! This bodes ill...

Yeah, this could be a bumpy ride. And reading ahead, I can't remember who was involved in the "get a reputation story"

EDIT: Found it: it was Tibor Nyilas saying it to Alex Orban. Confirmed to me by Steve Sobel, who was side-judging that bout.

Originally Posted by Inquartata

No. They merely solve the problem by rationing rather than price.

Are you are advocating government rationing of health care in the US?

Those countries ration no more than we do. In UK you can go around NHS and pay for your own, just like the scenario you proposed for somebody denied insured coverage here.

For rationing: I'm very conflicted by this, frankly, and it's more than a yes/no - though it's mostly "no". Go read Peter Singer's article in last week's NYT magazine, and the multiple responses in yesterday's letters to the editor in the same place. If rationing is inevitable, as some are claiming, I'd rather it be based on what's called "evidence based medicine" (eg: what is effective - and not always the case that more care is better care) rather than somebody making his numbers to get a bonus. Deep water.

Originally Posted by Inquartata

OK.

I wish I could take credit for the idea, but the possibility was actually suggested to me as I was watching a program on PBS...I think it was "Charlie Rose". ( I went so far as to write it down, but now I can't find the note. So I'll have to summarize.)

The man who was being interviewed said that for years electrical power usage in China had roughly tracked its GDP growth. Which makes sense when GDP growth is coming through industrialization: the greater your factory output, the more power you consume. But he said that recently, power use had stopped being a useful proxy for GDP growth. The interviewer asked what that might mean. The guest replied that it suggested that China was making up its GDP numbers...

This is certainly a possibility in countries whose accounting is not transparent. That started me thinking about ways in which GDP figures might turn out not to be closely comparable in other sorts of countries, from differing ways of measurement to different accounting methods to per capita variation to....

Reminds me of the "missile gap". I'm curious about the China case independent of this thread (when I was there 25 years ago, they turned off the electricity one day to a district I was visiting).

All measurements are bounded by error tolerances of +/- caps, so it's never been a perfect thing. And, I expect that when we're talking about first world countries we've been discussing w.r.t healthcare (eg: UK, Germany, France, Nordic countries) that their accounting isn't a priori worse than ours (I except Italy, where Berlusconi owns the whole place and spends his money on bimbos!). So, it's still a useful tool.

Originally Posted by Inquartata

The problem, though, is that you probably will not have the chance to find out. I strongly suspect that we are going to change our system to one more closely resembling theirs, and comparisons of systems will then be impossible.

It is really, really hard to perform repeatable experiments or do double blind studies of macro scale events. And simulations just don't have that satisfying taste.

Originally Posted by Inquartata

TThough I'm sure this will not break your heart.

Not if my expectations are right. Otherwise, I'll be very disappointed. My goal is good results, not expansion of the State. If the private system Did It All, and Did It Well, I would be quite content.

Originally Posted by Inquartata

IMO, not enough to matter yet. Apart from Japan the differences are no more than a few percentage points. ( Assuming again that census figures are comparable and that they control for exogenous factors such as immigration. )

And ask yourself: What are the productivity growth rates of those countries with the largest aged populations? Are they sacrificing that to maintain high social program benefits? If so, it's only a matter of time until it catches up to them...

Well, that's the same story as health care: either way, the decreased ratio of worker bees to beneficiaries decreases - and those countries are further down the curve than we are.

Originally Posted by Inquartata

Yes, so?

Who is arguing that the costs imposed by regulation will make the prices of disparate items equal?

My bad - I thought you were!

Originally Posted by Inquartata

Obviously there are other costs of producing goods, in addition to those imposed by regulation. These costs vary enormously by type of product. Did I say otherwise?

A misunderstanding. I thought you were saying that the (medical) Lexus cost more than the (medical) Yugo because of regulation. Feel free to return the consumed electrons and bits back to the primordial plasma from which they came.

Originally Posted by Inquartata

All I was in fact saying was that your claim that the price of good X is more expensive than the price of good Y simply because the maker of X "wants" to charge more is not correct. And that regulation imposes costs. It is not a nonissue in the escalating costs of healthcare...

Okay, we were talking at cross-purposes, and not for the first time. My point was nothing more than how the private choice of a physician to use an expensive non-reusable device when a lower-cost one would be just as good was an example of waste in the absence of governmental interference.

Originally Posted by Inquartata

It's a red herring that you have imagined, then, because I never said that cost differences between various goods are SOLELY due to regulatory costs.

Or maybe it's a red straw man that smells like herring. ( smily )

Ah, you've exhausted emoticons - victory is mine!

Originally Posted by Inquartata

Where did I say otherwise? I was answering your statement that "No government regulation involved in its price nor in the doctor's option to use one." That, and only that...

Okay, okay - got it!

Originally Posted by Inquartata

Sorry---what question?


Possibly. It will not be the first time I have lost track of one of the arguments in this thread. ( smily )

No problem. Even Homer nods, and all that.

Originally Posted by Inquartata

Sorry, but yes, it does. That it does not raise it by the full price of the device does not mean that it does not raise it at all. Nor does it mean that having the government or an insurer willing to pay for it without market-based restraints does not distort demand for it...

Okay here too - we had dogs in different fights and thought they were in the same fracas.

I still find it incongruous that Bayou Bum claims to have professional knowledge of the instrument I used for this example, but that's another tack altogether!