Health Care Reform in the US

[thereom4]

My proposal for the drug industry is to use eminent domain; the gov't should buy the patents at fair value and then open them up for generic production.

Eminent domain refers to the taking of real or personal property. Patents are intellectual property. The federal government doesn't have any constitutionally granted power in the area of intellectual property.

[lindajdunn]

Has anybody seen any guesstimates on what a "public plan option" would cost per month for the people who select it? I hear the pundits say it will be less than private insurance, but I've never heard a rough ballpark estimate yet.

Similarly, if it's similar to what members of Congress pay, what are they charged for their "public option" health care plan?

I can answer the second question because I'm a federal employee and I'm on the same health care plan as congress critters. The answer is: it depends.

Government employees can choose from a smogarsboard of available plans with different options, components, etc and deduction levels. I opted for Blue Cross Blue Shield's family plan. I pay $352.26 every other week (13 times a year) for a family plan and that's on the high end. There are less expensive plans and some civilian employees have HMOs (availability depends upon geographical area).

http://www.opm.gov/INSURE/HEALTH/

is a link that shows the types of plans available. We have open season once a year.

http://www.opm.gov/insure/health/rat...talhmo2009.pdf

The above pdf document shows plans for non-postal employees, premiums paid, and the government's contribution.

[Inspector Gadget]

Eminent domain refers to the taking of real or personal property. Patents are intellectual property. The federal government doesn't have any constitutionally granted power in the area of intellectual property.

Yet. [why do you people insist upon giving those lunatics these ideas? - some of them are so dumb, it wouldn't have occurred to them until they were told of the remote possibility that something like that could happen, because for example: right now a company can order a person away from their desk and take VIRTUALLY everything - including your ideas and claim them as their own, because you were on payroll.]

[I_luv_saber]

Because the insurance companies own most of Congress (other major industries also have options on most Congresscritter). If they don't toe the line, they'll be out in the next election.

Companies retain marketing firms to set up astroturf organizations that fight to preserve their interests AND to convince the gullible American public that it's in our best interst to give them what they want.

Ultimately, it's our fault as American citizens. Sure, they may have a lot of sway in Congress, but it's our job to kick Congress in the butt and get them moving anyway.

Credit companies have also held a lot of sway in Congress. Many Americans have finally decided to put more pressure on Congress, and lo and behold we see introductions of new consumer rights bills and disclosure bills.

The same thing needs to happen with insurance. "Oh, they own Congress" is a cheap cop-out and not a good argument for instituting a public plan. If that were the case, there would be NO change, because most of the de facto have strong lobbies trying to keep it that way. It's our job to tell our Congressmen and women that insurance companies are being too undehanded in their dealings and to shape them up, or they won't get reelected.

Basically what I've been saying for awhile... until Americans really start giving a damn about it, nothing is going to change.

[thereom4]

Yet. [why do you people insist upon giving those lunatics these ideas? - some of them are so dumb, it wouldn't have occurred to them until they were told of the remote possibility that something like that could happen]

I'm not exactly sure what you are saying. If you are saying that the taking of intellectual property is possible then I would say yes it is possible. Anything is possible. But will it happen? Probably not. Why? Because we are governed by a constitution and the taking of intellectual property has not been expressly granted to the federal government. Though a creative lawyer could successfully argue that eminent domain extends to the taking of intellectual property. I'd be afraid of what precedent this would set, but it could be done. But what would end up happening is that people would stop creating things worth patenting. If the government could just take my idea why even bother?

because for example: right now a company can order a person away from their desk and take VIRTUALLY everything - including your ideas and claim them as their own, because you were on payroll.

Totally different animal. You answered your own "question"......because they get (got) paid.

[Hauptman]

Eminent domain refers to the taking of real or personal property. Patents are intellectual property. The federal government doesn't have any constitutionally granted power in the area of intellectual property.

Details, details... don't confuse me with the facts!! I was ranting, remember?

Ok, so instead of eminent domain they could just change the patent laws or pass new legislation. Or how about stepping in and buying those patents from the universities before the pharmaceutical companies? The point is I'm sure it could be done if there was the will to do it.

[migopod]

Details, details... don't confuse me with the facts!! I was ranting, remember?

Ok, so instead of eminent domain they could just change the patent laws or pass new legislation. Or how about stepping in and buying those patents from the universities before the pharmaceutical companies? The point is I'm sure it could be done if there was the will to do it.

How about the feds just funding the crap out of public universities and really work to develop research programs therein. Not just for new drugs, but for the sciences in general. That way you get your research and patents and you wind up better educating the next generation of scientists at the same time.

[lindajdunn]

How about the feds just funding the crap out of public universities and really work to develop research programs therein. Not just for new drugs, but for the sciences in general. That way you get your research and patents and you wind up better educating the next generation of scientists at the same time.

I LIKE that idea.

[PeterGustafsson]

Hi!

Ultimately, it's our fault as American citizens. Sure, they may have a lot of sway in Congress, but it's our job to kick Congress in the butt and get them moving anyway.

Credit companies have also held a lot of sway in Congress. Many Americans have finally decided to put more pressure on Congress, and lo and behold we see introductions of new consumer rights bills and disclosure bills.

The same thing needs to happen with insurance. "Oh, they own Congress" is a cheap cop-out and not a good argument for instituting a public plan. If that were the case, there would be NO change, because most of the de facto have strong lobbies trying to keep it that way. It's our job to tell our Congressmen and women that insurance companies are being too undehanded in their dealings and to shape them up, or they won't get reelected.

Basically what I've been saying for awhile... until Americans really start giving a damn about it, nothing is going to change.

On to one of my recurring topics - feel free to make your eyes spin if you think that I have posted on it too many times.

Still with me? Good. The problem is systemic (as ILS alluded to above), and not especially linked to just the health insurance industry, even if they are the ones which presently are best at using this particular weakness in the USA political system.

What weakness? Put simply, the USA political system is not good at counteracting well-organized and funder special-interest lobbying, since it does not have strong design features in place to deal with them.

With extremely few exceptions (some intra-party nomination fights, mainly) USA elections feature at most two viable candidates. 3rd-party candidates have not been anything else than spoilers - their latest major-election sucesses were back in the Bull Moose era.

Then there are a lot of elections which have only one viable candidate, even uncontested runs in many cases. In those cases, voters who do not agree with the majority candidate have nowhere to go. This leads to voter apathy, and lobby groups can conserve their resources.

Back to the most interesting common election case in USA, one candidate each from the major parties (and possibly an assortment of minor party candidates who never get elected). The major party candidates try to defeat each other, and disregard the minor party candidates. In order to win a competitive race, a major-party candidate must embrace a lot of positions which are acceptable to the median voter, and then embrace positions which show that he is a champion of the causes held dear by the core voters of, and major donors to, his party.

So, three major considerations influence which positions he chooses to embrace. However, of these three one will less important - that of the median voter. Median voters are a diverse bunch, and while important in close races, not all that common. Furthermore, they seldom self-identify as "median voters" - such is not human nature. People in general do not consider their averageness a defining characteristic, since it does not feed the need to feel oneself, in some way or another, special. Instead, people in the great majority of cases self-identify by some personal characteristic which is at least one of the following: relatively uncommon, clearly definable, lauded by those not sharing it, or extreme in some way. (Some people self-define by common-ness, but that is not the same thing as averageness. Instead, it is a way for those people to contrast themselves from elitists, a group to which they can never belong and despise.)

Back to beliefs held by median voters. A savvy politician can satify the requirement of picking which median-voter beleifs to espouse by using his gut feelings, polls, and focus groups. This is not expecially expensive compared to other election costs. Also, since median voters do not self-identify as such, they do not form median-voter pressure groups. It is a reasonable strategy for a politician to start out by embracing some beliefs held by median voters but not too many, since that can constrain his politican freedom of movement later on in the election. If he needs more voters, he can relatively risk-free start endorsing more median-voter beliefs later on - his core voters have nowhere to go unless they want to cause an outcome which is even worse for themselves.

So, the savvy politician will start out endorsing beliefs/positions which are important to his core voters (except those which makes him unelectable by a majority in close races) and those which earns him major donations, since USA elections are so costly. Their costliness are linked to two features which are typically american - the prevalence of TV ads, and the huge populations served by each voted seat. (In countries in which it is much cheaper to run for a seat with a reasonable chance of success, you do not see this politician dependence on donors.) Core voters are important since they can punish him at the next nomination, and disregarding them can lead to a recriminations fight which takes focus away from actually winning the race. Also, the politician will often agree with core voter beliefs.

Too long, part 2 below.


Have a nice time!

Peter Gustafsson

[PeterGustafsson]

Hi!


Where do organized lobby groups fit into this? Well, the peculiar characteristic of the USA political system is that gives them a very simple game plan, and interested parties which really need what they can offer. This is a recipe for power.

The game plan for any rational lobby group:
1. Identify which races are noncompetitive. Those races are nothing but objectives for resource conservation. The only action necessary is to keep track of whether they lose their noncompetitiveness status.
2. For competitive races, there are two viable tactics.
2.1. Buy off both viable candidates.
2.2. Identify which viable candidate which is most positive to the positions held important by the lobby group, and support that candidate full-tilt.
3. Check that the lobby group will get a positive majority in the elected body.

Note that none of the parts of this game plan are difficult to understand, and the potential for backfiring is relatively limited if done competently.

What is the important difference between voters and lobby groups? Portability in space and time.

Voters can only vote in their own home district, but lobby groups can concentrate their resources on important targets. Furthermore, voters can only vote once every election cycle for a given seat, and they can not save their vote for the next election cycle. However, lobby groups can do just that - they can conserve resources in a no-hope election, and spend more resources in the next election cycle.

As any military historian will tell you, concentration of resources is paramount to success.

So far, the american political discussions which purport to limit the power held by lobby groups has centered around ways to directly limit the legally possible actions of lobby groups.

This is bass-ackwards, in my opionion. If such proposals actually were to become law, they would be limited in effect, and vulnerable to reversal due to said lobby groups.

Why would they be limited in effect? Simple. They do not mandate a complex game plan by any involved party. If the voters are left with their present options (one vote per person, once an election cycle) and lobby groups are severly limited in their actions, no one has a lot of viable different actions.

When one has a game in which there are only few - and in many instances only one - viable actions, then there are not many combinations of such viable actions, and all game players can count through all possible combinations to find the best one for their case. The election race becomes something akin to a real 100 m running race. In that sporting event, the game plan is super-easy to describe: accelerate as fast as possible to maximum speed, and keep it without fading to the finsh line. There is no difficulty with understanding the game plan, the only thing separating winners from losers is the physical abilities necessary to carrying it out.

On the other hand, when there are several different viable actions for each player, calculating them all though becomes computationally impossible, especially if it has to be done in real time. This can be compared to the sporting events of fencing or curling. In both sports, a successful outcome depends heavily on the ability to figure out a reasonably good set of actions, given that any concievable action can be countered by some counteraction by the opponent. (if that were not the case, all competitors would use that action exclusively, sort of like sabre with fleche.)

So, how to increase the range of possible and legal actions by the voters, in order to increase game plan complexity? There are of course countless possibilities, but I will limit myself here to outline two of them.

1. Run the primary concurrently with the election for the seat. This is done by demanding that each party which wants to take part in the election fields several different candidates at once. The voter chooses one candidate, and his party, during the election. However, it is not necessarily the candidate with the largest number of individual votes which wins the election. Instead, all votes for candidates of a given party are counted together. The party with the largest total wins the seat. Among its candidates, the candidate with the largest number of individual votes wins the seat. This system counteracts primary-election back-and-fro by candidates, and strongly limits the spoiler effect. Also, it limits the power of lobby groups, since it becomes more difficult for them to by off all viable candidates, and decreases the number of noncompetitive votes. A major plus for this system is also that it is relatively similar to the present voting system in the USA, so transition effects will be relatively minor. However, it is in many respects inferior to the one outlined below, which is at least as good as #1 except for transition effects. Note that it does not provide for portability of voter power.
2. Give each voter a multitude of votes in each election, and near-total freedom to spend them on different candidates. This can be done in different ways, and I will outline the simplest one which gives a reasonably complex game plan. Give each voter exactly two votes. He can use each vote as either a positive vote, or a negative vote. He can use the votes in any district of his choosing, whether he lives in that district or not. The only limitation is that he can not use both votes for the same candidate - that takes away the strategy which all politicians would demand of their core voters if it were legal. However, the candidate can use one positive vote for his preferred local major-party candidate and the other as a negative vote for that candidates main local rival, which would (in all probability) be the most common voter choice.

Once all votes have been cast, all votes regarding a given candidate are counted. The tally for a given candidate is calculated as the difference between the positive votes for him, and the negative votes against him. The candidate which gets the highest tally in a given district wins the seat of that district.

Now, the individual voter has many possible and viable strategies: He can vote for a local major and minor party candidate, he can vote for a local candidate and someone else that he likes across the country, he can punish a kook in another state by sending one of his votes as a negative vote to that guy, the possibilities are very numerous.

Precisely since the possibilities are so numerous, it becomes very difficult for a candidate to counter them. A major-party candidate has a strong interest in getting minor-party voters to give their second vote as a their second positive vote to them. In order to reach out to such voters, he runs the risk of alienating his core voters and any sponsoring lobby groups. Since there are som many possible voter streams, it becomes impossible for any lobbly group to keep track of them all, much less to buy off all politicians and their constituencies. A politician might respont to all this by going all-out on base politics - megaphone for your core, and the rest be dammned. However, such a strategy carries a very high failure risk - you run a very high change of becoming a magnet of negative votes from all over the country.

In districts which presently are noncompetitive, the rational voter game plan is to find candidates in other districts which that voter likes, and are engaged in a close race. Median voters will have many opportunities to find out-of-district candidates to their linking, extremist voters less so. This is a case of voters being able to concentrate their power in a place where it matters. Another effect of this system would be that constituencies which are spread out finally get a chance of representation.

This system is fairly straightforward concerning what is legal and possible actions (one more vote for voters, no change for candidates or lobbly groups) but gives game plans which are much more complex for the latter two groups.

Finally, I would like to compare the USA political system to that of most European countries. In most European countries, there are several viable parties (a total of 301 parties competed in the recent EU parliament elections) and most elections are for multiseat constituencies. Taken together, those two characteristics ensure that almost no elections are non-competitive. In Europe, most candidates have viable opponents on both sides of themselves on the political spectrum, so if he goes too far in one direction, he runs the very real risk of losing voters to the other side. Since there are so many viable candidates in any election, lobby groups have a hard time bying them all off. If they come close to doing that, voters can always turn to some minor party which before that would have had a small chance of winning a seat. Also, TV ads are much less important here, so candidates have to rely more on earned TV time (debates and interviews by hostile reporters) and town square meetings.

Our system has its share of weaknesses, but it makes it much harder for industry lobby groups to control elected bodies.

If the USA voters would do like ILS suggests and vote out the congressmen who presently are in the pockets of the insurance lobby, then that would only be a temporary solution. The lobby would be free to influence the new batch of congressmen, and doing so would not be any harder than before, since the system flaw has not been dealt with.


Have a nice time!

Peter Gustafsson

[Bayou Bum]

http://www.dailymail.co.uk/health/ar...climbdown.html

If government health care works so well, why is the rest of the world regretting it?

[jeff]

BB, you completely misrepresent the situation. Very naughty of you. Don't do that.

Not only is government healthcare still extremely popular - witness the quotes that Inq found, and the testimony, but the article is about outsourcing some treatment to private sector - paid with public funds. Duh.

[dcmdale]

Our system has its share of weaknesses, but it makes it much harder for industry lobby groups to control elected bodies.

Since we have discussed this before, I think you know that I don't prefer the party-centric nature of your proposal; however, I am in complete agreement that the medical lobby is a significant part of the problem and a barrier to any solution. My experience is that lobbyists (not just health care) operate as close to bribery as they legally can. The health care lobby is exceptionally well funded. Bluntly, if we were able to come up with a plan, no matter how good, that delivered high quality health care significantly more efficiently (i.e., cheaper, faster, better), that plan would be DOA because it would hurt the groups that are profiting from current inefficiencies. This is true whether we turned towards more government involvement (ala Jeff) or towards greater market competition (ala Inq). Anything that works better is going to take money out of somebody's pocket and they are going to resist.

As noted in the original post, there is *a lot* of money at stake here and a lot of people with vested interests in keeping their share of it.

[Hauptman]

http://www.dailymail.co.uk/health/ar...climbdown.html

If government health care works so well, why is the rest of the world regretting it?

Wow... you really think that article says anything remotely resembling your comment?

[dcmdale]

One of the things that I have noticed both on this board and in Congress and the State Legislatures and in Conservative and Liberal circles is the tremendous fuzziness in the use of term "Deregulation." When economists talk about deregulation, they are specifically talking about *market deregulation:* that is, the government should relax or eliminate regulations on the product/price offerings of a particular industry.

Example 1:
Company A is offering a particular good/service for $100. If Company B figures out how to offer the same good/service for $90, in a free market economy, Company B should be able to offer that product for $90, which will force Company A to reduce price, improve quality, or otherwise respond... or lose business. It is not a perfect system, but this is what economists are talking about.

However, I am appalled at how often the term deregulation has been used to relax or eliminate the regulation of anti-competitive behavior.

Example 2:
Insurance Company C is offering a policy with particular coverage at $1000. Insurance Company D offers the same policy at $900, but the reason that Company D is offering it at $900 is not because they have figured out efficiencies, but because they intend to defraud the purchaser. (Royal Globe).

Relaxation of rules against fraud, breach of contract, price fixing, abuse of monopoly power, over-reaching, etc is not market deregulation and do nothing to support the efficiencies of capitalism and free enterprise.

The fundamental premise of free enterprise is that a consumer be positioned to be able to make a free and fair comparison between competitive product offerings. If a consumer cannot rely on the law and the courts to equitably enforce the elements of the deal, then we don't have free enterprise.

[jeff]

Insightful posts from dcmdale. 'Follow the money' is a good idea when seeing how forces line up.

Just for the record - while I'm for more government intervention to provide better healthcare (which includes 'healthcare for all'), I only advocate that as a means to that end. If the private market could and would do it instead, that would be completely fine by me. I don't advocate government intervention for its own sake, but because that's a proven working model in other countries.

[jeff]

I just was passed this joke via e-mail:

The American Medical Association has weighed in on the new economic stimulus package.
The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastroenterologist had sort of a gut feeling about it, and the
Neurologists thought the Administration had a lot of nerve.
The Obstetricians felt they were all laboring under a misconception.
The Ophthalmologists considered the idea shortsighted.
Pathologists yelled, "Over my dead body!" while the Pediatricians said, 'Oh, Grow up!'
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
The Surgeons decided to wash their hands of the whole thing.
The Internists thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
The Anesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to the ass holes in Washington.

[I_luv_saber]

Rep is deserved.
None can be given.
Sadness.

(My Haiku is rusty, but meh )

[PeterGustafsson]

Hi!

Rep is deserved.
None can be given.
Sadness.

(My Haiku is rusty, but meh )

I fixed that.

PG

[thereom4]

I just was passed this joke via e-mail:

The American Medical Association has weighed in on the new economic stimulus package.
The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.

The Gastroenterologist had sort of a gut feeling about it, and the
Neurologists thought the Administration had a lot of nerve.
The Obstetricians felt they were all laboring under a misconception.
The Ophthalmologists considered the idea shortsighted.
Pathologists yelled, "Over my dead body!" while the Pediatricians said, 'Oh, Grow up!'
The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it.
The Surgeons decided to wash their hands of the whole thing.
The Internists thought it was a bitter pill to swallow, and the Plastic Surgeons said, "This puts a whole new face on the matter."
The Podiatrists thought it was a step forward, but the Urologists were pissed off at the whole idea.
The Anesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.

In the end, the Proctologists won out, leaving the entire decision up to the ass holes in Washington.

High-larious!