The Bill is passed.....

[Capt. Slo-mo]

Moreover, if you have sufficient personal resources to pay off a prospective judgement resulting from an (auto) accident, then usually you do not have to buy insurance.

What state has a "means" test for opting out of auto insurance? Every place I've ever lived, it's mandatory.

[Inquartata]

California, for one.

The concept is called "self-insurance". It's not uncommon for businesses to do this for their drivers of company vehicles, IIRC.

You can also have an umbrella policy which if of sufficient size will substitute for auto liability insurance.

[Rockstar44]

there are plenty of examples of state-run monopolies that work.

what?

[PeterGustafsson]

Is he saying that jack booted thugs forced socialized medicine down the throats of the British, French, Swedes, Australians, Dutch, etc?

Glugg...glugg...gluuuggg!

[PeterGustafsson]

Hi!

I actually agree people should not be forced to buy insurance.

Insurance is something I can pay for to protect me at a later date. It's a gamble, on both the side of the purchaser and the side of the insurer. The insurer is hoping that you'll never need to be covered, so that they make money without having to pay anything out. The purchaser is gambling that their spending of a lesser $ amount per month will be less than spending a large $ amount later. Otherwise they could have simply saved the money themselves and come out ahead.

To force everyone to take that gamble seems... silly to me. It tilts the balance of haggling in favor of the insurers. As it is now, if there are no good options, you can at least choose to simply go without, and set aside your own money hoping it will be enough when the time comes. If we mandate insurance, your only really viable option is to choose a lesser of evils in some cases, as the tax you'd receive from the IRS would make it essentially pointless to duck insurance and save on your own. Essentially the insurance companies can really have you by the balls in some cases (I understand the private option is supposed to be a counter to this, but I disagree with the public option for various stated reasons).

Very good points in the end. Let me suggest a possible solution: Mandate that all citizens should have health insurance, but specify in the law that citizens are expressly permitted to by this insurance from out-of-state, or out-of-country, providers. This should (at least partly) restore the balance of power between insurance companies and their customers.


Have a nice time!

Peter Gustafsson

[PeterGustafsson]

Hi!

Yes. And I have said before: Why aren't Obama, Reid and Pelosi et al. agitating to let companies compete, the way the auto insurers compete, and hard, for customers? Why are they not reforming the system by attacking the real root of the problem---lack of competition due to government restrictions and the unnatural attachment of insurance provision to employers instead of individuals?

Correct identification of root cause. As for why: because they can not take on one of the industries which is one of the biggest donors for election war chests.

Instead, they come up with a "public option", that is, establishing a new monopoly to swallow all the other monopolies. Because it will be a state monopoly, and a new lever of power for government, the solver of all problems, the answer to all questions!

Yes, a public option would function as a monopoly, or at least as a oligopoly member. However, the point of this power company is not to swallow other companies, it is to undercut their rates and thus stop price gouging/nasty business practices. You may think that the latter is all fine and dandy. In that case, we are at cross-purposes.


Have a nice time!

Peter Gustafsson

[Phaeton]

what?

The TVA.

[thereom4]

It may be all you can afford on what's left after you pay for everyone's health care...

Ha! ha! Funny.

In that it flouts the basic laws of economics, yes. If he won't say it, I will. Resources are scarce, demand for them is infinite. There is simply no getting around that fact, and "heath care" uses resources.

Yes resources are scare, but are those resources of more value than human life? I say no.

And what of those who simply have different priorities?

Let's say that you value early retirement more highly than carrying the health insurance that you have not ever needed. Why is it the right of the state to tell you that no, you MUST place the priority they choose higher than the one you choose? What gives the government the right to tell you that you MUST divert assets which you would have invested to provide a retirement income to health insurance premiums instead, thus making early retirement impossible?

Here's where we agree. I think. It shouldn't be mandatory to carry health insurance. But I do think everyone should have access to quality healthcare.

[lindajdunn]

Yes resources are scare, but are those resources of more value than human life? I say no.

It depends upon whose human life is at stake. If it's a friend or relative that you like who's hardworking and just going through a rough patch and everyone likes him or her, then most people are going to say, "Hell, Yes!". In the case, however, of the child that was recently killed by British Hospitals, http://www.cnn.com/2009/WORLD/europe.../uk.baby.dies/ most of us would say "Poor thing, don't prolong the suffering" while others would fight desperately to prolong what they call life. [To me, that's not living.]

I sometimes think that welfare and universal healthcare would be easier to sell to the public if welfare consisted of free but awful housing with only basic needs provided and a communal food service that dispensed cases of Ensure and baby food rather than food stamps. Health care would need to be dispensed to those who take a number and wait for bare minimum services. IOW, they'd receive generic brands for everything. Free birth control pills and insulin but if you want the patch or an insulin pump, you need to have a verified need (as opposed to a want).

I'm not advocating the above, I just think it would be easier to sell to the public.

Most people can survive on a diet of Ensure. They won't enjoy it, however, and that would appease many of the conservatives.

[jeff]

Glugg...glugg...gluuuggg!

Oh, good! I hadn't thought of that in so literal a sense. Cod liver oil or cough syrup?

[jeff]

And again, this is only because the government has seen to it that we must and will accept that risk. That's neither the only possible outcome nor the most rational.

I am interested in hearing the alternatives you suggest that would cover everybody.

These are public goods in the economic sense. Health insurance is not. ( "That is never too often repeated which is never sufficiently learned" , or apparently is never heard, or never understood, or rejected out of some irrational "but it oughta be!" moral opinion. )

The idea that a technical definition of "public good" trumps any other reason for or against a public policy decision is a perfect example of "it oughta be!" argument! (measured against the wide array of services that government provides regardless of that criteria)

Not to mention that the bills under discussion don't actually provide the good(s), but subsidize those who can't afford it, and at most provide an alternate *payer* to the same providers.[/QUOTE]

Heh, so a Dutchman thinks his system is better than ours. What are the odds?

If there wasn't so much evidence to support his claim, I would join you in jingoistic defense of our system :-) Seriously: he said what he thought we are very good at, too.

And I know it's horribly unfair and irrelevant, but I cannot resist wondering if the assistant Minister is named Schultz...

I see nothing, I hear nothing... (I can't render the accent right this moment).

Yes.

And notice that none of our brave Washington health care reformers are inclined to reform that.

Yep.

I wonder if he has seen the things I've posted ere now about things like the much better cancer survival rates under the US system than under the socialized ones...

If so, how convenient that he has forgotten to discuss them!

Better qualify that. Overall post-diagnosis outcomes is roughly comparable. There are a small number of very nasty cases in which have superior care, but that doesn't apply to the vast majority of cancers, nor does it apply to the vast majority of the population - who can't get access to the niftiest treatments.

Later - they're about to start my flight boarding.

[jeff]

California, for one.

The concept is called "self-insurance". It's not uncommon for businesses to do this for their drivers of company vehicles, IIRC.

You can also have an umbrella policy which if of sufficient size will substitute for auto liability insurance.

I just saw this. Your prior post on the topic said sufficient personal resources. Are there really any personal self-insurers?

As you say, business often self-insure, but they have a pool of funds and a pool of risk that can make an external insurer redundant. How many individuals do you think can and do self-insure?

[I_luv_saber]

Not sure how many do it either, but here it is for reference:

Financial responsibility is required on any vehicle operated or parked on California roadways.

<snip>

Types of financial responsibility

• A motor vehicle liability insurance policy
• A cash deposit of $35,000 with DMV
• A DMV issued self-insurance certificate
• A surety bond for $35,000 from a company licensed to do business in California.

I snipped out some stuff for brevity, but here's the gist of it.

http://www.dmv.ca.gov/pubs/brochures...cts/ffvr18.htm

[Philistine]

I just saw this. Your prior post on the topic said sufficient personal resources. Are there really any personal self-insurers?

As you say, business often self-insure, but they have a pool of funds and a pool of risk that can make an external insurer redundant. How many individuals do you think can and do self-insure?

Pennsylvania does it, too (though it requires $50,000 for the 1st car, and $10,000 per car for others).

Pennsylvania's option seems a little better than California's as it does seem to allow certain collateral (e.g. escrow accounts, LOC, etc.) that would allow you to actually make money on the funds.

I've never come across an individual self-insurer (though I wouldn't have expected to), but I'd suppose perhaps it might be attractive to someone with a fair amount of assets who is (or who has family who are) high risk or where otherwise the cost of insurance is extremely high.

In that case, if they were rational, they'd most likely have an umbrella policy that was secondary. To most people with sufficient assets to actually self-insure, you'd think avoiding the administrative hassle and risk of liability would probably outweigh any potential cost-savings on the insurance.

--Philistine

[PeterGustafsson]

Hi!

I don't want to pay for my neighbor's viagra. Let him do it the old fashioned way. California poppy, kava and fresh oats. Fresh oats, nettle leaves and seaweed. Ginkgo. Whatever. But close the curtains, please.

In the spirit of Mr. Swift, let me come with a not-so modest proposal:

The younger women of USA, if they vote democrat, should not pay for any viagra, nor should they let their neighbors - if those neighbors vote republican - go without the joys of female companionship. The benefits of this are twofold:

Firstly, the democrat men will go without said companionship, which will heighten their fervor to do political battle, and they will go to greater lengths to lend Obama a hand in -12, and come to grips with their own complacency.

Secondly, and more importantly, said companionship will cause the GOP men to show that they can rise to the occasion, even if the women are many years their junior, and multiple in number in a given occasion. If said democrat women are cunning in their choice of men, this can cause said men to refrain from voting GOP, permanently. The perfect choice is of course overweight men, preferably afflicted by a weakness of the heart. If the wives of those men find out, so much the better. Let those women who say that they can do anything as good as any man, show that their feminine guile is good enough to do who no man can even begin doing!

Previously, English women have been exhorted: "Lie back and think of England!" Instead, I wish to exhort the young democrat American women: "When that Glenn Beck-lookalike has his way with you, work him hard until he comes and goes at the same time! You will save America from the Palinheads, one redneck at a time!"


Have a nice time!

Peter Gustafsson

[Inquartata]

Yes resources are scare, but are those resources of more value than human life? I say no.

No, you say yes. You just don't know it yet. Allow me to demonstrate...

1) Let us say that a pharmaceutical company comes up with a drug which will cure an obscure form of cancer which kills, let us say, 10 people a year.

The drug requires an extract from the pineal glands of...hmm...puppies. Let's say 100,000 of them per dose.

Do you go ahead with making and using the drug?

If so, let's say that instead of puppies it's an endangered species. Polar bears or something. And producing the drug will make them extinct...

2) Let us say that a medical treatment procedure is discovered which can save the life of a single sufferer from one disease. Unfortunately it will cost so much that it will require the equivalent of 3/4 of the national GDP for one year. Extracting this much from the economy his will certainly send it into a depression and put 100 million Americans out of work.

Do you go ahead? Or are those resources suddenly more valuable than human life?

If not, let's say that the only person currently dying from this disease is Osama Bin Laden. Is saving his human life worth the expenditure of all of those resources?

3) There is an illegal immigrant dying of thirst in the southern Arizona desert as he tries to enter the US. He can be saved if you press this button. But if you do, your house will burn to the ground, you will lose your job and all your savings...and your health insurance.

Do you push the button?

If so, let's say that instead of an illegal immigrant it's a notorious Somali pirate who has killed 8 people during his career.

It shouldn't be mandatory to carry health insurance. But I do think everyone should have access to quality healthcare.

Everyone does.

"Have access to" is not the same thing as "can afford".

I am interested in hearing the alternatives you suggest that would cover everybody.

Tsk, naughty, trying to establish that as the base condition!

There are of course none, because of scarcity, the basic economic limitation faced by all societies. "Covering everyone" is impossible within the constraints of limited resources, even for government---which we are going to learn in the next 50 years or so, I am afraid.

[quote]
The idea that a technical definition of "public good" trumps any other reason for or against a public policy decision is a perfect example of "it oughta be!" argument! [quote]

Just as a society gets the leaders it deserves, it gets the policies it deserves.

If there is a national decision to do something which is economically foolish and unsustainable, it of course has the right to do it regardless of the consequences. But that does not make the policy smart and sustainable all of a sudden, and there will be consequences.

I am simply arguing that this is a policy which flies in the face of rationality and economic possibility, and will come back to bite us in the you-know-what if we are so rash and blind as to go ahead with it...

(measured against the wide array of services that government provides regardless of that criteria)

Off hand I cannot think of any other nonpublic good or service that the government provides to all.

Not to mention that the bills under discussion don't actually provide the good(s), but subsidize those who can't afford it, and at most provide an alternate *payer* to the same providers.

A distinction without much of a difference, really. The same quibble can be applied to just about every government service, including ones which actually ARE public goods...and it doesn't keep them from being public goods.

Better qualify that. Overall post-diagnosis outcomes is roughly comparable.

That's not what the findings I posted before showed. Remember them?

I just saw this. Your prior post on the topic said sufficient personal resources. Are there really any personal self-insurers?

I know a couple, so yes. But of course, I could just be making that up to support my position.

How many individuals do you think can and do self-insure?

I've no idea, and probably no one else does, either. Perhaps the several state insurance departments. But really, do you think that Steve Jobs or Oprah Winfrey or Warren Buffet couldn't pay any conceivable judgement out of pocket change?

[jeff]

Tsk, naughty, trying to establish that as the base condition!

I don't think that's naughty. It's a goal realized today by other countries, who - remember - spend much less on health care than we do.

There are of course none, because of scarcity, the basic economic limitation faced by all societies. "Covering everyone" is impossible within the constraints of limited resources, even for government---which we are going to learn in the next 50 years or so, I am afraid.

How then explain the first world societies that do in fact cover all of their citizens, at less cost than we cover less than all of our citizens? France, Germany, Sweden, Switzerland, Japan, Australia, Netherlands, Canada, Spain, etc.

"Proof of existence" trumps hypotheticals. The statement "X is impossible" is shown to be false when examples of X are available.

The cute counter-examples of cures that cost 3/4 of GDP don't come into play: they can't be afforded, period, whether private or public system. What no system can do is provide infinitely expensive care to even a fraction of its citizens - but that obvious limitation is orthogonal to "private vs. public".

Just as a society gets the leaders it deserves, it gets the policies it deserves.

If there is a national decision to do something which is economically foolish and unsustainable, it of course has the right to do it regardless of the consequences. But that does not make the policy smart and sustainable all of a sudden, and there will be consequences.

How then is it sustainable in all the countries I listed? (and many more besides) You beg the question by asserting without proof that such policies are "economically foolish and unsustainable". See again under "proof of existence"

I am simply arguing that this is a policy which flies in the face of rationality and economic possibility, and will come back to bite us in the you-know-what if we are so rash and blind as to go ahead with it...

How so, when other countries manage to do it? I feel rather like somebody being told that his science says "bumblebees can't fly" (we've used this metaphor before, haven't we?) when one flies by...

Off hand I cannot think of any other nonpublic good or service that the government provides to all.

Well. Use the weapon hand. Scorpion position for classical economists, otherwise hanging limply by your side.

BTW, are police/fire public goods or not? If a cop is patrolling my neighborhood, he isn't in another one, so it's rivalrous, no? Similarly, if a firestation is built near enough to protect me, it won't be near enough to protect somebody else. Ditto teachers/schools. I'm having difficulty seeing an inherent difference between these examples (which seem to be widely accepted as okeydokey) and health care. Substitute doctor and hospital as appropriate.

I note that the Wikipedia article (before which we must all bow ) at http://en.wikipedia.org/wiki/Public_good says that even national defense is not necessarily a public good. Also a distinction between "public" and "club" goods. Interesting, to the extremely limited extend that economics can be interesting

Still begs the questions: how does the rather technical and apparently debatable definition of "public good" translate into "should", let alone "others are not economically sustainable". That leap has not been proven, other than as assertions.

A distinction without much of a difference, really. The same quibble can be applied to just about every government service, including ones which actually ARE public goods...and it doesn't keep them from being public goods.

What can I say? If the government doesn't actually provide the service it is in reality quite a different thing. People in the US may not want a UK-style NHS, but might be very happy with a system in the Swiss or French (mon dieu!) style. I would say there really is a very big difference in the services provided and received in those models.

That's not what the findings I posted before showed. Remember them?

I remember dimly, but not the conclusion or the link itself. Where's my "Got link?" t-shirt?

Besides, as this week's brouhaha over mammography proves, what one study or panel claims today as authoritative truth can be contradicted the very next day with equal assuredness.

I know a couple, so yes. But of course, I could just be making that up to support my position.

No, you wouldn't do that. There's a few people on this board who just make stuff up, but you're not one of them.

I've no idea, and probably no one else does, either. Perhaps the several state insurance departments. But really, do you think that Steve Jobs or Oprah Winfrey or Warren Buffet couldn't pay any conceivable judgement out of pocket change?

Oh sure, they can all afford all kinds of extravagances, though I would imagine that at least Buffett's accountants would ask the notably frugal man why he's wasting money that way when he could buy a policy on much more attractive terms.

So, let's design systems that work really well for billionaires? Well, that will scale to the population at large.

Maybe it works for Jay Leno, since he has so many cars that he may as well use fleet-style insurance.

[Inquartata]

I don't think that's naughty. It's a goal realized today by other countries, who - remember - spend much less on health care than we do.

It may be, but I don't think it's a very good goal, so why should I try to think of ways to achieve it? That was my point---it was a loaded question.

How then explain the first world societies that do in fact cover all of their citizens, at less cost than we cover less than all of our citizens? France, Germany, Sweden, Switzerland, Japan, Australia, Netherlands, Canada, Spain, etc.

We've been over this before. I am still not ready to accept the terms of the comparisons or the accounting methods. I'm also not sure that all of the costs are in fact being measured ( how do you gauge the opportunity cost of nonprice rationing, for instance? ). And finally there is the matter of the assumption that "since X does Y over there, it will do it over here, too". I look askance at that one, especially given the apparent whimsical nature of the understanding of simple economics by proponents of the system now being cobbled together by a congeries of politicians who have not demonstrated much ability to design efficient, economical systems in other areas of endeavor...

The cute counter-examples of cures that cost 3/4 of GDP don't come into play: they can't be afforded, period, whether private or public system.

Quite. Those were merely intended to show that blanket statements like "human life is more important than resources" have limits beyond which they are manifestly untrue. In the end we are left with something like Churchill's "now we're just haggling over price".

What no system can do is provide infinitely expensive care to even a fraction of its citizens - but that obvious limitation is orthogonal to "private vs. public".

And it may not be able to provide normally expensive care to all for much longer, either. Demographics are already challenging those foreign universal health care systems, and things are only going to get worse.

How then is it sustainable in all the countries I listed?

I don't think it is. Eventually it is going to founder on the rocks of "too few workers paying for the benefits of too many elderly retirees". Throw in a few serious economic dislocations or disasters and things look bleaker still.

You beg the question by asserting without proof that such policies are "economically foolish and unsustainable".

To me, government provision of nonpublic goods is by definition foolish. That people want something does not mean that it is wise for them to have it, or even that it will be good for them in the long run...

How so, when other countries manage to do it?

This is like me saying that because Keeth Smart can flunge half the length of the strip I can do it, too.

Countries and governments are different. That Country A can do a thing does not prove that Country B can do it, much less do it the same.

I feel rather like somebody being told that his science says "bumblebees can't fly" (we've used this metaphor before, haven't we?) when one flies by...

Yes, yes. But to me it's more like being told that yes, this ostrich should be able to fly, because after all so many other birds can.

Well. Use the weapon hand. Scorpion position for classical economists, otherwise hanging limply by your side.

Heh. And do Marxian economists use it to cover target?

BTW, are police/fire public goods or not?

They are generally considered to be so.

If a cop is patrolling my neighborhood, he isn't in another one, so it's rivalrous, no?

But the burglar he arrests robbing my house will not be robbing yours tonight. If I have paid for his services and you have not, yet you are still benefitting from his work. You are what we call a "free rider". You have no incentive to pay for him to do his job, so long as someone else does, yet you are still protected. This tends to mean that no one is willing to pay, or at least not enough people to provide for efficient coverage. Hence the state taxes everyone to pay for it.

But aside from the communicable disease aspect, this does not apply to medical care. If you pay a doctor to tend to your broken arm or heart surgery or what have you, it does not improve my health. It neither harms nor helps me. It affects me not at all, in fact. There is no free rider problem. It's a normal good...

And the communicable disease angle is a tiny part of health care.

to the extremely limited extend that economics can be interesting

Bah. Bah, I say!

Still begs the questions: how does the rather technical and apparently debatable definition of "public good" translate into "should",

Well, as in most sciences I think "should" in economics follows from understanding the consequences of "don't"....

What can I say? If the government doesn't actually provide the service it is in reality quite a different thing.

So...if the military uses civilian contractors for some things, it's not really a military any more?

Is the end---protection of the nation, the ability to extend power abroad---changed at all?

A public good is a public good, by its nature, not because of how it is managed. A normal good is a normal good, regardless of how it's production and provision is arranged.

People in the US may not want a UK-style NHS, but might be very happy with a system in the Swiss or French (mon dieu!) style. I would say there really is a very big difference in the services provided and received in those models.

Sure. My objections are on economic grounds. I am not concerned with what makes people happy. NASCAR and beer make a lot of people happy, too, but that doesn't mean that the state should provide them...

And of course there is the small issue of whether it is in fact what "the people" want, or whether it is rather something they are told is for their own good by their leaders.

I remember dimly, but not the conclusion or the link itself. Where's my "Got link?" t-shirt?

Heck, I don't know! I'd have to go looking for it. I seldom save the things in any useful fashion.

Oh sure, they can all afford all kinds of extravagances, though I would imagine that at least Buffett's accountants would ask the notably frugal man why he's wasting money that way when he could buy a policy on much more attractive terms.

But he wouldn't really be expending any money at all, so long as he wasn't in any at-fault accidents---as opposed to the ongoing premiums of an insurance policy. He'd actually be saving money.

Of course, the point is kind of moot, since probably none of the really wealthy ever drive themselves anywhere, anyway...

[thereom4]

No, you say yes. You just don't know it yet. Allow me to demonstrate...

No, I say no. The questions/examples you present are extreme yet they appear to be philosophical in nature. I have an idea, and I get this idea from your saying, 'you just don't know it yet', that you believe that I my answers to your questions would go a certain way. If I answered accordingly, you would therefore be provided with an inconsistency which you could harp on and use as evidence to support your position. Regardless of how I'd answer the questions you presented, my core belief that human life is more valuable than resources would not change. At the end of the day these resources are for our use.

"Have access to" is not the same thing as "can afford".

While "have access to" and "can afford" are not the same thing, in this case they go hand in hand. If you need to see a gastroenterologist but you don't have health insurance because you can't afford it, you will likely not have access to a gastroenterologist.

[lindajdunn]

Remember that discussion earlier about whether or not medical costs are higher because some people don't/can't pay? According to a report in the local paper, quoting the local head of the local hospital, the cost to the insured patient is higher due to medical write-offs. Since the article is not online and accessible to non-subscribers, I'm inserting relevant quotes.

Like many other hospitals across the nation, HRH writes off huge amounts of money because patients or their insurance providers haven't paid. In 2010, the hospital board was told this week, that will amount to more than $106 million.

Unfortunately, patients with private insurance such as Anthem have to pick up the slack for others, Keen said. Hospitals like HRH negotiate rates above their cost with these private insurance providers.
"They're actually paying more than they shoule be paying," Keen said of patients with private insurance. "We're having to charge them more to overcome these Medicare and Medicaid shortfalls".

Keen estimates Hancock Regionaly only gets 10 cents on the dollar for charity care patients because "the self-pay people generally don't have the money to pay you."

Together, write-offs for Medicare, Medicaid, private insurance and charity care account for about 44 percent of the hospital's total patient service revenue. That will total $106.61 million in 2010. Medicare writeroffs, as is typical, will cost $63.65 million.

Inserting statistics:

In 2008, there were an estimated 67,282 people in the county. Estimated number of children 0-4 = 4,804, estimated number residents 65 or older = 8,438. Median age is 37.4. Families on welfare=158. Median household income=$65,421

End statistics.

My notes, strictly to put these costs into perspective since there are regional differences in COL.

This is a small, rural county hospital in an area where most county residents go to the urban county next door (which has multiple hospitals and specialists) if they develop serious problems such as high risk pregnancies, cancer, etc. It's not a county with a high number of welfare cases and you can buy a nice house on a half acre lot for $100K. Costs are relatively low in this area.

If we look at the amount they're writing off: $106 million, and divide this by the number of residents in the county, 67,282, we have approx. $1500 per resident for medical write-offs every single year.