Universal Health Coverage

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Postby shostakovich » Sun Jan 21, 2007 10:56 pm

"Work"? For whom? I'm on a fixed income. Price caps would be good for me. The free market works for the utility companies, among others, just fine.
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Postby Selma in Sandy Eggo » Mon Jan 22, 2007 4:40 am

The more I think about it, the more I think that "free market medicine" is a thing we used to have, didn't like, and got rid of.

Doctors accept patients if they feel like it. Doctors' fees are whatever the doctor cares to charge. Medications the same, and you can get whatever you want. FDA? Socialist nanny outfit that it is, it'll have to go. Hospitals would also have to be relieved of the legal obligation to treat whoever arrived at their door in need of care. Indigent care becomes a charity matter, or nonexistent.

Of course, the rate of exposure to communicable diseases is going to go way up. With no subsidized immunizations for the less affluent, we can expect our current barrier of immunized citizens to thin and dwindle away. This will be a good thing, though, because with the loss of family planning services we'll have a rising birthrate and will need the increased childhood mortality to balance it. The rising maternal mortality rate will also help offset that rising birthrate, too.

Social Security funds should be out of trouble, though, since the survival rate for untreated secondary pulmonary infections among the elderly should severely prune the number of folks drawing retirement benefits.


Doesn't this sound sort of 19th century? And isn't it something we already did and disliked? That was free-market medicine.

Maybe I should put a :wink: on the end of this, to mark it as either sarcasm or a dreadful illustration, I'm not sure which.
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Postby barfle » Mon Jan 22, 2007 10:48 am

Selma in Sandy Eggo wrote:You are, in practice, assuming that each "consumer" has the theoretical knowledge of a physician and research biologist.

Not really. There are many aids in making informed choices when it comes to various ways of spending money. Consumer Reports rates lots of things, as do many specialty magazines. There are public fora where gripes are aired regularly. It's not necessary to be an expert on fuel injection systems and automagic transmissions to purchase an automobile, although it may help. Research aids ARE available to the laymen.
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Postby GreatCarouser » Mon Jan 22, 2007 4:18 pm

A little fuel for this fire?
Some comments on Bush's health care plan
"On the radio, Mr. Bush suggested that we should “treat health insurance more like home ownership.” He went on to say that “the current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance.”

Wow. Those are the words of someone with no sense of what it’s like to be uninsured.

Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an “incentive” to buy insurance; they need something that makes getting insurance possible..."
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Postby Shapley » Mon Jan 22, 2007 5:12 pm

GC,

You're blogger obviously just listened to the radio, and didn't bother the research the plan at all before posting his comments. There is a bit more to the plan than meets the eye, or rather ear:

Bush Eyes Tax Break For Health Insurance

The plan actually is designed to make health care affordable for more Americans, which is what Medicare, Medicaid, et. al. were supposed to be doing since the '60s. It will do this by lowering the premiums for Americans who buy their own health insurance. How? By allowing them to deduct the cost of coverage, something the self-employed and those without employer-provided coverage have been asking for since at least the '80s, and which the Republicans in Congress should have fixed a long time ago (shame on them). The tax cut will be 'payed for' by a tax on employer-provided plans costing more than $15,000/yr./employee (the so-called 'gold-plated' plans the President addressed). I doubt many factory workers will find themselves burdened by this tax, but I strongly suspect that the boardroom may feel the pinch. It's a 'tax on the rich', which the Democrats always seem to want to impose, but probably won't support.

The plan does not address, nor is it meant to address, the problem of the uninsurable or the indigent. The indigent already have the right to coverage under Medicaid and other, State run, plans. The uninsurable will have to be addressed seperately, and may be when the full plan is unveiled.

Mind you, I'm not saying I support the plan. I'm not familiar enough with it to make that call just yet. I'm simply suggesting that the blogger's knee-jerk response to it is rather typical of the Bush-bashers desire to nay-say anything he proposes without taking the time to give it a proper hearing. The plan does, after all, incorporate the 'soak the rich' mentality that Democrats are usually so eager to embrace.

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Postby Shapley » Mon Jan 22, 2007 5:25 pm

A little additional searching found this

In his speech Tuesday night, the president will also propose increasing the federal assistance to states that make private healthcare plans available to low-income or chronically unhealthy people who are uninsured.

The administration hopes to provide waivers under Medicaid -- the government health insurance program for the poor that is jointly funded by the federal government and the states -- to allow states to redirect money from hospitals and nursing homes to individuals to help them buy health insurance.

Some states already are moving to offer healthcare coverage to the uninsured. In California, Gov. Arnold Schwarzenegger recently announced a plan to provide coverage to about 6.5 million people, including many recent immigrants, who are uninsured. If the plan is approved by the state legislature, California would become the fourth state -- along with Massachusetts, Vermont and Maine -- to offer near universal health insurance.

Taken together, Bush's proposals are his most ambitious attempt to address the healthcare crisis. In the past, Bush had pushed for limited tax breaks to help people buy health insurance, but those initiatives never gained traction. He has also advocated health savings accounts, consumer-driven plans with higher deductibles and lower premiums than those in traditional insurance.


Of course, Mr. Krugman has already framed the debate - ignore the realities of the plan and attack the 'out of touch' President for failing to address that which he addresses. Scanning through the comments to Mr. Krugman's piece, his followers are already falling for it.

That's what happens when you let the bloggers do your research for you.

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Postby BigJon » Mon Jan 22, 2007 8:02 pm

Selma in Sandy Eggo wrote: There's no lack of quality information. I can find anything I look for. The problem is that the "ultimate consumer" is not usually capable of searching for, finding, and comprehending said information.

I have a huge vocabulary, decent librarian skills, and sufficient biology, chemistry, and pharmacology knowledge to let me do detailed study on my diagnosis. Do you? Does the 19-year-old mother of the Phenylketonuric infant? And how much time should be allowed for this activity? That baby is going to be brain damaged by this time next month if not treated appropriately TODAY!

You are, in practice, assuming that each "consumer" has the theoretical knowledge of a physician and research biologist.

Wot we got here is failure to communicate

I think you are making my point for me. Did you read my earlier post? The ordinary patient does not have the information, and cannot get it, nor does she have the training to even understand the issues if she can find the info. Therefore she makes extra-expensive decisions or turns those decisions over to someone with a vested interest in maximizing revenue. Thus she cannot be said to be engaging in a free market exchange.

The germ of my idea is; what if we had a team of Selmas with no stake in the revenue to help her make the most effective decision. Then the free market could operate efficiently. My question is how would we go about implementing something like that?
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Postby BigJon » Mon Jan 22, 2007 8:22 pm

Selma in Sandy Eggo wrote: The more I think about it, the more I think that "free market medicine" is a thing we used to have, didn't like, and got rid of.

I'm not sure where you got the "didn't like" part. The main shift in the US came when employer-sponsored healthcare became the norm. It didn't have anything to do with consumers liking or not liking. It looked like a free ride to the employees, so they took to it with gusto. This insurance eliminated the normal free market limitations because the consumers paid no penalty for overuse of the benefit and the producers discovered that they could continually invent new ways of attracting revenue without a serious usefulness or efficiency throttle from the payers . The insurance companies didn't care because they just forwarded all the increases to the employers. It didn’t start to hurt until recently. Had we kept with the free market ideals, this either would have started hurting long ago, or the practice of medicine would have evolved quite differently.

Selma in Sandy Eggo wrote: Doctors accept patients if they feel like it. Doctors' fees are whatever the doctor cares to charge. Medications the same, and you can get whatever you want.

You are not describing a free market, sorry.

Selma in Sandy Eggo wrote: FDA? Socialist nanny outfit that it is, it'll have to go.

Where does it say a free market is completely free of review and regulation? A truly free market would allow us to choose our regulators and reviewers, but it doesn’t do away with them. That is just foolishness and a strawman argument.

Selma in Sandy Eggo wrote: Hospitals would also have to be relieved of the legal obligation to treat whoever arrived at their door in need of care. Indigent care becomes a charity matter, or nonexistent.

This is the stickiest wicket of all. Not insurmountable though and not a reason to abandon free markets in most other healthcare related transactions.

Selma in Sandy Eggo wrote: Of course, the rate of exposure to communicable diseases is going to go way up. With no subsidized immunizations for the less affluent, we can expect our current barrier of immunized citizens to thin and dwindle away. This will be a good thing, though, because with the loss of family planning services we'll have a rising birthrate and will need the increased childhood mortality to balance it. The rising maternal mortality rate will also help offset that rising birthrate, too.

A free market does not preclude regulation of the commons. Communicable disease is part of the commons. Strawman.

Selma in Sandy Eggo wrote: Doesn't this sound sort of 19th century? And isn't it something we already did and disliked? That was free-market medicine.

Maybe I should put a :wink: on the end of this, to mark it as either sarcasm or a dreadful illustration, I'm not sure which.

It’s funny, but my 19th century forefathers could get medical care in trade for their farm goods. Sure it was 19th century care, but it sounds like an OK way to consume to me.
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Postby shostakovich » Mon Jan 22, 2007 10:11 pm

A "free market" with regulators is not my concept of a free market. I guess the term means different things to different people. To me, a free market would allow sellers to decide on costs, and buyers to decide whether or not to buy. Unfortunately, many people do not have the wherewithall to make the decision. They are out of the loop. When it comes to necessities of life, such as health care, this is not (or shouldn't be) acceptable. The truly impoverished may have Medicaid to help, but there is an economic group, a substantial one, I'd guess, that is not poor enough to receive Medicaid assistance, and not rich enough to afford a health plan, not even Bush's new proposed one. Our Governor Rell has also proposed a state plan similar to the Bush plan, which also leaves a substantial segment of Connecticut society hung up to dry.
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Postby OperaTenor » Tue Jan 23, 2007 2:37 am

"Free" market with regulation?!

:rotfl:
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Postby Selma in Sandy Eggo » Tue Jan 23, 2007 3:07 am

The germ of my idea is; what if we had a team of Selmas with no stake in the revenue to help her make the most effective decision.

Trust me, you wouldn't like it. Be careful what you wish for, it might happen.
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Postby piqaboo » Tue Jan 23, 2007 11:54 am

BigJon wrote:Selma in Sandy Eggo wrote:
Doctors accept patients if they feel like it. Doctors' fees are whatever the doctor cares to charge. Medications the same, and you can get whatever you want.

You are not describing a free market, sorry


Time to define your terms, BigJon.

Because thats a pretty good description of a free market IMO.
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Postby BigJon » Tue Jan 23, 2007 4:12 pm

piqaboo wrote:
BigJon wrote:Selma in Sandy Eggo wrote:
Doctors accept patients if they feel like it. Doctors' fees are whatever the doctor cares to charge. Medications the same, and you can get whatever you want.

You are not describing a free market, sorry


Time to define your terms, BigJon.

Because thats a pretty good description of a free market IMO.

Charging whatever you want is a monopoly practice. If you want to stay in business in a free market economy, you can only charge what the market will bear.
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Postby BigJon » Tue Jan 23, 2007 4:14 pm

Selma in Sandy Eggo wrote:
The germ of my idea is; what if we had a team of Selmas with no stake in the revenue to help her make the most effective decision.

Trust me, you wouldn't like it. Be careful what you wish for, it might happen.

Sure I would, if I had the choice to ignore your advice or use it.
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Postby BigJon » Tue Jan 23, 2007 4:31 pm

OperaTenor wrote:"Free" market with regulation?!

:rotfl:

You and Shos aren't listening too well.
First, do you understand the Tragedy of the Commons? The tragedy happens because the commons are unregulated, not because free markets don't work, they work too well, depleting the Commons. The Commons require regulation to prevent depletion.

I never said who the regulators should be. The leftists and populists, of course, say the regulators must be the gubby, it's the only way it work. The free marketeers say, let us be free to choose our regulators and covenant together to not destroy the commons. That's where the League of Selmas (TM) would come in. They would be the regulators, they would covenant with our insurers and health care providers to make wise decisions and control costs. If I didn't like one LoS (TM) I could switch over to another LoS.

Just as Selma and I (and you Shos) stated above, health care is way too complicated for the average U.S. citizen to know or understand all of his options and make wise, cost effective decisions. Neither does the current system have sufficient incentives to operate efficiently. I'm trying to brainstorm ideas to change this without the gubby getting their hands on the whole pie. (They already have about 40% of it, and I'm not sure anyone is truly happy with their current performance.)
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Postby Selma in Sandy Eggo » Tue Jan 23, 2007 5:07 pm

...the Tragedy of the Commons? The tragedy happens because the commons are unregulated, not because free markets don't work, they work too well, depleting the Commons. The Commons require regulation to prevent depletion.

Gobbledygook. Undefined terms, assumptions, circular reasoning, and an unsupported conclusion.
...the League of Selmas (TM) would come in. They would be the regulators, they would covenant with our insurers and health care providers to make wise decisions and control costs.

No, I would not do any such thing. I'm mortally offended by the suggestion that adding another layer of bureaucracy to the existing mess would improve anything. I'm out to remove a layer of the bureaucracy - the insurance layer.

Dude, I'd socialize you. Med students could apply for full-ride grants, to be repaid with years of indentured servitude in my clinics. Your mandatory Medicare tax would be increased, your insurance premium would go away, and my hospital emergency rooms would no longer provide indigent clinic-level care; they'd provide a referral to an actual clinic instead. Clinic level management of your family's routine care and chronic health conditions is definitely the way to go. If you don't like my free clinic, you can pay cash at the Wal-Mart clinic. As for the diagnosis of diseases and determination of appropriate treatment - that's the job of the doctor. Not the patient, and not the local Professional Selma, either.

Refusal to immunize your children would be a prosecutable case of child endangerment. This would give employment to some of the lawyers who'd be out of the business of suing pharmaceutical houses because drugs have side-effects. Of course they do. And doctors can't cure everybody - eventually you die. Malpractice cases would be limited to criminal courts and ambulance-chasing lawyers would be SOL.

:hmph: :curse: There. I've eliminated two large burdens on the health-care delivery system. Cash-skimming insurance is gone, as are the 40%-of-award-no-cash-in-advance malpractice lawyers.
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Postby dai bread » Tue Jan 23, 2007 5:26 pm

...then maybe you could get your cost of healthcare down closer to the 7% of GDP that we pay.
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Postby piqaboo » Tue Jan 23, 2007 5:26 pm

BigJon wrote:
piqaboo wrote:
BigJon wrote:Selma in Sandy Eggo wrote:
Doctors accept patients if they feel like it. Doctors' fees are whatever the doctor cares to charge. Medications the same, and you can get whatever you want.

You are not describing a free market, sorry


Time to define your terms, BigJon.

Because thats a pretty good description of a free market IMO.

Charging whatever you want is a monopoly practice. If you want to stay in business in a free market economy, you can only charge what the market will bear.

Ohferpetessake.
Whateveryouwant carries with it the risk that no one will buy your services. So, I can paper my waiting room with gold, and charge $5000 for an annual exam. The guy down the street may choose paint and $125 for the same annual fee. My fee includes the lab costs, his fee does not - those will be separate. You are free to choose which of us to make your appt with.
Probably, we'll both have clientele. But if not one comes, I have the option of reducing or doubling my fees. I might discover myself very poplular if I double my fee and add a "free" whole body scan to my services (cost to me, ~ $100).

Terms defined. I can charge whatever I like. And if no one else likes it, I will go out of business. There is no regulation of my fees.

BigJon, that was a silly nitpick.
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Postby barfle » Tue Jan 23, 2007 5:27 pm

I believe the "commons" as referred to by BigJon are the various resources that are considered public property. For example, I am able to take fish out of the ocean without paying anyone for the fish. Until I catch the fish, it is a "common."

If the commons, such as a fishing ground, are unregulated, though, someone could take all the fish, rendering the resource no longer available to the public.

Does that help?
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Postby OperaTenor » Wed Jan 24, 2007 3:25 am

barfle wrote:I believe the "commons" as referred to by BigJon are the various resources that are considered public property. For example, I am able to take fish out of the ocean without paying anyone for the fish. Until I catch the fish, it is a "common."

If the commons, such as a fishing ground, are unregulated, though, someone could take all the fish, rendering the resource no longer available to the public.

Does that help?


The concept still sounds like hypocrisy coming from the mouth of an avowed free marketer.

Selma's got it. I don't understand why so few people actually get it.

This is one instance where altruistic principle and sound bottom-line thinking coincide. It's not even rocket surgery.
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