Universal Health Coverage

[barfle]

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

Ouch.

I'll leave Jon to defend his own position, but even a totally anarchistic laisez faire free marketer understands that someone cannot take all the air as his own (which is what air pollution encroaches on)., and still have a functioning society.

[piqaboo]

Which comes right back to what the market will bear. The market (aka we the people) wont bear someone polluting all the air, so they got someone to regulate it.
The someone in this case was the gov't. That in fact is why we choose to have a gov't, n'est ce pas?

[OperaTenor]

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

Ouch.

I'll leave Jon to defend his own position, but even a totally anarchistic laisez faire free marketer understands that someone cannot take all the air as his own (which is what air pollution encroaches on)., and still have a functioning society.

In that case, a free market is an impossibility, so why try to go halfway? Getting most of the way to a purely free market doesn't cut it. It only opens the door for ecological and social disaster by allowing enough anarchy to leave the general public vulnerable to God-knows-what kind of man-made catastrophe.

Not mkaing a good case for Libertarianism here....

What possible harm can there be in erring on the side of society and ensuring all members are given the same chances?

That the principle of minimizing government is kept inviolate?

That the uberrich maintain their entitlement to their riches at the expense of the lower class(es)?

[Shapley]

That the uberrich maintain their entitlement to their riches at the expense of the lower class(es)?

If it is their riches that they are maintaining entitlement to, they do not do so at the expense of anyone. Are you suggesting that the lower class(es) have entitlement to the riches of others?

[OperaTenor]

If it is their riches that they are maintaining entitlement to, they do not do so at the expense of anyone. Are you suggesting that the lower class(es) have entitlement to the riches of others?

As a matter of general social compromise in a less than ideal world, you bet.

And if you don't think we already do that[in a much broader and shallower sense], then you're once again residing on that river...

[Shapley]

Oh, I'm quite aware that the government has given to the 'poor' title to some of the property of the 'rich'. It's amazing how generous they are when giving away wealth that is not their own.

[BigJon]

...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.

Wow Selma, I’m saying this without my normal lightheartedness. I’m surprised at you. This is not babbling, this is a well-supported theory of economics, demonstrated by practical examples the world over. Have you done study on it?

...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.

I’m not looking to add layers either, I’m looking to strip them away, as they are inefficient and don’t add value to the transaction. I’d want to replace the multiple levels with one level. For instance, insurance would function as insurance not gatekeepers or pre-paid service providers. They’d have no say in treatment decisions because they have covenanted with the LoS to abide by their decisions. Most of the paperwork of insurance justification would be eliminated too as it is mostly redundent and unneeded.

Dude, I'd <snip>

As long as I’d have a choice to take me and my dollars elsewhere, You could do what you believe to be right in your league.

Refusal to immunize your children would be a prosecutable case of child endangerment.

Ah! So you do believe in the theory of Tragedy of the Commons. You’ve just described one of its most shining examples of how it can work for good for the entire society.

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: 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.

It would be foolhardy to eliminate insurance. Can you really take on a $5,000,000 illness from your own pocket? It’d be better for everyone to make insurance a catastrophic coverage device only. My covenant idea would also eliminate almost all avenues for lawsuits regarding care too. I support you fully there.

[BigJon]

BigJon, that was a silly nitpick.

In the bigger scope of Selma's rant, it wasn't a nitpick. She was using it as a justification on why the current system is broken. I was pointing out it had nothing to do with it.

True competition brings efficient pricing. If you are seeing inefficient pricing, there is a barrier to true competition. Eliminate the barrier and costs come down.

[BigJon]

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

How so? What's the market price for a liter of atmospheric air? Is there a trading floor for it? What's an inch-acre of rainfall going for these days? To whom did the farmer pay when it fell on his land? Can I trade in the sunshine that falls on my property for some bonds in my old-age fund? Commons are all around us. To deny this would be to live in a world of unreality. The Commons which can be exploited for gain can also be depleted, making them available to no-one. Thus they must be regulated. Again, I never said who the regulators should be, just that they need to be regulated to prevent degradation and destruction.

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.

I'm sorry, I don't get it. Socialized welfare is the road to inefficiency, slow growth and dragging innovation. A well regulated Commons along with free market everything else is the road to innovation, rapid growth and allocation of resources elsewhere, where they can be invested more productively.

Help me figure out how to do this and we are both better off.

[BigJon]

Which comes right back to what the market will bear. The market (aka we the people) wont bear someone polluting all the air, so they got someone to regulate it.
The someone in this case was the gov't. That in fact is why we choose to have a gov't, n'est ce pas?

This is not a market mechanism.

[BigJon]

What possible harm can there be in erring on the side of society and ensuring all members are given the same chances?

Bankruptcy, slow growth, lack of innovation, inefficiency, tyranny of the bureaucrat . . .on and on.

[barfle]

In that case, a free market is an impossibility, so why try to go halfway? Getting most of the way to a purely free market doesn't cut it. It only opens the door for ecological and social disaster by allowing enough anarchy to leave the general public vulnerable to God-knows-what kind of man-made catastrophe.

Not mkaing a good case for Libertarianism here....

Insuring that we all have equal access to the "commons" does not invalidate the idea of a free market in any way. You need to recognize that there are things that are owned, and things that are not owned. If you own it, you have the right to use it as you see fit. If you don't own it, you don't have that right. This is libertarianism at its heart, but then I've noted in the past that you don't understand the concept. It doesn't mean anarchy, and it certainly doesn't mean socialism.

What possible harm can there be in erring on the side of society and ensuring all members are given the same chances?

That the principle of minimizing government is kept inviolate?

That the uberrich maintain their entitlement to their riches at the expense of the lower class(es)?

"erring on the side of society" would mean opening up medicine to competition, instead of having it be the closed society that it is now, with government licensing keeping prices artificially high. You can't shop for a physician like I can shop for attic flooring because of excessive regulation.

And the rich got that way because they had the foresight and courage to see an opportunity and make the most of it. I once thought I saw an opportunity, and had the courage to make the most of it, but the opportunity turned out to be different than I had determined it to be, so I'm back working for a living. Sure, I would prefer to be überrich, and I'm a bit jealous of the lifestyle, but I certainly don't feel I deserve ANY of Bill Gates' money.

[barfle]

Which comes right back to what the market will bear. The market (aka we the people) wont bear someone polluting all the air, so they got someone to regulate it.
The someone in this case was the gov't. That in fact is why we choose to have a gov't, n'est ce pas?

I am certainly not advocating the elimination of government. The society we enjoy is predicated on having a government that enforces many laws against such evils as trespass and assault, and those enforcements need to continue, since there are a minority of anti-socials who do not understand the value of a generally cooperative society.

The difficulty comes in the level of enforced cooperation. Some feel that a system "from each according to their ability, to each according to their need" is the right level. History has shown that such an idea is a disincentive to success, since your reward for your effort is not yours to enjoy, so there is little to take "from" and a multitude to give "to." Some may feel that all cooperation must be voluntary, but history has shown that such a society rarely has much in the way of commerce, since a person is individually responsible to maintain his or her person and property against those who decide not to cooperate. The ideal is in between, so we're really just bickering over price.

[Shapley]

The ideal is in between, so we're really just bickering over price.

That is absolutely correct. We've all pretty much agreed that basic, affordable health care should be available to everyone. It sounds like a simple concept, but ultimately someone has to define what we mean by 'basid' and 'affordable', and even 'health care'.

Does 'affordable' mean we all pay the same, or we pay a fee based on our ability to pay? If the latter, who determines our ability to pay?

Does 'basic' mean just life-saving proceedures and routine preventative medicine, or does it include things like elective surgery, cosmetic surgery, and rehabilitation? Should those who can afford it be allowed to buy 'better than basic' health care, in essence establishing a two-tiered health care system?

I, myself, favour a system similar to what we now have, that includes a primarily free-market system, but with a 'safety net' for those who are unserved by the free-market (the poor and the uninsurable). It still requires a lot of debating and defining as we determine who is 'poor' and who is 'uninsurable', and what level of service the public is required to provide to them. Ultimately, however, I think the public good is best served if we maintain freedom of choice and freedom of the market within the health care system.

V/R
Shapley

[Selma in Sandy Eggo]

At present, the "health care" dollar is being divided among several actual industries.

Direct care:
(1) There's the pharmaceutical industry, which developes, produces, markets, and distributes drugs, immunization sera, etc. (Should we include diagnostic products like Piq's test stuff here, or in the next category?).
(2) There's the health care delivery system, which would include doctor/nurse/caregiver/support staff and their assorted offices, clinics, and hospitals.

Other:
(1) Insurance. All kinds, any kinds. Costs and benefits of this industry are arguable, but they treat no disease, avert no disease, prolong no lives, and improve nobody's health.
(2) Parasite lawyers. Again, costs and benefits of this industry are arguable, but there are no medical benefits associated with suing doctors, hospitals, or pharmaceutical houses.

It is my opinion that the dollars spent in "Other" are not properly health care expenses. They handle money and information, and a large part of the money they handle sticks to their own hands.

[jamiebk]

Where do you place the HMO's in your list? (besides burning in hell)

[Selma in Sandy Eggo]

As long as I’d have a choice to take me and my dollars elsewhere, You could do what you believe to be right in your league. ...It would be foolhardy to eliminate insurance. Can you really take on a $5,000,000 illness from your own pocket?

Nope, I just said I'd socialize you. You get to pay your 6% (initial ballpark #, may be adjusted) of your gross income, just like everyone else gets to pay their 6%. Part of the joy of citizenship. And, since I've just socialized you, you don't have to worry about the $five-mill illness. Because I just socialized you. This should cover health care, chronic disease management, critical care, trauma repair and rehab, congenital deformity, etc. We'll exclude things like face lifts, tummy tucks, and hair dye.

Have you noticed, we're actually back to our native social philosophies? I strongly believe that the things I consider basic human needs should be managed in a different manner than things you can live with or without. Some folks disagree.

[Selma in Sandy Eggo]

Where do you place the HMO's in your list? (besides burning in hell)

HMO's (your parenthetical placement is absolutely correct) used to be Kaiser. It was the only one, and it worked like socialized medicine: you pay your annual fee and they provide whatever you need at their facilities. Somehow, they picked up the copay idea from the insurance companies and the insurance companies picked up the cover-everything idea and the bastard HMO was born.

The idea of the HMO is excellent. Collect money, provide payment for whatever service the client needs. In practice, I have to fight like mad with HealthNet clerks and "gatekeeper" staff whenever anything the least bit unusual comes along. Somehow, "provide service" turned into "decide if the doctor is qualified to say this is medically necessary".

Sadly, I'd now count HMO's as part of the insurance industry.

[jamiebk]

Sadly, I'd now count HMO's as part of the insurance industry.

...and, I would agree with you

[Shapley]

Insurance has a valid place in the health-care system. Socialized medicine is really little more than a government-run insurance monopoly. Medicare and Medicaid serve as insurance plans for the old and the indigent.

Among other functions, insurance serves to contain medical costs, working as a sort of consumers cooperative to negotiate prices with health-care providers for the consumers they serve. They do, also serve to provide one of the services many of you claim to want - referral service. The 'preferred provider' plans refer the consumer to those health care providers that meet the insurance company's service level requirements. More often than not, those requirements are fiscal rather than quality related, but it is a start.

As BigJon points out, they also act as buffer between the cost of service and the consumer, protecting the consumer from expensive health-care service costs by allowing them to, in essence, finance those services over the life of their coverage, and even to share those costs with other consumers.

Parasitic lawyers, like ticks and mosquitoes, probably also serve some useful purpose within the system, but I'm still not convinced we wouldn't be better off without them.

V/R
Shapley