patrick.net

Allow the rich to buy and fence off all the productive fisheries . . . well, whatever it is, we're soaking in it now.

Teach a man that he's entitled to other people's fish because he owns the ocean, and you've created a Republican!

Bellingham Bob says

Allow the rich to buy and fence off all the productive fisheries . . . well, whatever it is, we're soaking in it now.

"What's the bigger crime - taking away the goose from the common, or the common from the goose?" - A 19th Century Aussie convict on his 'crime'.

Honest Abe says

Teach a man to fish, feed him for a lifetime. Teach a man that he's entitled to other peoples fish, ensure collective starvation.

Hmmm... I am starting to see your point, so...

Give a man health care, and you cure/care for him for the day.

Teach a man to preform his own diagnosis, surgeries, and medicine production and you cure/care for him for a lifetime.

Yes, seems like it could work.

mieses says

- Free high quality healthcare encourages unhealthy lifestyles. (This situation is a utopia that will never exist. The Wall-E spaceship.)

- Free low quality care discourages unhealthy lifestyles, especially in the absence of market choices. (The completely socialized case fails, despite misleading data and stats about the EU, etc.)

This has a very good chance of being Shrek (under a different handle), because it is very worthy of a place on the stupidest things ever heard on Patrick.net. Sherk specializes in this kind of quarter baked nonsense.

For one thing Free Quality healthcare may be a problem because of overuse/abuse wasting too many resources, so let there be copay. Maybe even as high as $30 to $50

But your premise, even if true at the margins (yes, some people would be more cautious about their diet and exercise, if death rather than diabetes or heart disease was the consequence), but let's face it, for the most part these choices are made when people are young when the long term consequences of choices are not a factor in their thinking anyway.

But the markets and environments that bring them crappy choices in the first place, such as fast food and high fructose corn syrup, that's another story all together.

Poverty is by far the single biggest factor. I guess cynically one might argue that cheap junk food keeps the cost of higher quality food down for the rest of us. But that would be more than offset by the higher health care cost and lower quality of life later. Besides, I don't believe that to be true in any case.

(side note: maybe owning up to all of us paying for everyone's health care - other than at the emergency room - will positively impact our junk food culture)

Also, you have a highly inflated view of what doctors can fix, and the damage that they can undo. The lifestyle issues don't catch up to us until later, except in the extreme cases. Sure doctors treat these, but they usually can't undo the damage. They do address chronic and critical illnesses and diseases that happen to a small % of younger people. They dispense wonderful modern antibiotics and other medicines when needed (some are wonderful).

But otherwise a huge part of what they do is providing the advice and psychological support for our bodies to heal themselves when they can.

Teach a man that he's entitled to other people's fish because he owns the ocean, and you've created a Republican!

Only governments attempt to own oceans.

Teach someone a proverb, and he'll use it out of context to make an unrelated point.

bdrasin says

I don't see any evidence at all that removing the ability of states to regulate health insurance (another way of saying 'allow purchase across state lines') would improve anything. I do see LOTS of evidence from around the world that heavily regulated health care/insurance systems can work in a variety of ways. Witness every other first world country. Evidence trumps ideology, sorry.
Or is there some first-world country with a health care system that works the way you think ours should work?

So... CA apparently does not allow people/small businesses like Patrick's to purchase the type of health insurance plan that he just stated he would like to purchase to meet his particular needs. And you see no evidence that allowing Patrick to purchase that plan that he wants, across state lines, would help him resolve the very issue that he complains about in this thread, for his own purposes? Better that he be priced out of health insurance altogether than to have some type of coverage? (And somehow it is the fault of Republicans that he cannot get the type of plan he wants in CA?). Apparently, ideology does in fact trump evidence.

Yes, Republicans are to blame because they would not allow for a public option that would bring serious competititon to the insurance cartel.

Teach a man that he's entitled to other people's fish because he owns the ocean, and you've created a Republican!

Blame Republicans for everything, and you'll never get around to having your Democrat-run state allow for the sale of health insurance policies that you say you want.

What solutions have Republicans offered? Privatizing Medicare?

The most dangerous man in America

Paralithodes says

So... CA apparently does not allow people/small businesses like Patrick's to purchase the type of health insurance plan that he just stated he would like to purchase to meet his particular needs.

No, no, no! No one will sell Patrick a plan that meets his needs at a reasonable price! You assume as a truism that this is due to California's regulatory system but there's no reason to suspect that this is the case.

Paralithodes says

And you see no evidence that allowing Patrick to purchase that plan that he wants, across state lines, would help him resolve the very issue that he complains about in this thread, for his own purposes?

There's no law against Patrick purchasing a plan from another state. Lots of insurance companies sell plans in multiple states. Removing all state-level regulations on health insurance (which is what you are proposing) won't force companies to sell plans anywhere they don't want to.

Paralithodes says

Better that he be priced out of health insurance altogether than to have some type of coverage? (And somehow it is the fault of Republicans that he cannot get the type of plan he wants in CA?). Apparently, ideology does in fact trump evidence.

Ok, tell me which state has these great health insurance packages that they would love to sell Patrick? And which California law is preventing this? You assume that they must exist; I'm afraid this is just not so.

I can name literally dozens of countries where this wouldn't be a problem because he would be covered by a national heath care system of one sort or another (none of them are perfect, but they are better for small businesses).

bdrasin says

No one will sell Patrick a plan that meets his needs at a reasonable price!

And even worse -- they are increasing the premium cost at 78% per year for me lately. They all seem to be doing it in lock-step. And note that insurers are exempt from anti-trust laws:

http://www.examiner.net/news/x1914248650/Health-insurance-companies-exempt-from-anti-trust-laws

So it's legal for them all to sit down together and agree to prevent any compeition.

bdrasin says

Ok, tell me which state has these great health insurance packages that they would love to sell Patrick?

Yes, please tell me about them! The first question from each insurer is inevitably what state I live in. And then they show me only plans in that state. I never once saw any out-of-state plan offered by anyone.

In a way, you can buy insurance from out of state. Big companies like United HalthCare, Aetna, Cigna, Wellpoint, etc. sell their poicies in all 50 states under different affiliates. So saying that allowing interstate purchase of health insurance will bring down costs is simply not true. If I don't liek my Cigna policy in NJ, what shoudl I do? Buy a Cigna policy from California? And that is goign to save me money?

Yes, please tell me about them! The first question from each insurer is inevitably what state I live in. And then they show me only plans in that state. I never once saw any out-of-state plan offered by anyone.

Yes, you never once saw any out-of-state plan offered by anyone because the plan they sell you must comply with the regulations in your state. If you find a plan that is better tailored to your needs, that is offered for sale to residents of another state, you have no choice in the matter, unless you move to that state.

HousingWatcher says

In a way, you can buy insurance from out of state. Big companies like United HalthCare, Aetna, Cigna, Wellpoint, etc. sell their poicies in all 50 states under different affiliates. So saying that allowing interstate purchase of health insurance will bring down costs is simply not true. If I don't liek my Cigna policy in NJ, what shoudl I do? Buy a Cigna policy from California? And that is goign to save me money?

Yes, saying that interstate purchase of health insurance will bring down costs, "in a way" that you describe that it exists now, is not true. What is also not true is that your description is applicable to the actual argument regarding interstate purchase "in a way" or in any way.

To boil it down: the argument is: If State A allows insurance companies to sell to individuals a "basic health insurance plan" with perhaps a "10 % co-pay" or even a 50% co-pay, then why shouldn't individuals in State B, which does not allow companies based in that state to sell those policies, have the option to buy that policy from the company in State A?

What solutions have Republicans offered? Privatizing Medicare?

For one, allowing more competition among the types of plans offered across the country, by allowing individuals or businesses in one state to escape the regulatory capture that exists in another state. Ask yourself WHY these big companies have affiliates in all of the states to sell policies there: it should be obvious that it is because those policies must be tailored to the specific rules and regulations in that state. Ask yourself WHY Cigna needs to have an "affiliate" (assuming you mean subsidiary as opposed to resellers) in NJ at all in order to do business there. Why can't you call a company based in CA and buy a policy from them if it better fits your needs, regardless of what companies based in NJ must sell? Somehow giving YOU the individual choice is bad?

Some folks argue that the free market isn't working at all, but even dismissing the interstate competition argument (i.e., no reason to believe that increased competition or increased allowance of tailoring of plans would help reduce prices for many) is acknowledgement that aspects of the free market are not even allowed to operate in the first place.

Paralithodes says

For one, allowing more competition among the types of plans offered across the country, by allowing individuals or businesses in one state to escape the regulatory capture that exists in another state. Ask yourself WHY these big companies have affiliates in all of the states to sell policies there: it should be obvious that it is because those policies must be tailored to the specific rules and regulations in that state.

They don't need to have an 'affiliate' in each state; most choose to operate this way but it isn't required. For example, Blue Cross of Texas sells health insurance in California (I know this because a company which recruited me here in CA used them for coverage).

It is true that there are some market inefficiencies caused by having state-level regulation of health insurance (just like any other product which is regulated at the state level) but you are being wildly unrealistic in assuming this is more than a minor factor.

Have a look at this infographic:
http://www.commonwealthfund.org/usr_doc/site_docs/slideshows/PremiumTrends/PremiumTrends.html

Health insurance premiums costs are not that much different from state to state. Even if we assume ALL of the difference in cost is due to regulation that would leave Patrick saving like 1k/year by getting a policy from North Dakota instead of CA (average cost for family of 11.5k vs 12.6k in 2009).

These differences are tiny compared to the savings that other industrialized countries enjoy with their 'socialized' systems:
http://seekingalpha.com/article/146992-comparing-u-s-healthcare-spending-with-other-oecd-countries

I don't have a problem in principle with replacing state-level regulation of health care with a nationwide regulatory system, but
1) Its unrealistic to think that the savings will be enough to deal with the scale of the problem, and
2) It will be a long, long difficult process to get all of the states to agree on such a system. And I think this is the point; the republicans who favor this basically want to do nothing.

The point is we pay too much per service, not that we are forced to buy too many services.

Costs won't be affordable until they change the way people get billed and start seeing actual costs they or insurance pay.

If any of you show up at a hospital, in most cases, you'll get about 10+ bills from different departments inside, different doctors and they'll never give you an estimate prior to care even.

The way medicare pays, it makes costs higher due to subsidy. And it also makes doctors not go into Family practices because very little is paid there.

There are a lot of things that need to be addressed. But government isn't a solution. Competition creates innovation, lower prices, etc...

If you're worried about over-use, just have a 10% co-pay on everything. That small cost will stop most of the frivolous usage.

No it wont, what's 10% of seeing a pecker checker, because you feel peckish? $20, $30 tops? But those that only use it when absolutely necessary, and find something like what Steve Jobs is battling, that 10% could be a lot.

My best friend's wife just under went chemo, the cat scan was ordered with in days after the treatment stopped. Her doctor said that he would have rather her had it several weeks later, as the residual effects were still working when the CS was ordered. He would now like her to have a follow up CS, but the insurance company wont pay for it, and it cost 8K. She now has to wait 3 months, and in which time, the window for options her doctor has now, wont be viable.

We need a health care system in this Country that our taxes pays for, even if it cost us more in the long run. A system that isn't a "Hey you used more than ME!!!!" argument. Sounds like a bunch of greedy two year olds, fighting over icecreme.

Anything that looks like Insurance will STINK like insurance stop kidding our selves.

Either you will be bankrupted and forced to use some kind of socialized insurance, or someone in your family will die without treatment. I feel sorry for your children.

I appreciate the concern however so far my children are quite healthy.

One thing I think you and others are doing is confusing "Health Care" with "Health Insurance". While my children do not have health insurance they do have health care. We have a family doctor (we pay cash and generally get a discount for doing do). We visit him regularly.

Furthermore I do not get where you all think that medical care is so expensive. Sure a heart transplant is expensive. Other things are expensive but many things are not that expensive. We had a broken leg (broken in two place) recently and it was about $800 total out of pocket cash. Sure that bill could have been more expensive but what do you expect?

It seems like many of you are actually complaining about not having free health care.

I think if people got over their fears and pre-occupation with health insurance we'd have much more affordable health care in this country. Its supply and demand after all. Right now the health industry can barely keep up with the demand created by our national hypocondria.

Finally for those of you demanding a link to where you can get under $400 health insurance. I wonder where you are getting our quotes from sometimes. Just google insurance and start getting quotes. Now your lower cost plans will of course have higher deductibles but whats the point. You either pay deductibles or premiums and when you pay premiums your cost is guaranteed , statistically speaking, because the Insurance company is taking the risk.

Also there are a growing number of co-opts like Samaritan which work out really well. For Samaritan you have to be a Christian and you can't smoke but for you pagans out there I am sure there is probably some sort of Pagan co-opt out there where you can do all kinds of stuff.

And even worse -- they are increasing the premium cost at 78% per year for me lately. They all seem to be doing it in lock-step. And note that insurers are exempt from anti-trust laws

Patrick - where are you getting quotes. I find it hard to believe what your saying. Im not saying its untrue but I just checked last week for my own family and did not think rates were so outrageous.

Note - I do not live in CA though so perhaps thats the difference. Everything is outrageous in CA.

Also Patrick - you might want to Check http://www.samaritanministries.org/. I know a number of people using it and it has worked out well. I think it is about $350 per month and there are various caps but it might give you some peace of mind and will take care of some pretty major stuff.

gromitmpl says

Either you will be bankrupted and forced to use some kind of socialized insurance, or someone in your family will die without treatment. I feel sorry for your children.

I appreciate the concern however so far my children are quite healthy.

One thing I think you and others are doing is confusing "Health Care" with "Health Insurance". While my children do not have health insurance they do have health care. We have a family doctor (we pay cash and generally get a discount for doing do). We visit him regularly.

There is a case to be made that normal doctor visits should not be dealt with through insurance (I don't agree, but the idea isn't absurd on its face). You should know however that more than half of bankruptcies in the US are caused by medical bills (first link of google here: http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm). In most other industrialized countries that number is zero.

In NY, health insurance can cost as much as $8,400.... a month. The free market at work!

http://articles.nydailynews.com/2011-05-31/news/29621719_1_health-plan-association-leslie-moran-health-care

The best way to lower health costs is to:

1. Take profit out of the equation

2. Control salaries for doctors (specialists make substantially more in the US than in other industrialized countries)

3. Control prescription drug costs through importation and negotiaton

4. Fine hospitals that encourage non-critical patients to use the ER. There was an article in the Huffington Post yeasterday about hospitals ADVERTISING their ERs on billboards.

FortWayne says

If any of you show up at a hospital, in most cases, you'll get about 10+ bills from different departments inside, different doctors and they'll never give you an estimate prior to care even.

Yep, this is more or less how it works. Very few medical providers will give quotes on costs for procedures, but in my experience this for out-of-plan providers, and there is no way to compare cost with in-plan providers because the in-plan providers will not give you an estimate.

FortWayne says

The way medicare pays, it makes costs higher due to subsidy.

That is not the way medicare works. Medicare sets their own rates and is often 20-30% cheaper than private care.
http://www.cbo.gov/ftpdocs/99xx/doc9924/Chapter5.9.1.shtml
Scroll down to the section on "Comparison of Public and Private Payment Rates "

FortWayne says

And it also makes doctors not go into Family practices because very little is paid there.

So, you are saying that this is medicare's fault? There are many factors that are contributing to this problem in US medical care, medicare is not one of them.

FortWayne says

There are a lot of things that need to be addressed. But government isn't a solution. Competition creates innovation, lower prices, etc...

Kind of like how removal of government intervention, and encouraging competition has created innovation and lower prices in industries such as: fire services, police services, roadways, etc.

There are some industries where free market practices work great, and even then you need government regulation to ensure that competition continues and monopolies don't arise.

Other industries don't work well in a free market and if left to the private sector can stifle the greater economy. Could you imagine the effect to commerce if every time you pulled out of your driveway you had to pay a toll, or even a toll to use the sidewalk?

I agree with Patrick's claim that nationalizing health care would be a good thing for small business, and the over all economy.

Tenouncetrout says

Teach someone a proverb, and he'll use it out of context to make an unrelated point.

Tenouncetrout says

We need a health care system in this Country that our taxes pays for, even if it cost us more in the long run. A system that isn't a "Hey you used more than ME!!!!" argument. Sounds like a bunch of greedy two year olds, fighting over icecreme.

Anything that looks like Insurance will STINK like insurance stop kidding our selves.

We need people making comments to have the ability to know whether anyone other than themselves can decode what they are saying. Does the term self involved mean anything to you?

Or maybe it's just the weed.

Does medicare look like insurance? Somehow they handle a huge part of all the really big stuff, you know, those pesky little health issues that come up in old age.

I love how govt. de-regulation created innovation on Wall St. Look at all the wonders that innovatins like derivates, credit default swaps, and mortage backed securities brought. That worked out great. I hope we can replicate that same innovation in healthcare.

HousingWatcher says

I love how govt. de-regulation created innovation on Wall St. Look at all the wonders that innovatins like derivates, credit default swaps, and mortage backed securities brought. That worked out great. I hope we can replicate that same innovation in healthcare.

Yes, health care in this country needs more innovation in how to make it more profitable.

gromitmpl says

Furthermore I do not get where you all think that medical care is so expensive. Sure a heart transplant is expensive. Other things are expensive but many things are not that expensive

The total bill for our last child delivery was over $30K. I'd call that pretty expensive.

I have a geat idea: Let states and Wall St. take out life insurance policies on retired teachers, deny them healthcare so they will die quickly, and then make millions of dollars from the policies.

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Medicare expense growth rates vs. private insurance growth rates:

HousingWatcher says

I have a geat idea: Let states and Wall St. take out life insurance policies on retired teachers, deny them healthcare so they will die quickly, and then make millions of dollars from the policies.

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Come on let's be fair, they never said that they would deny health care. They just stood to profit 100's of millions on the death of retired teachers, and the quicker they died the better for their bank account.

Never be worth more dead than alive.

HousingWatcher says

Medicare expense growth rates vs. private insurance growth rates:

I would be interesting to see the chart 2000-2010.

HousingWatcher says

Oh wait, Rick Perry already thoght of it:

http://www.huffingtonpost.com/2011/08/25/rick-perry-texas-life-insurance-scheme_n_935666.html

Oh, yeah and what did the teachers get out of the deal...

50-100 bucks up front and that warm feeling inside knowing that the state and rich investors need you to die ASAP to get a return on their investment.

leoj707 says

Come on let's be fair, they never said that they would deny health care. They just stood to profit 100's of millions on the death of retired teachers, and the quicker they died the better for their bank account.

I would agree that there must be a little more to this story, not to be in any way defending it, or Perry.

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

As for the idea that they planned on denying health coverage, that's pretty hard to believe. Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him. Not to mention the fact that it would be a huge crime.

IT was a stupid idea though. Maybe secretly they figured that buying life insurance on old people for other's benefit would cause the insured to die of paranoia.

leoj707 says

Yep, this is more or less how it works. Very few medical providers will give quotes on costs for procedures, but in my experience this for out-of-plan providers, and there is no way to compare cost with in-plan providers because the in-plan providers will not give you an estimate.

This really should be addressed. I do think this is a big contributor to the problem. People don't know what they are paying or will pay.

I once showed up to a doctor, it took almost an hour to get an estimate out of those people.

leoj707 says

That is not the way medicare works. Medicare sets their own rates and is often 20-30% cheaper than private care.
http://www.cbo.gov/ftpdocs/99xx/doc9924/Chapter5.9.1.shtml
Scroll down to the section on "Comparison of Public and Private Payment Rates "

I know they do. But often it costs more than in private sector because of the subsidy. It costs less to the patient because their bill is less, cumulatively it adds to a bigger number.

leoj707 says

So, you are saying that this is medicare's fault? There are many factors that are contributing to this problem in US medical care, medicare is not one of them.

It's how government pays for medical care. It directs how medical field goes. Look if they'll start paying subsidies for you to make IBM computers, all computer tech field will go in that direction for "free" uncle Sams sugar. Thats how our medicine works.

leoj707 says

Kind of like how removal of government intervention, and encouraging competition has created innovation and lower prices in industries such as: fire services, police services, roadways, etc.

Fire services and police services are state, not federal. Freeways which are federally sponsored is a totally different topic, taxpayers paid for commerce when private sector could not do the job yet.

Problems in medical industry need to be addressed though, and not by simple tax more and spend more. That's just wasteful.

bdrasin says

It is true that there are some market inefficiencies caused by having state-level regulation of health insurance (just like any other product which is regulated at the state level) but you are being wildly unrealistic in assuming this is more than a minor factor.

You are being wildly presumptuous in assuming that I believe it is a major factor vs. a minor factor. But I am happy that you do acknowledge it as a factor.

bdrasin says

I don't have a problem in principle with replacing state-level regulation of health care with a nationwide regulatory system, but
1) Its unrealistic to think that the savings will be enough to deal with the scale of the problem, and
2) It will be a long, long difficult process to get all of the states to agree on such a system. And I think this is the point; the republicans who favor this basically want to do nothing.

This is not about replacing a state system with a national system, but even using that assumption: you don't have a problem with it in theory, but you do in practice, because:
1) Even though there might be some savings involved, it is not enough for your liking, and
2) You think it would take too long because of the difficulty getting all the states to agree, although this is completely irrelevant to allowing individuals to purchase plans from wherever they want?

In other words, you are for only major, revolutionary changes, not minor changes even if you agree they may have minor positive impacts. And since Republicans are not for the revolutionary change you want, then their proposal for a minor change - that you acknowledge might be helpful - counts as not wanting to do anything.

Another example of ideology first.

marcus says

Even if Perry were a total dirt bag, he would have to have the political savvy to know how that could hurt him.

Maybe... but he should have had the savvy to know that betting on old people dieing would not looks so good politically.

marcus says

Buying insurance on a pool of old people shouldn't be profitable. That's what actuaries are for, to make sure it's slightly profitable to the insurance companies. Unless they knew for some reason that teachers in retirement have especially lower life expectancy.

Yeah, that was very strange to me. The only way to profit through a life insurance scheme is to know something that the actuaries don't.