patrick.net

bob2356 says

Care to document how the US has a healthier lifestyle than any of the countries with public health care?

I did not say that the US has a healthier lifestyle nor did I mean to infer it.

I said that socialized healthcare promotes unhealthy lifestyles because a persons' good health is, in theory, insured. Reality differs from theory. Let's first look at pricing, quality, and availability of care in three extreme cases.

- 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.)

- Access to high quality care at market prices discourages unhealthy lifestyles. (This is not the condition in the U.S. We are very, very far from being a free-market. Talk to any doctor.)

Let's look at how scarcity influences behavior. The biggest health issue in the US is obesity. The classic healthy European diets come from a history of scarcity and famine. Scarcity leads to better decisions. The American diet has derailed due to an over-abundance of resources and a general anti-culturalism (food is culture). We have comfort food and corn starch subsidies.

Just like famine leads to healthier diets, socialized healthcare may, perversely, lead to better lifestyle choices. Europeans are more afraid to get sick because their healthcare sucks. (And it does suck. Save your misleading data for the naive.) Health care costs go down when people don't visit the doctor or because the waiting list it so long that they die waiting.

A market driven system produces the same outcome as socialist scarcity by discouraging people from consuming healthcare. But at least good healthcare is available.

The compromised corporatist hybrid system (what the U.S. excels at) provides the worst of the two extremes - the most corruption and the most demoralization.

Which is the better way to discourage poor lifestyle decisions? Market pricing of services or the fear of relying on ineffective entitlements? In the second case, your own personal survival may depend on the existence of other countries with free market care.

wtfcapinv says

Never having to worry about the allocation of scare resources is a fairy tale dream world operating on borrowed time.

Medical care is not a question of scarcity. Most of it is just pure face-to-face services with minimal consumption of resources other than the doctor's available tee times at the local country club.

Care is expensive due to the rents. Uber-capitalists like yourself have a massive blind-spot about economic rents and the damage they do over time.

There is very little standing in your way of stealing resources from people that support your causes to build the kind of health care model you want. You just choose to steal capital from people that do not agree with you because you think you can allocate it better than they can.

blah blah blah same old tiresome righty refrain. You guys were wrong in your opposition to Medicare 50 years ago and you're still wrong now for the exact same reasons.

Japan, Canada, Norway, Sweden, Denmark, Finland, Germany, the UK, and perhaps France do healthcare better than us.

We can learn from them or not. Our choice.

mieses says

Free high quality healthcare encourages unhealthy lifestyles.

bullshit ideology ignoring real world facts that having a healthy lifestyle to begin with heightens ones' quality of life in so many areas.

Your commitment to silly right-wing economics is producing assertions that are counter to reality. Kinda like Marxists in that respect.

Famine, in Europe? Utterly bizarre thesis.

By the way, are all the user accounts that start their replies with the word b**sh** the same IP address or is bullying and crassness the default conversational style of the socialist leaning members of patrick.net?

I play the ball not the man, mieses. Utter bullshit, and I will call you on it if I feel like it.

But I'm done with you now. Welcome to ignore.

B-Bob, you clearly did not read what I wrote or missed the point entirely.

Please preface your reply with the requisite b-word.

wthrfrk80 says

It may have been cheap, but was it safe? I don't mind new drugs needing FDA approval considering the potential dangers inherent in drug treatment.

So how safe was the Cox-2 drug any way? The idea that a government bureaucracy can decide what's safe what's not is quite absurd . . . yet it's repeated over and over again since at least when Levitacus was written. Those regulatory bureaucracies are guarateed to be captured by the very industries that they regulate, to the detriment of consumers.

This seems like a compelling argument. A big difference is the human "emotional" factor, though. We don't feel guilty if a poor person lacks a cell phone or computer (they're ultimately luxuries), but we do feel guilty if a poor person can't afford to cure his illness, especially in a life-or-death situation.

Anyone can voluntarily help the needy at any time . . . except for when the government bans unlicensed individuals to render help to the poor so that the rent seekers making loans to build licensed hospitals, buy medical equipment and get medical degrees can run up enormous sums of profit.

The silly people who can not see beyond their noses in terms of consequence analysis has blood on their hands as they drive more and more middle class into poverty because medicine is over-priced. Ultimately it's this poverty and high price of medical service that kill people by making medicine unavailable on a timely basis. Feel guilty about that!

HousingWatcher says

Yes, I agree with mieses' statement. If someone gets stomach, prostate, or breast cancer, it was obvivously their fault since they lhad an unhealthy lifestyle.

Seriously though, do you conservatives evn try anymore, or have you given up and just spew whatever nonsense you can think of?

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Reality says

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Free market at work. Asymmetries of information will tend to do that.

tatupu70 says

OK--here's what I think. Insurers can sell health care plans in any state they want right now. There is no restriction against a health care company operating in all 50 states. They do have to follow the laws governing each state, however.
So what you are proposing is a way to circumvent state laws that some insurance companies find objectionable. And as such, you would not reduce health care costs per service but rather simply reduce services.
It wouldn't be more efficient--it would just be crappier coverage. That's not the direction I'd like to go in...

Exactly right. State laws restrict what consumers can buy, simply because the consumer lives in the particular state. It's easy to circumvent with physical products, but not so easy for services such as health insurance. And the most immediate issue in this thread is not reducing health care services in general, but reducing the cost of obtaining health care insurance by small businesses such as Patrick's. What if Patrick found a plan provided by some company operating according to another state's rules, that allowed a la carte coverage selections? What if that plan covered only certain services that Patrick reasonably believes that he needs or should provide for himself and his employees? What you consider "crappier coverage" might be just the solution that certain people find appropriate for themselves, given their own circumstances, given their own desire to go out on their own into business and be able to afford something, rather than nothing.

What's really needed is basic health insurance coverage at a reasonable premium for everyone, with a 10% copay to limit overuse.
But that would interfere with giant insurance company profits, and health conglomerate profits, so there is no way any Republican congressman would vote for it. It violates the prime Republican directive of redistributing income from the middle class to the ultra-rich.

What you fail to realize is that the whole "allow people to purchase policies across state lines" would actually allow such a choice. You live in CA, which is to my knowledge run primarily by Democrats, and the limits to what policies are provided are rooted in your own state laws. But being as that you've slid so far to the left in the couple of years I've followed this site, I can only hope that you'd get beyond simply hating Republicans, and look at what is really driving some of these situations.

Why doesn't CA allow such a plan that you need?

tatupu70 says

Reality says

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Free market at work. Asymmetries of information will tend to do that.

No it is not. The victims in those gold-digging expeditions are the tax payers who have to foot the bills. Those who can pay the bill for themselves certainly have the right to have whatever body part of their own taken out, regardless the doctors's opinions.

mieses says

Just like famine leads to healthier diets, socialized healthcare may, perversely, lead to better lifestyle choices. Europeans are more afraid to get sick because their healthcare sucks. (And it does suck. Save your misleading data for the naive.) Health care costs go down when people don't visit the doctor or because the waiting list it so long that they die waiting.

You are aware that public health care and Europe aren't synonymous aren't you? There are public health care systems all over the planet. Oh, sorry , that's a misleading fact.

Can you provide anything at all concrete to document that people in "europe" are afraid of getting sick because their health care sucks and they don't visit their doctor. Oh right, you don't deal in actual facts, they are misleading. It's much better to deal in anecdotes and ideological misstatements.

I will put in one bit of "misleading data". The cost for public health care countries that don't have any waiting lists is about 10% higher than the countries that "ration" health care with waiting lists. That is still about half the cost of health care in the US. This article is a bit older, but still is interesting. http://www.commonwealthfund.org/Publications/In-the-Literature/2005/Jul/Health-Spending-in-the-United-States-and-the-Rest-of-the-Industrialized-World.aspx

Not that any of this would be relevant to someone who doesn't believe in "misleading data".

Paralithodes says

What you fail to realize is that the whole "allow people to purchase policies across state lines" would actually allow such a choice. You live in CA, which is to my knowledge run primarily by Democrats, and the limits to what policies are provided are rooted in your own state laws.
[ad-homonym comment snipped]

Why doesn't CA allow such a plan that you need?

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?

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

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