patrick.net

http://trueslant.com/matttaibbi/2009/08/12/health-care-meets-goldman-sachs/

Setting aside the debate, I am disappointed that these healthcare issues are appearing on the site, mixed in with the real estate story links.

Perhaps the thought process is that patrick.net is a large enough forum to showcase the issue, BUT - today's links were half healthcare, and half real estate. I come for the real estate, I get the health care stuff covered enough by the media.

I plead with patrick to reconsider this, perhaps a seperate page for those links, or broken out to seperate headers under the date at which the links are organized currently.

Please consider this, and hopefully you'll consider another option for organizing things seperately.

Thanks
Greg

I wanted to take the time to thank you for posting the healthcare links. Its a major issue and I find the links you post very informative.

I too appreciate the health care links. This is an especially HUGE issue for just another few months
(not that it won't be after that), but now is the time for us to get informed, and hopefully time for the ignorance to fade and for disinformation to be supplanted by facts and intelligent discourse.

If you don't want the health care links on Patirick's site, why not just not read them.

What's the heading that the links are falling under:

"Housing Crash News from Patrick.net (rss)"

I scan the links for interesting real estate articles, and health care doesn't fall into that topic - so I find it a waste of my time. Why not create a seperate page, perhaps patrick.net/health vs patrick.net/housing

Or perhaps, just another section on that page titled:

"Health Care News from Patrick.net (rss)"

It's not like I'm asking for them not to be here, I'm just asking that things be organized.

Thanks
Greg

Patrick,
I agree with you. Please go to youtube and search on health insurance hypocrites. You'll see video's I've posted.

You can also go to my site www.hey-its-all-about-you.com

Keep it up.

Wayne

ObamaCare would impose on all 50 states rules that have already proven to be failures in numerous states. Because these mandates would raise the cost of insurance, ObamaCare would then turn around and subsidize individuals to buy the insurance that the politicians made more expensive. Only in government could such irrationality be sold as "reform."

http://online.wsj.com/article/SB10001424052970204908604574332293172846168.html

Yes, thanks, Patrick - I appreciate your efforts as well, for the whole site in general. There is something to be said for putting your neck out there, knowing the inevitable slings and arrows you'd invite. You stated your convictions without the comfort zone of anonymity and your Fuck You has a lot more gravity and sincerity because of it - at least more so than the tissue tigers who jump on here and hide behind an avatard to avoid any real authorship for their attacks.

If the goal is to get government to operate like a private service, what is the value added by having it provided by the government in the first place?

http://www.lewrockwell.com/rockwell/obama-postoffice126.html

The president is promoting the most colossal, brazen bait-and-switch operation since the Bush administration snookered the country into invading Iraq with apocalyptic visions of mushroom clouds over American cities.

http://www.salon.com/opinion/paglia/2009/08/12/town_halls/index.html

People here keep saying that Medicare and Medicaid (or MediCal, in California), are available to everyone. Not true.

In order to qualifty for Medicare, one must be disabled 24 months. During the time you're waiting for the disability to be awarded by Social Security, there is no coverage for assistance in most states. No medical care, nothing. Zip. Nada. Soooo, if a person has a failing liver, it will take two years from the point that the patient can't work before Medicare is available if the patient paid into the system during his working lifetime. If the patient needs a liver transplant, he won't be placed on the list until he has Medicare. From the point of Medicare approval, he will be slowly moving up on the list until it's his turn. Most patients die before they receive their disability, much less their transplant.

Medicaid is a program for people without insurance who are very low income and, in most cases, are disabled as determined by the Social Security system. If the patient receives SSI, he is eligible for Medicaid. In some states, the patient can pay to the Medicaid program to qualify for the care each month, often the patient's entire income. But in most states, the average person doesn't qualify. This is different for children and pregant mothers - they usually qualify as long as they meet the very low income requirements.

We don't have a system right now that covers people, Medicare & Medicaid aren't covering people and conditions are becoming serious due to lack of treatment. Fearmongerers are printing their interpretation of the proposed plan - Sarah Palin (who walked out on the job for which she was entrusted by the people of Alaska) called it evil because it would introduce euthanasia to her parents and retarded child. These people, and people who post the bill online with their own editorializing entitled "monstrosity" aren't doing anyone any good.

Read the bill. It discusses payment for discussions between doctors & patients, and that the MD's are required to discuss these issues with patients if they are agreeable. End-of-life decisions are difficult to make and shouldn't be an aside while speaking with the doctor about other things.

Healthcare is already rationed, to those people fortunate to have coverage as long as they don't cost the for-profit insurance company much. Chrisborden stated it took four months to get his parent off of private insurance and onto MediCal - I'm gonna go out on a limb and guess that it was a Medicare HMO (Advantage Plan) that refused to release her even though they sent the request in writing. A huge California congolmerate is well-known for this sleezy practice. They receive over a thousand dollars each month for every patient signed onto their service so they don't want to let the patients disenroll.

Under the new plan the patient would have been advised about hospice care, and wouldn't have had to suffer a painful and undigified death that occurred whether or not the conversation happened.

There's alot of misinformation, fearmongering, lies & inuendos about this plan. Fox news is doing its best to create havoc in order to make money. Big insurance companies are making money hand over fist, pharmaceutical companies are raking in the bucks, and huge hospital corporations don't want to lose their stranglehold on the market. Every for-profit company is against reform, and non-profits want to protect their market share by claiming they serve the community. But they all, profit & non, serve themselves. Our system is broken.

Patrick was responding to a particular person calling him out because he supports healthcare reform and is using his site, his own forum to use however he wishes, to encourage discussion. I dare say his "fuck you" comment was too kind - seems to me like sex is an awesome thing that person doesn't deserve. I'd have told her I hope she never had sex again.

President Obama just revealed at the New Hampshire "town hall" that he rejected Federal government supplied insurance for himself and his family when he was in the U.S. Senate, and instead of the government regulated stuff he took advantage of his wife's private insurance supplied via her $317,000 per year political fixer/politician's wife job with the University of Chicago Hospital.

http://blog.mises.org/archives/010444.asp

"Therefore Obama is right in a strange way: private enterprise has triumphed and government service is terrible. Everyone knows this."

These "town meetings" are really nothing but propaganda sessions run by members of Congress who are trying to burnish their fraudulent credentials as public servants, and trying to perpetrate a huge fraud of a health care bill that purports to be a progressive "reform" of the US health care system, but that actually further entrenches the control of that system by the insurance industry, and to a lesser extent, the hospital and drug industry.

http://obamboozled.blogspot.com/2009/08/why-arent-progressives-disrupting.html

How Obama's Deal With Big Pharma Undermines Democracy

http://obamboozled.blogspot.com/2009/08/how-obamas-deal-with-big-pharma.html

Lew Rockwell states: private enterprise has triumphed and government service is terrible. Everyone knows this.

Again, I wonder if State Senators share in this over generalization, including the insurance coverage they enjoy.

"Everyone" knows that government service is terrible, except for all of those VA and Medicare recipients who continually say that they like their service.

Why is it an issue that Obama chose the superior coverage offered by his wife's employer (given that it was a medical organization, it's no surprise that it was good coverage) to that of his employer? I certainly hope there isn't anyone stupid enough to think that a "public option" automatically means "the best insurance possible, and cheaper than anything else". As long as it's INSURANCE, it is highly unlikely to be "better" than the top-tier private plans (which are obscenely expensive for the employer, and in most years more expensive than the actual cost of medical care!).

This really misses the point. Obama isn't really pushing for single payer at this time (though he has voiced support for it). Instead his primary objectives are:

#1 Lowering overall costs, particularly for entitlements like medicare
#2 Covering everyone.

Nowhere in there is there a goal of creating a public insurer that is superior to the best private insurance. Nowhere.

Will it be better than most crappy insurance? Absolutely! Will many employer-provided plans be better? Of course.

If the plan was truly better than the employer plans, it would become a defacto single payer system and everyone would join it.

I don't think it's constructive to call someone a racist because they disagree with you. That can go both ways, like when people called Obama a racist for calling the Cambridge Police stupid, and he was called a racist. By the way, I was involved in a very similar episode with the Cambridge Police about 10-15 years ago. I was at the Hong Kong Chinese Restaurant(across from Harvard Square) after a night of drinking with some friends. We were at the restaurant, had just ordered, and gotten our food and were about to eat when the waiter told us that they were closing and that we had to take our stuff to go. We were quite, not causing any trouble at the time. A friend of mine, who is Asian, went up to the cashier and told him that it's unfair for them to kick us out like that, and asked if we can just eat for 20-30 minutes. The cashier said no, we have to clear out. My friend said to the cashier, "Why didn't you tell us that we'd have to take our stuff out before we ordered? We were seated at the table? I'm a Harvard Business student and we come here every weekend, we never cause trouble, and it's unfair that you kick us out like that." Next to the cashier was a group of Cambridge cops. One, who happened to be African American, stood up and told my friend, "Why don't you take your Harvard Ass out of here!" And my friend responded, "Am I doing something wrong? I'm not shouting. I'm not bothering anyone. If I'm doing anything wrong, why don't you arrest me?" The cop then grabbed my friends hands, spun him around, and put hand cuffs on him and arrested him. I didn't read the police report, but my friend said that the report was a complete lie. He had to hire a lawyer, which cost him a couple of thousand dollars, to get the case thrown out.

So my take on the Cowley Gates incident is that police lie, that the Cambridge cops have something against Harvard students and professors(in fact, there is a very antagonistic relationship between Harvard and Cambridge), that the Harvard community looks down on the locals(they derisively call them "Townies"), but I highly doubt that Cowley is racist. He's just a liar like many cops. I'm not saying all cops are liars, but they're human just like you and me.

Kevin,

I mostly agree with your points above. Some insurance is better than no insurance. Medicare and the VA insurance is better than even crappier insurance. There are some policies that cover everything and cost nothing(except for your employer who likely is paying you less because he/she's paying $20K a year to pay for that policy).

As for the high rates of satisfaction for patients on Medicare and VA, read my take on the VA from yesterday. Seniors(most) and veterans tend to be VERY appreciative of the care they get. I worked at a VA and if not for the VERY VERY low pay for doctors compare to a private group and the VERY VERY poor ancillary services, I would love working at a VA. In terms of following evidence medicine, they are probably the best. But... If you took a group of Stanford Professors, dot.com professionals, etc. and made them get their care at a VA, I guarantee that satisfaction rates would drop to zero. In fact, this is an interaction I had with one of these individuals. A patient of mine had dropped by unexpectedly because she was just diagnosed with terminal liver cancer. I consoled her and spent some time with her as we both cried. This made me about 10 minutes late in seeing my next patient, a VP at a major dot.com. As soon as I got in the exam room and apologized for being late, the VP picked up her cell phone and started to make a call and told me, you wasted a half an hour of my time, now I'm going to waste yours. So I waited as she talked to her friend on her cell phone. She was on the phone for about 5 minutes but I waited patiently, but seeing that she was not going to get off the cell phone(by the way, there is a sign in the exam room and the waiting room asking patients to turn off their cell phones)I had to check on another patient in another exam room undergoing a procedure. I was not in the other room for more then a couple of minutes when I hear shouting from the VP with F bombs at my medical assistant demanding to know where I was and that I was making her late. So I hurry out of the other room, apologize to the VP, calm her down and treat her. I wonder how she'll be happy going to a VA type system.

My favorite patients are migrant workers, seniors, veterans, blue collar workers, etc. No funny business, no demands to treat them "holistically"(not that I have anything against "holistic medicine" but if you want to be treated holistically, go to a alternative care physician), no bringing in endless internet articles, etc. They just want to get treated so that they can go back to living their lives.

i just wanted the 200th post

>>>2ndClassCitizen,

I understand your point about the government's role in inflating healthcare costs. Clearly we agree that many government interventions have created a wildly uneven and inequitable system. But the analogy to the housing bubble isn't a perfect one.

While the government did play a role in inflating U.S. healthcare costs, it did so most glaringly by refusing to intervene rather than by any sort of intervention. I've mentioned that the Canadian Medicare system pays approximately 60% of what we pay per person. U.S. Medicare costs have similarly gone up at 1/3 less rapidly than private healthcare costs in the U.S. since the plan's inception in the 1960s. In other words, if, hypothetically, we had all been able to buy into the medicare plan, our premiums would be 2/3 what they are today. Despite all rhetoric to the contrary, Medicare is simply far more efficient than private insurance, with only about 3% of expenses going to administration (as opposed to over 15% for private insurers).

In the housing bubble, it could be argued the the Fed also erred by failing to intervene, most specifically, as Dean Baker has pointed out many times, by denying the bubble rather than using the Fed's bully pulpit to warn of the bubble's existence, and, hopefully, by so doing, ending the frenzy.

However, unlike with the housing market, I don't believe that the healthcare landscape would be appreciably better if the government had never intervened at all. In fact, it has been the privatization and corporatization of healthcare that, more than anything, has driven up costs in my lifetime. When I was born, most hospitals were run by charitable organizations, either religious groups or philanthropic groups. Profit wasn't the primary driver, helping people was. The same held for the major insurers. Blue Cross and Blue Shield used to be non-profits. Yet since 1990, in many areas, they converted to for-profit corporations that were then bought up by larger healthcare conglomerates. Here in CA, Anthem, the parent company of Blue Cross of CA, pulled 10 billion dollars in cash out of the local company in 2008. That's money that would have gone to reducing premiums in the past.

The reason standard market rules don't apply in healthcare is that people approach meidcal care far differently than they do buying a car or a house. They place complete trust in their doctors - in fact, they trust them with their lives. It is all but impossible to shop for prices for heart surgery or many similar treatments. The system is not set up for it, and people are simply not psychologically able to approach healthcare with the same attitude as they would shopping for a computer. And really, can you blame them? Paul Krugman made an excellent analogy when he said you wouldn't want to comparison shop for firemen. People approach healthcare in much the same way as they do other public services. Sure, when forced to, they will comparison shop in India, but this is mainly out of desperation. It is not optimal.

I'm all for introducing innovations into the marketplace that work and that drive down costs. But we must also be realistic and realize that healthcare is different than other markets. It is for this very reason that all the fear mongering works so well - people are terrified of being left to suffer on their own. And it's on these fears that the right and "centrist" politicians are currently playing.

Can you imagine a world where the government does not interfere with the doctor patient relationship at all? It would be great, doctors wouldn't have to fill out endless piles of paperwork and instead could spend more time talking and working with patients. Medications would be less expensive because Medicare would not be driving up the costs. The insurance industry would either not exist or be a minor player because government did not give them subsidies in the form of tax exemptions to businesses.

It would not be perfect, because no human endeavor is.

For that matter why do we have health insurance in the present form anyway? I can't buy comprehensive car insurance that will pay for a new starter when mine wears out or a new set of tires.

That is because these are routine and predictable expenses associated with owning a car. Why does insurance have to get involved in routine maintenance such as physical exams, blood pressure medication, etc.. Shouldn't insurance be for catastrophic illnesses like cancer, and motor vehicle accidents?

Insurance (no matter if it is private or public) drives up costs, piles on red tape and limits choice. And make no mistake about it: during the Nixon years government backed the insurance industry and has been doing it ever since. Bush gave us the biggest expansion of government in history with Medicare Part D (a public private partnership where government foots the bill and industry reaps the rewards). Government blew this bubble and the powers that be want to keep blowing.

srla,

I agree that too much $ that goes into private insurance companies go to line the pockets of sharholders and the CEOs who make $10M a year.

But I don't think that arguments against reform are just "fear mongering". Already, those with Medicare in some counties have trouble finding a primary care physician. Since the rates that Medicare pays is below what is required to run a medical practice in the Bay Area, (in some parts of the country, it is enough, or some organizations with large private donations like the Mayo Clinic can thrive on Medicare rates) many providers won't accept Medicare anymore. In some of the current plans, there are plans to cut 10-30% from Medicare to offset some of the costs of covering more individuals. If this happens, there will be even less providers accepting Medicare, unless we go to a single payer system and all physicians are forced to accept these rates(which will bankrupt most large groups immediately). Sure there are plans to make providers improve quality to lower cost, etc. but no one seems to discuss any specifics.

Some Guy says

2ndClassCitizen says

Some Guy,

The government is SUBSIDIZING health insurance companies by giving tax exemptions to companies who purchase health insurance for their employees. Citizens can’t get this subsidy only businesses. Government is blowing this health care bubble by its tax policies and fee for service plans like Medicare.

You didn’t address my point at all. You simply repeated what you said before. I already refuted that.

I didn't know you had a point, but if you can't understand what I am saying I can't help you. My posts are pretty clear. The government (which is part and parcel with corporate America who funds the campaigns of the most influential leaders in government) blew the health care bubble by offering tax exemptions to employers that are not available to individuals, and by creating and expanding fee for service programs like medicare.

Also, Canada is fee for service, and if they have a bubble, it's only 60% as big as ours.

The administration economic adviser who appeared on the Daily Show Tuesday put it well when he said that, due to the conglomeration and monopolization of health insurance companies, they are now competing to find new ways to exclude sick people from coverage rather than fostering true competition that leads to lower prices and improved service.

We need a real dialogue comparing all available options. Instead we are getting a legislative process warped by a monied healthcare lobby, a lobby hell bent on preserving profit margins through any means necessary. This means "supporting" a variety of watered down options and also supporting fear mongering amongst the legislative opponents of the very same plans they are supposedly supporting. The manipulation of the legislative process is breathtaking in its complexity and duplicity. No wonder your average citizen is reacting on a purely visceral level, often one driven by fear.

SRLA,

Maybe Canada's bubble is smaller because they have 40% less red tape.

>>>2ndClassCitizen "Medications would be less expensive because Medicare would not be driving up the costs." Um... what? Medicare, while handcuffed by the Republicans when they created part B and thus unable to negotiate better rates, does NOT drive up any costs. In fact, it has been quite effective in containing costs. As I said, its expenses have gone up 1/3 less than private care over the past 4 decades.

"For that matter why do we have health insurance in the present form anyway? I can’t buy comprehensive car insurance that will pay for a new starter when mine wears out or a new set of tires." -- Okay, no offense, but now you're just not thinking things through. Most of us can pay for new tires or a new transmission out of pocket (or at least on manageable credit). We might also be able to pay for a basic medical exam out of pocket. However, IF we happen to need heart surgery, the vast majority of us could never afford to pay for it, even if we dedicated every cent we made for years. THIS is why we have medical insurance. It's the same reason we have car insurance, to protect us in the instance that we have a major accident.

There are many very real issues to be discussed and argued when it comes to healthcare reform. But we need to think things through and be informed, rather than subscribing to arguments that simply don't make sense.

srla,

I believe you just made my point. Health insurance, if it is to exist, should only be for catastrophic needs like open heart surgery.

By the way, if you don't know Medicare Part D is driving up costs, you probably don't work in a pharmacy.

If my posts don't make sense you are free to ignore me thank you.

2ndClassCitizen - Um, less red tape, yes. That is the nature of a single payer system. They have no forms to fill out. But unless you are envisioning a healthcare system where doctors do little more than treat sinus infections and sprained ankles, the high cost of many procedures would neccesitate lots of forms, whether to insurance companies or creditors. And have you ever tried taking out an unsecured loan for 100,000?

Yes, Medicare's drug coverage is a disaster in that it intentionally stopped the government from negotiating the same group discounts that the V.A., Canada, and every other country get. But is this not an argument for government intervention with drug pricing? How else do you contend that part D drove up drug costs?

No, the nature of a single payer system is wealth redistribution on a national scale. Add to that single payer will force me and millions of Americans to fund yet another government program the majority of us do not want. Like I said in my first post, how about ya'll who want the program put your money together and run it. Just let the rest of us opt out.

Wow free will, what a concept.

Patrick,
I applaud your fierceness on your health reform forum. Let me just
say, I had to deal with the medical system and my HMO insurance
company in depth due to my illness, and they suck.

Of course, I never realized they s.... until I had problems. I, like
most working people, were basically healthy, and got satisfactory
services for the kind of minor illness I have.

But when I needed something slightly different, the medical group was
against me, Blue Shield at all levels was against me for no good
reason. They made me wait and wait and went though rejection after
rejection. Do not think it will not happen to you readers. It just may
happen if these health insurance companies have no competition to
make the system better.

We need to fight hard for a better system with reasonable and
"predictable" cost/premium. Right now, we are "slave" of he medical
and insurance systems here. We have to work just to have insurance.

I hope our President and Legislative Bodies learn from Taiwan, a small
country with s pretty successful mandatory national health insurance.

http://blog.lib.umn.edu/schwitz/healthnews/2008/01/humbled-by-taiw.html

Part D costs tax payers in the fact that it exists and is expensive, very expensive. Part D costs seniors in that insurers are constantly changing their formularys to maximize profits and seniors can't keep up with the changes. Part D forces seniors to subscribe even if they don't need any medications by forcing up premiums for every month they don't join the plan. Part D encourages beneficiaries to utilize their benefits because they are already paying for them (they might as well get something even if they know they don't really need it). Part D might suppress drug prices for some beneficiaries but the other consumers are paying for the difference in higher costs and co-pays. Pharmacies generally charge much higher rates for people who have no insurance because they have to just to make up for the losses they incur due to unreasonable reimbursements by insurance companies (especially part D). Part D drives up costs by refusing to give patients a 90 days supply of medication, and instead forcing them to visit the pharmacy each month. Should I go on......

srla,

It seems like you're the one that isn't thinking things through and you're arguments are just rehash from liberal websites.

2ndClassCitizen said:
"That is because these are routine and predictable expenses associated with owning a car. Why does insurance have to get involved in routine maintenance such as physical exams, blood pressure medication, etc.. Shouldn’t insurance be for catastrophic illnesses like cancer, and motor vehicle accidents?"

It may not be a bad idea to have everyone(regardless of if it's a government plan or a private plan) to have an insurance plan that covers any major procedures or if out of pocket expenses over $5000.

I took my less than $10K car for a routine maintenance checkup and it cost me $1300 (labor plus expense to replace a few worn out parts) and and extra $200 to fix the antenna(which had broken at the base).

For a routine follow up with with a primary care doctor, Medicare pays the doctor about $30. $100 if the problem is more complex. If you don't have Medicare and no insurance(or a high deductable plan) it would probably cost you $100 for a routine visit or $250 if the problem is very complex. Of course if you need an MRI, it will cost you $4,000.

This way, no one is bankrupt by poor health(if you can't afford $5000, then the government should subsidize it).

Insurance should insure you against major loss. It should not be used to go to the emergency room everytime you have a cold.

altos,

I deal with Blue Shield all the time and they have been reasonable. Can you give some examples of thing they denied? Was what you were seeking experimental? Was it supported by the medical literature? Was it based on evidence medicine? If so, did your physician try to submit an authorization so that you can get it?

Everyone needs to understand that with a single payer system, it's not going to be a license to get every single procedure or medicine you want. In fact, unnecessary, experimental, marginal, procedures are exactly the things that will be cut out. It needs to be. Otherwise, it will be just as expensive and wasteful as the current system. It may even be worse if they don't regulate these things.

"No, the nature of a single payer system is wealth redistribution on a national scale." Um... well, since we already fund 60-65% of healthcare, would it really be that much worse? Especially when you throw in the massive amount of money wasted on the employer tax credit we both dislike. Add that in, and we are already paying for upwards of 70-75% of healthcare costs.

There might be a free market alternative to our system, but I have never heard one proposed that has a chance of working. On the other hand, every other major nation has some form of national health care for all citizens, so we know they can be effective.

Look, we're paying trillions for wars many of us opposed on the grounds they would not benefit us. Sometimes we pay for things we don't like. As a currently single person, I pay far, far higher taxes than married people with kids, like it or not. In fact, I find it amusing when many older married people complain about their "tax burden", only to find out they pay a few thousand bucks a year on a six figure salary. I compared figures with somebody I know who is married with kids and made the same as I did one year. He paid $6,000 and I paid $32,000. I might not like paying being taxed five times as much, but that's the way our society works, so I grin and bear it.

We need to change the system, or we will all go broke. If you know of a free market plan that will actually work, I would love to hear the details. But if we as a society were to decide to opt for single payer like everyone else has, then I guess those who don't like it will have to live with it. And I'm sure in any case, I'll pay quite a bit more for it than many others will.

srla,

Are you trying to scare us with threats like "change the system, or we will all go broke?" I can't think of any society in history where everyone went broke because they couldn't pay for health care. This bubble will pop if we get government and its insurance industry pimps out of the picture.

DT: "It seems like you’re the one that isn’t thinking things through and you’re arguments are just rehash from liberal websites."

If you have any specific evidence to support that, I'm all ears. I happen to side with the single-payer people on this one issue. I hardly agree with liberal websites on many issues. But simply because liberal people make certain statements does not make them untrue.

You said, "It may not be a bad idea to have everyone(regardless of if it’s a government plan or a private plan) to have an insurance plan that covers any major procedures or if out of pocket expenses over $5000." There is some logic to this approach, to be sure. There is a high degree of waste in no-deductible plans, and people do make dumb decisions when they have no financial investment. But if the deductible is too high, many will make equally bad decisions and put off seeing a doctor, thus leading to even higher decisions down the line.

This problem could be rectified in any system by simply having some sort of co-payment, especially for ER visits, and potentially income-based so as to disincentivize everyone equally from abusing the system. Canada is dealing with this very issue too. But a balance needs to be struck.

2ndClassCitizen, that is not a scare tactic, but a fact, based on cost projections from the CBO and other sources. You can disagree about what needs to be done, sure. But it's impossible to deny that if costs keep going up at the current rate of 17% a year, we will indeed go broke. It seems you want something to be done, but you prefer a free market approach. Fair enough. But are do you really believe that if we keep the present system as is, costs will not be prohibitive?

Some guy,

Yes, people are rioting in the streets for health care. No wait, they are accused of rioting against it. My mistake.