patrick.net

bob2356 says

AdHominem says

“With wiretaps and bailouts for all.”

Brought to you by your friendly local conservative true american patriot George Bush.

Also, to be fair we must give “credit” to a whole bunch of Democrats and Republicans in Congress (most of whom are still in office!)

AdHominem, if I have this correct, you, as a Libertarian, are an advocate for charity care for the Medicare/Medicaid group. At least this is what I'm reading in Ron Paul's Revolution book and from some of your comments.

Here are a few questions: looking at our health care expenditures, how much is consumed by the Medicare group?

Why are companies quick to get rid of promised health care bennies for retirees forcing them onto Medicare and why is the gov paying these companies to keep these retirees on their health insurance plans?

What would health care look like for this population is charity was their main source of care? Just like in the olden days before Medicare/Medicaid existed. How would charities prioritize, for example.

And given that such a huge amount of health care $ is this population, what happens to all the doctors, nurses, etc.

Help me grasp this. I know Medicare can't go on as is but I'm having a hard time seeing solutions without restricting care, denying coverage, requiring much more out of pocket, etc.

Give me some details. Thanks. Leigh

Leigh says

Help me grasp this. I know Medicare can’t go on as is but I’m having a hard time seeing solutions without restricting care, denying coverage, requiring much more out of pocket, etc.

There needs to be a free market in health care in order for proper allocation of resources. We can't have government intervention setting prices, restricting access, misallocating resources etc... That is what we have now. More of the same is going to give us even more of the same.

In order to make health care affordable and accessible we need:

1. Tax free medical savings accounts.
2. Tax free insurance purchase (not just for employers but for everyone)
3. End license requirements for providers which restricts supply of providers, drastically reduces competition, drives up cost of education and creates a powerful monopoly for the few who do obtain a license. (the marketplace will demand competency, and punish incompetency better than any bureaucracy could)
4. A marketplace and information exchange like a priceline.com for health care (shop around, check the ratings, competitive bidding, find what works for you)
5. Freedom to purchase health insurance without regulations. Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access. Sort of like a cell phone plan. Current laws make this onerous or illegal for them to do so. But that would be a great way to cut out the middle man and the waste associated with it.

These ideas are just a start. I am sure the free market (if there was one) would come up with many new, innovative and cost effective ways to deliver care.

AdHominem says

Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access.

There are doctors that do this (concierge medicine). It's fine, as long as one doesn't need any labs, tests, procedures at hospitals, etc.

elliemae says

AdHominem says

Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access.

There are doctors that do this (concierge medicine). It’s fine, as long as one doesn’t need any labs, tests, procedures at hospitals, etc.

I'm sure the market will meet this need if government didn't encourage most people to get health insurance from the mega-insurers through their employer because of unfair tax laws.

Leigh says

Give me some details. Thanks. Leigh

AH never does details, only platitudes. The devil's in the details and he never provides any details of how or why his idea's would work. I have pointed out huge gaping holes in his ideas's several times on this post. Surely there must be a real life example of the type of health care he advocates being used somewhere in the world that we could look at to see the validity of his plans in a real world environment but I can't think of where. Perhaps AH would like to provide the examples of health care systems around the world that show his idea's at work for everyone to examine?

bob2356 says

Leigh says

Give me some details. Thanks. Leigh

AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work. I have pointed out huge gaping holes in his ideas’s several times on this post. Surely there must be a real life example of the type of health care he advocates being used somewhere in the world that we could look at to see the validity of his plans in a real world environment but I can’t think of where. Perhaps AH would like to provide the examples of health care systems around the world that show his idea’s at work for everyone to examine?

Here bob,
http://www.healthnewsdigest.com/news/Guest_Columnist_710/What_America_s_Healthcare_Delivery_System_Can_Learn_from_India.shtml

from an earlier post...
In order to make health care affordable and accessible we need:

1. Tax free medical savings accounts.
2. Tax free insurance purchase (not just for employers but for everyone)
3. End license requirements for providers which restricts supply of providers, drastically reduces competition, drives up cost of education and creates a powerful monopoly for the few who do obtain a license. (the marketplace will demand competency, and punish incompetency better than any bureaucracy could)
4. A marketplace and information exchange like a priceline.com for health care (shop around, check the ratings, competitive bidding, find what works for you)
5. Freedom to purchase health insurance without regulations. Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access. Sort of like a cell phone plan. Current laws make this onerous or illegal for them to do so. But that would be a great way to cut out the middle man and the waste associated with it.
*a new addition* 6. Private an public insurance needs to be banned from price setting, which stiffles innovation, competition etc... and promotes the status quo/and or large corporations who know how to game the system.

These ideas are just a start. I am sure the free market (if there was one) would come up with many new, innovative and cost effective ways to deliver care.

bob2356 says

Leigh says

Give me some details. Thanks. Leigh

AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work. I have pointed out huge gaping holes in his ideas’s several times on this post. Surely there must be a real life example of the type of health care he advocates being used somewhere in the world that we could look at to see the validity of his plans in a real world environment but I can’t think of where. Perhaps AH would like to provide the examples of health care systems around the world that show his idea’s at work for everyone to examine?

wow ... how odd it is for a liberal minded lefty to attack on the personal level. It's as rare as sand on a beech.

Bap33 says

bob2356 says
Leigh says

Give me some details. Thanks. Leigh

AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work. I have pointed out huge gaping holes in his ideas’s several times on this post. Surely there must be a real life example of the type of health care he advocates being used somewhere in the world that we could look at to see the validity of his plans in a real world environment but I can’t think of where. Perhaps AH would like to provide the examples of health care systems around the world that show his idea’s at work for everyone to examine?
wow … how odd it is for a liberal minded lefty to attack on the personal level. It’s as rare as sand on a beech.

That's a personal attack?? You conservatives are awfully sensitive, aren't you?

Thank you, tatupu70, with my mommy fog I often question my thinking and I was thinking this exact same thing...a personal attack? Seriously?

what is the definition of is?

Leigh says

Thank you, tatupu70, with my mommy fog I often question my thinking and I was thinking this exact same thing…a personal attack? Seriously?

Tatu says: "AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work."

That IS a personal attack in my book. But at least he didn't call me a paranoid nerd. He just made false accusations.

from an earlier post...
In order to make health care affordable and accessible we need:

1. Tax free medical savings accounts.
2. Tax free insurance purchase (not just for employers but for everyone)
3. End license requirements for providers which restricts supply of providers, drastically reduces competition, drives up cost of education and creates a powerful monopoly for the few who do obtain a license. (the marketplace will demand competency, and punish incompetency better than any bureaucracy could)
4. A marketplace and information exchange like a priceline.com for health care (shop around, check the ratings, competitive bidding, find what works for you)
5. Freedom to purchase health insurance without regulations. Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access. Sort of like a cell phone plan. Current laws make this onerous or illegal for them to do so. But that would be a great way to cut out the middle man and the waste associated with it.
*a new addition* 6. Private an public insurance needs to be banned from price setting, which stiffles innovation, competition etc… and promotes the status quo/and or large corporations who know how to game the system.

These ideas are just a start. I am sure the free market (if there was one) would come up with many new, innovative and cost effective ways to deliver care.

But, details are probably not good enough for you so it really doesn't matter what I say does it? Some people will never believe a truly free market is the most efficient way to allocate resources. They think that we need a big brother with a big stick making sure everyone stays in line and gets the same portion of rice and broth.

AdHominem says

Tatu says: “AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work.”
That IS a personal attack in my book. But at least he didn’t call me a paranoid nerd. He just made false accusations

Thanks, but I didn't actually say that. Calling that a personal attack was a personal attack on me!

Thanks Thunderlips11, and from what I am reading is parts of this new bill or should I say one of a few bills, it will require name brand drugs to be the ones covered, not generics! And they are extending the patents by three years to prevent generics from hitting the market earlier. Grrrrr.

I said it. It's hardly a personal attack. It's an observation. A personal attack would be saying something like Ah is a stupid jerk and his ideas are just rushbot fodder (for the people who can't tell the difference the previous sentence was an EXAMPLE). There's a big, big difference. Anyway, Ah keeps putting up the same list of feel good items but they don't wash. Some are at best a start, but hardly a cure all.

1. Tax free medical savings accounts.
A very good idea that exists already. Many, many companies have tax fee medical savings accounts. Did you mean personal medical savings accounts?? You first proposed this idea as allowing deductions for medical expenses. Which you can if expenses are over 7.5% of agi. I agree it should all be deductible. Either way it only matters to people who itemize their taxes, less than a third. Once more into the breach dear friend, what about everyone else????????? Or is part of your free market/ less government solution to force everyone to itemize taxes and force all companies to offer MSA's? You can't have it both ways.
2. Tax free insurance purchase (not just for employers but for everyone)
I was not aware there was sales tax on health insurance. How much is it, what percentage of total health care spending does this represent??????? What will our savings be?????? How much will other taxes have to be raised to make up for the loss of revenue??????? Or are you talking about corporate taxes paid by health insurers on their profits?? Sure make health insurers profits tax free, why not? I'm positive the savings will be passed on to the consumer, not used for executive bonuses. I also believe in the Easter bunny.
3. End license requirements for providers which restricts supply of providers, drastically reduces competition, drives up cost of education and creates a powerful monopoly for the few who do obtain a license. (the marketplace will demand competency, and punish incompetency better than any bureaucracy could)
This is just silly. The market will punish incompetency?????? You go first, you, your wife and children can be the wind dummies. By definition incompetency would have to be proven by people getting hurt or dying. Great. I will go with licensed doctor's thank you.
4. A marketplace and information exchange like a priceline.com for health care (shop around, check the ratings, competitive bidding, find what works for you)
That's probably workable for people getting a boob job, but hardly applicable when you are dealing with sick children in the middle of the night, or get chest pains and can't take a breath. I don't know anyone who doctor shops on price, even if they are paying out of pocket. People go with who they know or who friends recommend. It's just human nature.
5. Freedom to purchase health insurance without regulations. Many doctors would like to be your insurance company. They would be happy to charge your family lets say $120 a month in exchange for unlimited access. Sort of like a cell phone plan. Current laws make this onerous or illegal for them to do so. But that would be a great way to cut out the middle man and the waste associated with it.
Really? All the doctors I know, and I know a bunch since I used to do medical billing, want to do a LOT less business management and paperwork. Running a faux insurance company on top of everything else involved with running a practice isn't going to be a wildly popular idea. Please cite the laws involved (just the statute # and title will be fine) that prohibit a doctor from doing capitation on their own. I have never heard of this. It didn't exist 10 years ago. Boutique medical practices use this model, are they breaking the law??? It's a nice model by the way, but boutique practices are almost always in area's of high income, which usually means better health. Aka, they cherry pick.
6. Private an public insurance needs to be banned from price setting, which stiffles innovation, competition etc… and promotes the status quo/and or large corporations who know how to game the system.
This doesn't really make sense to me. Public health care rates are set by politicians. Private health care providers, which are the ones you support set their own rates by the free market. What is the point??? How is anyone banned from price setting? Somehow, someway, sometime the price has to be determined by somebody. Do you mean price fixing? Who is doing price fixing?? Where, how?

Maybe you just don't understand what people mean by details. Asking for details is not an attack on your idea's, just a request that you support them. When you say "CURRENT LAWS" do whatever (a favorite phrase) it's really meaningless. What is the law, where is the cost analysis, how much would a change to the law affect the costs, why would people change their behaviour if the law were changed, etc.? Without providing those kinds of things then just saying eliminate the law the free market will provide is most certainly a platitude.

Maybe the best place to start on healthcare reform, which almost everyone agrees is needed, is to see what works first. How can places like the Cleveland clinic and the Mayo clinic provide high quality health care at very reasonable rates? Maybe whatever they are doing right can be applied across the board. Saving 30% across the board would be a really big number. Maybe other countries have lessons we could apply. They are getting better results for half the cost.

That kind of research along, with the concurrent recommendations, would take several years to do. Simply not going to happen with the get something done now political climate we are in. The current plans in congress are most certainly no more than political theater combined with vote buying for the next election cycle. Which means that whatever gets passed will probably not work very well. I am not surprised, Obama was never more than a mark 1 mod 0 basic issue politician. Very smart, probably a better choice than McCain, but not anything special.

tatupu70 says

AdHominem says

Tatu says: “AH never does details, only platitudes. The devil’s in the details and he never provides any details of how or why his idea’s would work.”

That IS a personal attack in my book. But at least he didn’t call me a paranoid nerd. He just made false accusations

Thanks, but I didn’t actually say that. Calling that a personal attack was a personal attack on me!

My apologies tatu. It was bob making the false accusations.

bob2356 says

I don’t know anyone who doctor shops on price, even if they are paying out of pocket.

Exactly and that is fueling the health care bubble. We need a paradigm change.

bob2356 says

This doesn’t really make sense to me. Public health care rates are set by politicians.

No, they are set by bureaucrats and lobbyists.

AdHominem says

The current plans in congress are most certainly no more than political theater combined with vote buying for the next election cycle.

At least we agree on that.

@Ad
You would seriously pick a doctor based on price? And without any licensing?

Any product, market, or service is self regulating based on the wishes of consumers. Its only when governmnet interferes that the efficiency of free will becomes negated, efficiency lost, costs go up, jobs get 'out-sourced,' taxes go up, peoples standards of living go down. Many might argue "but its for the common good" - right on Comrade!

Consumers always know whats best for themselves.

@Honest

That's only true if information is readily available and accessible. Which isn't the case for Drs.

I'm glad you addressed all my points ah. Good job bolstering your position

Honest Abe says

Any product, market, or service is self regulating based on the wishes of consumers. Its only when governmnet interferes that the efficiency of free will becomes negated, efficiency lost, costs go up, jobs get ‘out-sourced,’ taxes go up, peoples standards of living go down.

So that would make somolia and nigeria the most efficient places on earth with the highest standard of living? There are no scams, hustlers, or con artists in your perfect world?

tatupu70 says

@Honest
That’s only true if information is readily available and accessible. Which isn’t the case for Drs.

Or almost any business or government agency you care to name. Why bother to call for less regulation when the regulators we have are simply handmaidens of the industries they regulate? Madoff, medicare, housing, banking whatever. There were plenty of regulations on the books that could have prevented disaster in each case that no one bothered to enforce. Bush (actually probably Rove and Cheney) was very smart about that. Instead of getting into a political battle about regulations he didn't like he just eliminated enforcement.

AdHominem says

bob2356 says

This doesn’t really make sense to me. Public health care rates are set by politicians.

No, they are set by bureaucrats and lobbyists.

Freshman government 101. Bureaucrats administer the laws passed by politicians. Whats your point with this hair splitting?

Based on the wishes of CONSUMERS. No, its not a perfect world, but CONSUMERS make choices based on their own best interest. That dynamic has nothing to do with scams, hustlers or con-artists. Hustlers and con-artists are criminals, if they are breaking the law. Again, that has nothing to do with consumers making free choices.

Free choices by consumers reward the efficient produces and punish the inefficient. Its self cleansing...all based on consumers "voting" with their dollars.

Our government, on the other hand, has rewarded the inefficient companies, with taxpayer dollars. That kinda sucks, doesn't it ??? My wife is going to try the government method, she's going to spend us out of debt.

Lew Rockwell.com

Honest Abe says

Free choices by consumers reward the efficient produces and punish the inefficient. Its self cleansing…all based on consumers “voting” with their dollars.

OK--but how do I make an efficient choice about my doctor then? If I pick a bad one and he kills me, I certainly won't choose him again, but I'm thinking it's probably too late at that point....

I agree with tatupu70. The free market does not work for essential medical care.

Are you going to go to "Budget Surgeon" because it's a good value, half the price but 20% more fatalities from complications? I think not.

For small or elective medical treatment, the market works.

For big or essential medical treatment, the market fails completely. They charge whatever they want, and you have to pay or die. (That's also known as "robbery" if you want the legal term.)

The insurance market is even worse. Competition could work there, but they have corrupted Congress, so anti-trust laws are not enforced against them and there are only a couple of insurers in each state, each one offering the same BAD deal. Take your pick of bad deals.

Tatupu - you'd make a decision about a doctor the same way you do now.

Patrick - Why would you assume "For big or essential medical treatment, the market fails completly". According to who? The "market" is the collective free choice of millions of people...free choice can never be "wrong".

And its not "you have to pay or die". Treatment is given before payment...or else my nephew would have died a week ago.

For small or elective medical treatment, the market works.

Good So lets start there. restore a free market in small and elective medical treatment. And allow people to buy insurance just for catastrophe.

AdHominem says

For small or elective medical treatment, the market works.

Good So lets start there. restore a free market in small and elective medical treatment. And allow people to buy insurance just for catastrophe.

People are perfectly free to buy catastrophic coverage now. No one is stopping them. The only thing stopping them is that most people, for whatever reason, prefer comprehensive coverage. What is your point?

bob2356 says

What is your point?

Conservatives: Good. Liberals are the root cause of all evil and have victimized him.

That's his point.

elliemae says

Conservatives: Good. Liberals are the root cause of all evil.

not "liberals", but "liberalism". Liberals are just victims. Liberalism is the cancer.

bob2356 says

AdHominem says

For small or elective medical treatment, the market works.

Good So lets start there. restore a free market in small and elective medical treatment. And allow people to buy insurance just for catastrophe.

People are perfectly free to buy catastrophic coverage now. No one is stopping them. The only thing stopping them is that most people, for whatever reason, prefer comprehensive coverage. What is your point?

Bob, the point, though you will probably never get it is that government policy coerces people to "buy comprehensive coverage" by making it tax free when "given" as part of "benefits package" at work. This means government is subsidizing the insurance industry. Then the rest of the people who don't get insurance from work rely on the government to bail them out. Demand is high, supply is low. The curve is shifted and they are not in equilibrium. Demand is shifted due to government policy and liberal philosophy which makes people feel entitled to health care and everyone else should to pay for it. Supply is shifted because insurance and government set prices not the free market/consumer.

right on AH, right on.

AdHominem says

Demand is shifted due to government policy and liberal philosophy which makes people feel entitled to health care and everyone else should to pay for it

There are a couple of things wrong with that... #1--that's not liberal philosophy. #2--even if it were liberal philosophy, that wouldn't artificially shift demand. It's where demand rightfully should be. If I believe something and make purchases based on my belief, then that's real demand--not artificial demand.

Your ideas are interesting, but not very practical for reasons that I've detailed on another post. Health care is one of those rare cases where free market yields a less desirable result. Poor information flow and lack of substitutes are just some of the reasons why..

good post tatupu.

but, the fact that poor people are made into psuedo consumers through transfered wealth, making tax-payers fund their own competition, instead of just getting the poor people services for free from providers does create falsehoods in the market (any market) .. right?

It'd be alot easier if we cut out welfare programs altogether. Once the people starve to death and die from exposure and lack of healthcare, we wouldn't have to deal with their pesky requests.

We should quit subsidizing the military (they WANT to serve, let 'em) and cut out all the funding for old people in nursing homes, stop funding stupid projects like the interstate road system, and allow state governments to fail. And we should eliminate tax breaks for everyone, no more house credit, head of household deductions, etc.

Let's start with healthcare, tho. Let's make it illegal to access healthcare without payment. Arrest them as they arrest in the ER.

Bap33 says

but, the fact that poor people are made into psuedo consumers through transfered wealth, making tax-payers fund their own competition, instead of just getting the poor people services for free from providers does create falsehoods in the market (any market) .. right?

I'm not sure that I completely follow your supposition. Transferred weath? Do you mean a social program? When I think of transferred wealth, I think of my hard work going to fund my company's board of directors meeting in Paris, or the corporate jet that takes them there, or the millions in bonuses... but I digress.

So, you're saying we'd be better off forcing Drs. to give their services out for free? To poor people? How exactly would that work? What if a Dr didn't want to give away his services for free? After all he's $300K in debt and needs $$. Would there be free clinics? or do you go to the Drs. office?

And even if you came up with answers to all the above, don't you think the providers would raise their rates to everyone else?

well, yes, I do think the providers will have the OPTION to over-charge paying customers, and those customers will have the OPTION to take their business elsewhere.

The free service/clinic deal might work like this: If a person wants to be a med professional they get to take an entrance test and begin that journey FOR FREE at a Gov school for med pros. Not at a current school for med, those will have to compete for the med pros, but will still be a pay-as-you-attend school as they are now. The gov med pro school will be an entire new set-up, designed to only allow entry to those who bring the required minimum abilities. Those that attend these free schools and graduate and pass ability exams will then work in the free gov supplied clinics at 80% of the going rate in that area/market (the pay-for places set the rates by tax records) for 10 years minimum. After 10 years of service in the free clinic they are free to go as they wish. Imagine it a little bit like Naval Officer Pilots .... get their wings for free in the Navy, fly for the Navy for a minimum number of years, then they can head to United. Kind of like that.

What this does is it gives unlimited access to healh care clinics staffed by not-for-profit, med pros that owe us. They get 6 or 8 years of med pro schooling, they then get a job and a wage and are obligated to do what they agreed to do .... or pay back every dime, or sit in debtors prison for a like amount of time.

Now, here is where we may not agree. I do not feel there should be an income qualification to walk into a free clinic. I think that ANYONE should have the same right to gov supplied health clinics, not just some portion of the group designated by a vote-whore. Free to all who wish to access it.

Those who can and do have insurance or means to pay for their care will go where they wish ... including the free places, if they wish.

THat makes things a little more acceptable for me. You see, all money does is give a person more choice. If you have no money, you walk everywhere. If you have a little money you ride a bike. If you have lots of money you get flown by helicopter. It is not fair to force working people to pay for other folks to ride a helicopter, but most folks need something better than walking, so teach grads how to build bikes and then set bikes out for use by ANYONE. If you want a helicopter ride, you pay for it. If I must pay for the ride, make it non-profit and make it avbailable to ANYONE, and do not worry if it's only a bike. A bike is better then walking.

Also, I see the docs and pharms grinning all the way to the bank. How they have been able to stay hidden durring this crap is amazing. The docs and pharms get paid - automaticly - when a person is "poor". They would love nothing more than for the entire population to fall under gov-nanny-med classification.

Make all med and pharm service not-for-profit and full public access, like the protection of the Army or Fire, and then I will not have a beef. Ofcourse, the med pros may not be driving BMWs and such, but that's not my worry.

AdHominem says

Bob, the point, though you will probably never get it is that government policy coerces people to “buy comprehensive coverage” by making it tax free when “given” as part of “benefits package” at work. This means government is subsidizing the insurance industry.

So explain it to me. You keep talking about this but never actually come up with any explanation of how or why. Just general feel good phrases like above. The same so called subsidy applies to catastrophic as well as comprehensive policies. Where exactly is this coercian? The same insurance companies write both kinds of policies. What subsidies apply to comprehensive policies that don't apply to catastrophic. Why don't all the people who pay for health insurance themselves choose catastrophic now? The exact same tax issues apply to both kinds of policies.

You have never addressed this basic point which is central to your entire argument. People want comprehensive policies. People like comprehensive policies. Short of passing a law forcing them to have catastrophic policies, people will continue to want comprehensive policies. I am actually speaking from personal experience here. I had a catastrophic policy when I was self employed. The agent didn't even know how to write it, he had never had anyone ask for one before.

Good ideas bap. The military actually does this with doctors already. The Indian health service is somewhat along these lines. There are repayment of student loans for work in rural areas programs also in place. Of course the tin hat crowd will totally freak out at any such ideas. Just the word government sends them into deep apoplexy.

Making all med and pharm services not-for-profit and full public access is what the rest of the first world does already.