patrick.net

elliemae says

This is a constructive criticism, not a verbal attack such as you use

elliemae says

Seems like you need someone to fight against to validate your existence.

Case closed. NEXT.

elliemae says

alot

uhhhh, it's a lot as in two words, not one word Little Miss Spelling Bee Champion. LOL !!

Oops. You are correct. I left out a space.

So - you were right once. Congrats! Mark this date on your calendar, as it doesn't happen often. RayAmerica says

elliemae says

This is a constructive criticism, not a verbal attack such as you use

elliemae says

Seems like you need someone to fight against to validate your existence.

Case closed. NEXT.

Exactly what case did you close? And why does it matter? Or should I ask, to whom does it matter? Certainly not to me - and it's obvious that you really want to matter to me. Otherwise, why do you post ridiculous statements on the interweb? Judging from the underwhelming response you receive, it doesn't impress many of us.

But I do enjoy discussing your sentence structure with you. Hopefully you will learn something - perhaps how to use the interweb to access help with your writing - that will enable you to further your professional career. Knowing that I'm a positive influence on you makes me warm & fuzzy inside.

elliemae says

Yet you ask why healthcare is so expensive. You are fully capable of finding out the answer -

Yes, But I want to know why YOU think health care is too expensive? Because YOU want to solve a problem with government interference. But in order to solve the problem we first need to understand it. So again I ask why is health care so expensive?

Top 10 reasons health care is expensive:

1. Medical School Tuition (Higher education tuition is in a lending bubble)
2. Medical Mal Practice Insurance (Thank you John Edwards)
3. Inflation
4. The Medical Establishment is the most protected and restrictive establishment in this country
5. Insurance Companies acting as criminal enterprises refusing to pay doctors.
6. Doctors price gouging to recover the cost off treating those who don't pay
7. The FDA regulates the industry to death
8. Medicare/Medicaid pay doctors next to nothing for services
9. The Elderly
10. The American Diet

You forgot one Oak. There is no real substitute for health care. If you get sick, you HAVE to use the health care system. They have monopoly power.

tatupu70 says

You forgot one Oak. There is no real substitute for health care. If you get sick, you HAVE to use the health care system. They have monopoly power.

Yeah, and don't forget the food service system. They have a monopoly on food!! If you get hungry there is no real substitute. When you are hungry you HAVE to buy food from a food retailer. We really should regulate those restaurants and grocery stores because they have monopoly power.

So again I ask why is health care so expensive?

Why wouldn't it be? Is there nothing not as important as your health or the health of a loved one?

While a new filling might only cost $50 in materials and labour, its utility is worth many tens of thousands to me. And that's a relatively minor health ailment.

Demand is completely inelastic and supply is relatively limited!

Basic economics tells us we're lucky to have the prices we do now, LOL.

There's only two options. Rigorous extra-market (ie GOVERNMENT) cost controls, optionally coupled with insurance mandates, or complete deregulation a la the deregulation of the mortgage market accomplished by the Republicans 1998-2003 in the hopes that new service providers will drive down profit margins.

Libertarians gravitate toward the latter because they are ideologues with their heads in cloud-cuckooland and therefore unable to learn from the real-world policy successes of the socialized systems -- from Japan to [er, I was going to say Ireland but their public system isn't that good] Norway.

Prices aren't high because of tuition (that's mistaking the cart for the horse), malpractice (less than 0.5% of costs go to malpractice), inflation (costs are rising many multiples of CPI), the FDA (the FDA is run by the industry). [Though I have to agree with Oakman that elderly + obesity is a big combo. The Medicare trust fund is going to be blown through later this decade, right when the baby boomers are entering their 60s.]

Disease itself isn't necessarily costly, as long as it kills quickly. Obesity adds a variety of syndromes that increase demand for care over longer periods of time and thus greatly increases health care costs.

You want to fix our system, study other systems and learn from them.

AdHominem says

We really should regulate those restaurants and grocery stores because they have monopoly power.

Jesus Christ you are a f---ing retard. This country is overflowing in food and productive farmland. The shit literally grows on trees.

The barriers to entry as a farmer or food preparer are minimal. Labor involves common household operations like turning on a stove and carrying a plate. We as a nation import millions of unskilled farmworkers to harvest the shit. We individually purchase food many times a day and can judge quality and value for our money trivially. Hunger is a trivially cured ailment.

Food service and medical service are two different planets, anybody who confuses the two has NO F---ING clue of the real world or economics.

Let's get this straight. Government passes laws that restrict the supply of medical services and medical practitioners (license requirements, education requirements, strict regulations on everything about the process etc..). The resulting shortage of "care" causes prices to go up.

Government caused the problem. Now we think government can fix the problem?

It's like asking Al Capone to take over law enforcement.

AdHominem is so right! We should be letting copy clerks do surgery using things they find around the office! There is no need for those pesky laws requiring that medical practitioners provide evidence that they have studied and now know things about medication and surgery and anatomy. Let's open up the field and see what the free market does with it! I myself make a patented heal-all tonic, I would tell you what's in it but it's a family secret, you understand, perhaps you would like to buy some?

AdHominem says

Government caused the problem. Now we think government can fix the problem?

There will never be an unlicensed medical service sector on this planet. Libertarians got 0.4% of the vote last time and that may or may not prove to be the highwater mark, depending on what rightwing nutjobs run in 2012.

Drink your collodial silver and turn blue for all I care.

Troy says

There will never be an unlicensed medical service sector on this planet.

that is just plain ignorant. If you need an organ transplant, are willing to pay, and don't mind using the black market.... where there is a will there is a way (or so I saw on vhs)

AdHominem says

where there is a will there is a way (or so I saw on vhs)

Why, is your eight-track broken?

elliemae says

AdHominem says

where there is a will there is a way (or so I saw on vhs)

Why, is your eight-track broken?

They make Eight-Tracks with video now? The reel to reel projector will SOON be obsolete!

Just curious, if you could afford an organ on the black market (and needed one for yourself or someone you love), would you go the non-licensed route? Why/why not?

Food service and medical service are two different planets, anybody who confuses the two has NO F—ING clue of the real world or economics.

And yet, a sweepingly general tautology that the health care industry has a monopoly on the health care system shows a "F—ING clue of the real world or economics...." LOL! I'm pretty sure that the analogy to the food industry was simply an attempt to show the stupidity of the original argument, but then again, conservatives don't think and they use 8-track tapes, and liberals think and use DVDs....

right you are Paralithodes, if there are monopolies in health care they are created/enabled by government legislation.

But by and large there is still a market (albiet an unfree/regulated market) in health care and alternative medicine. The left-libs want to argue that: "medicine is a right and since when you need medicine ("there is no elasticity in the market" they say) it needs to be provided by the state."
Well when you need food there is no elasticity in the market either. So I think the state should feed us too! 1984 here we come!

AdHominem says

Just curious, if you could afford an organ on the black market (and needed one for yourself or someone you love), would you go the non-licensed route? Why/why not?

I don't know. Unless I was faced with the actual problem, I honestly don't know. But I'm leaning toward hell yes. The problem is that the origin of the organ would be suspect; was someone killed for it? is it diseased? But when you're grasping at straws, you grab the one closest to you in the hopes that it works.

I was once asked if I could vote for the death penalty. My answer was that I would have to feel strongly enough about the issue to take personal responsibility for that person's death, because I feel that my vote would be the same thing. I have also amazed myself by advocating the death penalty in a few local cases, most notably:

http://en.wikipedia.org/wiki/Beau_Maestas

...except his sister should fry, too. But first they should torture them in cruel, cruel ways.

http://www.fox5vegas.com/news/19602218/detail.html

140 years? not long enough. He should be allowed in general population wearing a shirt declaring his crimes, then he should fry.

Back to the current topic, which has (again) morphed into healthcare. I'm fortunate enough to have a serious, yet treatable disease. Without health insurance, I would remain in excruciating pain and die. I support a change to our current system, because I've experienced it from both the provider's and the patient's point of view.

Paralithodes--

Perhaps the monopoly analogy was a bit simplistic, but do you disagree that health care in general presents some unique problems for a free market? Do you think free markets can function effectively in health care?

tatupu70 says

Paralithodes–
Perhaps the monopoly analogy was a bit simplistic, but do you disagree that health care in general presents some unique problems for a free market? Do you think free markets can function effectively in health care?

Ask anyone that received laser eye surgery. It's probably the only area of health care that the market is allowed to function.

tatupu70 says

Paralithodes–
Perhaps the monopoly analogy was a bit simplistic, but do you disagree that health care in general presents some unique problems for a free market? Do you think free markets can function effectively in health care?

Tatpupu, Good, valid questions, but I am not sure I can answer your questions to your satisfaction based on what I assume is their underlying premise: that health care operates in a free market today. I am not sure that I agree that health care, or health insurance in particular, is operating in a "free market" in the first place.

First, one of the main positions of conservatives is that the Commerce Clause can be used to increase competition across state lines: something that does not exist now. Second, it seems to me that the consumer is way too disconnected from the cost of health care service for it to be considered as operating properly as a "free market."

The first problem may be caused by inaction at the Federal level. Whether the second problem was actually caused by the free market itself, by itself or in response to government intervention, I can't answer: I just don't know enough of the background of how this situation came to be.

So maybe I should answer: health care *may* present some unique challenges in a generally "free market." But I don't know for sure because I don't believe that it is operating in such a market, and I don't believe that blaming the generally very low-profit margin middle man as the primary cause of the problem is going to lead to the solution.

Paralithodes says

First, one of the main positions of conservatives is that the Commerce Clause can be used to increase competition across state lines: something that does not exist now. Second, it seems to me that the consumer is way too disconnected from the cost of health care service for it to be considered as operating properly as a “free market.”

Forgive my lack of knowledge, but I've never understood this argument. I've lived in several states and have enjoyed health care benefits from the same companies. Cigna, United Healthcare, etc. support plans in all states, don't they? What exactly would this "increased competition" do? How would it lower costs? Further, most companies with sites in multiple states have the same exact plan for everyone. Again--don't see how it would increase competition.

The disconnect between behavior and cost is interesting. I'm laughing thinking of peoples' reaction to a sliding scale of premiums based on body mass index or # of donuts eaten/month. I think it's an interesting idea, but it might be a problem politically.

tatupu70 says

Forgive my lack of knowledge, but I’ve never understood this argument. I’ve lived in several states and have enjoyed health care benefits from the same companies. Cigna, United Healthcare, etc. support plans in all states, don’t they? What exactly would this “increased competition” do? How would it lower costs? Further, most companies with sites in multiple states have the same exact plan for everyone. Again–don’t see how it would increase competition.
The disconnect between behavior and cost is interesting. I’m laughing thinking of peoples’ reaction to a sliding scale of premiums based on body mass index or # of donuts eaten/month. I think it’s an interesting idea, but it might be a problem politically.

This is a very good question! Of course there is no federal prohibition against an insurance company selling insurance in more than one state, and we all know that if we stop to think about it for a minute. In fact, the McCarren-Ferguson act of 1945 pretty much prevents the federal government from regulating insurance (this is why they are exempt from antitrust laws): http://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act.
Health insurance is regulated at the state level for the same reason that almost everything else is regulated at the state level; namely that the United States is a federal republic! There probably are some inefficiencies caused by this, but it isn't the result of a federal ban nor is it any different than countless other industries which are regulated by the states (that is, everything from liquor to lawyers).
So this is just business in the United States - every industry would like the US Congress to pass laws about how they should operate and say that these laws trump state regulations. (well, lobbying state governments is cheaper than congress, but never mind for now.) This isn't even because they think that they could get congress to pass overly-business friendly laws (though that certainly would be nice from their perspective), it's simply that having one set of regulations to follow, one legislative and regulatory process to track, would simplify their business and reduce their administrative overhead. All businesses that operate across state lines want this. But they don't all get it because in our governmental system we generally see the concept of local regulation as valuable enough to trump the inefficiencies it introduces.
So another way of saying 'allow consumers to purchase insurance across state lines' would be 'get rid of the rights of states to regulate insurance', which is a bit ironic because the Republicans are supposed to favor states rights. Rhetorically this is brilliant because, while not actually a lie, it creates the false impression that there is a federal law which forbids companies from operating across state lines and once we get rid of that law there will be all this choice and competition. Really it is a red herring designed to make reform more difficult because:
1) It would require a large legislative effort for Congress to come up with comprehensive regulation to replace what states do now, and
2) It would create more conflict because the regulations necessarily would differ from some states existing regulations (stricter than some, more lenient than others, etc.) which would make an already difficult representative-by-representative negotiation even harder.
So in sum, I think this really is a talking point disguised as policy.

bdrasin says

Of course there is no federal prohibition against an insurance company selling insurance in more than one state, and we all know that if we stop to think about it for a minute.

And also of course, no conservative has argued that there is such a federal prohibition.... Therefore, your representation of the conservative argument with this statement is completely invalid.

bdrasin says

So another way of saying ‘allow consumers to purchase insurance across state lines’ would be ‘get rid of the rights of states to regulate insurance’, which is a bit ironic because the Republicans are supposed to favor states rights.

You seem to be simplifying things quite a bit to make your point, but the irony is that you seem to not consider the Commerce Clause... Isn't that what the Democrats are basing their argument on that intervention in the health care industry to this degree is Constitutional? The further irony is that one could assume that you are saying that Democrats do not support this approach *because* of respect for state rights...

bdrasin says

Rhetorically this is brilliant because, while not actually a lie, it creates the false impression that there is a federal law which forbids companies from operating across state lines and once we get rid of that law there will be all this choice and competition.

Rhetorically, your assertion is simply a strawman because you are basing it on a false impression of the argument, which you are creating, since the argument is for use of a "law" (the Commerce Clause) not the removal of some non-existent law.

bdrasin says

So in sum, I think this really is a talking point disguised as policy.

Of course. Is there a conservative argument or position that is not a "talking point?"

Again--you didn't answer my question. How would it lower costs?

tatupu70 says

The disconnect between behavior and cost is interesting. I’m laughing thinking of peoples’ reaction to a sliding scale of premiums based on body mass index or # of donuts eaten/month. I think it’s an interesting idea, but it might be a problem politically.

You've unfortunately done this several times ... swap a word in someone's description of a position in order to change the meaning of that position to something other than what was intended.... I never said the word "behavior." That is your word, which, while is broadly accurate, you have narrowly applied... My actual statemement was: "Second, it seems to me that the consumer is way too disconnected from the cost of health care service for it to be considered as operating properly as a “free market.”

People with medical insurance are generally insulated from either the true or the inflated costs of medical services because all they generally see are premium payments and relatively small co-payments. This may result in many more trips to doctors for minor things that do not require it, or numerous "second" opinions for the same thing, or simple unquestioning of the treatments, medications, etc., required. I know of no person, liberal or conservative, who thinks before going to the doctor: "What is going to be my burden on the whole system? If I incur more medical cost to the system than my premiums cover, for routine/non-emergency treatments, how will that affect the costs of everyone?" The general rule seems to be, if there is any question, go to the doctor: you are already paying the insurance and it costs very little to just get the consulation and peace of mind.

I think that's an example of the free market at work actually. As others (Nomo?) have pointed out, there are policies out there with high deductibles/copays, but nobody wants them. For whatever reason, people seem to prefer higher premium policies...

That's a slippery slope as well Not sure we want to discourage people from visiting the Dr. if they might be sick. Most diseases are much less costly when caught early.

tatupu70 says

Again–you didn’t answer my question. How would it lower costs?

tatupu70 says

lived in several states and have enjoyed health care benefits from the same companies. Cigna, United Healthcare, etc. support plans in all states, don’t they? What exactly would this “increased competition” do? How would it lower costs? Further, most companies with sites in multiple states have the same exact plan for everyone. Again–don’t see how it would increase competition.

Those are some pretty big gorilla companies you gave as examples, which often have offices/registrations in every state. If you saw a plan by a company based in only TX with no footprint or office in any other state, or plan catered specifically to any other state, and you lived in VA, could you buy into that plan from that company? If not, then your options and opportunities to select a plan to your liking based on price, coverage, or whatever other factors, are limited. If this were addressed, the outcome based on the increased customer choice, expanded company markets (with lower overhead), and associated increased competition could help lower costs. It should be self-evident that increased competition among companies would help lower costs, except to those who deny that competition or market forces ever does this and only government intervention results in cost decreases.

Here is an older article I found regarding an initiative in Colorado (I do not know the outcome)....

http://facethestate.com/articles/lawmaker-proposes-revolutionary-shift-health-care-purchasing

DENVER – Colorado would become the first state in the country to allow its citizens to purchase out-of-state health insurance under a bill proposed by Rep. Cory Gardner, R-Yuma.
....
Currently, state law permits health insurers to sell only policies in Colorado that comply with state regulations and mandates on care, even if the same company does business in other states. Consequently, there is no national market for health insurance, unlike life insurance or banking services, which are regulated by states but may be purchased across state lines.

tatupu70 says

I think that’s an example of the free market at work actually. As others (Nomo?) have pointed out, there are policies out there with high deductibles/copays, but nobody wants them. For whatever reason, people seem to prefer higher premium policies…
That’s a slippery slope as well Not sure we want to discourage people from visiting the Dr. if they might be sick. Most diseases are much less costly when caught early.

It might be the free market at work, and if so then it is a good example of where the free market is not working well in that aspect. It might also be the result of government intervention and policy, or a collission/collusion between the two. I do not have enough background or information on how this came to be so I can't conclude one way or the other. My impression is that neither do you, nor nearly anyone else posting here. The slippery slope argument works both ways: My point is essentially that we are on the opposite slope right now. The issue is how do we get the slope to be flatter or less slippery.

Paralithodes says

Those are some pretty big gorilla companies you gave as examples, which often have offices/registrations in every state. If you saw a plan by a company based in only TX with no footprint or office in any other state, or plan catered specifically to any other state, and you lived in VA, could you buy into that plan from that company? If not, then your options and opportunities to select a plan to your liking based on price, coverage, or whatever other factors, are limited. If this were addressed, the outcome based on the increased customer choice, expanded company markets (with lower overhead), and associated increased competition could help lower costs. It should be self-evident that increased competition among companies would help lower costs, except to those who deny that competition or market forces ever does this and only government intervention results in cost decreases.

OK--I think I understand the issue. But it's really not a lack of competition--any company can offer health care in any state as long as they meet that state's requirements. You're implying that there are barriers to entry that are artificially restricting competition and therefore choice. I don't see that at all.

Could that little company in TX offer health care to someone in Maine? They don't know the Drs or hospitals there. And, if so, why isn't it operating in Maine? If they could offer better coverage for cheaper, why aren't they doing it??

tatupu70 says

OK–I think I understand the issue. But it’s really not a lack of competition–any company can offer health care in any state as long as they meet that state’s requirements. You’re implying that there are barriers to entry that are artificially restricting competition and therefore choice. I don’t see that at all.

You deny that the states' requirements are a barrier to entry? On what grounds?
http://en.wikipedia.org/wiki/Barriers_to_entry

You disagree with the article and assert that there is a national market for health insurance, and you can purchase health care across state lines even if the plan you may specifically want to chose for yourself does not comply with your resident state mandates?

Paralithodes says

You deny that the states’ requirements are a barrier to entry? On what grounds?
http://en.wikipedia.org/wiki/Barriers_to_entry
You disagree with the article and assert that there is a national market for health insurance, and you can purchase health care across state lines even if the plan you may specifically want to chose for yourself does not comply with your resident state mandates?

No that's not what I said. I said "You’re implying that there are barriers to entry that are artificially restricting competition and therefore choice". Cherry picking phrases is just the sort of practice that you constantly accuse me and others of doing. To get to the crux of the issue--how much do the different state mandates limit competition? And would creating a national mandate reduce or increase costs? In my mind, it's just as likely your costs would go up--it depends on whether the state you currently live in has business friendly or consumer friendly mandates....

tatupu70 says

No that’s not what I said. I said “You’re implying that there are barriers to entry that are artificially restricting competition and therefore choice”. Cherry picking phrases is just the sort of practice that you constantly accuse me and others of doing.

That's exactly right, I am implying that the state requirements are in fact barriers to entry that artificially restrict competition and therefore choice. You said that you "don't see that at all." So do you deny that state requirements are a barrier to entry, or do you not deny it? If you do not deny it, then I accept that I misunderstood you and apologize for taking your phrase out of context. If you do deny it, then how exactly did I cherry pick anything?

How exactly would an increase in competition make costs go up? If a state has a business friendly or consumer friendly mandate, as you put it (though the two are NOT mutually exclusive), then the degree to which it is business unfriendly will simply be a remaining barrier to entry.

I deny that the differing state mandates restrict competition and therefore choice. They are such a low barrier as to be almost non-existent. Remember--we're not talking about the mandates themselves as a barrier-only the difference between one state and another state. You're always going to have mandates regardless.

If you got rid of the individual state mandates, you would almost certainly have to develop a Federal mandate to replace them. This Federal Mandate would likely be more restrictive than some of the individual state mandates. I would argue that costs will increase in those states under that scenario.

So apparenty I cherry-picked nothing!

OK--I'm tiring of your semantics. You misrepresented what I said, but whatever. Do you have a comment on the substance of my post?

tatupu70 says

OK–I think I understand the issue. But it’s really not a lack of competition–any company can offer health care in any state as long as they meet that state’s requirements. You’re implying that there are barriers to entry that are artificially restricting competition and therefore choice. I don’t see that at all.
Could that little company in TX offer health care to someone in Maine? They don’t know the Drs or hospitals there. And, if so, why isn’t it operating in Maine? If they could offer better coverage for cheaper, why aren’t they doing it??

Establishing a provider list (which means negotiating a rate schedule with doctors and hospitals) is a lot of work and introduces a lot of administrative overhead. I don't see any way that could change without MAJOR regulatory intervention like in Switzerland or the Netherlands. Even the very big insurers can't just dictate rates to doctors (although they do try) and have to invest major resources in negotiating reimbursement rates. This is why your insurer will tell you to double check even with doctors they list to make sure they are still working together.
As to the extra overhead for an insurer who wants to operate in more than one state and deal with that states regulation, I don't know really but I suspect it is pretty minor for the big players. A friend of mine who did tech consulting for a large national insurer in Florida tells me that almost none of the business rules were for Florida-specific issues or regulations. For a hypothetical small Texas company it probably would be harder.
I don't really have a problem with replacing insurance regulation at the state level with national regulation, but I think it would be VERY difficult politically.

Stop being so anti-semantic! To comment on your post... I strongly disagree with your opinion on the state mandates and the degree to which they are or aren't barriers to entry. I am not sure whether I agree or not about the Federal mandate: I could see the argument for some type of minimums in plans that cross state lines, but the depth or scope is something to think on further: I'm sure we would disagree on the details. I am, however, very surprised that you would oppose this because costs may increase under some states (which we have to assume from your statement might be below those minimum standards in the first place).

Paralithodes says

Stop being so anti-semantic! To comment on your post… I strongly disagree with your opinion on the state mandates and the degree to which they are or aren’t barriers to entry. I am not sure whether I agree or not about the Federal mandate: I could see the argument for some type of minimums in plans that cross state lines, but the depth or scope is something to think on further: I’m sure we would disagree on the details. I am, however, very surprised that you would oppose this because costs may increase under some states (which we have to assume from your statement might be below those minimum standards in the first place).

Actually, I'm a rabid anti-dentite. You really think the DIFFERENCE between state mandates limits competition?? I just don't see how that is possible. Do you have any examples of specific differences that would be a large barrier to entry?

Like bdrasin said--I would imagine that it costs a heck of a lot more to set up a provider list in a new state than it does meeting any differences in mandates. That is a much larger barrier to entry...

I never said I oppose it--just that I don't think it will make a hill of beans difference in cost.

tatupu70 says

Actually, I’m a rabid anti-dentite.

LOL! Great comeback!!!!!!!!!

Yes, I think the difference in state mandates limits competition. The article re. Colorado can serve as the example that there is no national market for health insurance due to state regulations making it difficult to put into effect. You may be correct about the provider list, but there is no way to test that theory without opening these state constraints in the first place. If you are correct, if it makes no difference, then what is there to lose with trying this approach? Nothing. A barrier falls and no one does anything. No cost, no new real regulation, etc.