Re: A Real Free Market in Health Care
(lost track of who wrote what) But if you repeal ALL government mandates, you'll wind up with lots of policies that appear to cover everything a consumer might want, but are actually full of loopholes so that the insurer need not pay for standard treatments. That seems the opposite of transparency. Comments? I don't see how your conclusion (2nd paragraph) follows from your stated assumptions. Are you making an unstated assumption that many consumers will purchase policies that are full of loopholes? If so, why would they? I think the assumption that consumers will purchase policies full of loopholes is a fair one. I see this every day in the world of physical therapy. Folks are offered 2-6 plans and don't look at the physical therapy benefit, the look at basic doctor visit/med copays as the most frequent cost basis and evaluate assuming much of the other plan will follow suit. It is not until folks need the other benefits that they find the loopholes, like visit maximums (most commonly something like 30 visits per year regardless of the type or number of problems- from catastrophic things like stroke or 2 knee surgeries, etc). I have heard in Florida that some plans have a 20 visit maximum per body part per lifetime. Some of the Medicare Advantage plans look attractive to folks since they have lower copays and contrary to 30 days of rehab under conventional Medicare and then paying more, the Advantage plans require copays of $150-200 per day for 30 days then picks up the tab. Most folks don't really want to read all the details or get presented with such a huge variety of things they don't know how to sort it all out. A standard set of options can be compared by consumers much easier. Since healthcare providers have to help folks live with the consequences of policies, we see how confusing it is to average people. My 2 cents only on this part of the dialog, Dee ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 4:32 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Either it will have a higher premium to cover pre-existing conditions, or it only covers things not caused by the pre-existing condition. That is not how health status insurance works. It is insurance against an increase in health insurance premiums. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 6:46 PM, Trent Shipleytship...@deru.com wrote: The people outside the boundary are not my responsibility. They are not my people. Furthermore, they don't participate in my moral economy. The status of the poor in my country has an immediate effect on me. I may be among the poor, and if I am not I may have feelings for my fellow countrymen, and even if I don't there is a real cost to tripping over the hungry and homeless in the streets, and the crime associated with extreme poverty. Poverty is a society wide expense. Then why isn't the relevant boundary much smaller -- city-sized? Certainly your interaction with most of 300 million people in the US is relatively small. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 4:42 PM, Trent Shipleytship...@deru.com wrote: So insurance could charge someone with type II diabetes more, but not someone with type I diabetes. You could charge more to people who, smoke, are over weight, who don't exercise, or who practice un-safe sex. You couldn't charge more because of sex, age, or a prior cancer--except to the extent it was caused by a lifestyle choice. Insurance is a way of pooling risk, but in virtually all types of insurance, the premiums charged are proportional to the estimated level of risk for each participant. If that is not the case, then people who are low risk will avoid insurance pools that contain higher risk people, since their premiums will be lower that way. Then you end up with lower risk pools with lower premiums and higher risk pools with higher premiums. Which is what you would have had anyway, if the premiums were not artificially restricted. If the government is going to interfere in the insurance market, it seems to me that it would be simpler just to directly subsidize those who cannot afford to pay health insurance premiums, and leave the insurance market to function rationally. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 4:34 PM, Lance A. Brownla...@bearcircle.net wrote: The analogy between auto and health insurance fails in one regard: Most of the time, a 5x increase in auto insurance premiums is a direct result of decisions by the covered person. Many of causes for increases in health insurance premiums are outside the control of the covered person. Another good reason for heath status insurance that does not hold for auto status insurance. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Original Message: - From: John Williams jwilliams4...@gmail.com Date: Sun, 16 Aug 2009 23:21:45 -0700 To: brin-l@mccmedia.com Subject: Re: A Real Free Market in Health Care Another good reason for heath status insurance John, you realize what you are arguing, don't you. If the number a is too big, then do a bit of algebra and obtain a =b*(1+c). Pay b and c. Guess what, with this type of algebra, nothing is gained. Now, there will always be niche markets for things like health status insuranceespecially when health insurance tends to be year by year. So, someone in their 20s could pay extra to be in a big pool when they are 50. But, the only reason that young folks can pay health insurance costs is that they don't have families and are in the low risk pool. So, they postpone the inevitable. There is a reason why there isn't affordable long term insurance. It's in the algebra. What you are searching for is akin to trying to find an even prime number. Dan M. mail2web.com What can On Demand Business Solutions do for you? http://link.mail2web.com/Business/SharePoint ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 18/08/2009, at 12:11 AM, dsummersmi...@comcast.net wrote: What you are searching for is akin to trying to find an even prime number. It's really easy to find one... ...but then you go looking for another... Charlie. But There's One, So There Must Be Another Eventually Maru ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, it seems to me that it would be simpler just to directly subsidize those who cannot afford to pay health insurance premiums, and leave the insurance market to function rationally. That is extremely expensive, for all it's simpler. Again, paying from a pool on risk assessment encourages insurance companies to invest heavily in preventative care rather than the more expensive critical care for many conditions, which the government simply paying out vast sums in insurance for sick people doesn't provide. (More, the government has to set limits somewhere if it is directly subsidising insurance...) AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 23:03, John Williams wrote: On Sun, Aug 16, 2009 at 4:32 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Either it will have a higher premium to cover pre-existing conditions, or it only covers things not caused by the pre-existing condition. That is not how health status insurance works. It is insurance against an increase in health insurance premiums. Of course that's how it works. It's in the interest of insurance companies not to pay out. Your shilling for corperations is amusing, but not based in reality: insurance allways takes into account risks. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, You call it interference, I call it participation. Well, at least you don't try to hide your bias. Dave ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 7:11 AM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: There is a reason why there isn't affordable long term insurance. Yes, government interference and people who would rather spend other people's money for their own insurance. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: Of course that's how it works. It's in the interest of insurance companies not to pay out. Your shilling for corperations is amusing, but not based in reality: insurance allways takes into account risks. No, considering pre-existing conditions is not how health status insurance works. It takes into account the risks of health insurance premiums rising drastically in the future. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 9:33 AM, Dave Landdml...@gmail.com wrote: On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, You call it interference, I call it participation. I'd agree with forced participation. Here's an example of government forced participation: http://www.wbir.com/news/local/story.aspx?storyid=96009catid=2 | But this trip has been frustrating. There just aren't enough volunteers | to help all the people who need it, because of California state law. | We tried to get a waiver to bring in good ol' East Tennessee boys and | girls to fix teeth, do eyes, but unfortunately, except in Tennessee, the | rest of the country won't allow practitoners of medicine from one state | to cross over and help in another state, said Brock. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, it seems to me that it would be simpler just to directly subsidize those who cannot afford to pay health insurance premiums, and leave the insurance market to function rationally. That is extremely expensive, for all it's simpler. Actually, studies have shown that consumer driven health care reduces costs, and does not decrease preventative care. http://www.actuary.org/pdf/health/cdhp_may09.pdf | With regard to first-year cost savings, all studies showed a favorable | effect on cost in the first year of a CDH plan. CDH plan trends ranged | from -4 percent to -15 percent. Coupled with a control population on | traditional plans that experienced trends of +8 percent to +9 percent, | the total savings generated could be as much as 12 percent to 20 percent | in the first year. All studies used some variation of normalization or | control groups to account for selection bias. | For savings after the first year, at least two of the studies indicate | trend rates lower than traditional PPO plans by approximately 3 percent | to 5 percent. If these lower trends can be further validated, it will | represent a substantial cost-reduction strategy for employers and | employees. | Generally, all of the studies indicated that cost savings did not | result from avoidance of appropriate care and that necessary care | was received in equal or greater degrees relative to traditional | plans. All of the studies reviewed reported a significant increase in | preventive services for CDH participants. Three of the studies found | that CDH plan participants received recommended care for chronic | conditions at the same or higher level than traditional (non-CDH) plan | participants. Two studies reported a higher incidence of physicians | following evidence-based care protocols. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 7:11 AM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: Original Message: - From: John Williams jwilliams4...@gmail.com Date: Sun, 16 Aug 2009 23:21:45 -0700 To: brin-l@mccmedia.com Subject: Re: A Real Free Market in Health Care Another good reason for heath status insurance By the way, you lost the context of the discussion with your snipping there. That is not a complete sentence, and even if you included the complete sentence, you need to read a couple previous posts to realize that the matter being discussed there was why there might be a demand for health status insurance but not auto status insurance. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 17 Aug 2009 at 12:51, John Williams wrote: On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: Of course that's how it works. It's in the interest of insurance companies not to pay out. Your shilling for corperations is amusing, but not based in reality: insurance allways takes into account risks. No, considering pre-existing conditions is not how health status insurance works. It takes into account the risks of health insurance premiums rising drastically in the future. Which are based on your pre-existing conditions, right. Either insurance companies are idiots, or they're out there to make money. Hmm. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 17 Aug 2009 at 12:57, John Williams wrote: On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, it seems to me that it would be simpler just to directly subsidize those who cannot afford to pay health insurance premiums, and leave the insurance market to function rationally. That is extremely expensive, for all it's simpler. Actually, studies have shown that consumer driven health care reduces costs, and does not decrease preventative care. Except you're not proposing consumer driven health care, you propising that the government pick up an lot of expensive healthcare costs. More, it doesn't create incentives to increase prevenative care either. | For savings after the first year, at least two of the studies indicate | trend rates lower than traditional PPO plans by approximately 3 percent | to 5 percent. If these lower trends can be further validated, it will | represent a substantial cost-reduction strategy for employers and | employees. 3-5%, when the total health cost overrun compared to other countries systems is an order of magnitude higher. Hmm. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 4:47 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 17 Aug 2009 at 12:51, John Williams wrote: On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: No, considering pre-existing conditions is not how health status insurance works. It takes into account the risks of health insurance premiums rising drastically in the future. Which are based on your pre-existing conditions, right. Yes, health insurance premiums are based on pre-existing conditions. But health STATUS insurance premiums are not (they are based on likelihood of future chronic costly conditions). ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 4:47 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 17 Aug 2009 at 12:57, John Williams wrote: On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 16 Aug 2009 at 23:18, John Williams wrote: If the government is going to interfere in the insurance market, it seems to me that it would be simpler just to directly subsidize those who cannot afford to pay health insurance premiums, and leave the insurance market to function rationally. That is extremely expensive, for all it's simpler. Actually, studies have shown that consumer driven health care reduces costs, and does not decrease preventative care. Except you're not proposing consumer driven health care, you propising that the government pick up an lot of expensive healthcare costs. More, it doesn't create incentives to increase prevenative care either. Actually, a health insurance market without government interference would be a lot more consumer-driven than the current system, which is why I mentioned it. In nearly all cases, if there is to be a government-redistribution of wealth program, people are better served if the government does not prevent them from making agreements with each other, but rather simply subsidizes those who need it (or manage to persuade politicians that they need it). | For savings after the first year, at least two of the studies indicate | trend rates lower than traditional PPO plans by approximately 3 percent | to 5 percent. If these lower trends can be further validated, it will | represent a substantial cost-reduction strategy for employers and | employees. 3-5%, when the total health cost overrun compared to other countries systems is an order of magnitude higher. Hmm. 3 to 5% PER YEAR. It adds up. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Hello all -- I didn't mean to drop out of this, ummm, 'discussion', but I lost the email I intended to respond to over the w/e. What can I say? I turned 61 and had to put a 9 year old cat down due to cancer -- not a good day until Charlie reminded me 61 is a prime number! Cheered me right up. The Engineer (my husband, companion and love of my life for almost 38 years) is working in BFE Utah and staying in Cortez, CO, and only makes it home every third w/e. I try to go there for a week or 10 days every month or six weeks. My life is a little topsy turvey right now. I also don't seem to have copious amounts of free time to respond ad nauseum. Did someone say John's been on this list for 10 years? Did I misread that?? I don't remember being this prodded to respond for many years -- probably since JDG was here =+)). Anyway, John, you said health care was an emotional issue for me. I prefer passionate. I'm passionate about people having equal access to good care for treatment of disease, equal access to disease prevention and equal access to health promotion. Not just the best care money can buy. And comparing health insurance to car insurance is an apples and oranges thing for me. If your car insurance goes up 5x due to bad choices (DUII, speeding, etc.), you can take a bus, taxi, ride a bike, etc. and no one dies. If your health insurance goes up (or you are unable to even get it) due to a drunk crashing into you at age 18, your life gets very complicated, very quickly. And Charlie is an old and respected member of this list. As is Dan, Alberto, Andy, Julia (where is Julia?), Doug and many, many more. Respect is earned here, as it is in most communities. I don't agree with some of the people that I consider our sages -- frex, I think Dan and I disagree greatly about the value of religion in raising children -- but I still respect his opinions. I guess it comes down to not so much what is said, but how it is said, and I find your tone often arrogant, John. Amities, all. Jo Anne evens...@hevanet.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 17 Aug 2009 at 17:06, John Williams wrote: On Mon, Aug 17, 2009 at 4:47 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: On 17 Aug 2009 at 12:51, John Williams wrote: On Mon, Aug 17, 2009 at 9:19 AM, Andrew Crystalldawnfal...@upliftwar.com wrote: No, considering pre-existing conditions is not how health status insurance works. It takes into account the risks of health insurance premiums rising drastically in the future. Which are based on your pre-existing conditions, right. Yes, health insurance premiums are based on pre-existing conditions. But health STATUS insurance premiums are not (they are based on likelihood of future chronic costly conditions). And in most cases, the likelyhood of you developing those conditions is dependent on pre-existing conditions! | For savings after the first year, at least two of the studies indicate | trend rates lower than traditional PPO plans by approximately 3 percent | to 5 percent. If these lower trends can be further validated, it will | represent a substantial cost-reduction strategy for employers and | employees. 3-5%, when the total health cost overrun compared to other countries systems is an order of magnitude higher. Hmm. 3 to 5% PER YEAR. It adds up. So it magically constantly decreases costs? No, read it again - the trend is that it will be 3-5% cheaper than a PPO plan. Actually, a health insurance market without government interference would be a lot more consumer-driven than the current system, which is why I mentioned it. In nearly all cases, if there is to be a Howso? You've just empowered the insurance companies to do a lot more cherrypicking of good customers and to jack rates up for everyone else. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 5:45 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: And in most cases, the likelyhood of you developing those conditions is dependent on pre-existing conditions! I have not seen any evidence that suggests this. There are a large number of conditions that can result in a large increase in cost of health care, and many of them are not correlated. Having a heart condition is not likely to lead to prostate cancer, for example. So it magically constantly decreases costs? No, read it again - the trend is that it will be 3-5% cheaper than a PPO plan. Interesting that you would say that I should read it again. I have read the entire article carefully before I posted it. For example, I read these passages, twice now: | Beyond the first year cost savings with CDH designs, is there | is a continuing favorable effect on cost over a multiple year | timeframe? Traditional actuarial models assume that cost savings from | plan design changes are persistent over time (i.e., the differential | cost of a given benefit remains lower by a similar amount), but the | utilization difference for changes in cost sharing is not assumed to | compound or result in lower trends over time. It has been suggested | that the favorable utilization changes associated with CDH designs | may also create reduced demand for health care services over a | multi-year period and further reduce the ongoing trend when compared | with traditional plan trends. This reduced trend may not be unique | to CDH designs and may be a component of all higher cost-share | designs. However, unlike the first-year result, reduced multi-year | trends have not been established previously as a core actuarial | principle that is applied consistently to all plan designs. | Results for continuing cost-savings experience with CDH designs are | often difficult to interpret, but the studies do seem to indicate that | there may be a favorable effect on ongoing cost trends as well. Some | studies have combined multiple years of results together and indicated | that the overall trend over a two-year period has been less than the | corresponding traditional product trend over the same time period. The | Cigna study specifically identified the trend for the second year of CDH | plan experience and compared it to the corresponding traditional plan | trend. It found that the second-year trend in the CDH plan was nearly | 5 percent lower than the traditional plan trend. The Uniprise study | measured trend savings over a four-year period and suggests that the | trend for the CDH plan is about 3 percent lower per year on average over | the four-year period. | If this favorable trend effect can be further established as significant | (e.g., 3 percent to 4 percent or more per year) and persistent over | a multiyear period, this would be a strong argument for the further | adoption of these plans. There are few other alternatives available | to employers that demonstrate this degree of ongoing savings and trend | reduction. It is possible that the favorable trend effects currently | being observed are merely due to residual riskselection effects or other | factors that may cause this apparent trend to erode or disappear over | time as larger data sets become available. It is also possible that | this apparent trend-dampening feature of higher cost-sharing plans is a | consistent element of all plans (similar to the first-year effect which | has been well-measured), but one that has not been measured historically | because the differences in cost-sharing levels for traditional plans is | relatively small. Also, you seem to have ignored the substantial first-year savings: | the total savings generated could be as much as 12 percent to 20 percent | in the first year. Actually, a health insurance market without government interference would be a lot more consumer-driven than the current system, which is why I mentioned it. In nearly all cases, if there is to be a Howso? Competition for consumer business. You've just empowered the insurance companies to do a lot more cherrypicking of good customers and to jack rates up for everyone else. No, I have not empowered anyone. I do not control other people. Other people are free to do as they wish without my interference in their lives. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Do you think you're fooling anyone with this schtick? I hope not. It is certainly not my intention to fool anyone. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 6:32 PM, John Williams jwilliams4...@gmail.comwrote: Actually, a health insurance market without government interference would be a lot more consumer-driven than the current system, which is why I mentioned it. In nearly all cases, if there is to be a Howso? Competition for consumer business. Is there some way in which consumer-driven means something other than unregulated? Is health care so unimportant that it deserves no regulation? Is health care so unimportant that people should have to compete with each other (that's the other side of the equation when the companies are competing) for basic care? If we take it as a given that a consumer-driven market for health care is better, then why not do the same with roads, police, water, oxygen, etc.? How do you draw the line there? Nick ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 7:29 PM, Nick Arnettnick.arn...@gmail.com wrote: Is health care so unimportant that it deserves no regulation? We are starting from different worldviews, I think. I believe in freedom for people to make agreements with each other as they choose -- that is my starting point. You appear to believe that freedom is something that is to be permitted by government, when it concerns something unimportant, otherwise, if something is important, than the government should restrict the freedom of people to make consensual agreements. So I would say that health care is important, and therefore people deserve to have free choice in the matter. Is health care so unimportant that people should have to compete with each other (that's the other side of the equation when the companies are competing) for basic care? I cannot answer the should, I can only answer that the fact is that people do have to contend for limited resources in the world. There is not enough health care to give everyone in the world unlimited care. And several people that have posted here do not seem to believe that Americans should allocate their health care resources equally among all Americans AND non-Americans. So there is definitely competition among people in the world for health care. Just as there is competition for food and shelter. If we take it as a given that a consumer-driven market for health care is better, then why not do the same with roads, police, water, oxygen, etc.? I'm not sure I follow the oxygen part. For the others, I would like to see more privately run roads and less government interference in water companies. I've stated here recently that I think police are best handled through government, since I think it is less likely to be suborned than private police. Another related question is why are the markets for essentials like food and shelter largely free of government interference, while health care markets have such extensive government interference? I think it has to do with people being afraid and emotional about health care, and not being good at rational analysis on the subject. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Did someone say John's been on this list for 10 years? Did I misread that?? I told John many of us had been. Maybe that got mangled. Maybe by me. :-) Dan M. myhosting.com - Premium Microsoft® Windows® and Linux web and application hosting - http://link.myhosting.com/myhosting ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Mon, Aug 17, 2009 at 9:25 PM, Rceebergerrceeber...@comcast.net wrote: On 8/17/2009 11:09:15 PM, John Williams (jwilliams4...@gmail.com) wrote: On Mon, Aug 17, 2009 at 8:58 PM, Jo Anneevens...@hevanet.com wrote: And there I rest my case on the tone thing. I wrote that as clearly and as sincerely as I could. I assure you there were no undertones intended. Well, first I'd have a good laugh and then I'd ask Charlie what we could do to keep speaking to each other, and could I help him get his panties all un-bunched up because that could be pretty uncomfortable. Unfortunately, my panties are riding up after trying to talk to you about health care, like his did about pollution regulation. He did not try to discuss pollution regulation with me at all -- I would have been happy to discuss it with him, and to clear up the apparent question that he had about me allegedly changing my mind. But he just wrote FUCK YOU and then said that he kill filed me. That is what I mean by intentionally obtuse. Add intentionally selective memory to the list. What is what you mean? I assure you, I am not being intentially obtuse. I find your posts very difficult to understand. When I do read between the lines, you tell me I am jumping to conclusions, and when I do not, you tell me I am intentionally obtuse. You tell me there is a group of we that all know what everyone else thinks, and then you and another of the wes answer one of my questions oppositely. Perhaps I am obtuse, but it is not intentional. I am definitely confused. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
The Atlantic has a thoughtful article by David Goldhill on health care and health insurance reform. It is long, but I think well worth reading. I've also included below a few paragraphs that I thought were particularly interesting. http://www.theatlantic.com/doc/print/200909/health-care | I’m a Democrat, and have long been concerned about America’s lack | of a health safety net. But based on my own work experience, I also | believe that unless we fix the problems at the foundation of our health | system—largely problems of incentives—our reforms won’t do much | good, and may do harm. To achieve maximum coverage at acceptable cost | with acceptable quality, health care will need to become subject to | the same forces that have boosted efficiency and value throughout | the economy. We will need to reduce, rather than expand, the role | of insurance; focus the government’s role exclusively on things | that only government can do (protect the poor, cover us against true | catastrophe, enforce safety standards, and ensure provider competition); | overcome our addiction to Ponzi-scheme financing, hidden subsidies, | manipulated prices, and undisclosed results; and rely more on ourselves, | the consumers, as the ultimate guarantors of good service, reasonable | prices, and sensible trade-offs between health-care spending and | spending on all the other good things money can buy. | But health insurance is different from every other type of | insurance. Health insurance is the primary payment mechanism not | just for expenses that are unexpected and large, but for nearly all | health-care expenses. We’ve become so used to health insurance that | we don’t realize how absurd that is. We can’t imagine paying for | gas with our auto-insurance policy, or for our electric bills with our | homeowners insurance, but we all assume that our regular checkups and | dental cleanings will be covered at least partially by insurance. Most | pregnancies are planned, and deliveries are predictable many months in | advance, yet they’re financed the same way we finance fixing a car | after a wreck—through an insurance claim. | Every time you walk into a doctor’s office, it’s implicit that | someone else will be paying most or all of your bill; for most of | us, that means we give less attention to prices for medical services | than we do to prices for anything else. Most physicians, meanwhile, | benefit financially from ordering diagnostic tests, doing procedures, | and scheduling follow-up appointments. Combine these two features of | the system with a third—the informational advantage that extensive | training has given physicians over their patients, and the authority | that advantage confers—and you have a system where physicians can, | to some extent, generate demand at will. | Do they? Well, Medicare spends almost twice as much per patient in | Dallas, where there are more doctors and care facilities per resident, | as it does in Salem, Oregon, where supply is tighter. Why? Because | doctors (particularly specialists) in surplus areas order more tests | and treatments per capita, and keep their practices busy. Many studies | have shown that the patients in areas like Dallas do not benefit in | any measurable way from all this extra care. All of the physicians I | know are genuinely dedicated to their patients. But at the margin, | all of us are at least subconsciously influenced by our own economic | interests. The data are clear: in our current system, physician supply | often begets patient demand. | Perhaps the greatest problem posed by our health-insurance-driven | regime is the sense it creates that someone else is actually paying | for most of our health care—and that the costs of new benefits can | also be borne by someone else. Unfortunately, there is no one else. | For fun, let’s imagine confiscating all the profits of all the | famously greedy health-insurance companies. That would pay for four | days of health care for all Americans. Let’s add in the profits of | the 10 biggest rapacious U.S. drug companies. Another 7 days. Indeed, | confiscating all the profits of all American companies, in every | industry, wouldn’t cover even five months of our health-care | expenses. | Cost control is a feature of decentralized, competitive markets, | not of centralized bureaucracy—a matter of incentives, not | mandates. What’s more, cost control is dynamic. Even the simplest | business faces constant variation in its costs for labor, facilities, | and capital; to compete, management must react quickly, efficiently, | and, most often, prospectively. By contrast, government bureaucracies | set regulations and reimbursement rates through carefully evaluated | and broadly applied rules. These bureaucracies first must notice | market changes and resource misallocations, and then (sometimes | subject to political considerations) issue additional regulations or | change reimbursement rates to
Re: A Real Free Market in Health Care
At 02:51 AM Sunday 8/16/2009, John Williams wrote: The Atlantic has a thoughtful article by David Goldhill on health care and health insurance reform. It is long, but I think well worth reading. I've also included below a few paragraphs that I thought were particularly interesting. http://www.theatlantic.com/doc/print/200909/health-care I'm only a little way into the article, but I take it Semmelwies is no longer mentioned in the medical school (or pre-med) curriculum? . . . ronn! :) ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 4:05 AM, Ronn! Blankenshipronn_blankens...@bellsouth.net wrote: I'm only a little way into the article, but I take it Semmelwies is no longer mentioned in the medical school (or pre-med) curriculum? I think that the guidelines Goldhill refers to are more systematic and comprehensive than anything Semmelweis discussed. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
One thing that is often discussed in reference to health insurance is that if someone is unexpectedly afflicted with a chronic condition, their health insurance premiums will usually increase drastically. Health insurance for someone diagnosed with a chronic condition might go from $2,000 a year to $10,000. Many people would be unable to pay the higher amount, and cite this as a reason for making health insurance non-voluntary with a very large risk pool. However, having health insurance premiums unexpectedly increase is the sort of personal risk that can itself be insured against. Sometimes called health status insurance, such insurance pays out a lump sum or as an annuity if an event occurs that drastically raises health insurance costs. Here is an article discussing health status insurance: http://www.cato.org/pub_display.php?pub_id=9986 ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
When you reach a point where the suggested solution to ridiculously overpriced health insurance is to take out an insurance policy on your insurance ... perhaps it's a sign that you ought to consider some other system. Patrick On Sun, Aug 16, 2009 at 12:24 PM, John Williamsjwilliams4...@gmail.com wrote: One thing that is often discussed in reference to health insurance is that if someone is unexpectedly afflicted with a chronic condition, their health insurance premiums will usually increase drastically. Health insurance for someone diagnosed with a chronic condition might go from $2,000 a year to $10,000. Many people would be unable to pay the higher amount, and cite this as a reason for making health insurance non-voluntary with a very large risk pool. However, having health insurance premiums unexpectedly increase is the sort of personal risk that can itself be insured against. Sometimes called health status insurance, such insurance pays out a lump sum or as an annuity if an event occurs that drastically raises health insurance costs. Here is an article discussing health status insurance: http://www.cato.org/pub_display.php?pub_id=9986 ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 12:28 PM, Patrick Sweeneyfirefly.ga...@gmail.com wrote: When you reach a point where the suggested solution to ridiculously overpriced health insurance is to take out an insurance policy on your insurance ... perhaps it's a sign that you ought to consider some other system. Actually, charging a high price for health insurance for someone who is almost certain to incur high costs is not ridiculous at all, but rather perfectly rational. That is exactly how insurance should work. For example, consider auto insurance. Drivers who are at higher risk of accidents pay higher premiums. With health insurance, if premiums are not higher for people who are likely to have high expenses, then there is a strong incentive for healthy people to carry no health insurance until they get an expensive condition, and then purchase health insurance. The idea of purchasing insurance against an unexpected expensive event is also perfectly rational. Health status insurance is as reasonable as life insurance. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: On Sun, Aug 16, 2009 at 12:28 PM, Patrick Sweeneyfirefly.ga...@gmail.com wrote: When you reach a point where the suggested solution to ridiculously overpriced health insurance is to take out an insurance policy on your insurance ... perhaps it's a sign that you ought to consider some other system. Actually, charging a high price for health insurance for someone who is almost certain to incur high costs is not ridiculous at all, but rather perfectly rational. That is exactly how insurance should work. For example, consider auto insurance. Drivers who are at higher risk of accidents pay higher premiums. With health insurance, if premiums are not higher for people who are likely to have high expenses, then there is a strong incentive for healthy people to carry no health insurance until they get an expensive condition, and then purchase health insurance. The idea of purchasing insurance against an unexpected expensive event is also perfectly rational. Health status insurance is as reasonable as life insurance. John-- It does strike me as a kludge, though. To continue your example of car insurance, I don't believe that anybody markets insurance against having your car insurance premiums rise dramatically. I'd guess that Patrick is expecting health insurance to have health status insurance already built into it. ---David ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 1:47 PM, David Hobbyhob...@newpaltz.edu wrote: I'd guess that Patrick is expecting health insurance to have health status insurance already built into it. One would think the whole point of health insurance is to provide you with health care (more precisely, the funds to acquire such) should you fall ill. Both of us are playing the odds. I'm betting that I'll need some expensive procedure I can't afford on my own someday; the insurer bets I don't. But if I do fall ill, for the insurer to raise my rates rather than provide the agreed-upon care seems like dirty pool. And to suggest that I ought to insure my insurance policy (and perhaps to be certain, I ought to insure the insurance on my insurance?) seems like a sign of massively broken system. For anyone but the insurers, at least. Patrick ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 1:47 PM, David Hobbyhob...@newpaltz.edu wrote: It does strike me as a kludge, though. To continue your example of car insurance, I don't believe that anybody markets insurance against having your car insurance premiums rise dramatically. I do not think there is a as large a risk of such a dramatic rise in auto insurance premiums. Possibly auto insurance premiums could go up 5x after 2 DUI's, but short of that, I cannot think of anything that would result in such a thing. And that is relatively unlikely, compared to developing a chronic condition at some point in one's life. I'd guess that Patrick is expecting health insurance to have health status insurance already built into it. New ideas can be difficult to get used to. Perhaps they could be bundled together for those who prefer it. But it would be a bundle -- the two types of insurance are fundamentally different, since one pays a lump sum or equivalent (like life insurance) for a single event, and the other pays out many payments for multiple events. Perhaps yet another flavor would be to have health insurance like life insurance, in that you lock yourself into a contract for many years. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 2:05 PM, Patrick Sweeneyfirefly.ga...@gmail.com wrote: On Sun, Aug 16, 2009 at 1:47 PM, David Hobbyhob...@newpaltz.edu wrote: But if I do fall ill, for the insurer to raise my rates rather than provide the agreed-upon care seems like dirty pool. That is only true if you had an agreement with the insurance company that lasted longer than a month or year. All insurance has a time period either explicit or implicit. Most of today's individual health insurance plans have a short time period. The premiums are low for healthy people because the chances of a healthy person needing costly care over a short period is relatively low. If, on the other hand, one signed a health insurance contract for a lifetime policy (or even, say 10 years) with a fixed premium, then the premium would be higher than that for a short period policy, since the chances of needing prolonged, costly care are higher over a longer period. A long-term policy or a bundled health-insurance / health-status-insurance policy may be preferable for some people. But personally, I don't like to be locked into anything that I can avoid. I would prefer to have flexibility to change my health insurance providers...even every year if I want. Having separate health insurance and health status insurance would be a benefit for me, allowing me more choice. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 14:08, John Williams wrote: New ideas can be difficult to get used to. Perhaps they could be bundled together for those who prefer it. But it would be a bundle -- the two types of insurance are fundamentally different, since one pays a lump sum or equivalent (like life insurance) for a single event, and the other pays out many payments for multiple events. And immediately you're creating the concept that as aoon as anything happens, your insurance will go up, because the risk to the insurer that you'll not be paying them anymore has been pushed to another party. Hence, you're simply creating a situation where health insurance costs will generally be higher, with less people able to insure themselves, and only the people able to afford both the insurance and the insurance for the insurance able to ensure there's some sort of cap on their healthcare costs. More, you're discouraging routine healthcare, because it's immediately less in the interest of insurers to pay for it because of people's insurance on the insurance paying out, etc. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 2:32 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Many people won't go for checkups if they have to pay out of pocket, and they will ignore dangerous conditions for too long. Did you read the article, or just the excerpts I posted? This was discussed in the article. Sure, evidence is that because you'd be punishing people financially when they wanted proper preventative care, they'll be paying out more in the longer run. No, there was nothing suggested that would punish people for preventative care. And you still have the exact same condition of many people being one illness from poverty, a refusal to cover pre-existing conditions and no way for poorer people to get the care they need for those conditions, leading to a need for chronic care rather than far cheaper accute care. Dealing with the poor was discussed in the article, as was mandatory catastrophic insurance for all. As for the other things, please see the article I referenced in another post about health-status insurance. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 2:38 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: And immediately you're creating the concept that as aoon as anything happens, your insurance will go up, because the risk to the insurer that you'll not be paying them anymore has been pushed to another party. I do not see how this follows. Perhaps you have misunderstood health-status insurance. Did you read the article? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 14:44, John Williams wrote: On Sun, Aug 16, 2009 at 2:32 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Many people won't go for checkups if they have to pay out of pocket, and they will ignore dangerous conditions for too long. Did you read the article, or just the excerpts I posted? This was discussed in the article. Yes, you're simply refusing to accnowledge the actual results of the policys proposed... none of this is things which have not been seen when you push routine costs onto people and make new ways for them to be charged (as their status insurance can be cancelled, as well as their normal insurance). Sure, evidence is that because you'd be punishing people financially when they wanted proper preventative care, they'll be paying out more in the longer run. No, there was nothing suggested that would punish people for preventative care. Pushing routine prevenative costs onto people does exactly that, wereas basic cover being assured (companies cannot refuse to offer it) and a pool assigned to companies based on patient risk does the exact opposite (because it's in the company's interests to monitor acute conditions and to catch problems early, saving themselves money). And you still have the exact same condition of many people being one illness from poverty, a refusal to cover pre-existing conditions and no way for poorer people to get the care they need for those conditions, leading to a need for chronic care rather than far cheaper accute care. Dealing with the poor was discussed in the article, as was mandatory catastrophic insurance for all. As for the other things, please see the article I referenced in another post about health-status insurance. This isn't something you can say just concerns the poor, it affects the vast majority of Americans. And I've seen the article, it's simply wishful thinking that there has to be a way to Be Better. No, it'll just raise premiums and reduce cover again. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 3:34 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Yes, you're simply refusing to accnowledge the actual results of the policys proposed... What exactly am I refusing to acknowledge? to be charged (as their status insurance can be cancelled, Health status insurance cancelled? Not if there is a contract. It is like life insurance. Do you worry about life insurance being cancelled? Pushing routine prevenative costs onto people does exactly that, Having people pay for a service is a punishment? So am I being punished when I pay my auto mechanic to change the oil? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 15:52, John Williams wrote: On Sun, Aug 16, 2009 at 3:34 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: Yes, you're simply refusing to accnowledge the actual results of the policys proposed... What exactly am I refusing to acknowledge? That you'd simply once again reduce the number of people with proper insurance, drive older workers onto the grey market and reduce the scope of insurance-covered healthcare. to be charged (as their status insurance can be cancelled, Health status insurance cancelled? Not if there is a contract. It is like life insurance. Do you worry about life insurance being cancelled? As yes, good and equivalent example. Firstly, in many cases life insurance is unavaliable. Secondly, the premiums depend on precisely the same issues which drive up health insurance, so if you're a bad health risk or have prexisting conditions you're very unlikely to be able to get status coverage at a deacent price or at all in the first place, or if you can the amount of increae you could would be limited. Then there are exclusions which cover a lot of activites, and in many cases, for example, flatly exclude claims happening outside America. And yes, there's no reason to believe that they wouldn't be cancelled if the company providing health insurance claimed that there was a fraudlant application, because of course fraud on the policy means the insurance on the policy is invalid. And they can allways have their own standards to investigate as well, with their own cancelation procedures. Pushing routine prevenative costs onto people does exactly that, Having people pay for a service is a punishment? So am I being punished when I pay my auto mechanic to change the oil? I'd suggest you read up on the basics of preventative medicine, and look at the prices of simple doctor's visits in America. A better analogy is pay roads, where every major road is one. AndrewC Dawn Falcon ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Sun, Aug 16, 2009 at 4:10 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: , so if you're a bad health risk or have prexisting conditions you're very unlikely to be able to get status coverage at a deacent price or at all in the first place, That is not the way health status insurance works. A pre-existing condition has little bearing on health status insurance. Health status insurance is insurance against an unexpected future chronic and costly condition developing. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On 16 Aug 2009 at 16:30, John Williams wrote: On Sun, Aug 16, 2009 at 4:10 PM, Andrew Crystalldawnfal...@upliftwar.com wrote: , so if you're a bad health risk or have prexisting conditions you're very unlikely to be able to get status coverage at a deacent price or at all in the first place, That is not the way health status insurance works. A pre-existing condition has little bearing on health status insurance. Health status insurance is insurance against an unexpected future chronic and costly condition developing. Either it will have a higher premium to cover pre-existing conditions, or it only covers things not caused by the pre-existing condition. Given the Human body is a system, the second makes it trivial to deny claims because they're linked to the pre-existing condition. AndrewC ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams said the following on 8/16/2009 5:08 PM: On Sun, Aug 16, 2009 at 1:47 PM, David Hobbyhob...@newpaltz.edu wrote: It does strike me as a kludge, though. To continue your example of car insurance, I don't believe that anybody markets insurance against having your car insurance premiums rise dramatically. I do not think there is a as large a risk of such a dramatic rise in auto insurance premiums. Possibly auto insurance premiums could go up 5x after 2 DUI's, but short of that, I cannot think of anything that would result in such a thing. And that is relatively unlikely, compared to developing a chronic condition at some point in one's life. The analogy between auto and health insurance fails in one regard: Most of the time, a 5x increase in auto insurance premiums is a direct result of decisions by the covered person. Many of causes for increases in health insurance premiums are outside the control of the covered person. Should this play into the plans? I don't know. --[Lance] -- GPG Fingerprint: 409B A409 A38D 92BF 15D9 6EEE 9A82 F2AC 69AC 07B9 CACert.org Assurer ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Lance A. Brown wrote: John Williams said the following on 8/16/2009 5:08 PM: On Sun, Aug 16, 2009 at 1:47 PM, David Hobbyhob...@newpaltz.edu wrote: It does strike me as a kludge, though. To continue your example of car insurance, I don't believe that anybody markets insurance against having your car insurance premiums rise dramatically. I do not think there is a as large a risk of such a dramatic rise in auto insurance premiums. Possibly auto insurance premiums could go up 5x after 2 DUI's, but short of that, I cannot think of anything that would result in such a thing. And that is relatively unlikely, compared to developing a chronic condition at some point in one's life. The analogy between auto and health insurance fails in one regard: Most of the time, a 5x increase in auto insurance premiums is a direct result of decisions by the covered person. Many of causes for increases in health insurance premiums are outside the control of the covered person. Should this play into the plans? I don't know. --[Lance] I've heard people say that insurance reform should discriminate between lifestyle risks and inherent risks. So insurance could charge someone with type II diabetes more, but not someone with type I diabetes. You could charge more to people who, smoke, are over weight, who don't exercise, or who practice un-safe sex. You couldn't charge more because of sex, age, or a prior cancer--except to the extent it was caused by a lifestyle choice. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: On Wed, Aug 12, 2009 at 3:59 PM, Trent Shipleytship...@deru.com wrote: John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Why not? The basic reason is that people are both tribal and self-interested. Would this be an accurate expansion of that? It is ethical to take wealth from some people in order to help other people with less resources, but only if all of those people are in the same political boundary? Whether it is ethical or not depends on what ethical system you adhere to. It sounds like a reasonable ethical proposition to me. Many Americans would find no fault with it. If so, then why is the political boundary more important than the fact that there are other people outside the political boundary who are much worse off than most of those inside? And when I say why, I am not looking for a sociological answer about tribes, but rather an argument about ethics. The people outside the boundary are not my responsibility. They are not my people. Furthermore, they don't participate in my moral economy. The status of the poor in my country has an immediate effect on me. I may be among the poor, and if I am not I may have feelings for my fellow countrymen, and even if I don't there is a real cost to tripping over the hungry and homeless in the streets, and the crime associated with extreme poverty. Poverty is a society wide expense. Poverty in another country is an external expense, especially if it is a result of unfair global capitalism favoring the metropole or of old style colonialism. And as every business student knows, and externalized cost is a good cost. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Jo Anne said the following on 8/12/2009 9:04 PM: Also, when we had a H.S.A., it expired after a year. We had to use everything in the account within the year or it was gone. You have to look deep into your crystal ball to decide exactly how much heath savings you need each year. Jo Anne, did you have an HSA or a health care flexible spending account? Flexible spending accounts have a pre-selected amount of pre-tax dollars set aside that you can then spend on non-covered medical expenses. Those funds expires at the end of the calendar year. I thought all HSA accounts allowed you to accrue money over time. Flexible spending accounts do need a fair bit of crystal ball gazing. I lost about 500 bucks last year because I overestimated my needs. --[Lance] -- GPG Fingerprint: 409B A409 A38D 92BF 15D9 6EEE 9A82 F2AC 69AC 07B9 CACert.org Assurer ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Aug 12, 2009, at 8:30 PM, dsummersmi...@comcast.net wrote: Compassion, folks. IAAMOAC. And remember .. http://xkcd.com/386/ .. because it's always, *always*, true. :D When you mention that we want five debates, say what they are: one on the economy, one on foreign policy, with another on global threats and national security, one on the environment, and one on strengthening family life, which would include health care, education, and retirement. I also think there should be one on parts of speech and sentence structure. And one on fractions. -- Toby Ziegler ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Actually, I believe that the US WWII generation did more to improve healthcare around the world than any nation in the history of the world, especially when they were riding the gravy train in the 1950's and 60's. (US medicine and transportation of food surpluses probably did more to create a population problem in third world countries that anything else.) My generation has become noticeably stingier as our balance of trade swung around from crazy black to very red, starting with Nixon. Now it appears some do not even think we can care for our own people. And the argument is that it is everyone for himself. If this argument prevails I see the dark ages ahead and a return to feudal times. As the namesake of this list has said many times, the enemy is the oligarchy always and forever. learner On Aug 12, 2009, at 1:06 PM, John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Aug 12, 2009, at 6:19 PM, John Williams wrote: On Wed, Aug 12, 2009 at 6:01 PM, Dave Landdml...@gmail.com wrote: Other than various charities, there isn't a world government (i.e., a mutually agreed-upon means by which people can pitch in to help each other out) through which I can redistribute wealth from people in the US to the people in the world who have far worse health care than those in the US. But there are charities. And the ambitious (and/or extremely wealthy) can start their own organizations. Why must your desired method involve government? It mustn't, but it generally does. Did you not read the part where I mentioned Habitat for Humanity, or was it just harder to build a straw man if you took it into consideration? Dave ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
OK, group, those of you who've been acquainted with me over the years know I believe in communication above all. I believe John has a right to express his opinion. If I sound crankier than usual, it's because I am. This debate is one of the most important we can have in this country right now, so I'm a little more blunt than usual. My apologies if I offend anyone. John wrote: I'll be glib here and object to universal. What I think you really mean is all US citizens, or perhaps all US citizens and non-citizen residents. But see my question here about why we are not more concerned about helping those much worse off than most Americans. Glib? Are you sure you're not trolling? I agree with what Chris has to say about the US spreading allopathic western medicine around the world post WWII and thereby causing a population explosion that we now have to deal with. That aside, the topic *I'M* discussing is health care in the US. I think these sorts of details should be up to each consumer to decide upon. And I wonder how much of a believer you would become should you, your partner, you children, your parents, etc. be suddenly injured or struck with a long-term/life threatening illness later today. You can make all those 'sound economic decisions' you want to, and it won't stop Ifni from pointing a capricious finger in your direction. What is it, something like half of all personal bankruptcies are due to medical problems? No offense intended, but I have seen that attitude by many people who work as health-care providers. But I think the needs and desires of health care providers are quite different from those who must bear the costs of that health care. Certainly it is easier to work in a hospital if you do not have to worry about the costs and benefits of each test or procedure, but that is not the way for those who bear the costs to get the most value for their money. Well, some offense taken. Just what are the 'needs and desires' of health care workers? The patients I took care of in a large Canadian hospital were not as sick when they entered the hospital as those in a large American city that I took care of around the same time. They had access to doctors earlier in their illness. It's easier to work in a hospital when those in your care have a better chance of getting well than those who your work your tail off to save, get out of the hospital and have them back the next week because they couldn't get the help they needed in the interim. Andy what makes you think that health care workers don't bear the cost of their own health care too? I suppose you could refuse health care in Canada, that's you right. I think it would be nutty, but probably doable. But if you don't think health care in this country is rationed, you are mistaken. No we don't have to wait for an MRI, *if you have insurance and can afford it*. If you can't, you have to go to one of the clinics that accept 'indigents' (or in some parts of Oregon, even Medicare patients) and wait, and wait and wait. So how many people in the US have to wait? I just tried to get into physical therapy for vertigo on Tuesday, and they want me to wait a week to see a therapist. We raised two kids in Canada with all the troubles and trials having little kids brings (in two different Provinces, BTW), and never experienced what your 'expert' quotes. Also, am I to understand that you will refuse Medicare when you turn 65, or Social Security? Do you have any idea about the breakdown of the workload by those people on Medicare/Medicaid vs. private insurance? Also, do you think their work is mostly pointless, or did their work (together with the insurance rules) help to keep costs down? In other words, if not for their work (and insurance rules), would there have been many more tests and procedures performed that had a low benefit to cost ratio? No, I don't have a clear understanding of what they did in the billing department, just as you seem to not understand what nurses were trained to do. My point was that since they had one primary insurance to bill, and only a few secondary insurances, it took far fewer bureaucrats to get the job done. And at the time, Canada was providing insurance to all it's people for something like 8.2% of GDP while were were spending over 11% of GDP for our health care. Now I understand that the US is somewhere around 18% of GDP. I don't want to take the time to look up Canadian stats, but I'm about 99% sure it's not more that 18% of GDP. Compassion and government are strange bedfellows. I'd prefer to express my compassion without government. Good luck with that. You are part of the government. Amities, Jo Anne Cranky Crone of the Willamette evens...@hevanet.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
[Lance] wrote: Jo Anne, did you have an HSA or a health care flexible spending account? Flexible spending accounts have a pre-selected amount of pre-tax dollars set aside that you can then spend on non-covered medical expenses. Those funds expires at the end of the calendar year. I thought all HSA accounts allowed you to accrue money over time. Flexible spending accounts do need a fair bit of crystal ball gazing. I lost about 500 bucks last year because I overestimated my needs. Ya know, I'm not sure. It must have been the flex account, because we had a choice of how much we put into it every month, but it did expire after a year. We lost money one year too. An accountant friend of mine told me where that money went once, but it didn't make a lot of sense to me, so I didn't put it in long term memory. It had to go somewhere, I just wonder who benefitted from my not using my savings for my own care. I suppose I could have gotten lots of unnecessary tests to make up the difference. This is one more thing that annoys the hell out of me about our current health care. You need an advanced degree in Understanding the Health Care System to make good choices and not bankrupt yourself. Amities, Jo Anne evens...@hevanet.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Thu, Aug 13, 2009 at 9:41 AM, Chris Frandsenlear...@mac.com wrote: My generation has become noticeably stingier as our balance of trade swung around from crazy black to very red, starting with Nixon. Now it appears some do not even think we can care for our own people Our own people? Who would that be, exactly? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 4:31 PM, John Williams jwilliams4...@gmail.comwrote: It is ethical to take wealth from some people in order to help other people with less resources, but only if all of those people are in the same political boundary? Another straw man. Developed countries put about $120 billion into less developed nations, just for health care, in 2006, the most recent year I came up with doing a quick search. Ignoring the existence of foreign aid for health demonstrates either being hopelessly out of the loop in terms of international politics or deliberate omission of material facts. Nick ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
A Real Free Market in Health Care
People on this list have argued for the advantages of a free market system for health care and health care insurance. I have thought about it, and decided to apply what we know from other markets that have considerable less government intervention. For example, big screen TVs. If you have the money and want it enough, you decide to buy it. If you don't have the money, you don't buy it. So, if a heart bypass will save someone's life, and they don't have the cash to pay for it and the banks won't loan them the money, they die. If someone cannot afford chemotherapy, they don't get it. Thus, they die. The closest thing we have to this in the US are those folks who don't have health insurance and do not qualify for Medicare. We find that those among this group are more likely to die if they have a first stage cancer than someone with health insurance and a second stage cancer. And, this even with the non-free market principal that hospitals must provide care if death is imminent without care. Now, one might argue that privately bought insurance is the answer to this. Well, normal insurance for someone with no history of health problems is about 6500 per year for an individual and about 14k/year for a family (paying for COBRA for my daughter who's between being covered by our health care and health care from her first real job gives me the first number pretty accurately). But, if one has risk, one has to get risk pool insurance. I own my own business, and looked at private insurance vs. COBRA for our family. The health insurance broker looked at our family and gave up...my wife had a pre-existing condition, which meant he couldn't compete. My friend who is also self-employed has a wife with diabetes. He has to pay in the 40k range for basic, no frills insurance. If we extend this to eliminating Medicare, we will clearly see that as one ages, one goes from the low risk to the high risk pool. Thus, older people will find that they would have to pay 40k+ for insurance. For the vast majority of them, this will exceed the maximum amount of income they could devote to insurance (assuming they ate and lived somewhere cheap). Thus, they would not have insurance, and would be looking at any serious treatment as too expensive. The result would be that a lot of people would die far sooner. John Williams pointed out the absurdity of paying for very expensive surgery for those in there late 80s, who are likely to die soon. I don't disagree with thatthe US system is just about the only one where that happens. But, lets say someone can have chemotherapy at 70, the cancer goes into remission, and they live another 15 years. That's not absurd, IMHO. So, I'm curious. Do the advocates of switching to the only totally free market health care system in the world, you know those who are not their brothers keepers, think that we are morally obliged to go to a system that will lower US life expectancy significantly (probably 5-10 years)? Dan M. mail2web.com - Microsoft® Exchange solutions from a leading provider - http://link.mail2web.com/Business/Exchange ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 8:50 AM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: People on this list have argued for the advantages of a free market system for health care and health care insurance. I have thought about it, and decided to apply what we know from other markets that have considerable less government intervention. This post seems similar to something you posted several weeks ago, and to which I responded in detail several weeks ago. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
I think this WSJ article is free for anyone to read: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html but just in case you cannot read it, here are the 8 bullet points (and a quotation) from Whole Foods founder John Mackey about The Whole Foods Alternative to ObamaCare Eight things we can do to improve health care without adding to the deficit: Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Repeal all state laws which prevent insurance companies from competing across state lines. Repeal government mandates regarding what insurance companies must cover. Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. Make costs transparent so that consumers understand what health-care treatments cost. Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility. Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program. The problem with socialism is that eventually you run out of other people's money. —Margaret Thatcher ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html Alex Tabarrok wrote: |For about the last 10 years the United States has been experimenting |with consumer driven health care plans. CDH plans typically combine |a high-deductible insurance policy with a health savings account or |health reimbursement account. CDH plans now cover well over 8 million |individuals, up considerably from 4.5 million in 2007 and these types of |plans continue to grow rapidly. So what have been the results? [results snipped] |It's remarkable that in the current debate over how to control health |care costs so little attention is being given to the important results |of our 10-year experiment with consumer driven health plans. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 11:32 AM, John Williams jwilliams4...@gmail.comwrote: http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html Alex Tabarrok wrote: |For about the last 10 years the United States has been experimenting |with consumer driven health care plans. CDH plans typically combine |a high-deductible insurance policy with a health savings account or |health reimbursement account. CDH plans now cover well over 8 million |individuals, up considerably from 4.5 million in 2007 and these types of |plans continue to grow rapidly. So what have been the results? I can tell you the results for our family - run the other way. A high-deductible plan with an HSA is a nightmare if you get sick before you've had a chance to build up the HSA. It's fine if you're young and healthy and stay that way for a number of years to build up a cushion in your HSA. But if you get even a mildly serious illness in the first year of this kind of plan, as my wife did, it gets very expensive very fast. We emptied her HSA in a couple of days and she had to spend three more hospitalized. There needs to be some allowance for those who get seriously ill before they've had an opportunity to put money in the HSA. As for us, we're back to the more traditional plan with a lower deductible. Nick ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: I think this WSJ article is free for anyone to read: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html but just in case you cannot read it, here are the 8 bullet points ... Repeal government mandates regarding what insurance companies must cover. ... Make costs transparent so that consumers understand what health-care treatments cost. ... John-- Going by the present state of things, the two bullets above seem to contradict each other. I can see why one might object to some government mandates that insurance must cover certain categories of care. For instance, contraception, mental health treatment, substance abuse treatment, and physical therapy. But if you repeal ALL government mandates, you'll wind up with lots of policies that appear to cover everything a consumer might want, but are actually full of loopholes so that the insurer need not pay for standard treatments. That seems the opposite of transparency. Comments? ---David ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Straw man. -- GPG Fingerprint: 409B A409 A38D 92BF 15D9 6EEE 9A82 F2AC 69AC 07B9 CACert.org Assurer ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 12:15 PM, David Hobbyhob...@newpaltz.edu wrote: John Williams wrote: Repeal government mandates regarding what insurance companies must cover. ... Make costs transparent so that consumers understand what health-care treatments cost. ... Going by the present state of things, the two bullets above seem to contradict each other. I can see why one might object to some government mandates that insurance must cover certain categories of care. For instance, contraception, mental health treatment, substance abuse treatment, and physical therapy. But if you repeal ALL government mandates, you'll wind up with lots of policies that appear to cover everything a consumer might want, but are actually full of loopholes so that the insurer need not pay for standard treatments. That seems the opposite of transparency. Comments? I don't see how your conclusion (2nd paragraph) follows from your stated assumptions. Are you making an unstated assumption that many consumers will purchase policies that are full of loopholes? If so, why would they? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 1:22 PM, Lance A. Brownla...@bearcircle.net wrote: John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Straw man. I understand why that question makes you uncomfortable. It makes me uncomfortable too. It is extremely difficult to answer in a way consistent with the ethics of many people. Still, I am interested to hear how others who advocate more and larger wealth-redistribution policies might answer. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
dsummersmi...@comcast.net wrote: People on this list have argued for the advantages of a free market system for health care and health care insurance. I have thought about it, and decided to apply what we know from other markets that have considerable less government intervention. For example, big screen TVs. If you have the money and want it enough, you decide to buy it. If you don't have the money, you don't buy it. So, if a heart bypass will save someone's life, and they don't have the cash to pay for it and the banks won't loan them the money, they die. If someone cannot afford chemotherapy, they don't get it. Thus, they die. The closest thing we have to this in the US are those folks who don't have health insurance and do not qualify for Medicare. We find that those among this group are more likely to die if they have a first stage cancer than someone with health insurance and a second stage cancer. And, this even with the non-free market principal that hospitals must provide care if death is imminent without care. Now, one might argue that privately bought insurance is the answer to this. Well, normal insurance for someone with no history of health problems is about 6500 per year for an individual and about 14k/year for a family (paying for COBRA for my daughter who's between being covered by our health care and health care from her first real job gives me the first number pretty accurately). But, if one has risk, one has to get risk pool insurance. I own my own business, and looked at private insurance vs. COBRA for our family. The health insurance broker looked at our family and gave up...my wife had a pre-existing condition, which meant he couldn't compete. My friend who is also self-employed has a wife with diabetes. He has to pay in the 40k range for basic, no frills insurance. If we extend this to eliminating Medicare, we will clearly see that as one ages, one goes from the low risk to the high risk pool. Thus, older people will find that they would have to pay 40k+ for insurance. For the vast majority of them, this will exceed the maximum amount of income they could devote to insurance (assuming they ate and lived somewhere cheap). Thus, they would not have insurance, and would be looking at any serious treatment as too expensive. The result would be that a lot of people would die far sooner. John Williams pointed out the absurdity of paying for very expensive surgery for those in there late 80s, who are likely to die soon. I don't disagree with thatthe US system is just about the only one where that happens. But, let’s say someone can have chemotherapy at 70, the cancer goes into remission, and they live another 15 years. That's not absurd, IMHO. So, I'm curious. Do the advocates of switching to the only totally free market health care system in the world, you know those who are not their brothers keepers, think that we are morally obliged to go to a system that will lower US life expectancy significantly (probably 5-10 years)? Dan M. NO. That is an acceptable side effect for greater freedom and economic efficiency. Freedom isn't free. I think it would be very reasonable to have real free market health care. If that were our collective choice then emergency rooms would need to refuse care to heart attack patients who couldn't pay. There's nothing wrong with that except that it is politically impossible to implement. If we choose I also think there's nothing wrong with giving everyone reasonable health care and rationing access fairly through bureaucracy. I even have no problem with hybrid systems like they have in Australia, The Netherlands, and Germany. What is REALLY STUPID is having government coverage for some people, private health care for other people, and allowing those with private coverage (or rather lack of coverage) who can't pay to use the emergency room. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Why not? The basic reason is that people are both tribal and self-interested. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 3:59 PM, Trent Shipleytship...@deru.com wrote: John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Why not? The basic reason is that people are both tribal and self-interested. Would this be an accurate expansion of that? It is ethical to take wealth from some people in order to help other people with less resources, but only if all of those people are in the same political boundary? If so, then why is the political boundary more important than the fact that there are other people outside the political boundary who are much worse off than most of those inside? And when I say why, I am not looking for a sociological answer about tribes, but rather an argument about ethics. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: On Wed, Aug 12, 2009 at 12:15 PM, David Hobbyhob...@newpaltz.edu wrote: John Williams wrote: Repeal government mandates regarding what insurance companies must cover. ... Make costs transparent so that consumers understand what health-care treatments cost. ... Going by the present state of things, the two bullets above seem to contradict each other. I can see why one might object to some government mandates that insurance must cover certain categories of care. For instance, contraception, mental health treatment, substance abuse treatment, and physical therapy. But if you repeal ALL government mandates, you'll wind up with lots of policies that appear to cover everything a consumer might want, but are actually full of loopholes so that the insurer need not pay for standard treatments. That seems the opposite of transparency. Comments? I don't see how your conclusion (2nd paragraph) follows from your stated assumptions. Are you making an unstated assumption that many consumers will purchase policies that are full of loopholes? If so, why would they? John-- Sorry, I thought that part was obvious. How on earth is the average consumer going to check that their policy is NOT full of loopholes? They'd need a LOT of legal and medical expertise. Or are you proposing that they just avoid ALL policies that don't clearly state what's covered? Could you PRODUCE a sample of a policy where it WOULD be easy for the average consumer to check what's covered? ---David ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: On Wed, Aug 12, 2009 at 1:22 PM, Lance A. Brownla...@bearcircle.net wrote: John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Straw man. I understand why that question makes you uncomfortable. It makes me uncomfortable too. It is extremely difficult to answer in a way consistent with the ethics of many people. Still, I am interested to hear how others who advocate more and larger wealth-redistribution policies might answer. John-- This is an old kind of argument that is usually used to support not taking action. It asks How can you worry about A, when B is so much worse? My answer is, Why we'll work on both problem A and problem B at the same time. In this context, that means spending some resources inside the country, and sending some outside to help problems there. I support some humanitarian aid abroad, and feel that most people do. We may well disagree about how MUCH aid to send to the Third World, of course. ---David (I've also seen the same argument used against doing anything to improve animal rights.) ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 5:26 PM, David Hobbyhob...@newpaltz.edu wrote: How on earth is the average consumer going to check that their policy is NOT full of loopholes? First, I'll point that I know of no system to ensure that there are not loopholes or other problems with a product or service. The government cannot magically eliminate the problems. A few (or even a bunch of) government technocrats are not able to write regulations that cover all possibilities for all people (or even the most important for most people) without leaving loopholes in the regulations that will cause all sorts of unforeseen problems. As for how a consumer can decide what product or service is best for them, I can think of several non-government possibilites: 1) Reputation / brand-name 2) Word of mouth: friends, relatives, email-lists :-) 3) Careful research 4) Consumer magazines or websites If you think a government solution is important, why not make it non-coercive? Have a government-funded version of _Consumer Reports_ for every product or service that you think needs it. Consumers could access the ratings and reviews from a government-run website, with an option to get printed material for those who have no internet access or nearby library with internet access. Could you PRODUCE a sample of a policy where it WOULD be easy for the average consumer to check what's covered? Probably, but I doubt I could do that AND produce a good business-plan based on it. That does not mean that it cannot be done. There are plenty of people out there more knowledgeable about both healthcare and business than I am. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Aug 12, 2009, at 4:31 PM, John Williams wrote: On Wed, Aug 12, 2009 at 3:59 PM, Trent Shipleytship...@deru.com wrote: John Williams wrote: There are billions of people around the world with worse healthcare than virtually everyone in the United States. If the goal is to redistribute wealth to improve healthcare because of the belief that everyone should have a chance to live and be healthy, then why not focus on redistributing wealth from people in the US to the people in the world who have far worse health care than those in the US? Why not? The basic reason is that people are both tribal and self-interested. Would this be an accurate expansion of that? It is ethical to take wealth from some people in order to help other people with less resources, but only if all of those people are in the same political boundary? If so, then why is the political boundary more important than the fact that there are other people outside the political boundary who are much worse off than most of those inside? And when I say why, I am not looking for a sociological answer about tribes, but rather an argument about ethics. Very interesting questions you raise. This discussion seems (to me) to have pitted those who hold that governments are a mutually-agreed upon means by which people can (and maybe should) pitch in to help each other vs. those who believe that governments are bullies that steal from some people people in order to give it to other (apparently unworthy) people -- at gunpoint, in the most extreme form of this meme. Your question hinges on the mutually agreed-upon part of the way I characterized the liberal point of view: as a U.S. citizen I tacitly (and sometimes not so tacitly) agree to pay my taxes as dues for the things I get from that government. For good or ill, I am part of one tribe, mainly concerned with the well-being of that tribe. I could, and perhaps should, consider myself a citizen of planet Earth, with equal concern for people in Guatemala and the Horn of Africa and Iraq and Greenland as I have for people in San Jose, California, the USA. In fact, I've done my bit on that front, traveling with Habitat for Humanity to Guatemala to build houses. I say this not to brag as much as to say that I have done a tiny, tiny bit to express my world citizenship, even if I am mainly a member of the USA tribe. Other than various charities, there isn't a world government (i.e., a mutually agreed-upon means by which people can pitch in to help each other out) through which I can redistribute wealth from people in the US to the people in the world who have far worse health care than those in the US. Dave ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Hello Group -- This discussion about health care is driving me a little crazy, as a retired nurse. I agree with Dan, Nick, David and everyone else who sees the need for some sort of universal risk pool. The one thing that irks me about talking about high deductibles and health savings accounts is that no one has talked about stop loss so far. Usually with a high deductable comes a high stop loss. Our daughter recently had to go on the only insurance available to her after her employer cancelled insurance, and her stop loss after a $4000 deductible is something like $15000!!! For that privilege she pays around $600/mo for her and the two kids. Her husband has his own high deductible, high stop loss policy. That's a lot of money for a young family of 4 -- we just hope everyone stays relatively healthy and the kids don't break an arm, or something. Also, when we had a H.S.A., it expired after a year. We had to use everything in the account within the year or it was gone. You have to look deep into your crystal ball to decide exactly how much heath savings you need each year. When our kids were hit by a drunk driver and both broke their necks and backs, leaving one with paraplegia, and even though we were covered with 'good' health insurance, there was a lien placed on our home by the hospital in a few days. This could happen to any one, today, and then I wonder how attitudes about health insurance would change. Having worked in both Canada and the US as an R.N. (although it was many years ago that I worked in Canada), I'll take the Canadian System with all it's problems *ANY DAY* over the expensive, administratively cumbersome system we have now. I worked at a 600 bed hospital in Edmonton that had 2 (yes, that's right, TWO) people working in the billing office. Here there are 10's if not 100 working in a similar system because they have to deal with all the different insurance programs. We all need to be in the same risk pool. Oh, and BTW, since I'm 61 now, 80 doesn't look that old for those 'life saving surgeries'. Women, particularly, are living into their 90's quite often, these days. Lest anyone think I'm a raving socialist, you might be right =+)). Compassion, folks. IAAMOAC. Amities, Jo Anne evens...@hevanet.com ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 5:33 PM, David Hobbyhob...@newpaltz.edu wrote: This is an old kind of argument that is usually used to support not taking action. It asks How can you worry about A, when B is so much worse? That was a question, not an argument. And I am not being flippant. My point is that I am not arguing against helping anyone -- people can be helped with or without a government intermediary. My answer is, Why we'll work on both problem A and problem B at the same time. In this context, that means spending some resources inside the country, and sending some outside to help problems there. I support some humanitarian aid abroad, and feel that most people do. We may well disagree about how MUCH aid to send to the Third World, of course. We may well. I wonder if you know what percentage of US GDP goes to foreign aid, and what percent of that is non-military? I think it is highly likely that if people could individually choose what to do with the money that would otherwise be redistributed by the government, that non-Americans who are much worse off than most Americans would be helped a lot more than they are now. I have seen repeatedly here statements that say or imply that it is selfish or unethical to NOT send money to the US government to be redistributed to people in the US. But I just cannot see the ethics of limiting it to people within a political boundary. Why not send charitable contributions to where they will do the most good? And will that not often be outside the US? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
John Williams wrote: On Wed, Aug 12, 2009 at 5:26 PM, David Hobbyhob...@newpaltz.edu wrote: How on earth is the average consumer going to check that their policy is NOT full of loopholes? ... As for how a consumer can decide what product or service is best for them, I can think of several non-government possibilites: ... 4) Consumer magazines or websites If you think a government solution is important, why not make it non-coercive? Have a government-funded version of _Consumer Reports_ for every product or service that you think needs it. Consumers could access the ratings and reviews from a government-run website, with an option to get printed material for those who have no internet access or nearby library with internet access. Hey, a constructive suggestion. Good. The government really doesn't have to do more than rate policies in order for consumers to get enough information. I agree, that would solve the problem with policies that appeared to cover things and actually didn't. There are other reasons to have universal health care, but there would have to be an element of coercion to the implementation. You seem to be against even taxation, as a matter of principle. Could you PRODUCE a sample of a policy where it WOULD be easy for the average consumer to check what's covered? Probably, but... I still doubt you could, and encourage you to try. You'd probably have to use phrases equivalent to experimental procedure, usual and customary, and so on. These would soon acquire technical meanings that the average consumer would be unaware of. The devil is in fact, in the details. ---David ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 6:01 PM, Dave Landdml...@gmail.com wrote: Other than various charities, there isn't a world government (i.e., a mutually agreed-upon means by which people can pitch in to help each other out) through which I can redistribute wealth from people in the US to the people in the world who have far worse health care than those in the US. But there are charities. And the ambitious (and/or extremely wealthy) can start their own organizations. Why must your desired method involve government? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Compassion, folks. IAAMOAC. I agree with your points Jo Anne, and welcome hearing from you. mail2web LIVE Free email based on Microsoft® Exchange technology - http://link.mail2web.com/LIVE ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
I agree with Dan, Nick, David and everyone else who sees the need for some sort of universal risk pool. I'll be glib here and object to universal. What I think you really mean is all US citizens, or perhaps all US citizens and non-citizen residents. But see my question here about why we are not more concerned about helping those much worse off than most Americans. The one thing that irks me about talking about high deductibles and health savings accounts is that no one has talked about stop loss so far. stop-loss - the dollar amount of claims filed for eligible expenses at which the insurance begins to pay at 100% per insured individual. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance. I think these sorts of details should be up to each consumer to decide upon. It sounds like you and your family would favor a policy with a lower stop-loss. I think if the government reduced most of their interference in the health care market (see some of John Mackey's points in the article I linked to earlier), that there would be a lot more choice for consumers as to what type of health care plan they can buy. Having worked in both Canada and the US as an R.N. (although it was many years ago that I worked in Canada), I'll take the Canadian System with all it's problems *ANY DAY* over the expensive, administratively cumbersome system we have now. No offense intended, but I have seen that attitude by many people who work as health-care providers. But I think the needs and desires of health care providers are quite different from those who must bear the costs of that health care. Certainly it is easier to work in a hospital if you do not have to worry about the costs and benefits of each test or procedure, but that is not the way for those who bear the costs to get the most value for their money. Also, I think John Mackey had an interesting comment about the Canadian system: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html John Mackey wrote: | Even in countries like Canada and the U.K., there is no intrinsic | right to health care. Rather, citizens in these countries are told by | government bureaucrats what health-care treatments they are eligible to | receive and when they can receive them. All countries with socialized | medicine ration health care by forcing their citizens to wait in lines | to receive scarce treatments. | Although Canada has a population smaller than California, 830,000 | Canadians are currently waiting to be admitted to a hospital or to get | treatment, according to a report last month in Investor's Business | Daily. In England, the waiting list is 1.8 million. | At Whole Foods we allow our team members to vote on what benefits | they most want the company to fund. Our Canadian and British | employees express their benefit preferences very clearly—they want | supplemental health-care dollars that they can control and spend | themselves without permission from their governments. Why would they | want such additional health-care benefit dollars if they already have | an intrinsic right to health care? The answer is clear—no such | right truly exists in either Canada or the U.K.—or in any other | country. I worked at a 600 bed hospital in Edmonton that had 2 (yes, that's right, TWO) people working in the billing office. Here there are 10's if not 100 working in a similar system because they have to deal with all the different insurance programs. Do you have any idea about the breakdown of the workload by those people on Medicare/Medicaid vs. private insurance? Also, do you think their work is mostly pointless, or did their work (together with the insurance rules) help to keep costs down? In other words, if not for their work (and insurance rules), would there have been many more tests and procedures performed that had a low benefit to cost ratio? Compassion, folks. IAAMOAC. Compassion and government are strange bedfellows. I'd prefer to express my compassion without government. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
Compassion and government are strange bedfellows. I'd prefer to express my compassion without government. I understand. But, since you expressed it as I am not my brother's keeper, that's what most folks would call no compassion. You are free to express itbut we are free to disagree. Dan M. mail2web.com Enhanced email for the mobile individual based on Microsoft® Exchange - http://link.mail2web.com/Personal/EnhancedEmail ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 7:43 PM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: I understand. But, since you expressed it as I am not my brother's keeper, that's what most folks would call no compassion. You are free to express itbut we are free to disagree. Why do we always end up with such silly exchanges? Of course you are free to judge me to have no compassion. Seems a rather cruel judgement, though. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
I think I fell victim to several non-glitches in a row and accidently sent this to just John. Sorry. But, I found a fast way to fix it...so I'll try to be good from now on. Original Message: - From: John Williams jwilliams4...@gmail.com Date: Wed, 12 Aug 2009 21:36:46 -0700 To: dsummersmi...@comcast.net, brin-l@mccmedia.com Subject: Re: A Real Free Market in Health Care On Wed, Aug 12, 2009 at 7:43 PM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: I understand. But, since you expressed it as I am not my brother's keeper, that's what most folks would call no compassion. You are free to express itbut we are free to disagree. Why do we always end up with such silly exchanges? Of course you are free to judge me to have no compassion. Seems a rather cruel judgement, though. Well, when you quote Cain as a fudmental moral position, you write words that result in a straight reading of the text leading to that conclusion. Dan M. mail2web.com - Microsoft® Exchange solutions from a leading provider - http://link.mail2web.com/Business/Exchange ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Re: A Real Free Market in Health Care
On Wed, Aug 12, 2009 at 10:08 PM, dsummersmi...@comcast.netdsummersmi...@comcast.net wrote: Well, when you quote Cain as a fudmental moral position, you write words that result in a straight reading of the text leading to that conclusion. Which has now thoroughly been taken out of context, and been repeated several times despite the fact that I gave a clearer statement of my meaning. Is this horse dead yet? ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
