Is health care a right?

[Cy]

I would like someone to explain to me how something that is subject to the law of scarcity can be a right.

What I mean is simply this:

Those things that are subject to the law of scarcity are by definition the purview of economics, and as such they are goods and services. We cannot, for instance, have a right to a trip to the moon, to gold, or to a cigarette boat. The law of scarcity prevents that from happening.

Rights, by contrast, are things that are universally shared. By virtue of being born, by having property, and by having life, we are granted the rights of life, liberty, and property. The only thing getting in the way of the universal enjoyment of our natural rights is not the law of scarcity, but the laws of tyrants. Tomorrow, if every government would agree, the whole world could enjoy full human rights without the exhaustion of a single resource.

Further, goods and services require person A to provide something for person B. If something is going to be called a right which is a good or service, then whoever person A happens to be would be the provider of that right.

In other words, rights, as historically understood, are seen to be endowed by our Creator, by nature, or by some universal entity bigger than man and his conventions.

Rights, as we are now beginning to understand them, are increasingly being seen as something endowed by other people, like doctors, or farmers, or most significantly, by the government.

But that's what happens when what was historically seen as rights is broadened to include goods and services.

So, if I have a right to what you alone are able to give...can you all see the dangers of this and where this is going?

The dangers of broadening this understanding of rights occurs precisely at the "Person A giving to Person B" point, because in the end, the government will never be Person A (because they are not in the business of goods and services), therefore they will necessarily have to FORCE another person, Person A, to give to Person B.

And any argument for rights that ends up with a collective body forcing a human being to be a producer of something for the sake of another is (a) immoral, and (b) doesn't work.

Why will it not work? Because in the end, Person A's mind cannot be tapped into and exploited. If we all have the right to the knowledge in Person A's mind concerning, say, treatment of cancer, we can make all the laws and use all the guns to force him to unload that knowledge for our sakes, but in the end, it is his choice. And under a system where he is forced to betray the intelligence of his profession, because it is claimed that the product of his mind is not his own, but belongs, by right, to others, he will very likely not be so keen to do so.

Where am I wrong?

[MJZiggy]

Because you don't die on the floor of a California emergency room from being denied a trip to the moon. It doesn't cause you pain. A doctor's care is not scarce.

How is the right to free speech endowed by our creator? It's endowed by our Constitution.

Or the right to gun ownership? Guns most certainly cause pain, damage health and cause the need for healthcare. By your logic, though, keeping weapons is not a right.

[Freak Out]

If "they" are taking my money to fund "their" (Fed, State, Local/Muni) healthcare plan/pension then it is my right to get the same. Should we as a nation help those that are less fortunate and supply healthcare to them even if they have no real income to contribute? Yes.

[HowardRoark]

Where are you wrong?

I am trying to get a response from one of these assholes, but they are being all standoffish and giving me the silent treatment.

http://www.hot.ee/evlliit/morv_1.jpg

[mraynrand]

Because you don't die on the floor of a California emergency room from being denied a trip to the moon. It doesn't cause you pain. A doctor's care is not scarce.

How is the right to free speech endowed by our creator? It's endowed by our Constitution.

Or the right to gun ownership? Guns most certainly cause pain, damage health and cause the need for healthcare. By your logic, though, keeping weapons is not a right.

This is the way the world ends, not with a bang, but a whimper.

[mraynrand]

Cy, you are so 18th century. The world has changed. Brightness is shining upon us.

Once the supreme court is properly staffed, things will get even better, with expanded rights that, as Ziggy said, will be endowed by the equal protection clause of the 14th Amendment. Please turn in all your monies on the way to paradise.

http://www.amazon.com/Second-Bill-Rights-Unfinished-Revolution/dp/B000W93416/ref=pd_bbs_sr_3?ie=UTF8&s=books&qid=1226170207&sr=8-3

[HowardRoark]

http://ecx.images-amazon.com/images/I/71EP2ZZJ6DL._SL500_PIlitb-dp-500-arrow,TopRight,45,-64_OU01_AA240_.gif

[bobblehead]

Because you don't die on the floor of a California emergency room from being denied a trip to the moon. It doesn't cause you pain. A doctor's care is not scarce.

How is the right to free speech endowed by our creator? It's endowed by our Constitution.

Or the right to gun ownership? Guns most certainly cause pain, damage health and cause the need for healthcare. By your logic, though, keeping weapons is not a right.

Rights end where anothers right begins.

A right to free speech or gun ownership does NOT infringe on your rights. A right to healthcare infringes on a doctors right to charge the top rate he can get for his services. It infringes on my right to pay REASONABLE income taxes. It infringes on my right to choose my provider.

That being said we have infringed on rights a ton. We have programs that in no way should be allowed. There are certain things that are not "rights" but better society as a whole and therefore are virtuous (can't believe I give the liberals that). I don't view gov't takeover of an industry as virtuous ever. Our gov't has proven they can't efficiently do things like run SS (take, hold, give back in 40+ years), I have no faith in the gov't to run anything. As a matter of fact I can think of VERY few cases where its ok to infringe on the rights of few to benefit the masses.

edit: guns don't cause pain, people do. I could argue that knives cause all the same things....wanna ban those too?

[Freak Out]

Deja vu all over again?

[Fosco33]

Imagine this...

No electricity for a facility to provide care. No medical device or drug industry.

No doctors or nurses available or willing to provide care because they are state employees by virtue of a right.

I'd really like to argue those who say everything should be available - especially watching the numbers of qualified docs and nurses are dwindling (it's as big a risk as paying for care - trust me).

Furthermore, watch the number of ERs closing (but what of emtala and access to care - that is a right)... look at LA over the last 6 years for an example of poor management of HC and lack of funding from the primary users of the service.

HC is a service because 'it' is defined by the number of facilities, beds, equipment, infrastructure and most importantly - people.

To make HC a right - you'd have to take over the entire structure - not just give a tax credit or increase taxes to fund social programs. You'd have to determine the optimal or maximum about of benefit and fully front the cost. You'd also be eliminating free market effects and medical advances in the 'right'. You'd need to find/train/retain talent.

Should we cover for uninsured - mostly. Access to medical emergencies, police/fire depts, flight for life, etc... - yes. Urgent/Emergent - maybe. Elective - nope. Preventative - debatable. Cosmetic - never.

Debate the breakdown of the number of uninsured by age, job status, etc...

Also, research how employee based HC coverage started (Ford, 20th century, response to gov't regulation). Now, this sort of coverage has greatly expanded access to care and the payoffs for those wanting to provide services (docs, nurses, admin, tech, etc.)...

I could keep going, too. 8-)

[retailguy]

Deja vu all over again?

Yep. Looks that way.

[Freak Out]

Imagine this...

No electricity for a facility to provide care. No medical device or drug industry.

No doctors or nurses available or willing to provide care because they are state employees by virtue of a right.

I could keep going, too. 8-)

Who ever said anything about making "all health care workers" State employees?

[MJZiggy]

Freak, somehow they've changed a simple insurance network into communism. I wonder if they realize that the government already insures 2.8 million federal workers...All those damn federal doctors.

Best I can tell, the only doctors employed by the government to administer care are working for the VA. Wait a minute, that's right. No doctors would work for the VA because they'd be state workers and not get top dollar. Wait a minute, who's running Bethesda Naval Hospital? It's a big building and the lights are on...

To read this forum, you would think the whole place was a hard-core conservative, religious right extremist board. McCain didn't even win the PackerRats vote. I'm sorry to tell you guys this, but the guy who ran on a healthcare and economic reform platform won the election. Even here in the Romper Room. There will be some form of health coverage for people. (and I'll bet we even get a couple years of Obama leadership before the economy im-- um. Well, Let's just look at it and say he can't do much worse and if you tell me that it wasn't Bush's fault then I guess he can't make much difference. Either way, it's his ship to steer. Those of you who want to cry iceberg, please just let the rest of us enjoy the party on the deck while we can.

[mraynrand]

To read this forum, you would think the whole place was a hard-core conservative, religious right extremist board.

How many hard-core conservative, religious right extremist boards do you read for comparison?

[mraynrand]

I'm sorry to tell you guys this, but the guy who ran on a healthcare and economic reform platform won the election. Even here in the Romper Room. There will be some form of health coverage for people.

THANK OBAMA! Because we know that no one has coverage right now.

[MJZiggy]

I'm sorry to tell you guys this, but the guy who ran on a healthcare and economic reform platform won the election. Even here in the Romper Room. There will be some form of health coverage for people.

THANK OBAMA! Because we know that no one has coverage right now.

Yes, thank Obama, because those that don't will. If you have coverage, great, your insurance will not change. But he was voted into office on his policies and as much as you bitch and complain about it, this is still one of the major parts of his campaign platform and he is determined to get it done no matter how little you like having an extra insurance network in the world.

[Fosco33]

http://www.thehealthcareblog.com/the_health_care_blog/2008/03/a-detailed-anal.html

Cost is the issue - not reimbursement.

Companies can (and may) end coverage because they'd have to pay a minor amount to a public pool.

MJ/Freak - you missed the points. You didn't research my questions. You can say, health care is a right. And think that's all it takes to fix it. Laughable.

My point was - hc is not a right. It's a service. If it's truly a right that needs to be provided by gov't (like police, fire departments, etc.), then the workers in the system would be employed by the gov't. Since the system isn't a right and the Obama proposal doesn't make it a right, it will continue to bleed and likely have side effects for quality and improvements/portability.

Even investing in hc technology as a way to manage cost is a joke - HC is the only industry that has a 2X negative ROI on technology/cost. Obama makes huge promises and has little substance to back up the proposals. Without ripping apart the system from every angle will it be fixed without a focus on cost efficiency.

Also note, Obama (and Senator Grassley) will end property tax breaks for non-profit hospitals because charity care will be removed from the equation. That's an automatic 3-5% cost to the entire system automatically reduced from potential income. Right now, even the most well run hospitals, struggle to eak a small 'profit'.

BTW - I spend 80 hrs/wk fixing health care for the top rated hc consulting firm in the country. I'm pretty sure I have more relevant, poignant and reasonable ways to remedy the situation without pumping billions into a broken system and hoping it isn't abused/mismanaged/corrupt or inefficient. We work with the VA and almost every major health system in the country. We see the real issues and manage the cost and efficiency.

[MJZiggy]

There's a place on his website where you can weigh in on the issues. Why not offer up something more substantive than a question about a puppy?

[wist43]

Good lord people... I can't begin to fathom what some of you were taught about the Constitution in school...

The Constitution does not "grant" a single right... what it does is restrict the government. Rights do, in fact, come from God - according to our founders, and our traditional American societal understanding.

What do the amendments say, or are worded as such??? "Congress shall make no law... "

America is dying under the weight of leftist ideology... "those who refuse to learn from history are doomed to repeat it"... left wing ideology has been around as long as recorded history, and it has killed every society it infected. Our founders studied the question, laid out the argument, and warned us not to let it happen here.

Goes to show you how dumb "the masses" are determined to be. America used to be about freedom, now it's about "what can the government do for me".

Of course, all governments do are control and manipulate people... that's not freedom, that's subjugation.

Doesn't matter what banner the leftist attack takes place under. Health care is just as effective as "Global Warming", is just as effective as anti-semitism, is just as effective as "working men of the world unite". Pick your rallying cry, they all lead to total government.

[Tarlam!]

Înteresting discussion.

In Germany, HC isn't a right. Health Insurance is legislated i.e. If you work, you will take out insurance. It's deducted from your income. You pay 50% and your employer pays 50%.

There are 2 types: Public and Private. Everybody must belong to at least a public fund. The costs are between 15%-20% of your gross salary for the public funds.

To qualify for Private, one must either be self employed or earn > € 48k p.a.

Interestingly, the Private funds cost less, offer better coverage and the funds are profitable. I will admit the premiums increase with age...

The public funds lose billions each year.

It may interest you to know, that for myself, my stb ex-wife and my 2 kids, my monthly premium in a private fund are about 1600 USD per month.

:drma:

We now return you to your favourite programme...

[HowardRoark]

Interestingly, the Private funds cost less, offer better coverage and the funds are profitable. I will admit the premiums increase with age...

The public funds lose billions each year.

[HowardRoark]

To read this forum, you would think the whole place was a hard-core conservative, religious right extremist board. McCain didn't even win the PackerRats vote.

Yet rarely do we hear anything of substance from these people. Sure we get the :D from gex, or the :oops: from Ty, but rarely is there a very good defense of positions on the Left

Ziggy, I have a feeling you may be one of us. You seem way too open-minded and intelligent to be stuck under the thumb of the “Man.”

[Cy]

I'm sorry to tell you guys this, but the guy who ran on a healthcare and economic reform platform won the election. Even here in the Romper Room. There will be some form of health coverage for people.

THANK OBAMA! Because we know that no one has coverage right now.

Yes, thank Obama, because those that don't will. If you have coverage, great, your insurance will not change. But he was voted into office on his policies and as much as you bitch and complain about it, this is still one of the major parts of his campaign platform and he is determined to get it done no matter how little you like having an extra insurance network in the world.

Cy: Actually, what he has promised to do is force businesses to either pay for their employee's insurance or pay a 7% tax. Most businesses will easily choose the tax, because it will be cheaper and less paperwork. One by one businesses will hand their health care providence over to the state.

[Cy]

Good lord people... I can't begin to fathom what some of you were taught about the Constitution in school...

The Constitution does not "grant" a single right... what it does is restrict the government. Rights do, in fact, come from God - according to our founders, and our traditional American societal understanding.

What do the amendments say, or are worded as such??? "Congress shall make no law... "

America is dying under the weight of leftist ideology... "those who refuse to learn from history are doomed to repeat it"... left wing ideology has been around as long as recorded history, and it has killed every society it infected. Our founders studied the question, laid out the argument, and warned us not to let it happen here.

Goes to show you how dumb "the masses" are determined to be. America used to be about freedom, now it's about "what can the government do for me".

Of course, all governments do are control and manipulate people... that's not freedom, that's subjugation.

Doesn't matter what banner the leftist attack takes place under. Health care is just as effective as "Global Warming", is just as effective as anti-semitism, is just as effective as "working men of the world unite". Pick your rallying cry, they all lead to total government.

Cy: Exactly! It's a fundamental differnence.

Our government does not "give" rights. It protects the rights we already have. But goods and services must by definition be contractually given from a producer to a consumer. And once you declare a good or service a right, then what you are in essence saying is someone else has a claim on ME.

Notice that subtle changes that leads to statism.

[Cy]

Because you don't die on the floor of a California emergency room from being denied a trip to the moon. It doesn't cause you pain. A doctor's care is not scarce.

How is the right to free speech endowed by our creator? It's endowed by our Constitution.

Or the right to gun ownership? Guns most certainly cause pain, damage health and cause the need for healthcare. By your logic, though, keeping weapons is not a right.

Cy: But you do die on the floor of an ER when no doctors are there. And it is simply a rather ignorant claim to say that a doctor's care is not scarce. Everything is scarce. Right now I don't have a doctor massaging my lower back. Care is scarce.

You say, "But you don't really need that."

And there enters the demon, because now my care is being managed by another, namely, you, who are going to determine what scarcity is, who gets care, and to what extent.

So, you fall back into the emotional outburst, "But what about the poor Mexican on the ER floor. O my God! O my God!"

And that is where discourse has gone. Because following the rationalist line to its ends may not satisfy our emotional yearnings, but in the end, they explain why more doctors are in the U.S. than in other socialized systems, and why care here is far more available than in other countries.

[mraynrand]

I'm sorry to tell you guys this, but the guy who ran on a healthcare and economic reform platform won the election. Even here in the Romper Room. There will be some form of health coverage for people.

THANK OBAMA! Because we know that no one has coverage right now.

Yes, thank Obama, because those that don't will. If you have coverage, great, your insurance will not change. But he was voted into office on his policies and as much as you bitch and complain about it, this is still one of the major parts of his campaign platform and he is determined to get it done no matter how little you like having an extra insurance network in the world.

Cy: Actually, what he has promised to do is force businesses to either pay for their employee's insurance or pay a 7% tax. Most businesses will easily choose the tax, because it will be cheaper and less paperwork. One by one businesses will hand their health care providence over to the state.

And once it's controlled by the state, people will flee state coverage like they flee from failing public schools. Like in Cleveland, where anybody who can flee to a parochial school or a charter school can't get there fast enough. Why? because for the majority of things, government control sucks.

[Iron Mike]

Care here is far more available than in other countries.

I'm gonna go ahead and pull the "apples vs. oranges" card out, because apparently some people here continue to equate "access to health insurance" with "access to healthcare." :roll:

[mraynrand]

Care here is far more available than in other countries.

I'm gonna go ahead and pull the "apples vs. oranges" card out, because apparently some people here continue to equate "access to health insurance" with "access to healthcare." :roll:

but they usually do it the wrong direction - equating those without insurance as being without access. Access is actually very good. Coverage has it's problems, but it's been discussed already.

[texaspackerbacker]

I would like someone to explain to me how something that is subject to the law of scarcity can be a right.

What I mean is simply this:

Those things that are subject to the law of scarcity are by definition the purview of economics, and as such they are goods and services. We cannot, for instance, have a right to a trip to the moon, to gold, or to a cigarette boat. The law of scarcity prevents that from happening.

Rights, by contrast, are things that are universally shared. By virtue of being born, by having property, and by having life, we are granted the rights of life, liberty, and property. The only thing getting in the way of the universal enjoyment of our natural rights is not the law of scarcity, but the laws of tyrants. Tomorrow, if every government would agree, the whole world could enjoy full human rights without the exhaustion of a single resource.

Further, goods and services require person A to provide something for person B. If something is going to be called a right which is a good or service, then whoever person A happens to be would be the provider of that right.

In other words, rights, as historically understood, are seen to be endowed by our Creator, by nature, or by some universal entity bigger than man and his conventions.

Rights, as we are now beginning to understand them, are increasingly being seen as something endowed by other people, like doctors, or farmers, or most significantly, by the government.

But that's what happens when what was historically seen as rights is broadened to include goods and services.

So, if I have a right to what you alone are able to give...can you all see the dangers of this and where this is going?

The dangers of broadening this understanding of rights occurs precisely at the "Person A giving to Person B" point, because in the end, the government will never be Person A (because they are not in the business of goods and services), therefore they will necessarily have to FORCE another person, Person A, to give to Person B.

And any argument for rights that ends up with a collective body forcing a human being to be a producer of something for the sake of another is (a) immoral, and (b) doesn't work.

Why will it not work? Because in the end, Person A's mind cannot be tapped into and exploited. If we all have the right to the knowledge in Person A's mind concerning, say, treatment of cancer, we can make all the laws and use all the guns to force him to unload that knowledge for our sakes, but in the end, it is his choice. And under a system where he is forced to betray the intelligence of his profession, because it is claimed that the product of his mind is not his own, but belongs, by right, to others, he will very likely not be so keen to do so.

Where am I wrong?


Cy, I really hate to even give the appearance of siding with the forum bad guys (and girls) over you, and in a strict literal sense, I agree, there is no formal Constitutional RIGHT for health care.

I picture it like this, though:

Laws generally don't force us to keep your yard neat--at least not to the standard most people do. Laws don't force us to avoid going around in public filthy and stinky--but most people do keep themselves to a fairly decent standard that way. Lots of things are NOT legally on Constitutionally required.

We do what is generally considered the "right" thing in those areas, just the same. Why? Well, for most of us, it isn't a matter of giving in to social pressure. I, and probably you, too, tend say "Oh yeah, hell no" when social pressure is applied to follow the crowd. What most of us good normal Americans do, however, is take pride in the appearance of things associated with us.

We don't pay (either voluntarily or through government) for homeless shelters to be nice to the damn bums sleeping on sidewalks. We do it because it is ugly and disgusting having them around, and we want to get them out of sight.

It's the same thing with health care. It is kind of unseemly and in a sense ugly--below our high standard which decent normal Americans--which in most cases means conservative Americans--take pride in. I don't necessarily give a damn about the medical condition of poor people, but it's offensive to our senses to read all the silly sad crap about them dying or whatever due to lack of care--just like the freeloaders sleeping in the street.

The question is, what's the best way to rid ourselves of this nasty little problem.

Obviously, we can't just round up all the poor people and put them in camps, or something. Aside from the fact that even a solution like that would cost money, they might break out and kill us or something.

Most of us with good sense know that some Obama-esque government takeover of the health care system is a horrendous way of dealing with the problem too.

The fact is, there really AREN'T THAT MANY people who both need medical care AND lack the means to pay for it. Most people who don't have health insurance, I would bet, don't have it because they don't want it. They realize paying money for health insurance is like flushing money down the toilet.

IMO, the best solution is what we have right now. We actually have the best health care in the world right now, and the fact is, NOBODY goes without lifesaving or critical care in this country. Sure, there are a few who can't pay. They get their care. Hospitals and doctors absorb the costs--and presumably, pass them on to the rest of us. Yeah, that makes costs a little bit higher, but we can easily afford it, and it's a helluva lot less hassle than either of the other extremes: socialized medicine OR just letting 'em suffer and die.

Just look at it the same way you look at other little nuisance expense you have to keep up appearances.

[Freak Out]

MJ/Freak - you missed the points. You didn't research my questions. You can say, health care is a right. And think that's all it takes to fix it. Laughable.

My point was - hc is not a right. It's a service. If it's truly a right that needs to be provided by gov't (like police, fire departments, etc.), then the workers in the system would be employed by the gov't. Since the system isn't a right and the Obama proposal doesn't make it a right, it will continue to bleed and likely have side effects for quality and improvements/portability.



All I said was if you are going to take my money to fund your healthcare system I better be able to take part in it. I help fund the pension and healthcare coverage for the local cops and firefighters and am locked out of it. I help fund the pension and healthcare system for Feds and am not able to take part in it. They take my money through taxes and use it for their gain.

[Harlan Huckleby]

Access is actually very good.

This is just nonsense. People without insurance are forced to choose between health care and economic ruin. And the government programs to cover the poor or uninsurable have gaping holes.

Your "access" is theoretical, and really a word game. As a practical matter, many people are pressured into forgoing medical care.

[wist43]

Harlan... I'll just tell it like it is... tough, tough shit.

That doesn't give you the right to reach into my wallet, or your neighbors wallet to help your other neighbor.

You're a fundamentally dishonest person, as is anyone who thinks they have the right to help themselves to anyone elses hard earned money.

Your sanctimonious bullshit doesn't wash with me... you want to compare scars??? Trust me, you can't come close to me... I've been homeless, I've starved, I was kicked out on my own as a teenager - did I come asking for handouts??? Did anyone offer to help me???

Aside from living in a Chrisitian homeless shelter, I received no help in surviving.... and you know, what??? It was no one else's business. It was my struggle, and I'm a better man for it.

Tell your sob stories walking... bunch of whining assholes.

[mraynrand]

Access is actually very good.

People without insurance are forced to choose between health care and economic ruin. And the government programs to cover the poor or uninsurable have gaping holes.

Your "access" is theoretical, and really a word game. As a practical matter, many people are pressured into forgoing medical care.

What you say is true. Some people are in bad spots. No doubt. But access is still very good. And quality of care is for the most part outstanding.

[wist43]

And furthermore, for the boo-hoo'ers in here... my mother had quadruple bypass surgery without any health insurance.

Didn't have the money... worked out a settlement with the hospital for a fraction of what they owed, which still came to, what was for my mother a very large sum of money - $40,000 as I remember. Had to cash in some investments, the dividends from which they were living on.

They ended up getting rid of cable TV, internet, cut back on other expenses as well, but they get by. Don't see them out whining about, "poor me"... "everybody owes me"... "I deserve my cable TV back"... "boo fucking hoo".

She's not running around with her hand out... in fact, she's just as disgusted by you socialist pigs as I am. Bunch of whining thieves - you can hide behind perceived altrusim, but it's still thievery.

I dare any one of you to come and knock on my door and try to force me to open my wallet to pay for you or your neighbor - I dare ya!!!

Of course you won't... you don't have the guts. You hide behind government... use the power of the mob, and government force to do your stealing for you. Weak, filthy thieves.

[texaspackerbacker]

This is exactly what I'm talking about in the category of "if it ain't broke, don't fix it"--and it sure as hell AIN'T broke.

Wist, the $40,000 "settlement" you spoke of undoubtedly left a larger figure unpaid, absorbed by the hospital, and passed along to the rest of us. I'm not complaining, though, and others shouldn't either, as this "settlement", others like it, and even complete write-offs are no big deal in the grand scheme of things.

To CHANGE--there's that dirty word again--our whole wonderful system and make things infinitely more inconvenient and probably a lot more expensive too, all things considered, for everybody would be just plain stupid--Obama-esque stupid.

Just about as bad would be to empower government to force people to pay for health insurance--kinda like with car insurance. Strange how some people who seem to be against government intrusion in a lot of venues can somehow see fit to advocate government sticking it to individuals to the tune of forcing people against their will to flush away money for health insurance.

[HowardRoark]

Strange how some people who seem to be against government intrusion in a lot of venues can somehow see fit to advocate government sticking it to individuals to the tune of forcing people against their will to flush away money for health insurance.

Yet, you have no problem with "us" being forced against our will to flush our money away in this manner:


Wist, the $40,000 "settlement" you spoke of undoubtedly left a larger figure unpaid, absorbed by the hospital, and passed along to the rest of us.

[texaspackerbacker]

It's a question of the lesser (or least) of three evils, and I see the status quo as clearly the least bad.

[Cy]

Harlan... I'll just tell it like it is... tough, tough shit.

That doesn't give you the right to reach into my wallet, or your neighbors wallet to help your other neighbor.

You're a fundamentally dishonest person, as is anyone who thinks they have the right to help themselves to anyone elses hard earned money.

Your sanctimonious bullshit doesn't wash with me... you want to compare scars??? Trust me, you can't come close to me... I've been homeless, I've starved, I was kicked out on my own as a teenager - did I come asking for handouts??? Did anyone offer to help me???

Aside from living in a Chrisitian homeless shelter, I received no help in surviving.... and you know, what??? It was no one else's business. It was my struggle, and I'm a better man for it.

Tell your sob stories walking... bunch of whining assholes.

Cy: And blessed are you that you've come to where you are at. So many people go through life waiting for some "they" to take care of them. They waste so much time that could be spent saying, "Hey, I'm the master of my own fate.

You came to that conclusion, and as you say, you are the better for it.

[Cy]

And furthermore, for the boo-hoo'ers in here... my mother had quadruple bypass surgery without any health insurance.

Didn't have the money... worked out a settlement with the hospital for a fraction of what they owed, which still came to, what was for my mother a very large sum of money - $40,000 as I remember. Had to cash in some investments, the dividends from which they were living on.

They ended up getting rid of cable TV, internet, cut back on other expenses as well, but they get by. Don't see them out whining about, "poor me"... "everybody owes me"... "I deserve my cable TV back"... "boo fucking hoo".

She's not running around with her hand out... in fact, she's just as disgusted by you socialist pigs as I am. Bunch of whining thieves - you can hide behind perceived altrusim, but it's still thievery.

I dare any one of you to come and knock on my door and try to force me to open my wallet to pay for you or your neighbor - I dare ya!!!

Of course you won't... you don't have the guts. You hide behind government... use the power of the mob, and government force to do your stealing for you. Weak, filthy thieves.

Cy: Preach it, brotha!

[wist43]

I have a way of killing threads, don't I??? :lol:

[Partial]

I don't think it is.

[Harlan Huckleby]

Harlan... I'll just tell it like it is... tough, tough shit.

That doesn't give you the right to reach into my wallet, or your neighbors wallet to help your other neighbor.

You're a fundamentally dishonest person, as is anyone who thinks they have the right to help themselves to anyone elses hard earned money.

Your sanctimonious bullshit doesn't wash with me... you want to compare scars??? Trust me, you can't come close to me... I've been homeless, I've starved, I was kicked out on my own as a teenager - did I come asking for handouts??? Did anyone offer to help me???

Aside from living in a Chrisitian homeless shelter, I received no help in surviving.... and you know, what??? It was no one else's business. It was my struggle, and I'm a better man for it.

Tell your sob stories walking... bunch of whining assholes.

A Christian homeless shelter you say, aye?

Yes, I believe that government has a role in helping people.

I just forgot what thread I'm in - is this about health care?
Having a more efficient and humane health care system, like they have in, say, Japan or Germany, would not just be the right thing to do morally. It also can be good for business. Right now, businesses are strangled by health care costs, and the system is rotten to the core with inefficiency.

I can't speak to extreme anti-government people like Wist. The logic of his argument can be applied to the elimination of social security, public education, publicly financed roads. If you are against pooling our resources and taking collective action, so be it.

The small group of people in our country that want to go back to a 1800 style government are roughly equivalent to the small mobs in Russia that assemble every May 1 and wish for a return of communism.


Our healthcare system is the most market-oriented system in the world. And its the market effects that make it rotten.

[Freak Out]

Wist needs to take advantage of some publicly funded mental health care programs in his area...he really sounds like an angry, paranoid individual in need of some help.

[wist43]

Harlan... I'll just tell it like it is... tough, tough shit.

That doesn't give you the right to reach into my wallet, or your neighbors wallet to help your other neighbor.

You're a fundamentally dishonest person, as is anyone who thinks they have the right to help themselves to anyone elses hard earned money.

Your sanctimonious bullshit doesn't wash with me... you want to compare scars??? Trust me, you can't come close to me... I've been homeless, I've starved, I was kicked out on my own as a teenager - did I come asking for handouts??? Did anyone offer to help me???

Aside from living in a Chrisitian homeless shelter, I received no help in surviving.... and you know, what??? It was no one else's business. It was my struggle, and I'm a better man for it.

Tell your sob stories walking... bunch of whining assholes.

A Christian homeless shelter you say, aye?

Yes, I believe that government has a role in helping people.

I just forgot what thread I'm in - is this about health care?
Having a more efficient and humane health care system, like they have in, say, Japan or Germany, would not just be the right thing to do morally. It also can be good for business. Right now, businesses are strangled by health care costs, and the system is rotten to the core with inefficiency.

I can't speak to extreme anti-government people like Wist. The logic of his argument can be applied to the elimination of social security, public education, publicly financed roads. If you are against pooling our resources and taking collective action, so be it.

The small group of people in our country that want to go back to a 1800 style government are roughly equivalent to the small mobs in Russia that assemble every May 1 and wish for a return of communism.


Our healthcare system is the most market-oriented system in the world. And its the market effects that make it rotten.

I'm not "anti-government... I stand right beside our founding fathers, i.e. limited government.

You, on the other hand, stand beside Karl Marx... amazingly, you can't seem to make the connection that your advocacy of collectivism is advocacy for totalitarianism.

Your disdain for our founding fathers paints you as an anti-american leftist. Openly advocating "collectivism"... you do realize that collectivism and communism are synonymous???

Truly amazing.

[Harlan Huckleby]

we do many things collectively.

are you against NASA?

arguing the merits of capitalism vrs socialism (or collectivism, whatever you want to call) is for 9th graders. We have many elements of socialism in our system, layered on top of capitalism. It's not an either-or question and is never going to be.

[wist43]

The Constitution is an anti-socialist document... can't state it much clearer than that.

Read the Federalist Papers, you might learn something.

[Fosco33]

Funny that JSO had an article about physician shortages in WI right after I posted that here last week...

Let's just open up hc to everyone in the world :roll:

[MJZiggy]

Insurance, dear, insurance.

[Harlan Huckleby]

The Constitution is an anti-socialist document... can't state it much clearer than that.

Read the Federalist Papers, you might learn something.

OK, perhaps this is a fair reading, at least arguably so. Certainly the founders never envisioned anything like social security, or FDIC insurance for bank accounts, or medicare. But the government has evolved, and the changes in government have passed constitutional muster with all the Supreme Courts since the country's founding.

Do you propose to roll-back 225 years of political evolution?

You are very resentful of the notion that the government should fund health insurance for all, called it stealing. But this argument could be made for EVERY and ALL government expenditures. What about the $10B spent every week on the IRaq War against the wishes of so many voters?

I think health care is a worthwhile priority for government spending. Its an area where the free market does not and can not serve our citizens well. It is fine if you disagree with this priority, but don't even bother suggesting that it is morally wrong for the government to spend money.

[mraynrand]

The people can vote it in - that doesn't mean it doesn't go beyond enumerated powers. Defense spending is enumerated and yes, we do vote for the guy that primarily decides what conflicts are in our national security interest to engage in. All those other programs you mention don't pass constitutional muster, but as you suggest, the genie is out of the bottle. Emanations of penumbras can account for all sorts of unconstitutional bullshit.

[Harlan Huckleby]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

I suppose you think changes have to come strictly through amendment rather than court interpretation.

[HowardRoark]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

Which parts of the Constitution do you believe are specific the the midset of the 1780s?

[mraynrand]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

I suppose you think changes have to come strictly through amendment rather than court interpretation.

The constitutional mindset of 1789 was pretty fucking awesome. Yes, it would be pretty damn great if changes came through amendment and OF COURSE through legislation at the state level. Remember Federalism? Thinking in national terms, each state is like a testing ground for ideas.

Harlan, the point that you seem to gloss over, even though it's been pointed out multiple times is that the founders understood that Government is intrinsically BAD - it is corruptable, it becomes corrupt, it IS corrupt. It's a bipartisan thing. LOOK at the government in Washington. THEY SUCK. THEY FUCK US OVER ON ALMOST EVERYTHING. I reject the modern interpretation that government is great, we just need to clean it up. It cannot be cleaned up. You can't stop it, you can only hope to contain it. And it looks like it's at epidemic breakout stage. Separation of powers was intended to cripple the government so that it wouldn't become the despotic oligarchy that it is rapidly morphing into.

[Harlan Huckleby]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

Which parts of the Constitution do you believe are specific the the midset of the 1780s?



how about the 3/5ths clause, that declared a black to be 3/5 of a full citizen.

I just throw this obvious one out there to show how differently people were wired 200 years ago.

[Harlan Huckleby]

the founders understood that Government is intrinsically BAD - it is corruptable, it becomes corrupt, it IS corrupt.

the founders just got done escaping the tyranical grips of King George. ITs understandable that their mindset would be very leery of government.

ITs true that over time we've become more trusting of government.

Your view that government is inherently evil is not shared by a majority of Americans. Government has a mixed record.

Honestly, I think philisophical arguments about whether government is inherently good or evil are pointless. Its like saying a running game is inherently good or evil. Obviously it is needed in correct moderation, and that is the debate.

[mraynrand]

Your view that government is inherently evil is not shared by a majority of Americans. Government has a mixed record.

Honestly, I think philisophical arguments about whether government is inherently good or evil are pointless. .

Evil? i said corrupt. All governments are corrupted. Yes, there is a mixed record. Government does some good, but it is corrupt. I would say the 9% approval rating for Congress suggests more may think that government is inherently corrupt.

The reason to continue the philosophical debate is to convince people that less government is better. I think it can be done, but people want their handouts, even if they see shitty government in action.

[Kiwon]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

I suppose you think changes have to come strictly through amendment rather than court interpretation.

No and yes.

[HowardRoark]

IF the constitution were not allowed to evolve in meaning, we would be trapped by the mindset of the 1780's.

Which parts of the Constitution do you believe are specific the the midset of the 1780s?



how about the 3/5ths clause, that declared a black to be 3/5 of a full citizen.

I just throw this obvious one out there to show how differently people were wired 200 years ago.

Do you know why they were 3/5 of a full citizen? Without this, there is a good chance slavery would have lasted a lot longer.

[Harlan Huckleby]

Do you know why they were 3/5 of a full citizen? Without this, there is a good chance slavery would have lasted a lot longer.

I think it was some sort of compromise, that allowed the southern colonies to move from Articles of Confederation to a tigher union under the constitution. I don't know why you say that this compromise helped end slavery quicker, but I bet you're gonna tell me.

My example is not a good one for your question, I know you were looking for more fundamental notions. The federalists clearly thought of the states as autonomous regions. We've evolved towards a stronger central gov, much to the chagrin of you 1780's guys, but it did allow, for just one example, civil rights for blacks in the 1960's. And an interstate highway system.

Or, you could even look as early of Marbury vrs. Madison, http://en.wikipedia.org/wiki/Marbury_v._Madison, where the notion of judicial review by the Supreme Court was put in place. That is a concept that the original founders didn't think of, and has served the country well.

I was thinking of our Continentel Soldiers - Partial, Wist, MrAynRand, Cy and perhaps yourself - who think the 1780's "rocked", as Ayn said. The book "A Confederacy of Dunces" is about a guy who thinks that political thought and social life peaked at about 1350, and everything since has been a big mistake. Ignatius T. Reilly would fit in nicely with your club.

[sheepshead]

so you want these people in charge of health care?



http://abclocal.go.com/wls/story?section=news/local&id=6502412

[Harlan Huckleby]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

[bobblehead]

Quick Q and A:

Q: you wake up in the morning and your arm hurts. do you:

1) go to a HMO provider and say "ouch"
2) wait a week to see if it gets better and save $70
3) find a reputable doctor who works for someone other than the HMO paying the bill?

hint: only one answer is indicative of free market capitalism.

[Harlan Huckleby]

yes, making people pay for services out of pocket would drive down demand and costs. If your only consideration is lower costs, this will work. The effect on people is another issue.

If you believe the major dysfunction in our health care system is massive numbers of people seeking unnecessary services, then I would just say you are locked into an ideology and ignoring reality.

[Fosco33]

Harlan-

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

From an insider perspective, I see those examples where the CDM is way out of line - mostly for out-of-network carriers (disincentives) and self-pay (force primary care or get some money from a large bill).

The cost of hc and depletion of resources (MDs, nurses) along with the growing need (based on wanting to provide equal care to all people, aging of America, etc) is the downfall. The current delivery and reimbursement are smaller matters.

[GK]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

I think I have figured out what you do not understand. You keep referring to the insurance companies as the consumers. The insurance companies are not the consumers. Let me repeat that again - the insurance companies are not the consumers.

You are the consumer.

I am the consumer.

Insurance companies are motivated by market forces to decrease costs. So what do they do? They eliminate services. Here is the important point - they are completely unqualified to make those decisions.

There are two major flaws with your contention that there is a "free market" in health care right now:

1) Insurance companies are not consumers. They are big businesses that are in the business of maximizing profit (as they should be). How do they do that? Get as much money from customers as possible, and pay out as little as possible. What does this lead to? High premiums, and lack of payment of health care services. Sound familiar? Patients themselves have a different motivation. They are not purely trying to maximize profit. Sure, they are partially trying to "maximize profit" (keep more of their own money), but they are also trying to maximize their own health and well being. Insurance companies have no ability, no ability whatsoever, to maximize a patient's well being. They have no interest in it at all. But the individual patient has a tremendous ability to maximize his own health and well being, because that is what he has an interest in. This distinction is worth billions of dollars.
2) By pushing the responsibility of controlling the market from patients to insurance companies, you have just guaranteed that billions of dollars that could be spent on mammograms, surgeries, and vaccinations (if spent by patients) is now spent on paperwork, meetings, seminars in Florida, and IT infrastructure, by an industry whose sole purpose is to minimized the amount of healthcare that is delivered to actual patients.

So stop saying that "there is a free market in healthcare" right now. There is not. Your contention that insurance companies are the consumers in healthcare (rather than the patients) is foolish. By a historical aberration, insurance companies have established a position that they are not willing to give up. But it is very clear that insurance companies are the polar opposites of "health care consumers." They want to siphon money out of the system while making sure that patients get as little care as possible.

You say that a free market in health care doesn't work. How do you know? It has never been tried.

Imagine that a magical, wonderful, superhero could overnight change our healthcare system (I know, I know, most of you liberals have already been imagining a magical superhero fixing your lives. And I am sure Dear Leader will be able to do it, too! Hope!), and put $15,000 in the hands of every American, to be spent on healthcare. No more big insurance contracts. No more middlemen. Just health care producers (doctors and hospitals), and health care consumers (patients). What would happen? What would doctors' offices do? What would hospitals do? What would people do? How long would CT scans continue to be $2000? Three days? Two days? What price would they drop to? How long before there would be spa services in hospitals? How nice would those delivery rooms become? How long before a guy could get a PSA blood test from a kiosk at the mall for three dollars?

Please don't argue against free markets. It makes you look silly.

[GK]

I was just listening to a guest host on the Rush Limbaugh Show explain why health care costs are high and everything is screwed up.

He says there is no free market, and nobody cares that aspirin costs $50 on a medical bill.

NO WONDER YOU CONSERVATIVES ARE SO IGNORANT ON HEALTH CARE. Apparently the convervative talking points from your gurus are full of the same nonsense that you repeat here.

We currently have a free and active market for health care services. Insurance companies are super-informed, motivated consumers who are constantly bargaining and arguing for lower costs with providers. OF course they fucking care - you think they like paying more?

And in this mythical "free market" of happy shoppers some of you have spoken of, do you propose to eliminate insurance companies from the bargaining? How would this even effect the ability of individual consumers to comparison shop?

A free market in health care doesn't work, that's the fundamental problem we face. A market only wants to insure healthy people, and many businesses and individuals can't afford coverage. Conservatives are hiding from reality.

If you think insurance companies are the consumers in health care, do you also think that schools are the consumers in education?

[Fosco33]

GK-
Welcome to PR.

I mostly agree with your above posts. Although there is some incentive by insurance companies to have healthier members. It costs less for preventative care and alternatives to expensive care (unneeded surgeries, drugs, ER visits, long IP stays, etc.). That's why we have SNFs, LTACs, rapid care and even incentives of lower premiums by passing medical tests (also a company initiative). My ins carrier has 'free' call centers that answer patient questions and help direct appropriate care routes (lower cost). In reality, insurance companies make their money from healthy, young patients. 80% of a person's lifetime hc cost is used in the last 20% of their life (love Pareto).

I'm not sure where the $15K number comes from... is it that admin is eliminated (overhead) and it comes from each family? Is the 15K per person (if so, imagine an average fam of 4 making $40K paying $60K for hc). I know where you're going with the free market concept - and I generally agree. I typically loathe Walmart - but their in-store clinics could be a new model of cheaper care.


Check out the latest proposal to fix hc. It's a joke.
http://www.boston.com/news/health/articles/2008/11/13/baucus_blueprint/

Force companies to provide insurance :roll:
Look up the history of employer provided hc... how far we've come :oops:
http://findarticles.com/p/articles/mi_m1094/is_n2_v28/ai_13834930/pg_2

Lower Medicare eligibile age :roll:

Medicare's insolvency date was lowered to something like 2018 a few years ago and is likely even lower today. My guess last year was 2015 - with this proposal it'd be broke in a matter of years.

I heard a terrific speaker (one of the top in the industry) - his take - lower benefits and raise eligibilty to 90 years old. And it still would not be a long-term viable program.

[Harlan Huckleby]

Quick Q and A:

Q: you wake up in the morning and your arm hurts. do you:

1) go to a HMO provider and say "ouch"
2) wait a week to see if it gets better and save $70
3) find a reputable doctor who works for someone other than the HMO paying the bill?

hint: only one answer is indicative of free market capitalism.

bobblehead,

I've thought more about your point, which is certainly true and valid in principle. Now you have to test the theory against experience.

Leaving aside the negative consequences of pressuring people into avoiding doctors, my impression is that only modest savings could be realized from reducing services. Its not credible that excessive demands for services are currently a huge part of our health care problem. Seeing an HMO doctor is a time-consuming journey, HMO's are already filtering like mad. Those waiting rooms are not filled with malingerers.

I think health care is fundamentally different from say, the market for TVs. It is relatively cost inelastic. People NEED to get antibiotics for an infection. I don't believe that most health care is discretionary. Putting off health care purchases often costs rather than saves.

[Harlan Huckleby]

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

I can't decipher these details. But you verify that the insurance companies are negotiating contracts, demanding discounts. Ultimately they are paying the bills, so the bottom line is they are controlling costs. There are many insurance companies and many providers - that's a market.


The cost of hc and depletion of resources (MDs, nurses) along with the growing need (based on wanting to provide equal care to all people, aging of America, etc) is the downfall. The current delivery and reimbursement are smaller matters.

This sounds right to me. My primary reason for supporting single-payer health care is not to control costs, that is a bonus.

[Fosco33]

Most insurance companies (and gov't providers) DONT care about individual 'costs' of healthcare.

For one, they get tremendous contractual discounts and often pay on a per diem or DRG basis (meaning set amounts).

I can't decipher these details. But you verify that the insurance companies are negotiating contracts, demanding discounts. Ultimately they are paying the bills, so the bottom line is they are controlling costs. There are many insurance companies and many providers - that's a market.


It means a hospital could provide infinite amount of care for 'X' diagnosis (DRG). No matter the actual cost is, the insurance company (and Medicare) only pays 'Y' amount.

In fact, there are TONS of charges that are never entered on bills for precisely that reason. Something like 80% of lab charges at many institutions are never even billed. Many supplies/trays and consults are missed, too. They call it 'charge capture'. Only works when insurance companies have to pay '% of charges' type contracts.

Regardless, those missed supplies/drugs/etc cost the hospital. The list price is irrelevant.

[Harlan Huckleby]

I think I have figured out what you do not understand. You keep referring to the insurance companies as the consumers. The insurance companies are not the consumers. Let me repeat that again - the insurance companies are not the consumers.

You are the consumer.

I am the consumer.



Insurance Companys are ALSO consumers. They are shopping among health care providers. They are in a different market than we end users are, they are shopping for different services. But they most assuradly are in a free market.


1) Insurance companies are not consumers. They are big businesses that are in the business of maximizing profit (as they should be). How do they do that? Get as much money from customers as possible, and pay out as little as possible. What does this lead to? High premiums, and lack of payment of health care services. Sound familiar? Patients themselves have a different motivation. They are not purely trying to maximize profit. Sure, they are partially trying to "maximize profit" (keep more of their own money), but they are also trying to maximize their own health and well being. Insurance companies have no ability, no ability whatsoever, to maximize a patient's well being. They have no interest in it at all. But the individual patient has a tremendous ability to maximize his own health and well being, because that is what he has an interest in. This distinction is worth billions of dollars.
2) By pushing the responsibility of controlling the market from patients to insurance companies, you have just guaranteed that billions of dollars that could be spent on mammograms, surgeries, and vaccinations (if spent by patients) is now spent on paperwork, meetings, seminars in Florida, and IT infrastructure, by an industry whose sole purpose is to minimized the amount of healthcare that is delivered to actual patients.


I agree with much of what you say. I wish the Insurance Companies would go to hell.
It's your advocacy of a free markiet that keeps them in business.



So stop saying that "there is a free market in healthcare" right now. There is not.

We just have to agree to disagree about whether insurance companies are consumers in a free market.

But you and I as end consumers can shop for services right now. There are PLENTY of uninsured people looking for services and price shopping between providers - THAT IS A FREE MARKET.
I have been there.
That free market sucks ass!! Uninsured people pay much higher prices for services than the insurance companies. And you or nobody else have every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

[Fosco33]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

[Harlan Huckleby]

It means a hospital could provide infinite amount of care for 'X' diagnosis (DRG). No matter the actual cost is, the insurance company (and Medicare) only pays 'Y' amount.

In fact, there are TONS of charges that are never entered on bills for precisely that reason. Something like 80% of lab charges at many institutions are never even billed. Many supplies/trays and consults are missed, too. They call it 'charge capture'. Only works when insurance companies have to pay '% of charges' type contracts.

Regardless, those missed supplies/drugs/etc cost the hospital. The list price is irrelevant.

OK, I do follow what you are saying, it sounds about how I figured things work. The detail you provide doesn't really support either side of the debate, it cuts both ways.

[Harlan Huckleby]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

sounds like you have damn cheap health insurance! Who are you blowing?

Again, what you are saying is interesting, but it just seems to argue that the current system is rotten, which everyone agrees on.

My head hurts. Enough for me.

[Fosco33]

Uninsured people pay much higher prices for services than the insurance companies. And you or nobody has every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

True and false.

About 5% of all non-profit hospital charges are written off to charity cases (uninsured). A good amount of uninsured patients are given decent discounts (usually 20-30%) and don't pay ANY monthly premiums (I pay like $4K/yr for my family's insurance - and I haven't seen a doctor in 10 years - do the math). I could've easily paid for catostrophic insurance or paid for most services straight-up had I been uninsured.

Also realize that many uninsured simply don't pay the bill. They get sent to debt collectors who have a very low recovery rate. Current legislation protects these patients as well. Average bad debt rates for non-profits are about 3-5% of charges - with over 50% coming from uninsured patients.

Also look up the trends in hc. CA has laws on the books basically having uninsured patients being charged no more than the reimbursement from CARE/CAID. Other states have similar things in the works.

sounds like you have damn cheap health insurance! Who are you blowing?

Again, what you are saying is interesting, but it just seems to argue that the current system is rotten, which everyone agrees on.

My head hurts. Enough for me.


Haha. I work for the nation's largest, highest rated hc consulting firm in revenue cycle and am one of the 'experts' - so I better get damn good coverage (up until last year, I didn't have any premiums)...

My head hurts too. :lol:

[bobblehead]

Quick Q and A:

Q: you wake up in the morning and your arm hurts. do you:

1) go to a HMO provider and say "ouch"
2) wait a week to see if it gets better and save $70
3) find a reputable doctor who works for someone other than the HMO paying the bill?

hint: only one answer is indicative of free market capitalism.

bobblehead,

I've thought more about your point, which is certainly true and valid in principle. Now you have to test the theory against experience.

Leaving aside the negative consequences of pressuring people into avoiding doctors, my impression is that only modest savings could be realized from reducing services. Its not credible that excessive demands for services are currently a huge part of our health care problem. Seeing an HMO doctor is a time-consuming journey, HMO's are already filtering like mad. Those waiting rooms are not filled with malingerers.

I think health care is fundamentally different from say, the market for TVs. It is relatively cost inelastic. People NEED to get antibiotics for an infection. I don't believe that most health care is discretionary. Putting off health care purchases often costs rather than saves.

My point wasn't limiting services...it was not wasting them. It was also meant to point out that the doctors effectively work for the HMO's the way it is now. They are NOT competing to provide excellent service. If your arm hurts in a week I want you to go to the doctor...of your choice....who doesn't make an appointment for 1pm and finally see you at 2:15PM. I also want him to actually take a good look at it and not prescribe motrin and hope you don't come back for something more expensive because he works effectively for the guy paying the bill and if he runs up too much expense the guy paying the bill will pull his preferred provider status and he will have to try and make a living outside the network...the very network that controls 90% of the capital.

[Harlan Huckleby]

My point wasn't limiting services...it was not wasting them.

Your intention is to save money by avoiding waste, and you will succeed to some extent. But by putting more of the cost on the end consumer, the result is that you deliver less service, that's where your savings come from. You gave the best-case scenario as an example - somebody forgoes a service they don't really need - but there will be many more unintended and unpleasant consequences.


It was also meant to point out that the doctors effectively work for the HMO's the way it is now. They are NOT competing to provide excellent service.

But the HMO is competing for customers. The doctor reports to the HMO. Why do HMO's advertise like crazy, trying to convince people they are so swell and caring? Maybe the market is shitty and expensive for consumers, but it is a market. Many of the factors that work against the current market will plague your new market. And I think Fosco's points about the real costs of health care make this clear.

BTW, I don't think HMO's are so bad. They provide OK service for their members. I suppose some are better than others, I've been in three HMO's over the years that worked passably.


If your arm hurts in a week I want you to go to the doctor...of your choice....who doesn't make an appointment for 1pm and finally see you at 2:15PM. I also want him to actually take a good look at it and not prescribe motrin and hope you don't come back for something more expensive because he works effectively for the guy paying the bill and if he runs up too much expense the guy paying the bill will pull his preferred provider status and he will have to try and make a living outside the network...the very network that controls 90% of the capital.

I see what you are getting at. If we got rid of HMO's and Insurance Companies, and consumers just shop directly for service, it will work well for some people, and there will be more direct accountabilty to the end customer.

There are many problems with this model.
1) How do you propose to get there from here? How or why would the HMO and Insurance companies disappear?
2) Whereas your model should result in some cost savings for some, it does NOTHING to deal with the problems of high risk or poor Americans. And this is a lot of people, growing every day in the weak economy.
3) You still haven't explained why health care costs are so high for uninsured people now. They can comparison shop. Right now there are plenty of doctors and providers outside HMOs available for "free market" service. By what magic would your market be so much better than the shit situation we see today? There will be more people, but economies of scale aren't going to kick-in with a labor-intensive, personal service like health care.


We both want to slay the dragons of the HMO's and Insurance Companies. Your answer is a market where people shop till they drop. I want Big Bro to expand medicaid and pay for all basic services. (LEaving a private market for premium services.)

I know the arguments against a government approach. But it is working pretty well all over the world.
Your notion is theoretical, no developed country currently does anything like your approach. And I say for good reason, the unintended consequences would be disasterous.

[GK]

I think I have figured out what you do not understand. You keep referring to the insurance companies as the consumers. The insurance companies are not the consumers. Let me repeat that again - the insurance companies are not the consumers.

You are the consumer.

I am the consumer.



Insurance Companys are ALSO consumers. They are shopping among health care providers. They are in a different market than we end users are, they are shopping for different services. But they most assuradly are in a free market.


1) Insurance companies are not consumers. They are big businesses that are in the business of maximizing profit (as they should be). How do they do that? Get as much money from customers as possible, and pay out as little as possible. What does this lead to? High premiums, and lack of payment of health care services. Sound familiar? Patients themselves have a different motivation. They are not purely trying to maximize profit. Sure, they are partially trying to "maximize profit" (keep more of their own money), but they are also trying to maximize their own health and well being. Insurance companies have no ability, no ability whatsoever, to maximize a patient's well being. They have no interest in it at all. But the individual patient has a tremendous ability to maximize his own health and well being, because that is what he has an interest in. This distinction is worth billions of dollars.
2) By pushing the responsibility of controlling the market from patients to insurance companies, you have just guaranteed that billions of dollars that could be spent on mammograms, surgeries, and vaccinations (if spent by patients) is now spent on paperwork, meetings, seminars in Florida, and IT infrastructure, by an industry whose sole purpose is to minimized the amount of healthcare that is delivered to actual patients.


I agree with much of what you say. I wish the Insurance Companies would go to hell.
It's your advocacy of a free markiet that keeps them in business.



So stop saying that "there is a free market in healthcare" right now. There is not.

We just have to agree to disagree about whether insurance companies are consumers in a free market.

But you and I as end consumers can shop for services right now. There are PLENTY of uninsured people looking for services and price shopping between providers - THAT IS A FREE MARKET.
I have been there.
That free market sucks ass!! Uninsured people pay much higher prices for services than the insurance companies. And you or nobody else have every explained how allowing everybody to become effectively uninsured, negotiating for themselves, would result in a favorable market for consumers.

You are not seeing my point. (Actually, isn't that the lifeblood of the Packerrats board?) But kidding aside, you cannot look at current "little free markets" in healthcare and use them to draw conclusions about a true free market in healthcare. To use an example from real life, in the old Soviet Union black market blue jeans cost a ton of money. Did that mean they really cost a lot of money? They were cheap in the US, a truly free market. So when 90% of a market is being manipulated by central forces, and a little part tries to be free, it doesn't work.

What if we all had grocery insurance? (Come to think of it, food is more important to life than healthcare, so why don't we have grocery insurance?) What if our employers bought our grocery insurance for us, and we would just go to the store, fill up our carts, not look at the bill, and then submit the receipt to our employer provided grocery insurer. It would all be taken care of for us, because food is essential to life. What would happen to the price of a gallon of milk after three years of this? What if millions of people did not care what groceries cost? After ten years of this, the entire supply chain would be inflated. So then, what if after milk became twenty dollars a gallon, a few people wanted to start a little market to "introduce market forces?" It wouldn't matter. All the wholesalers would be charging heavily inflated prices because the majority of the industry would support that. Who would care about the fledgling little free marketeers? No one. They wouldn't matter, and prices would be just as high as they were anywhere.

You need to introduce market forces everywhere, if you are going to introduce them anywhere.

[HowardRoark]

I agree that the solution to the problem (costs rising too fast and limited access) is truer free markets.

I find this discussion interesting. Especially as it seems there is an actual expert on the subject posting. I have always, perhaps simplistically, thought that high deductible plans combined with HSAs would be a good solution. Fosco33 what is your opinions on this?

If we could scrap the entire system as it is now and start over….take away all the side arguments, what would be the best system? I currently pay out of my pocket around $15,000 pre-tax for my health care insurance for me and my family. If I could put a similar dollar amount into an HSA, while also funding a high deductible account for major issues, I believe I (as well as wife) would be more selective in how we would spend money out of the account. In the aggregate, if everyone in the country would be doing the same, it would force healthcare to improve while brining down the cost.

To Harlan’s point on pre-existing conditions, I wonder about that too. I am a perfect case study. Healthy 39 year old, stroke, heart surgery; could I even get a high deductible policy anymore? I don’t know. But I would guess that a business person could sell policies that have higher premiums from the start but could not kick you out if you ever had a major issue. Once again, letting the market place come up with the solution.

As for the truly uninsured, I think that is an entirely different subject. But the free markets would bring down costs and raise services.

[bobblehead]

I agree that the solution to the problem (costs rising too fast and limited access) is truer free markets.

I find this discussion interesting. Especially as it seems there is an actual expert on the subject posting. I have always, perhaps simplistically, thought that high deductible plans combined with HSAs would be a good solution. Fosco33 what is your opinions on this?

If we could scrap the entire system as it is now and start over….take away all the side arguments, what would be the best system? I currently pay out of my pocket around $15,000 pre-tax for my health care insurance for me and my family. If I could put a similar dollar amount into an HSA, while also funding a high deductible account for major issues, I believe I (as well as wife) would be more selective in how we would spend money out of the account. In the aggregate, if everyone in the country would be doing the same, it would force healthcare to improve while brining down the cost.

To Harlan’s point on pre-existing conditions, I wonder about that too. I am a perfect case study. Healthy 39 year old, stroke, heart surgery; could I even get a high deductible policy anymore? I don’t know. But I would guess that a business person could sell policies that have higher premiums from the start but could not kick you out if you ever had a major issue. Once again, letting the market place come up with the solution.

As for the truly uninsured, I think that is an entirely different subject. But the free markets would bring down costs and raise services.

Howie, here is my free advice and I am being sincere. Drop the 15k policy and put it into an HSA. Research medical tourism (start with PlanetHospital). Ty has talked about this at times, but honestly you can get as good/better care in certain hospitals overseas for a fraction of the cost. Usually around 15%. Pay for the little annoying costs that you would never travel for out of the HSA, but if you need something like orthopedic surgery or worse you can pay for a ticket, get the surgery, get superior post care for under 10k usually.

I have company sponsored health that costs me almost nothing, but I still hit bumrungrad hospital in thailand for a MONSTER comprehensive physical for $350 every 2 years. There is a hospital in India that does heart bypasses for 6k (96k in america) and has a 99.6% success rate. I hate to admit it, but national healthcare is coming, and those of us with the means will probably seek quality care elsewhere as the quality here plummets.

[Harlan Huckleby]

What if our employers bought our grocery insurance for us, and we would just go to the store, fill up our carts, not look at the bill, and then submit the receipt to our employer provided grocery insurer.

Stop.

Pigging-out on steaks and Hagan Daas is quite different from getting annual flu shots, or getting a prostate exam, or getting stitches for a wound. (All services that people without health insurance often forgo because of cost.)

We're trying to have a serious conversation. The notion that people are eager to devote hours to sit in hospital waiting rooms to pig-out on services they don't really need is absurd.



What would happen to the price of a gallon of milk after three years of this? What if millions of people did not care what groceries cost? .

Even in your silly example, you ignore that there are still cost control forces at play. The employer's insurance cost is going to depend on the cost of the services. The end consumers don't care about price, but there are larger players who very much care.

you ignore realities that conflict with your theory in the case of healthcare, your hypothetical is just more of the same.


So then, what if after milk became twenty dollars a gallon, a few people wanted to start a little market to "introduce market forces?" It wouldn't matter. All the wholesalers would be charging heavily inflated prices because the majority of the industry would support that.

:lol: You have created an entire industry that supports heavily inflated prices. They must pay those prices, but they "support" them because ... I guess I missed that part. This is a very strange conspiracy, and very strange view of economics.


You need to introduce market forces everywhere, if you are going to introduce them anywhere.

You have addressed none of the problems of a free market in the case of health care, I guess you don't want to think about it too much. You are speaking in pure dogma.