Is health care a right?

[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.

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.