The Myth of Free-Market Health Care in America

Why other Western countries offer no panacea for American woes

ObamaCare is in retreat. That much was clear the moment the president started springing B-grade Hollywood references to "blue pills and red pills" in its defense during his news conference last week. But before ObamaCare can be beaten back decisively, its critics need to answer this question: How did his plan for a government takeover of roughly a fifth of the U.S. economy get this far in the first place?

The answer is not that Democrats have a lock on Washington right now—although they do. Nor that Republicans are intellectually bereft—although they are. The answer is that both ObamaCare's supporters and opponents believe that—unlike Europe—America has something called a free market health care system. So long as this myth holds sway, it will be exceedingly difficult to prescribe free market fixes to America's health care woes—or, conversely, end the lure of big government remedies.

The fact of the matter is that America's health care system is like a free market in the same way that Madonna is like a virgin—i.e. in fiction only. If anything, the U.S. system has many more similarities than differences with France and Germany. The only big outlier among European nations is England, which, even in a post-communist world, has managed the impressive feat of hanging on to a socialized, single-payer model. This means that the U.K. government doesn't just pay for medical services but actually owns and operates the hospitals that provide them. English doctors are government employees!

But apart from England, most European countries have a public-private blend, not unlike what we have in the U.S.

The major difference between America and Europe of course is that America does not guarantee universal health insurance whereas Europe does. But this is not as big a deal as it might seem. Uncle Sam, along with state governments, still picks up nearly half of the country's $2.5 trillion annual health care tab.

More importantly, contrary to popular mythology, America does offer public care of sorts. It directly covers about a third of all Americans through Medicare (the public program for the elderly) and Medicaid (the public program for the poor). But it also indirectly covers the uninsured by—at least in part—paying for their emergency care. In effect, anyone in America who does not have private insurance is on the government dole in one way or another.

This is not radically different from France, where the government offers everyone basic public coverage, of course—but a whopping 90% of the French also buy supplemental private insurance to help pay for the 20% to 40% of their tab that the public plan doesn't cover.

Meanwhile, in Germany, about 12.5% of Germans who are civil employees or above a certain income opt out of the public system altogether and rely solely on private coverage—even though they know it is well nigh impossible to return to the public system once they switch. And more Germans likely would go private if they were not legally banned from doing so.

The most striking similarity between America, France and Germany, however, is the model of "insurance" upon which their health care systems are based. In other insurance markets, the more coverage you want, the more you have to pay for it. Consider auto insurance, for instance. If you want everything—from oil changes to collision protection—you'd have to pay more than someone who wants just basic collision protection. That's not how it works in health care.

For the same flat fee—regardless of whether it is paid for primarily through taxes as in France and Germany or through lost wages as in America—patients in all three countries effectively get an ATM card on which they can expense everything (barring co-pays) regardless of what the final tab adds up to. (Catastrophic coverage plans are available in America, but the market is extremely limited for a number of reasons, including the fact that most states have issued Patients Bill of Rights mandating all kinds of fancy benefits even in basic plans.)

Thus, in neither country do patients have much incentive to restrain consumption or shop for cheaper providers. In America and Germany, patients don't even know how much most medical services cost. In France, patients know the prices because they have to pay up front and get reimbursed by their insurer later—a lame attempt to ensure some price consciousness. But since there is no cap on the reimbursed amount, the French sometimes shop for doctors based on such things as office decor rather than prices, according to a study by David Green and Benedict Irvine, researchers at Civitas, a London-based think tank. (Green and Irvine reported this as a good thing.)

So what are the consequences of this "insurance" model and how are the three countries coping with it? America, as Obama continuously reminds us, spends 16% of its gross domestic product on health care—the highest percentage in the world. If current trends persist, in 75 years health care will consume about 50% of the GDP—and all of the federal budget. But France is not doing a whole lot better. Its health care system is the third most expensive in the world with over 11% of its GDP going toward health care—nearly three times more than the amount in 1960. The French fork over more than 20% of their income in taxes for public coverage (and another 2.5% to purchase supplemental private coverage)—yet their public program suffers from chronic deficits. Germany, similarly, spends about 11% of its GDP on health care with Germans contributing more than 15% of their income toward buying health care.

If France and Germany are not spending even more on health care, one big reason is rationing. Universal health care advocates pretend that there is no rationing in France and Germany because these countries don't have long waiting lines for MRIs, surgical procedures and other medical services as in England and Canada. And patients have more or less unrestricted access to specialists.

But it is unclear how long this will last. Struggling with exploding costs, the French government has tried several times—only to back off in the face of a public outcry—to prod doctors into using only standardized treatments. In 1994, it started imposing fines of up to roughly $4,000 on doctors who deviated from "mandatory practice guidelines." It switched from this "sticks" to a "carrots" approach four years later, and tried handing bonuses to doctors who adhered to the guidelines.

Meanwhile, in Germany, "sickness funds"—the equivalent of insurance companies—have imposed strict budgets on doctors for prescription drugs. Doctors who exceed their cap are simply denied reimbursement, something that forces them to prescribe less effective invasive procedures for problems that would have been better treated with drugs. But the most potent form of rationing in France and Germany—and indeed much of Europe—is not overt but covert: delayed access to cutting-edge drugs and therapies that become available to American patients years in advance.

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  • ||

    And the best first move toward a free market in health care, will be to break the AMA's monopoly cartel hold on the supply of new doctors in the US.

  • Kyle Jordan||

    Great pic. Love that movie.

  • mark||

    The Patients' Choice Act reforms Medicaid and turns it into a refundable tax credit with a debit card to pay for out-of-pocket medical costs or buy insurance.

    If you had seen the Michael Moore "documentary" Sicko you would have learned about Operation Coffee Cup and Ronald Reagan speaking out against Medicare. The sad irony, lost on Moore, is that Reagan was right. Medicare is the main reason why our health care system is out of control. Not sure how to reform it other than gutting it, though...

    On preview: What movie, Kyle?

  • Kyle Jordan||

    Planet Terror.

  • Paul||

    Great pic. Love that movie.

    Meh... I suppose it was the best of the group.

  • ||

    More importantly, contrary to popular mythology, America does offer public care of sorts. It directly covers about a third of all Americans through Medicare (the public program for the elderly) and Medicaid (the public program for the poor). But it also indirectly covers the uninsured by-at least in part-paying for their emergency care. In effect, anyone in America who does not have private insurance is on the government dole in one way or another.

    This disingenuous argument needs to die. Comparing emergency room visits to Universal Coverage is a bullshit argument. Considering that uninsured people have died waiting in overcrowded ERs, and many hospitals basically stabilize you and send you to the local county hospital, comparing that to actually being able to visit a doctor in their office when you get sick is the height of dishonesty.

  • ||

    CT, but the thrust of the article is right. We do not have a free market health care system. The gvt. is, by far, the biggest player. Its damn near 70% of the market.

  • ||

    As I have told MNG countless times, take a look at medical/health care costs pre-1964, the year of Medicare's birth, and today. The average Crowley could buy a lot more health care, out of his pocket, in 1963 than he could today. Health care expenses also constituted a much smaller percentage of the average Crowley's budget in 1963.

  • kilroy||

    "Considering that uninsured people have died waiting in overcrowded ERs"

    This is a triage problem, not an insurance problem.

    "comparing that to actually being able to visit a doctor in their office when you get sick is the height of dishonesty."

    I went years without any insurance at all. If I needed a doctor I went in and paid him. If I hadn't been able to afford it I would have gone to the ER and waited. Treatment was available.

    Who's being disingenuous here?

  • ||

    This is a triage problem, not an insurance problem

    Actually it's an overcrowding problem that is caused by a lack of insurance or lack of funds to pay out of pocket. Many ERs just can't keep up with the amount of sick people. The reason so many are in the ER is cuz they can't afford insurance of to see a doctor. So they go the ER where they know they wont be denied care.

    Who's being disingenuous here?

    The person pretending that a mandate that ERs don't turn away sick people without an ability to pay as being anywhere equivalent to universal coverage.

    People wait to go to the ER (when their illness gets much worse) because they can't afford a doctors visit or the doctor won't take them without insurance. Many doctors I have seen wont take self pay without a CC or some form of guaranteeing payment.

    CT, but the thrust of the article is right.We do not have a free market health care system

    Im not passing judgment on the overall article (at least not publicly right now) but if you have good arguments (and there definately are some) it takes away from your credibility when you present these dubious ones.

  • Seward||

    ChicagoTom,

    Note that the majority of people seeking care at an ER because they cannot get a PCP are folks with medicare/medicaid. Really, the insured take up a very small amount of healthcare costs in the U.S., partly because so many of them are both healthy and relatively wealthy.

    Furthermore, universal coverage does not mean universal access to healthcare. That has proven to be impossible to do in every nation that has tried to provide universal coverage. In other words, just because one has a card provided by the government that says you have coverage doesn't mean you'll actually get seen. Try as one might, even the government cannot get around the fact that healthcare is a commodity.

  • robc||

    The person pretending that a mandate that ERs don't turn away sick people without an ability to pay as being anywhere equivalent to universal coverage.


    Ending the mandate is a good start.

  • Seward||

    ChicagoTom,

    Actually it's an overcrowding problem that is caused by a lack of insurance or lack of funds to pay out of pocket.

    As I just noted, most ER visits for things that should have been addressed by a PCP are done by folks with medicare.

    The reason so many are in the ER is cuz they can't afford insurance of to see a doctor.

    no, the reason they are there is due to a shitty government run program which underfunds the services it covers so much that many doctors refuse to see patients with that coverage.

  • robc||

    Everyone has universal coverage. Just use cash.

  • Russ 2000||

    Considering that uninsured people have died waiting in overcrowded ERs, and many hospitals basically stabilize you and send you to the local county hospital, comparing that to actually being able to visit a doctor in their office when you get sick is the height of dishonesty.

    Ah yes. The old "You're being disingenuous, therefore I cannot be disingenuous" argument.

    Yeah, people die in emergency rooms. Uninsured AND insured. Of gunshot wounds, etc. Nobody gets shot in the abdomen and then calls a doctor for an appointment. And people in the US go to emergency rooms because they have the sniffles, insurance or no insurance.

  • Seward||

    robc,

    There is that cool hospitathat is pretty awesomel system in Florida which posts its prices .

  • Seward||

    robc,

    That should have read:

    There is that cool hospital system in Florida that posts its prices that is pretty awesome.

  • Russ 2000||

    Actually it's an overcrowding problem that is caused by a lack of insurance or lack of funds to pay out of pocket.

    DEAD FUCKING WRONG.

    The State of Illinois routinely denies requests to open new hospitals. THAT'S why there's a shortage. Also, how many years is the State Of Illinois behind on its Medicare and Medicaid payments?

    Sit in the legal department of a hospital for a few hours and everything you think you know about the health care system will be turned upside-down.

  • Seward||

    Russ2000,

    Yeah, there is this myth that there is this great sea of uninsured folks who are choking ERs. I think roughly 2-3% of healthcare costs are associated with the activities of the uninsured.

  • kilroy||

    So you think increasing the demand without increasing the supply of doctors will result in more people getting better healthcare? Really?

    You want to put everyone on medicare. That is essentially your solution as I understand it. This idea will wind up with a medical system that mirrors the educational system, where people will be forced to maintain a pitifully broken public system while also paying for their own private system.

    The only realistic solution is to get the government totally out of the healthcare market. 100% out, not 100% in.

  • Chad||

    Dalmia is more or less right until the end.

    The free market will not solve the problem, because no matter what kind of "insurance" you have, what YOU consume does not affect your bills. Indeed, that is the whole point of insurance! To the effect that this is not true (eg, co-pays), one is actually looking at at a lack of insurance.

    The market failure is not public vs private. It is insurance itself. Unfortunately, medical insurance is both a necessity and a market failure, regardless of who pays. Death with it.

  • ||

    Considering that uninsured people have died waiting in overcrowded ERs,

    [citation needed]

    I can tell you, from years of experience, that I find it very difficult to believe that anybody receives faster care in an ER if they are insured, or slower care if they are not.

    Actually it's an overcrowding problem that is caused by a lack of insurance or lack of funds to pay out of pocket.

    Oddly, when Massachusetts extended coverage, its ER costs went up, ER visits went up, and the percentage of non-emergency patients in the ER stayed flat. You can look it up.

  • ||

    The market failure is not public vs private. It is insurance itself. Unfortunately, medical insurance is both a necessity and a market failure, regardless of who pays. Death with it.

    RC'z Law, FTW!

  • ||

    The State of Illinois routinely denies requests to open new hospitals. THAT'S why there's a shortage.

    Linky?

    Also, how many years is the State Of Illinois behind on its Medicare and Medicaid payments?

    In Illinois the average delay of medicare/medicaid payment is 150 days.

  • ||

    Considering that uninsured people have died waiting in overcrowded ERs,

    [citation needed]


    One

    Two

    Now I'll grant that I don't know if these people were insured or not (the articles don't say), but they died waiting in the ER, and ERs are getting more and more crowded.

    At least part of that is because it has become the only way for some poor people to get any health care.

  • ||

    Sit in the legal department of a hospital for a few hours and everything you think you know about the health care system will be turned upside-down.

    I think I can confirm that.

    If this letter from the Illinois Hospital Association supporting the Illinois Certificate Of Need program doesn't turn you against it, nothing will.

    I fondly recall debating a member of the Wisconsin legislature on CON at a public forum, shortly before Wisconsin dumped its CON program, when I characterized CON as "Soviet-style central planning." Good times, good times.

  • ||

    Now I'll grant that I don't know if these people were insured or not (the articles don't say), but they died waiting in the ER, and ERs are getting more and more crowded.

    Well, I don't think anyone was denying that people die in ERs, CT.

    It was your implication that they die because they were uninsured, or that the ERs were crowded because of the uninsured, that remain unsupported.

  • ||

    So you think increasing the demand without increasing the supply of doctors will result in more people getting better healthcare? Really?


    Who are you talking to?

    I absolutely think the supply of doctors should be increased and the AMA should be destroyed.

    You want to put everyone on medicare. That is essentially your solution as I understand it. This idea will wind up with a medical system that mirrors the educational system, where people will be forced to maintain a pitifully broken public system while also paying for their own private system.

    People who have medicare actually like it. The complaint I see the most is that medicare underpays, but I doubt you would support raising the reimbursement rates for medicare, right?

  • ||

    It was your implication that they die because they were uninsured, or that the ERs were crowded because of the uninsured, that remain unsupported.

    I do believe that the lack of insurance for many has added quite a bit of patients to the ERs.

    In any case, my original point stands. ER mandates aren't anywhere near the same as guaranteed health care for the uninsured.

  • 24AheadDotCom||

    Here's a huge downside of Obama's healthcare plan. I'd suggest that libertarians use that against him - such as by attending townhalls to ask about that - except that's probably the only part of the plan they'd support.

  • ||

    So... if you make an illegal alien legal, and as a result, his income becomes taxed legally, and thus he pays taxes, how does this not help?

    I understand a big reason illegals are able to survive is by undocumented pay.. but if you force that to be come documented, imagine how much revenue that would bring.

  • ||

    I do believe that the lack of insurance for many has added quite a bit of patients to the ERs.

    How do you explain what happened in Massachusetts?

    How do you explain the fact that Medicaid patients use the ER for non-emergencies at at a rate almost 40% higherthan the uninsured?

    Almost 20 percent of all ER visits are made by Medicaid beneficiaries, who account for less than 15% of all U.S. residents. By contrast, only 12% of all ER visits are made by uninsured individuals, who make up nearly 15% of all U.S. residents.

  • ||

    Unfortunately, medical insurance is both a necessity and a market failure, regardless of who pays.



    You seem to have confused "insurance" with "what to pay doctors bill with". Insurance is to pay for unforeseen events.

    You get diagnosed with cancer or get hit by a bus, insurance is what you need.

    You and the wife want to have a baby, save up the cash for pre and post-natal care and delivery before she goes off the pill. Insurance for unforeseen complications fine. Oh, and the pills she takes before, those are out of pocket. I can't imagine having insurance to pay for birth control pills tan I can imagine having insurance to pay for tonight's supper.

    The sooner we set insurance free from the concept of "someone to pay all my medical expenses" to "something to protect me from unforeseen bankrupting expenses" the better.

    A first step is to eliminate the tie between employment and insurance. I'm not sure how but I think there are a lot of perverse incentives that have created the connection.

    As for the "what about the poor" complaint, insurance is not the answer. If poor people have needs beyond what hey can pay for with what they earn the answer is direct cash (or cash proxy - Medical Stamps?) relief.

    But in between rich and poor there are a bunch of folks who could afford medical care if they only budgetted for the out of pocket stuff (you know you're going to need that checkup this year, don't you?) and for the cost of premiums for a catastrophic insurance plan. These are people who just need to rethink their priorities.

    Those of us who have it have been lulled into a dangerously false sense of security, not to mention entitlement, by employer provided (either in whole or part) insurance. It is not a good model.

    And neither is a state plan. No matter how well they apper to work in Germany, France, England or Canada, those results won't be duplicated here. And all of their problems will be amplified.

  • ||

    While your logic makes sense given the term "insurance," you fail to acknowledge that the main reason most people HAVE insurance is so they can afford routine doctor visits. I went to see a doctor for a cough I couldn't shake while I was uninsured (due to switching jobs). It cost me 125$ JUST TO SEE THE DOCTOR. Before he saw me. (He diagnosed it as strep throat.)

    Most people can't afford to pay 125$ every time they go see a doc.

  • kilroy||

    "I absolutely think the supply of doctors should be increased and the AMA should be destroyed."

    Agreed, but you then lower the incentive to be a doctor by having the government dictate what they make. Lot's of people become doctors because they are certain to be relatively wealthy. Putting everyone in the country on medicare will certainly eliminate that incentive.

    "People who have medicare actually like it."

    I doubt the ones whose PCP won't take medicare any longer are very happy with it. I imagine they're hanging out in those crowded ERs you keep talking about.

    "The complaint I see the most is that medicare underpays"

    And it'll pay even less when it's the only show in town.

  • Russ 2000||

    The market failure is not public vs private. It is insurance itself. Unfortunately, medical insurance is both a necessity and a market failure, regardless of who pays. Death with it.

    Insurance in its original form is a mutual society - your premium is based on your risk level, higher risk = higher premium. The benefit of a mutual society is that the members get direct ownership shares and therefore share in the profits.

    Two things ruined that. First was FDR's wage freeze which was skirted by offering health insurance in lieu of additional wages - this eventually reduced the risk assessment to rubber-stamp nothingness. Second was the mutual societies de-mutualizing in the early 70's to became publicly traded corporations; the members took a back-seat to uninterested shareholders. Then health insurance became little different than any other fractional-reserve financial outfit. And we all know the non-existent risk assessment done by banks over the last 10 years. About the only risk assessment done today is a survey asking if you smoke or are on any meds.

    Until we stop our denial of how life and death works - the sick-n-poor die - costs will continue to rise beyond normal.

  • ||

    People who have medicare actually like it. The complaint I see the most is that medicare underpays, but I doubt you would support raising the reimbursement rates for medicare, right?

    Medicare isn't broken because of the care it provides. It's broken because of how much it costs to provide that care. The fact that Medicare underpays the market rate simply means that Medicare is indirectly subsidized by private payers, while obviously being directly subsidized by taxpayers.

    The problem with the public plan debate is that the people pushing it are failing to outline what services are going to be provided. There appears to be an implicit assumption by the populace that what is to be provided is access to medical care upon demand, and that care should include whatever is necessary to make a person "healthy". That's simply a false assumption.

    We will eventually have a health system that mimics our schools system. A massive government run monopoly that provides sub-standard care to everyone. This will co-exist with a private system for the wealthy. It's kinda what we have now, but it will become far more prevalent. And it will have all of the defects that the public school system has now, including administrative bloat, poor results, and costs that are influenced by the voting populace which also happens to be the ones getting paid by the government. But we're going this way because people simply aren't willing to accept the notion that a person could be denied a treatment because they can't afford it.

  • ||

    If this letter from the Illinois Hospital Association supporting the Illinois Certificate Of Need program doesn't turn you against it, nothing will.



    Holy crap, R C, I don't know whether to be shocked that such blatant rent-seeking goes on or whether to be shocked that nobody seems to recognise it for what it is.

  • Russ 2000||

    Linky?

    Here's one.

    http://www.dailyherald.com/story/?id=268113

    Don't have the time to look them all up. I know of one denied in Tinley Park last year as well. Needless to say, if you never heard of the Hospital Facilities Planning Board, your views on health care are questionable.

  • ||

    Wow, I'd kinda like someone to explain why we need a Certificate Of Need to build a hospital.

    Why not a Certificate Of Need to build a grocery store. Foods essential right. Got to have the right planning or everyone's gonna starve. Won't they?

    Like I said, I don't know whether to be shocked that such blatant rent-seeking goes on or whether to be shocked that nobody seems to recognise it for what it is.

  • roystgnr||

    Libertarians support welfare for new immigrants? I didn't even think libertarians supported welfare for native-born citizens, 24. You learn something new every day, I guess.

    Of course, libertarians do support people's rights to buy land from sellers in other countries, to live on land they own, to cross arbitrary lines on maps, etc. That doesn't necessarily imply that once someone has crossed such a line they ought to be able to vote the next day and get into the free government money line the day after.

  • Invisible Finger||

    But in between rich and poor there are a bunch of folks who could afford medical care if they only budgetted for the out of pocket stuff (you know you're going to need that checkup this year, don't you?) and for the cost of premiums for a catastrophic insurance plan. These are people who just need to rethink their priorities.

    My wife and I have a 5-bedroom house for my 2 kids in private school, plus a minivan and a Lexus on 6-year financing. We just can't afford health insurance.

  • kilroy||

    "If this letter from the Illinois Hospital Association supporting the Illinois Certificate Of Need program doesn't turn you against it, nothing will."

    Holy Shit! They put that in writing?

    Synopsis:
    Medi* is bankrupting us, kill the free-market alternatives so we can overcharge private insurance to make up for it.

  • ||

    Wow, I'd kinda like someone to explain why we need a Certificate Of Need to build a hospital.

    CON programs are an offshoot of the quasi-public system we have already. They're an attempt to regulate supply of services paid for by the general public (i.e. Medicare, Medicaid, and free ER) such that those services are better distributed geographically. They also come into play when justifying the use of the public purse in health facility construction.

    CON programs are a natural offshoot of a publicly funded system. It is logical for the government's administrative arm to do this, since that arm is attempting to manage costs and distribute services across a populace.

    Is it really all that surprising that CON programs exist?

  • ||

    As I always say, Invisible Finger, I'm always open to being corrected.

    Sounds like you're really struggling there. :)

  • ||

    You know, it's probably not that unreasonable to expect the government to fix what it broke in the first place.

    What makes me wonder is why anyone thinks doing more of what broke it is going to fix it.

  • ||

    R C Dean,

    Is it really all that shocking to state that for-profit health care will skew away from developing institutions that may obligate it (due to existing laws) to provide services for which the consumer won't pay and the government will underpay?

  • engineer||

    "And it will have all of the defects that the public school system has now, including administrative bloat, poor results, and costs that are influenced by the voting populace which also happens to be the ones getting paid by the government"
    And the problem, invariably, will always, always, ALWAYS be a lack of sufficient funding, so sayeth the ruler of Be'ethos.

  • Chad||

    You get diagnosed with cancer or get hit by a bus, insurance is what you need.

    You and the wife want to have a baby, save up the cash for pre and post-natal care and delivery before she goes off the pill. Insurance for unforeseen complications fine. Oh, and the pills she takes before, those are out of pocket. I can't imagine having insurance to pay for birth control pills tan I can imagine having insurance to pay for tonight's supper.


    The problem is that unlike a bus crash or your house catching on fire, health is opaque and cause-and-effect blurred to the point of the impossible to know. It's easy to understand why I can't buy, for example, insurance against a pre-existing fire at my house. But how does that work with health care. Say I have diabetes now. Can I "foresee" the negative consequences of that disease? If I have a heart attack, was it caused by diabetes or something else? Is it even meaningful to ask?

    The way health insurance would have to be in order to actually work would be for when you get a disease, your current insurance company would then be liable for ALL future costs related to that disease, even if you stopped paying tomorrow. Your new insurance company would then be liable for any new diseases only. That's how other insurances work...and it is obvious why health insurance can't work that way.

    There is a fundamental lack of knowledge that causes health insurance to differ from other, completely functional, insurance systems.

  • TallDave||

    In other words, just because one has a card provided by the government that says you have coverage doesn't mean you'll actually get seen.

    No kidding. They're assigning doctors via lottery in Canada, and people are pulling their own teeth in Britain for lack of dentists. Surprise, price controls lead to shortages.

    What makes me wonder is why anyone thinks doing more of what broke it is going to fix it.

    It's more than a little amazing. The problem with health insurance is, obviously, that it's too socialized -- there are so many mandated coverages that you as a consumer really have no choice(even if you don't want to insure against something you're still forced to) and the lower your risk the worse a deal insurance is for you, both of which means premiums keep going up and fewer people can afford or want coverage. The solution being offered is: more socialism, including mandated ratios between lowest and highest premiums, and coercive measures designed to FORCE healthy people to subsidize everyone else by fining them if they don't carry insurance.

    I don't see how anyone who's even been dealt a glancing blow with an economics textbook could imagine this is going to improve the situation.

  • ||

    There is a fundamental lack of knowledge that causes health insurance to differ from other, completely functional, insurance systems.

    It's almost shocking how many people don't understand that.

  • TallDave||

    Without the health planning program, Illinois would become the target for entrepreneurial specialty facilities
    ...
    A properly functioning health planning process provides protections against a... profit-driven market.




    Oh dear God that's scary.

  • ||

    Chad is Dr. Block from Planet Terror.

  • TallDave||

    Can I "foresee" the negative consequences of that disease? If I have a heart attack, was it caused by diabetes or something else? Is it even meaningful to ask?

    Yes. Actuaries compile huge amounts of data on these questions.

    The way health insurance would have to be in order to actually work would be for when you get a disease, your current insurance company would then be liable for ALL future costs related to that disease, even if you stopped paying tomorrow.

    That doesn't work either, because many diseases are not simple binaries where you either have them or don't but are a matter of degree.

    What's different is that if you knew your house was going to burn down twice a year no one would sell you fire insurance, but we socialize known health care costs into healthy people's premiums.

  • Invisible Finger||

    It's almost shocking how many people don't understand that.

    WTF?

    People know what happens with diabetes. People know what happens with bone cancer. There's these people called doctors and actuaries that study this stuff.

    The difficulty comes with research and being qualified for clinical trials. A change in insurance could mean the disqualification for clinical trials. Those trials are expensive and insurance companies won't pay for them when it's a pre-existing (to them) condition. You COULD legislate away things like "pre-existing condition" disqualification, but that will absolutely increase costs.

    R&D costs money and the majority of clinical trials are conducted in the US even though it makes up 5% of the world population. Some trials pay the patients, but these are still costs and are counted in the GDP figure.

  • mark||

    The way health insurance would have to be in order to actually work would be for when you get a disease, your current insurance company would then be liable for ALL future costs related to that disease, even if you stopped paying tomorrow. Your new insurance company would then be liable for any new diseases only. That's how other insurances work...and it is obvious why health insurance can't work that way.

    Because selling such a policy would no doubt be illegal?

  • ||

    Yes. Actuaries compile huge amounts of data on these questions.

    So what? That doesn't solve either:

    A) A substantial increase in policy costs.
    or
    B) A termination of the policy.

    Health insurance works fine for healthy people who break an arm. But it breaks down for people who have long lasting medical conditions. You can wish that society would be willing to accept that people with long lasting conditions would have to pay until they couldn't anymore and just deal with it once the money ran out. But that wish will never come true. And that will always leave us with, at a minimum, socialized medicine for the infirm and the poor.

  • ||

    I sure do miss Harry Browne. He was the one who coined the phrase how government will expand its power by "Breaking your leg" and then attempt to be the savior by offering you a crutch.

    The Fed's regulation of the health industry and programs such as Medicare/Medicaid have made it next to impossible to have Medical care a pay as you go system for anything more than a minor ailment.

    Let alone the States who have failed to curb health litigation.

    Ideally, health insurance would exist for those who obtain it while uninsured would either pay out of pocket like any other service. The indigent would be taken care of as a "charity case" by the hospital/doctors or the local community.

    The unfortunate state of affairs today is that if an individual who is uninsured or without a "medical card" were to suddenly have an accident or heart attack, they are left with a six figure bill and have no recourse other than bankruptcy.

  • TallDave||

    So what? That doesn't solve either: A) A substantial increase in policy costs.

    Sure it does. Match costs to benefits.

    But it breaks down for people who have long lasting medical conditions.

    An expensive, chronic condition is tragic, but whether it's one person's problem or society's problem is an open question. If we, as a society, want to continue to socialize such costs then we will have to accept ever-higher premiums. There is no free lunch.

    Anyone promising both full coverage and lower costs is a fool or a liar.

  • Anonymous||

    No, no. You people simply don't understand. There isn't enough information! Only the government has enough compassion to care for its subjects. Evil corporations are designed for profit, not compassion; therefore they will always oppress the consumer.

  • ||

    An expensive, chronic condition is tragic, but whether it's one person's problem or society's problem is an open question.

    It may be a debatable point, but society has clearly chosen to socialize it. You and I may not agree with that choice, but it's far more realistic to offer up a system that accounts for that choice vs. trying to change that choice.

    Anyone promising both full coverage and lower costs is a fool or a liar.

    Yes, and I said as much above. Socialized medicine implies rationed coverage. However, so does a private system. The only people without rationed coverage are Bill Gates and Warren Buffett.

    The reality is that you're not going to get this society to accept that:
    1) Hospitals should be able to turn away patients with no ability to pay.
    2) Doctors should stop treatment when patients run out of resources. Particularly elderly patients.
    3) Insurance companies should not refuse customers with pre-existing conditions and should not charge the people with pre-existing conditions the rates dictated by actuaries.

    Without an acceptance of those three points, socialized medicine is here to stay.

    In addition, you're faced with the constant struggle of what type of treatment should be used. Should it be the latest and greatest (and thus the most expensive) or should it be 1970's medicine? Everyone wants the latest and greatest. Cost control indicates otherwise. But there's a strong majority that believes that to deny someone an available new technology is tantamount to killing them. Again, we may not agree with this majority opinion, but it's there, it's not going away, and we need to present a policy proposal that deals with that.

    Thus, advocating for a fully privatized system is a fools errand. Killing off employer sponsored health care and mandatory insurance is probably the best that libertarians will be able to come up with.

  • Anonymous||

    Thus, advocating for a fully privatized system is a fools errand. Killing off employer sponsored health care and mandatory insurance is probably the best that libertarians will be able to come up with.

    If society creeps left, I guess I'll have to go with it. I have not chance of restoring personal liberty, but maybe we can bribe the warden to loosen the rack. After all, it's not like it will ever get to the point where our limbs will be torn from their sockets.

  • ||

    No, no. You people simply don't understand. There isn't enough information! Only the government has enough compassion to care for its subjects. Evil corporations are designed for profit, not compassion; therefore they will always oppress the consumer.

    Nice point. Even conceding that corporations are heartless, profit driven entities- those advocating goverment control over the health industry as a means to help those less fortunate deep down have a very cynical and warped view of human charity.

    Back in the old days Catholic hospitals would treat these charity cases on the basis of "good works" or bringing individuals into the faith. Since over time government has gradually stepped in by establishing a monopoly on the charity business, these kinds of actions have become almost non-existent.

  • SIV||

    And the best first move toward a free market in health care, will be to break the AMA's monopoly cartel hold on the supply of new doctors in the US.

    That might take a little while but it is probably more politically palatable than drug legalization (the whole pharmacopoeia)and the abolishment of government enforced professional licensure.

  • ||

    I have R.A. and trust me with this you do NOT want to depend on the goodwill of the government to help you...We will all be sorry if this passes

  • MNG||

    Yes, yes we don't have a perfect free market system. Also, the Soviet Union never achieved "true" communism at any time. But of course in the real world what we would do is compare in relative terms; if the U.S. has worse outcomes than nations with comparatively greater government interference in health care and more restricted markets in health care than that is telling of something.

  • MNG||

    '€Back in the old days Catholic hospitals would treat these charity cases on the basis of "good works" or bringing individuals into the faith.'"

    Oh yes, everyone got excellent coverage back in those days!

  • MNG||

    MP
    And why should we accept those things?

    We expect, for example, that the government will provide some minimum level of police protection to all persons, regardless of their "resources" or "pre-existing conditions", so why is it so far out to expect something in regards to health care? Sure it's a bitch when someone robs you, but its a bitch when you get a deadly stomach virus too. We don't tell the people in the first situation "hey life ain't fair", so why the second?

  • ||

    Rather then have the government directly messing with your life how about health vouchers that you can spend on yourself and family. That way you can exclude the ilegals

  • Mad Max||

    'Back in the old days Catholic hospitals would treat these charity cases on the basis of "good works" or bringing individuals into the faith. Since over time government has gradually stepped in by establishing a monopoly on the charity business, these kinds of actions have become almost non-existent.'

    You fascist bastard, what you fail to realize is that Catholic hospitals are a threat to the Republic because they fail to provide abortion, abortifacient methods of contraception, or sterilization. Trusting those theocrats to care for the poor is evil - the Catholic Church has a 2,000 year history of providing health care without also providing abortions and sterilizations. Clearly unacceptable in the modern age.

    Fortunately, we have groups like Merger Watch, to protect us from the horrifying possibility that Catholic hospitals might deny 'reproductive health services' - the most blatant euphemism for evil since the term 'domestic institutions' in the 1850s.

    As MNG so eloquently points out, this country would have been better off if Catholic hospitals had never existed - it would have decreased the surplus population.

  • ||

    I'm just finishing my thought: Health vouchers that you can use to buy insurance for chronic problems or save for emergencies. Government wouldn't need your information and you would check and find the best rates for doctors hosp. ect and you could make sure that it goes to the U.S. people

  • Mad Max||

    Here's a thought - there are a lot of American Catholics of a social-democratic bent who believe that the federal government has to Save Health Care. But they draw the line at federal subsidies for abortion (which would contradict existing federal policy as expressed in the Hyde Amendments) or at forcing health-care workers subsidized by taxpayers from being forced to do abortions (the Church Amendments, authored by a pro-abortion Senator, protect conscience rights).

    So, if you libertarians point out to these faithful Catholics that the Obama proposals will allow for taxpayer subsidies for abortion, overriding the conscientious scruples of health-care workers, then these folks could become as reliable fighters against Obamacare as you are.

    To start the ball rolling, why not ask (in an appropriately innocent tone) that Congress include language in the health bill to reaffirm the principles of the Hyde and Church Amendments - no taxpayer subsidy for abortion, no violation of the conscience rights of federally-subsidized medical personnel. If Congressional leaders reject such amendments (which they have done so far) then you can help make the health bill as good as dead.

    It depends on your willingness to make coalitions with the evil, icky Religious Right.

  • Gilbert Martin||

    "Both the supporters and opponents of ObamaCare believe that America-unlike Europe-has something called a free market health care system"

    There may be some opponents of Obama's healthcare deform plan who believe we have a free-market system but I doubt that all that many do.

    The left always wants to perpetuate the lie that we have a free market so the can try to blame the failures of government meddling on that (non-existent) free market and then claim that more government is needed to fix it.

    They did the same thing with the financial crisis - yapping about it being a free market failure - instead of a government meddling failure as it really was.

  • ||

    But how does that work with health care. Say I have diabetes now. Can I "foresee" the negative consequences of that disease?



    See, here we see the problems that the Chad's of the world have with life. They can't understand the concept of "tough luck".

    Yes, Chad, that's right.
    sometimes it's just "tough luck" what happens to some people.

    You see, I have relatives in Canada who have had bad outcomes from treatment that was fully paid for by the system. But, there's nothing anyone can do. "Tough luck". As an aside one of those cases would have done awfully well in the USA with an ambulance chaser like John Edwards (actually, easy case - obviouse medical mistake - your local latenight TV advertising Shyster could have won), but, guess what, you can't win a case like this in Canada. Rely on the government. Nanna will take care of your booboos. Even if an incompetent quack left you in intractable pain for the rest of your life.

    But, then, we already know that Cad's definition of a "Market Failure" is any outcome he doesn't like. "Tough luck", Chad.

    By the way, back in the days of mutual benefit societies like the Foresters et al, for your annual dues you got a guaranteed payout if you got a dread disease like cancer or diabetes.

  • TallDave||

    It may be a debatable point, but society has clearly chosen to socialize it.

    Sure, and if we decide we're willing to pay higher premiums in exchange for socializing costs, that's perfectly fine, but here's the rub: the same people who have created this problem are now calling it a "crisis" that must be solved with even more governemnt intervention.

    I'm just finishing my thought: Health vouchers that you can use to buy insurance for chronic problems or save for emergencies.

    An excellent idea, but one that will be rejected because it does not socialize costs.

    The simple fact is some people consume far more health care than they pay for. We can either socialize them or cut them off. We cannot solve this problem by underpaying health care providers; that will simply lead to massive shortages.

  • ||

    Seems to me that I'm going to have to retire in India, Thailand, Singapore, or Mexico to avoid getting killed by the government's rationing by congestion scheme.

    -jcr

  • 冰蓄冷空调||

    Every Living Person Has Problems

  • Chad||

    TallDave | July 30, 2009, 7:36pm | #

    Yes. Actuaries compile huge amounts of data on these questions.


    That says nothing about my disease, which may or may not have been caused by my pre-existing condition.

    That doesn't work either, because many diseases are not simple binaries where you either have them or don't but are a matter of degree.

    That's my whole point, Dave. But that is how all other insurance DOES work. Health insurance cannot work the same way, which is why it is fundamentally different.

  • Chad||

    Isaac Bartram@live.com | July 30, 2009, 11:03pm | #

    But, then, we already know that Cad's definition of a "Market Failure" is any outcome he doesn't like. "Tough luck", Chad.


    No, my definition of market failure is any time that the rules and assumptions underlying free-market theory are violated, leading the theory to be inapplicable and it's prediction of optimal outcomes false.

    The problem with ANY form of health insurance is that no matter who makes the decision, that person does not bear (almost) all of the costs and benefits. This is required for the theory to work.

  • Gilbert Martin||

    "No, my definition of market failure is any time that the rules and assumptions underlying free-market theory are violated, leading the theory to be inapplicable and it's prediction of optimal outcomes false."

    The free market is a term to describe the aggregate result of people exercising their freedom of contract. There can be no "market failure" because there never was any presumption of any particular outcome being guaranteed to begin with - other than the maintainence of maximum individual freedom.

    And there is no higher value outcome than that anyway.

  • MNG||

    "might deny 'reproductive health services' - the most blatant euphemism for evil since the term 'domestic institutions' in the 1850s."

    Uh, since they have to do with managing reproduction I would have thought it was a straightforward description of the services...

    "As MNG so eloquently points out, this country would have been better off if Catholic hospitals had never existed - it would have decreased the surplus population."

    Funny. But in non-Bizarro world my point was that for all the good these institutions did they clearly did not meet all the need that existed.

    "forcing health-care workers subsidized by taxpayers from being forced to do abortions"

    And here you mean "can either take the money and comply with requested services or not" by "forcing." I can tell ya that's going to be a hard sell around here...By your logic an employee at Lockheed Martin should be able to tell his boss to go stuff it if he is assigned to work on, say, a government subsidized defense project he has a moral qualm about.

  • ||

    The rationing argument against Obamacare is not really valid. The elderly are already enrolled in a socialized plan, so it is unlikely reform will change much. Except that Medicare better start rationing more or it will be broke in a decade.
    The only reform that is going to pass will force healthy young people into the insurance pool to help subsidize the older generation that stole their future. Hopefully young people will be smart enough to blame Obama for their increased expenses.

  • kilroy||

    "Hopefully young people will be smart enough to blame Obama for their increased expenses."

    I wish I lived in that world.

  • robc||

    In Illinois the average delay of medicare/medicaid payment is 150 days.

    Who does Illinois think they are, General Electric?

  • robc||

    MP,

    society has clearly chosen to socialize it.

    That is true enough. Still no reason for government to pay for it vs say, charities. They are a part of society too.

  • Gilbert Martin||

    "The only reform that is going to pass will force healthy young people into the insurance pool to help subsidize the older generation that stole their future."

    That is a 100% economically accurate statement.

  • Mike||

    I thought this was so brilliant I was amazed no one seems to bring it up very often.

    You handle people with pre-existing conditions by having them buy insurance-insurance before they get that condition. Essentially, you pay $X for your policy that pays for your emergency room benefits, and $Y for a policy that assures your ability to continue to buy your main policy in the future if you get some chronic disease.

    This is the one part I could see it reasonable to socialize - make health insurance untied to employment, allow people to see whatever private plans they want, but subsidize the ability to always buy a base level of insurance no matter how bad your condition is.

  • ||

    Wow, I'd kinda like someone to explain why we need a Certificate Of Need to build a hospital.

    Its actually an historical artifact of the days when hospitals were regulated as public utilities. They actually had to submit their rates for approval. Utility regulation has a couple of branches, based on the thinking that utilities are "natural monopolies." One is rate-setting, to prevent the monopoly from getting unconscionable margins. The other is "CON" approval of utility expansion plans, which both protects the monopoly from competition and from overbuilding (the theory is that excess capacity drives up price, believe it or not).

    Is it really all that shocking to state that for-profit health care will skew away from developing institutions that may obligate it (due to existing laws) to provide services for which the consumer won't pay and the government will underpay?

    So will non-profits, in order to survive. The problem here is that the State is mandating an unsustainable system.

  • Mad Max||

    'And here you mean "can either take the money and comply with requested services or not" by "forcing." I can tell ya that's going to be a hard sell around here'

    As opposed to the pro-life position, which is an easy sell on this blog. But it's not just lefties who believe in the concept of economic coercion. Freddie Hayek believed in the concept too - he pointed out quite correctly that you can coerce someone by threatening the job on which he depends for his livelihood. If some posters here are purer than Hayek on the libertarian scale, that's their business, of course.

    'By your logic an employee at Lockheed Martin should be able to tell his boss to go stuff it if he is assigned to work on, say, a government subsidized defense project he has a moral qualm about.'

    If, as a condition for all their lucrative government conracts, Lockheed Martin was required by Congress to respect the consciences of (say) employees who didn't want to make bacteriological bombs, then yes, my logic would apply.

    In the Church Amendments, Congress required that, if a medical facility takes takpayer money, it must agree in exchange not to require its employees to violate their consciences on abortion. If a hospital doesn't like this, it can simply turn down the federal check.

    Another condition of the federal funds is that the medical facilities can't engage in racial discrimination. Is that, too, a limitation of their entrepreneurial freedom?

  • Mad Max||

    And here's a shocking violation of academic freedom: If a university takes federal tax money, it must accept certain conditions like not discriminating against students based on race, providing information about campus crime, respecting the confidentiality of students records, allow access to military recruiters, and so forth.

    Do you intend to take up the cudgels against these requirements?

  • Sheldon Richman||

    "The point is that there is no health care model, whether privately or publicly financed, that can offer unlimited access to medical services while containing costs."

    There you go. Case closed, Obama, Kennedy, Dodd, Waxman, and the rest of the opportunistic creeps in Washington.

  • ||

    You libertarians folks kill me. Your reverence for the the deity of the free market rivals that of the fundalmetalist nut jobs reverance for the return of "Jesus"!

    I mean, give me a break! Anytime you have a large complex, diverse, and dispersed population there is a need for some type of agreement to allocate resources in a somewhat oderly fashion. Or you will have the situation of the "Lost Boys" as the organizing principle.

    Government helps to allocate scarce resources without people resorting to every man for himself. The same is true for healthcare. How can a free market system fairly regulate a healthcare system when people do not have access to all the relevant information?

    Bill Maher was right. It is indeed the profit motive that is killing this country.

    Free market whackos grow up! Everyone deserves good healthcare...eegads..even if the government has to provide it!

    b

  • ||

    Right, government allocates resources fairly. No politics ever get in the way of the perfect allocation of reasouces. Piss off Jerome.

  • ||

    Anytime you have a large complex, diverse, and dispersed population there is a need for some type of agreement to allocate resources in a somewhat oderly fashion.

    Oh, yeah, like the Soviet Union? Or China? Central planning of large economies has worked in exactly zero instances.

    Bill Maher was right. It is indeed the profit motive that is killing this country.

    Maher? I would be ashamed to hold him up as an example of anything but an ignorant asshole. "Profit motive" is a human condition. Anyone who claims they are above it are lying, very often to themselves.

  • Anonymous||

    The problem isn't institutions feeding on tax money in exchange for regulation designed to destroy the market, the problem is the motivation to profit from people who have no money!

  • Kreel Sarloo||

    Thanks for dropping by, bjerome.

    Nobody here has ever heard any of your brilliant and original ideas before.

    Please tell us more about our errors.

  • ||

    Anytime you have a large complex, diverse, and dispersed population there is a need for some type of agreement to allocate resources in a somewhat oderly fashion.

    Try reading that sentence in a German accent, for the full effect.

  • ||

    Don't forget the corporate tax. In the US, we've got one of the highest corporate tax rates in the world. Seems like a recipe for economic disaster, right? Well, no. The effective rate is actually much lower. How? Deductions.

    This is one of the ways the government passes shadow regulations. Raise corporate taxes, but then pass a "deduction" for things like having employee healthcare, etc. In effect, we've had socialized healthcare for years, it's just been very quietly snuck in under the noses of the American public. And they seem to like it. But, the problem is that these guarantees have a habit of being broken in bankruptcy proceedings. If the employees hadn't had these benefits, they'd be more likely to demand higher wages, and be left to their own devices on how to spend their earnings. Most would probably buy health insurance, and they'd do it on the free market. The younger members of the population, on the other hand, might make the wise choice to invest early while they're still healthy. But it'll be their choice, and they'll not build up reliance on guarantees that are only as good as the company's worth.

  • Sean W. Malone||

    Yes, yes we don't have a perfect free market system. Also, the Soviet Union never achieved "true" communism at any time. But of course in the real world what we would do is compare in relative terms; if the U.S. has worse outcomes than nations with comparatively greater government interference in health care and more restricted markets in health care than that is telling of something.



    MNG... Are you serious?

    The whole point of the article - and the obvious reality to anyone with a functioning brain and half a clue what's happened in health care in the US over the last 50 years - is that we are on the socialist side of things already.

    "No pure free market"??? We have nothing REMOTELY like a free market for health care.

    We are here (X):

    Freedom {---------------------X--} Centralized Control

    Funny how I could say the same thing for Stalinist Russia... No, MNG - Stalin never managed 100% perfect control, and as a result, they never managed "pure" communism. But you can get damn close and achieve the same ends: Centralized control & "planning" of the allocation of resources - you can even pretend that your goal is to have them "evenly distributed" to "everyone" (yes, that's a lot of scare-quotes).

    We are SO far away from a market system in Health Care, it's baffling that you would even bring up communism as an oppositional reference. Fail.


    And Bjerome:

    "I mean, give me a break! Anytime you have a large complex, diverse, and dispersed population there is a need for some type of agreement to allocate resources in a somewhat oderly fashion."



    Yes. The agreement is as follows: You own your stuff, I own my stuff. If I want what you have, I give you something you want for it.

    Done.

    You see how it works when you walk into your local video store with $5.00 and walk out with the "pre-owned" copy of Gay Sluts 10 that you'd always wanted to see.

    Go read Hayek, you fucking twat.

  • Klink||

    Try reading that sentence in a German accent, for the full effect.

    Any time ve haf unt large unt diferze population, dere iz unt neet fur some knockenkompffen.

    HOGAN!

  • ||

    1. Ban employer purchased insurance.
    2. Ban insurance companies from denying subscribers due to previous medical history.
    3. Give us tax deductions for all money spent on health care directly, or to insurance companies.
    4. Subsidize insurance premiums for low-income people.

  • ||

    You forgot getting rid of punitive judgement jackpots. Otherwise, pretty good.

  • ||

    The problem with this entire discussion is that people are just incredibly stupid. We have a mostly-working system with some problems. That's at least as good as, if not better than, most other countries.

    So how do people react? Idiots like Obama stump for 'sweeping change' which even the gullible sheep who voted for him don't really want. And then you get golden blog comments like this:

    "1. Ban employer purchased insurance.
    2. Ban insurance companies from denying subscribers due to previous medical history.
    3. Give us tax deductions for all money spent on health care directly, or to insurance companies.
    4. Subsidize insurance premiums for low-income"

    To whit:
    - Destroy the approach that is currently providing affordable, if not 'free', healthcare to most of working America
    - Require companies to 'insure' people who are already sick, which is not even insurance - it's federally regulated end-user cost-control, requiring vast subsidy
    - Reduce the amount of money going to fund those subsidies, thus ensuring the whole thing will collapse
    - And spend yet more government money enlarging already broken, corrupt, and inefficient government entitlement programs

    Wow. And you wonder why you can't ram this kind of legislation through.

    Learn to think. Then come up with a plan. It will save you a lot of headaches.

    Oh, and to Ms. Dalmia: your arguments would probably be more credible or attractive if you didn't echo the tiresome MSM line of Democrats being smart, dedicated, and just lacking 'power' while the evil Republicans are just stupid. Seriously, how can you work at a magazine called 'Reason' with beliefs that ill-informed? So far the Republican plan is the only thing approaching a workable one.

  • Terrell Perry||

    It is my understanding that the proposed penalty for not buying health insurance is $1000/year. It is also my understanding that insurance companies must offer insurance to anyone - even those with pre-existing conditions. If both of these premises are made into law, then one should opt for the penalty until they get sick, then purchase the most generous of the policies. I am on Medicare. ( I have no choice.) However, the premiums for Medicare and a supplement far exceeds $1000 a year. Dropping Medicare and paying the $1000 would certainly be cost beneficial for me. I suspect that anyone paying several thousand dollars per year in premiums would also benefit with this $1000 a year plan. - This example is simply one example of why government cannot make anything work.

    In the 70s, I worked in Germany. The private insurance for which I was eligible, was about half what the social insurance cost and when seeing a physician, I went to the head of the line. The difference - the private insurance paid the physician more and my cost was less because I only paid the insurance for myself - unlilke the social which paid for those who did not purchase insurance. There is another lesson here - socialized medicine penalizes those who are responsible and productive.

    The solution to affordable health care is for the government to get out of the business. This would include the entire spectrum from trying to control drugs (both legal and illegal), the licensing of health providers, and forcibly taking taxes from one to provide for another's health care. Open the medical schools to anyone qualified to enter and reduce the number of years required to prescribe and practice. There is simply no reason that one with four years of training following high school could not do general practice. A MS or PhD in medicine would be for those who wish to specialize. The free market offers the only solution.

  • ||

    Well, I see the libertarian multitudes have come out in full force. Since, a few of you have made a few decent points I will address some of those I find halfway sensible.

    First of all I don't need a lecture from any of you dweebs about Hayek, Ayn Rand, or for that matter Freidman. All I will say on this subject is refer to the comments of one of your own..Alan Greenspan. You can't get much more free market than him. He recently admitted that the free market in fact does not cure the gout. haha You see, this free market silliness is just that...silliness.

    "Yes. The agreement is as follows: You own your stuff, I own my stuff. If I want what you have, I give you something you want for it"

    Malone, are you deprived? I see, you are one of the original "lost boys". Everyman for himself. When has this system of organizing ever worked? What? I can't hear you. Read below an learn...

    Have you libertarian/Repubs ever heard of complexity science or Chaos theory. Probably not because you are still chasing the birther story. Anyway complexity science is the study of how complex systems made up of agents organize around a set of universal rules. Complex systems have been identifed in a number of diverse phenomena to include traffic, weather systems, and oh my god..economic systems. (Read books called the Origin of Wealth or Butterfly Economics for more info on this) Anyway, complex systems and network theory have a tendency to exhibit a phenomena called "the network effect" or also known as "the Matthew Effect". Ok, it is the power law. In other words the rich get richer and the poorer get poorer. This not just an axiom, but it is indeed how the world really works. And it works this way regarding the distribution of wealth and power. So, if we know that resources will have a tendency to be accumulated by organizations or people that already have a lot of the resources how can we expect the fair allocation of those resources? While I would agree that the government is by no means perfect it is the best ref we have. Who would you libertarians rather have divvy out resources? Big business? Lobbyist? I mean let's be real.

    AtheistConservative

    Your comments were cute, but silly. You know, most people are satified with Medicare, but that doesn't count because it is a government program. Or, TRICARE which military members have and are satisfied with. Oops, that is also a government program. Look, most people are happy with their insurance until they suffer a serious ailment. When that happens the insurance companies do everything they can to deny benefits. The U.S.A. healthcare system is the most expensive healthcare in the world and is one of the least effective making people well. The leading cause of bankruptcy in this country is due health cARE issues.

    So, you see healthcare needs to be fixed because the cost is rising at such a fast pace that it is putting a lot of businesses out of business.

    Libertarians you guys need to come up with some realistic policies that make sense. All I read in this blog are philisophical arguements that are not possible to implement.

    By the way..atheistconservative is truly a contradiction in terms...

    b

  • ||

    See tyrrell, you are exactly the type of libertarian I am talking about. I don't know what the penalty is for not having insurance but I would imagine that the penalty is mostly geared toward youn adults. Most folks who have children will not take the chance of being unisured.

    Ok, so the social care in Germany was more expensive than the private in your particular case. The social care I would think is targeted toward those who don't have the means to get private insurance. But, as a libertarian why would that concern you?

    Finally, I'll pass on doctors with just 4 year degrees as I would expect most people would. Also, take the government out of licensing? How would you know a doctor was qualified to help you? By his body count? See, this is what I mean by silly unrealistic answers libertarians give to serious problems.

    I do feel government involvement in any public endeavor should not be measured on whether it is limited or big government in nature. But, instead whether it is smart and targets the few governing rules of the respective complex system.

    b

  • Sean W. Malone||

    "Alan Greenspan. You can't get much more free market than him. "

    Utter. Bullshit.

    Alan Greenspan was the "maestro" of all central planners. Or hadn't you realized that that's what the Federal Reserve is?? Freemarket is the ANTITHESIS of central planning and the Federal Reserve is *cough*... the CENTRAL BANK!!


    That'd be like saying the fucking Pope is a devout atheist because 40 years ago he expressed some sympathy for atheistic ideas.

    Thanks for being a useless jackass.

    Since you've failed to understand even that, I don't think it's even worth remotely covering any of the rest of your ad homs and other nonsensical strawmen.

  • Chad||

    Have you libertarian/Repubs ever heard of complexity science or Chaos theory. Probably not because you are still chasing the birther story. Anyway complexity science is the study of how complex systems made up of agents organize around a set of universal rules. Complex systems have been identifed in a number of diverse phenomena to include traffic, weather systems, and oh my god..economic systems. (Read books called the Origin of Wealth or Butterfly Economics for more info on this) Anyway, complex systems and network theory have a tendency to exhibit a phenomena called "the network effect" or also known as "the Matthew Effect". Ok, it is the power law. In other words the rich get richer and the poorer get poorer. This not just an axiom, but it is indeed how the world really works. And it works this way regarding the distribution of wealth and power. So, if we know that resources will have a tendency to be accumulated by organizations or people that already have a lot of the resources how can we expect the fair allocation of those resources? While I would agree that the government is by no means perfect it is the best ref we have. Who would you libertarians rather have divvy out resources? Big business? Lobbyist? I mean let's be real.

    You are absolutely correct. I don't know how many times I have pointed out that economics is the chaotic, path-dependant system you described, not the idealistic textbook theory that libertarians wish it was. Bill Gates is not rich because he was somehow better or smarter than a thousand other bright people working on the same problem. He is rich because a few random events directed history right over top of his fledging company.

    Libertarians are also deliberately ignorant of the thousand and two ways that markets fail. ANY time that the benefits and costs are not concentrated on one single person, markets are sub-optimal. And how many times in the real world does one individual bear all the costs and benefits? About zero.

  • Joe||

    Chad and b:

    I have a serious idea for you to consider. Why don't we decide to part ways? We don't see the world in the same way. Why don't you and other statists take 40 states and the rest of us can have ten. We could conduct our experiments in how a people should govern itself free of interference from the other. Wouldn't that be for the best?

  • Neal Lester||

    It is possible to design a universal coverage health care system with incentives to provide quality care and control costs. For details, please see:

    http://www.3dsafety.com/thoughts-on-healthcare.htm

  • ||

    This is the kind of crap that continues to cost us all.
    Get the Mentally ill in institutions!
    National health care will remove malpractice awards. Why is the plaintiff bar against it?
    Experience based medicine will get rid of waste!
    Hospitals and Drug companies need regulation!
    What do France and Germany do with all the money they are saving from limited military?

  • ||

    Remove the employer break, make health insurance part of the income of the individual. This will free individuals from locked in plans. Why do we think that health care deserves a tax break? Make a plan available to take care of the catastophres! It can be affordable. Make the individual responsible for the day to day issues. You abuse you lose!

  • ||

    I have an HSA, so I have to choose my services with attention to pricing, if I don't want to run out of funds before the year ends. It is a real eye-opener to realize how many tests my local physician will order in order to protect himself from lawsuits. I found a doctor who is more willing to diagnose, and my medical costs dropped incredibly.

    I'm extremely happy with my HSA -- and I'm amazed (actually, no I'm not...) that our politicos don't push for more of them.

  • Add a T in the author\'s name ||

    Here's someone with a brain

    http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

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  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on...the Bible's books were written by people with very different mindsets...in order to really get the Books of the Bible, you have to cultivate such a mindset, it's literally a labyrinth, that's no joke

  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp. I'm not concerned that Mr. Crumb will go to hell or anything crazy like that! It's just that he, like many types of religionists, seems to take it literally, take it straight...the Bible's books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on...the Bible's books were written by people with very different mindsets...in order to really get the Books of the Bible, you have to cultivate such a mindset, it's literally a labyrinth, that's no joke

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