There Is No Such Thing As a Free Health Care. But There Are Lots of Things Called Free-er Health Care That Get Really, Really Expensive In Ways That Range Far Beyond Dollars and Cents.

Nick Gillespie | June 2, 2009

Get ready for the Summer of Glove, as in rubber-examination gloves used for digital exams. This time the patient is the entire U.S. economy, which we're being told suffers from bloating and sluggishness due to way too much spending on health care.

Legislation to revamp the health-care system likely would cut the rate of annual growth in costs by 1.5 percentage points, increasing the gross domestic product by more than 2 percent in 2020 above what it would be if no changes were made, according to projections by President Barack Obama's Council of Economic Advisers.

"Health care reform is incredibly important not just for the American people but for the American economy," Christina Romer, who chairs the council, said in a briefing for reporters on the CEA report released this morning.

Those are the types of bold, long-term predictions that hold as much water as an 88-year-old man on a full-liquid diet. I mean, really, if you're going to make predictions that are completely pulled out of your ass, why not follow what Treasury did with the TARP bailout and just choose a "really big number" picked out of thin air?

More to the point, the Wile E. Coyote Super Geniuses in D.C. have been working overtime since their junior-high theses on proposals to finally fix health care (despite it not being totally clear what the term even means, or how it means very different things to very similar people).

They have seen the past and it didn't work. But that doesn't mean it can't not work this time:

Democrats, who control both the House and Senate, are considering proposals that would require employers to cover all full-time workers or pay a penalty to the government; create a "health exchange" to allow consumers to buy insurance at lower, group rates; set up a new government-run plan to cover some of the uninsured; and levy new taxes to pay for universal coverage.

Employer mandates. Insurance pools. Government programs. New taxes. Hope and change, and even without Tom Daschle in the cabinet! I don't know they do it, but goddamn, it's beautiful.

Exactly how any of the above differs from what we're already doing escapes me. Our health care system is the ugly accretion of decades of stupid government policies (starting with the decision not to tax employer-based health care costs as compensation, thus pushing the idea of tying coverage to the workplace) that have gotten gnarlier and more twisted with each additional, incremental add-on.

So, if you're actually legislatin' in the 21st century on the promise of hope and change, why not actually start thinking about doing some things that are genuinely different and have at least a snowball's chance in hell of working?

Start with injecting actual market forces into health care by disrupting professional cartels that raise the cost of buying any prescription drug by $100 or whatever you get charged for a perfunctory doctor's visit (and by the way, start questioning the prescription drug regime too)?

Inject some actual price signals into the system by getting rid of the tax-code hocus-pocus that creates third-party payer systems and gets employers, most of whom can't turn a goddamn dollar at their chosen field of expertise, into the business of providing health care?

Take an example from fields such as dentistry and eyecare, where fewer services are covered by insurance and hence more open to the sorts of competition and discovery process that routinely drives prices down and the level of services up in every area of exchange from airline tickets to hamburgers to high-tech computer gear. And recognize that health insurance is not the same as health; indeed, it's not quite clear just exactly how the two are linked.

And also take a deep breath and recognize that spending more money on health care is not necessarily a bad thing, if it's the free choice of people (which currently it isn't). Like eating more prepared meals, it can be a glorious sign of increasing wealth.

But most of all, stop acting like characters from Tennessee Williams or William Faulkner. Learn from the past already, don't just mindlessly repeat it.

Comments

|6.2.09 @ 8:15AM|#

Nick, every suggestion you make requires government control and enforcement. The market - which we have now- has failed to solve this problem. If the free, unregulated market can solve it, why hasn't it?

Mike in PA|6.2.09 @ 8:20AM|#

I can't understand how they think giving more people health care that they don't pay ofr will save anyone money. If you have a minor injury that you would normally treat on your own, if it's cheaper to go to the doctor or hospital, you will. (not to mention, you have the bonus of suing the doctor if he does something another doctor might not do)

This means longer waits. More demand equals higher costs in the long run.

The only way to drive down costs is by MORE options, MORE competition, or LESS demand. These guys want to do the exact opposite.

Mike in PA|6.2.09 @ 8:22AM|#

If the free, unregulated market can solve it, why hasn't it?

Because the government keeps interfering! Quit letting people get health care they don't pay for, and watch the costs come down.

Joshua Holmes|6.2.09 @ 8:27AM|#

Remember this, liberals: politics is the art of the possible. You dreamed of a beautiful Swedish or French system which, despite its shortcomings, delivers decent health care at decent prices. But America isn't Sweden or France. You're not getting a Swedish or French system. You're getting an American system.

What is an American system? It's all the stupidest policies, subsidized by an increasingly regressive tax system (a tax system Obama has made more regressive, mind you). There's no French system coming because the special interests in health care are too powerful. Instead you're getting the current system, subsidized around the edges.

Read that again: the current system is staying, subsidized around the edges. That means all your horseshit about increased efficiencies and lowered costs goes right out the window, because nothing fundamental is changing. Nothing. All the greed and stupidity of insurance companies, run with the financial watch-care of the Pentagon and the commitment to excellence of the DMV. Stupid fucking assholes.

|6.2.09 @ 8:35AM|#

The problems is that liberals think they can get increased efficiencies by bureaucratic control instead of the market. They are dellusional. Having working in government for over a decade, I can say that there is no worse way to create efficiency than bureaucratic control. Inevitably you end up paying more money to the bureaucrat to keep you from getting ripped off than the bureaucrat saves you. You will end up paying "healthcare administrators" six figure salaries all the while squeezing doctors, nurses and people who actually do work out of the field.

|6.2.09 @ 8:44AM|#

"You dreamed of a beautiful Swedish or French system"

I'm not sure their systems are all that good. Consider, for example, for men with prostrate cancer, the survival rate in the US is 91.9%, in France, it is only 73.7%.

Swedish patients in need of heart surgery are often forced to wait as long as 25 weeks. Sweden's waiting lists have led some patients to visit veteranarians. Can you imagine sitting in the waiting room with dogs and cats. "Yes, Mr. Johanson, I can see you right after I give Fido his rabies shot.

Xeones|6.2.09 @ 8:47AM|#

If the free, unregulated market can solve it, why hasn't it?

Mostly because a market that is unfree and heavily regulated, such as, i don't know, health care, is by definition not free or unregulated, you ignorant slut.

MNG|6.2.09 @ 8:47AM|#

"Take an example from fields such as dentistry and eyecare, where fewer services are covered by insurance and hence more open to the sorts of competition and discovery process that routinely drives prices down"

I know only the yearly dental exam is covered by my insurance, and my yearly contacts exam are not. But if I got "ill ill" in my eyes, like glaucoma or what not, would my regular insuance cover it? If so then I'm afraid it's not fair to analogize eye and dental care to health care overall. I mean, if health care were limited to the yearly physical it would be pretty cheap I imagine. I would think one thing driving health care costs is inelasticity: if you are in real pain or fear of death you'll pay whatever to get relief...

"Because the government keeps interfering!"
But by that logic places like the US with lower levels of government interference should have less problems than places that have higher levels, right?

"You will end up paying "healthcare administrators" six figure salaries all the while squeezing doctors, nurses and people who actually do work out of the field."

Yeah, with my private health care I can be confident that I'm not paying for any six figure administrator salaries but instead am only supporting mom and pop doctors and nurses!

|6.2.09 @ 8:47AM|#

"The problems is that liberals think they can get increased efficiencies by bureaucratic control instead of the market."

They ought to know better than that. Just compare the service you get from UPS and Fed-Ex with the service you get from US Mail.

Mike in PA|6.2.09 @ 8:48AM|#

And what about innovation? What incentive do French and Swedes have to find new medical advancements if they can't fully profit from them?

MNG|6.2.09 @ 8:49AM|#

bookworm
Do you really want a war of citing various mortality figures?

Really?

MNG|6.2.09 @ 8:50AM|#

"Just compare the service you get from UPS and Fed-Ex with the service you get from US Mail."

I get great service from all three, which is pretty amazing when you consider the latter has to provide service for all markets in the US.

|6.2.09 @ 8:52AM|#

"Yeah, with my private health care I can be confident that I'm not paying for any six figure administrator salaries but instead am only supporting mom and pop doctors and nurses!"

Don't you think the doctors and nurses who do all the work deserve the higher rates of pay, not the government bureaucrats?

MNG|6.2.09 @ 8:52AM|#

"What incentive do French and Swedes have to find new medical advancements if they can't fully profit from them?"

Nobel prizes? Prestige? Getting noted in history? Helping other people (don't laugh, it motivates people like Mother Theresa)?

And I'm pretty sure you can still invent something and sell it in those nations. In fact, in some ways their copyright and patent laws are stiffer than ours.

MNG|6.2.09 @ 8:53AM|#

"Don't you think the doctors and nurses who do all the work deserve the higher rates of pay, not the government bureaucrats?"

bookworm, that jet engine sound is my point going over your head...Let me put it to you in another way: what in the world makes you think the private insurance/health care industry is not chock full of bureaucrats?

|6.2.09 @ 8:53AM|#

"I get great service from all three, which is pretty amazing when you consider the latter has to provide service for all markets in the US."

I certainly don't get good service from the US Mail with my mail going to other people and their's coming to me.

Mike in PA|6.2.09 @ 8:56AM|#

If you've ever seen the pile of damaged goods at a postal depot, you would definitely have a serious problem with applying their method to your health care.

MNG|6.2.09 @ 8:57AM|#

I get stuff from the Amazon.com second hand market all the time. Most of it is sent US Mail, but sometimes it is sent UPS Ground. I've never had any not get here, or get here damaged, regardless of which it was.

MNG|6.2.09 @ 8:59AM|#

"If you've ever seen the pile of damaged goods at a postal depot, you would definitely have a serious problem with applying their method to your health care."

My friends in high school worked at the local UPS terminal during holiday demand season, and they assure me there is a similar pile over there...

Of course, we don't need that discussion. Everyone who has interacted with a private health care insurance company can recall getting some insane bill from them and going WTF?, calling them, getting the run around, and then having them go "oh, yeah, you're right, we got it wrong."

|6.2.09 @ 9:04AM|#

prostrate cancer

bookworm, lol.

RC'z law.

Xeones|6.2.09 @ 9:12AM|#

Everyone who has interacted with a private health care insurance company can recall getting some insane bill from them and going WTF?, calling them, getting the run around, and then having them go "oh, yeah, you're right, we got it wrong."

Maybe someday i'll tell y'all about my four-year battle to get the Virginia DMV to stop charging me registration fees on a vehicle i no longer owned, and for which i had turned in the plates and everything.

Meanwhile, the postman makes it to my house after 5pm almost every day, except the days he doesn't show up at all, and we usually get at least a couple pieces of mail with the address of the house across the street CLEARLY marked. And of course they just raised the rates yet again. So, you know what? Fuck the USPS monopoly on letter delivery, fuck anyone who thinks said monopoly is just dandy, and triple fuck all the dumbasses who want health care to be more like the Postal Service than it already is.

|6.2.09 @ 9:15AM|#

and triple fuck all the dumbasses

Hmm... the triple fuck. There might be a story in that.

Xeones|6.2.09 @ 9:18AM|#

There might be a story in that.

If there is, you're the man to write it.

|6.2.09 @ 9:20AM|#

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|6.2.09 @ 9:21AM|#

"Yeah, with my private health care I can be confident that I'm not paying for any six figure administrator salaries but instead am only supporting mom and pop doctors and nurses!"


Why do they have those "administrators"? Mostly to ensure that they comply with government regulators. Hospitals spend millions every year trying to comply with medicare regulations that are nearly impossible to comply with. That will only get worse under a government run system. Once the money starts flowing, we will get the medical equivelent of the $500 toilet seat scandal and the response to be to regulate more increasing compliance costs and lowering the quality of care.

You want to know what is wrong with healthcare in this country? Look no further than Michelle Obama and her $300K hospital job for an example.

|6.2.09 @ 9:23AM|#

In fact, in some ways their copyright and patent laws are stiffer than ours.

If I make a dick joke here, does that make me gay or an 8th grader?

Or both?

Atanarjuat|6.2.09 @ 9:25AM|#

bookworm, that jet engine sound is my point going over your head...Let me put it to you in another way: what in the world makes you think the private insurance/health care industry is not chock full of bureaucrats?

Go back and reread. The discussion being had was that the free market provides an incentive to innovate and cut costs (such as unnecessary administrators) to stay competitive. Are you arguing that bureaucracies are more efficient?

Warty|6.2.09 @ 9:38AM|#

SugarFree | June 2, 2009, 9:15am | #

and triple fuck all the dumbasses

Hmm... the triple fuck. There might be a story in that.

Xeones | June 2, 2009, 9:18am | #

There might be a story in that.

If there is, you're the man to write it.

sugatbaby2009 | June 2, 2009, 9:20am | #

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That was beautiful.

|6.2.09 @ 9:46AM|#

Are you arguing that bureaucracies are more efficient?

Efficient is just a dodge. As is lowering costs. The people who want socialized medicine in the country DO NOT CARE if it is cheaper, they only care that it is "fair." They will not be swayed by arguments about the quality of care under a socialized system or about innovation. They see health care as just another commodity that should be distributed "equally" among everyone.

The utilitarian position is that it's fine if your health care suffers as long as someone else's gets even slightly better.

|6.2.09 @ 9:47AM|#

Warty,

I'm beginning to wonder if I am the keyword that the porn spammers are running.

|6.2.09 @ 9:51AM|#

"I get stuff from the Amazon.com second hand market all the time. Most of it is sent US Mail, but sometimes it is sent UPS Ground. I've never had any not get here, or get here damaged, regardless of which it was."

I had a book that was mistakenly delivered to the wrong address by the USPS. I'm thankful the the recipient of the mail was honest enough to bring it to me.

Fascitis Necrotizante|6.2.09 @ 9:58AM|#

Last year I received someone else's stimulus check at my address. My landlord verified that it wasn't a former tenant. I hung on to it for a week, asking around if anyone recognized the name, before turning it back in to the Post Office. The day after I did that, the addressee came to my door. He lived two blocks away and his address was one digit different from mine. He was a clearly very poor old black dude, as most of my neighbors are. I doubt that he ever got that money.

Kreel Sarloo|6.2.09 @ 10:04AM|#

The market - which we have now-...

Man, that inter-dimensional travelling device of yours must be a beaut.

|6.2.09 @ 10:08AM|#

"What incentive do French and Swedes have to find new medical advancements if they can't fully profit from them?"

"Nobel prizes? Prestige? Getting noted in history? Helping other people (don't laugh, it motivates people like Mother Theresa)?"

All that altruism and desire for prestige and Nobel prizes doesn't seem to be producing many new drugs in those countries. As Sally Pipes pointed out in "The Top Ten Myths of American Health Care", "In 2004, the federal government funded medical research to the tune of $18.4 billion. By contrast the European Union - which has a significantly larger population that the US - allocated funds equal to just $3.7 billion for medical research." She went on to say, "Between 1999 and 2005, the US was responsible for 71% of the sales of new pharmaceuticals. The next two largest pharmaceutical markets - Japan and German - account for jus 4% each." So, you see, the profit motive does work better than just plain altruism.

Kreel Sarloo|6.2.09 @ 10:12AM|#

The people who want socialized medicine in the country DO NOT CARE if it is cheaper, they only care that it is "fair."

Most of the ones I've met just care that some one else will be paying for for it.

MNG|6.2.09 @ 10:18AM|#

"Why do they have those "administrators"? Mostly to ensure that they comply with government regulators."

They also have them because there is a proliferation of private insurance companies, each with their own rules and procedures, and the health care companies have to comply with all that. Also, private firms of course have more incentive to pay only for what is absolutely necessary, so they have systems upon systems to try to ensure that, and, being large bureaucracies, things get administrative mighty quick. It simply can't be laid at the government's feet.

"the federal government funded medical research to the tune of $18.4 billion. By contrast the European Union - which has a significantly larger population that the US - allocated funds equal to just $3.7 billion for medical research"

Uhh, so you want more federal spending on medical research, because all you've shown with that is that governmental spending on medical research is correlated to advances....

MNG|6.2.09 @ 10:20AM|#

Sorry guys, I can match you "stupid insurance company" story with "stupid government agency" story all day. In fact, the general incompetence most people detect in dealing with their insurance and health care companies is why those industries are so on the defensive: if they were models of efficiency and competence we wouldn't be talking about reform...

|6.2.09 @ 10:22AM|#

"I get great service from all three, which is pretty amazing when you consider the latter has to provide service for all markets in the US."

MNG,

I find it humorous that you are trying to defend the USPS. A company with a state granted monopoly that can neither compete with it's rivals despite that advantage, or manage to keep costs down even with said monopoly.

The idea that there are those who want to replicate that "success," especially to those whose lives are on the line, is ridiculous.

|6.2.09 @ 10:26AM|#

Sorry guys, I can match you "stupid insurance company" story with "stupid government agency" story all day. In fact, the general incompetence most people detect in dealing with their insurance and health care companies is why those industries are so on the defensive: if they were models of efficiency and competence we wouldn't be talking about reform...

Yes but I get to change insurance companies if I am unsatisfied in a free market. What happens when I am unsatified with the government plan? I write my congressman? I'm sure my grievances will be quickly addressed no doubt. I mean I get so many results doing that now.

|6.2.09 @ 10:32AM|#

"Uhh, so you want more federal spending on medical research, because all you've shown with that is that governmental spending on medical research is correlated to advances...."

No, most of that money spent on research and development is spent by the private sector where there is a profit motive. When the government pays for the research and development, they tend to cut down costs to keep taxes from going to high and keep taxpayers from complaining too much.

"Also, private firms of course have more incentive to pay only for what is absolutely necessary"

So does univeral coverage. When taxes pay for health care, people tend to demand more of it since they get the feeling that it's free. When the taxes start rising, taxpayers start complaining and then the government has to start rationing in order to hold back costs and therefore hold back taxes.

Chad|6.2.09 @ 10:36AM|#

Pain | June 2, 2009, 10:26am | #

Yes but I get to change insurance companies if I am unsatisfied in a free market.

Yep, and then you pay your new insurance company for a year or two, then you get sick, and realize your new company is exactly the same as your old one.

What's the point of having a choice between a turd and a pile of dung?

Libertarians may as well get over it. We will NEVER have a nearly pure free market system. We will either have a universal single-payer system like the rest of the civilized world, or the hybrid public-private monstrosity we have now. The better choice between these two is obvious.

Fascitis Necrotizante|6.2.09 @ 10:37AM|#

What's the point of having a choice between a turd and a pile of dung...

... when you could be compelled by the state to eat a pile of dung turds and like it?

Chad|6.2.09 @ 10:37AM|#

When taxes pay for health care, people tend to demand more of it since they get the feeling that it's free

No. This occurs when ANYONE else pays your medical bills, including your insurance company or the government. Public vs private insurance has almost no impact on the moral hazard issue.

|6.2.09 @ 10:38AM|#

"In fact, the general incompetence most people detect in dealing with their insurance and health care companies is why those industries are so on the defensive: if they were models of efficiency and competence we wouldn't be talking about reform..."

The problem is the "solution" of replacing them with governmental systems that have proven to be less efficient and costlier. Even in the cases where costs were cut, it was only done through rationing.

MNG|6.2.09 @ 10:39AM|#

"No, most of that money spent on research and development is spent by the private sector where there is a profit motive"

WTF? How do you get that from what you posted:

"the federal government funded medical researchto the tune of $18.4 billion"

????

"and then the government has to start rationing"

Well, as you admit the private insurance companies have very motive to do the same thing, so what's the big deal?

"A company with a state granted monopoly that can neither compete with it's rivals despite that advantage"

See, words mean something. A company cannot both have a "monopoly" AND "compete with it's rivals", at least in the area they are supposed to have the monopoly.

But what you mean is that some of the services the post office engages in are protected by monopoly and some are not, and in the latter area they "fail to compete." But of course they not only have a monopoly in some areas, but corresponding duties and obligations that private companies don't have, because we don't think the public good is fostered in that way. The Post Office is supposed to provide for that public good in a way that private interests probably would or could not (because it would not be profitable), this is why our great Founders made sure to provide for it in the Constitution and as one of their first acts...

|6.2.09 @ 10:42AM|#

"No. This occurs when ANYONE else pays your medical bills, including your insurance company or the government. Public vs private insurance has almost no impact on the moral hazard issue."

True, but this is mostly because of our system of HMO's which were brought about by government regulation. Insurance shouldn't pay for routine care. It should only pay for catastrophic care. Imagine how high car insurance premiums would cost if car insurance payed for routine care like oil changes.

MNG|6.2.09 @ 10:44AM|#

It seems all insurance companies equally suck ass. Perhaps the nature of insurance is such that it just doesn't lend itself to development by the private sector, perhaps it is a public good that needs providing by the government.

But I hope not. I have really good insurance. They are amazingly wasteful, Byzantine in their administration, and incompetent as all get out, but I have great coverage, co-pays, etc. It's my hope health care reform does not go through, because there is a great chance that whatever results from the reform will not be as good as what I have.

But I also don't pretend like my case is the same for everyone. If I were uninsured or had a less generous plan or had some pre-existing condition, I may do better under reform.

What irks me are folks that act like there will not be some gains and losses, some winners and losers, under down either road.

|6.2.09 @ 10:44AM|#

You know what's better than coffee? A hot, steaming cup o' Nick Rant.

That's in a black leather cup, of course.

[sips] Mmmmmm...

MNG|6.2.09 @ 10:45AM|#

"True, but this is mostly because of our system of HMO's which were brought about by government regulation."

See, this kills me. Sure, sure, insurance companies would never have moved towards proposed cost-cutting relationships like HMO's if it weren't for the big mean government. Sure.

|6.2.09 @ 10:49AM|#

"the federal government funded medical researchto the tune of $18.4 billion"


Sally Pipes was referring to how much the US government is willing to pay for R & D versus how much other countries are. Not only do these countries cut down on costs through rationing, they also cut down on costs through giving less to R & D. The problem is how high the costs have been driven up by a system paid entirely through taxes which causes overuse when people feel they are getting their care for free.

In addition to what government gives to the medical industry for R & D, the medical industry funds their own R & D. Take away that profit motive and there will be a lot less R & D.

|6.2.09 @ 10:58AM|#

"See, this kills me. Sure, sure, insurance companies would never have moved towards proposed cost-cutting relationships like HMO's if it weren't for the big mean government. Sure."

A big factor that keeps health insurance high are state mandates. Lots of people can't afford health insurance because state mandates that require some non-essential treatments to be insured and also don't allow people to take out catastrophic insurance policies or shop for insurance across state lines. We need a system where there is more patient power. Patients need to be the customers instead of the government and large insurance companies. Doctors know they can charge big prices to the government and big insurance companies. If the patients were their customers, customers paying directly for routine costs and Medicaid and Medicare and Schips patients paying with vouchers, there would be more shopping around for medical care which would drive down prices and also drive down insurance premiums. We need insurance companies that are driven by the market, not by government edict.

|6.2.09 @ 11:03AM|#

"But I also don't pretend like my case is the same for everyone. If I were uninsured or had a less generous plan or had some pre-existing condition, I may do better under reform."

National health insurance isn't the only reform option. What we need is a true free market in health care. We don't have that now.

|6.2.09 @ 11:05AM|#

"""And also take a deep breath and recognize that spending more money on health care is not necessarily a bad thing, if it's the free choice of people (which currently it isn't)."""

If we can't afford it now, how will paying more help people out? I really don't think free choice is the issue. The money issue is relative, I don't think there is a health care problem for those who have plenty, or a good job that covers the insurance and they have plenty of choice. We have the best health care, but not everyone can afford it. When you talk about health care for all, you run into problems. Obamamama is trying to get those who can't pay covered, so the central question becomes who pays for those who can't.

""""You want to know what is wrong with healthcare in this country? Look no further than Michelle Obama and her $300K hospital job for an example.""""

So should the government do to the 300K hospital job what they did to the $75hr auto job? The hospitals seem not to have a problem paying lots for admin folk. The lesson of the year has been that a company being driven into the ground has little problems with big executive pay. So if the business don't want to change should they be made to. Slippery slope.

""""True, but this is mostly because of our system of HMO's which were brought about by government regulation.""""

One of the purposes of HMOs was to pool clients so they can bargin for lower medical costs. Then the medical industry cried foul becuase they were being paid less for their serivces. The industry loves insurance and government programs because they are new ways to pay the higher costs.

""""What irks me are folks that act like there will not be some gains and losses, some winners and losers, under down either road."""

Is the definition of universal one where everyone is a loser? I keed. I keed.

"""Insurance shouldn't pay for routine care. It should only pay for catastrophic care. """

If routine care was affordable, you wouldn't need it for routine care. If routine care could become inexpensive selfcare, we might be on to something. That would require affordable self-diagnostic equipment and more over the counter solutions. Then have insurance for catastrophic care. But who defines what is catastrophic and what is routine?

|6.2.09 @ 11:07AM|#

"Well, as you admit the private insurance companies have very motive to do the same thing, so what's the big deal?"

Those services are still available, the insurance company just doesn't pay for them. The services are still available in countries with national health insurance, but they're in short supply, so you have to get on waiting lists to get the service. Many die while on those lists.

kinnath|6.2.09 @ 11:10AM|#

I am so tired of this: Heath Insurance is not equal to Health Care. All modern single payer systems are essentially attempting to provide some level of cradle-to-grave health care. Any attempt to compare existing health insurance programs in the US to other countries health care system is pointless.

You can't even compare US medicare/medicaid programs to foreign single-payer systems because people with private health insurance in the US are underwriting the shortfalls in medicare/medicaid reimbursements from the feds.

|6.2.09 @ 11:16AM|#

"If routine care was affordable, you wouldn't need it for routine care. If routine care could become inexpensive selfcare, we might be on to something. That would require affordable self-diagnostic equipment and more over the counter solutions. Then have insurance for catastrophic care. But who defines what is catastrophic and what is routine?"

I believe doctors' visits have become more expensive because they're paid for by insurance except for a small copay. If these types of costs were paid for out of pocket, I believe they would come down. A high decuctible catastrophic policy would be a cheaper, better form of insurance for most people. Such policies along with voucher programs for the poor would bring about more competition in the medical industry and thus bring down prices.

|6.2.09 @ 11:24AM|#

"The Post Office is supposed to provide for that public good in a way that private interests probably would or could not (because it would not be profitable), this is why our great Founders made sure to provide for it in the Constitution and as one of their first acts..."

I'm not so sure that the private sector couldn't profitably run a mail service. It probably just didn't occur to our founders to allow the private sector to handle it.

|6.2.09 @ 11:25AM|#

Yep, and then you pay your new insurance company for a year or two, then you get sick, and realize your new company is exactly the same as your old one.

What's the point of having a choice between a turd and a pile of dung?

Why are you complaining about insurance companies? They are in the most heavily regulated sector of the market. Government regulation made them the way they are. They are the future you're advocating for, whether you realize that or not. Name another sector of the economy that isn't regulated that acts the way they do. If you do I guarantee they won't have customers for very long.

Oh that's right, now that the right people are in charge this won't happen anymore. It's not like insurance companies have lobbyists in DC that will assure that they get their rent covered with any new legislation or anything like that.

Brian Defferding|6.2.09 @ 11:38AM|#

Ray Butlers - it's posts like yours that make me wonder if some people have been living under a rock since the 19th century and just came out today.

We haven't had an unregulated market in health insurance for a long, long time. States have their own health care policies, mandates, minimums, and taxpayer-provided health care. Prescription drugs are NOT unregulated - drug manufacturers often have to spend over $600 million just to get a drug past FDA testing in order to bring it to market, not to mention the ban on imported prescription drugs keeping the price as high as American pharmaceutical companies desire it to be.

We have no free market health care. We have a public/private mixture at this point, and look at what we have to show for it? Has health care accessibility and affordability got better after decades of government "help"?

deluded1|6.2.09 @ 11:43AM|#

FedEx and UPS are publicly traded companies that fail or succeed on their own merit and investor's money.

USPS is a subsidized federal institution that constantly loses money and has no fear of failure because it can always have more tax money.

If their service is equal, why not choose the ones that doesn't waste taxpayer's money?
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The current health care system is a mess, a horrible, broken mess. And yet, it's the best in the world. Oh, people scream and gnash their teeth, and point to socialized health care in numerous other countries (canada, england, france, etc.) However, if something goes wrong, the rich and poor from these countries fly (or drive) here for treatment. Why? Because they can actually be seen and receive better treatment. Now, they go back home for the drugs, because they can get those for free/cheap.

Another downfall of socialized health care is the impact this will have on R&D. Generic pill makers do not invest in R&D, only "Big Pharma" does. Socialized health care will not invest in new drugs, because it's not the best deal. This reduces investment in "designer" drugs, which then whittles down the amount a lab can invest in it's R&D. The clincial Phase I/II/III/IV trials required for a new drug? Several hundred million dollars...and let's hope you don't screw up any of the required paperwork or you might not be able to sell it. Let alone if it's actually effective and marketable Sure, this might work for a while...until 20 years from now when we're still using the same antibiotics that no longer works on the bacteria or cancers we're attempting to fight. Anyway, don't expect giants like J&J, Merc, GSK, Bristol Meyers or Amgen to produce much new if this occurs.

And before you go blaming insurance companies as evil heartless bastards (they are, don't feel bad) keep in mind that government run medicare/medicaid is the standard by which ever insurance company bills and treats. That's right, they say how much they'll pay a doctor (and what treatments they'll pay for) and every other insurance company looks to them for guidance. They do try to rip people/doctors off past that point, but i digress.

I'm not going to even get into how much this screws over doctors (especially small practices!) Who often times charge cost of procedures to uninsured people in need.

Simply put, we do need an overhaul. Socialized medicine is AN answer. But as a person who prefers progress and hope (real hope, not the current trademark) to stagnation and resignment, I'd like to review the other options first. You know, full detailed analysis of both the pro's and con's, before we go with what's trendy.

|6.2.09 @ 11:58AM|#

# Ray Butlers | June 2, 2009, 8:15am | #

# If the free, unregulated market can solve it,
# why hasn't it?

Because the "legitimate" market -- which, as we see, is dysfunctional -- is highly regulated and has been for many decades. In the context of that truth, the "free, unregulated" market of which you speak is ... the BLACK MARKET! Possibly, the Black Market could solve problems (it obviously addresses enough marketplace needs to continue to exist), were it not always under pressure by the government bureaucrats as assisted by the criminal law enforcement establishment. It is this pressure and censure that actually turns the free market "black," forcibly mingling operations that might very well be legitimate and benign, if left alone to thrive, with true criminal actors and enterprises.

For instance, a (legitimate, licensed, established) doctor in New York recently tried to create a "subscription" plan, whereby patients would be eligible to use a number of procedures or services for a flat monthly fee, as Netflix makes DVDs available to their subscribers, or as a "health club" makes its gym facilities and trainers available to its members. "Not so fast," said the government. This sounds like an insurance scheme to us (after all, healthcare access is equivalent to health insurance, is it not?), so you can't do business in this way without qualifying as an insurance company in this State!

So Netflix offers "entertainment insurance"? 24 Hour Fitness offers "workout insurance"? Of course not. What crap. So now the Doctor is faced with flouting the law and working "underground" (i.e., in the Black Market); modifying his plan, perhaps into ineffectiveness or irrelevancy, in order to avoid being classified as an "insurance company"; or indeed, jumping all the hoops necessary to become an "insurance company" under NY law. Lost in all this is the idea of giving good health care to patients who need it, in a way that is convenient and affordable to them.

|6.2.09 @ 12:32PM|#

"""USPS is a subsidized federal institution that constantly loses money and has no fear of failure because it can always have more tax money."""

The problem is USPS doesn't charge enough, and the public cries too much about a .02 increase. UPS charges and extra $10 plus, just to deliver on Saturday. UPS and Fed Ex charge much more than $.44 to deliver a letter.

|6.2.09 @ 12:56PM|#

Off-topic and belated, but...

Helping other people (don't laugh, it motivates people like Mother Theresa)

Can we put this one to bed already? Mother Theresa's motivation wasn't helping other people (as we on earth understand it).

JB|6.2.09 @ 1:38PM|#

Old fucks are living too long and cost too much money in their last years of life. They should be paying for their own healthcare.

Oh wait? It's expensive? No shit! So maybe take that money you have saved up and instead of using it to get an extra six months of low-quality life you can donate it to your grandkids.

But when it's other people's money no wonder they don't care about spending it.

JB|6.2.09 @ 1:41PM|#

MNG just can't wait for that government healthcare. He wants healthcare run by the TSA with frequent anal probes.

Bob Bobson|6.2.09 @ 2:48PM|#

Multiple problems here. The costs for health care of the uninsured, who end up waiting until small problems become emergencies and have to go to the ER, are rolled into your premiums. You're already paying for them anyways. It's exactly like car insurance; you have to pay for the uninsured.

Diseases of the elderly, like liver transplants and most cancer treatments tend to prolong life by one or two years, leave people with a terrible quality of life, and are astronomical in terms of cost. Smokers might have to wait for lung cancer operations? What a travesty that would be. That's how you cut costs. You can call it "rationing," if you want to. I call it "common sense" so there's money for the little kid down the street to get taken to a doctor (not a hospital) for a cold before it turns into pneumonia.

Right now the insurance companies get billed for ridiculous amounts by doctors. Why? Becuase they don't have the resources to scrutanize this way. It's much more cost-effective for them to challenge that treatment is necessary at all.

Under a socialized system, if I need a transplant when I'm 60, it will be a problem for me. If I just need to see a damn doctor when I'm sick, it will be much better. Single-payer baby!

And the public hospitals are a total disgrace. Spend 4 hours in the Cook County ER some time. I actually got to spend 60 hours there when I was between jobs. They still have my name wrong on the bills. I just don't have any faith in insurance companies to try to do anything but make money. That's all they're supposed to do.

|6.2.09 @ 3:18PM|#

You can call it "rationing," if you want to. I call it "common sense" so there's money for the little kid down the street to get taken to a doctor (not a hospital) for a cold before it turns into pneumonia.

Or, of course, his parents could take him to the doctor, and pay for it themselves.

It never ceases to amaze me that people who can't afford to pay a nickel for medical care always have enough money to get their cars fixed.

|6.2.09 @ 5:01PM|#

"""Right now the insurance companies get billed for ridiculous amounts by doctors."""

No insurance pays the billed rate. They pay a contracted rate.

|6.2.09 @ 9:41PM|#

Howard Dean is correct.

"a"(Toothy, Robust)"public health insurance option is more important than bipartisanship, and Democrats should pass health-care legislation that includes the option with 51 votes if necessary."

"Democrats should have "no intention" of working with Republicans if it's not the strongest possible legislation that could be passed with a simple majority." (Howard Dean)

This is what WE THE PEOPLE gave the Democrats all that power to do for ALL of us.

You see, Dr. Dean knows that in medicine and healthcare there is only one acceptable standard. And that standard is the HIGHEST level of EXCELLENCE you can provide for everyone. Nothing less has ever been acceptable in caring for a precious human life.

And the White House is right too. "Good health care reform is essentially good economic policy." (Christina Romer)

jacksmith -- WORKING CLASS