New at Reason
Ronald Bailey looks at why big business is boarding the national health care bandwagon.
Comments to "New at Reason":
Surtr | May 11, 2007, 4:11pm | #
Notice no comment about trying to encourage competition within the HMO's and the insurance companies from big biz. Surprising, not.Lowdog | May 11, 2007, 4:38pm | #
One of the main things I'd be concerned about is whether or not lots of tax money is going to be dished out, like mentioned about Obama's plan. A lot of times, just like when the government says they're doing it for us, the companied don't have our best interests in mind, to say the least. When it's government and business doing/saying the same thing together, I get even more freaked.Still, if it comes out anything like Bailey's saying, we'll be a lot better off. I'm not holding my breath, though.
Baily | May 11, 2007, 5:04pm | #
Making quality health care inaccessible to low-income dolts helps cull the population. It isn't smart entrepreneurial types that are eating their way into early death; it's the morons at the other end of the bell curve, and they don't have much to contribute anyway. Fuck 'em.Guy Montag | May 11, 2007, 5:14pm | #
Without going to the article, let me guess that there is some element of people trying to get some benefit from the government without paying for it directly?Paul S | May 11, 2007, 6:03pm | #
Re: Wyden and Benett's Healthy Americans Act:I would *love* to "cash out" of my employers' healthcare plans. Two years ago I quit a job to do freelance work. The COBRA premiums on my former employer's insurance ran to something like $800/month for myself and my spouse -- healthy, childless, 30ish. I found a similar private plan (with much higher deductibles, natch, but then, we're *healthy*), and it ran to about $200/mo. That $800/mo was subsidizing my coworkers' baby-making, therapeutic massage, and acupuncture -- a tragedy of the (private!) commons.
Shawn Smith | May 11, 2007, 6:12pm | #
Isn't the assumption that employers would give every dollar of what they currently spend on an employee's health insurance plan back to the employee a stretch? What would prevent those savings instead going into the pockets of the company's officers or the shareholders? I would wager that most people don't know how much their employer spends on their health insurance. And I have the impression that the tax break comes only from itemizing, and then only on the amount that is more than 2.5% (or is it 7.5%; i forget) of adjusted gross income.Kwix | May 11, 2007, 7:11pm | #
I would wager that most people don't know how much their employer spends on their health insurance.That, in a nutshell, is the problem with employer funded health care. Most people don't know how much of their wages are actually being siphoned of as a "healthcare benefit", nor do they know how much individual procedures cost. By giving the employee the capability to a)shop around for the best competing individual insurance plan/company and b)shopping around at for the best bang/buck on procedures and hospitals the individual has the best ability to make his dollar work best for him.
What would prevent those savings instead going into the pockets of the company's officers or the shareholders?
If employers yank heath coverage and the employees just keep on working at the same salaries as before, then there's no reason why employers would (or should) use the money they've saved to increase salaries. But most employees won't just take it, since they have other opportunities. Competition among employers to get workers will cause wages to move to new equilibriums.
If employers yank heath coverage and the employees just keep on working at the same salaries as before, then there's no reason why employers would (or should) use the money they've saved to increase salaries. But most employees won't just take it, since they have other opportunities. Competition among employers to get workers will cause wages to move to new equilibriums.
MikeP | May 11, 2007, 7:40pm | #
What would prevent those savings instead going into the pockets of the company's officers or the shareholders?I find it amusing that those savings' going toward lower consumer prices was not one of the possibilities that crossed your mind.
Did I say amusing? I meant sad.
Baily | May 11, 2007, 7:49pm | #
"By giving the employee the capability to a)shop around for the best competing individual insurance plan/company and b)shopping around at for the best bang/buck on procedures and hospitals the individual has the best ability to make his dollar work best for him."Oh yeah, the nitwits who scarf down garbage food and sit on their fat asses all fucking day will shop around for the best deal in health care. What we really need is a privately funded eugenics program.
Ken | May 11, 2007, 9:08pm | #
In one class I taught on public administration I had my students read Von Mises book on Bureaucracy. It was a while back, but I remember being struck at how Von Mises essentially said that you can't run a public entity like a private one, there is no profit motive to measure success. But he did not finish there. He went on to say that in many public entities a profit motive (or something like it) would be most inappropriate. He gave an example of cops trying to catch a criminal, they can't really ask: would this be cost-efficient? You just have to catch that guy, period. How much of health care is like that? When someone is told "you have cancer" do you shop chemo sources looking for the best buy? You have to have it or you die In theory, as humans we have to be like that for anyone who comes in sick, we can't just say "well, my friend, we'd like to treat that, but you're 75 years old and soon to go anyway and this is not cost efficient..." Instead the medical profession aims to make everyone better that comes in sick. It strikes me that this just has to be paid for. Now let me qualify this by saying that this applies to people being 'very' sick. Every Tom that comes in with a cold doesn't HAVE to get care (though patients are almost by definition not going to be able to tell that cold from, say, some early stage of something dire).And Baily-Keep the faith brother, there'll be another fuhrer soon.
jp | May 11, 2007, 10:10pm | #
Ken -- In Arnold Kling's plan, the very poor would have government subsidized care. All others would be on their own. Those with some sense of foresight would buy insurance (high-deductible is what he sees as most likely). If you didn't have insurance and needed care you couldn't afford, you could lump it, get some sort of charitable assistance with your bills (groups that do that exist already, such as the Coalition of Caring Voices), or spend down your assets until you became very poor (the way a lot of seniors do today, eventually becoming eligible for Medicaid). No one would have to go untreated, since there would be a safety net. Government care would probably be no better than it is today for people on welfare or SSDI, but it's important that it not be too good, or else too many people would forgo insurance and plan to sponge off the state.Mad Max | May 12, 2007, 1:12am | #
Here's another bleeding-heart pinko criticizing eugenics and sterilization (see paragraphs 68-71):http://tinyurl.com/4ajk
Asharak | May 12, 2007, 4:20am | #
Here's another bleeding-heart pinko criticizing eugenics and sterilization (see paragraphs 68-71):http://tinyurl.com/4ajk
Heh, good point.
Of course, the fact Baily even supports eugenics means the creep isn't worth responding to (not to mention that quite a few genuine "pinkos" were initially for eugenics).
I would also speculate that Baily's never been self-reliant in his entire life. He seems to be the kind of privileged, spoiled asshole who sucks off Daddy's money while hypocritically putting down welfare mothers and calling low-income people in general parasites.
Asharak | May 12, 2007, 4:31am | #
I'm also skeptical of Baily's claim that lack of access to quality health care "cull(s) the population" considering that lower-income individuals tend to have more children than others.Hit & Run's been attracting some scumfuck trolls lately. First it's Telltruth, now this guy.
Baily | May 12, 2007, 11:06am | #
AsharakI'm a libertarian who believes in personal rsponsibility and has the balls to face genetic reality. You're obviously a crypto-statist with a romantic streak.
brotherben | May 12, 2007, 12:15pm | #
Mrs. broben and I worked for similar sized companies making similar wages. Insurance was offered to us both from BC/BS. Coverage, co-pay, deductables were all the same. What i couldnt figure out was why her premium was 60 dollars/month and mine was 659 dollars/month.And yes, we went with hers for our family(2 kids).
I must add that I have many friends that complain about not being able to afford insurance for their family and make too much for state assistance. Yet they have new cars and lots of toys as well, all on a monthly note. We have an expected standard of living here that is sometimes irresponsible and unrealistic. Insurance has to have priority over beeer ciggies and tattoos.
JP-interesting plan, I will check it out. I actually think even the very poor should have to pay something, like a sliding scale. But I am skeptical of the role of insurance in a solution since a great deal of medical overhead goes into the administrative process of sorting out who has what insurance and who does not, and keeping records for that insurance. So I'm skeptical that making everyone get private insurance will lower any costs. I also think that a lot of medical prices are "inelastic."
Ken -- High-deductible insurance (which is all that most people could or would want to pay for, as opposed to the current system of pre-paid health plans masquerading as insurance) would make healthcare more patient-driven and should therefore bring prices down while encouraging innovation that would lower costs. The administrative side of healthcare in particular seems to have a lot of room for increased efficiency.
black_box | May 12, 2007, 1:44pm | #
Much of the debate about health care reform focuses on the motivations of businesses and individuals, while giving passing mention to the most important party to this debate: the doctors and health care workers. While businesses and individuals squabble about the best way to structure any kind of reform, the doctors and health care workers will be unified in squashing any kind of reform that takes money or growth out of the current system. As we see time and time again in this country (think immigration reform), the unified special interest group (here the health care industry) will prevail over the wishes of the general populace.I guess this is a long-winded way of saying: don't count on health care reform happening any time soon. And especially don't count on reforms that will please the likes of libertarians period.
Isaac Bartram | May 12, 2007, 2:06pm | #
What i couldnt figure out was why her premium was 60 dollars/month and mine was 659 dollars/month.Ummm...because her employer paid a higher percentage of the total premium, maybe?
Steven Andrew Miller | May 12, 2007, 2:58pm | #
Bailey is obviosuly in the pocket of Big Big Business.Neu Mejican | May 12, 2007, 3:54pm | #
"I find it amusing that those savings' going toward lower consumer prices was not one of the possibilities that crossed your mind.Did I say amusing? I meant sad."
Yeah, just like the savings in production, transportation, and storage made CD's cheaper than vinyl records....
Company savings are always passed right along to the consumer.
Mr. F. Le Mur | May 12, 2007, 4:24pm | #
Of course, the fact Baily even supports eugenics means the creep isn't worth responding to (not to mention that quite a few genuine "pinkos" were initially for eugenics).Eugenics, "negative eugenics" yet, is alive and well in the US:
"One study of 53,000 women's choices, published in Obstetrics & Gynecology in 2002, found that the termination rate ranged from about 1 percent for conditions that were classified as having no impact on the quality of life, to 50 percent for those considered to have a serious impact.
Women were far more likely to choose abortions for disabilities that have a high probability of affecting cognitive functioning. For conditions that have little or no impact on the quality of life but might require medical or surgical therapy, the abortion rate was 16 percent, but doubled for those likely to cause mental dysfunction.
As for Down syndrome, doctors estimate that about 80 percent of women who get positive test results choose abortion."
http://www.nytimes.com/2005/11/20/weekinreview/20harmon.html?pagewanted=2&ei=5070&en=62249856d5371f0e&ex=1179115200
And, nearly everyone who decides to reproduce practices "positive eugenics" when they choose their mates. So what's the big deal?
Yeah, just like the savings in production, transportation, and storage made CD's cheaper than vinyl records....
I understand your argument, but records and CDs may not be the best examples of it. As I recall, when I was in high school in the mid-'70s, a record album cost about $7.00. According to the calculator at measuringworth.com, $7.00 in 1975 had the same purchasing power as $26.21 in 2006. That is about $10 more than a CD costs now, plus a CD can hold about 50% more music than a record album, is less fragile, and will last through more playings.
I understand your argument, but records and CDs may not be the best examples of it. As I recall, when I was in high school in the mid-'70s, a record album cost about $7.00. According to the calculator at measuringworth.com, $7.00 in 1975 had the same purchasing power as $26.21 in 2006. That is about $10 more than a CD costs now, plus a CD can hold about 50% more music than a record album, is less fragile, and will last through more playings.
Asharak | May 12, 2007, 7:28pm | #
I'm a libertarian who believes in personal rsponsibility and has the balls to face genetic reality. You're obviously a crypto-statist with a romantic streak.Wrong on both counts.
You're obviously a crypto-fascist sack of shit masquerading as a libertarian. Get lost, troll.
Ronald Bailey says: "Reforms must result in a market-based health care system; individuals must carry mandated health insurance coverage; coverage for low-income individuals will be subsidized; reforms must include strong personal financial incentives for adopting healthy behaviors; and the difference in tax treatment employer-provided and individual health insurance policies must be eliminated. As principles go these are pretty good ..."
"Pretty good"? Maybe if you're writing for a statist rag like Harper's magazine. Not so much so if you're writing for a libertarian magazine. Point #1 about a market-based system is good, but the rest? Point #2 advocates compulsory insurance coverage, point #3 advocates taxpayer subsidies, point #4 opens the door to nanny state meddling with our lifestyles; and point #5 could go either way, depending on whether whether "eliminating the differences" means a stealth federal tax increase by eliminating deductions for employer-provided insurance.
Overall, this plan looks like a wet dream for insurance companies and statist politicians.
"Pretty good"? Maybe if you're writing for a statist rag like Harper's magazine. Not so much so if you're writing for a libertarian magazine. Point #1 about a market-based system is good, but the rest? Point #2 advocates compulsory insurance coverage, point #3 advocates taxpayer subsidies, point #4 opens the door to nanny state meddling with our lifestyles; and point #5 could go either way, depending on whether whether "eliminating the differences" means a stealth federal tax increase by eliminating deductions for employer-provided insurance.
Overall, this plan looks like a wet dream for insurance companies and statist politicians.
LarryA | May 12, 2007, 8:00pm | #
Point #1 about a market-based system is good, but the rest? Point #2 advocates compulsory insurance coverageUnless you are advocating letting people who don't purchase health insurance die, any practical system has to mandate paying for coverage. Otherwise you subsidize those who don't pay by teating them on an 'emergency" basis.
point #3 advocates taxpayer subsidies
See above. If health care is priced out of poor people's range, they end up in the emergency room. At least with a subsidy you can encourage thrift by charging them a portion of the cost.
point #4 opens the door to nanny state meddling with our lifestyles
I don't have a huge problem with financial incentives, like charging people who smoke more because their costs may be higher. It's a lot better to be able to pay the higher premiums than have the true nanny state folks just outlaw the behavior.
The hole in this principle is that a "prevention oriented" program may end up costing far more as people live longer and spend more years in long term care facilities. A true economically based system might better encourage smoking, etc.
point #5 could go either way, depending on whether "eliminating the differences" means a stealth federal tax increase by eliminating deductions for employer-provided insurance.
Eliminating the tax incentives for everyone currently covered would be political suicide.
Besides, it won't make any difference. The government's going to take as much tax money as it can get away with regardless. Any tax savings on medical care will be compensated for in higher taxes elsewhere.
"Unless you are advocating letting people who don't purchase health insurance die, any practical system has to mandate paying for coverage. Otherwise you subsidize those who don't pay by teating them on an 'emergency" basis."
OK, LarryA, let's try a few more iterations of this statist philosophy:
Unless you're advocating letting people who don't purchase food die, any practical system has to mandate people buy their food only from government-approved food stores.
Unless you're advocating letting children grow up ignorant, any practical system has to mandate that children attend only government-approved and funded public schools.
Statists can always contend that unless a new government program is implemented, people will suffer -- while ignoring the suffering imposed upon people not currently in distress by the consequences of that government mandate.
I did enjoy your original use of the English language when you proposed "teating them on an emergency basis", though I'm a little unclear whether "teating" refers to prostitution or just a bit of nipple flashing. Care to clarify?
OK, LarryA, let's try a few more iterations of this statist philosophy:
Unless you're advocating letting people who don't purchase food die, any practical system has to mandate people buy their food only from government-approved food stores.
Unless you're advocating letting children grow up ignorant, any practical system has to mandate that children attend only government-approved and funded public schools.
Statists can always contend that unless a new government program is implemented, people will suffer -- while ignoring the suffering imposed upon people not currently in distress by the consequences of that government mandate.
I did enjoy your original use of the English language when you proposed "teating them on an emergency basis", though I'm a little unclear whether "teating" refers to prostitution or just a bit of nipple flashing. Care to clarify?
NovaTheCat | May 14, 2007, 12:13pm | #
If requiring people to get private (nonemployer) health insurance is to work, there should be a mechanism for people to join a risk pool so you won't have to pay huge premiums as you age or if you have pre-existing conditions. Right now, many self employed people can't afford health insurance because they have to buy it as an individual. Also, physicians, pharmacies, etc, should be required to post their prices so it is easier to shop around.Black box- regarding your comments on health care profession resisting change. The institution with whom I am current associated is loaded with professionals ready to jump ship at anyone who can provide a better system. Speaking more for doctors than nurses, although many entered the profession to earn, most passed up higher paying professional opportunities elsewhere to enter medicine. They want to practice. Anyone that can provide an easy profitable environment for them to practice in will stem the tide of doctors leaving medicine.