Addicted to Pills

As noted below, the era of big government is alive and well. And about to get bigger, as this AP headline makes plain:

Prescription Drugs for Elderly Closer

The tally for this taxpayer lark is widely expected to bust the $400 billion mark over the next decade. This, despite the fact that more than 70 percent of Medicare beneficiaries pay less than $500 out of pocket annually for pills and such. Yet perish the thought of a targeted plan (much less no plan at all)!

Ah well, in the words of Grandpa Simpson and his geriatric pals, "I'm Old! Gimme Gimme Gimme!" As the baby boomers running the Congress eye their own retirement, it's hard not to believe that, as with their interestingly timed embrace of World War II nostalgia, they're more interested in gilding their own retirement nests than in helping the truly needy.

Comments

[Mark Fox]

Boomers will likely force the rest to subsidize their old age, through debt because direct taxes are too obvious. Then as the Boomers eventually die off in sufficient numbers to lose their voting bloc, a wily schemer might enact an estate tax on the remaining Boomers to repay that debt.

That still leaves us with an expanded age/health bureaucracy offering limited, inefficient coverages (no market feedbacks, joe). If somebody has a scheme to dismantle that remnant of the process, this whole Elderly Boomer issue can be self-funding and-self liquidating.

[Tom from Texas]

Arjay,

A very similar argument was used by the Grand Army of the Republic to justify its pension demands after the Civil War - the soldiers had saved the union, so therefore the union owed all of them money, not just a one-time thank you/attaboy bonus, not just for those who were maimed or the families of the dead, but for all who served, for the rest of their lives. At one point either in the 1880s or the early 1890s, Civil War pensions were the largest single federal expenditure (can't cite exactly, but detailed in the GAR history "Glorious Contentment", which unfortunately I no longer own). Hardly the actions of a Cincinnatus.

Veterans have the ability to turn into some of the best customers an expanding government could ever wish for.

[D.A. Ridgely]

joe, I was addressing the major thread -- eliminate the tax advantage of corporate versus individual payment of health care cost and the problem you discuss will begin to disappear because many employees would love to opt out of company health care plans and would increasingly be able to do so.

Mark, you're quite right. I'm much richer than my grandparents were and the odds are overwhelmingly in favor of my grandchildren being much richer than I am. Moreover, we boomers will indeed eventually die out (however loathe we are to admit it) and we will leave the wealth of the world, less what we manage to squander first, to our descendents. Furthermore, the overall cost of medical care is likely to go down over the next several generations. Thus, notwithstanding my political objections to socialized medicine, I can't say I'm really all that worried about sticking my kids and their kids with the bill.

[joe]

DA

1. A large corporation can still get a better deal from an HMO for its hundreds of employees than an individual employee can get on his own, or a small business can get for its 20 employees. Not to mention the efficiency of admin costs.

2. Your comment still doesn't address the difference between large corporations and small.

[D.A. Ridgely]

joe: (1) cost containment isn't the only issue; (2) economies of scale do not go on forever and, in fact, typically become negative at some point; (3) no corporation of any size should be paying for people's health care; they should (whenever able) pay for it themselves; and (4)arguing the advantages of public financing as a means of equalizing costs among those who work for small versus large corporations is like arguing the advantages of becoming some thug's punk in prison so you don't have to worry about the other thugs -- probably true but hardly the optimal solution.

[Jason Ligon]

joe:

"...the impacts of employer-based coverage vs. public coverage on the competitive advantage/disadvantage of big businesses vs. small or self-employed"

I guess what I was getting at is that when you socialize, you are dramatically changing the context in which businesses are competing. "Coverage" doesn't mean the same thing it did previously. How many fundamental business models would you be altering? Medical care, medical devices, sterilization tools and servcies, plastic tubing, surgical steel, not to mention pharmas would be significantly different.

Businesses would certainly be leaner if they didn't have to pay for insurance coverage, but there are bagillions of costs to businesses associated with socialization of a large chunk of the economy. I think D.A. is on target with the idea of removing the tax benefit for corporations and giving it to individuals (or removing it all together if you prefer) as a way of getting companies out from under the burden of competing with lead boots on.

[Jason Ligon]

"1. A large corporation can still get a better deal from an HMO for its hundreds of employees than an individual employee can get on his own, or a small business can get for its 20 employees. Not to mention the efficiency of admin costs."

Counteracting bulk purchasing power is increased competition and efficiency when each person can choose a level of coverage they are willing to pay for. Also, most economists agree that the amount spent by companies on benefits are associated with a decrease in salary. Finally, voluntary purcasing groups (like unions) can form. You see some of this now in supplemental insurance.

[joe]

DA, 1) yes, many, many issues. Is it ok if we talk about one of them at a time? 2) So what? Is there any reason to believe that this point has been reached at all, let alone that this negative economy of scale is actually making a noticable difference? 3) and 4) Should I take your admission that you'd oppose publically-funded health care regardless of the benefits, as an admission that there are such benefits?

Here I've been trying to get a group of people obsessed by economics to discuss an economics issue, and you come back at me by talking about your feelings. I'll draw my own conclusions from that.

Jason, how does getting a tax break that isn't available to individuals put lead boots on businesses? And how does a tax break that is available to both large and small businesses put lead boots on either?

[D.A. Ridgely]

joe: [lounge lizard version of "Feelings" playing in the background] (1) many, many *interrelated* issues; (2) yes; (3) & (4) in the same sense I admit that snuggling up to Rocky after lights-out might have some advantage.

[Jason Ligon]

"Jason, how does getting a tax break that isn't available to individuals put lead boots on businesses? And how does a tax break that is available to both large and small businesses put lead boots on either?"

I must not have communicated very well.

The lead boots on business is their competitive disadvantage with companies that don't have to pay for healthcare. As I mentioned, much of this disadvantage is illusionary, as wages would likely have to increase when the benefit was dropped in order for employers to retain valuable employees.

The tax break problem is that you and I as individuals (not employers) don't get the same tax break for buying our own insurance as employers do when they are involved. This is the primary reason that employers are involved in providing health care. Employees demand a benefit that the government has created self interested motive for companies to supply. It is cheaper currently for companies to supply $1000 in insurance than for them to supply $1000 in wages.

[Phil]

"Prescription Drugs for Elderly Closer?"

Jesse Orosco needs prescription drugs?

[Mark Fox]

joe: You are eager to discuss the effects government meddling in business. To establish the least wasteful technique is an economic discussion. That such meddling is wrong (a feeling), might be a philosophical discussion. At the heart (!) of it, are individuals (the market) better able to make their own choices about how to pay the costs of physical frailty, or are outside analysts (government) smarter?

[thoreau]

Joe made a good point early in this thread. What would attract more conservative/libertarian outrage? Prescription drugs for all seniors, or prescription drugs for poor seniors?

From a pragmatic point of view, the fewer people covered the lower the cost. Since most of the people paying for the drugs will be younger workers who aren't receiving any benefits anyway, arguments like "I pay the taxes, I should get them too!" don't really apply. So a pragmatist should support means testing.

From a lefty point of view, it is virtuous to help the less fortunate, and those who have enough shouldn't demand anything from the public coffer. So a leftist should support means testing.

I'm trying to talk my mother out of voting Democrat by pointing out to her that my brother and I will help her when she's retired regardless of what shape the social security system is in. In 40 years (when I retire) there will be no social security, and I cannot in good conscience say "Oh, I'll let the government take care of my mother so I don't have to."

[JDM]

"Whenever liberals propose a program that helps the needy, conservatives start whining about welfare bums driving Cadillacs, and the bill expands to cover the middle class in order to avoid the stigma of - horrors - being limited to the poor. Your well-funded think tank echo chambers have done such a good job of turning Americans off from the idea of assisting the needy, that programs limited to those in need aren't even brought up anymore."

Even I have to give you points for creativity here.

How about this: conservatives are so evil that liberal are forced to take odious self-righteous stances on every topic so that no one can stand anything you say, forcing people to automatically hate all programs proposed by liberals, even ones which might legitimately help the poor. Wheeeeee!

[Thorley Winston]

Jason Ligon wrote:

Counteracting bulk purchasing power is increased competition and efficiency when each person can choose a level of coverage they are willing to pay for. Also, most economists agree that the amount spent by companies on benefits are associated with a decrease in salary. Finally, voluntary purchasing groups (like unions) can form. You see some of this now in supplemental insurance.

Good point, I?m paying for my own health insurance on my own through one such organization and it?s relatively cheap (cheaper than what my previous employer was paying). What we ought to be looking in addition to fixing the tax issue would be to (a) look at any governmental created barriers (if any) which make it difficult for people to form such voluntary purchasing groups and (b) remove mandated benefits (?prepaid health care? instead of actual insurance for catastrophic illnesses, accidents, and long-term care) which artificially raise the cost of health insurance and let people purchase the plan which best suits their needs and means.

[joe]

Yes, DA, if we remove the bottom 40 million, our numbers look good. You didn't, by any chance, used to write copy for the Bush2000 campaign, did you? 😉 I wonder how many of the 40 million uninsured Americans would pass up the chance to belong to England's National Health.

Freaking Iceland has lower infant mortality than we do, and they sell freaking fish for an economic base.

[Jason Ligon]

"I wonder how many of the 40 million uninsured Americans would pass up the chance to belong to England's National Health."

That depends on what their idea of a reasonable wait for 'free' angioplasty is.

http://www.marginalrevolution.com/marginalrevolution/2003/10/more_on_canadia.html

[JDM]

I like my job, although I'm not sure what that has to do with anything. I'm one of the 5 founding employees at a start-up that just got funded two weeks ago. I don't know many sane people who would call my job shitty, unless you mean in the sense that any job outside of Fire Jumper, rock star, or professional athlete is shitty. Also, mocking imbecilic jackassery is something I do when I'm in a good mood.

[joe]

Better late than never, JL. You think a lot of uninsured waitresses and convenience store clerks are getting angioplasty and mammograms in this country?

[JDM]

Jason,

A Canadian government comitee recently recommended that in order shorten wait times, that more patients be sent to US doctors. We owe it to the Canucks not to socialize our health care system. They'd have nowhere to go.

[Jason Ligon]

joe:

Everyone is waiting that amount of time in Canada, except for the politically connected. Those who can scrape together some cash don't have to wait here in the US. Dieing in a waiting line is no better than dieing without an insurance card.

People who have heart attacks and wind up in an emergency room in the US are operated on whether they have insurance or not.

And the point needs to be made again that if we nationalize, everyone else's nationalized systems are much less effective in delivering health care.

[joe]

"People who have heart attacks and wind up in an emergency room in the US are operated on whether they have insurance or not."

1)Yes, the government's commitment to subsidizing hospitals and otherwise serving as the payer of last resort, along with the laws requiring hospitals to treat the uninsured, has saved many lives, although at great costs in efficiency and human suffering.

2)Too bad an ounce of taxpayer prevention wasn't available to prevent the need for a pound of taxpayer cure.

[Anonymous]

Why don't we just ship the poor people to countries with socialized medicine and make everybody happy?

[Jason Ligon]

"1)Yes, the government's commitment to subsidizing hospitals and otherwise serving as the payer of last resort, along with the laws requiring hospitals to treat the uninsured, has saved many lives, although at great costs in efficiency and human suffering.

2)Too bad an ounce of taxpayer prevention wasn't available to prevent the need for a pound of taxpayer cure."

If only it were that straightforward. There are a lot of factors involved. For instance, to what degree would preventative coverage subsidize unhealthy lifestyles and simultaneously encourage excessive health care consumption? Which method is the ounce and which is the pound is not at all clear.

Also, don't make the mistake of arguing that if the government didn't build roads, no one would.

[joe]

The idea that people put down pints of Ben and Jerry's because they fear future health care costs is laughable. France, Italy, and Spain, all of which have universal health care, have lower rates of heart disease than the US. Heart attacks involve severe physical pain; the possiblity of death; painful recoveries; painful therapy, long periods in boring, depressing hospitals; ugly scars; possibility of brain damage and sexual disfunction; etc etc etc. And your hypothesis is that people who aren't motivated by these possibilities will be moved by the economic cost?

[Citizen]

The Ben and Jerry's man is going to die from a heart attack because he is lazy and stupid. If we had to pay taxes directly to the recipient would you want to cough up first to get fatty's ass off the couch and on a diet plan (preventative) or even to get him the angioplasty (reactionary)? I wouldn't either.

The fact that many of us spend a good deal of time and energy actively maintaining our health and avoiding harmful activities does not prevent us all from dying anyways. But it certainly increases the liklihood that we'll inccur lower costs down the line. With that said, I am willing to accept more risk because I think I've prepared for it, hence I prefer to pay less money and receive less health insurance.

Fatass has this option too, but he prefers to spend his time and energy devouring ice cream and TV. This is his freedom but he is likely to inccur greater costs; therefore he is likely to want to pay greater ammounts of money now for great ammounts of insurance. This sounds good to me.

Why then should fatty and me pay the same ammount for the same coverage?

[JDM]

Citizen,

Soon joe will explain to you why it's people that think like you who cause socialized medicine to be a political neccesity. It'll all make sense.

[Joe2]

Anyone here ever pay a doctor in cash for a discount? My ex has done this with her doctor and dentist. Makes my wonder why anyone should pay $200 per month in health insurance, only to pay $40 more for a doctor visit than is charged to the uninsured. I've heard several stories about this with dentistry.

All without the "bargaining" power of a large corporation.

[Dove in D.C.]

If government is going to provide any health benefits at all, then it ought to provide drug coverage too. Pharmaceuticals play a far greater role in medicine today than ever before. Granted, 3/4s of seniors already have some form of drug coverage, whether through Medicaid or private insurance, so the complaints of crisis from seniors groups seem overblown. Of course, complaints about socialized healthcare in the context of this legislation are bluster as well. Not that it matters--the final bill will undoubtedly be too liberal for to pass the House or two conservative to pass the Senate.

[Dove in D.C.]

Joe2: Dentistry is quite different from healthcare. That's why you pay, say, $70 a month for employer-provided health insurance and $10 a month for dental.
Clearly you've never been uninsured. Those without health insurance actually face far higher bills for the same service than the insured, precisely because of collective bargaining. Some people call that discrimination towards the poor/unemployed. But there's a GOP-led congressional investigation into the problem, so it should be solved any day now.

[Anonymous]

"God helps those who help themselves (maybe that's why religion and the Left don't see eye to eye)"

On the average, Red states are net recipients and blue states are net donors. It seems to me it is the hard working left that is subsidizing the right.

[Mark Fox]

The concept of insurance is to spread the cost of future losses among all who might incur them. It makes those who don't need help pay for those who do.

Since any society is composed of humans who break and bleed, there will be losses. If we socialize and aggregate all those expected losses then divide them between the population, we can arrive at a per capita cost of health care. This would be "perfect" insurance, I think. Still some people will not be able to afford their share, and it does not address Citizen's beef with the fatties. Thus under the guise of "health care" we are forced to redistribute wealth and limit some people's freedom of action.

If DA is not allowed to ignore the 40 million poor, then joe must not ignore people like Ctizen and Joe2, who would rather make their own contracts.

[richard]

Joe, you are dead wrong about Spain Italy and France...
http://in.news.yahoo.com/030905/137/27ldi.html

"Report says Italy's kids fattest in Europe"

Mark, why should I, Joe, DA, and anyone else brave enough to make posts here (Jean Bart where are you man? BTW Matrix Revolutions sucked...another post) subsidize the health of people who gorge on Ben & Jerry's, swill bottles of Jack, or smoke a pack a day of tar? Health insurance should reflect the risks we take and make...similar to car insurance. We should abolish cigarette taxes, alcohol taxes, and other sin taxes and insurance companies should be free to reflect those future health care costs (if indeed there is a statistical correlation between such personal choice items and health) statisticians will know how much to 'tax' these individuals and that money will certainly go to pay costs of health care. Unlike government, these companies have an incentive to pay for health care and save for future costs...government (as we have seen and will see even more dramatically in the near future) that government is a poor manager of future costs...i.e. a $1 paid into Social Security guarantees a .10 in the future -10% rate of return over 10 years.

Trust government and surrender your future now. What can it hurt?

[funpunker Archie]

"religion bashing"

= "saying anything remotely critical of organized religion or disagreeing with the components of organized religion"

"religion" = christianity

[Joes2]

"Clearly you've never been uninsured."

Dove, nope, being in the hi-tech industry, I have been uninsured (unemployed) in the recent past. I was only completely unemployed for a couple months (then did some contract work), but went uninsured BY CHOICE for about a year. For the $400 per month it would cost (under COBRA) to insure myself and my son I felt (er calculated, OK gambled) I was better off putting the money in the bank. It paid off - $4,800 in my pocket, minus about $25 for a prescription refill. I'm not advocating this "system" for anyone else though, just worked for me.

"Those without health insurance actually face far higher bills for the same service than the insured"

Yeah, but they will most likely actually see much smaller ones and DEFINITELY will not have to pay the premium, either directly, or taken from wages, or hidden in various taxes.

[Brad S]

What's funny about that "I'm Old! Gimme Gimme Gimme!" line is that Matt Groening juxtaposes it brilliantly with a "back in my day, nothing came for free - you had to work for everything you had - and you had to walk to and from school through eight feet of snow uphill both ways" speech by Grampa Simpson to one of his elderly friends. Classic stuff!

[StMack]

At least they can't claim to be doing it FOR the children. I wonder when it will occurr to then that they are doing it TO the children.

I see this as nothing more than a drain on my income from which I will never see any benefit because like Social Security it will have collapsed under it's own weight before I'm old enough to be eligible to get any of MY money back.

[Anonymous]

I, for one, look forward to being taxed to pay for Warren Buffet's prescription drugs. I can't wait until Bill Gates retires and I can buy his too!

[D.A. Ridgely]

And if you think this is bad, just wait until my baby boomer generation (the proverbial pig in the python) starts to retire en masse!

Not that I will refuse government largess, mind you. That would be irrational. (As a former colleague of mine once replied in a job interview when asked about his principles, "I have principles I've never even used!")

[Mr. Nice Guy]

We Gen-Xers are so screwed it's not even funny. It's never too early to buy that shack in Montana and stock up on canned dog food.

[joe]

"Yet perish the thought of a targeted plan..."

"they're more interested in gilding their own retirement nests than in helping the truly needy"

"I, for one, look forward to being taxed to pay for Warren Buffet's prescription drugs. I can't wait until Bill Gates retires and I can buy his too!"

Whenever liberals propose a program that helps the needy, conservatives start whining about welfare bums driving Cadillacs, and the bill expands to cover the middle class in order to avoid the stigma of - horrors - being limited to the poor. Your well-funded think tank echo chambers have done such a good job of turning Americans off from the idea of assisting the needy, that programs limited to those in need aren't even brought up anymore.

Thanks, fellas! Enjoy the debt!

[Andy D.]

This is a minor problem compared to the prospect of fully socialized medicine. That idea seems to be constantly gaining steam. I don't know how, but there needs to be a serious effort to reverse the trend in public opinion on this issue. And I don't mean just tossing out a couple Reason articles on this: preaching to the choir is not the right strategy. The great unwashed need to be convinced that universal health care would be a disaster.

[Argyles]

Which fellas here are you talking to? Would any of these posters advocate blanket expansions of any federal entitlements?

[joe]

"The great unwashed need to be convinced that universal health care would be a disaster."

The only problem being, it isn't. Like the Soviets showing "Grapes of Wrath" in an attempt to portray the horrors of the American system (the Russian people were amazed that even poor Americans drove cars), a large number of the people in this country look at your horror stories about Canada and Europe and say "Wow, they're a lot better off than I am."

[Tom from Texas]

Joe,

God helps those who help themselves (maybe that's why religion and the Left don't see eye to eye).

[D.A. Ridgely]

Well, if the great unwashed don't even bathe, no health care system will likely work.

[joe]

Tom, read anything from the Pope, or most other mainstream Christian sects, on health care or economics? They realize that the vast majority of poor people are helping themselves, and that even in America, most people without health insurance are either working people or their children.

Argyles, I'm talking to the fellas who bash "welfare bums" so much that any program to help the poor needs to be part of a budget-busting middle class entitlement program in order to be politically viable. Which pretty much includes every Republican and libertarian in America.

[tchiers]

Joes2 hits on a good point above. Not all of the uninsured are so because they can't afford insurance.

Currently my company spends $350 /mo to buy me health insurance. That's just insane - I'm young, healthy, and have a specific policy to cover me in the activity most likely to hurt me (driving a car).

I'm also not particularly risk averse. I'd gladly trade my company health insurance for an extra $350 /month (even a pre-tax $350/mo). The chance of me needing to spend more than $2100 /yr on health care (roughly what that extra $350 means in take-home) is acceptably small.

But it does give me a warm fuzzy knowing that if I were ever to do such a thing, joe and his buddies would spend their time worrying about how awful it is that I don't have my "universal" coverage.

[Andy]

Joe, there are some important differences between the US and other western countries. Perhaps the most relevant here is that the US is where most advancements in medicine occur, especially with drug development. A major reason for the relative expense of medicine in the US is that we are footing the bill for these advances. Another problem for us is that we live relatively unhealthy lifestyles, and any comparison between our medical expences and those of other countries needs to take this into account.

[Tom from Texas]

Joe,

My comment was more than a bit tongue in cheek (more directed at the religion bashers around here than at you). I am a firm believer in voluntary charitable donations. In Catholic school I was helping to buy milk for poor pagan babies when all you protestant brats were out torturing kittens and burning crosses (at least that's what the nuns said public school kids did). If we can define who is truly poor and needy, then I have no objection to a portion of the $125,000 my wife and I pay in taxes every year going to help them.

But I don't want to help pay for medications for 66-year-olds who are touring the country in an RV bought outright in cash from the sale of their own homes.

[joe]

Tom, If my Clancy Brothers loving father and his nine siblings heard you calling me a prod, you'd be passing rosary beads for a month!

[D.A. Ridgely]

Whether any or all of the uninsured should receive the same general level of health care as the insured is one question. Whether the state should provide such care is another.

Most state assistance programs, however defined, assist middle income Americans because they represent the overwhelming majority of voters. I don't believe robbing middle-class Peter to pay for middle-class and retired Paul's prescription drug costs is a very good idea. I don't think Peter (or you or I) should pay for extensive corporate subsidies or vastly inefficient government programs in general either.

But that has absolutely nothing to do with whether society should care for those who through no fault of their own cannot care for themselves, let alone how it should go about doing so.

[matt]

perscription drugs....just another way to steal from those who work and give to those who don't

[Jason Ligon]

"The only problem being, it isn't. Like the Soviets showing "Grapes of Wrath" in an attempt to portray the horrors of the American system (the Russian people were amazed that even poor Americans drove cars), a large number of the people in this country look at your horror stories about Canada and Europe and say "Wow, they're a lot better off than I am.""

That is because we are paying for our drugs and theirs too, of course. Canadian socialized medicine is already a disaster for Americans. It will become a disaster for Canadians only when they don't have someone else footing the bill.

[Daniel Franks]

Mmmmmm, perscription drug welfare--

aghaghrghghlghrgh....

[joe]

You've got is backwards, Kevin. The economies of scale and bargaining power of big corporations allow them to provide health insurance to their employees at a lower cost per person. Small businesses can either pay more for the same benefit (putting them at a disadvantage in their cost of doing business) or not provide health insurance (putting them at a disadvantage in the market for labor). Even if they pay a higher salary instead of offering insurance, the extra salary will not allow the employee to purchase teh same level of health care. This gives the big guys a leg up. By socializing these costs (oooooh, he said it!), small businesses and the self-employed can get the same level of coverage for the same price.

[Jason Ligon]

"By socializing these costs (oooooh, he said it!), small businesses and the self-employed can get the same level of coverage for the same price."

Not really, since the socialized model removes the advantages of competition from the scheme. You don't get the same price and while you have more 'coverage', the actual number of available options that are included under the umbrella of coverage is smaller.

It also eliminates the option of opting out, or of choosing a lower level of insurance based on a higher risk tolerance.

[D.A. Ridgely]

And, as P.J. O'Rourke put it so well, if you think health care is expensive now, wait until it's free!

By the same reasoning, big corporations could doubtlessly get their employees better deals on food, housing, automobiles, etc. (Of course, the employees would have to choose from among fewer models of car, fewer housing options and a more limited menu, but hey, that's collectivism for ya!)

Historically, health care (like food, clothing, shelter, etc.) was the individual's responsibility. Incredibly bad tax policy said, hey, if your employer pays for it, it's tax deductible, but if you pay it isn't. That has indeed affected the market, but we would go a long way toward correcting the situation if we treated all health care costs the same regardless of who paid.

[D.A. Ridgely]

By which I mean treat them the same for purposes of taxation, by which I mean make them tax deductible. Then again, there isn't much I can think of that shouldn't be tax deductible.

[Olsen Twin #2]

The boomers are the worst generation EVER in the history of mankind. Can't wait for them all to go into nursing himes and be seriously abused until their karma equals out!

[arjay]

Well in ten years when I'm firmly attached to the SSA teat, and I have coverage so I don't have to choose between my medication and a trip to Europe I'll be ever so grateful to the two young workers who are making it all possible.

"THOSE ARE MY PRINCIPLES. IF YOU DON'T
LIKE THEM I HAVE OTHERS." (Groucho Marx)

[Citizen]

joe, tell me again, fundamentally, why employers and health coverage are tied. It makes as much sense as employers offering cable TV coverage to employees.

[arjay]

Nick

Grandpa Simpson and the "Fighting Hellfish" saved us from Hitler there is nothing we can do that's enough to repay them.

[D.A. Ridgely]

"The boomers are the worst generation EVER in the history of mankind. Can't wait for them all to go into nursing himes and be seriously abused until their karma equals out!"

And not the least of our many sins is our failure to educate the younger generation.

[arjay]

D.A. Ridgely

As I understand it employer provided health insurance became prevalent during WWII when price and wage controls prevented employers from offering higher wages to attract employees.

Instead they sweetened the pot with fringe benefits.

[joe]

Jason, DA, Citizen, you all raise valid issues. I'm not going to address them, because the there's a perfectly good issue still hanging out there - the impacts of employer-based coverage vs. public coverage on the competitive advantage/disadvantage of big businesses vs. small or self-employed. Please read Kevin's 11:57 comment, and my 12:22 reply.

I'd rather follow that particular line than have yet another mile-wide-inch-deep thread.

[R C Dean]

I wonder how many of the 40 million uninsured Americans would pass up the chance to belong to England's National Health."

As just noted, many are uninsured by choice, and for healthy young people, it is a rational choice.

If you asked those 40 million uninsured to pay the taxes necessary to support National Health, my guess is most of them would pass.

Emergency rooms treat everyone because (1) federal law requires it, not because the feds are a payer of last resort; (2) they are afraid of the liability if someone dies untreated; and (3) many are nonprofit charities with a mission to treat regardless of ability to pay.

[D.A. Ridgely]

joe, Iceland? Puleezzeee! Reminds me of a Norwegian diplomat decrying the crime rate in New York and bragging how low the crime rate was in Oslo. Actually, replied his American counterpart, the crime rate in New York is very low too, among Norwegians.

[D.A. Ridgely]

Oh, and by the way, that "40 million" figure requires a little skeptical response. I don't know what the actual number is (and neither, I suspect, does joe or anybody else), but it certainly isn't a static number even though the conversation so far has allowed it to stand as though there was a huge, permanent underclass in the U.S. forever unable to get their angioplasties and mammograms. Phooey.

In fact, we already have a socialized medicine program for the permanent underclass (Medicaid), not to mention varous voluntary charities available to them. Some posting here would have us believe that health care for the poor in the U.S. is basically Monty Python's "Bring out your dead!" scene. Nonsense. The U.S. health care system may not be as egalitarian as Canada, etc., but I haven't had to step over a corpse on my way to work for ages now.

Second, people do rationally decide not to get health insurance. I did so for years as a (poor) graduate student. I was young, healthy and willing to take the risk that I'd stay healthy or, if not, those charities and socialized medical facilities would suffice. That's hardly uncommon. I suspect that a significant proportion of those uninsured in the U.S. fall into roughly that sort of situation.

Finally, since joe wanted to discuss economics so badly earlier, has anybody addressed the critical problem of the lack of prices in a socialized model? Pricing allocates resources efficiently. (Yes, yes, it also allocates more of those resources to the rich, per capita, than to the poor, but that's a different argument.) In a single payer system there is no free pricing mechanism to influence the allocation of resources and the almost inevitable result will be too many people getting certain sorts of medical services, too few getting others, etc.

joe, your reply?

[StMack]

I opted out of my company's insurance program 3 years ago. For doing that I get an extra $2,000 a year in income (before taxes). Through an association I bought a policy covering catastrophic illness and emergency care at a cost of $300 per year. For routine md visits and teeth cleanings I have spent about $500 over three years. they insurance payback from my company is taxed as a bonus so fro three years I've netted about $3,600. Minus medical expenses I'm still ahead by $2,200.

It will never be possible for anyone to convince me that I should now bear an extra tax burden to pay for coverage that I do not want or need.

[R. C. Dean]

StMack's post reveals the degree to which catastrophic care insurance is much cheaper than "first dollar" coverage or the low deductible/copay model commonly bought by businesses.

Somehow, people have gotten the idea that healthcare is an entitlement that someone else should be expected to pay for, not themselves, and forgotten the purpose of insurance - to pay for things you can't afford. Always get the highest deductible you can afford, and you will come out ahead (usually way ahead) over time in lower premiums.

Most people should have catastrophic insurance with a deductible at least equal to what they carry on their car insurance. Doing so would push the vast majority of health care services back into a true market where the recipient is actually paying for the services, and the usual benefits of the market would ensue.

[joe]

Healthy young single people with jobs that offer benefits are not the people who need help. Here's hoping you don't develop sick. Your pre-existing condition won't be covered, and you'll end up "sucking off the public teat."

[StMack]

Joe,

You missed or ignored the part about catastrophic illness insurance, or pehaps you don't understand the concept. If the cost of medical care for an illness excedes a predetermined threshold - the insurance covers it.

As for the sucking public teat - lets just say some things are better done in private

[joe]

file under "ignored." Whaddya think of John Kerry's plan for universal catastrophic coverage?

[Cramer Heather]

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DATE: 12/11/2003 03:19:02
Truth is a kind and gentle lie.

[kim bo ram]

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DATE: 12/21/2003 04:15:13
Morality by consensus is frequently morality by convenience.

[Dougherty Terence]

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DATE: 01/19/2004 12:59:13
For every action there is an equal and opposite government program.