Kling Kong on Health Care

Arnold Kling is an excellent and provocative economist, writer, blogger, and more.

The folks at Catallarchy have an excellent Q&A with Kling, keyed to the release of Crisis of Abundance, his important new book about health insurance. Snippets:

"There is very little chance that my house will burn down. But if it happens, and I'm not insured, it's a financial disaster. So I insure. For most people in most years, fire insurance pays no claims. With health 'insurance,' most people in most years are paid claims. I call it insulation, because it acts as a layer of insulation between the consumer and medical bills."…

"The doctor is the gatekeeper to the hospital and to the pharmacy. My guess is that you'll have to pry away their keys to those gates from their cold, dead fingers."

Whole thing here.

Comments

[mac]

Well, the article doesn’t discuss one big problem. I have catastrophic insurance, insured after $5000. I pay my medical bills directly. And I get screwed. The insurance companies set up bill schedules that are much more favorable, not just a “bulk” deal. (Not to mention that a bulk deal is supposed to be more efficient, while my payment requires no paperwork.)

It’s a problem of monopsony–I’m up against the Doctor’s guild here. The local Bartell’s has opened up a “minute clinic”, where I can get simple prescriptions and vaccinations. It helps keep costs down, but it doesn’t cover most things. (A 20 minute exam & peeing in a cup costs around $300 at the doctor’s office.)

[metalgrid]

The doctor is the gatekeeper to the hospital and to the pharmacy. My guess is that you’ll have to pry away their keys to those gates from their cold, dead fingers.

Finally, someone else realizes the intrinsic flaw in our system too. It’s not the insurance companies that are evil. It’s the doctor monopoly on our ability to seek medical aid. Unfortunately, there isn’t a viable solution to this in the near future.

[Jersey McJones]

This is stupid. Who believes this crap? TRhe doctors hold the key? Pl-ease. The only one’s in the way are the insurance comapnies. Nice try at lying, though. Hope your insurance stocks do well.

JMJ

[Jason Ligon]

I am a fan of Kling, and I often wonder if his affiliation with TCS keeps more people from hearing him.

I thought his comments about the limits of education were interesting …

[Jason Ligon]

JMJ;

Who writeth the scrip?

[Jersey McJones]

Jason, who payeth (never payecth) the bill? Who determineth which scrip you can and can’t get? Who determineths which doctor you can go to? Who layeth down the rules?

You guys are going after the doctors but not the insurance companies. It’s like blaming the teachers but not the school boards. Typical stupidity.

JMJ

[MikeP]

You guys are going after the doctors but not the insurance companies. It’s like blaming the teachers but not the school boards.

Umm. People don’t blame the teachers. People blame the teachers’ unions.

Similarly, individual doctors are not to blame. To blame falls on the AMA and the licensing boards they set up and the restrictions on free competition they prevent.

[Jason Ligon]

JMJ:

I submit that if insurance actually never paid the bills, our healthcare expenditures would not be, well, high.

[Clean Hands]

Hey, JMJ, if the doctors don’t hold the keys to your healthcare, try getting your hands on opioid painkillers, or birth control meds, or antibiotics, without a doctor’s “mother may I” sometime.

Drop us a line, let us know how you make out — just don’t forget that your correspondence will be stamped “Federal Penitentery Mail.”

I don’t think that anyone’s particularly thrilled with the “solutions” offered by many of the insurance companies, either, but blaming them exclusively makes no sense, either.

[Clean Hands]

But, of course, insurance companies are easy targets for JMJ and his ilk — after all, they’re businesses, and hence three-quarters convicted already of any heinous crime you might want to assign to them.

[Another Lurker]

“Who determineths which doctor you can go to? Who layeth down the rules?”

Jersey under the socialized system you seem to advocate in your tirades if your doctor sucked it would just be too bad for you. You would not get a choice. The government would lay down the rules. At least with insurance companies I can choose which devil I want to deal with, or I can switch companies.

I mean Ford and GM suck, but I somehow don’t think a national car company would fix things.

Think HMOs are bad? (yep they suck, I pay the extra couple bucks for the PPO). Government managed healthcare is the same as an HMO only much much worse.

Not that I think any of this will get through the Marxist shell of a skull of yours. But really I post it for others. I swear I am going to have to send you a copy of Trolling for Dummies because you really suck at it. I didn’t think it was possible but you learn something new everyday.

[Isaac Bartram]

mac at May 15, 2006 01:24 PM

I know of a couple of people who have negotiated more favorable fees with their physicians. I don’t know how one goes about doing it, but some do.

Also a few doctors have also opted out of the whole insurance payment system and accept cash only (leaving it up to patients to go after reimbursement – as it should be IMO).

[Clean Hands]

C’mon, Jersey! Put down the spliff and tell us what crackpot plan you have for saving us from the eeeeeeevil health insurance companies.

[Pro Libertate]

Hey, JMJ, if the doctors don’t hold the keys to your healthcare, try getting your hands on opioid painkillers, or birth control meds, or antibiotics, without a doctor’s “mother may I” sometime.

Drop us a line, let us know how you make out — just don’t forget that your correspondence will be stamped “Federal Penitentery Mail.”

Clean Hands, you can get all sorts of fun drugs by driving far enough south. I was intrigued by the shelves of what I’d normally call “prescription drugs” while in a drugstore in Cabo. Perhaps JMJ could take a road trip to Mexico and send us a report. After several years of study–this is science, after all.

[Kevin S.]

Mac,
IB is right, you can negotiate your fees with most Docs. Two cases:

1) wife had eye surgery to repair detached retina while a student and uninsured. Doc did surgery and set up a 0% interest payment plan but charged the ‘rack rate’ for the surgery. After paying for many years I called up the Dr office and told them I got a bonus from work and was wondering if they would accept something less than the remaining $1500 for a cash payment today. I paid them $700 and it was done (although her total payments even with the $800 discount were more than double than the ‘in-plan’ rates they charge insurance companies). We would have saved more money if I did it earlier.

2) Friend got colon cancer and had catastrophic insurance only. He just had a sit down with the office manager and negotiated the cost of treatment based on what they are used to getting from insurance company contracts.

If you can’t get on an employers plan, catastrophic insurance is the way to go for most normally healthy people. The premium savings more than makes up for the 2-3 times a year you incur out of pocket expenses. Negotiate the cost and it works even better. You just have to have a cash reserve to cover the high deductible…or negotiate a payment plan.

[Jersey McJones]

MikeP

“Umm. People don’t blame the teachers. People blame the teachers’ unions.”

Because people are so stupid that they buy into the sleazy hate-talkers on the Right who want to treat teachers like shit because they don’t care what happens to the public schools – they have the money to send their kids to private schools.

“Similarly, individual doctors are not to blame. To blame falls on the AMA and the licensing boards they set up and the restrictions on free competition they prevent.”

Man, you just believe every stupid anti-representation piece of shit rhetoric that falls on your ears, huh? Hey, should chambers of commerce be abandoned too? How about business guilds and associations? No? Hypocrite? Yes?

Jason,

“I submit that if insurance actually never paid the bills, our healthcare expenditures would not be, well, high.”

There wouldn’t be any. And you’d die the next time you contracted some treatable illness.

Clean hands,

“Hey, JMJ, if the doctors don’t hold the keys to your healthcare, try getting your hands on opioid painkillers, or birth control meds, or antibiotics, without a doctor’s “mother may I” sometime.”

The FDA and the pharmies are the ones who keep meds off the shelves, genius. They do it because the pharmies can make more money that way. Doctors and insurers would like more of just the opposite, in that case.

Clean hands,

“But, of course, insurance companies are easy targets for JMJ and his ilk — after all, they’re businesses, and hence three-quarters convicted already of any heinous crime you might want to assign to them.”

Okay, once again, for the 18,000,000,000th time – show me the cost/benefit analysis that shows a value added to the healthcare system from private insurance. Go ahead. I’ve asked everyone this but have NEVER gotten an answer.

AL,

“Jersey under the socialized system you seem to advocate in your tirades if your doctor sucked it would just be too bad for you. You would not get a choice.”

Yes, you would, genius. There is nothing innate to national healthcare that precludes a choice of doctor – BUT – the system you have now does. (Jesus Christ, you guys are off today! Must be a Monday thing…)

“I mean Ford and GM suck, but I somehow don’t think a national car company would fix things.”

Owning a car of a given type is a choice. Have functioning kidneys is not. Genius.

Clean hands,

“C’mon, Jersey! Put down the spliff and tell us what crackpot plan you have for saving us from the eeeeeeevil health insurance companies.”

Oh, I don’t think there’s some panacea awaiting discovery here. But we could reduce the profiteering, anyway.

JMJ

[SmokingPenguin]

What about medical tourism?

There are a lot of barriers before this really becomes an option most Americans would consider. However, since there appears to be no end in sight to medical inflation, it’s advantages will only get better with time.

[MikeP]

Man, you just believe every stupid anti-representation piece of shit rhetoric that falls on your ears, huh? Hey, should chambers of commerce be abandoned too? How about business guilds and associations? No? Hypocrite? Yes?

If I understand the point you are trying to make… I don’t think that the AMA should be “abandoned”.

I think the AMA should not be able to its leverage in state licensing mechanisms in order to (1) limit the supply of doctors, (2) set the prices of doctors, or (3) do anything else anticompetitive.

Similarly, I don’t think that hairdresser unions should be outlawed, but I do think that hairdresser unions should not have any say in state licensing of hairdressers.

Is this really such a difficult concept to grasp?

[Clean Hands]

The FDA and the pharmies are the ones who keep meds off the shelves…because the pharmies can make more money…

>Bzzzzzzt< Wrong. Opioids, birth control and simple antibiotics are not expensive medicines, Jersey, even when you do have the “mother-may-I” in hand.

…show me the cost/benefit analysis that shows a value added to the healthcare system from private insurance…(emphasis added)

Check your premises. How about benefit to the healthcare consumer? Isn’t that what we should be worrying about here? Here’s some benefits for you:

• Predictability: Knowing, month-to-month, what your healthcare costs are going to be (your insurance premium plus any contractual copays, etc.).
• Cost Reductions: PPOs, HMOs and the like do negotiate lower fees for members based on a predictable volume of usage. This has the effect of lowering actual costs for members.
• Insurance: I’m in agreement with the original article that kicked off this thread; most health “insurance” is not, strictly speaking “insurance.” However, for catastrophic illnesses or accidents, it does serve as true insurance, covering extraordinary expenses based on an actuarial risk pool.

Benefits enough for you, Jersey?

…we could reduce the profiteering…

Right. Profits are evil. Especially with things that we need. So, by this reasoning, we should also act to ban “profiteering” in the food industry, no? Housing, too, right?

[Jon]

JMJ:

Okay, once again, for the 18,000,000,000th time – show me the cost/benefit analysis that shows a value added to the healthcare system from private insurance. Go ahead. I’ve asked everyone this but have NEVER gotten an answer.

Okay, I’ll bite. I’m not one to defend the status quo, at least as far as the health insurance govonopoly is concerned, but this seems like an absurd request, JMJ. Let’s apply it to fire insurance–is there a “value add” in the aggregate? Of course not…rather than a relatively few people suffering very high losses, the existence of fire insurance spreads the costs more evenly across many homeowners. Given that the insurance companies do this to make money (by collecting more in premiums than they pay out in losses, and by making investment returns on the float), I guess you’d conclude that they “subtract value” from the system. But I’d also bet that you wouldn’t actually go without fire insurance, even if the bank would let you.

[Health Care Nut]

The real savings in health care would be to make all insurance companies not for profit, with resulting profits used to keep good employees and to decrease premiums.

Right now anyone with a for profit health plan gives 10+ cents of every premium dollar to the stockholders of that comapany. How does this increase the value to the customer?

[Another Lurker]

Jersey I have to say I like responding to you just to see exactly which canned liberal answer I will get. Funny thing is you think I am a right winger. Now that’s funny.

If you had a brain you could read this and get something out of it, but you don’t. You’ve been Marxist brainwashed too much.

http://www.gmu.edu/departments/economics/wew/articles/04/freehealthcare.html

This is a little ditty about Canadian healthcare. Highlights: Mass exodus of doctors and Ohio as the hip replacement capital of Canada.

[Jersey McJones]

MikeP,

“If I understand the point you are trying to make… I don’t think that the AMA should be “abandoned”.”

Thank you.

“I think the AMA should not be able to its leverage in state licensing mechanisms in order to (1) limit the supply of doctors, (2) set the prices of doctors, or (3) do anything else anticompetitive.”

Show me any proof of that whatsoever. I’ve never heard ANYTHING like that.

Clean hands,

Doctors DO NOT keep meds away from people. Prove it.

“Predictability:” Nothing would be more predictable than a single payor plan.

“Cost Reductions:” All countries with universal care have lower costs than we do.

“Insurance: I’m in agreement with the original article that kicked off this thread; most health “insurance” is not, strictly speaking “insurance.” However, for catastrophic illnesses or accidents, it does serve as true insurance, covering extraordinary expenses based on an actuarial risk pool.” And one giant risk pool would have the best and most fair dispersal of risk.

Your points are all wrong and stupid.

Jon,

“Okay, I’ll bite. I’m not one to defend the status quo, at least as far as the health insurance govonopoly is concerned, but this seems like an absurd request, JMJ. Let’s apply it to fire insurance–is there a “value add” in the aggregate? Of course not…rather than a relatively few people suffering very high losses, the existence of fire insurance spreads the costs more evenly across many homeowners. Given that the insurance companies do this to make money (by collecting more in premiums than they pay out in losses, and by making investment returns on the float), I guess you’d conclude that they “subtract value” from the system. But I’d also bet that you wouldn’t actually go without fire insurance, even if the bank would let you.”

Everyone gets sick or hurts themselves – everyone is born and dies, etc. Nice attempt, though.

Healthcare,

“Right now anyone with a for profit health plan gives 10+ cents of every premium dollar to the stockholders of that comapany. How does this increase the value to the customer?”

Thank you. You have reaffirmed my faith in humanity.

JMJ

[Another Lurker]

“The real savings in health care would be to make all insurance companies not for profit, with resulting profits used to keep good employees and to decrease premiums.

Right now anyone with a for profit health plan gives 10+ cents of every premium dollar to the stockholders of that comapany. How does this increase the value to the customer?”

Not to be rude be you obviously have no idea why companies go public in the first place. Selling stock increases capital (money) into the company. More money to help keep costs down and good employees around.

Profit is not evil. Please read some things other than Michael Moore’s books.

[Clean Hands]

Jersey, walk into your local pharmacy and ask for a bottle of Tylenol III. Without the doctor’s prescription in hand, they won’t sell it to you.

Who’s the stupid one? How much more simply can I explain it to you?

Nothing would be more predictable than a single payor [sic] plan

If by predictable, you mean ever-increasing costs, sure. When there is no cost incentive for the consumer to minimize his usage, costs will only go ever skyward. Indeed, you could chart our “progress” towards a single-payer plan (starting with the establishment of Medicare/Medicaid in the 60s) alongside overall acceleration in the increases of healthcare expenditures and see how closely they parallel.

All countries with universal care have lower costs than we do

They also have vastly lower access to healthcare, lower levels of innovation, and poorer overall health.

You still haven’t answered my larger question either, Einstein. If it’s right to insist on “single-payor [sic] healthcare,” then why not “single-payor [sic] food supply” or “single-payor [sic] housing?”

Fucking dumbass marxist.

[Health Care Nut]

I don’t read Moore (except for St. Thomas) but I’m looking at this process right now from the inside out and it’s not pretty.

Profit from building a computer or car and selling i? Cool, there’s something new in the world that has value in and of itself. Taking a cut of premium dollars?

[lannychiu]

Clean Hands

“You still haven’t answered my larger question either, Einstein. If it’s right to insist on “single-payor [sic] healthcare,” then why not “single-payor [sic] food supply” or “single-payor [sic] housing?””

I think your statement is absolutely correct and shows the difference between those who believe in free market solutions and those who don’t.

I would fully expect that those in favor of a single-payor health care provider, would also be very amenable to the idea of government providing (or at least insuring) a minimuim level of housing, food, and anything else deemed essential. After all, you rightly point out there are also essential goods which are not currently guaranteed by the government.

[Clean Hands]

HCN, are you claiming, then, that health insurers add no value to the process, and should be forced to abandon the business?

[Clean Hands]

How about car dealerships? They haven’t built a goddamned thing except for those goddamned obnoxious animated signs, right?

[metalgrid]

Well, to be fair, nationalizing healthcare, capping doctor fees and drug fees might be the only effective way to fight the monopoly that the AMA and the government has created since there is no chance in hell that the AMA will relinquish it’s power. And having a national healthcare plan provide minimum coverage isn’t neccessarily a bad thing when you can shop around for procedures in South-East Asian countries who already provide better access to medicine and care for middle class Americans.

It scares me that I can come to the same solution as JMJ but in my case, it’s based around vengefully screwing the AMA back for their monopoly whereas in his case, it’s based around a miseducated sense of social justice.

[Dave W.]

show me the cost/benefit analysis that shows a value added to the healthcare system from private insurance. Go ahead. I’ve asked everyone this but have NEVER gotten an answer.

I think the value add is that if a pHD of science is studying important subjects and gets sinus problems then we need to make sure he is in line ahead of the unemployed people. This way productivity is maximized. It makes sure the real earners are out there earning, while helping others who suffer from entitlement addiction not to foster new addictions.

This result flows directly from insurance companies running the show and might not be bestowed on us under any other model.

I am not sure this great advantage is susceptible to the neat cost-benefit analysis ur looking 4. Still, works for us!

[Pro Libertate]

The AMA must be destroyed. The state bar associations, on the other hand, are not “the fox guarding the hen house” and are perfectly okay. Cuz we’re all perfectly ethical and only concerned about the well being of society. Philosopher kings, if you will.

[MikeP]

Show me any proof of that whatsoever. I’ve never heard ANYTHING like that.

JMJ, you have an astonishingly confident opinion given how little you seem to know.

Hunting around a little, I find:

http://healthcare-economist.com/2006/02/04/is-the-ama-interested-in-quality-of-care-or-physician-profits/

…there are three major barriers to entry in the medical profession which the AMA in essence controls. The first is licensure. The AMA sets the requirements for a license to practice medicine and can suspend or revoke a license once it has been granted. Secondly, the AMA’s Council on Medical Education approves the number of medical schools in the US. By not approving additional medical schools, the AMA can reduce the supply of physician care. If fact, between 1905 and 1944, the number of medical schools in the US decreased from 162 to 69. Finally, the AMA has increased the length of medical training, thus making it more financially difficult for prospective students to enter the medical field. With fewer doctors, there is less competition and thus prices (and physician profits) will increase.

All of these powers are grounded in state licensure. Granted, government bureaucrats may not be the most qualified people to say who is should be a doctor or not. But the leeway given to the AMA to make that determination represents an overwhelming conflict of interest.

[metalgrid]

The state bar associations, on the other hand, are not “the fox guarding the hen house” and are perfectly okay. Cuz we’re all perfectly ethical and only concerned about the well being of society.

Considering you can represent yourself in court, it’s hardly the same kettle of fish.

Although I do like the idea I saw in a Justice League cartoon that all lawyers suffer whatever punishment that their clients incurred as a sure way of reducing the number of lawyers.

[Pro Libertate]

metalgrid, getting to represent yourself in court is like doctors “allowing” you to buy some drugs OTC.

Now stop bothering me. I’m working on a bill to make paralegaling a capital offense if done without the supervision of a lawyer.

[SR]

“Jason, who payeth (never payecth) the bill? Who determineth which scrip you can and can’t get? Who determineths which doctor you can go to? Who layeth down the rules?”

Why didn’t anyone tell me May 15 was “Talk Like a Pilgrim” Day?

[Health Care Nut]

They add the value of spreading risk over a huge number of people to keep costs down. Since they are doing such a good job of keeping costs down that everyone and their mother in the media seem to desire nationalized health care (which would ruin the whole business, imo) then perhaps they are taking too much water from the well.

Does anyone think they are not profitable already without taking the extra dime for the shareholders?

[Clean Hands]

Shareholders assume certain risks in owning shares in any company, HCN. These risks include loss of their entire investment, or reductions in its value. In order to make certain riskier stocks more attractive, some companies offer dividends; I assume that this is what you’re objecting to here.

No organization would offer more in dividend payouts than it must in order to keep shareholders from jumping ship to any of the myriad other investments available to them.

Anyhow, who are these evil shareholders who are making off with their ill-gotten gains? Oh, wait, it’s the folks who invest in mutual funds and other responsible retirement plans. Dirty rotten scoundrels, that lot.

[Jason Ligon]

Jersey,

To clarify your challenge about a private insurance scheme in healthcare, there are two distinct ideas to keep separate.

If your comparison to the current US system is a single payor, it is a misnomer to call that insurance. It is publicly funded healthcare. Rationing occurs at the political level rather than at the individual or insurer level.

Private insurance markets work very well, but they accomplish different things. They offset risks well, but they don’t pay known bills well.

[Jason Ligon]

HCN:

Have we really been reduced to the idea that profit = waste? Cars would not be made more efficiently without shareholder profit.

There are a lot of reasons our health care system doesn’t work well, and these reasons can be understood differently by people who for ideological reasons prefer a certain outcome, but you are objectively barking up the wrong tree.

People clamor for public coverage for two main reasons as far as I can tell:

1) Such a system in explicitly universal rather than implicitly universal. No one who goes to an emergency room gets denied care under our current system.

2) The comparison to other country’s health care models makes ours look extremely expensive. The problem is, those systems look more effective than they really are because we subsidize the world’s pharma research. It is absolutely true that we pay much more than anywhere else in the world for care. The consequence of that is that we fund the great majority of all development for all pharma companies – foreign or domestic. The US consumer keeps the system afloat.

[Swillfredo Pareto]

Taking a cut of premium dollars?

It’s called assumption of risk. You are paying someone to assume the risk that if you get AIDS, are burned over 3/4 of your body, or have a spinal cord injury, they will pay your providers the $1 million dollars worth of care you can count on needing. If you think there is a market for purchasing homeowners coverage when your house is on fire or buying medical coverage after you dive headfirst into a shallow pond have at it.

perhaps they are taking too much water from the well.

The profit margin is determined by competition. If you think there is too little competition(i.e. too much profit in the industry) talk to your legislators. They and their forefathers are the ones who have fucked the healthcare market up beyond recognition. Legislation and intervention have prevented the market from reaching zero economic profits (not to be confused with zero accounting profits).

[Clean Hands]

If you want an illustration of ways in which the prescription regime is abused, look no further than the sorry story of Sudafed.

Used to be that Sudafed was a useful, easily available OTC medicine. It was cheap (I used to regularly pick it up at the dollar store), and most importantly, it works — I can get back to productivity much more quickly with a dose of Sudafed when I’ve caught some damned cold.

Then along came the horrors of the myth, er, excuse me, meth epidemic. Meth, it turns out, is relatively easy to produce, given the cheap and readily-available precursor… Sudafed. State legislatures decided that Something Must Be Done.

So now, if I want to get some Sudafed, I must first pay a visit to my doctor’s office, wasting untold hours of time to make and keep the appointment, and get his “mother-may-I” permission slip to purchase the precious stuff.

Then, instead of popping in and out of the dollar store, I must submit the prescription to the controlled-substances area of the pharmacy and wait more hours while all of the necessary paperwork is processed, lost, found and finally approved.

Net result? I’ve effectively lost the useful application (saving me downtime due to illnesses) of Sudafed. When I lacked health insurance, this insane law also meant that Sudafed went from costing me a buck to costing me around $100.

(Now, the personal financial calculus is somewhat less prohibitive, at $20 – $10 copay for the doctor’s office, and $10 copay at the pharmacy. However, of course, my health insurance rates are ever so slightly higher, as well, due to the increased costs from all members’ usage of doctors to get permission to get Sudafed.)

Or, I can pop across the state border and pick up a big bottle of fucking Sudafed and remember to vote against the asshats who put this nonsense into place.

[Healthcare Actuary]

The value that insurers of any type provide is that they become the risk-bearers. If an individual is risk-averse (meaning the individual accepts a negative expected value in return for protection from a catastrophic loss), then an insurance policy is acceptable to him or her.

Healthcare policies are typically priced so that the expected claims are 80% of premiums (this varies by group size, but is appropriate for illustrative purposes). Of the remaining 20%, 75% goes to administrative costs (salaries, desks, pens, computers, etc). The last bit is what one would call profit (technical term is underwriting gain). However, claim costs are estimated and are often wrong. Profit is earned for this acceptance of risk.

It is important that the insurer price in some extra “profit” to lessen the chance of losing money (and eventual insolvency). This play-it-safe tendancy is mitigated by the fact that health insurers are subject to competition. Therefore, insurers typically do not make much money over a multi-year period. An insurer’s “excessive” profit is a signal to competitors to enter the insurer’s market.

Finally, stock insurance companies have to be more efficient than non-stock insurers since they need to earn their shareholders money as well as stay competitive with the non-stock competition. Therefore, stock insurers are typically the most innovative and cost-conscience of all insurers.

The biggest impediment to affordable healthcare is that the consumers of healthcare are not the direct purchasers of healthcare. It is as simple as that.

[The Real Bill]

I’ve been reading Kling for years now. For those that dislike TCS, Kling is no hack.

[HenChick]

Hello? It’s the money. Healthcare is 18% of the GDP. Follow the money and you will find out why people need universal coverage. We must stop making a profit from (literally) the lives of others. Let them invent a better mousetrap. Check the stock holders of your insurance company. Guess who founded the Blues? He was tired of being paid with chickens.