Paul Krugman says that it's not fair to accuse the Massachussetts health care program of costing $400 million more than originally projected.
The problem is that they’re all wrong. People are confusing an increase in costs that was largely (not completely) anticipated — after all, the plan is supposed to cover more people, and subsidize their coverage — with a cost overrun.The fact is that the plan does seem to be making a serious dent in the number of uninsured. One thing that has come to light is that there may have been more uninsured people in Massachusetts to start with than previously estimated, so there’s a steeper hill to climb. But claims that it’s all a disaster are based on nothing but bad journalism.
That link to the Healthy Blog post seems extremely misleading. Paul Krugman seems to be claiming that the post proves that the cost was actually mostly anticipated. But it doesn't. The unanticipated cost of $400 million is pretty much a direct quote from the budget, one that seems to be backed up by the statements of the governor and budget officials. The state budget is a byzantine hive of confusingly organized data, but it seems safe to say that the cost overrun portion of the spending growth is now in the hundreds of millions.
The main gist of the post linked by Professor Krugman is that the cost to the state of Massachussetts is less than $400 million, because the Federal government will be kicking in part of the cost. This is, of course, brilliantly irrelevant to any argument over national health care, since the Feds don't have another government to contribute to the kitty.
Whenever I see reasoning such as that, I am reminded of the following from a The Simpsons episode in which Homer is attempting to make money off of waste grease from cooking:
Homer: Okay, boy. This is where all the hard work, sacrifice and painful scaldings pay off.
Clerk: Four pounds of grease. That comes to... sixty-three cents.
Homer: Woo-hoo!
Bart: Dad, all that bacon cost twenty-seven dollars.
Homer: Yeah, but your mom paid for that.
Bart: But, doesn't she get her money from you?
Homer: And I get my money from grease. What's the problem?
Thank you for clarifying this, you are so totally right.
I'll take this kind of "bad journalism" over Krugman's economics any day.
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people? "Health care spending accounts" won't do diddly. We already have those, called section 125 or "cafeteria" plans, and have had them for years; costs continue to skyrocket. We can't simply declare that people will be more healthy. We can't let the free market decide and call ourselves human beings. So what's the answer?
I'm interested to see how Krugman will attempt to defend Hillary's ridiculous interest rate freeze idea. If his brain gets the better of his ambition, he won't touch it with a 10-foot pole, but we all know that's a bit much to ask... actually, here's a preview: 1. A lot of people who don't want to freeze interest rates are Republicans. 2. Now we all know every single Republican is a vile bigot with a Klan hood in his closet. 3. If you're against freezing interest rates, you're a racist. QED.
liberalrob, I think you forgot one more premise: We can't let the state decide and call ourselves human beings.
liberalrob:
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
I'm a conservative. I don't have to believe there's a solution.
That said, if you just froze the standard of care at, say 1990, we could probably cover everybody trivially. The problem is that care technology is advancing faster than costs are deflating... I do see the healthcare sector getting more efficient, in fits and starts, and suspect that the problem will more-or-less solve itself in 30 years if we don't screw it up in the meantime.
Which, presumably, we will.
liberalrob,
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
What evidence is there that health care is increasingly out of reach for people? As far as I can tell, the vast majority of Americans have access to far better health care than their parents did, and the quality and quantity of health care is continuously improving.
"People are confusing an increase in costs that was largely (not completely) anticipated — after all, the plan is supposed to cover more people, and subsidize their coverage — with a cost overrun."
So, people have confused the cost exceeding the budget with the cost exceeding the budget? I can see why they might.
None of which is to say there aren't things we should do - clearly we should break the tax-enforced insurance-coupled-to-employers at a minimum, and that probably requires some other form of pooling or savings accounts...
This is, of course, brilliantly irrelevant to any argument over national health care, since the Feds don't have another government to contribute to the kitty.
Of course, if you believe that it's profoundly immoral for people to go without health care because they can't afford it--in arguably the most economically powerful country in the history of the world-- the cost overruns are also "brilliantly irrelevant".
What evidence is there that health care is increasingly out of reach for people? As far as I can tell, the vast majority of Americans have access to far better health care than their parents did, and the quality and quantity of health care is continuously improving.
I can think of 47 million pieces of evidence off the top of my head.
I'm very happy to see people like Krugman defending Mass Health because it means they're taking some ownership of it. When the law was passed, I agreed with people like Arnold Kling who said that because this wasn't a total gov't solution, it would be disavowed by the left and the failures would be blamed on not enough gov't. So far that hasn't happened, which if it continues, could ultimately make the law worthwhile (even though as a MA resident, I'm paying for part it; I guess libertarians care about more than money after all).
Freddie, you're assuming that every single uninsured person is uninsured because s/he lacks the ability to get insurance, rather than, perhaps, making the choice to go uninsured for reasons both good and bad.
Freddie, the 47 million number has well been debunked for the purposes you are using it for:
10 M are not citizens and wouldn't be covered under plans I have seen.
18 M are in the top half of income distribution and choose not to buy health insurance
Millions of people are eligible for medicaid but have not enrolled, and would if they needed to
A quarter of the uninsured have been offered employer-provided insurance but declined coverage
see The NY Times
Well, we could just outlaw all this new expensive technology and let people die. We could outsource it to China, but I'm not too keen on letting people who can't make non-toxic dog food care for my health.
We could let people buy what they want and can afford while we search for cosmic justice. Perhaps I should phrase that as equal outcomes for all so as not to ruffle too many feathers. As my DI said, "life's unfair, and then you die."
Freddie,
Of course, if you believe that it's profoundly immoral for people to go without health care because they can't afford it--in arguably the most economically powerful country in the history of the world
People go without health care because they can't afford it in every country in the world. You don't seriously believe that rich people in Britain and Canada and France can't buy more and better health care than poor people, do you?
I can think of 47 million pieces of evidence off the top of my head.
What pieces of evidence would those be? You do realize that health insurance is not the same thing as health care, don't you?
what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
if you believe that it's profoundly immoral for people to go without health care because they can't afford it
Well, perhaps first the problem should be defined and quantified. In what sense does the health care go "increasingly out of reach"? Does the share of health care costs as a percentage of family budget grow? For what percentage of families? What does the dynamics look like (e.g. might there be a correlation with aging of disproportionately numerous baby boomers)? How many people do actually go without health care (completely? partially? if partially then what are the parts they are forgoing?) as opposed to without health insurance (they might not need it, or feel they don't need it).
Everything I've seen so far had to do with "nationwide health care spending" numbers or perhaps "per capita health care spending". Tells me diddly squat. My personal health care costs have certainly increased over the last 15 years (surprisingly enough, no one in my family is getting any younger) but I am fairly positive they have shrunk as a percentage of budget. Are there some aggregate numbers that would help us tell whether health care becomes prohibitively expensive or whether we have become affluent enough to purchase ever increasing quantities of it? And if certain part of population is being left behind, how big is it?
I like the idea of giving those who buy their own insurance (or who pay for their own health care costs) the same tax benefits as employers who buy it for their employees. Association Health Plans so smaller employers and other private organizations can pool together to buy plans at rates comparable to the larger employers would also be a good step. But most of all, we need to get back to the idea that health “insurance” is supposed to pay for things like major medical (e.g. hospital stays, catastrophic illnesses) rather than acting as a form of “prepaid health care.” Consumers should be able to buy a policy anywhere in the country without having to all of the added on unfunded mandates that various pressure groups lobby to require insurance policies to provide each of which increases the cost of insurance, leading to more people having no insurance coverage, and the inevitable whining about how the “free market doesn’t work” from the very people who pushed for the very government policies that make health insurance less affordable.
Reponse to liberalrob's question "what's your solution...":
Sign up everybody who makes above a certain income threshold for some kind of minimal national health plan that covers ONLY catastrophic health costs. Make the cost based on age, and deduct it automatically from their paycheck like Social Security.
Make it voluntary, but auto-opt-in-- that is, you're signed up unless you fill out a form and say "Thanks, but no thanks."
If you opt-out, decide not to buy insurance, and get sick-- tough cookies.
Everybody who makes below a certain income threshold gets automatically signed up for Medicaid, at no cost.
Oh, and of course either get rid of the employer tax deduction for health insurance or extend it so the employees get the same tax break if they buy their own insurance...
The value of the 47 million figure has proved controversial. It's not surprising that I find the evidence supporting it more convincing than the evidence against it, and it's not surprising that you who are opposed to universal health coverage find the opposite. But, again, if like me you find it morally indefensible for those who want health care to be unable to get it, or to be unable to do so without causing economic havoc on their lives, then the issue of how many loses a great deal of significance. If the number is one hundred million or one million or one, something has to change. I do find the notion that I'm supposed to care less because the figure of who can't afford health care is 35 million instead of 47 million hard to understand. I equally am unimpressed by appeals to the legal status of those who are uncovered or undercovered.
I don't expect you all or anyone to have the same moral objections to the status quo that I do, but I do think that if you accept a notion of a moral imperative to provide health care for all, quibbling about the numbers is an exercise in bad faith.
I live in Massachusetts, and the health plan I could afford does not cover routine doctor visits. I ask my doctor for a discount for cash, and I get 10%, because the doctor doesn't need to deal with the insurance company. I'd like to see all medical insurance eliminated, but that's not going to happen. It does seem to me, however, that if we eliminate the link between doctor and insurance company, making the patient deal with insurance and pay for visits, that we could lower the cost of health care 10%.
"OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?"-liberalrob
As Thorely argues, a good way to reduce health care costs is to address the problem of third party payment. That is a major cause of the rising prices. So we could elimnate the bias in favor of employer-provided medical care (which never made any sense). If people were choosing their own medical insurance, they would have an incentive to eschew "gold-plated" polcies in favor of catastrophic coverage. This would reduce the overuse of medical services (since people would be paying for more of their own care) and reduce costs. As the demand for a good falls, ceteris paribus, its price will fall as well.
The President proposed such a change in the 2007 State of the Union Address but as I recall it got a chilly reception from the Congress. That's too bad.
If the number is one hundred million or one million or one, something has to change.
Oh, but the changes do not have to be the same. If the number is 1 (one) then by all means, just buy the hapless sod whatever policy you deem equitable and pay for it from the federal budget. I'm sure 0.003c/yr will not break anyone's bank.
If you can positively demonstrate the number is indeed 100,000,000 -- of people who have to forgo some essential health care because of the cost -- then I will be inclined to reassess my view of the universal healthcare approach.
If, however, the numbers are in the range of single millions then there may well exist a wide variety of options for improving the situation without radical changes for everyone else. Why, I'm sure I've seen some of these options mentioned on this very thread...
The other side of the coin is that the Mass problem stems from the point that enrollment has massively exceeded expectations-- and this is in one of ovewealthiest states.
This strongly implies that people like Mixner above who claim there is no problem are even more incorrect then we realize.
The other side of the coin is that the Mass problem stems from the point that enrollment has massively exceeded expectations-- and this is in one of our wealthiest states.
This strongly implies that people like Mixner above who claim there is no problem are even more incorrect then we realize.
I ask my doctor for a discount for cash, and I get 10%
Another personal anecdote: when I had to go without medical (dire straits and lapsed COBRA) the pediatrician I was taking my kids to simply sliced 50% off his regular bills. Which was somewhat less than what he would normally get as "allowed amount" from the insurance company but probably on par once you take into account the billing overhead.
But, again, if like me you find it morally indefensible for those who want health care to be unable to get it, or to be unable to do so without causing economic havoc on their lives, then the issue of how many loses a great deal of significance.
One of the problems with this claim is that health care is not a single discrete product that you are either "able to get" or "not able to get" but a vast range of products are services. There is a vast range of medical tests, pharmaceutical drugs and surgical procedures that you cannot "get" in Britain or Canada unless you are willing and able to pay for them yourself. A recent article in the Economist described the case of two British cancer patients who are suing Britain's National Health Service for failing to provide them with a drug to treat their cancer. The article mentions that around 40 expensive new cancer drugs are expected to be licensed over the next few years, but that the NHS will probably refuse to pay for any of them. If you have the money, you will be able to buy the drugs privately, but if you don't have the money, you're out of luck. Do you consider this situation "morally indefensible?"
The other side of the coin is that the Mass problem stems from the point that enrollment has massively exceeded expectations-- and this is in one of ovewealthiest states.
This strongly implies that people like Mixner above who claim there is no problem are even more incorrect then we realize.
Possibly, possibly. But it could also show that the moral hazard problem is larger than we realize, too.
I do think that if you accept a notion of a moral imperative to provide health care for all, quibbling about the numbers is an exercise in bad faith.
Well, of course it is. But if you accept a slightly different premise--that there is a moral imperative to provide health care for those who cannot (as opposed to do not) provide it for themselves, then the provenance of those numbers start to matter a bit more.
spencer,
You need to stop attributing to me statements I haven't made.
The big lesson of the Massachussetts health care fiasco, especially this new finding that costs are likely to be much higher than anticipated, is that universal health care at the national level is likely to be much, much more expensive than Hillary and Obama are suggesting. That wasn't exactly a big secret even before this new development, but perhaps it will have the effect of forcing the Democratic nominee to be more honest in acknowledging the true costs of what they are proposing.
MM wrote: This is, of course, brilliantly irrelevant to any argument over national health care, since the Feds don't have another government to contribute to the kitty.
I saw this statement and immediately rushed to CNN to see what kind of revolution had overthrown the Chinese government, but CNN hasn't heard about it yet. Care to fill us in?
Freddie wrote: The value of the 47 million figure has proved controversial. It's not surprising that I find the evidence supporting it more convincing than the evidence against it, and it's not surprising that you who are opposed to universal health coverage find the opposite.
What you meant to say was, this figure has been roundly debunked for the purposes you intend to use it. But since 47M has more shock-and-awe value and justifies bigger and more over-reaching policy prescriptions than the 10-12M or so who are genuinely screwed under the current system, you prefer to keep spouting it and pretending that the figure is real and the objections are merely one of "controversy", rather than the result of a liar engaged in figuring.
liberalrob:
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
Price controls on pharmeceuticals and an end to Federally subsidized biomedical research. That will put an immediate stop to the invention of expensive new therapies.
Liberal rob asks for genius input above. here goes: You fundamental premise is wrong. We don't have a health care crisis in the US-of course, costs go up, but ALL costs go up--inflation is the norm and costs from improved medical equipment, pharmaceuticals and care are passed along. Moreover here's an assertion you will choke on: the US has the best healthcare in the world; every statistic that measures the state of health care intervention; eg, longevity and length of cure rates after medical intervention are improving. You falsely assume that health care insurance equates to healthcare. No citizen is denied health care in the US because of inability to pay--you will find that statement in every public or non-profit hospital in the country.
We know healthcare costs are spiralling out of control .... because the MSM are constantly pounding it into our heads.
It's not like they have an agenda or anything.
To what extent are health care costs distorted by lawsuits? I've heard that malpractice insurance is a considerable cost to doctors, perhaps tort reform that limits awards to damages only might lower costs?
This is, of course, brilliantly irrelevant to any argument over national health care, since the Feds don't have another government to contribute to the kitty.
Not yet.
The socialist world government is Phase II.
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
Number one, end the cartelization policies that make health care so expensive. The AMA should not be allowed to artificially restrict supply the way they have. Medicine is no longer a "noble" profession at high six-figure incomes.
Number two, end the insurance schemes that insulates both doctor and patient from cost decisions (mostly the doctor). People need to pay some siginificant percentage of their medical costs.
Three, stop assuming that medical care is a "right." OK, we can feed the indigent, and maybe welfare can also cover housing, but there are limits to how much free stuff we can provide to the unproductive by seizing the wealth of the productive. If you want to afford medical care, you need to provide a useful service to society which society is willing to pay you for.
HOLY COW! Mass. increased demand and costs went up. Who'd ever guess that increased demand, without increased supply, would cause costs to rise?
I'll bet economists, worldwide, are already studying this newfound demand-cost thing.
Also, I am always reminded when I hear this debate about how some middle-class families in southern border states dealt with rising health care costs: they went to Mexico, where they could get fillings for $1/tooth and see a doctor for $10.
We can't let the free market decide and call ourselves human beings
Uh, yes we can. You don't seem to be able to grasp a very simple point. Government involvement has driven costs up.
Random Trool Here.
In Better: A Surgeon's Thoughts on Performance by Atul Gawande, the author details his views that malpractice lawsuits generally help very few people harmed by mistakes. He acknowledes that medical mistakes happen more than doctors and their lawyers make out, but the siege mentality is such that the current state of affairs only helps plantiff's attorneys and a few dramatically aggrieved plantiffs.
He suggests a New Zealand model where all people harmed by mistakes are just compensated reasonably from a fund that all doctors pay into. This is a better use of the same amount of money (or less) that now goes to malpractice insurance and layers on retainer.
I can think of 47 million pieces of evidence off the top of my head.
Posted by Freddie
Hilarious.
You can? You have proof that everyone without health insurance can't afford it?
Please provide that evidence. Post haste!
I do enjoy watching the left pretend that health insurance is some sort of moral obligation. I guess that's what you have to tell yourself when you believe in inherently immoral things.
By the way, you, nor anyone reading, has any evidence that those (alleged) 47 million go without medical care. Which proves the ruse, you just want socialism under any guise.
We count the unreimbursed costs of treating the 9mm lead poisoning in the inner cities as a 'healthcare cost' ... is it, or is it a failed law enforcement cost that manifests in more 'healthcare'?
We count the hidden costs of preventing and insuring against unwarrented lawsuits against all parts of the heathcare system as costs of heathcare ... are they, or are they a cost of the out of control legal system in this country as compared to all other countries in the world?
We count the costs of delivering the 'anchor babies' for illegals, for free, as healthcare costs ... are they, or are they a part of the failed policies of safeguarding our borders?
"We can't let the free market decide and call ourselves human beings."
Hmm. I suppose the first time anyone did anything other than let the free market decide was sometime in the 20th century. What do you call everyone who lived before then?
He suggests a New Zealand model...
This is also the worker's compensation and no-fault auto insurance model, and it's successful in those two contexts. The fundamental tradeoff is the elimination of the need to litigate fault in exchange for reduced payments; both sides get a little something and their lawyers get nothing.
The tricky part is deciding who is harmed by "mistakes." In workers's comp, any injury at work is compensable, including, in one famous case, injuries caused a hurricane which damaged a hotel in which an employee was staying during a business trip. On the flip side, non-work injuries are outside the workers' comp system even if caused by your employer, e.g. UPS driver gets hit by UPS truck while driving a rental car on vacation.
How is such a thing possible in the medical context? Sometimes people get worse despite competent treatment; sometimes they develop unrelated maladies for no reason; sometimes mistakes hurt them. If we need a complicated apparatus to determine which injuries are compensable by this system, then we may not get the cost savings we hope for.
Maybe New Zealand has solved this problem, but it's also possible they aren't as eager for a day in court down there.
I equally am unimpressed by appeals to the legal status of those who are uncovered or undercovered.
And I'm equally unimpressed with your hysterical lying and disregard for the legal status of those you want covered. (Hint: covering those who should not be getting benefits reduces the available benefits for those who should).
But carry on comrade!
I don't live in Mass., but when I posted about Boston's ban on in-store health clinics some time ago, a commenter from Boston, a pathologist, commented that it's now very difficult there to find a primary care provider (PCP):
"...you can't really find a PCP anymore - certainly not a good one (unless you're in the medical field). Former Gov Romney's health care plan mandated that everyone have insurance in the state. This meant that there was a sudden influx of people with new insurance who had to choose a PCP. As a result, PCPs quickly stopped taking new patients. And those of us that do have PCPs have trouble seeing them, due to the high number of patients."
Does this square with what others living in Massachusetts have seen?
Why is it a "moral imperative" to permit 85 years olds to consume every possible medical service available, without regard to cost, to extend their lives by an additional two years?
Why is it a "moral imperative" to pay for the medical costs associates with obseity, smoking, drug abuse, etc?
Yes, I'm sure that the media will really push hard on the Democrats to be honest... pfft, hahahaha. Couldn't keep a straight face (straight fingers?). Come on. The media will roll over like a tipped cow, and we won't hear anything about costs until after it's far too late.
Here's a very straight forward example of a medical equipment improvment that increases costs 4X: Medical scanning equipment goes from 16 slice to 64 slice technology. Medical result: much greater accuracy in diagnosis; Cost to consumers for increased diagnostic accuracy: radiologists time to read scan increases four times. (not counting equipment life cycle costs from R and D to replacement) Question for all: is the improvement in diagnostic accuracy worth four times the baseline cost? And the real answer is, of course, only if it's your condition that is accurately diagnosed--the value on THAT transaction is usually priceless.
Rich Canadians, such as their MP/ auto-part giant heiress came to California for cancer treatment. Non-wealthy Canadian, such as my sisiter-in-law's mother was told to either pack up and go home, or be given morphine to ease over to the other side.
Story: My sister-in-law's 92 years old mother went to market on her own. Upon returning home, she fell and broke her hip. She was admitted to tax-payers paid "free" hospital care. The doctor gave her morphine to induce coma and ease her pain. Then the doctor told the family it would take at most five days of morphine to ease her over painlessly. The family took the mother home to her 96 years old husband.
Story: My colleague's uncle needed a triple by-pass in England. Wait period: 3 months. His American nephew flew over there and paid his hard-earned American dollars for his bypass with a private establishment.
How much taxes do the Canadians and the Brits pay for their "free" care?
Morals: no free lunch, no free health care
We can easily cap the spirally health cost: don't look for miracle care, e.g. stay home and plan for your funeral if you have cancer. Chemo is expensive, afterall our grand parents just stiffened their spines and slipped away courageously, not burdening us with the spiralling health cost. And, don't send your child to the emergency room if he runs a high fever. Call your neigborhood docotr to bleed a pint or so to lower the fever. It's much cheaper than going to the emergenccy room where a whole troop of specialists fuss over him.
"OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?"
Kill any lawyer who brings a malpractice suit that is summarily dismissed, for one. Then, kill all lawyers who make legal problems for people who don't have an MD degree but are nurses or other health professionals who treat sore throats, colds and stuff like that. Then, kill all lobbyists who get in the way of legislation that enables the above. Put caps on malpractice insurance. Don't allow people to bring more than two suits against doctors in their lifetimes. The list is endless.
The one thing that is a SUPREMELY BAD idea is to add another alphabet soup federal bureaucracy to the existing herd. They do an incredibly bad job of everything they've tried to do on a large scale thus far. Why on earth would we want to entrust to THEM something that actually matters? Why not just skip the feds and let the UN handle our health care?
Cripes, but the Left has run out of ideas.
A very good friend of mine from back in the high school years, is a maxilliofacial reconstructionist, (sorry if I mispelled, I'm just a simple cop). According to him, his liability insurance is around 250k a year. Granted, he and another surgeon have their own office together, but this is just one of the many areas where they have to raise their prices, to offset their costs. Yet another major cost is the byzantine process that drug companies have to go through to get new drugs on the market. Has anyone ever seen the tables on the amount of R&D, and money it takes just to get one new drug approved by the FDA? You wanna know why the costs of medical care has gone up so high, those are two of the main reasons right there.
I wonder how much we could save if we just got the health insurance companies out of the way. How much of what we pay goes to administrative overhead, company profits, and the armies of bureaucrats looking for ways to deny treatment?
Gotta put that into the soup as well...
"OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?"
Get gov't out of health care. The reason it is screwed up is because they are involved in every aspect of it.
Government housing - so bad we're paying millions to tear it all down
Government education - so bad even Hillary wouldn't send her daughter there
why does everyone think government medical care will improve the situation?
I don't know which is sadder, Krugman's now constant misleading use of figures or the people who believe anything he writes. Just the other day he was bemoaning how poorly America has done in providing broadband to Americans. Of course he left out that more Americans actually _have_ broadband than any other nation on earth.
I am a practicing physician, and I believe that the only sustainable solution is a return to a true free market. I'm tired of seeing my patients hurt by the numerous government regulations on health insurance and health care - this is the cause of the inefficiencies and cost shifting. The current problems are caused precisely by politicians and interest groups trying to guarantee health care as a "right". That is not a proper function of government.
For more details on both the source of the current problems and a viable solution, I highly recommend the following article by Zinser and Hsieh:
"Moral Health Care vs. 'Universal Health Care'"
http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp
Among other things, the authors note that the sectors of medicine which are least regulated (such as LASIK and cosmetic surgery) show the usual pattern of decreasing prices and increasing quality over time, just as with normal consumer goods subject to the laws of supply and demand.
The free market works in the other 5/6-th of the US economy, and there's every reason to believe it would work just as well in health care.
I wonder how much we could save if we just got the health insurance companies out of the way.
Probably a lot IF we transferred their cost-controlling function to consumers, who can shop around, self-deny care, and haggle for free. But nothing at all if we transfer it to the government, which will have to either perform the very same administrative functions (with civil service employees) or simply pay up blindly (inviting fraud and overcharging).
Those insurance companies aren't spending a dime more than they have to paying their bureaucrats; if they could fire them all with no ill effect, they'd do it.
Why is it a "moral imperative" to permit 85 years olds to consume every possible medical service available, without regard to cost, to extend their lives by an additional two years? Why is it a "moral imperative" to pay for the medical costs associates with obseity, smoking, drug abuse, etc?
Because Freddie is an accredited high priest of the Order of Social Guardians and wields a +10 Sword of Flaming Moral Imperative. You have to be at least a level 30 to beat him.
Tom and Dan are completely right.
Forcing everyone into a government-run mandatory medical system just because some people have no health insurance would be just as wrong as forcing everyone into a government housing project just because some people are homeless.
"...since the Feds don't have another government to contribute to the kitty."
Hmmm. Those Euros keep saying that they want the opportunity to vote for the US President. How 'bout we let them, providing that they pay for our health care? :)
Freddie wrote:
Of course, if you believe that it's profoundly immoral for people to go without health care because they can't afford it--in arguably the most economically powerful country in the history of the world-- the cost overruns are also "brilliantly irrelevant".
Three questions for you, Freddie:
1) Is it fair to infer from what you've written that you do, in fact, believe it's immoral for people to go without health care?
2) Similarly, is it fair to infer from what you've written that you do, in fact, believe that this moral imperative renders concerns over costs irrelevant?
3) What percentage of your disposable income do you dedicate to paying for health care for others?
Where in the constitution is the federal government given the authority to do anything about this? The fed govt should get out of the way and let each state deal with it separately.
--Greg
I grew up in Canada, and had enough experience with the healthcare system there that I think I can comment usefully. First, healthcare in Canada is not all bad - there are lots of very skilled and very dedicated doctors and nurses doing their best to take care of patients. If you have a heart attack or get hit by a truck and get hauled into the ER, you will be treated and treated well. If you are generally healthy, and just need to see a GP once or twice a year (and you live in a major urban area) then the system will work well for you - it will cost too much for what you get - but you'll be ok. If you have a chronic condition, like you need a hip replacement, you will likely wait two years for the procedure and will become a morphine junkie in the meantime. Basically, if you need some kind of expensive, difficult and/or rationed care (something exotic like and MRI) you will wait in line until the condition becomes critical, at which time you may be treated before you die (or not, roll of the dice). If you present at the ER with a less-than-immediately life threatening condition, you will likely be treated on a gurney in the hallway, where you are free to contract something truly life-threatening like SARS.
When I was 16 I came down with a really bad case of Salmonella, and spent three days in Emergency, watching (and smelling) old people die because there was no room to be had in the regular wards upstairs. My Mother's appendix burst while it was being removed because her surgery kept being delayed. All this in one of the "better" hospitals in a fairly affluent suburb. Most of the leftie politicians who inflicted this on the country go to Florida, California or the Mayo Clinic for treatment, as do other wealthy folk. Some less-wealthy people go to India.
If America adopts this system, I think I'll have to move yet again.
I like the idea of getting the market back into medical care. The government regulated insurance industry is the real problem. Encourage people to buy health insurance that covers major, unexpected costs and then let everyone buy stuff with their own money (tax deductable or not, whatever). This will drive down costs.
I know a number of doctors who refuse to deal with insurance companies because it's too much work. So I end up filing my own paperwork and then having to keep after the insurance company to make sure they pay (oops, I forgot to draw a parrot in box 12 on page 87 of form 123XXR! No money for me!).
I'd rather just pay for doctor visits but not have a big monthly premium (and get the money my employer is paying, too).
Oh, and it's nice to participate in a thread where we can be nasty to each other without a lot of angst over who started it and how nasty is too nasty. :)
You might think I'd become a little dejected at the frankly comical level of vitriol I entertain around here. But I have the advantage of being able to place this blog's comments section in an actual national political and social perspective, which makes me downright cheery.
When I'm called a liar, for instance, regarding the 47 million uninsured figure, it would probably be important to note that the figure is used often without controversy. Anony-mouse asserts that the figure has been "debunked", and acts as if that is a known fact, rather than a statement of dubious truth. Never mind that it is used by the national newsmedia at all levels, and by political commentators, right-wing and left, regularly. As I've conceded, in any figure of the type, there is room for disagreement about the specific nature of what that information reveals. But what is not a matter of any disagreement from anyone seriously discussing the issue is the fact that there are tens of millions of Americans who do not have access to health care because it's beyond their economic means. As I've taken care to note, no one is obligated to agree that there is anything morally questionable about that fact. But the American people believe exactly that, and they are using our political process to effect change.
Again, taken out of context of real life, it might appear that I should be discouraged. But, of course, universal health care is one of the most consistently and overwhelmingly supported policy initiatives in American life. In poll after poll after poll, Americans support universal health care, and by large margins. In poll after poll after poll. This is reflected in the policy positions of every major Democratic presidential campaign, current or recently conceded. These candidates, reflecting the will of the large majority of the American people, are in a position of unique strength this election cycle. More damningly for my opposition, the Republican Presidential primary campaign has included a great deal of discussion about the American health care crisis, and the major Republican Presidential candidates have equivocally but genuinely begun to confront the problem. At several debates, they have conceded the need for public policy initiatives which satisfy my most basic desire: that no one be denied access to health care because of economic inability to obtain it.
And, in the larger view, of course, I have the knowledge that the conservatives who attack me are part of an increasingly marginal social movement who's bankrupt ideology has been as thoroughly discredited in the last 8 years or so as one could possibly imagine. Having failed the most important test of any political ideology-- the ability to wield power-- conservatives are being banished from office. Your side, to put it bluntly, is getting it's ass kicked, and it's happening because your ideology has utterly failed to provide the American people with what they need to live their lives. As for my self-styled "libertarian" critics, what even needs to be said? You are a part of a powerless and embittered minority, one which has never wielded any significant power in this country and whose bellicose frankly cultish public demeanor ensures that is unlikely to change.
So let me reflect the growing consensus among those who follow this country's political life and it's public policy: universal health care is coming to this country. The people want it, the liberal party is actively pushing it, the conservative party is afraid to stand against it. It's coming. And all of your snark, your disdain, your jokes, your insults, and disregard for people you disagree with won't change it.
So how's that?
Freddie thinks 1/that it is immoral for people who need health care not to be able to afford it, and 2/ that quibbling about numbers is an exer cise in bad faith.High quality health care requires high quality doctors, nurses,technicians, therapists,hospitals, medicines, research,drugs,equipment,machines, and devices just to name a few.How much health care is Freddie willing to provide without quibbling over costs? Vacations in the Caribbean for those whose nerves, depressions,psychiatric needs etc desperately require them?Home nurses for Mothers whose daily routine leave them exhausted?Emergency care a 2am for a child with an uncofortable sprained ankle?If numbers are an exercise in bad faith, what is it if the government taxes me to pay for obesity surgery for those who refuse to discipline themselves or exercise.I know that we should think of Liberals not as " bad people " but just people with different opinions ,but thes kind of comments make it necessary to willingly suspend disbelief to avoid the feeling that they are either incredible stupid or deliberately attempting to bankrupt all of us into revo;ution.
Liberalrob and others: what are you defining "healthcare" to include? It's not a binary "you have it or you don't" choice. At the ridiculous low end, no doctors, no medicine, if you're cut you use duct tape. At the ridiculous high end, each person has his own physician who follows him around with customized pharmaceuticals and a medevac heli on call. Where are you going to draw the line?
Since we can't afford to spend, say, $100,00 per person per year on this, ultimately you're going to have to draw it based on cost, and say either "if you want more, you pay for it yourself" or "if you want more, too bad".
But what is not a matter of any disagreement from anyone seriously discussing the issue is the fact that there are tens of millions of Americans who do not have access to health care because it's beyond their economic means.
This assertion is just utter nonsense. There is a large network of public and private health care programs and facilities that provide free or heavily subsidized health care to the indigent. The fact that you keep repeating this "tens of millions who can't get health care" nonsense demonstrates only that you yourself are unwilling to engage the issue seriously. Rather than keep mindlessly repeating claims and slogans you found at moveon.org or some similar source, why don't you try actually investigating the issue yourself, freddie?
The composition of the number, 47 million Americans uninsured, is important, as you seem to agree. Of that 47 million, how many of them are eligible to receive newly created government sponsored healthcare, are presently unable to purchase healthcare themselves while being ineligible for Medicaid? That is the number that is relevant to the discussion at hand. As others have noted, that number is less than 47 million.
Oops! My comment was directed to Freddie.
Freddie,
A-M (and others) pointed out that the figure was debunked for the purposes you intended, namely as a number of people who cannot afford "medical care."
47 million is (so I'm told) the number of people who do not have medical insurance. There are at least two differences between that number and the one you want: some people without insurance can get care, and some people without insurance could get it if they wanted.
For the record, 1) I don't support calling you a liar, at worst you're exaggerating a tad to make a point, and 2) I don't disagree with your general "moral imperative" argument. Your lack of specificity makes it hard to disagree; if you want the very fanciest, most-advanced treatment for indigent 90-year-old smokers, I'd have a problem with that. If you want 1985-level care for all, hey, that's fine with me; plenty cheap and frankly not at all bad. But you never get down to making those kind of fine slices, so most of us are left with no choice but to joust with strawman, being unsure where the actual Freddie is.
Oh, and if you are under the impression that W and the congressional Republicans have acted "conservative" while in office, then you need to get out more. Medicare part D, NCLB, shamnesty, cronyist Cabinet appointments, DHS--a lot of us real conservatives are just as pissed as you are. Republicans have failed badly. Conservatives haven't gotten a shot at it yet, and in all probability never will.
all of your snark, your disdain, your jokes, your insults, and disregard for people you disagree with won't change it.
No, but it will preserve our right to say "told you so" when it (inevitably) fails. You have to keep your eye on what's really important.
OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people?
1. Get real when addressing fraud. Some estimates have the cost of fraud in medical care reaching into billions of dollars a year. People on Medicaid or Medicare who shouldn't be. One case comes to mind of a woman in a wheelchair, getting free medical care via Medicare, who jumped up and ran away when the police came to arrest her for something or another.
2. Reduce administrative overhead and waste. The average US physician spends ~15% of his or her income on filing paperwork with insurance companies. Drop that in half, and you'll reduce the overall cost to the patient.
3. Malpractice lawsuit reform. One lawsuit can ruin a physician's chances to get malpractice insurance, or raise the rates of such insurance to beyond reasonable. Ex-father-in-law spent $100K in his last year of practice, because of ONE patient who brought suit on unfounded claims. She lost, he won, but the rates skyrocketed.
4. Promote healthier lifestyles and preventative care. Roughly 30% of the US population falls into the "obese" or "morbidly obese" definitions. 20% of the US smokes cigarettes. We engage in risky behavior. We drive drunk. We use illegal drugs. We have crappy dietary habits. We don't take care of ourselves, and it's expensive when it catches up to us.
Those are four ideas off the top of my head. Give me time, I'll think of more.
Freddie--I think most people would agree that there are about 47 Million or so Americans without health insurance--but you take that figure and tell us that 10s of millions lack access to health care--they may well lack access (geographical, medically underserved areas or the like). But the point you don't appear to acknowledge is that health insurance does not correspond to access to health care. Health care is available to any person in the country without regard to their ability to pay. We can argue about the quality of that care, or that the cost of ED care is passed along--but the assertion that is 10s of million Americans lack health care is absolutely without merit.
True enough, it is a societal question whether health insurance should be provided by the government--and the political system is the appropriate mechanism for making that decision. But as long as you continue to equate health care with health insurance you will be misrepresenting the nature of the problem, and, therefore the solultion as well.
Matt,
Excellent questions. Following on, must point out that Freddie's conclusion:
The government must subsidize healthcare.
Does not follow from his premise:
Universal healthcare is a moral imperative.
Why does a moral imperative = a mandatory government program? I submit it does not... you may believe that all people should have healthcare regardless of cost, but this in no way implies that the government should ignore cost and implement a universal plan.
1: It's not a moral imperative. Access to a doctor at the expense of the general public is certainly a nice idea, but failure to provide it does not make us an immoral people.
2: It is not government's responsibility. If you believe it is a moral imperative you are free to act upon that, but you are not free to force that moral judgment upon me through legislation.
3: It is unconstitutional. No reasonable reading of the Constitution reserves to the federal government the power to levy a tax on the population for the purpose of distributing subsidized health insurance to the population.
4: It does not solve the problem. As many have pointed out, there is a vast difference between universal insurance and universal care. At least under the regime in Ireland which I experienced for 4 years, national healthcare is a guarantee of long waits, substandard care, crowded facilities, poor practitioners, and astonishing cost overruns.
5: It ignores all other duties of government. If universal healthcare is worth any cost, what about all the other things government does that are similarly important? Framing the question as such ignores the balance that must be struck between this proposed duty and other existing ones. We do not have infinite resources.
Freddie, if you truly believe that prompt access to a doctor whenever you need it is an issue of morality that must not be ignored, your highest priority should be to prevent our government from getting involved. At least now you can go to an emergency room.
-spool32
I have a few random thoughts:
1. to say health has improved since my parents' day means nothing: logevity means I have needs they did not have (exaple: they did not have antibiotics)...
2. In my area we have a number of hospital directors (CEO) maiking ove a million a year.
3. If I go to the emergency room because I have no health coverage, they must take me in. they then pass on costs to those there who are insured "upstairs"--patients at the same place. Then the insurance companies say it costs too much so let us cut coverage and raise costs for insurance.
we all lose.
4. be conserative or liberal but do not call the plans put forth by Clinton or Barak socialism:
those plans are for govt insurance, the same way
that your bank account is insured by the govt or Medicare insures people..
5. Who pays for health insurance for members of Congress? how good is their plan?
Well, it's an interesting complaint, but it's not much of an argument for govt-provided healthcare or insurance. The majority have believed in many things, including notions that 'progressives' deplore. The fact that something's coming doesn't make it good. The questions in my mind are:
1) why haven't we tried a more free market approach? Why are corporatist and government-provided the only solutions? There are nascent association-based approaches happening. Why wouldn't these make sense, and why can't they be subsidized (or not) *equally* with corporate plans?
2) if we won't try a free market approach, what will be the maximum marginal taxpayer cost for the Nth insured that would cause us to stop? This is the real crux of the question that the moral imperative language tries to wave away.
3)will govt-provided healthcare remove all personal responsibility through mandates? Is that a good thing for healthcare costs? (hint - I say no)
Personally I favor a govt provided catastrophe plan and the rest as free market as possible. Several others have suggested the same thing. I would characterize these as good faith entries in the discussion, and they certainly do not require injured populist rejoinders.
As for the 47 million, being correct is simply a matter of saying "don't have insurance" as opposed to "have no access to healthcare". The latter would require a much smaller number (some sources listed here). This is a distinction proponents tend to gloss over, demonstrating that tricky phrasing is a non-partisan activity.
PS - I'm sure I've been snarky, but I don't believe I've insulted. Hope not, anyway.
I think that a useful guide to understanding governmental healthcare in the US can be seen in coverage/payment for hemodialysis. Traditional hemodialyais has a very high mortality rate (approx. 20%/year). Traditionally this consists of 3 dialysis treatments per week.
1. It is very expensive and the government (and congress) have tried to enact cost controls over different aspects of the treat at different points. In a 2006 report, GAO recommended to the House Ways and Mean committee a bundling of drug payments with all other dialysis services to better able contain and control payments to doctors and dialysis facilities.
2. A new, (and by all evidence) better, method has emerged that uses dialysis at home 6 times per week. The advantages range from a lesser need for medications (e.g. Epogen), less hypertension to better patient well-being.
From Medscape news (2005)
"Nocturnal hemodialysis has again been shown to modify important cardiovascular-disease (CVD) risk factors—in this case leading to improvement in arterial baroreflex sensitivity and compliance—in hypertensive patients with end-stage renal disease (ESRD), Canadian researchers report"
American Kidney Fund: 2004
"Published reports and analyses of these two modalities continue to show improved clinical results and increased patient satisfaction. Reports also point to reduced hospitalization, decreased medication requirements and, when reported, some medication, and in-patient hospital cost savings to Medicare"
Medicare doesn't pay for the new method because they have to do studies that confirm that it is cheaper overall. To quote an article from Hemodialysis Internation (2004)
"What does this all mean for patients today who want the best treatment? We now know that more frequent dialysis, long nightly or short daily, is much better than conventional three times weekly center dialysis—but this is not available in most places and is not paid for by Medicare."
Interestingly it is paid for by many insturance companies.
So basically national heath care comes down to cost control, and therefore rationing in one sense or another. If your group can lobby congress to get payment, you are a winner. If not, you'll have to wait for the policy analysts to see if you are worthwhile.
This is the consequence of the "moralist" postition.
Freddie, your ability to write so much and still manage to ignore every point made is epic.
Such obtuseness has to be natural, you can't coach thickness like that.
Bravo.
Matt,
Excellent questions. Following on, must point out that Freddie's conclusion:
The government must subsidize healthcare.
Does not follow from his premise:
Universal healthcare is a moral imperative.
Why does a moral imperative = a mandatory government program? I submit it does not... you may believe that all people should have healthcare regardless of cost, but this in no way implies that the government should ignore cost and implement a universal plan.
1: It's not a moral imperative. Access to a doctor at the expense of the general public is certainly a nice idea, but failure to provide it does not make us an immoral people.
2: It is not government's responsibility. If you believe it is a moral imperative you are free to act upon that, but you are not free to force that moral judgment upon me through legislation.
3: It is unconstitutional. No reasonable reading of the Constitution reserves to the federal government the power to levy a tax on the population for the purpose of distributing subsidized health insurance to the population.
4: It does not solve the problem. As many have pointed out, there is a vast difference between universal insurance and universal care. At least under the regime in Ireland which I experienced for 4 years, national healthcare is a guarantee of long waits, substandard care, crowded facilities, poor practitioners, and astonishing cost overruns.
5: It ignores all other duties of government. If universal healthcare is worth any cost, what about all the other things government does that are similarly important? Framing the question as such ignores the balance that must be struck between this proposed duty and other existing ones. We do not have infinite resources.
Freddie, if you truly believe that prompt access to a doctor whenever you need it is an issue of morality that must not be ignored, your highest priority should be to prevent our government from getting involved. At least now you can go to an emergency room.
-spool32
1. We can only use outcomes to measure healthcare objectively. Of course, following your advice, there are no absolute differences of innovation or progress, only inequality. Ironically, this is the perfect 'progressive' argument - the one that calls equality 'progress' and progress 'inequality'.
2. So what? Being a hospital director is difficult and exposes managers to liability. Shall we mandate lower pay to lessen the competition? Shall we tell all the non-profit hospitals to stop paying their staff so much?
3. True conclusion, wrong chain of logic. So what?
4. Why not call the government taking over a private sector activity 'socialism' (then again why - who cares)? A matter of degree not substantive difference. So what?
5. Their employer, just like me. I hear it's excellent and expensive. So what?
1. to say health has improved since my parents' day means nothing: logevity means I have needs they did not have (exaple: they did not have antibiotics)...
Huh? Americans live longer than they did a generation ago, in large part because of advances in health care. Many more medical tests, pharmacetical drugs, and surgical procedures are available now than were available a generation ago. The quality as well as the quantity of health care services has also improved. Many more heart attack victims are surviving and living longer. Many more cancer victims are being treated successfully. Serious infectious diseases that were widespread in the 1950s or 1960s have been virtually eradicated. Common disabilities like hearing and eyesight loss are now much less common, thanks to advances like cataract surgery and implantable hearing aids. And so on and so forth. How you can claim all this "means nothing," I have no idea.
Why do you assume that a "problem" must have a solution?
The simple fact of the matter is that the main reasons for rising healthcare costs have nothing to do with government healthcare policy all.
One of the main reasons medical costs keep going up is due to the fact that most new medical interventions are 1) more effective than what they replace 2) more expensive than what they replace (especially when the current standard of care doesn't include an effective treatment). It's a very rare thing when an innovation actually reduces treatment costs - laproscopic surgery is the only one I can think of off hand. If you want a constantly rising standard of care, you're going to have constantly rising costs. You see this tradeoff pretty clearly in rationing under the Canadian system, where new equipment and techniques get deployed slowly relative to the US.
The other major factor is demographic, namely that the populations are getting older, and older populations mean more chronic illness. Chronic illness is particuarly expensive, since it requires periodic interventions, often increasing magnitude if the illness is getting worse, and unlike preventative care, the interventions require personalization, so you can't take advantage of economies of scale.
Neither of these has anything in particular to do with where the money is coming from. Indeed, systems with centralized funding encounter periodic budget crises as a direct result of these phenomena. See this article on rising drug expenditures in the UK, for example, and contrast it with the rhetoric about how eliminating rising drug costs simply being an issue of having the government negotiate the price.
Costs are increasing across all the different payor schemes - they manifest as periodic funding crises and rationing of novel treatments in centralized systems and rising insurance prices in private insurance systems. NONE of you (and that includes libertarian types who insist that price transparency is going to solve all our problems) have some magic bullet for rising healthcare costs. You're all just talking out of your asses because you don't know a damn thing about heathcare funding, but you do know which political tribe you belong to and you willingly wolf down whatever pile of hot, steaming bullshit is served up to you as the latest panacea by its leaders.
Freddie:
Again, taken out of context of real life, it might appear that I should be discouraged. But, of course, universal health care is one of the most consistently and overwhelmingly supported policy initiatives in American life. In poll after poll after poll, Americans support universal health care, and by large margins. In poll after poll after poll.
Links please?
NONE of you (and that includes libertarian types who insist that price transparency is going to solve all our problems) have some magic bullet for rising healthcare costs.
Who among libertarians claims that price transparency is a "magic bullet" which will cause healthcare costs to stop rising? The claim is, rather, that market pricing will allow efficient allocation of resources. Maybe we don't need a few more ultra-high-resolution MRIs. Maybe we need a whole bunch of cheaply made ones that would have been top notch 15 years ago. Maybe we don't need a plethora of new drugs, but rather a larger quantity of the now-generic ones.
On the flip side, maybe we do need those fancy new things--indeed, we need more of them than we are getting now, because at the behest of our insurers, we wastefully spend too much on older, less effective therapies and diagnostics.
I suppose the first time anyone did anything other than let the free market decide was sometime in the 20th century. What do you call everyone who lived before then?
Budding socialists.
If any of you really want to get the government out of the business of providing healthcare for those who can't afford it and leave those poor souls to the "mercy" of the free market, be my guest. The resulting inequities will most likely result in the expansion of the current underclass and produce fertile breeding grounds for militant socialist politics, i.e., of the "give us healthcare now or we'll fuck your shit up real good" type. It'll be 1930s-style class warfare all over again, and this time there won't be any FDR to placate the roiling masses with another New Deal.
Who's up for some political violence? Anybody? Aw, you bunch of pussies.
If any of you really want to get the government out of the business of providing healthcare for those who can't afford it
I'll settle for keeping the government out of the business of providing healthcare for those who can afford it, a feat which Freddie informs me is impossible.
Still, I don't think it would be that bad. How threatening is a mob of people with debilitating illnesses and crippling, untreated injuries?
"Well, it's an interesting complaint, but it's not much of an argument for govt-provided healthcare or insurance."-M. Dreck
I agree with Mindles Dreck. Freddie hasn't provided much of an argument for government controlled health care.
He has asserted:
But hasn't explained what particualar policy follows from that. I don't think anyone could claim that I've insulted anyone on this thread. But it does seem reasonable to me to ask for some sort of argument--premises leading to a conclusion or a reasonable inference based on hard data.
I would put it differently, but agree that this society ought to enusre at least a basic level of medical care for everyone. A subsidy for those who cannot afford medical care makes perfect sense, then.
But why should Bill Gates or Mitt Romney be under a national health system? They don't need government assistance. I don't see an answer in any of Freddie's posts.
Maybe if we just went back to paying for regular office visits ourselves, without insurance, the prices would go down. Insurance should be for catastrophic coverage, accidents, chronic illness, etc. When the well baby visit at the pediatrician's office costs $150 for the uninsured, but costs $85 HMO negotiated cost, perhaps, just perhaps, the doctor would be willing to take $50 cash for the visit with no paperwork, no negotiating prices. If one must pay for one's own care, one might use a little discretion over whether to go to the doctor or emergency room or urgent care center for any little thing. It's easy to go when one looks at it as "The insurance is paying for it". It's easier to say, a little Advil will lower my fever and a after a day of rest I'll feel better if one must pay for the visit out of pocket. Many times the doctor says take some Advil and rest anyway.
Think about what your deductible is, how much you pay monthly in premiums (add in what your employer pays too to figure out how much is actually going towards your healthcare costs). Then figure out how much you are actually getting for that. If you have a chronic illness or a catastrophic illness, perhaps you are getting more bang for your buck. But if you are relatively healthy, would you be better off with only catastrophic insurance and be able to pay a lower price in cash for regular care?
The solution is simple:
Ration care for the plebes.
Boutique care for those that can afford it.
It doesn't matter how much you pretty it up with various Stalinist/HilliaryCare delusions. Denial of benefits is the only way to rein in cost.
Ration care for the plebes.
You mean proles. USMA/USNA freshman are notoriously healthy.
Rob,
I think you're attributing a different/stronger claim to me that I made; I'm not claiming that anybody is saying that costs increases will stop completely, but that the weaker claim that price transparency (by removing the insuring middleman, whether it be gov't or private, so that patients see the full cost of treatment) would have a significant impact on costs, which Kling has made in various pieces, is also wrong.
The insurance companies are probably actually better at holding down costs than transparent pricing would be, as they have a strong incentive not to spend on medically unnecesary procedures and meds (that's what all that overhead is actually about - take out the medical necessity documentation and you'll see non-overhead expenditures go up). Copays and coinsurance already discourage excessive usage via price signals. These can be quite high, so the question is, if there's a bunch of excessive usage that could be solved by increasing the price transparency, why wouldn't the insurance companies have acted on it already?
The fact of the matter is that transparency has quickly diminishing returns. Let's look at this with a more formal model.
Let's say there are two options, one of them cheap and one of them expensive (a good generic stand-in for an old generic drug vs a new drug from the same class).
It's efficient to use the less expensive option if:
Bexpensive - Bcheap Fpatient(Cexpensive - Ccheap)
where F is the fraction of the price that the patient pays.
So, the patient will chose the more efficient option as long as
Fpatient > (Bexpensive - Bcheap) / (Cexpensive - Ccheap)
So it's possible to have less than complete price transparency and still have efficient usage of a resource.
Insurance companies want to set F as low as possible, since they're selling protection against variation, but not so low that Fpatient
(continued from above, 'cause server squirels ate the last graf)
Insurance companies want to set F as low as possible, since they're selling protection against variation, but not so low that Fpatient
Freddie, your points are why Republicans will actually lose in November.
Not saying one way is right or wrong, but the reality of people's situations often transcends the practicality of a given theory or policy stance.
So invariably voices here will be "right", and reality will hand them something else.
One thing that would help a LOT is if MDs as a group would grow some balls and announce that henceforth, they will refuse to treat malpractice attorneys, their spouses, siblings, parents, and children. Just announce it and follow through.
That would save untold tens of billions.
My brother is a surgeon, and he says that he and his colleagues will not allow themselves to be pushed very much further with mandates and cost-cutting. Any of them who have accumulated a decent amount of assets will just retire. Soon.
(my bad - forgot about a <)
Insurance companies want to set F as low as possible, since they're selling protection against variation, but not so low that Fpatient < (Bexpensive - Bcheap) / (Cexpensive - Ccheap), since a competitor would end up being able to offer a reduced benefit package at a higher price difference than the difference in the average self-pay cost, so Fpatient should be at or very close to (Bexpensive - Bcheap) / (Cexpensive - Ccheap) in an insurance plan. This is a somewhat simplified model of insurance (the effective F becomes rather complicated when you're talking into account MOOPs and deductables), but it does show why there's no vast reserve of potential efficiency gains in the current system.
"OK geniuses, so what's your solution to arresting the upward spiral of health care costs that is putting health care increasingly out of reach for people? "
... I think he misses the point that most of us here think a lot of the cost problems started with meddlers like him in the first place, eh?
If the government is paying for medical expenses, the costs will rise. If I recall correctly, increases in medical costs and higher education costs have both greatly surpassed the rate of inflation for a number of years. Both of those "areas" are affected by the "easy money" provided by the government. If government loans were not so readily available for college costs, the costs would be much lower. What college would charge $40,000 a year for tuition to people who could never pay it? Government-backed loans allow the people to pay ridiculous tuition costs, thus encouraging the growth in those costs.
Likewise with medical costs. The more money that is readily available to pay for an item, the more the item is going to cost. Massachusetts is only the beginning.
Here's my idea for avoiding lawsuit costs; Set an amount for damage caused (except, perhaps, wrongful death.) If the Doctor can prove that they offered to pay that set amount of compensation within a set time frame then they are absolved of any damages. If not, they can still be sued.
This solves a few problems;
1. This prevents a lottery effect where people with legitimate greivances are not compensated while a few people willing to work the legal system are.
2. It will still work to quickly eliminate medical quacks who continue practicing bad medicine, whereas capping damages would lessen this effect.
3. This will help people solve problems without lawyers, which it, I would guess, an important frictional cost.
Matt,
I agree that costs are what they are; it takes real economic resources to deliver health care, and you can't reduce the input of resources unless you reduce the output, too. As I said to liberalrob in another thread, we can move costs around to different payers, and we can change the kinds of costs (rationing in place of cash, for instance), but we can't magically reduce the quantity of resources that it takes to deliver a given service (although that might drop thanks to other factors, like economies of scale).
You're certainly right that it is possible to allocate efficiently with respect to the choice between therapies if the pricing is properly structured and if patients have adequate information about relative benefits.
I have my doubts about the quality of information available to consumers of both health insurance and therapies about both products, and therefore doubts about the validity of a simple model. I'm sorry that I don't have time to go into detail; but suffice to say that our disagreement is likely minor, if any.
Re: national healthcare is a guarantee of long waits, substandard care, crowded facilities, poor practitioners, and astonishing cost overruns.
If you think American healthcare is not full of the same then you haven't had much contact with American healthcare. I earn a good income, and have very good insurance, but I've experienced all of the above, or known people who have in this country.
As for the poster who spoke of people getting contagious illnesses in the hallways of foreign hospitals, iatrogenic (look it up) diseases are extremely common in the US too. Germs don't pay much attention to human architecture; and they ignore door signs that say "Private".
And as for the poster whi spoke of a relative suffering a burst appendix in a foreign hospital, I've known two people in this country (one was my father) who suffered ruptured appendices ibn this country-- after visiting doctors, because of abdominal pain, who did not think their symptoms even merited hospitalization.
The one advantage about a government-type style of healthcare is that the costs would be spread over a much larger pool of citizens.
Remember that among those 47 million (or however many) lacking health insurance are those who CAN'T get health insurance due to "prior conditions." Insurance companies will simply turn them down. Then what? You got cancer way back when, you're now totally locked out of the system? A hell of a way to run a railroad.
We also have the problem of the "chronic stuff" such as diabetes, etc. The two places I lived (Japan, UK) did have a bit of a nanny-state aspect to nagging you to get yearly checkups (at most corporations they're mandatory), cut down the salt, etc. Note however that the result of this is the average Japanese is quite healthy and they certainly have quite a few people living beyond 100.
What I would suggest is a dual system: an "opt-out" NHS-type system which will cover you up to a certain reasonable extent; anything very experimental/extraordinary you need to either cover out of your own pocket or get your own private insurance to cover. You can (after reaching 18) opt out, pay less taxes, and be responsible totally for your own health (private health insurance, etc.) You can at any point go back ON the NHS system provided you have a full complete check-up and show that you are at least as healthy as the average person of your age on NHS.
Wonder how this would work out?
Freddie
Of course, if you believe that it's profoundly immoral for people to go without health care because they can't afford it...
Freddie, I offered evidence in a previous post that spending on non-medical expenditures like better food and the time and equipment to exercise (not to mention drug treatment programs run by private charities) was far more effective per-dollar than increased spending on medical care. Forcible reallocation of people's money from these productive areas where their health could be greatly improved towards medical spending which offers minimal returns per dollar will diminish health, not improve it. Such programs seem profoundly immoral to me because they hurt people. I don't see how you could continue to support a plan which you acknowledged would, on the average, hurt peoples' health.
I fail to see how a program which hurts more people than it helps could be considered a legislative 'moral imperative' in any sense of the word.
...in arguably the most economically powerful country in the history of the world
It is America's respect for the free market, compared to other nations, which has helped make it the economic powerhouse that it is. You seem to be suggesting that material providence can be equated with morality. That should also make our nation arguably the most moral nation in the history of the world. And that morality would be diminished by a massive healthcare system.
I don't believe in that moral system, mind you. I prefer effectiveness over compassionate yet harmful gestures and respect for individual rights.
BTW Freddie:
"it's profoundly immoral for people to go without health care"
So are you talking here about health care, or health care insurance? Because I know of very, very few instances were people who needed care, esp. on an emergency basis, were not able to get it. As a matter of fact one of the great problems driving up the cost of health care is the large amounts of money spent on illegal immigrants who show up at emergency rooms and MUST be given care.
Can you cite for us numbers of uninsured people who have been turned away for care? Becuase it seems to me you are trying to equate health insurance with health care, and they are two entirely different things.
Lets keep in mind that we do have fully socialized health care. Anyone, to include illegal immigrants, can get health care at the local emergency room. You just have to stand in line with all the illegal immigrants, and no, you don't get access to the latest in preventative care. You do get access to the latest in life saving technology.
For the people who don't care to stand in line, there are ambulances, which jump you to the front of the line, and there are private practicioners, where you get access to preventative and even cosmetic surgery. For these super-services, you get to pay more.
"For the people who don't care to stand in line, there are ambulances, which jump you to the front of the line, and there are private practicioners, where you get access to preventative and even cosmetic surgery. For these super-services, you get to pay more."
Yes, at least we have the option to get health care if we choose to pay for it. If it is immoral for people to go without health care, I wonder what Freddie thinks about countries with "universal" care like Canada and the UK where certain procedures are out of reach for patients either due to a prohibitive waiting list or outright rationing.
So let's get this straight: The MA government is stunned because when they subsidize a service, people come out of the woodwork to sign up. Of course they do, they are many people who would otherwise have bought health insurance on their own. Now they can get the state, and you the taxpayer, to kick in hard cash towards their medical costs.
The fundamental truth is that a given standard of care costs a given amount of money. For what the country can afford, we can either give rationed care to everyone, or unrationed care to a portion of the population. Anyone who claims anything else is sloganeering. Pushing healthy people to buy health care won't work. Even if every healthy person in the country bought health insurance at market rates tomorrow, that would cover, what, about 24 months of the INCREASE in health care costs. Then we would be back to the treadmill.
Grumpy Realist,
I would dispute your assertion that the average Japanese is healthy because of the state-run healthcare system. The traditional Japanese diet (and the meager portions of postwar Japan) probably has a lot more to do with longevity than the healthcare system. It would be interesting to study a control group of obese Japanese (retired sumo wrestlers?) and compare them to their US equivalents.
How threatening is a mob of people with debilitating illnesses and crippling, untreated injuries?
Pretty threatening if they're old, because they vote.
Doesn't really matter, though. If I get bored with taking people's property through my job as a lawyer, I'll start taking it by force, just for fun.
Gee, I see the usual civility being exercised by the usual suspects here. Of course, Freddie deserves it, no question about it, right?
Emphatically agree. You don't have the numbers, you can't make good policy.
On a final note, there seems to be certain schizophrenia here; on a related thread, it was pointed out that the pharmaceutical companies don't really spend $500 million or $800 million or whatever per average drug trial, that it was a purely emotive figure, and not anything to do with calculation. The reply was whether it was $50 million, $100 million, etc, it was still a lot of money, and that even if it really didn't cost $500 million now, it certainly would at a later date. To which I agreed.
So it seems that turnabout is fair play. Freddie is right, I've certainly seen the 47 million figure bandied about without a blink of an eye, and until a few people started challenging it here, I have never heard it seriously disagreed with.
But since there does seem to be some dispute, have those who are raising the point done their homework? Where are their cites and stats for their modified figures? How many people 'truly' do not have insurance because they cannot afford it, and is this number substantially lower?
And speaking of substantially, what counts as substantially? Just 40 million 'truly' uninsured? 35 million? Thirty? It seems to me that in the name of consistency, if we grant even at one eighth the cost of $800 million, $100 million is still a lot of money to be spent on bringing a drug to market, so must we grant that if the true figure is 'only' ten million (one fifth the initial quoted figure) who cannot afford insurance, that is still a lot of people who do not have adequate health care. And of course, in direct comparison with the pharmaceutical case, even if the figures are 'substantially' lower, the fact is that this number will only increase.
You wouldn't happen to have, say, some actual cites, figures, comparisons and the like, would you?
This doesn't make any sense. Are you actually claiming that four times the resolution results in four times the cost? That the new machines are four times as expensive, and it takes four times as long to read the things?
I'd like to see some evidence of _that_. My partner was treated for a partially crushed cervical vertebra last year, and required several MRI's. I did my usual oohing and aahing over the tech when we saw the scan, and the gentleman responsible for interpreting it remarked casually that yes, the new technology _is_ remarkable over what was available just a few years ago, and that the new machines made reading the imaging easier and quicker to read. The exact opposite of what you're claiming.
I'll say it again: Lack of insurance != lack of healthcare. People who truly can't afford insurance have medicaid. underinsurance is a problem, and for the most part it is an issue of underinsurance or bad planning combined with a chronic disease or medical crisis. That's why I advocate that government-provided or mandated coverage only focus on catastrophic coverage.
btw, I offered a link with plenty of citations challenging the 47 million above, but I'd still say the main problem is insured vs. healthcare (with a honorable mention to whether the speaker is implying citizens or not, which is apparently a very large difference)
You wouldn't happen to have, say, some actual cites, figures, comparisons and the like, would you?
Just as a precautionary note; I don't claim to know what the statistics show, though I've tried hard to find them. I've heard a lot of people try and use 'infant mortality' as a standard. This is deceiving, since a 12 hour old infant who dies in many parts of Europe would be considered 'stillborn' but would be considered to have had a 12 hour lifespan in the US. The American way of accounting seems better, since it encourages saving more newborns (identifying a problem is the first step to solving it) but it also makes American figures look much worse.
Likewise, while improvements in emergency care seem to have saved a number of lives (and reduced the murder rate) diet and lifestyle are much bigger factors than healthcare in a nation's lifespan (partly why Japanese Americans live longer than the national average.) So simply going off of figures like 'lifespan' and not counting issues like drug use in a population, diet or exercise produces unreliable figures.
I don't have the figures to support this, but it is my impression that this is the big cost driver. Actually, the slings and arrows of outrageous fortune that are amenable to shiny! don't tend be that expensive; sure, it costs an arm and a leg, but it's effective, and once you're done, you're done.
Not so with chronic illness. Not even so with chronic illness that is treated with the low-tech approach; that's usually the most expensive treatment of all, since it is so manpower-intensive.
Sinclair Lewis made this point thirty years ago in "The Lives of the Cell". I think the particular essay was "The Magnificent One-Horse Shay", but don't quote me on it.
This would be interesting if true, and several people have claimed that it is life-style habits that are the true culprits, but no evidence has been offered for this assertion. For example, it turns out that it's not all Muesli commercials in Europe, with sturdy yodelling blondes back-packing across the Alps and such like. In fact, the rate of tobacco use is _higher_; in some places, much higher. And yet they still have superior outcomes.
So I would say that those who are making the claim that it's all about 'life-styles' have got some 'splainin to do. Backed up, of course, by sources and cites.
SOV,
You may have missed it in your haste, but M. H. Dreck gave a link that contains much analysis of the 47 million number. So, it has been seriously disputed. To convince us that the 47 million has any residual meaning, you will have to counter it.
Backed up, of course, by sources and cites.
"Freddie is right, I've certainly seen the 47 million figure bandied about without a blink of an eye, and until a few people started challenging it here, I have never heard it seriously disagreed with."
Greg Mankiw makes it clear enough that the 47 million figure is too high. It includes illegals, people who can afford to buy their own insurance and people who have just not bothered to sign up for Medicaid but could. So that figure overstates the problem.
rwe,
You beat me to it! I was in the process of searching for Mankiw's analysis.
SOV,
So, you have two options- counter the above links-with sources and cites, or concede that the 47 million number is a bit of an overstatement when used in the claim that 47 million Americans can't get health insurance. I look forward to your reply.
Healthy people rack up higher medical costs
http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=512333&in_page_id=1774
Clearly, the solution is to have fewer healthy people.
faraway,
When I have children, I plan on teaching them to smoke at age two. It may cut down on future costs for college.
I am dismayed by this discussion. It sounds like most of the people posting don't know anyone without insurance and have never had to go without insurance themselves.
As someone who has intermittently had to go without, and has worked in several medical offices, here's my take:
Most health care is not like, for example, getting your teeth cleaned, which can be appropriately managed by the free market. For most medical care (and for all serious medical care), the patient has no bargaining position relative to the doctor. The patient lacks the expertise to decide whether specific treatments are unnecessary or overpriced. Additionally, the patient has no control over, say, which lab processes his/her blood, or which doctor is reading his/her x-ray. Also: a seriously ill patient is in no mental or physical position to be negotiating in this way.
The idea that anyone (other than the top 1%, maybe) can afford to pay the "market rate" for the cost of a catastrophic illness is ludicrous. That is of course why we share the risk through insurance.
My suggestions: the link between employer (or union) and health insurance needs to be severed. Insurers need to accept all applicants regardless of pre-existing conditions. Contrary to some others' posts, I find the waste & bureaucracy of our insurance companies to be much worse than that of Medicare. I'm in favor of reducing the eligible age for Medicare by one year each year until all are covered.
However, to cover all Americans, we are going to have to accept that not everything will be covered to everyone's satisfaction. The most expensive treatments with a low likelihood of success will not be covered. There will ALWAYS be a gap between the health care that the rich get and the health care the poor get. The question is, how big is that gap? Way, way too big right now. Let's do away with the unbelievable administrative costs of the insurance companies, and focus on making Medicare as smart as possible--providing some kind of basic care for all, as well as catastrophic coverage. Everyone is going to have to give something up--and that includes doctors and pharmaceutical companies.
I daresay I haven't read all the comments, but I have a question, and a comment:
1. The majority of posters seem to be against the nationalization of heath care, and seem to be very articulate in their opposition. Atlantic Monthly is hardly a right-wing rag, yet Freddie says "The people want it, the liberal party is actively pushing it, the conservative party is afraid to stand against it. It's coming."
So what gives? Are you commenters just odd birds coming over from Instapundit? And are the majority of voters with Freddie?
2. Most of the supporters avoid using the rationing language. I'd like them to be more open and discuss it. They sometime seem to imply we have rationing now based on ability to pay.
So they then should say that they are more comfortable with rationing by queue, or location (proximity to major cities), or political connections, or age (say 80+ yeears), or behavior (obese, smoker) or presence of co-morbid conditions.
I think a rationale discussion would be most helpful. Hand waving may feel good, but it is not very analytical...and suggests that the poster doesn't want to deal with the hard questions.
It is true that you can get treated if you show up at an ER, but that doesn't mean that you get treament for ongoing problems such as heart disease, diabetes management, cancer. The acute issue is addressed but once stable, you are sent home--with paperwork to sign up for medicaid (if you qualify) and a referral card to follow up at a physicians office. You call the Dr. office and it may take a month or more to get in but first you have to pass the insurance test-- Do you have insurance? How will you pay? Where do you work? Now if you just got diagnosed with a brain tumor at the hospital after your seizures are stablilzed, you are sent home with some antiseizure meds and a Dr. referral. If you don't have insurance or the money to pay for the chemo, no appt. is made. If you are lucky, you live in a state like MA or NY where you can get in to a state hospital and be treated. But your medicaid pending won't cover the pain meds. And, by the way, you can't drive because you have a brain tumor and get seizures nor can you work.
If you own property, you may not qualify for medicaid, or you may have what they call a "spend down" which can range from $50 to $5,000 (0r more).
I agree that investment and priority spent on preventative care makes sense but it cannot solve every problem, like leukemia which is a very expensive disease to treat and can hit any one from the very young through the very old. I worked at a facility in which they had to hold an ethics meeting because the urology director denied access to a pheresis machine to an unisured newly diagnosed acute leukemic-- it would have served as a life saving intervention as her white cells were blasting but he had his budget to consider and plenty of dialysis patients who needed the staff and equipment resources.
I don't think CEOs and CfO's of ins. companies and hospitals should be pulling down multi million dollar salary and bonuses while perpetuating a corporate culture which denies care and procedures to it's paying customers. I also don't see the costs today for simple regular care being reasonable enough for people to afford on their own. At the same time, efforts to "contain costs" leave patients feeling very dehumanized and unsafe due to understaffing, overcrowding, hallway admissions and hospital acquired infections. Facts are we really don't get much bang for the buck and perhaps that is why people like my sister don't see the point in spending $600 per month for a family insurance plan through her job when she nets $2000. Should healthcare insurance costs exceed housing? I don't see a NHS solving those problems.
While there is plenty of responsibility for an individual to hang on, you cannot deny that government policies on banking, finance and response to various business interests have encouraged the citizenry to spend like there are no more rainy days and then mortgage their homes and spend some more. There are no incentives for saving-- banks don't even offer children savings accounts anymore (they used to when I was young and did not charge any fees--they actually paid interest). Credit card rates approach ursury. How healthcare savings accounts could possibly keep pace with rising healthcare costs is as clueless as my kid thinking his summer job might actually pay for a semester at college. (My summer job did, but that was 24 years ago).
My mother has chronic emphysema/bronchitis most likely a result of smoking her entire adult life (and being exposed to secondhand smoke her entire childhood). She has been without healthcare (access) even though she lives on Social Security -- she does not qualify for Medicaid (she brings in about $1100/month). She ends up going to a clinic when the bronchitis is exacerbated, sees a different practitioner (never a doctor) each time and gets no management for her high blood pressure, nevermind any kind of smoking cessation assistance. Difficulties in getting treated at the clinic and the general experience there are another story. This year she turns 65 and will be eligible for Medicare. I am so happy she has managed to live long enough and perhaps will finally get some real help. Two years ago she went to the ER via ambulance d/t syncope (and contrary to stated opinion here, although she arrived by ambulance, she was not treated first--they wheeled her into the waiting room and no, they did not put a heart monitor on her in the ambulance-- which ride cost her $650. She could not get Tenncare nor Medicaid and ended up tossing the cardiologist's business card out after failing the insurance test. Should she be denied healthcare because she is a smoker?
It's all very well and good to get on a high horse and determine who "deserves" healthcare basing decisions on "lifestyle" choices. I happen to disagree as those that have such "lifestyle" impediments are usually those that have the most need for healing and intervention. It's like saying only healthy people who get into accidents should get healthcare. The sickest among us are the best teachers-- who else do you think drug companies test new drugs on?
Healthcare is a complicated issue and I don't believe that there are simple answers for the problems of cost, access and affordability. There are too many variables (pharmaceuticals, liability, gov. regulation and mandates, third party payers, non-compliance etc.).
Yancey, you and I have nothing to discuss at this point. Whether we ever do or not is entirely up to you(I also suspect you of using some rather childish psuedonymns, but I can't prove it.)
J Wharton,
The first part of your comment is beating a strawman for the most part. Almost none of the commenters here have suggested that there is or should be no role for a third party expertise to serve as an agent for a seriously ill patient. Some have suggested that patients can manage their relationship for routine medical care, yes, but for serious ailments, the kind that are covered by catastrophic insurance, then the patient isn't negotiating or judging what he needs or can pay for.
It is interesting that you criticize the insurance companies for actually performing this agency duty for the insured of today. Let me ask you, how does Medicare manage the care of it's patients? Does it perhaps simply use insurance company standards to determine what and how much it pays providers for service, and in the absence of the private management, Medicare would have to start more active management of care?
As for the last part of your comment, I mostly agree with all of it but the move to universal care you advocate.
SOV,
I only comment under my name anywhere unless I am making a joke that plays off a pseudonym, and I never do that to make fun of someone specifically (I have made fun of the class of people who don't actually seem to read what Megan writes before criticizing it, but the pseudonym was part of the point-and, in any case, I also made the criticism under my name as well), as was being done to you. If I have something to say to someone that is critical, I always do it up front and with my real name attached (unlike some people).
I realize you don't like me, but it is clear why. You don't like people calling you on some of the nonsense you post here. In addition, you are clearly uncomfortable being to held to the standard you are constantly criticizing others for not meeting. In other words, I consider you a hypocrite.
TallDave,
I'm a practicing radiologist and while I don't have much love for the AMA it's not the AMA putting the brakes on physician supply. The American Assiciation of Medical Colleges and the ACGME are the gatekeepers there, and while the organizations do overlap there is no conspiracy to limit physician production. There is simply a tremendous capital barrier to entering the market and a low supply of teachers.
That and demographic changes to med school populations as well as lifestyle expectations among med school populations that will likely result in a functional decrease in the effective number of physician FTEs even compared to today. The question is whether the shortage can be made up through the promised efficiencies of things like genetic medicine.
A 64-slice CT costs about the same as the single-slice CTs that preceeded them a few CT generations back, and the cost is not increasing significantly despite what works out to be a 4x increase in images to view and often a 2x increase in interpretation time. If anything the patients are getting a better deal for the same charge.
Medical malpractice reform in my state has decreased my malpractice rates by 50% in four years, for which I am thankful. As a beneficiary of defensive medicine but not a practitioner my unscientific SWAG is that there is not net effect on "defensive" practices. Nobody I know wants to be cavalier with the health of another, and there's a certain amount of OCD in all physicians that drives the n-th degree rule-out things. If practicing evidence-based medicine was proof against both liability and guilt then it might be more popular, but you have to be willing to write off the statistical outliers, like the ruptured appendixes that don't present like appedicitis. I don't know anyone who can do this.
Scent of Violets,
There was a recent release of data comparing US and EU countries in cancer survival at 5 years, I believe in the London Daily Mail or The Telegraph. The US was substantially better, an interesting outcome since early detection pursued by a socialized system should produce better outcomes, not worse. There are also population differences, but there are clearly some things our creaking, "immoral" and slapdash system does better than the hive minds of the Continent.
Is it immoral that they let more people die? Just asking.
My perspective is not one of compassion, or humaneness, or what have you. Or rather, I have my own private notions of what 'should' be the case, but I don't think those really have a place here. Probably both more and less humane than some would think.
No, my perspective is one of efficiency. My baseline preference is that the for the most part part, private enterprise and free markets do a pretty good job of getting resources where they need to be at the right time. The government should only step in as a last resort when it has been demonstrated that the private sector has systemically failed in some way.
This is true for many desired goods - police, schooling, the military, big research, etc., so it is not a priori impossible that this is also the case for health care (despite what some would say, let them have their say and then thereafter ignore them.)
Is this actually the case? Would there be efficiencies achieved by government managed health care? That's a tough question, but for the moment, based upon rather scanty information, this would appear to be the case.
Oh, and yes, there will be rationing in such a system, just as there is rationing now. One good question in the abstract is which sort of rationing is preferable, but that's more a philosophical issue, and the public wants something done now.
I'm sorry, Kathy, but above a certain floor, I think the answer is 'no'(this is complicated by a certain age factor which I would grandfather in.)
This is not to pick on smoking (I used to smoke two packs a day), but the fact of the matter is that there will have to be some rationing, and there is, as some would have it, a 'moral hazard' issue. If your mother gave up smoking, then yes, I would raise the floor some, and treat some of her smoking-related illnesses. But to keep smoking, knowing what the effects are, and then wanting other people to pay the price for her decision? That strikes me as being a little 'immoral'.
Yes, care rationing exists in the idyllic countries many breathlessly point to as models.
Everywhere, the bottom line comes to costs, and no one wants to talk realistically about keeping costs in check (not even the US insurance industry).
Re: She has been without healthcare (access) even though she lives on Social Security
??
If she's old enough for Social Security (or is on Social Security for disability) she should qualify for Medicare.
Always interesting discussions here.
Universal government controlled healthcare? I shudder at the thought.
Think about what that would entail. If the government has the final say in your healthcare they also have final say in your lifestyle. Imagine the diet and exercise police.
Healthcare as a "right"? OK. But you can't deny someone something that is a "right". Not even if they're a 90 year old, morbidly obese, chainsmoking, hard drinking gay methhead that is into "barebacking". Think about the lawsuits. Where's your cost control there?
Or are you going to deny people the right to sue their healthcare provider? Wasn't that one of the guarantees in the Democrat's Patient Bill Of Rights?
On the other hand, don't we read constantly about deathly ill patients that are denied some expensive miracle treatment by their insurance companies because it is "experimental" or unproven? What is the government going to do in these cases? The same as insurance companies I'll bet.
I am retired Army and a disabled Vet. I am currently covered by VA and CHAMPUS which is Medicare for retired military. I have had "universal" government controlled healthcare for the past 40 years. I'm sure glad I have employer provided health insurance now. I would hate to have to depend on them any more.
Cover everyone AND control costs? Something that is not possible. Unless we can hire Gandalf and Dumbledor with an assist from the Toothfairy.
Based on my experiences of dealing with the hassle of getting insurance here in the US (and the paperwork whenever going to the doctor) vs. my experiences with both the U.K. and the Japanese health care systems, I'm going to put my foot firmly in the NHS camp. The hassle of insurance runarounds, having multiple bills, having to keep track of whether medicine X will actually get covered or not--as opposed to the "little white card" we used in Japan....well, I know which one I prefer.
How many of the people posting here actually a) have been turned down for health insurance b) had the experience of both NHS and non-NHS systems? Seems to me there's a lot of posting from people without actual knowledge.
Scent of Violets challenges my assertion that US health care is the best in the world--he/she wants cites, references etc. First of all SOV, I cited two major stats: (1) Longevity---look up longevity in 1950 and 2000 and tell me what you find; (2) more significantly: cure rates following medical intervention. Those figures are readily available on line and I don't propose to do your research for you--but I will stand by my assertions.
Second, you need to understand some fundamentals of epidemiology if you are going to look at statistics (I assume you are not an epidemiologist; I am, so bear with me while I give you an overview of epidemiology). The US, unlike most developed countries, has a much more diverse population. Comparison the US which has a significant subgroups to say, Scandanavian countries where the population is homogeneous does not work. The fundamental issue in epidemiology is to compare like populations; for example, populations of American Hispanics of mexicana origin with Mexican hispanics and not aggregate mexican and amerian populations--using aggregate populations doesnt yield accurate comparisons. In epidemiology, you have to compare common denominators and common numerators to derive rates; you also have to age adjust the populations to ensure you have comparability.
Looking at bogus figures like ordinal rankings or infant mortality stats that are commonly cited in the popular literature are foolish.
Finally, SOV: As the ultimate subjective test of the quality of health care, I will ask you in what country would YOU want to be treated for a life threatning illness, or end stage renal disease, or organ transplantation, or neonatal intensive care. Somehow I bet you are trying to get to Cuba or Canada or the UK to get treated.
Freddie:
I don't expect you all or anyone to have the same moral objections to the status quo that I do, but I do think that if you accept a notion of a moral imperative to provide health care for all, quibbling about the numbers is an exercise in bad faith.
Well, Freddie, if it's really a "moral imperative" for the government to "provide health care for all", then it must be obligated to provide health care for all humans, not just humans inside the United States! What, you say? The prohibitive costs make that task unfeasible? Well, that's just an exercise in bad faith!
Or, even better yet Freddie, since money is no object when it comes to health care, why aren't you making the problem better yourself? Certainly you could use all of your own income to pay for the health insurance of several other people. So why don't you? Because it would be logically and physically impossible to do so without ruining your quality of life? Because you would have to stop using electricity, eat food from dumpsters, and live in a cardboard box?
But that shouldn't be a problem for you! In your magical world, money just poofs out of nowhere to pay for an infinite amount of health care! It's a moral imperative to provide healthcare for all, regardless of such inconvenient realities as there not being enough money to actually do so without screwing up life for everyone, right?
Deuce, I'm curious about current trends in libertarian thinking. Apart from policing and fire protection, is there anything government does that you support? Should state universities be abolished? What about public schools? Should we continue to fund public libraries? Please advise.
Good point, Deuce. And one that can be extended to arguments about trade policy, immigration, retirement and taxation - to the frustration of very different groups of partisans.
I've always wondered how the 'trans/post-national progressive' crowd deals with this parochial border-drawing. If 'communities' have rights, how will we define the communities?
I've tried to post this at least five times now in refutation to Mankiw's piece. I pointed out that health professionals should probably be the authorities cited for health statistics. Here are the life tables from WHO:
http://www.who.int/whosis/database/life_tables/life_tables.cfm
They make it very easy to make at least rough corrections for some of the claims here. For instance, the claim that what is recorded as infant mortality skews the statistics in different countries. Looking at the tables for the U.S. vs Canada we see that life expectancy after the first year (I used the years 1-4 row), we see that this figure is 77.4 years for the U.S. vs 79.9 for Canada. So the differential metric theory doesn't seem to hold here. Let's look at the life expectancies from 30 years and on to get past the years when so many young men presumably meet untimely violent deaths. There we see (in the 30-34) row that from this point on, the life expectancy in the U.S. is 49.3 years vs 51.4 years for Canada.
When it comes down to accuracy in these matters I'll take WHO's tables over an opinion piece by Mankiw, thank you very much.
Which reminds me, will people accept WHO's figures as nonpartisan? I certainly tend to. Just as I will most assuredly _not_ accept any figures from Cato (referenced earlier), AEI, The Heritage Foundation etc, unless those figures are taken from some other reputable source. I don't mean to say that everything they publish is partisan (ok) and dishonest[1] (not ok), but at this point, I'm not going to take the trouble to wade through their presentations to find out what is accurate and what is not. If at all possible, post the links to the reputable sources without using partisan organizations like Cato as an intermediary.
[1]for example, in 1996, Cato published a piece used in an election ad against Clinton claiming that under his administration, taxes rose twenty or thirty or eighty percent - I don't recall the exact figure, but it was absurdly high. It turns out that what was measured was the collection of gross tax receipts in 1991 vs 1995 and then taking the percentage difference as a 'tax increase'. Most people would agree this is an absurd way to figure such things; few complain when receiving a raise that their taxes have 'increased'.
Stan, I'm curious about trends in (modern) liberal thinking. Is there anything you don't want the government to control in one way or another? Is there anything domestically the government does now that you would like to see it cut? Should the government nationalize the health care industry? Why not other industries as well? Steel? Airlines? Banks? Evidently you think that government is more efficient than private enterprise.
Right now government spending at all levels is about 34% of GDP. Add to that the indirect influence of regulation and the government controls at least 40% of the economy, and maybe significantly more. Is that not enough for you? Do you really think we are suffering from too little government?
Thanks for the information, Duvall. Yes, I was aware of the cancer statistics. But I don't understand your question. Are you asking about just how cancer is dealt with, or the total system? I just want the best possible outcomes for the lowest amount of money, and I don't particularly care for any given system as a matter of ideology. If it's private care, so be it. If it's public, ditto. A combination of the two, natch.
I must say, I am consistently puzzled by the sort of people who would apparently cut off their nose to spite their face; when it comes between cleaving to an ideology or adding five years to my life, I'll take the five years every time. I'm not willing to die a half-decade early just to show how peachy-keen Capitalism is, or Socialism, or any other Ism for that matter.
That strikes me as being more than a little bit nuts.
SOV: Until you disaggregate the population group in each country and compare them separately, any metric is bogus. sorry--that is the way epidemiology works.
As to the use of ordinal rankings: An ordinal ranking, while it might fit in with the horserace mentality, again does not factor in population groups. Moreover, the only accurate measure of longevity is not ordinal--thats useful only for politicians or people who dont understand statistics. Given the relatively small variation in life expectancy, a better measure is the mean life expectancy for like countries and where each nation falls in the gaussian distribution. As long as it within one standard deviation, that will not be much more than plus or minus two years.
As to infant mortality: the WHO criteria is quite specific: any movement, attempt at breath, or cry is basically the criteria, and any foetus with longer than 24 weeks gestation can probably do that; the US is one of the few nations that fully abide by the stringent definition. Other nation, eg, Switzerland, measure a live birth in terms of length; the former USSR and its satellites use an even less stringent criteria.
I thought your claim was the contemporary U.S. as opposed to other developed countries had better metrics. What the state of the art was fify, sixty years ago, I don't particularly care, and am, quite frankly, mystified as to what the connection you are trying to make is.
For the rest, I don't care if you stand by your assertions or not; means bupkas to me. If you want me to believe you, it's up to you to proved supportive evidence. Not me to do your research.
You being an epidemiologist and all, I'm sure you'll understand when I say that this doesn't cut it; you need to show me the numbers.
Huh? I'm trying to pick out something that makes sense there, but I don't see it, particularly that last sentence. Could you rephrase?
SOV: I told you how to do the numbers; I doubt seriously you would accept my calculations so I don't plan to waste my time. If you need help running these figures, there are some elementary instructional aids on line. You will need census figures by race, gender and age for each country you plan to compare; that will give you raw data; then you need to age adjust those data. Google "age adjusted" to find out how. Nothing more than arthmetic is involved. And if you can't do it, let me know and I will be glad to recommend some aids. And I can understand your confusion as to last paragraph. It should read: "somehow I bet you are NOT trying to get to Cuba, or Canada, or the UK...." Sorry for mistyping that.
Uh huh. Why don't you explain why this is rather than simply stating it, you being such a pro and all.
Uh huh. You do know that, among the activities I do to get by, I teach statistics, right? That I've also been engaged by different university departments to do some statistical analysis on the the cheap, and one of those departments had me do some reductions on health surveys done specifically for the CDC?
So if you want to make those claims, fine. But if you want to convince me, you better show me the figures.
Are you really trying to say that a two-year difference in life expectancy is no big deal? You've got to be kidding. If you're trying to imply that we can't reject the null hypothesis that the difference in life-expectancies between differing countries is negliglible, well that's just plain wrong.
I've been trying to post this for a while, but the filters won't let it past:
http://www.who.int/inf-pr-2000/en/pr2000-life.html
I suggest you read the whole thing; it includes speculations as to why the United States fares so poorly, but I suspect I've quoted too much as it is.
You must have missed my post linking to the WHO life tables. A glance at them debunks this particular claim, as I've already shown in the specific case of Canada compared to the U.S.
SOV,
The question was rhetorical, intended to be sarcastic, and not aimed directly at you.
There are several things about this cancer data that raises questions. In general, the earlier cancer is found the better the cure rate. In modern medicine, this means imaging and endoscopies. While socialized medicine may generate more doctor-patient encounters, those encounters may not result in the same amount of imaging as is performed in the US. The issue may be later detection.
The difference may simply be in the types of tumors found. More small-cell lung malignancies in a population will definitely skew your survival data downward, though when you take all comers and the US is still better overall, that would tend to suggest that tumor type is a minor factor.
The difference may be in treatment. If for fiscal reasons you are using 1970s-80s era chemotherapy, or have to wait (the time factor again) to begin your radiation therapy then your population survival odds would be expected to decrease. Individually your tumor may not progress between diagnosis and treatment, but if you take everyone with the same tumor then waiting to begin therapy WILL negatively impact some people in that group.
It's arguable that cancer survival isn't a good metric, since cancer is an extremely serious disease and everybody has to have an endpoint.
But it's equally arguable that there's hardly a tougher test of the ability to integrate medical disciplines successfully. Succeeding against the longer odds of cancer (compared to other diseases) says something, to me anyway, about the ability of the system to get the job done, and at least a 10% improvement in successful outcomes compared to the next closest socialized medicine system.
If you're after the best possible outcome for the least amount of money, a) don't get sick, and b) there is really no bottom to that. The least amount of money is none. The best possible outcome is at that point up to your genetics, environmental exposures and accidents, but as far as bang-for-the-non-buck it's as good as it gets. Death is an effective cost-control method, and really, it's not an unexpected outcome.
I don't think you'll make much of a parade out of supporters for that concept. Americans are pretty individualistic and the idea that they should not receive care for the common fiscal good will not fly well, particularly if healthcare is a right. If that concept becomes the zeitgeist, then the people who need healthcare the most have the most right to it ahead of anyone else, and I'm pretty sure they can find a lawyer to argue that. Cancer diagnoses and "futile care" cases will be to the "right to healthcare" what flag burning or offensive speech is to the right to free speech -- it may offend us but we have to tolerate it.
JMO. I just don't see the Baby Boomers collectively taking it for the team with lower-quality healthcare to meet a budget estimate.
Funny thing, RJA, but I'm spending quite a bit of my time linking to reputable sources, digging for data doing basic scutwork here, and I don't expect I will convince you in the slightest.
But that's not why I'm posting this stuff. I'm posting it because it's the right, the credible thing to do.
And I think my credibility is rather higher than yours at this point. Speaking of figures, btw, I've having a little trouble with using the De Rham cohomology to characterize some manifolds that are not connected but not necessarily non-orientable.
You wouldn't happen to know a good Mayer-Vietoris sequence that might come in handy, would you? If not, I'm having a little trouble coming up with a basic proof showing that two nxn matrices when multiplied together have the same characterisitic equation, that is the characteristic equation of AB is the same as the characteristic equation of BA. I can go the usual route of comparing generalized eigenspaces, but I'm told there's a simpler way. I dislike having to tell my students that this is simply the case and when learn why this is later on in the semester, so this would be a great help. You wouldn't be able to help out, would you?
You being such a dab hand at figures and such, I mean.
SOV asks: "Uh huh. Why don't you explain why this is rather than simply stating it, you being such a pro and all." "This" refers to the need to disaggregate populations in order to compare population metrics. Thats a fair request, so here's why: The US has one of the most diverse populations of all developed nations. Life expectancies vary considerably by ethnic group and regretably, life expectancies are less for African Americans, native Americans and some other immigrant groups than they are for the caucasian population. (thats another separate, but important issue) The basis of rate comparison is comparing ratios that have the same numerator and denominator. Thus you should compare blacks in the US with blacks in Canada, or any other country you wish to compare; you should compare caucasians to caucasians, and so forth. Hope that helps.
As for the WHO tables, the critical factor is not what the WHO reports--they accept the reports of live births from reporting countries; the WHO specifies what the criteria for live births are. It is up to the reporting countries to abide by those criteria, and many countries do not. GIGO then applies.
SOV,
You must have missed my post linking to the WHO life tables. A glance at them debunks this particular claim, as I've already shown in the specific case of Canada compared to the U.S.
Huh? His statement was about the different ways in which infant mortality is defined by different countries. I see nothing in the WHO life tables that debunks his claim, or that even discusses the definitions of infant mortality at all.
Advances in genetics are what's going to sink the private health insurance market. No insurance company will (willingly) cover people known to be high risks, and we're not too far away from being able to identify pretty much everyone as a known risk for something. When the majority becomes unable to get affordable health insurance, government will be forced into action.
Free market advocates ought to get ahead of the train. My (vague, hand-waving) proposal is that every citizen has access to a government provided health care line of credit. You can draw on that line of credit, but any use of it becomes a tax liability. When you pay your taxes, any balance on your health care line of credit creates a tax surcharge until the line of credit is paid off. This would include estate taxes, which I would make taxable at 100% for outstanding health care debt.
This would mean no one goes without health care due to an inability to pay, but it retains (and enhances) free market accountability. Individuals are conceptually spending their own money for their health care, so they have incentive to shop wisely. You're not limited to the health care line of credit, so it becomes a floor, not a ceiling on health care. It doesn't even rule out private health insurance, although it makes it less attractive.
Regarding the use of statistical data:
1. You cannot draw any meaningful conclusions about the quality or performance of different nations' health care systems from aggregate health indicators like average life expectancy or infant mortality rate. Any differences in those indicators attributable to differences in health care systems are swamped by other variables, such as patterns of diet and exercise, rates of smoking, alcohol and drug use, crime and accident rates, pollution standards, etc.
2. In order to meaningfully compare health care system performance, you need to look at data that actually measures outcomes attributable to the health care system. One clear and important example of such data is cancer survival rates. Cancer survival rates provide a fairly robust indicator of how successful a health care system is at diagnosing and treating cancer. And the U.S. has the best cancer survival rates in the world, substantially better than Europe's.
Well, yes, this is well-known. I thought you were going to explain why this was inherent, rather than a measure of something extrinsic to the subpopulation, say, I don't know, quality of healthcare.
on edit: let me try posting this _again_, without the link. Why does the Atlantic use a such a buggy program? I've never had this happen before.
begin
Thanks, Duvall. You give good info. I'm not sure if there is a 'best' health metric, but I'd suggest as a general rule of thumb that unless a disease is a big cost-driver in terms of the number of people it afflicts (and not simply the expense of the treatment itself), we really shouldn't consider it. Though you're right about the integration. In fact, a look at the WHO stats seems to confirm my impression about care for chronic diseases being the big cost-driver:
(deleted to get past filter; link available upon request)
This certainly confirms my general impression. Although, sadly, I'm much more likely to know on a personal basis a fifty-year old or older than I am a person aged twenty to forty.
Very true. I 'eat healthy', run seven miles three or four days a week, take vitamins, including probably non-beneficial supplements like glucosamine chondroitin (though there is no evidence they cause any harm either). The end result being that I'm told I have the heart/lungs/metabolism of somebody twenty years younger at my regular checkups.
But that gives exactly zero protection against violent accidents, or any of the various cancers, or some sort of odd disease vector.
There's no good answer, unfortunately, just a range of less bad ones.
That's my fear as well. They've (and that includes me) always seem to have had a disproportionate amount of political clout for their own pet causes, and I don't want this to become one of them. By discussing rational alternatives now, we may get an improved health-care delivery system. If we wait until later, look to see a horde of 65+ screaming for their 'rights' to kidney transplants[1], unlimited blood transfusions, in-home nursing care, etc. The political push-back later may become impossible to resist then, so we better be planning for that eventuality now.
[1]There was a scary story I read 35 years ago titled 'Caught in the Organ Draft'. About just what it says. Scary, repellent, and plausible for what it said about human nature.
end
SOV, I have just chacked the US Census data myself. You are free to check as well if you like. You have to generate the tables yourself. The spam filter won't let me provide a link, so just go to the census bureau's home page, click "health insurance," then "data access" then "CPS data creator." In part 4 enter "health insurance coverage" and "household income" as your row variables and, if you like, for convenience change the income ranges in part 6 to $5,000 increments.
If you do you will find that there are indeed 47 million people without health insurance. But 9.3 million of those have houshold incomes of more than 75,000 per year. Another 8.4 million have household incomes between 50,000 and 75,000.
Surely those people ought to be excluded from serious discussions about poor people lacking health insurance. That brings us down to about 29 million. As for illegals, noone knows how many there are for sure, but they are included in the census and there are likely at least a few million of them who do not have health insurance. So already we're down say 24 million or less.
In a quick check, I was not able to find how many are eligible for Medicare but have not bothered to sign up. I'm willing to take Mankiw's word for it that there are several million more who could sign up for Medicaid at any time but haven't yet (because their healthy). Mankiw is one of the most respected economists in the world (his papers are some of the most cited) and he would not be were he in the habit of making up data. Certainly most of us would consider him a more reliable source of information than Ralph Nader & co.
Regardless, it's abundantly clear that the 47 million figure substantially exaggerates the problem. Noone can tell with certainty exactly how many people who are here legally can't afford to buy medical insurance, but it's much less than 47 million.
This makes me suspect you did not click on the link and did not look at the actual tables. They give the life expectancies not just from birth, but from a given age as well, both for the general population , and then breakdown by gender. So if you want to exclude the inconsistent reportage of live births, you just go to the next line down and look at the typical life expectancies (given in remaining years) of children aged 1-4. Ditto for any other age-correlated mortalities
SG: an interesting proposal, but it misses the risk-pooling aspect of insurance which is essential. Probably you're going to have to cap the possible tax surcharge (essentially, make it a deductible) and go with free care above that point.
SoV: Freddie was treated abusively for no good reason. His use of the 47 million statistic was misleading, and he refuses to answer simple questions such as what level of care he thinks is morally mandatory, but there's no reason to call him a liar.
I find the waste & bureaucracy of our insurance companies to be much worse than that of Medicare
So... the insurance companies are just blowing money on administration for no reason whatsoever? The hassle isn't going to, say, prevent fraud?
This is part of the argument I find hardest to swallow. Those insurance execs are nothing if not good a making a buck, so if there are huge inefficiencies in their operations somewhere, they aren't of the type that the government can easily eliminate.
rwe, I tried to post this several times last night, but I couldn't get past the filters. Now that I've managed to distribute those links over several posts, I'll include part of the body of my original reply:
begin
In an opinion piece, citing very little to back up his claims. Uh-huh. I'd prefer that instead of citing economists for health issues that he cite health professionals and health organizations.
For example, WHO:
(deleted - already posted)
I'll take WHO over Greg Mankiw for this sort of information, thank you very much.
But this does raise an interesting point (or rather, re-raises it; I've already remarked on a certain hypocrisy): Let us suppose that the actual number of people who can't get adequate health care for monetary reasons is much smaller, say only 20 million. Is this the magic figure at which there simply aren't enough people in this category to constitute a problem that needs to be addressed nationally?
Or turn it around - if certain trends continue, if there are not yet 47 million people who can't get decent health care because they can't afford it, the odds seem to be good that nevertheless there will be this many in the future. If that was the case, would it _then_ be the case that some sort of national implementation and organization of health care would be considered necessary?
Or - as I suspect is really the case - do you not really care what the number is, no matter how large? Even if in later decades this figure rises to 50 million 'really' uninsured? Or 60 million?
Because if that's the case, it really is dishonest to try to attack the exact magnitude of the figure; it suggests that the numbers really are troubling, but rather than address the issue, you would rather distract from this by quibbling over the exact size of them.
So at what point do figures like 47 million become 'troubling'?
end
As you can see, he was wildly off on the health statistics, so, no, I don't consider him particularly reliable.
Otoh, I do consider the U.S. Census very reliable. Anyway, please respond to my post of last night, reprinted in part above.
The moral arguments aside, Megan's position is stupid for the exact reason her position was stupid in the last post, and the exact reason I commented about the stupidity.
Megan is saying that the Massachusetts insurance plan turns out to be too expensive because too many people signed up for it. That means there's no overrun cost as to the per-person, only that there are more people signing up the plan. That means either the plan is providing such great health care that the market forces are switching to it (yay invisible hand), or that there is more uninsured than we thought. But the former blesses the program, not indicts it, and the latter blesses the need for the program, rahther than indicting it. If the problem is that our health care system is EVEN WORSE THAN WE IMAGINED, that seems like a silly reason to pull a program that is doing something to stop that.
The only lesson is that a plan designed to supplement the regular regime of private insurance has to realize
a) how many uninsured there actually is
b) that there may be some people who will switch to the government system from the private system (at lower overall costs, as Ezra points out).
Neither of this supports Megan's stupid truthi meta point, that government health care plans understimate the cost to the government of providing a citizen with health care.
And of course, for a plan that substitutes the current system (true universal health care), then Megan has no point, because the number of people who sign up for the program is set at the number of, ya know, people.
Or, to be brief, Megan has no point.
That means either the plan is providing such great health care that the market forces are switching to it...
This hardly blesses the program as superior to private healthcare; because it's subsidized by taxes, the same care should cost less to the insured as a private plan (if it doesn't then we have a case of truly wanton government incompetence). Naturally people will prefer to pay less for something, even if they can afford to pay more.
Re WHO table/life expectancy/infant mortality--I see where we are not communicating. Infant mortality stats start from the computation the crude death rate from birth to age one. Life expectancy stats deal with the remaining age cohorts. My concern with the IM stats is, like life expectancy, they are usually laid out by advocates in some ordinal ranking as evidence about how the US doesnt compare favorably with, say, Cuba, Bosnia, Canada or the like. The measure of IM depends of the honesty of how the data is reported. Hope that clarifies my concern about IM.
And after all of this is said and done, as it turns out, life expectancy doesnt correlate very strongly to the health care system--it correlates most strongly with life style, SES, and status of public health programs in each country.
"Let us suppose that the actual number of people who can't get adequate health care for monetary reasons is much smaller, say only 20 million. Is this the magic figure at which there simply aren't enough people in this category to constitute a problem that needs to be addressed nationally?"-SoV
I think it should be addressed. Above I argued that those who cannot afford basic medical care should get a subsidy in some form from the government (there is Medicaid, but maybe that should be reformed). There are grave defects in the current American system that really ought to be addressed.
But I remain unconvinced that anything like the British NHS (which I have experienced first-hand) is the best solution to our problems. I think there are other reforms one coud introduce that would rely chiefly on markets but would offer government assistance for those who need it.
Competitive markets tend to reduce prices and increase quality. I don't see why they couldn't do the same for our health care.
Incidentally, I don't think the precise figure (47 million--or 20 million or whatever) should be the focus of the debate. But you asked why some were disputing the reliability of the figure and so I tried to answer.
I don't like data being abused, by anyone, that's for sure. But that doesn't address the point that life expectancies and health outcomes in different countries can't be explained away by differing definitions or what are (in)arguably 'non health' reasons.
That there is a real difference, and not merely an artifact of reportage is beyond dispute.
That may or may not be, but there is more to health care than just life-expectancy; that's just a stand-in. See my other WHO cite about healthy vs non-healthy life expectancy.
And in any case, as always, if you want to make the claim that there is only a weak correlation between health and health care systems, it is incumbent upon you to prove it, not upon others to disprove it.
Let's see your cites and data.
Without knowing more details about the program, I don't think you can draw those sorts of inferences.
rwe, or whoever asked about trends in liberal thinking: I think having so many people without health insurance is bad for the country. People without insurance don't get as much preventive care as they should. They clog up emergency rooms, they die sooner, their babies die sooner, and they don't contribute as much as they could to the economy either as workers or as consumers. In my opinion, our present health system, if it can be called that, is poor public policy.
I can't answer for other liberals, but as for me I think true socialized medicine, as in the military or the VA, or a single payer system, as in Medicare, would be too disruptive to the economy and too rigid. I also feel that the insurance industry plays a vital and beneficial role in the economy through its investment activities and that this should be preserved. The medical insurance proposal by the Democratic candidates seems to me to be a reasonable compromise. It provides universal or near-universal coverage at what seems to me to be an acceptable cost. Sorry if this offends you.
SOV: It appears we are in areement that there are certainly differences in Life Expectancy and Infant Mortality and that the differences are troubling. I cannot say how differences in reporting affect infant mortality stats except that there are differences and some nations do not apply WHO standards. I don't know if you would join this statement or not: The extent these differences in IM and LE have to do with the (1) health care system and (2) health care insurance are largely unknown.
As to correlates. Let me give you a some citations in the scholarly literature about correlates of life expectancy (and unfortunately, these are more relevant to the developing countries than the developed: SES--http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V8K-4CXMW44-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=40d4210661e7a14db5233b40447a1146; and http://www.popline.org/docs/0038/272268.html; and Public health infrastructure: http://deepblue.lib.umich.edu/handle/2027.42/24048
It is of course incumbent on me to make my case for my assertions; however, I would suggest that you this is a blog and not a scientific journal. The appropriate place for your standard of proof, I submit, is in peer reviewed journal. If you expect the same standards of proof in a blog, neither I, nor anyone else, can accomplish that.
And there you have it, for all to see. RWE demonstrates convincingly that the 47 million figure is an overstatement. An argument based on government census data, and yet that is not enough to convince SOV that the number is, in fact, an overstatement, or that Mankiw was correct all along. Instead, he backs off to the position that it doesn't matter rather than acknowledge the facts.
Philosophically and practically, the actual number does matter. If it is the case that 10% of the population can't get health insurance, then the best solutions might take one form while, if the number were 33% of the population, they might take another. We are not quibbling over nothing.
There's an election campaign in Alberta, the Texas of Canada. What was the right-wing government's first promise? To eliminate all premiums for health care. They know it's a vote-getter. They know that a fiscally responsible conservative government can deliver the goods on universal health care.
http://www.theglobeandmail.com/servlet/story/RTGAM.20080205.walberta05/BNStory/National/home
"So at what point do figures like 47 million become 'troubling'?"
When the population is 100 million instead of 300 million.
So anywhere from 250 million to 280 million people in the US currently have health insurance. This is 83%-93% of the population. Seems like solving this problem shouldn't require putting the 90% who have health insurance on government funded/mandated insurance.
And if you subtract th2 10-20 million illegal aliens, the percentages are even better...
"Instead, he backs off to the position that it doesn't matter rather than acknowledge the facts."-YW
Yancey, I want to point out also that Freddie ducked out of the argument. He started this whole thing off by endorsing "national health care" but never made any kind of case for it.
He then implied that there are 47 million Americans who can't afford health insurance, and that is just not true. But even if it were he offered nothing in the way of a defense of a single-payer system or some other sort of national health care.
He made an assertion about morality (again without any kind of argument) but never connected that in any rational way with a specific policy proposal. I think that is why he got such a rough response on this thread from some commenters (though not me).
I often disagree with Brooksfoe, but he at least would offer some sort of argument. He would have reasons for his position. And generally when he makes factual claims he is careful about them.
SOV,
And in any case, as always, if you want to make the claim that there is only a weak correlation between health and health care systems, it is incumbent upon you to prove it, not upon others to disprove it. Let's see your cites and data.
A clear example is a comparison between the United States and Costa Rica. Costa Rica spends only 5% as much per capita on health care as the U.S., and has only half as many doctors per capita. And yet Costa Ricans live about as long on average as Americans. Why? Because their rate of smoking is much lower, they have many fewer motor vehicles (meaning that they get a lot more exercise from walking, and have many fewer deaths from motor vehicle accidents), and they have a much healthier diet. Socioeconomic variables of this kind swamp any impact on average life expectancy from differences between health care systems.
rwe, or whoever asked about trends in liberal thinking: I think having so many people without health insurance is bad for the country. People without insurance don't get as much preventive care as they should. They clog up emergency rooms, they die sooner, their babies die sooner, and they don't contribute as much as they could to the economy either as workers or as consumers.
Do they? I often see claims of this kind from proponents of "universal health care," but never any serious evidence to back them up. You say, for example, that "People without insurance don't get as much preventive care as they should." But is this more because they do not have access to preventive care, or more because they simply do not make use of the care that is available to them? And as for those clogged ERs, are they really clogged with uninsured persons who turn to them as a last resort because they can't get health care elsewhere, or are they clogged with insured persons who use them in place of waiting for an appointment with their primary care physician. I know parents who run to the ER every time their kids get a runny nose or a bruised knee, and their insurance pays most of the bill. Maybe things like that are what cause clogged ERs, rather than the uninsured.
I thought it was common knowlege that there isn't a correlation with type of healthcare system and LE/IM, etc. Anyway, I'm not looking it up.
It's no ones job to prove a negative. The burden of proof is usually on the posetive.
I find it astonishing that a previous commenter states she has worked in medical offices with Medicare and still espouses expanding Medicare downward to cover everyone. Setting aside that Medicare already has an outsized footprint that serves to set rates for all other coverage in the populations it serves, I would certainly never recommend that it be offered as a solution for the country's medical needs. Many MDs don't currently accept Medicare due to its low reimbursement (would be good for the taxpayers, I guess, were it not offset by the fraud) and arduous filing requirements, let alone its often arbitrary restrictions on which procedures/surgeries/etc. it will cover. Medicare coverage can be less than the cost of service and those MDs who do accept it have to offset those losses with "paying" patients (those with non-government insurance). How this could be a recipe for success for universal coverage escapes me.
Here's an example of Medicare at work. I saw a patient that I suspected was in the initial stages of Alzheimer's and referred her for a neuro evaluation. Well, Medicare rules allowed coverage of her testing but not the physician to evaluate the testing! We finally were able to work things out but it was a ridiculous and unnecessary hurdle for everyone.
The commenter's additional anecdote of her mother is maddening. If her mother received poor care at the clinic (no health care system run by humans can guarantee perfect care), for God's sake, go to another clinic. Or find a local MD who will accept self-pay at a discount or offer payment plans (most do, if asked, including any office I have ever worked for). There are also specialty clinics that only focus on chronic illness in some cities (I volunteer at a free one in our smallish city that actually ends up servicing mostly illegals because citizens have other resources). Not to mention that Wal-mart (and now Target) offer a wide variety of older but time-proven hypertension meds for $4 per prescription!Transportation services for the elderly are offered in most places, even if they are just a group of local church volunteers with their private vehicles. The amount of free and reduced cost resources in most towns and cities is pretty amazing once you check into it. Uninsured does not mean no access to care.
Socialized medicine is a fool's utopian dream of perfect free care for everyone. Universal health coverage fulfills the progressive's need for seeing himself as a moral actor, a brave rescuer using the power of the state but the actual reality when it's implemented is truly no better than what we already have, with all its warts. Both systems involve rationing of some sort and both have strengths and weaknesses. Assuming that a socialized system protects you from decisions that your preemie 650-gm baby (1 1/2 lbs) isn't worth the dollars spent or eliminates the health issues of the poor is wishful thinking.
Funny, here in the People's Republic of Massachusetts, I can't find a single citizen that believes this law will do anything for anyone but the politicians and those who give them money to be allowed to suck at the public teat, which is just the way things work here in Kennedy Country. The poor people that this law purports to help gain access to healthcare ALREADY have access, either through Medicaid or the ER (ask a doctor or nurse how many patients are treated as part of the what we call here the "free care pool").
The losing candidate for governor in 1990, John Silber, shocked the voters when he said that at a certain age, "it's time to go". Our society is now one that believes all heroic measures necessary be take to prolong life at any cost. Any commodity that is consumed without limit will not last long, and now we see in Britain what's in our future, where doctors are now just tossing people off the waiting lists for procedures because the NHS says waiting lists have to shrink.
Are we willing to stratify our healthcare as is done in France. If not, are those at the top of the pyramid willing to accept reduced services to help those who aren't?
Bearing-PCPs here were swamped BEFORE this mandate. My PCP, a great doctor and a great guy, finally got sick of dealing with the bullshit and left his Mass General-affiliated medical office to start his own concierge practice. He's already adopted the stratified French model; care from him now costs $6,000.00 per annum just to get in the door, and he does NOT accept any insurance. I'm still part of his old practice, but I was 13 months without an official PCP until they found a new doctor to take up the slack.
What I would like to see are the numbers relating to how much of this unexpected overage is due to the forced insuring of those currently free riding. One of my gym buddies is one of these, 43 years old, in great physical condition, and he hasn't had coverage in 15 years. He says he only gets hurt at work! : )
Certainly there are differences attributable to the two types of systems, and certainly the amount of difference is unknown. And yes, every effort should be made to get the numbers on the actual differences and they can be attributed to.
But since you agree there is a correlation, albeit a weak one, there's the other factor to consider: cost. Even if only, say, 10% (to pluck a figure out of the air) of the differences in health outcomes are attributable to the health care systems, the fact remains that it seems by all accounts that a)we would still have better outcomes (albeit perhaps only weakly better), and b)the total aggregate cost of those outcomes would be cheaper (all other things being equal.)
These do not help your case, as you yourself admit.
Oh, come now. Looking things up on Google is easy. And it most definitely does not rise to the level and rigor of serious scholarship. Looking back, aren't you at least a little bit happier knowing there are some actual facts being flung around as opposed to completely unsupported assertions, personal abuse, and collective chest beating by a certain claque? Also, anyone can just make up numbers, use flat declarative statements (those really make me grind my teeth, especially when delivered by mentally under-equipped personages who have studied the Heinlein School of Rhetoric.) So what? What does that accomplish, exactly? So, no, I disagree, my standards are not that hard to live up to, and they are certainly more productive than the other way, where it's all dependent on who has the majority and who can most loudly and vigorously shout down the opposition.
Finally, what I have to constantly poke and push and prod for is nothing radical, nothing out of the ordinary, this is the way arguments are supposed to be undertaken - by objective evidence, facts, appeals to reason rather ideology and tribalism, etc.
If you don't have that, you get Powerline, Instapundit, Michelle Malkin, etc. No thank you. I've been to each of those places, briefly, and have no intention of going back.
Freddie, the plebes have decided it's OK to vote themselves bread and circuses. Is this a good justification?
Oh, wait, I forgot the "moral" issue. The crack whore's addicted spawn and the anchor baby's rash is my problem.
I jokingly (kinda) give my retired dad a hard time about his seemingly daily visits to the doctor after a lifetime of not really taking care of himself. But at least he spent 50 years paying into the kitty.
I hereby dub thee Freddie the Freeloader!
Funny thing that, but it's already been conceded that there is a correlation. Now we're arguing over whether the correlation is strong or weak, and to what extent there is actually causal arrow.
Sigh. And just when I thought you were getting better. Would it kill you to admit that I never said any thing like that? And not at my prodding either.
In an odd bit of irony, if find that immediately following my post in the queue is this:
Is _this_ really how you want to discussions to be conducted, RJA? Is this the posting of a serious or critical person, someone you would trust to fairly evaluate complex mechanisms, not leap to snap judgements, whose words you could take at face value?
I would hope not.
SOV,
But since you agree there is a correlation, albeit a weak one, there's the other factor to consider: cost. Even if only, say, 10% (to pluck a figure out of the air) of the differences in health outcomes are attributable to the health care systems, the fact remains that it seems by all accounts that a)we would still have better outcomes (albeit perhaps only weakly better), and b)the total aggregate cost of those outcomes would be cheaper (all other things being equal.)
You are confused. You cannot infer from the presence of a correlation between health care quality and life expectancy that any part of the longer life expectancy of Country A compared to Country B is attributable to a superior health care system in Country A. Since other factors, like diet and exercise, swamp the influence of the health care system on life expectancy, Country B may well have the superior health care system even if it has a lower life expectancy. This isn't exactly rocket science.
Again, to make meaningful comparisons of the quality or performance of the health care systems of different nations, you need to look at data that actually measures the performance of the health care system. Life expectancy is not an example of such data. Cancer survival rates are. And the U.S. has the best cancer survival rates in the world.
I would also recommend for those of you who seem to be absorbed with statistics and numbers to go see for yourself. Volunteer, be part of the solution. You don't have to be a medical person - admin and telephone support are great, too. See the people you say you want to help by using Uncle Sam's money up close and personal. You don't have to wait for HillaryCare.
SOV, I thought Freddie was the one who deserved the criticism. I tried to phrase my remark to leave you out of it. Hence the somewhat awkward locution.
Incidentally, unless I missed something in the thread above, Freddie was the one who started with the insults, accusing his interlocutors of "bad faith" and implying that their position is deeply immoral.
Above I've only addressed Freddie's arguments, not him as a person. And honestly, I don't see much of an argument at all.
Once again, though, I haven't said a negative thing about you on this thread, SOV. Nor have I even criticized the reasoning in any of your posts. You asked a question and I tried to answer it. That's all.
rwe,
Yes, Freddie is the first to raise the 47 million number, but then SOV tried to defend it, and when he failed, refused to acknowledge that the 47 million number was an overstatement. He went so far as to claim that economists, analyzing health insurance coverage and income data from census material, should defer to the opinions of health professionals and health organizations.
"Funny thing that, but it's already been conceded that there is a correlation. Now we're arguing over whether the correlation is strong or weak, and to what extent there is actually causal arrow."
Or, if it's causal, what the sign is. (sorry that I probably come accross as being rude.)
I've missed something, where was the correlation proven. I haven't seen a relationship described, let alone proven.
Yancey, I don't want to comment on it one way or the other. I will say though that I don't agree with SoV about the general quality of your posts. Hopefully I can at least say that without getting drawn into the dispute.
As I say, though, I would rather focus my criticism on Freddie, who was making strong claims without any justification. And after accusing others of "bad faith" he played the victim when they responded with some irritation.
rwe, keep in mind that Freddie only called it bad faith to quibble about numbers if you accepted his moral imperative argument; that's not so crazy. If you see it in the stark moral terms that he does, then even 1 person being denied healthcare is a terrible travesty, so quibbling is pointless.
For my part, I'm still waiting for him to tell us how much and what kind of health care is a moral imperative; if he wants unlimited access to leeches to suck the bad blood out of the deserving poor, we can easily afford to salve his conscience.
Fine Rob. He put it in the form of a conditional. Nevertheless, Freddie should quit making groundless moral claims and start making rational arguments.
Brooksfoe and I disagree about tax cuts. I could say it's immoral for the government to rob me of my freedom. And Brooksfoe could say it's immoral for the govenrment to allow poverty to persist and inequality to continue to widen. And if neither of us provides any more argument than that, the whole exchange is pointless and is doomed to end in acrimony and recrimination.
Thankfully Brooksfoe doesn't do that. He doens't just make assertions--he gives reasons. And not long ago he persuaded me that I was wrong about a matter of some importance and he was right.
Freddie isn't going to persuade anybody unless he starts offering reasons. And he's going to continue to irritate people if he goes on maintaining, without justification, that he has some superior moral insight the rest of us lack.
And by the way, Rob, the conditional form doesn't necessarily change the implication. To paraphrase Freddie: 'If you were as moral as I am, you too would see why cost overruns are irrelevant and quibbling with the numbers I gave is in bad faith.'
SOV: first of all why do you refer me to other posters stuff? Please don't drag me into comparisons of other posters material. If you believe that posting material on a blog can compare to a seriously written article in a peer reviewed journal, great. Your standards of proof, then are much lower than you believe them to be. At any rate, my interactions with you are now in the realm of pig wrestling, and I will leave the sty to you. Beat your chest, demand proof, and all the other rhetorical flourishes you appear to have mastered. I will continue to suggest, along with Mixner, and for the reasons we both have suggested, that LE and IM are not valid measures of the effectiveness of a health care system. YMMV. And again, if I encourage you to seek health care from Cuba, Canada, or the UK if you are in serious need of medical intervention. Cheers.
rwe, I don't disagree with you much; see my own posts criticizing Freddie's numbers and lack of argument.
Aaron, I think you might be confusing correlation causality. There is indeed a correlation, but is this indicative of a causal relationship? Maybe the difference is all diet and exercise and clean living, in which case there is no causal connection, or maybe it's solely because of the type of health care delivery, in which case there is a very strong causal, connection, etc.
And rwe, it's not a matter of being 'in a dispute'; it's a simple matter of fact. If you really don't want to give offense to anyone, all you had to do was suggest scrolling back through to the initial posts. In fact, here is my very first post on this thread:
Posted on February 4 at 9:32 p.m. Really, none of this is terribly hard, and if anyone had tried to tell me something that I knew wasn't so, I'd correct them. Ideology, feuds, what have you, have nothing to do with being wrong or right . . . or shouldn't.
Er, no. What Freddie is saying (and I agree with), is intentionally arguing over the exact size of a figure when it makes not one bit of difference to what you will accept anyway is dishonest. In any direction, any ideology.
That being said, I don't he argues his case very well, in the sense that economic arguments generally shouldn't really on moral imperatives. If you want me to be extremely rude, I'll say that I don't think he's much of a numbers guy.
Hmmm? I'm simply pointing out that there are different types of arguments, as well as differing qualities, and that you are judged by what you post. If you feel comfortable with what I quoted, in fact, prefer it to referenced data, by all means, cease to respond to me.
Uh, I think I said _exactly_the_opposite_. Go ahead. Reread what I wrote. I said that given the tools available, it's very easy to at least include a link if such is necessary. And it's preferable to unsourced assertions like "it's been scientifically proven that the free market is the best possible form of resource allocation, and anyone who doesn't accept that is denying basic science."
Sigh. Demanding proof is not a rhetorical flourish where I come from. I don't know how I can convince you of that.
You can 'suggest' you like(though, frankly, what you've been doing is 'insisting'.) You obviously have some reason to believe the way you do, but unless you are willing to share it with the rest of us, I'm afraid I can't accept this on your mere say-so.
No disrespect intended, of course.
If you want me to be extremely rude, I'll say that I don't think he's much of a numbers guy.
I don't want you to be extremely rude, but that hardly qualifies anyway.
But arguing the figure when it makes no difference to you, personally, isn't dishonest. Part of why one argues in a public forum rather than by private email is for the sake of convincing the lurkers. Even if you, personally, don't give a crap if 100 million Americans can't afford health care, it's fair game to attack Freddie's number (both the magnitude and the meaning he ascribes to it) for the sake of those people who might otherwise be convinced by what he says (or, for that matter, on the off chance of convincing him). As long as we can plausibly believe that someone cares, it's not really bad faith.
Thus, an atheist might attack creationism on grounds of being bad theology; such an argument is not in bad faith, and is far more likely to win converts (so to speak) than to attack it on grounds of being bad science.
It's only bad faith if you agree with his strong moral premise; then quibbles really do become pointless one-upsmanship games.
SOVYou can 'suggest' you like(though, frankly, what you've been doing is 'insisting'.) You obviously have some reason to believe the way you do, but unless you are willing to share it with the rest of us, I'm afraid I can't accept this on your mere say-so.
It's called common sense. Do you really believe that poor health and premature death have nothing to do with diet, exercise, smoking, drug use, crime, accidents, and so on?
But if you intend to keep questioning the obvious, try this. You should read the whole thing, but here's a money quote:
.That's right: "shortfalls in medical care" account for a mere 10% of premature deaths. Behavioral patterns account for four times as much. That is why the claim that Nation A has a better health care system than Nation B on the grounds that Nation A's average life expectancy is a few years higher than Nation B's is such utter nonsense. And yet this claim is repeated over and over again by proponents of "universal health care."
The piece also cites the landmark Rand Health Insurance Experiment. The Rand HIE is the largest and most comprehensive study ever conducted on the effects of health insurance on health. It tracked several large groups of American families for over 15 years. One group had high-quality, comprehensive health insurance that covered almost all its medical bills, while another had very restrictive, "catastrophic" insurance that covered very little, leaving families in that group to pay most of their medical bills out of pocket. As a result, the well-insured group consumed 40% more health care dollars than the badly-insured group. And yet at the end of the study period, the researchers found virtually no difference in health between the two groups. Health insurance, and consumption of health care services, simply does not make much difference to health outcomes across large groups of people.
Freddie wrote: Anony-mouse asserts that the figure has been "debunked", and acts as if that is a known fact, rather than a statement of dubious truth.
Actually, it has already been addressed both in this thread, and in some past threads, and the result, again, is that your plans need to account for about 10-12 million people who are genuinely screwed, not 47 million who do not have nominal insurance coverage. And this, for the 47 millionth time, does not equate directly to lack of access to care, either.
Do ya "get it", yet? Because if not, there are really only two possible reasons: 1. You are extremely stupid (unlikely, based on your past performance), or 2. You are sticking with the number because it conveniently overstates your case by a factor of four to those who don't bother to look at it too closely (increasingly likely, based on your ongoing performance). Maybe there's a third option I'm overlooking.
Never mind that it is used by the national newsmedia at all levels, and by political commentators, right-wing and left, regularly.
Yes, those are all bastions of deep research skills and statistical prudence, and would never cite a widely-touted number, off-hand and without accurate contextualization, simply because it was convenient. I stand corrected!
Interesting to see my earlier link dismissed because the url is Cato. I chose that link because it includes several citations within its text to census and Dept. Of Health studies (i.e. the aforementioned 'neutral' studies).
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st84/stat84.pdf
http://www.sipp.census.gov/sipp/workpapr/wp243.pdf
http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Statistical%20Brief&opt=2&id=813
http://healthpolicy.stanford.edu/publications/is_health_insurance_affordable_for_the_uninsured/
http://aspe.hhs.gov/health/reports/05/est-uninsured/report.pdf
I can see one thinking Cannon (at Cato) is biased. His sources are another matter, and dismissing them for an incoming link is the worst sort of ad credentium nonsense. Waving hands at the url rather than dealing with the substance therein is all too convenient. Data does not become specious purely by virtue of the url path one took to it.
The 47 million number is the "Mission Accomplished" of the universal healthcare crowd.
rwe,
Fair enough. I apologize for trying to draw you into the dispute.
It seems my comment yesterday is still stuck in Megan's approval queue - too many links.
In short, the link I provided before was to a Cato page, and the evidence therein was apparently dismissed for that provenance. The reason I chose that page is because it contains many links to census and govt reports and academic studies to support the author's positions.
Whether you think Cannon is biased or not, those are "neutral" citations. Dismissing them because they happen to be on a Cato page is lifemanship, not high standards of evidence.
SOV, you're right, I was confused, but not about that.
I thought that someone had done an analysis correcting for population differences and found no relationship with policy type. I think it was actually spending, not policy type, that was looked at.
Sigh. So, Mindless, if you post a link to the Discovery institute, Focus on Family, any of a number of Einstein Was Wrong sites, I am obliged to go through them and find the 'neutral' links, however disreputable the initial linked site may be.
Uh, no. in fact, I didn't reject any linked articles out of hand; once I saw the Cato logo come up, I exited the page without reading any text or cites. And as I made quite clear, I am more than willing to consider those sources, as long as I don't have to click on Cato to get to them:
Seems pretty clear to me. Do you have a reading comprehension problem? Or is it something else? Nice of you step up to the plate when certain individuals who were on your side of the divide were being abusive, btw. 'Cause you're just that sort of even-handed guy.
One thing to remember about couching the issue in human rights or moralistic terms: something cannot be a right if it infringes upon the rights of another.
This is a political question, despite best efforts of universal care advocates to make it a religious one.
Dreck, if you had bothered to read the syllabus you would also know that there is a 250-word minimum, it must be in 12-point Arial font, double-spaced, and that late work will under no circumstances be accepted.
SOV, can we get you a cup of coffee, too? ;)
As I've made clear before, SOV, you wildly exaggerate or invent from whole cloth the abuse you receive and engage in rampant condescension and abuse, which you somehow feel is justified in return. If you need defense from imaginary creatures, I think you'll have to find a parent.
Case in point, the "reading comprehension" remark above. There's a big difference between understanding it and accepting it, which I am under no burden to do.
Anyway, good for a laugh - when you're losing an argument freak out about the ground rules.
Sigh.
You said:
I did _not_ dismiss them. I did not say, "Well, since Cato is using these people as a quote, they must be worthless." I didn't even look at them. As I said quite explicitly.
I also said that I would look at them so long as I didn't have to go through Cato. Again, as I said quite explicitly.
And when I say, quite clearly, that I am willing to consider them, and you say 'Aha! That means you're dismissing them!', what else can I assume other than poor reading comprehension?
It's either that or something worse, something that goes not to innate abilities, but the type of decisions you make.
As to 'losing an argument', well, you just go ahead and say whatever you need to get yourself through the day. Given the quality of your contributions, I'm placing you in the same category as Mixner from here on out.
Insistence on silly unilateral groundrules != argument or discussion
comprehension of silly ground rules != consent or even acknowledgment of said silly ground rules.
categorization with Mixner combined with useless personal abuse..priceless.
I don't know much about Mixner, but I'm sure there is something intended by ad homenizing us together....well, Better to be categorized with Mixner than to never be categorized at all!....
And I'm only accepting responses submitted in triplicate using a #2 pencil on 9.5X13 graph paper and reserve the right to make new submission guidelines in the future as I see fit. Other than that I'm entirely open to discussion.
Ah, I see my post with direct links has made it in. There it is, entirely free of big, scary libertarian think tank logos twisting the data with their nefarious bias rays.
We are Cato, the great and powerful! You clinking, clanking, clattering, collection of caligenous junk! Pay no attention to that individualist rabble behind the curtain!
I'll get you, and your little citation, too! AAH HA HA HA HA.....
Sorry, folks, this has all been a bit too funny.
Fine. You are on record as not having a reading comprehension problem.
That means you just called me a liar, you nasty little twit. My initial suspicions were justified, despite your whining that I was reading you wrong, and you deserve every bit of abuse coming your way. Especially abuse that happens to be true.
Starting with the fact that you are rather stupid; I never 'imposed' any rules on anyone. I've merely said that I abide by the common standards, that for example, if you make a claim, it's up to you to be able to support it. Don't want to do that? Fine. I'm not forcing you(I don't see how I could possibly force you to, but being the idiot that you are, I guess you don't need anything to base your beliefs on.)
But I am under no obligation to accept anything just upon someone's say-so. That may be fine for you, but not for me. Insisting that I behave in this fashion is _you_ forcing your rules (and very odd rules they are) on _me_.
Thank God I don't have to worry about the remote possibility that you behave as you do in good faith . . . you've very explicitly just said that you don't.
And so I am done dealing with you.
Buh-bye twit!
PLONK!!!!
Whee! off it goes. Like when you let go of a balloon you've been inflating before tying the knot.
I have to shake my head and remind myself that the point of contention here is whether govt or academic links should be considered in discussion if they are offered via a convenient compilation in the Cato website.
Asserting that they should is apparently tantamount to waterboarding! What an extraordinarily heated reaction!
I cannot say I am surprised that abuse has been invented from whole cloth and words have yet again been thrust into the reluctant mouths of the innocent.
Seriously, I invite any third party reader of this thread (or several others) to read through and attribute personal abuse points. SOV by a mile.
And of course there's much more in the latest post, apart from being called stupid and told I act in bad faith:
Never called anybody here a liar. No epithets at all, in point of fact.
Never whined, never complained of misreading (unless imagined abuse falls under this heading, which I most certainly do accuse you of).
Amazing! This accusation is straight from bizarro world,a 100% inversion of actual events, plainly visible in the above thread. Even to us "stupid" folks.I look forward to whatever random and hilarious assertions will be attributed to this posting or some subsequent thread.
You are down the paranoia rabbit-hole my friend. Relax and live...
CLICK!
PS - Some may call me twit, but I am by no means little.
A big twit it shall be!
Fascinating!
I want a pony. I find it morally indefensible that I don't get one.