After a little thought, I'm not sure that I made what I was thinking quite clear on my earlier post on McCain's healthcare plan: markets are hard. We used to think that, like Topsy, they "just growed". The experience of Russian shock therapy belies this. Once bad government regulation has screwed things up, fixing them is not always just a matter of removing the original bad law. Nor of simply willing, via legislative fiat, that a better one shall grow in its place.
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So what would you propose be done instead of or in addition to Senator McCain’s proposal?
They do grow like topsy. Unfortunately in a vacuum, or in a bad environment the fruit is not fine wine, but the mafia.
Anyone who has spent any time working in health care policy, working for providers and working with and against the insurance industry understands that our current system operates in the exact inverse of traditional markets. The incentives are not for better care but for more care.
There's also the issue of the complexity of the issue, buying back surgery isn't like buying a car. Oh and the fact that many purchases need to be made in very short time frames, when the purchase is unconscious or incapacitated etc.
The health care "market" does not behave in any way like a regular market. The sooner the glibertarians and conservatives figure this out the sooner the rest of us can move on to actually fixing this system.
Accelerating forwards into a tree will damage your car, but that doesn't mean you can fix your car by accelerating backwards.
The core, central problem with US healthcare is that we've become conditioned by decades of bad regulatory policy to view our medical expenses as stuff that other people should pay for.
I just read an article in Slate where a reasonably intelligent person criticized McCain's healthcare plan for not allowing people to buy insurance to hedge against the risk of getting diseases they already have, which makes as much sense as betting on the losing team to win last year's world series.
I mean, I'm a pretty hardcore libertarian, and the thought of paying for a routine doctor's visit with my own money makes me a little queasy. That's how far we've slid.
To Thorley, the only thing that we can do is to present our best case against this viewpoint. It certainly won't be easy; "you should be paying more for healthcare" isn't a terribly popular thing to say.
Ideally, we'd have a leader with the balls to say just that, to point out that modern healthcare is incredibly valuable, that it is (even at current prices) an absolute steal, and that "pay for it or do without" should rightly be the norm and not the outlier.
War hero or not, I just don't think McCain has the courage, or the motivation, to do that.
Well, I think most of us would be more sanguine about paying for routine visits if the costs actually reflected the care being delivered. It seems to be a mantra that the extra cost comes from people 'demanding more'. That the costs over and above inflation are because of high tech solutions, and so on and so forth.
But if that were the case, then quite routine procedures like tonselectormies should then be quite cheap. Bills for the extras - bandages and such - would be quite reasonable.
Big surprise, they're not. When my partner went in last year for her procedure, she was billed $60.00 for a paper hospital gown. Not too many years ago, I received a bill for $80.00 worth of butterfly bandages after a visit to the emergency room (broken glass in a hay bale.) Somehow, I don't think those figures reflect the true cost of those items ;-)
The core, central problem with US healthcare is that we've become conditioned by decades of bad regulatory policy to view our medical expenses as stuff that other people should pay for.
Yes, thank you, I've been saying this for I can't even remember how long.
SoV, you're right that somethings are outrageously overpriced. It's at least in part a risk premium; the hospital charges crazy prices to individuals because so many people (especially to the ER) simply don't pay. Insurance companies get lower prices because they pay reliably.
Sometime you should try waving a wad of cash in front of your doctor and demanding a discount. This works especially well with doctors who cater to somewhat bank-shy immigrant communities with haggling cultures, like Koreans.
Re: We used to think that, like Topsy, they "just growed". The experience of Russian shock therapy belies this. Once bad government regulation has screwed things up, fixing them is not always just a matter of removing the original bad law.
The problem in Russia is that not only bad laws were removed but no good laws were left to prevent bad people (often the same bad people hwo had been running things before) from rigging the market to their own benefit. Markets do need the Rule of Law to function properly, and in Russia under Yeltsin the law was a joke.
Re: I just read an article in Slate where a reasonably intelligent person criticized McCain's healthcare plan for not allowing people to buy insurance to hedge against the risk of getting diseases they already have, which makes as much sense as betting on the losing team to win last year's world series.
Problem is though if the disease is an expensive one and the patient can't pay then the rest of us will do so-- because no ethical society can allow its citizens to die on the streets if it has the means to save them. So why not just set up a system that provides such payment (at least for high dollar losses) up front? Seems to me that solves the problem nicely. It's not like people deliberately go out and rack up high healthcare bills for the sheer joy of it. Getting sick or hurt sucks-- big time.
Re: Well, I think most of us would be more sanguine about paying for routine visits if the costs actually reflected the care being delivered.
Right. I'd happily pay for routine things myself, if the bills made sense. I just got an EOB for a blood test I had done. The lab billed $300 (!) for a fairly simple and straightforward test, but accepted the $50 that my insurance was willing to pay (after multiple contractually agreed-upon discounts were applied). I'd pay that $50 myself-- but I couldn't since without insurance I'd get a $300 bill instead and that's insanely inflated. On the other hand I once had a doctor who did not take insurance, except Medicare. As a result he needed just a single receptionist/billing clerk, not legions of employees working for him, and he also did not need to see ten patients an hour to generate enough income to support his practice. He charged a flat $50 an office visit (and I could get partly reimbursed by turning the bill into my insurance myself), so an insurance-less practice, at least for GPs could work. Now there are people who can't aford even $50 so there would have to be a Plan B in place allowing them to receive more deeply discounted basic care-- but I suspect that too is possible.
So: We should have a universal and comprehensive catastrophic insurance system, funded by a flat X percent (not sure the exact number) of payroll or income, while returning to a cash payment system for routine, low-dollar care, with some provision for the those of truly limited means to receive cheaper care. Not sure what to do about Rx, since some of those can rapidly rise to the catastrophic expense, that's something to be debated separately I think.
The Republican Senators in the late 40s rescued us, patients and doctors, from a British style National Health Service advanced by Harry Truman. John McCain, advised by Doctor Maguire, who created UnitedHealthCare, a well thought out insurance plan, is going to try to continue flexibly advancing healthcare and broader coverage. OTOH, it might be of interest to get the perspective of Warren Buffet who has endorsed Obama. Of course, he may just generally vote for the candidate NARL, the national abortion rights league supports; who knows?