The Republican alternative for Health Care...

Edwin wrote:

Public option with Stupak amendment doesnt cover abortions. What does? Republicans' employee insurance. http://bit.ly/2c9nUt

Not anymore. http://news.yahoo.com/s/ap/20091113/ap_on_re_us/us_republicans_abortion_insurance

MattDaddy wrote:
Edwin wrote:

Public option with Stupak amendment doesnt cover abortions. What does? Republicans' employee insurance. http://bit.ly/2c9nUt

Not anymore. http://news.yahoo.com/s/ap/20091113/ap_on_re_us/us_republicans_abortion_insurance

It must have been the fault of all of those Nelson Rockefeller Republicans who controlled the RNC from 1991 to 2009.

Robear wrote:

We already had 8 years to figure out that the Republicans can't manage complicated issues. Now we get a glimpse of the underlying incompetence.

No politician or group of politicians can. The system is just way too complex for any individual or group to be able to figure out and "plan". That's what makes this whole idea so laughably absurd.

Robear wrote:

We already had 8 years to figure out that the Republicans can't manage complicated issues. Now we get a glimpse of the underlying incompetence.

It's only taken one to figure oput te Democrats can't either

Robear wrote:

Now you argue that *unintended* (because *unanticipated*) side effects are the result of intention to achieve the result. No, I can't agree with that.

What about "*unintended* (because *unanticipated*) side effects are the result of intentional acts"?

I'm fine with that, but the establishment of the employer-based health care system was *not* the result of government interference intended to set it up that way.

I agree. It was simply the result of intentional government interference.

It was accidental. It's one of the few things you *can't* legitimately cite as a problem with government, unless you're simply saying "accidental outcomes are bad". Which is kind of anti-climatic. :-)

"Accidental" implies some kind of randomness, unexpectedness, chance. There was no randomness here, no chance. And yes, unintended consequences are a legitimate, major, and predictable problem with government actions (and other actions, for that matter). They are often not predictable in the sense of "I know exactly what is going to happen", but they are very predictable in the sense that "we know there will be consequences we aren't aware of".

One of the fundamental problems of government is that there is a strong tendency to a) ignore, belittle, and refuse responsibility for unintended consequences, and b) once they can't be ignored, suggest more government action to deal with them - and in the process, generating more unintended consequences. We didn't mean to, it's not our fault, but we're going fix it!

The healthcare system in the United States and the current "reform" effort are simply modern examples of the hubris of the central planner. The belief that the "experts" and the politicians have any possible method of planning the healthcare of hundreds of millions of different people with different needs, different desires, and different means is quite simply absurd. This attempt at government interference, like every other attempt, is going to cost far more than predicted, generate new unintended consequences, and generate more government attempts to "fix" the system - that much is as predictable as gravity.

I think at least though you understand the point I'm making? I get your argument, I just think you've got a really wide definition of "intention" and so you are ascribing causality where correlation is more appropriate. :-)

Yes, I understand, I just completely disagree. The problem is that causality does exist. One lead directly to the other. It would be a huge stretch to argue that without wage and price controls employer-based healthcare would have taken off the way it did, considering that the only reason it was even considered was because employers couldn't pay higher wages. It was obviously not a correlation, a coincidence, a mere happenstance. If it wasn't an IRS loophole, it would have been some other workaround. It is the opposite of accidental, the result of deliberate interference.

Nosferatu wrote:
Robear wrote:

We already had 8 years to figure out that the Republicans can't manage complicated issues. Now we get a glimpse of the underlying incompetence.

It's only taken one to figure oput te Democrats can't either ;)

Man, you guys are slow. Didn't take me that long for either group.

For the first time ever in a Gallup poll, more Americans believe that it is not the responsibility of government to make sure that all Americans have healthcare coverage.

Note: take care to read the whole thing, because apparently Americans also do not equate a public option with a government guarantee of health coverage.

What about "*unintended* (because *unanticipated*) side effects are the result of intentional acts"?

Much more accurate. It decouples the result from the intent.

"Accidental" implies some kind of randomness, unexpectedness, chance. There was no randomness here, no chance. And yes, unintended consequences are a legitimate, major, and predictable problem with government actions (and other actions, for that matter). They are often not predictable in the sense of "I know exactly what is going to happen", but they are very predictable in the sense that "we know there will be consequences we aren't aware of".

It was accidental. Did you listen to the podcast I cited? There was a *lot* of randomness, precisely because the rise of American health care was *not* planned, especially not by the government.

If we live in fear of unintended consequences, we might as well pack in any attempt to govern at all. When they happen, we deal with them - unless our fear of *that* change stops us, as has indeed happened with health care in the past. (Also, that argument is one of the usual anarchist ones, which I doubt you intend. If you think government is *always* that way and can't be fixed, that's an anarchist viewpoint. If you think it can be fixed, then you need to get past the idea that it's always wrong and consider what it does right and how that can transfer to things it screwed up.)

One of the fundamental problems of government is that there is a strong tendency to a) ignore, belittle, and refuse responsibility for unintended consequences, and b) once they can't be ignored, suggest more government action to deal with them - and in the process, generating more unintended consequences. We didn't mean to, it's not our fault, but we're going fix it!

That's not at all limited to government, nor is it always true. For example, consider health care. For decades, the Republicans have ignored, belittled and refused to take responsibility for health care policy, and when pushed, they manipulated the process to create worse situations. But this is not because they are "government", it's because that's where the profit motive took us. The fact that Republicans have blocked a lot of change, and slanted others to the "free market" approach is not at all a function of government, it's a function of greed. Congress has reflected that in it's policies, but not because that's the viewpoint of "government". It's the viewpoint of *Republicans*. (And this happens in the management of companies, too.)

The history of US healthcare is very much the history of the two parties, with the Democrats pushing for government management, and Republicans pushing to move the system more to the corporations. Currently, the latter system is what we have. If you want to understand government policy on public health care, look at the history of the Republican proposals, not at the successful Democratic ones like Medicare. But there are clear government successes that should not be ignored.

Government is not some monolithic opaque institution, it's a reflection of those who seek to create or change policy. We need to understand those people, and also the source of existing policies, in order to understand how things got to be the way they are and thus how they can be changed. If we just dismiss government as something apart from business or social interests, we miss the underlying motivations that drive it.

The healthcare system in the United States and the current "reform" effort are simply modern examples of the hubris of the central planner. The belief that the "experts" and the politicians have any possible method of planning the healthcare of hundreds of millions of different people with different needs, different desires, and different means is quite simply absurd. This attempt at government interference, like every other attempt, is going to cost far more than predicted, generate new unintended consequences, and generate more government attempts to "fix" the system - that much is as predictable as gravity.

Again you're giving government a special status that you don't accord to any other large organization. Why is healthcare impossible when it's done by government, but a healthcare company can solve exactly that problem? Further, why can other countries' governments do it? (Why can *we* do it for 1/3 of our citizens already?) The argument that "experts and politicians" can't do what companies and governments can is the absurd one, because it contradicts reality. The only source for this conclusion is your dislike of government.

If companies can provide healthcare rationally, government can too.

Yes, I understand, I just completely disagree. The problem is that causality does exist. One lead directly to the other. It would be a huge stretch to argue that without wage and price controls employer-based healthcare would have taken off the way it did, considering that the only reason it was even considered was because employers couldn't pay higher wages. It was obviously not a correlation, a coincidence, a mere happenstance. If it wasn't an IRS loophole, it would have been some other workaround. It is the opposite of accidental, the result of deliberate interference.

Usually, causality is linked with intention when trying to show that government "did something" deliberately. I agree - without wage and price controls, the IRS change would not have created the same situation. But to argue that the wage and price controls existed in any way as part of an overall health care policy is just incorrect. They were put in place for a completely unrelated situation.

If you seek to blame government for the creation of employer-based health care, you have to show that it *intended* to do that. Clearly it didn't. There's no sign of a linkage of intent. That in turn means that the question has to be asked, has government *ever* actually done more than overhaul the existing system? The answer to that is no.

Perhaps it's time for a change. Yes, there will be inefficiencies and mistakes, but any large organization has those, not just government. What's clear is that the system that we've got now is so inefficient and so onerous that we can't sustain it. Other governments have done well with health care; heck, over 100 million US citizens have successful government health care plans right now. So contrary to your assertions, we have good evidence that government *can* do this well. You just don't like the idea.

The idea that this system would have arisen anyway has to be based on something more than your gut. What made it inevitable that employer-based health care would get some other boost? You don't provide any mechanism to prove that, it's just an assertion, and one that allows you to paint government as somehow out to get us. Government is not a special case, it's a large organization just like IBM or any other large bureaucracy in it's internals, and that's how it's best understood.

If you don't like government, and you don't like the corporate system, what's your proposal?

Robear wrote:

It was accidental. Did you listen to the podcast I cited? There was a *lot* of randomness, precisely because the rise of American health care was *not* planned, especially not by the government.

We'll just have to disagree.

If we live in fear of unintended consequences, we might as well pack in any attempt to govern at all. When they happen, we deal with them - unless our fear of *that* change stops us, as has indeed happened with health care in the past. (Also, that argument is one of the usual anarchist ones, which I doubt you intend. If you think government is *always* that way and can't be fixed, that's an anarchist viewpoint. If you think it can be fixed, then you need to get past the idea that it's always wrong and consider what it does right and how that can transfer to things it screwed up.)

What we need to do is acknowledge that unintended consequences can have huge, long-term impacts, and avoid imposition of such things as much as possible. I do not believe the problem can be fixed. I believe it has to be tolerated in certain specific instances where it is absolutely necessary, and carefully avoided in all others (which is the minarchist view).

For example, consider health care. For decades, the Republicans have ignored, belittled and refused to take responsibility for health care policy, and when pushed, they manipulated the process to create worse situations.

The Republicans have been highly supportive from the very beginning of Medicare. It's critical to separate what politicians say from what they do.

But this is not because they are "government", it's because that's where the profit motive took us.

That's not where the profit motive took us, it's where the government took us with their interference. Is it any surprise that there are so many health care lobbyists when the government is 50% of the payers and regulates every aspect of the market? When the government is so heavily involved, the existence of rent-seeking is obviously endemic.

The fact that Republicans have blocked a lot of change, and slanted others to the "free market" approach is not at all a function of government, it's a function of greed. Congress has reflected that in it's policies, but not because that's the viewpoint of "government". It's the viewpoint of *Republicans*. (And this happens in the management of companies, too.)

I'm glad you put "free market" in quotes, because nothing the Republicans or Democrats have done in the last fifty years has been remotely oriented towards the free market - which is literally defined as the absence of government interference. Congress reflects that greed in its policies because it provides a base for market manipulation in the favor of the largest or most influential organizations, which is what happens when government starts regulating every aspect of a market. What do you think is going on right now? Choosing between the government option and a few politically connected corporations is not a choice at all.

Government is not some monolithic opaque institution, it's a reflection of those who seek to create or change policy.

Precisely correct.

We need to understand those people, and also the source of existing policies, in order to understand how things got to be the way they are and thus how they can be changed. If we just dismiss government as something apart from business or social interests, we miss the underlying motivations that drive it.

We know what those motivations are - greed and power. It's not a deep or difficult concept. the only way to significantly change things is to remove government inteference from the equation. Without that, the only "change" that is going to occur is who gets the loot.

Again you're giving government a special status that you don't accord to any other large organization.

Because it has a legal monopoly on force, can legally force people to give it money, and cannot go out of business short of a systemic collapse or rebellion? Right, there's no differences at all between the government and other large organizations. Sigh.

Why is healthcare impossible when it's done by government, but a healthcare company can solve exactly that problem?

Not impossible, inefficient. And a healthcare company isn't trying to solve the problem for everyone, just their customers. It also doesn't have the power to force people to buy its products, and thus must actually listen to the customer, at least somewhat, if it wants to stay in business.

Further, why can other countries' governments do it? (Why can *we* do it for 1/3 of our citizens already?) The argument that "experts and politicians" can't do what companies and governments can is the absurd one, because it contradicts reality.

Just because we can doesn't mean we should. The Soviets obviously planned their economy - but they were terrible at it. So are we - only we absurdly think we aren't. Nothing we can do or say will change that, as the total problem is far beyond the capabilities of any human or humans. A free market provides a better service precisely because no one is trying to manage the whole thing - only dealing with their little piece of it. Government, by definition, tries to "reform the system", trying to change the way everything works. That doesn't work, and cannot. If you legislate the impossible, the disastrous possible will happen instead. I much prefer a system with low costs, good care, and plenty of choice.

The only source for this conclusion is your dislike of government.

The source for this conclusion is the clear conflicts of interest, inefficiency, vulnerability to fraud, and insane costs present in our current government-mercantilist system.

If you seek to blame government for the creation of employer-based health care, you have to show that it *intended* to do that.

What? So if I didn't mean to shoot that bank teller, I shouldn't be blamed for it? Seems like a problematic philosophy.

Clearly it didn't. There's no sign of a linkage of intent. That in turn means that the question has to be asked, has government *ever* actually done more than overhaul the existing system? The answer to that is no.

Thank goodness. What we need here is the government to do less, not more.

Perhaps it's time for a change.

Definitely.

Yes, there will be inefficiencies and mistakes, but any large organization has those, not just government.

Yes, but large organizations have several limiting factor that keeps them in line - they can go out of business if they make too many mistakes, or lose all their members. Neither one of those things applies to government, and thus the mistakes keep compounding themselves.

What's clear is that the system that we've got now is so inefficient and so onerous that we can't sustain it. Other governments have done well with health care; heck, over 100 million US citizens have successful government health care plans right now. So contrary to your assertions, we have good evidence that government *can* do this well. You just don't like the idea.

Government pays for half of the current system, and regulates every corner of the rest. Which is it? Is our current system inefficient and onerous, or successful? What we have is good evidence that government does poorly, and a system that we can't sustain. Other governments are in the same boat, with unsustainable systems. Why would we want more of what is causing the problem?

The idea that this system would have arisen anyway has to be based on something more than your gut. What made it inevitable that employer-based health care would get some other boost? You don't provide any mechanism to prove that, it's just an assertion, and one that allows you to paint government as somehow out to get us.

This system is almost assuredly not the one that would have arisen in the absence of government interference. I didn't say that employer-based healthcare would have gotten some other boost, I said that people would have worked around any government plans or regulations to pursue better workers. If it wasn't employer-based healthcare, it might have been group-based healthcare, and there would be healthcare unions today with different but similar problems. The mechanism is the same one that thwarts financial system regulation - if the government is involved in a market, great pressure is brought to bear by the market players to use the government for their own ends. It's inevitable, and as difficult to fight as swimming upriver. The best way to deal with it is not to start it in the first place.

Government is not a special case, it's a large organization just like IBM or any other large bureaucracy in it's internals, and that's how it's best understood.

So IBM has an army and a police force, and can legally force everyone to pay them money or be thrown in jail? Let me know when that happens, and on that day, I'll treat government like a large company. Until then, it's a special case. Sorry.

If you don't like government, and you don't like the corporate system, what's your proposal?

I don't have a proposal. I'm not arrogant enough to presume that I have the solution to every single American's healthcare problems or that I can even conceive a system that will meet everyone's needs. What I do know is that in a true free market system, many different proposals, many different systems will arise, because demand for health care isn't going to go away. Some will be good, and some will be bad. Some will be work for some people, and others will work for other people. What I support is freedom of choice, no coercion, unbridled competition, and allowing the market to find and refine the best solutions and then adapt as things change.

Phoenix Rev wrote:
MattDaddy wrote:
Edwin wrote:

Public option with Stupak amendment doesnt cover abortions. What does? Republicans' employee insurance. http://bit.ly/2c9nUt

Not anymore. http://news.yahoo.com/s/ap/20091113/ap_on_re_us/us_republicans_abortion_insurance

It must have been the fault of all of those Nelson Rockefeller Republicans who controlled the RNC from 1991 to 2009.

Did I even mention fault? I pointed that the issue is being dealt with. How many congessmen do you think even used it for an abortion while serving?

MattDaddy wrote:

Did I even mention fault? I pointed that the issue is being dealt with.

No, you did not. And I never indicated you did. My retort was in response to the article. Since the Religious Right has pretty much steered the RNC ship, I find it interesting that somehow this little provision just slipped by. From the article, it seems that it wasn't part of the HI before 1991. So, who checked the box to opt in?

How many congessmen do you think even used it for an abortion while serving?

I do not know. Since HI policies cover families (if selected) it might have been the wife or daughter of the Congressman who used the coverage. My guess is that such usage would never be made public due to the rank hypocrisy of it all. But, if one did come to light, I am absolutely certain all a pro-life Congressman would have to do would ignore the questions and wave the "family values" banner (a la Sen. David Vitter).

Another way of putting what Aetius is saying: private companies have only so much power to stick with bad ideas. We don't know how to truly solve the healthcare issue yet; it may not really even be solvable. So what we need is a thousand little flowers in the garden to find out what blooms and what doesn't. We already know some ideas are bad, and we can pass laws that prevent those abusive practices, but from there, we need to experiment.

When government provides a service, it generally has a monopoly, whether explicit (by laws preventing competition) or implicit (by not having to carry a tax burden in providing the service). So meaningful competition is very difficult. Further, with its ability to tax and print money, once it decides it likes an idea, no matter how bad that idea actually is, it can back that idea to the point of the destruction of the entire society, as in fact our government is presently doing with its bailouts of the financial system.

If there's any field in an economy that's prone to wishful thinking, it'll be healthcare. Everyone wants to stay alive forever; nobody wants to actually pay for what it costs to do so. But it's so, so easy to take money from the nebulous "rich people" to keep yourself alive, no matter how bad an investment it is for society as a whole. If we spend a half-million dollars saving you from your brain tumor, but you then only provide another $250,000 in tax revenue over the remainder of your lifetime, that was a freaking disaster. That half-million dollars could have completely educated five or six young people, maybe more. Or it could have built a good chunk of a school, or just been left in private hands to grow at the usual 5 to 7 percent.

Saving people is very popular, but hard fiscal reality is that wealth we consume doing that is wealth we don't have available for other purposes, like saving more people later on when it's relatively cheaper to do so.

Popular != right, or even sensible. And governments usually do what's popular, especially when it relates to money.

And if you needed any more indication that both parties are owned, how about lawmakers from both parties repeating the talking points written for them by a health care company.

Because it has a legal monopoly on force, can legally force people to give it money, and cannot go out of business short of a systemic collapse or rebellion? Right, there's no differences at all between the government and other large organizations. Sigh.

I just want to point something out here that you keep missing in these discussions. There's a difference between the structural nature of an organization - how it's constructed, how it runs itself, it's internal systems - and what it can do external to itself. Government can indeed impose force on citizens. But that has nothing to do with how it functions internally.

You often make claims that government can't be organized efficiently, or can't implement policies efficiently, which is a claim about it's internal structure, not it's externalities. That kind of claim is wrong because internally government is no different from any other large organizations. The power it has externally has *no* effect on the internal efficiency of the bureaucracy. When you claim that government can't organize itself to take on a task in the same way as a health care corporation (or any other) you are mixing up two realms.

Not impossible, inefficient. And a healthcare company isn't trying to solve the problem for everyone, just their customers. It also doesn't have the power to force people to buy its products, and thus must actually listen to the customer, at least somewhat, if it wants to stay in business.

For a health care company, it's customers are everyone. And the government is not proposing that everyone buys it's health care, far from it. It's proposing that everyone who can afford it *has* health care, whether public or private. No one holds a gun to people to force them to join Medicare, Medicaid, the VA or the like.

You've got an argument of force here that has to ignore the private market to make sense.

Just because we can doesn't mean we should. The Soviets obviously planned their economy - but they were terrible at it. So are we - only we absurdly think we aren't. Nothing we can do or say will change that, as the total problem is far beyond the capabilities of any human or humans. A free market provides a better service precisely because no one is trying to manage the whole thing - only dealing with their little piece of it. Government, by definition, tries to "reform the system", trying to change the way everything works. That doesn't work, and cannot. If you legislate the impossible, the disastrous possible will happen instead. I much prefer a system with low costs, good care, and plenty of choice.

And all this is based on a ridiculous premise that is not on any table at all - that the US is going to adopt a Sobiet system of planning for it's economy. Sorry, not proposed by anyone, not going to happen. Your definition of impossible is just wrong - "First, imagine we are the Soviets..." Come on, that's not remotely like what's going on here.

The source for this conclusion is the clear conflicts of interest, inefficiency, vulnerability to fraud, and insane costs present in our current government-mercantilist system.

You forgot the innate ability of government to force people to do things against their best interests. Clearly, the only solution is anarchy.

Yes, but large organizations have several limiting factor that keeps them in line - they can go out of business if they make too many mistakes, or lose all their members. Neither one of those things applies to government, and thus the mistakes keep compounding themselves.

Really? I guess that explains why we still have a Great Society welfare program... Wait a minute! It went out of business! We *don't* have that inefficient monstrosity any more. How did that happen? That mechanism is built into government. We just need to force it's use now and then.

Government is capable of meaningful reform in it's programs.

This system is almost assuredly not the one that would have arisen in the absence of government interference.

Aetius, it arose *completely* without government interference in any meaningful sense (that is, with the intent of interfering.) Unless random unrelated changes with unforeseen and initially unnoticed side effects are deliberate interference.

So IBM has an army and a police force, and can legally force everyone to pay them money or be thrown in jail? Let me know when that happens, and on that day, I'll treat government like a large company. Until then, it's a special case. Sorry.

Externalities are not under discussion here. I'm talking about the internal workings of government, as noted above.

What I support is freedom of choice, no coercion, unbridled competition, and allowing the market to find and refine the best solutions and then adapt as things change.

Do you propose this for water, power, education, police, prisons and Major League Baseball as well? All of those lack the attributes you name.

Another way of putting what Aetius is saying: private companies have only so much power to stick with bad ideas.

Another way of putting what Robear is saying: government and private companies implement policies using the same rules of bureaucratic functioning. You guys are making claims about bureaucratic internalities by criticizing government externalities. These are however two different things.

Government can be *very* efficient if properly organized, and that has nothing at all to do with it's abilities to print money, exert military force or coerce membership in programs. Claims that government can't implement health care efficiently founder not only on that misunderstanding, but have to actively ignore the fact that the US government *already* manages health care for about 1/4 to 1/3 of the US population. Likewise, these claims are different from claims about whether the policies implemented are actually good or not. Efficiency within an organization has nothing to do with it's motivations or implementation of policy it's handed.

No matter how efficient it is, if it's doing the wrong thing, it doesn't matter, and it can't be put out of business by someone who IS doing the right thing. It's the exact same problem that monopolies and cartels cause, making competition impossible.

We restrict monopolies from using their monopoly power to enter other fields; they can compete fairly, on level ground, but they can't exploit their unique position in one market to dominate another. We learned, from Standard Oil and IBM, just how bad monopolies can be, and we have a whole bunch of specific case law about it.

Government is another kind of monopoly, and it's just as toxic as any other monopoly when it uses its special position to enter into a new market. Competition matters. It's critically important to finding out what the best way is of doing something. Putting it in government hands is going exactly the wrong direction. The government needs to stop abuses (like dropping people or increasing their rates because they get sick), but then stay the hell out of the market and let the thousand different possible approaches spring up. I would see no problem, in fact, with it seeding a bunch of different little companies to get into that market.

But when it's centralized, that eliminates competition, because government doesn't have to pay tax. In a field as competitive as insurance, even a 5% difference in margins can make or break the business; those guys work on very slim margins on gigantic volumes of money. And the government being able to fund itself by extracting money by force, instead of having to convince customers that their insurance plan is the best one, means that private insurance can't compete, because you will have to pay for the government insurance either way.

And, honestly. Robear. You really need to get off the 'efficient government' schtick, because LOOK AT OUR GODDAMN GOVERNMENT. We are sixty trillion dollars in debt, and we're adding to that debt at 1.5 trillion a year. There is nothing small and efficient about the US government anymore.

I GUARANTEE you that you don't want your healthcare money mixed in with the warfighting money, because when Congress has to choose between the two, they're gonna raise your rates, cut your benefits, and send in the troops.

but have to actively ignore the fact that the US government *already* manages health care for about 1/4 to 1/3 of the US population.

And doesn't have enough money to do it. Medicare is the worst disaster in the government budget after Social Security.

Let me rephrase that last bit for clarity: yes, the government is already running healthcare for a lot of people. And all you have to do is look at what passes for bookkeeping in the Federal Government for ironclad proof that it is doing a miserable job, impossibly terrible.

No private company could run a healthcare system like they do, where they don't actually pay for what they use. And not even the government can keep that up forever.

Malor wrote:

The government needs to stop abuses (like dropping people or increasing their rates because they get sick), but then stay the hell out of the market and let the thousand different possible approaches spring up.

And this is where you lose me. On the one hand, you say the government needs to let the market work, and on the other, you say that the government needs to stop companies from dropping people and increasing their rates when they get sick.

How exactly do you think the market works?

Robear wrote:

I just want to point something out here that you keep missing in these discussions. There's a difference between the structural nature of an organization - how it's constructed, how it runs itself, it's internal systems - and what it can do external to itself. Government can indeed impose force on citizens. But that has nothing to do with how it functions internally.

It has everything to do with how it functions. An organization that has no fear of risk, no possibility of failure, functions fundamentally differently than one that does, internally and externally. An organization that can literally force people to be customers has no incentive, no drive to do right by those customers. That's one of the problems we're trying to solve - why on earth would we want to increase and incentivize that behavior?

And the government is not proposing that everyone buys it's health care, far from it.

No, it's worse - the government is proposing to force everyone (with a fine or even jail time) to purchase health insurance from politically-connected private companies or the government. So we get mercantilism or government, all in one shot. Choosing between worse and slightly less worse is not a choice.

It's proposing that everyone who can afford it *has* health care, whether public or private. No one holds a gun to people to force them to join Medicare, Medicaid, the VA or the like.

No, what's being proposed is forcing everyone to buy health insurance, and if you can't afford it forcing someone else to pay for you. If you don't, you get fined and potentially go to jail. The gun is very much in evidence.

You've got an argument of force here that has to ignore the private market to make sense.

Forcing people to buy a product from a private company (or the government) isn't force?

And all this is based on a ridiculous premise that is not on any table at all - that the US is going to adopt a Sobiet system of planning for it's economy. Sorry, not proposed by anyone, not going to happen. Your definition of impossible is just wrong - "First, imagine we are the Soviets..." Come on, that's not remotely like what's going on here. :-)

Well, lets consider this. The proposal on the table is to define the product sold (insurance converage mandates), define who it will be sold to (everyone), define how much is going to be paid for it (government option), and force people to participate (insurance mandate). Are we adopting the Soviet system? No. Are we attempting to completely plan and control a market? Certainly. Are we going to fail, just like they did? Yep.

Really? I guess that explains why we still have a Great Society welfare program... Wait a minute! It went out of business! We *don't* have that inefficient monstrosity any more. How did that happen? That mechanism is built into government. We just need to force it's use now and then.

Exactly correct - the quicker we get rid of government health care programs, the better.

Government is capable of meaningful reform in it's programs.

For a while, yes. However the incentives lead back down. I think everyone would prefer a system that doesn't required repeated trillion-dollar "reforms".

This system is almost assuredly not the one that would have arisen in the absence of government interference.

Aetius, it arose *completely* without government interference in any meaningful sense (that is, with the intent of interfering.) Unless random unrelated changes with unforeseen and initially unnoticed side effects are deliberate interference. :-)

Same argument we had before. I said in the absense of government interference, any interference, intended or not.

What I support is freedom of choice, no coercion, unbridled competition, and allowing the market to find and refine the best solutions and then adapt as things change.

Do you propose this for water, power, education, police, prisons and Major League Baseball as well? All of those lack the attributes you name.

Possibly, yes, yes, no, no, and gods yes.

Little Raven wrote:

And this is where you lose me. On the one hand, you say the government needs to let the market work, and on the other, you say that the government needs to stop companies from dropping people and increasing their rates when they get sick.

How exactly do you think the market works?

An unrestrained capitalism is primarily the rich taking unfair advantage of the poor, because the poor have little individual power. It's pitting the strong against the weak, and the weak lose, often very badly. The natural tendency of capitalism is toward monopoly, and once a monopoly exists, capitalism breaks down.

If football were played by the rules of capitalism, the last ten yards would be a moat, there'd be a gigantic wall to absolutely prevent field goals by the other team, and they'd have snipers deployed along the edges of the pitch just in case anyone got too close. Teams that didn't do things like this would lose badly to the ones that do.

In my view, government's primary goal is to keep the playing field as fair and level as possible for all players, and when some players get so powerful that they can dominate their sections of the economy, to break them up or regulate them. But it shouldn't be playing itself, and it absolutely shouldn't be trying to determine specific winners and losers, or specific scores, only the rules of the game.

The government entering these markets is having the referees fielding their own teams.

China is a good example of an unregulated capitalism; they themselves call it 'man-eat-man'. It's an incredibly unpleasant system to live in, unless you're one of the people on top.

Malor, what if Medicare entered into the market; say along the lines of how the Post Office operates?

But I think we all can agree, more than anything, if we need one thing to spur change, a major stride forward could happen if insurance choice were stripped away from employers and into the hands of the consumers.

The issue is less, should the government provide me insurance, and much more should the government protect me from getting screwed.

And God Damnit, why is no one in Washington trying to address the cost issue directly? We can do it with water, power, and gas.

KingGorilla wrote:

But I think we all can agree, more than anything, if we need one thing to spur change, a major stride forward could happen if insurance choice were stripped away from employers and into the hands of the consumers.

I think we all can agree - but you'll note that this obvious-to-us step is in not in the proposals of either major party.

Malor, what if Medicare entered into the market; say along the lines of how the Post Office operates?

Well, that's been tried, with the GSEs (Fannie Mae and Freddie Mac), and their status as quasi-governmental agencies is the second leg of the mortgage bubble (the first being the Fed, the third being AIG.) The Fed was providing the fuel and the lack of oversight, but it was the GSE's presumed government guarantee that allowed them to borrow at well below market rates. That guarantee turned out, of course, to be explicit, and the investors were correct to lend at lower rates. That in turn let FNM and FRE lend at lower rates than their competitors, driving down the overall market. Then Congress told them to lend to less-creditworthy borrowers, and that put serious air into the bubble, and they were making such huge profits that they kept lowering lending standards further, all on their own. I'm pretty sure they knew what the eventual outcome would be, too, but any agency "borrowing short" and "lending long" does not care about the future in any way, shape, or form.

I'd be fine with privatized Medicare if it were really privatized, if the laws are written in such a way that it would be essentially impossible for Congress to guarantee its debts or make its payments if it goes insolvent. It has to be able to fail.

But considering that we won't even let PRIVATE companies fail, I think a privatized Medicare would be a fig leaf at best, so for that reason I oppose the idea. It would be noticeably worse than what we have now, because Medicare would suddenly have a profit motive. Knowing they had government backing, they would do stupid stuff to make money, like growing their insurance too fast by writing policies that were too cheap, pocket huge bonuses, and then when things went south, the government would be on the hook.

The privatized profit, socialized risk scenario is the most toxic I've ever seen. You just couldn't come up with a worse setup if you tried. The government gets none of the profit, but it takes all of the risk. This is a slow-motion disaster; there's no limit to what risks will be taken, to what stupid stuff will happen in the economy, when the big players know that there's a safety net.

Malor wrote:

An unrestrained capitalism is primarily the rich taking unfair advantage of the poor, because the poor have little individual power. It's pitting the strong against the weak, and the weak lose, often very badly. The natural tendency of capitalism is toward monopoly, and once a monopoly exists, capitalism breaks down.

I understand that, but unless you're saying that medicine suffers from or is in imminent danger of a monopoly if privatised, then I'm not sure how it's relevant.

Let's take a look at an area where the market has arguably worked well for insurance: auto insurance. When you buy auto insurance, how much you pay depends greatly on your previous record and your demographics. If you have a safe record and are married, have good credit and are between 35 and 50, you are going to pay very little for insurance. If you have a bad record or are in the wrong demographics, say, male, between 18 and 25 and single, you're going to pay through the nose. Your auto insurance company can and often will drop you after you have an accident, and when (if) you get new coverage, you're going to pay a lot more for that coverage, if you can get it at all. This is how the market works: by attempting to price risk accurately.

If you want to let the market work in health insurance, you're going to have to let it work the same way. You can't simply say that you're going to let the market work and then tell health insurance companies that they can't attempt to weed out bad risks. That's no different than price controls, and we both know where those lead. In a market based solution, a young person with no health problems would ideally get reasonable coverage for a decent price, which would pay out for say, 6 months or so if and when they got really sick, then the company could drop them and they could find new insurance, more suited to their new situation. It's not a pleasant solution, but it isn't the job of the market to be kind.

Of course, there's one other major problem preventing a real market solution from developing. When you take your car to the auto shop, they can and will refuse to fix it if they have reason to believe you can't pay for it. Right now, hospitals are required by law to take care of anyone who shows up on their doorstep. Any market solution is going to be seriously distorted by that law, to the point where it might not work at all. Not sure what you do about that either.

I think a market solution could work. But let's be realistic about what that would entail.

Well, if you get cancelled by an auto insurer, you can always get new insurance. All states with requirements for insurance also, to my knowledge, sponsor a last-effort insurance program that will take anyone and offer at least the statutory minimum protections. Even at that, of course, a lot of people can't afford it, and drive without insurance, which can get you thrown in jail in many states. It's a bad place to be in; too poor to afford insurance, but absolutely requiring a car to survive. That's quite common in California, for instance. It can trap you in poverty, because if you get thrown in jail, you'll usually lose the crappy job you had, and then you're REALLY screwed.

But even at that, you won't die. And I would argue that health insurance that can drop you if you get sick is not, in fact, health insurance. It's fraud. Another form of that fraud is setting up 'risk pools', which is just lumping a bunch of people together. Then, as people get sick, the rates in that pool go up. Then 'healthy' people find new pools to jump to, so that the rates start spiraling catastrophically for the sick people that are left. This is another way of cancelling health insurance if you get sick. And once you lose insurance, you often can't get it anymore at ANY price, so you die.

This is imbalance of power, and I would argue that it is, in fact, a business model based on deception, and shouldn't be allowed. The laws should prevent that kind of abuse. Any plan offered by any insurance company to any group should be clearly publicised, and open to anyone who wants to join it, from the Senatorial plan on down to the local fishmonger's union. And they should not be able to drop you if you get sick.

Given those two items, health insurance is going to go up substantially, without a doubt, but the reason insurance is even this cheap is because plans that are offered to private individuals are based on the basic fraud of it not being available once you really need it.

Pass at least those two laws as a beginning; health care costs will go up, but many more people will buy into the system, without even needing to be forced, which should spread out the risk and be at least something of a drag on costs. And work on setting standards for information and payment exchange, so that paperwork is reduced and overhead eliminated.

From there, I'm not sure what would happen, but removing fraud should be a key factor in any reform. All the government should be spending is money to enforce the laws; let the market figure out how to create non-fraudulent health care.

There's a problem coming from the other side, too, in that people can buy the cheapest possible plan that covers almost nothing until they get sick, and then swap to something that DOES cover whatever they just came down with, which will rapidly bankrupt insurance. We'd need to address that as well.

Any plan offered by any insurance company to any group should be clearly publicised, and open to anyone who wants to join it, from the Senatorial plan on down to the local fishmonger's union. And they should not be able to drop you if you get sick.

Holy mackerel. That's...completely contrary to how the entire health care market works. Most of my friends in the industry would say that you're more of a socialist than Obama.

The entire point of insurance to aggregate risk and price it accordingly. If you forced everyone into a single risk pool...aren't we basically looking at single-payer, then? What's really the difference between your version and a flat out government takeover of health care? Who signs the checks?

Little Raven wrote:
Any plan offered by any insurance company to any group should be clearly publicised, and open to anyone who wants to join it, from the Senatorial plan on down to the local fishmonger's union. And they should not be able to drop you if you get sick.

Holy mackerel. That's...completely contrary to how the entire health care market works. Most of my friends in the industry would say that you're more of a socialist than Obama.

The entire point of insurance to aggregate risk and price it accordingly. If you forced everyone into a single risk pool...aren't we basically looking at single-payer, then? What's really the difference between your version and a flat out government takeover of health care? Who signs the checks?

Yeah, I gotta say Malor, that just wouldn't work. At least not as far as insurance goes. There's not an insurance company in the world that would offer a product under those circumstances, they simply couldn't.

Not saying it's not an intriguing idea, but it's not insurance.

That's...completely contrary to how the entire health care market works.

You noticed. This is not a drawback.

Most of my friends in the industry would say that you're more of a socialist than Obama.

If you want to be in the business of health insurance, that means you have to be in the business of health insurance. Health insurance only matters if you are sick, so there should be no way to be punished for being sick. Insurance companies should not be able to drop or punish expensive clients, or prevent new ones from joining. But that has to be balanced coming from the other way, too, because then we put the informational advantage in the hands of individual consumers. They'll destroy the insurance companies as happily as the insurance companies kill people today.

I'm not sure how to balance it all yet, but it's not health insurance if it can be cancelled. And we need to start from that premise and figure it out from there.

The entire point of insurance to aggregate risk and price it accordingly.

And make a profit doing so. They're merely going to be required to aggregate risk across larger groups, instead of cherry-picking the clients they want. The existing cherry-picking means that the expensive people end up on the government's dime, while private companies keep all the profits from insuring people who don't really need insurance.

If you forced everyone into a single risk pool...aren't we basically looking at single-payer, then?

No, you're looking at many separate groups, each of which can have a different approach to health care. They can focus on prevention or overhead or streamlining treatment or whatever happens to work for them, and then everyone else will grab and copy the ideas that work, and drop the ideas that don't.

What's really the difference between your version and a flat out government takeover of health care? Who signs the checks?

The people who pay the premiums. We explicitly don't get the guys who print money to balance their checkbooks involved.

Malor, I can get behind your "No Dropping Sick People" clause, that makes sense. Your home insurance can't drop you when a tree falls on your roof because the tree fell on your roof while you were covered. Getting sick while covered should preclude your insurer from dropping you to avoid paying. Got no problem there.

The problem is your "Anyone Can Join Any Plan" clause. That's virtually impossible for an insurance company to do. They design the premium based on who's going to be in the potential pool. Letting someone else come in and join that pool by definition will change the price of the plan - unless that person's expected loss ratio exactly matches that of the pool, which is highly unlikely. The only way for an insurance company to do that is to assume the entire nation is their pool of participants and price based on that. I don't see many insurance companies offering the product in that circumstance.

Again I'm not saying your proposal is a bad idea, but it's not an insurance product.

Malor's system doesn't really sound socialist. Government law requiring health insurance for every citizen (much like it does for car insurance now) coupled to government law requiring that one cannot be allowed to turn anyone away from coverage (and cannot drop them) solves most of the problems.

That way everyone pays for health insurance, not just when they're sick. And insurance companies can't sit fat on the high horse, confident that they can drop sick people who might actually cost money.

You still run into the problem of insurance companies finding creative means to drop people (insane premiums, for one) -- but it goes a long way.