Osler's Razor

(2). As a lawyer who is not currently defending an insurance company, I am required to think that insurance companies are run by Satan himself, which they sort of are. The idea is nice, but they're not motivated by a desire to serve a public need but by making a profit. This is the aim of all capitalistic ventures, and I don't think most people realize that in capitalism, someone has to foot the bill for profits.

In some industries (luxury goods, say) this works fine: you want luxuries, you pay a premium for them so that the producers can turn a profit. So long as luxury goods companies don't exploit their workers and allow some form of democratic management (like a mass bargaining agreement with a union) I, the ardent socialist that I am, have no problem with it.

But health care isn't one of those industries. Everyone needs it, and when you have it almost exclusively financed by insurance (like in the United States) and those insurance companies are in business to make a profit, not to serve the public, there's a problem: someone has to eat the costs of that profit, because wealth doesn't just flow into a system. It has to be created. (For those interested, I suggest Marx's Critique of Political Economy as a good starting point for value and wealth theory).

And, unfortunately, the way the current system is set up is that the hit on profit is born by the consumers. The theory is that if we spread the cost of insurance out over the people, it will remain affordable for everyone. This, in theory, would work, but not everyone works for a company that opts-in to insurance, and it can be prohibitively expensive to get it otherwise.

Government subsidizing of health care (or even government-run health care, but let's be serious and use the infrastructure we have at first instead of converting it all to government-run facilities) seems like a better plan: this way, the total tax burden is less than most private insurance costs, and the profit motive is removed so that the government need only tax us as much as it will likely spend in a given year, instead of an insurance company trying to maximize profit by paying out as little as possible.

I realize the actual logistics need to be more nuanced and I don't think anyone advocates something as simplistic as I am representing here. But, at the analytic, theoretical level, the current model is set up so that wealth accumulates in the insurance companies at the expense of payments by the consumer, who may not get anything in return for their value exchanged if some legal means can be found for denying coverage. This ultimately hurts the consumer, and I'm generally against things that hurt consumers.
 

I agree with Lane, completely. And I know I'm going to get pounced on by mentioning Michael Moore here, but I think he did a great job of exposing American insurance companies' profit motive in his last film.

I don't know how we would pay for it--and frankly, I'm not optimistic that the US can make such a sea change in policy in order to thoroughly revamp health care to make it free or cheap and available to all-- but I want universal health coverage.
 

Who cares? Sarah Palin is HOT! USA! USA!
 

Good god, the gov't can't even manage to run the present system effectively, and ya'll want them more involved? The smartest thing the "universal health care" crowd ever did was quit advocating gov't run health care, and start pushing universal health insurance.

Doctors and hospitals charge money and make a profit for a reason--it's the only way we'd ever have health care better that witch doctors and herbalists. I can't imagine "mercy" care like Medcines Sans Frontier would last long without wealthy doctors' and hospitals' donations.

Insurance also exists for a reason--there's risk out there and someone is willing to bet calamity will strike less often than not. Not to mention it's the only way most people can afford the very high quality of care we have in this country. When you speak of shifting burdens, the buck has to stop somewhere. Don't you think that once you start eating into an insurance company's profit margin, they're going to be MORE apt to deny benefits, not less?

A national health insurance program I could get behind, but only if we ditch direct payment and primary care programs to pay for it. (VA, Medicare, Medicaid). What'd be the point of redundancy? We ould make sure the groups currently served by such programs get very low rates, or free care.
 

Universal health care!!!

Woohoo!!

Lower the seas!!

Woohoo!!

Jobs for everyone!!

Yipee!!

All this and more if you just submit to your government overlords!!

I'm Barack Obama. I'm from Harvard. I'm here to save you.
 

While I agree that the healthcare system is not true capitalism, it is a mutant form of capitalism that protects the income of those providing care and the hospitals that allow them to practice/employ them and also the pharm companies and insurance companies. And I also disagree that the government regulates prices. For instance, while medicare does specify how much medicare will pay for a service, it does so through forcing the provider or hospital into a medicare write off. As a private citizen that does not have insurance or a government program like medicare, you still pay the full retail price that can be as much as 70% more than medicare pays. Often, the retail price is driven up exponentially because the hospitals and providers are compensating for both the insurance/government write offs and also the failure of many individuals w/o benefits to pay there Dr. or hospital. So if you are the poor schmuck who doesn't have insurance and actually pays his bills - you foot the bill for both the deadbeats and special interests. It really is remarkable that we put up with the system at all.
 

Is that RRL in disguise?
 

I say pay off the deficit first, and then lets talk about adding new government programs (like health care). Currently, each U.S. citizen's share of the 9.6 tril deficit is approx $31,000 each.
 

I am sort of thinking that a "single payer" system for health care might end up being the solution. Another might be to put All Americans into the system used by the Federal Government. Fed employees get to choose one of several plans ranging from high deductible basic service appropriate for young single people to fancy family plans or plans for older folks.

But there needs to be some sort of cost control and a LOT more competition. Customer service is often non-existent.

My recent experience with the health care system and a few recent experiences with the health care system by family members have given me new insights:

Unlike the legal profession, there is not enough competition amongst Doctors and as a result "customer service" is atrocious! Doctors and other health care pros are late, rude, brusque and uninformative. Patients are left waiting in waiting rooms, hospital rooms for hours... if not days for information, let alone treatment.

The Doctors don't care about price or cost, they just figure the insurance companies will pay. If I or my colleagues and paralegals and staff treated our clients like that, they'd walk and walk quick.

We're told to be good consumers of medical services, but the medical profession is as arrogant and poorly run as the airlines! Just as you really DON'T have a choice of airlines in most cases (Its American or Continental or nothing, or it USAir or nothing, etc.) you don't really have much choice for medical services, especially if the treatment has started.


Meanwhile the insurance companies try to avoid paying for anything and look for excuses NOT to pay. If the Doc didn't fill in the right code or used the wrong form, etc. etc. you, the patient, have to mess around to fix the problem.

I'd rather just pay the Doctor directly and send a receipt to an insurance company. That's what I do with my dental insurance... and its actually a lot easier. Probably costs less in administrative expense too.
 

Jesse -- the government runs lots of things very well (post office, fire, police, libraries, etc.). Public management isn't necessarily a problem so long as you (1) entice competent people in to it by offering competitive salaries and meaningful work and (2) use a minimum of bureaucracy by having democratic oversight by the electorate. The problem with many social programs today is that they're demeaned in the media and hampered by arbitrary restrictions placed on them to prevent "abuse of the system." Abuse occurs when rules overlap to create areas where two or more rules could apply and no decision procedure is given.

I'll say this: the only legitimate aim of a government is to serve and protect the citizenry. If a government exists at all, its only moral justification for continuing existence can be that it provides for the citizens.
 

I find it interesting that the examples Lane gave of the government doing things well were mostly things run by local governments (cities, counties, states) such as fire, police, libraries. And the post office is not micromanaged by some federal government agency and is really run mostly like a corporation and unlike almost any other federal agency or system.

Seems like an argument in favor of federalism and devolution of power to the smallest possible governmental unit capable of handling the problem. Seems like a strange argument for a socialist with a bent for big federal social programs that are almost universally less effective than social programs run by states and municipalities.

Oh, and yeah that was my post under "the democratic party" name. I forgot:

Peace on earth!!!! No more nuclear weapons!!! Feed the world!!! End poverty!!!

And cut taxes for the middle class!!!!

Yes we can!!!!
 

Sometimes I will have this same discussion with some of my friends who are doctors. Usually when the cost of healthcare comes into the conversation, they are quick to tell me about how much their clinics are spending on liability coverage. Apparently, this is a pretty substantial expense, the cost of which is happily passed on to patients.

Interestingly though, many states choose to regulate the amount of recovery available to a medical malpractice claimant.

The problem with this was that most states, after passing these limitations, did nothing to balance out the problem. So, there is statutory maximum payout but there is no corresponding maximum price. These statutes had successfully reduced malpractice recoveries, but somehow the costs of malpractice insurance didn't drop.

My idea: since we're already scalping John Q. Public on his malpractice claims and reducing costs for these insurance companies, why not go ahead and regulate the cost of med. malpractice insurance? If we can reduce this expense for doctors, maybe we can lower healthcare prices somewhat. It isn't perfect, but it will at least bring more of the pricing decisions to the actual healthcare providers, who generally have more competition (and therefore reason reduce prices) than malpractice insurance providers.

If we don't think there is enough competition, (and let's be honest, becoming a doctor is difficult and expensive and not a lot of people do it) we might want to create some sort of deferrable tax deduction for Medical School expenses. If we can make it more enticing to become a doctor, without sacrificing the quality of our healthcare, maybe we can create some actual pricing competition in the name of affordable healthcare.
 

Lot of particularly stupid attacks on Obama this time by RRL and his cronies. Republicans didn't used to be this way.
It doesn't help and it's often wrong.
It didn't used to be this way.
 

"Lot of particularly stupid attacks on Obama"

Where was the attack? I was making a joke in response to what I assumed was another joke made by someone about patriotic folks and how dumb we are for not getting that Sarah Palin is the antichrist, which were obviously high minded critiques aimed at deep thinkers. Democrats never had a sense of humor, but one can hope.

"this time by RRL and his cronies."

I have cronies? Where are they? Who are they? I need to know so I can direct them to use their time more wisely attacking people on other message boards.

"Republicans didn't used to be this way."

How did we used to be?

"It doesn't help and it's often wrong."

Man, I'm "stupid" and "wrong", which I assume you meant in the "your offensive" way, or some other whiny thing. Wow, you're really raising the level of discourse around here. We should meet up so you can point a finger at me and go, "nah nah nah nah boo boo, your not cool and smart like all us liberals."

"It didn't used to be this way."

What way? Attacks on political candidates? Jokes about political candidates? I guess all those pamphlets distributed by the founding fathers attacking Washington, Adams, Jefferson, etc. didn't happen. If we all close our eyes and wish hard enough we can actually forget that Republicans didn't invent negative campaigning or political attacks. Karl Rove isn't that original or creative.

Sorry I'm not laying down and waiting on my government overlords to save me like a good little boy. I will try harder, I promise. But next time you come to Political Mayhem Thursday you might want to bring an argument with you. Or at least something funny, like a dirty limerick or a story about a sad panda. Or else I'm sending my cronies after you in their black helicopters!!! Right after they get done with Cindy Sheehan and Keith Olbermann obviously.....
 

Market failure is one of the key reasons that government systems exist- when the free market cannot provide a service efficiently or effectively to everyone, it becomes the job of the government to do so. I think health care is a basic human right (and many will disagree with me on that), and I think that when the market fails to provide it efficiently and effectively at even the most basic levels to everyone, it becomes the job of the government to step in and help. There will always be a debate about the competing interests of public and private management and the role of the government, but ultimately no one benefits from a populace that can't afford basic care for all its citizens.
 

A federally-funded universal health care program, with standards and procedures set at the federal level, but with administration and most day-to-day regulation done at the local or state level is not an uncommon nor an unwieldy system.
 

Yeah, my old buddy Jack K. He has my blood pressure under control, my cholesterol is no worse than before. The itching has stopped (and the rash has cleared up, and after only one shot!) I pay Jack through a barter system--he keeps me healthy and I translate for his Hispanic customers. Really works. Other customers are just dying to get in.
 

It looks like the Republicans are split on this one.