I’ll be brief, for once.
Health insurers are blasting out flurries of FUD about the proposed public option. Their first reaction is the most telling: “We won’t be able to compete with a taxpayer-funded option.”
We won’t be able to compete. In other words, “we’re afraid it will be better.”
Seems like an endorsement, if you think about it that way, doesn’t it?
I’ll disagree, for once.
Not being able to compete with taxpayer-funded stuff isn’t about quality of provision. If you’re growing carrots in your yard and selling them, but someone with deep pockets is undercutting you, not caring that they are making a loss, then you can’t compete with them. Doesn’t mean their carrots are better than yours.
The question you should perhaps be asking instead is: so what? — why should there be private health insurers at all? You don’t have a private Secret Service competing with the taxpayer-funded one to protect the Prez, or a private Attorney-General competing with the other one. But this is, of course, European thinking.
I understand your point, but “better” in this case is a larger picture than you’re looking at. Not “better” in individual terms, but “better” in the sense that people in general want to do it that way.
“Better” in the sense of the wider social good, huh? That stuff that only commies believe in?
In regards to Grinebiter’s first comment, the bit about carrots is dead on. The Secret Service one really isn’t applicable because of it being a government function for government, whereas the proposed heath care nationalization is, in theory, government for citizens.
In regards to Dwasifar’s “better”:
“Not ‘better’ in individual terms, but ‘better’ in the sense that people in general want to do it that way.”
…I’ll wager that ‘better’ varies by notably by state, and that some states really want government health care, and others really don’t. I’d imagine there’ll be some ‘purple’ (no strong consensus) between the ‘red’ (no) and ‘blue’ (yes) states, but in many it’s a reasonably clear yes/no. A blanket decision for all the states is not ‘better’ in representational government terms. By state is the way to go for many reasons, including that it is ‘better’.
@Grinebiter: Close enough.
@Brock: I’ve been thinking more about your state-by-state idea since I learned that’s the way Canada achieved it. It started with a partial program in one province (Saskatchewan) and eventually expanded to full coverage nationwide. The guy who pushed it through (against stiff opposition, as we have here now) is now regarded as one of Canada’s greatest heroes.
I envy you the federal system, allowing 50 different laboratory trials. One simply can’t do that in a unitary state, although the UK does tend to let the Scots go into the haunted house first.
Until we, as a society, rein in our sense of entitlement, any health care payment system that has government funding that also doesn’t cost the insured in proportion to the amount of treatment received will bankrupt the Treasury. By this I mean that unless each insured person feels a monetary impact in proportion to the total cost of care being provided (whether 20%, 50%, or whatever), and the government is footing the bill, the demand for care in additional procedures, tests, extraordinary measures, exotic treatments, appliances, and devices, and so forth will sky rocket.
The alternative to cost sharing will be rationing and “death panels”–decisions about your care made by others who *will* be watching the money. I see no trajectory toward self-control in the population at large, so I see no hope that our gluttony for ever bigger medical consumption will abate. Also, the baby boomer generation has not faced its own mortality yet. They do not expect to die, and they will expect their health insurance to pay and pay and pay to keep them plugged in and wired in to whatever mechanisms will prevent their deaths. Nancy Pelosi and Harry Reed and the others didn’t sign up for death, and will not go gently (or cheaply).
The right solution is to keep the government out of the solution and let individuals and employers arrange insurance. The folks who are uninsured are actually not as at risk as you might fear. Certainly they cannot afford extreme hospital costs, but this is not a massive national tragedy. There is data to show how many people are not covered, and how little health care they receive, and how sad it all is. But what is not happening is that millions of people are not dying on the streets for lack of $250,000 hospital stays. This is really a giant non-problem for government, but a giant excuse for them to exercise control over an aspect of our lives heretofore not controlled.
I would have agreed with you as recently as two years ago, Fnortner, but the experience of other countries doesn’t bear it out. Canada shows no sign of being bankrupted by its national healthcare, and they have longer life expectancies, lower infant mortality, and better care outcomes in general, in spite of paying less per capita for healthcare than we do in the USA. France has the best healthcare in the world, pays less per capita than we do (less than Canada, too), and also is not in any danger of breaking their treasury even though the government picks up 79% of their healthcare costs.
Right now the US government pays about 45% of healthcare costs, through a variety of programs including Medicare, Medicaid, and various indigent subsidies. In Canada, the figure is about 70%. But the per capita expenditure is $7290 and $3895 respectively. (All figures in US dollars.) This means that the US government, under the current system, is paying more per capita, today, than it would be if we adopted the Canadian system and successfully achieved similar cost results.
None of this would matter much if the system we have now actually worked. But it does not. The measure of a healthcare system is not simply whether millions of people die on the streets. There’s a lot more to health than just not dying. And it’s disingenuous to say that this would allow government to “control” something that is currently “not controlled.” Private healthcare at personal expense will always be available to those who choose to pay extra; and to those who can’t, the decision to ration their care, and thereby “control” that aspect of their lives, is currently made by their private insurance carriers. Basic economics tells us rationing is inevitable, whether it is done by the government, the market, or by insurance companies pointing to fine print to renege on their obligations.
So it’s not a matter of choosing whether to have rationing; it’s a matter of choosing the way that works best and results in the most favorable general outcome, and that is self-evidently not our current system. The private carriers have shown that they don’t do as good a job overall at maintaining the general health as the various single-payer plans of other nations do. US citizens pay more and get less. I don’t like that outcome either, but the numbers are inarguable.
The Federal government won’t fix health care, it will further centralize things and cause new problems beyond the current ones being buried. The answer is to move decisions by state and lighten the regulatory issues at hand in the field.
Something I’d like to see as an option is limited regulations, limited liability, and competition. I think there’s a market for lower price new medical facilities, but structural costs keep this from happening. I also think there’s a chance some pro-socialized health care states might do well if given a fair chance (removal of Federal obstacles and “red state” resistance).
A single big Federal program is a bad idea on many levels. The current system is broken. Trading one for the other may even result in short term gains (or maybe not), but longer term it isn’t a sound solution. Decentralizing is advisable.
Can’t go with you on this one, Brock. I seriously doubt that the answer to an industry that already abuses its customers with abandon is to further reduce their liability and regulatory control. Providers and insurers would be all over that like white on rice, and we’d wind up with dangerous, unaccountable medical care facilities and insurers doing their best to push every customer into them. It would be a race to the bottom.
The point with lowering regulation is to:
1. Make operating less expensive. Flexibility allows for improving care while lowering costs. It also allows for greater efficiency.
2. Allow easier entry to market. More competition.
It would be interesting to see a breakdown of costs. When my Gallbladder was removed, it was less than one day hospital stay with 2 hours in surgery. Cost? About $12,000. With insurance? Around $2,000. Seems to me what I paid was about what it should have cost. Why so expensive? I don’t know. Obviously there’s facilities costs, but only 2 hours of time per surgeon, two assistants, and an anesthesiologist, who may not have been there the whole time. I also had a nurse that was not dedicated solely to me for the rest of my time in there. Factor in regulatory overhead, liability insurance, medical insurance overhead, and it still surprises me that costs crossed the $10,000 mark. I also had to wait a few weeks to get worked on.
High costs and poor service smell of lack of competition to me, coupled with excessive regulatory and other outside expenses. The current industry needs new, more nimble, lower price competition. It won’t appear under current conditions.
I don’t think it would work out that way. Flexibility allows for improving care while lowering costs; it also allows for degrading care further while lowering costs and increasing profits. Guess which one they’ll choose? No matter how easy it is to enter the market, new players will be forced to choose between quality and profitability, under market pressure from the lowball low-quality providers and the insurers who push their customers toward them. It won’t matter if some of them choose quality; they’ll wither and die because insurance won’t pay any more than the bottom-feeding minimum established by the lowball providers.
Your suggestions make sense when talking about, say, breakfast cereal or new cars, but people don’t buy those things with insurance. If your insurance company was paying for your breakfast cereal, you’d get a box full of dog kibble and pencil sharpener shavings. The point is that insurance companies, not consumers, drive provider selections, and so the providers that would do best under your plan are the ones that keep the insurers healthy, not the patients.
I’m thinking it gets a bit speculative without the overall cost picture. How much cost is due to insurance? How much is pure medical costs? How much is regulation related? I don’t know. How does one know a solution without knowing the big picture? Realistically, I don’t think they can. Understanding by state vs. Federal is pretty easy, but having insight as to where deregulation or extra regulation might be handy is hard to know without the figures and causes. It’s easy to say my Gallbladder operation was rip-off expensive, but knowing why isn’t as obvious.
> Your suggestions make sense when talking about, say, breakfast cereal or new cars
Yes and no. Looking back at the auto industry last century, it was overly concentrated for decades with few regulations. The regs didn’t really start to kick in until the mid-1970s, and by then foreign competition started to push Detroit. In this instance, even with a lack of regulations, there was little new competition for multiple decades, and it ultimately came from overseas.
Aren’t you undercutting your own argument there though? American cars are much better now, in a tightly regulated market, than they were in the 1960s when the makers pretty much had free rein. They are also more expensive. If there was less regulation, cars would be cheaper, but also less safe (and certainly less green). This would inevitably lead foreign manufacturers to build to lower standards for the US market as well, just to be able to compete on price. It’d be another race to the bottom, which would probably introduce cars that can’t currently be sold here, like the Tata Nano, which doesn’t meet US safety or emissions standards. Is this what we really want?
Why do you capitalize “gallbladder” every time you write it, btw? Not meaning to criticize; just genuinely curious.
> Aren’t you undercutting your own argument there though?
I thought I was to some degree (the delay for competition in the U.S. auto market). I’m okay with that.
> American cars are much better now, in a tightly regulated market, than they were in the 1960s when the makers pretty much had free rein.
As mentioned, yes and no. It’s interesting that it took that many years for competition to appear in an industry that was centralized, and also that it came from abroad. The Japanese did have an advantage of limited regulation in the critical earlier years. The door they walked through (fewer regs) is largely closed now, but it wasn’t when they arrived. Honda started in the U.S. in the far less regulated motorcycle market in the 1950s. That worked well for them. Entering a less regulated late 60′s/early ’70s market was also very advantageous.
Regulations have not improved quality, nor have they pushed safety where it is today. Consumer demand for safety exceeds regulations, and vehicles reflect this.
> They are also more expensive.
Last I knew, cost adjusted, cars are cheaper now, certainly for what you get.
> …like the Tata Nano, which doesn’t meet US safety or emissions standards. Is this what we really want?
Emissions? No. Safety? Yes. Many vehicles exceed government crash regulations, and this is a selling point. That’s great. The market provides products people want.
> Why do you capitalize “gallbladder” every time you write it, btw?
Same reason I capitalize ‘Rickshaw’. I don’t know the reason, but darn it, it’s the same one!