health care and confidence


Erik Kain

Erik writes about video games at Forbes and politics at Mother Jones. He's the contributor of The League though he hasn't written much here lately. He can be found occasionally composing 140 character cultural analysis on Twitter.

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16 Responses

  1. Avatar Dan Summers says:

    One little follow-up thought about cost controls — the private insurance industry already exerts significant effort to control the amount it pays out, and I have a hard time believing that a single-payer public model would really lead to a hit for doctors and hospitals.Report

  2. Avatar E.D. Kain says:

    Good point, Dan. In some countries like Japan it certainly has, and I think net income for doctors in countries like the UK is lower than here, but overall I don’t think these outweigh the benefits.Report

  3. Employer-based health insurance is not even a remotely free market – the customer (the employer) and the consumer (the employee) have vastly different interests. The insurer thus need not worry much about whether it is serving the consumer of its services – only whether it is serving its customer. While universal single-payer may work ok in other countries (keeping in mind that some of the allegedly socialist European countries actually have a freer health care market than we have and definitely do not have universal single-payer), we also need to keep in mind that our bureacracy is different from other nations’ bureacracies. Anyhow, I made my own proposal for health care reform awhile ago here:

    Bottom-line – I’m in favor of expanding existing programs like SCHIP, etc. significantly. But there also needs to be a corresponding push towards individual rather than employer based health insurance.Report

  4. Avatar mike farmer says:

    There have been attempts by healthcare providers to lower costs and be competitive in innovative ways but they are stopped by some regulation — one doctor recently was going to charge a certain amount a month to patients, which was a reasonable amount, but the regulations stopped him, because they said he can’t act as an insurance company. Government has gummed up the system — we’d be better off starting over with free market solutions and charity hospitals, without all the stifling government regulations, Medicaide and Medicare. High powered physicians wouldn’t able to receive protection from competetive solutions like PAs and the costs would come down significantly. Add in tort reform, and you will be close to a solution.Report

  5. Avatar E.D. Kain says:

    The free market is a beautiful theory, but in practice I simply don’t believe it works for something like health care. For one thing consumers of health care will never be wise enough or savvy enough to really know what the best options are for their actual health needs. Also, I think there is a real danger of private monopolization.

    I do think that there is room for certain free market principles to be applied – I think low cost clinics could be very, very good for instance. But I think the free market has moved more doctors away from general practice (which is where the real health benefits occur for most Americans) and toward much more lucrative practice in specialties.Report

  6. Avatar E.D. Kain says:

    Mark – at your article you write:

    But why complicate things? I’m less knowledgeable in this area than Klein, but why not just push for a gradual expansion of Medicare, Medicaid and SCHIP while simultaneously phasing out the incentives that make the employer-based system more viable than an appropriate individual-based system?

    You see, I think keeping these programs and having all these different entities operating is actually more complicated than turning toward one program for all health care concerns. Why have Medicare, Medicaid, SCHIP, and whatever else comes along to fill in the gaps?Report

  7. Avatar mike farmer says:

    General practice is more suited for someone with PA or RN type training, which would be much less expensive. But licensure restrictions protects MDs. We’ll have to agree to disagree on the validity of free market solutions. I worked in a private healthcare facility in the early eighties before government regulation for that type of facility became so stringent — I can’t go into the differences in cost and quality of care here, but beleive me, the freer we were to make smart decisions, the better off everyone was.Report

  8. Well, I wouldn’t have a problem with consolidating them into one program. But someone really should have the ability to decide what medical coverage best suits them – for plenty of people, a high-deductible but less costly insurer would work wonderfully. The very concept of insurance is meant to provide a hedge against disaster; it’s not supposed to be intended as sort of a catch-all for everything.

    As for the issue of over-specialization, well, I’d say that our current structure of insurance probably plays a pretty big role in that, although that’s not an area where I’ve got enough familiarity to discuss things rationally.Report

  9. Avatar E.D. Kain says:

    There can indeed be room for choice – once again I think Germany’s system may be most palatable to the American people, as it does incorporate choice, means-testing (for cost scaling) etc.Report

  10. Avatar Jaybird says:

    What percentage of health care is used by what age groups?

    If, for example, a plurality of health care is used by those 80 and up, that would be something worth discussing, wouldn’t it?Report

  11. Avatar Dan Summers says:

    “For one thing consumers of health care will never be wise enough or savvy enough to really know what the best options are for their actual health needs.”


  12. Avatar E.D. Kain says:

    Jaybird – of course it’s worth a discussion but, then again, if everyone is covered it doesn’t really matter all that much. Old people are bound to take up more funds, as are alcoholics, the obese, and mentally and physically handicapped people. That’s the nature of the beast.Report

  13. Avatar Sam M says:

    “a flourishing society must also be a healthy one”

    Is this true? I think you can look at a place like Pittsburgh from 1910 to 1960 and consider it “flourishing.” It built the steel for most things that matter. It built a vibrant middle class, too, not to mention a vibrant local culture, complete with its own accent.

    Do you think people who lived in Pittsburgh from 1910-1960 were healthy, using any commonly acepted version of the word? I mean even by contemporary standards? Ever hear of Donora? A black cloud of pollution descended on it, I think in the 1940s, and stayed for a week or something.

    So it really suckled to live there inn that sense. But, you know, it flourished. Right? This is not to argue FOR black clouds of pollutions. But I do think relatively unhealthy people can thrive, as a society.

    As for “one event leading to bankruptcy,” I just don’t see it. I had a cousin who decided to go without health insurance in his 20s. Because he spent the money in bars. Until he got sick and had to have surgery. It cost several hundred thousand dollars. He didn’t pay a dime. The hospital basically forgave the bill. As I thik they were required to do by Maryland law.

    More recently, I worked on a landscaping crew last summer. One guy had a heart attack and ended up in an ICU. He had surgery. A few days later, the foreman said, “This is why we need socialized medicine.”

    “Why,” I asked.

    “So he could get his surgery.”

    “He got his surgery,” I said. “The doctor performed the operation.”

    “Yeah,” he said. “But…”

    Then there was nothing to say after that.

    Seems to me that, in point of fact, we do have socialized medicine after a fashion. Seriously. Let’s say I forego insurance. Even crusade against it as immoral for some reason. make a huge spectacle of myself. And the next day I have a stroke and someone takes me to the hospital.

    They take care of me. Right? I believe they do. And are required to do so by law. Now, this might not be efficient. But i terms of people actually getting care, from what i understand, they get it. even when they are 20-something barflies who could afford insurance but chose to forego it in favor of Wild Turkey.Report

  14. Avatar Sam M says:

    “Old people are bound to take up more funds, as are alcoholics, the obese, and mentally and physically handicapped people. That’s the nature of the beast.”

    But you do also have to come to terms with the fact that nationalized medicine basically guarantees the growth of the creepy nanny statism that has come into fashion of late. Maybe you are OK with that. But that alone is something that I see as a sufficient argument against nationalization.

    It doesn’t hurt much of it’s your ox being gored. But just wait util they ban something you do.Report

  15. Avatar Nancy Irving says:

    The employer-based insurance system also creates problems for those who would otherwise become entrepreneurs. It is extremely expensive, and often not even possible, to insure the self-employed, or those who work for small firms. So starting your own business usually means losing insurance.

    This is probably the reason why women are now more likely to start their own businesses than are men. Dad is more likely to have a job with family insurance benefits, which means he can’t move into the entrepreneurial sector without putting his children at risk.

    I would also point out, though I know it’s beside your point here, that it’s not true that if you’re poor enough, you qualify for Medicaid. It depends on the state. In California, for example, even the poorest adults do not qualify if they are not either disabled, or have at least one minor child, or qualify for a few special programs, as for instance, in California, if you have breast cancer.

    Most middle-class people think that if you’re just poor enough, you’re taken care of, but it just isn’t true.Report

  16. Avatar E.D. Kain says:

    Great points, Nancy. I wasn’t aware of California’s laws in that matter, though that does surprise me. Here in AZ it is much less strict.Report