on healthcare

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. Dan Summers says:

    Private insurance companies are in the business of making money, just like any other business. Their goal is not the welfare of their customers, no matter what their ads may proclaim, and they will take whatever steps are necessary to maintain a favorable balance sheet. Executives of the companies are quite up front with this, as evidenced by their placid intent to continue with the odious policy of rescission (http://www.latimes.com/business/la-fi-rescind17-2009jun17,0,3508020,full.story). I am deeply skeptical that a free market approach will yield a corrective, because the free market will always be concerned about profits and indifferent to human costs.Report

    • E.D. Kain in reply to Dan Summers says:

      Right. And thus my proposal is the “thunderdome” approach. Put a truly free market up against a socialized system and may the best one win!Report

      • Dan Summers in reply to E.D. Kain says:

        Does this mean I can show up at work dressed like a post-apocalyptic Mel Gibson?

        By the way, you’re totally right about costs inducing rationality. For all my support of public health insurance, it is readily apparent that patients/families with no stake in their healthcare costs think nothing of coming in for the most picayune reasons. Some kind of copay would put a small check on this kind of irresponsibility.Report

  2. Dan says:


    I think part of the problem is that their is no free market solution, at least in the sense that you are defining solution. The “free market” has never preformed a surgery, given a vaccine, or charged a dime for anything.

    The “market” is merely a legal space established where persons can exchange or give as gifts goods and services. The “market” can’t, by its very nature, provide the solutions you are looking for (i.e. an institutional solution). The market is about spontaneous social order arising from the primordial soup (The legal space established mentioned earlier). The sort of institutional solution you want can’t be predicted without complete knowledge of all actors in the legal space.

    As Blanche pointed out, “I have always depended on the kindness of strangers.”Report

    • E.D. Kain in reply to Dan says:

      I’m not following you here, Dan. Are you saying the market can’t provide health insurance at all? I realize the nature of the market, which is why I’m advocating one “track” that is wholly market (primordial soup etc.) and spontaneous and competitive.Report

      • Dan in reply to E.D. Kain says:


        Yes, the market can’t provide health insurance, or food, or decks of cards for Parcheesi. Those things are provided by people, corporations, institutions, etc. Some will do a good job, some won’t. There is really no guarantee that any of them will do the job at all, only that everyone would be allowed to try. I think you’re uncomfortable with this uncertainty. There is a certain sense in which you distrust human activity that isn’t planned. You see a problem and must devise a stratagem to solve it. You don’t trust that others will have the foresight, compassion, and respect for human dignity that you do.

        That may be a warranted suspicion but it pretty much rules out a non-technocratic approach.Report

        • E.D. Kain in reply to Dan says:

          Okay so we’re arguing semantics now. The “market” is “people, corporations, institutions, etc.” isn’t it? And no, I don’t trust it to work sufficiently in this area because trusting these things is inherently risky. A safety net needs to exist. Again, that’s why I have proposed two tracks.Report

          • Dan in reply to E.D. Kain says:


            It may be a matter of semantics but it is important to realize that the questions you are asking, questions of particular solutions to particular problems cannot be answered by those you insist provide answers. Their answers are not technocratic ones. They can’t answer, “How can person X get the health care they need?” because they don’t know and believe that that sort of knowledge is impossible. They wish to allow individuals to come up with solutions to such questions on their own terms. You view this idea as risky. They view your technocratic answer as doomed to failure. But their answer is not merely a knee jerk suspicion of technocratic solutions but a position formed by a basic trust that human persons, on balance, can be relied upon to find and provide solutions to their own problems.Report

            • ChrisWWW in reply to Dan says:

              “But their answer is not merely a knee jerk suspicion of technocratic solutions but a position formed by a basic trust that human persons, on balance, can be relied upon to find and provide solutions to their own problems.”
              And yet they haven’t. Hrmmm…Report

              • Dan in reply to ChrisWWW says:


                If they tried they would be thrown in jail for practicing medicine without a license.Report

              • ChrisWWW in reply to Dan says:

                I’m sympathetic to the idea the licensing increases labor costs by reducing the pool of possible doctors. However, it’s not going to help a lot with expensive procedures that require extensive training and years of education. And it’s not going to help with equipment or drug costs.

                We’d probably see more so-called “alternative” medicine, but I like the imagination to see it fixing the real problems with our system which revolve around complex and expensive medicine.Report

  3. Francis says:

    It would be much more helpful if everyone talking about this issue would stop using the word “insurance” and use something else — like “cost pool” or, for that matter, “banana”. A small group of people — mostly well-off, well-educated young libertarians — actually want insurance (ie, protection against catastrophic outcomes only, with high deductibles so expected periodic costs come out of pocket). Everyone else just wants to go to the doctor when they’re sick, without worrying about paying the bills. In other words, they don’t want insurance; they want to belong to a cost sharing pool.

    That’s OK as a concept, but it’s difficult to achieve through employer-based pools because they’re too small. Such pools are impossible to achieve on an individual basis. So as a society we find ourselves in this impossible situation where private “insurers” are ever more heavily regulated to force them to provide what the public wants, and in return the private “insurers” work ever harder to get the undesirables out of the pool (eg, recission, astronomical rates for individual policies, non-meritorious billing disputes, etc.)Report

  4. the other Patrick says:

    I’m genuinely baffled by this notion a. universal coverage cannot possibly be achieved and that b. even if someone were to pull it off, it would be a disaster on an unprecedented scale. Most wealthy countries have it already! Universal health coverage is not a new, bizarre, unproven concept that a cabal of liberals just pulled out of their asses to piss libertarians off – it’s already out there!Report

    • Joseph FM in reply to the other Patrick says:

      Well yes. The problem is that absent a government monopoly “single payer” system that enrolls everyone by default- a system that would be politicallyimpossible to implent regardless of its merits or lack thereof – you will always have some
      people refusing to opt in either because of upfront costs, feeling invulnerable, or whatever. Even with mandates in place people still drive without car insurance.Report

  5. Badger says:

    There are plenty of examples of insurance with usual and regularly occuring payments. Worker’s Compensation immediately comes to mind. A talking point has gotten out there that insurance is supposed to cover rare events, and it just isn’t true. What makes insurance different than other financial transactions is that insurance is the one instrument where you cannot prosper by the event occuring. That doesn’t mean half or even 3/4’s of your premium dollars can’t be paid out as benefits yearly. In the health insurance world, we aren’t even close to half the premium dollars being returned in benefits to the insured within a year anyway.

    Some sort of means testing or cost needs to be associated with the public option as well, both as a cost-control mechanism but also as a mechanism of rationality.
    This claim has been made repeatedly. Costs would be contained when we added co-insurance. Costs would be contained when we added copays. Costs would be contained only if we jacked the deductible up high enough. We know for a fact that this isn’t the case. The apologists then just claim things would have gotten more expensive quicker without them. Heads you win; Tails you lose. They tried co-pays in Britain on an experimental basis and found it cost them more to administer it and didn’t provide cost savings. The plain simple truth is that while everyone getting checked by their doctor ever 3 months would be very expensive, it just isn’t the case that that is where the big money in health care is.

    The truth is that the place where money can be economized is on the supply side, specifically the hospitals. Instead we have been building more hospitals and having them compete, duplicating technologies. It is called ruinous competition, and it occurs in any industry where the capital expenditures are large. This is also why competition for cable and phone service haven’t done much to lower costs. This is why competition for electrical service hasn’t done much for lowering costs and actually increased them. Understanding this would require free market ideologues to understand more economices than what is taught in a freshman course though.Report