Community as safety-net

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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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72 Responses

  1. Avatar greginak
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    says:

    Good stuff. Well snarked. The only point I might add, is that from my EVIL LIBERAL point of view having the gov do something IS having the community take action. I don’t view gov as inherently evil , so by having the gov step in, it is just one way of having communities and families help each other. then after that we sing Kumbaya.Report

  2. Avatar mike farmer
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    says:

    It’s a failure of imagination, which is easy to understand, since none have the capability to comprehensively envision a society without statist intervention, yet it’s fairly easy to envision how such a society could address catastophy without the help of the State. If it can be done with the State, it can be done in the private sector. Without State intervention in business and the economy, and our welfare, things would be much different – had the private sector been allowed to develop naturally, more than likely propserity would have increased, insurance arrangements would have developed and socity would have regularized such private safety nets as insurance plans from the moment of birth. They would likely be well funded and low-cost, althought the costs would be variable according to whether the policy covered future unemployment, education needs, medical emergencies and so forth.

    For the absolute desolate and poor, although there would be less poverty in a free, properous society — and I’m betting it would be much more prosperous based on the histories of capitalism and socialism – charity organizations would be well funded and would be powerful safety nets — they would have even found ways to use donations for low-risk investments so that returns could offset costs of charity. Creative arrangements we can’t even imagine would have come about — they still can, although it will be difficult to untangle statism.Report

    • Avatar greginak in reply to mike farmer
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      says:

      I don’t’ know, i think i have pretty good imagination. I can picture multiple green Venusian slave girls (wink wink nudge nudge) , riding dragons and pitching a winning world series game.Report

    • Avatar Alex Knapp in reply to mike farmer
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      says:

      This would be easier to believe if even some proto-private sector systems arose in the absence of a social safety net. But they didn’t. And anyone who thinks that in the absence of government, the private sector creates less poverty needs to re-read the economic history of the 1800s, with a focus on truck systems and company towns.Report

    • Avatar 62across in reply to mike farmer
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      says:

      Exhibit A for “It allows people to sit in their comfortable towers, surrounded by their absolutist theories, basking in the warm glow of their superior thinking – safe in the knowledge that their ideas will never be put to the test – that some impurity will always protect them from failure, allowing them to say always that if only their idea hadn’t been tainted it would have worked!”Report

      • Avatar mike farmer in reply to 62across
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        says:

        It’s not an absolutist theory — but it’s a better bet than what we’ve suffered for decades. in case no one has noticed, we’re on the brink of financial collapse. The safety net is getting ragged. Plus I don’t sit in a tower, I work daily with the homeless and jobless to help them get on their feet. We currently have 56 people in our program who have found jobs, are paying their way and becoming independent of State services.

        When they do have to seek State services, it seems they are getting the run around — many are flatly turned down. I advise them to get up earlier looking for work, and they find a job.Report

        • Avatar Bob in reply to mike farmer
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          says:

          Free of state services such as public education, fire and police protection, public libraries, sewage and trash pickup, roads, public utilities, public hospitals, etc?

          Mike the fact that the people you work with get the runaround sometimes/often from governmental agencies is weak tea in arguing against them. Greg was correct in his initial comment. State safety nets are how we have decided to address problems that the private sector can’t address, or wont address.

          These are choices the folks have made, you do not approve, obviously, but state safety nets were not imposed, any and all can ignore any and all state services.

          Get up earlier? That was meant to provoke a smile, I hope.Report

  3. Avatar RTod
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    says:

    Good post, E.D. I have to agree that the anti-statist argument being bandied around is overly convenient, and seems to be trotted out as a way to avoid arguing really difficult and nuanced issues.

    I can’t help but worry, however, that the entire “should everyone have health insurance or not” argument is doing the same thing to the very real problems in healthcare. I’m a risk manager, and my firm manages several healthcare programs in the Pacific Northwest. And despite the sexiness of the universal healthcare issue, I can tell you that everyone in my industry (including both healthcare providers and insurers) agree that the poor being insured or uninsured is nothing compared to the problems that will occur within the next decade if the system is not changed dramatically in some meaningful way. The current skyrocketing cost of healthcare, which does not, contrary to common reason, significantly increase “healthiness” or mortality rates on a statistical level, shows no signs of slowing.

    It’s pretty commonly agreed among my peers that by 2015 most american families who have employer-based group coverage will no longer be able to pay premiums on all family members, and will choose to pay only for converge on the ill or at-risk. This, by the way, will actually make things worse, as having the healthy stop paying premium will only drive up the cost for those who need it. Bringing everyone on mandatory coverage does seem like it will reduce everyone’s cost initially, (except for those who weren’t paying anything perviously, of course), but it doesn’t address, let alone solve, any of the fundamental problems, and we’ll just be back in the same boat after a few years.

    I don’t mean to rant, and I know that it’s slightly off topic, but the way everyone is arguing RNC or DNC talking points and ignoring the huge elephant in the room make my head want to explode. A plea, then, for you & other bloggers to talk more about the things that make our system unsustainable and how we might fix it, and less on the sexy Left issues (help the poor) or sexy Right issues (the government wants to steal your babies).

    Thanks.Report

    • Avatar E.D. Kain in reply to RTod
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      says:

      No apology necessary – you make excellent points. And I wish the reform being pushed now addressed them better. Certainly universal coverage does not denote cost-containment. I’m just not sure that leaving things the way they are – even if the only reform we get is this one – is preferable. Simply having the edifice erected for these exchanges may be an important step down the road in reining in costs.Report

    • Avatar Mark Thompson in reply to RTod
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      says:

      I assume this means more blogging on how absolutely ridiculous the concept of tying insurance to employment is, and how no reform that fails to sever this link will be meaningful in any way?Report

      • Avatar RTod in reply to Mark Thompson
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        says:

        I hope not. It’s true that employer-based programs have inherent quirkiness, but they do have significant advantages.

        Health insurance isn’t like, say, auto insurance, where you’re providing a safety net for something that statistically won’t happen to you (but might), it’s creating group purchasing power for things that will absolutely happen to you (unless, say, you’re hit by a bus going 60 mph at age 40 and never have to deal with high-cost health issues in your lifetime). It’s hard to see a more efficient system for having such buying groups, unless all healthcare is government mandated (which has other issues).

        Still, I’d rather see bloggers (and more importantly, politicians!!!) address the problem from any angle. It’s probably happening somewhere, I suppose, but I’m not seeing it. All I’m seeing is Help The Poor or Government Steals Your Babies. Like I said above, sexier arguments and more likely to appeal to the bases, but not so good at solving a problem that I believe really, really needs to be solved.Report

      • Avatar E.D. Kain in reply to Mark Thompson
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        says:

        Actually I think that simply having the exchanges opens the door to that better suite of reforms. Certainly having Wyden’s (albeit watered-down) Free Choice amendment will help. In other words, I think that however lousy this first step may be, it is still a step perhaps sort-of in the right direction.

        But maybe you had something else in mind?Report

        • Avatar RTod in reply to E.D. Kain
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          says:

          I hope that you are correct. I REALLY hope that you are correct.

          What would I like? A good question, and I wish i had a pithy, clever and wise answer. But the truth is I think I would just feel more comfortable if the people driving the debate were acknowledging issues that I know they are aware of, and throwing out ideas, and debating them. The thing that makes me skittish, E.D., isn’t that ideas may be initial clunkers that might be improved upon, but that they don;t seem to want to address the issues. Our 24-News cycle being what it is, my concern is that if a clunker of a law is passed, we will move on to the next sexy issue and abandon healthcare for years. (Like we did with Social Security after W failed to reform in in ’05.)Report

          • Nob Akimoto Nob Akimoto in reply to RTod
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            I think there’s a distinct difference between what the talking heads are debating (public option, etc.) and what policy wonks actually want to see in the bill (spread caps, guaranteed issue/mandate, open exchanges, medicare/medicaid possibly changing from fee for services to something closer to fee for results) with the latter actually surviving intact much of the time because the former dominates the public debate. Wyden’s “unintended consequences” provision is probably a good way to let policy makers figure the more difficult and long-term fixes out as they go (particularly at the state level) rather than the news cycle.Report

    • Avatar Art Deco in reply to RTod
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      says:

      You would have to persuade the Democratic and Republican congressional caucus to stop playing games and tell the public in unison that cost control requires one of two responses:

      1. Consumers confronting actual costs and full-freight prices; or

      2. Service distribution through administrative command and control.

      The parties do not trust each other, political leadership is in the hands of most wretched buffoons, and the mindset of some portion of each caucus would prevent them from acknowledging either reality, and members of the general public habituated to seeing their internist for a $15 co-pay would have to be told they have to pay $90, because that is the true cost. I cannot imagine the crisis which would have to ensue to bring any of this about.Report

      • Avatar RTod in reply to Art Deco
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        says:

        Agreed, and lack of optimism shared.

        But, not to take things on a completely new subject, I would argue that it’s the job of journalists to keep them honest about such things. But again, I don’t see it. I see lot’s of TV and radio “reporters” restating RNC/DNC talking points, and I see lot’s of journalists speculating on what they think the popularity of those talking points will mean in the 2010 elections.Report

        • Avatar Art Deco in reply to RTod
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          says:

          Journalists are generally schooled in either literature or in vocational programs. It is doubtful many are thinking as a student of economics might, and a number are likely nearly innumerate. Another problem is that the economist with the most prominent platform (Krugman) decided about eight years ago to play the partisan shill.Report

      • Avatar Alex Knapp in reply to Art Deco
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        says:

        “The parties do not trust each other, political leadership is in the hands of most wretched buffoons, and the mindset of some portion of each caucus would prevent them from acknowledging either reality, and members of the general public habituated to seeing their internist for a $15 co-pay would have to be told they have to pay $90, because that is the true cost. ”

        My current, employer provided insurance does not have co-pays, just a high deductible. Guess what, though? All the doctors in my area charge pretty much the same amount per visit, and I have zero leverage in talking down the price.

        Do you have any empirical evidence that suggests that paying full price causes prices to come down? Because I’ve looked and I haven’t seen any. All the evidence I have suggests that paying full price simply causes people to use health care services less. But given the fact that there is a limited supply of doctors, this doesn’t actually bring the cost of health care down–it just means shorter wait times.Report

        • Avatar RTod in reply to Alex Knapp
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          says:

          “But given the fact that there is a limited supply of doctors, this doesn’t actually bring the cost of health care down–it just means shorter wait times.”

          Actually, its a crazy thing about healthcare, but the cost actually goes UP with the addition of additional providers. Not on a per case basis, of course, (though it doesn’t go down), but on an aggregate basis. For example, if you have one clinic with 5 cardiovascular surgeons in a town, and another open up down the street with 10 more, the prices don’t drop. You just have 3 times the amount of cases being treated as you had before. Ironically, this doesn’t improve the town statistically from a health or mortality point of view.

          It’s just crazy.Report

          • Avatar Art Deco in reply to RTod
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            says:

            Ivan Illich would not have been the least bit surprised. I can tell you some stories about iatrogenic illness in my family.

            Question: are you measuring the mortality rate of the population in general or of the sets for which improved medical technology might have the greatest impact (persons over 80, for example)?Report

            • Avatar RTod in reply to Art Deco
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              says:

              Normally the way we track is two-fold: What is the mortality rate per dollar and procedure in specific healthcare spent (e.g.: number of cardiac arrests that lead to death per cardiac procedures performed), and what are similar-community comparisons.

              This last is always the more interesting. It consistently shows that levels of “healthiness” and mortality go improve from zero providers until it gets to some relatively low level of providers. After that, it levels off, despite the fact that the number of procedures continues to escalate as the number or providers increases. Our current working assumption is that after a certain point you have procedures to feed the machine, so to speak, not to get the community healthier. In other words, a small community that has 100 bypasses a year most likely has it because that’s the number of bypasses needed to support the current number of providers.Report

              • Avatar Art Deco in reply to RTod
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                says:

                Hmmm.

                You have internists and general practitioners and you have a utilization management and review apparat in both hospitals and insurance companies. How much of this can they filter out?Report

              • Avatar RTod in reply to Art Deco
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                says:

                From what we see, “as much as the customer base will let them” – which isn’t much. Hard to hear from your carrier that a procedure your doc is recommending won’t be covered without going bat-shit crazy on them… or at least that’s my experience.Report

        • Avatar Art Deco in reply to Alex Knapp
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          says:

          I have not looked at any empirical studies and have no clue about how the price dynamics of medical care would compare to the sort of microeconomic models I am familiar with.

          The delivery of medical care is characterized by so much cost-shifting and opacity, I have no clue as to what the posted prices you are paying mean. I can point out that plans such as you have are operating in the context where about 40% of the cost of medical care is borne by public expenditure at administered prices and about 36% is borne by employers’ insurance where the prices are typically opaque. I think if we had a universal system of public insurance (over a high deductible) conjoined to out-of-pocket expenditure, the price schedule would be quite different than what it is now for all parties.

          The thing is, we have had a secular increase in the portion of domestic product attributable to medical care. In 1940, it stood at 4.5%; in 1960, it stood at 5.2%; in 1993, it stood at 13.8%; now it stands at 16%. Keep in mind also that real income per capita has been increasing at about 1.8% per year over that time. That is an artifact of the socialization of costs (among other things). If people pay the full freight, they are inclined to consume less. In turn, there is a recission in production of and investment in medical services and a restraint on future price increases as costs are more fully borne by the consumer.Report

          • Avatar Alex Knapp in reply to Art Deco
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            says:

            “If people pay the full freight, they are inclined to consume less. ”

            That’s not necessarily true. In 1940, we could cure a LOT fewer diseases and conditions than we can in 2009. Are the costs a problem of opacity of prices, or the advance of technology in creating new demand?Report

            • Avatar Jaybird in reply to Alex Knapp
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              says:

              Why can’t it be both?Report

              • Avatar RTod in reply to Jaybird
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                says:

                Another factor to consider: We don’t make rational choices when we purchase healthcare they way we might with, say, a home or a car.Report

              • Avatar Alex Knapp in reply to RTod
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                says:

                RTod –

                Indeed. And we don’t always have a choice, either. If I don’t like the price of the car I want, I might look for other options or put off buying a new car for awhile. If I’m diagnosed with leukemia, however…Report

              • Avatar RTod in reply to Alex Knapp
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                says:

                Absolutely. My mother had cancer metastasize in her brain 2 years ago, and got talked into getting radiation treatment from a new technology. The doctor claimed it would help her with motor control and memory loss for her last months. It didn’t, was outrageously expensive (like over $100K expensive), and afterwards the doc confessed that its potential helpfulness was a long-shot at best.

                But if my kids, or wife, were in the exact same situation, could I really say no to treatment? No way.Report

              • Avatar Art Deco in reply to RTod
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                says:

                My condolences.

                But, treatment toward what end? If the purpose of the treatment was to ameliorate distress and not excise the cancer, it does not seem to me that the age of the patient is more than a modest consideration.Report

            • Avatar Art Deco in reply to Alex Knapp
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              says:

              Megan McArdle has been making this argument as has R.M. Kaus: that households and societies change their consumption mix as they grow more affluent and more fundamental wants are satisfied. If that is the case, devotion of resources to medical care will still retain some sort of natural ceiling. What is necessary is to structure public committments so that the ceiling emerges.Report

          • Avatar Mark Thompson in reply to Art Deco
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            says:

            Here’s a question: how much of the increase in health care as a percentage of GDP has to do with the baby boomer generation aging, and thus creating an increase in the amount of demand for health care. Additionally, to what extent are doctors of that generation retiring at precisely the moment when demand for their services is increasing, resulting in a demographically-charged increase in demand and reduction in supply?

            I honestly don’t know the answers to those two questions, nor what those answers would mean in the end.Report

            • Avatar RTod in reply to Mark Thompson
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              says:

              Mark, I don’t know the answer either. But everything at our firm points to the total lack of a single cause or villain. (And truthfully, there doesn’t actually seem to be an actual villain anyway.) It’s not just demographics. It’s not just technology. It’s just not unnecessary treatments. It’s not just insurers not being incentivized to negotiate prices. It seems to us to be, basically, all of these things and a whole lot more.Report

            • Avatar Art Deco in reply to Mark Thompson
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              says:

              Again, the share of domestic product accounted for by medical care has been on an upward trajectory since 1940 and the matter of the increasing devotion of investment to production of medical services has been a matter of public discussion since about 1977. The eldest cohort in the post-war demographic bulge hit retirement age last year.Report

  4. Here’s one thing I would like to see eliminated from the conversation: the word insurance. Or at least maybe some kind of division of terminology. For example, I have great health ‘insurance’ through my employer, but it certainly isn’t insurance in the same sense as my car insurance. With my car insurance the hope is that they never have to pay out because I will be a good driver, or even if they do, the pay-out will still be less than the sum total of my premiums. This isn’t the case with health insurance. With my company-provided plan there is 100% certainty they will pay out numerous times throughout the year for routine medical care like check-ups, dental cleanings, eye exams, etc. So it’s not really ‘insurance’…is it?

    So my proposal is to separate the routine from the catastrophic. Why not change the model to the old country doctor approach and have people pay for routine medical care out-of-pocket? The down-side there of course is that this will probably lower the income of family doctors and dentists, but it is also a more free-market approach will allow consumers to drive down costs with their checkbooks. We can still maintain some version of ‘health insurance’ for those unforseen things like a surgery or a root canal, but surely it would completely blow apart the industry model when they know every policy holder will not be soliciting funds several times per year.Report

    • “Why not change the model to the old country doctor approach and have people pay for routine medical care out-of-pocket?”

      There are a signficiant number of insurance plans that do just that. Millions of people are enrolled in them. Like me, for instance. No change in prices as far as I can tell.Report

    • Avatar historystudent in reply to Mike at The Big Stick
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      says:

      That would be a step in the right direction. Try persuading Congress.Report

    • Avatar Art Deco in reply to Mike at The Big Stick
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      says:

      Alas, one component of the current debate was the Republican adoption of the public posture that Medicare benefits must never be constrained. This is larded over the assumption, which appears to be modal in the Democratic Party, that no benefit conferred which creates a patron-client relationship between Democratic legislators and a constituency group may ever be reduced in value. On top of that is the view of the press corps that insurers must be publicly bullied and shamed into springing for every dodgy treatment the medical profession can conjure. On top of that is notion (abroad in the press, the political class, and the public) that making actuarial calculations and setting premiums accordingly is ‘discriminatory’, i.e. illegitimate, as if risk pooling services could be provided any other way.Report

    • Because the cost problem isn’t the cost of routine care, it’s the cost of things when they get really bad, combined with an overpopulation of specialists. There’s already not enough general practitioners, making routine care out of pocket would exacerbate that problem and make catastrophic insurance have to cover just that much more in high cost procedures.Report

      • Avatar Art Deco in reply to Nob Akimoto
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        About $2,000 bn in medical services are consumed each year and another $200 bn is in custodial care in nursing homes. IIRC, about a quarter of the former sum is accounted for by inpatient care.Report

      • Avatar Art Deco in reply to Nob Akimoto
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        My error. Hospital care accounts for 35% of the former. The sum of inpatient and outpatient treatment for kidney disease is around 1.6% of the former and the sum of inpatient & outpatient treatment for cancer is around 4.6% of the former. That would leave north of 60% of consumption in the realm of the mundane (office visits, laboratory tests, prescription drugs, &c).Report

      • Avatar Art Deco in reply to Nob Akimoto
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        says:

        My error. Of that sum of $2,000 bn, about 35% is devoted to hospital care; inpatient and outpatient cancer treatments account for 4.6% and inpatient and outpatient treatments for kidney disease account for 1.6%. So, somewhere north of 60% appears to be devoted to mundane matters (office consultations, prescription drugs, and laboratory tests).Report

      • Avatar Art Deco in reply to Nob Akimoto
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        As of seven years ago, outpatient care for diabetics cost about $52 bn. Add an increment for the intervening years and that amounts to 3% of the total. There are a number of other ailments that are resource sinks like kidney disease (e.g. sickle cell anemia, muscular dystrophies, cystic fibrosis), but these generally have quite small clientele, not the 350,000 or so which have end stage renal disease. Sum it up and we are still not at the halfway mark.Report

    • Avatar Bob in reply to Mike at The Big Stick
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      Mike, aren’t you ignoring the pooling nature of insurance? Say you have new coverage on your car, you change companies, you total your car the first month the insurance is active. You have not come close in payments to cover the payout, but others in the pool have provided the company with the funds sufficient to cover your claim. Is this not the came situation regarding medical insurance? Each year insurance companies do manage to turn a profit, at least I hear that very often.Report

  5. Avatar Art Deco
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    says:

    The point, I think, is to properly demarcate the territory between the state, philanthropies, and families, and to avoid the construction of perverse incentives in the process.

    The contemporary morass of social policy levies regressive taxes on the impecunious and then kicks back a portion in the form of means tested and state administered benefits which encourage people restrict their earning power and distorts the mundane expenditure patterns of households. One step toward a proper demarcation of the territory occupied by the state, the family, and voluntary association would be to dismantle all subsidies for mundane expenditure (groceries, rent, utility bills &c.) and improve the disposable income of the least affluent through comprehensive tax reform.

    We have a good many finicky controversies about the content of state-sponsored instruction and the ideology of the institutions which train its providers. Education and social work might be transferred to philanthropic bodies, to be financed by vouchers and donations.Report

  6. Avatar Scott
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    says:

    E.D.:

    Thanks for reminding us that the state is mother, the state is father.Report

    • Avatar Art Deco in reply to Scott
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      says:

      Prior to 1929, the state operated police forces, courts, and prisons (on the one hand) and veterans’ hospitals, orphanages, sanitoriums, asylums, and poor houses (on the other). I suppose you could say that the state was ‘father’ and ‘mother’, but that would be a metaphor that confused as much as it enlightened.Report

  7. Avatar steve
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    says:

    When you open up health care to the free market, how can you guarantee costs will come down? You always forget the provider side of the equation. If you free the consumer you also free the providers. Maybe they will find better ways to market and make even more money.

    Insurance is the big corrupter. I see no way you can have first world level health care without it. How do you pay for the sick neonate or traumas when one is young? However, once you throw in insurance it makes it difficult to control costs.

    SteveReport

    • Avatar RTod in reply to steve
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      “Insurance is the big corrupter. I see no way you can have first world level health care without it. ”

      I’m not sure this is the right answer, Steve. My experience is that at the end of the day, the carriers are going to make their 3% regardless of what costs do. They’ll never make 10%, they’ll never lose 10%. There have been a lot of cases where they have taken the aggressive price watchdog role for the consumer, which is (after all) their real job. But in all of those cases, consumers have sided with providers and left those carriers who have tried to drive down costs. The most extreme example is HMOs, of course, but every year there are stories of carriers renewing contracts with provider networks and the providers having the consumer force the carrier to give in on negotiations.

      I think the insurance company acts as a good villain in politics, but I don’t think focusing solely on them is the key to solving the problem.Report

      • Avatar Art Deco in reply to RTod
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        says:

        I am interested in the mechanism by which consumers force these kind of changes. I do recall a dozen years ago legislatures acting to compel hospitals to retain women who had given birth for some baseline of time and those human interest stories you see from time to time cast the insurer in the role of villain (for refusing to finance the procedure) rather than the provider (for refusing to self-finance it). What goes on between providers and consumers and between consumers and insurers in these sequences?Report

        • Avatar RTod in reply to Art Deco
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          Generally the mechanism is supposed to work like this:

          The consumers, via their employers, “hire” a carrier to negotiate prices for the provider; the provider charges them based on previous years payables (in the form of premium). The carriers then negotiate a set of prices for all of the various procedures that the consumer, via the insurer, are willing to pay for on a group basis. Then, depending upon how payables for the year go, the carrier sets a new rate at renewal for the consumer, essentially just making sure they get 2-4% to keep themselves to pay for admin & profit.

          Part of the problem over the past twenty years, however, has been that the insurance companies have not been consolidating, but providers have been. That means that they have a far superior stance at the bargaining table, and have been able to dictate price increases on a regular basis, as well as getting procedures that may not be medically necessary but may be potentially popular with the consumer approved by treaty.

          In addition, the providers have learned that despite the fact that the carriers act as their counsel in negotiations, they inherently trust doctors more than insurance companies. (Don’t we all?) Therefore, these days when carriers begin to dig in their heels during negotiations (usually because of an outcry from employers and consumers), providers will bypass the insurer and lobby consumers through TV/radio ads, mailers, and even direct phone calls, encouraging them to contact the insurance company and tell them to let their doctors have control of pricing and procedure approval. Which, when it’s happening, seems normal and right, but when you stop and think about it seems weird, if not perverse:

          You hire someone to negotiate on you behalf, asking them to get you lower prices. The party they are negotiating come back to you and complains that your negotiator is having some success lowering your prices, and asks you to step in on their behalf. You then call your negotiator and chastise them for being mean and trying to withhold money from the very party you hired them to negotiate. It makes your head hurt.Report

          • Avatar Travis in reply to RTod
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            says:

            Except that just as often, we hear the horror stories of insurance companies digging through someone’s medical past to find some insignificant thing they left off their history form to justify canceling the policy and shoveling the costs back on the patient.

            Until that kind of practice is ended, I will never believe a single thing any insurance industry person tells me. They’re known liars, their goal is profits ahead of patients and that’s all there is to it.

            Don’t pretend the insurance companies are on the patients’ side, because that’s just not true.Report

            • Avatar Art Deco in reply to Travis
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              says:

              You hear the horror stories because propagating them is in tune with the commercial interests of the news business and the world view of journalists. It would be rash to assume that the practice is all that common. Only about 9% of the consumption of health care is financed through insurance purchased by individual households.

              Insurance purchased from commercial companies and mutual insurers is not welfare. That is not to say that there is anything wrong with welfare, it is just a different thing. The body of policies vended by the company have to be actuarially sound. That is something difficult to do if the terms of your contract with a customer can be modified post hoc or the customer can conceal salient information without penalty.Report

            • Avatar RTod in reply to Travis
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              says:

              Travis:

              First off, the carrier isn’t on anyone’s “side.” They are, however, hired by your employer to negotiate future prices and specific benefits on your behalf. That you may or may not like what is negotiated does not change that.

              Furthermore, for whatever it’s worth, the stories you are referring to do not apply to group coverage. You simply can’t deny those claims under a group setting. They apply to single-person coverage. And while there are indeed true stories of coverage being denied to those that need care, it’s not quite as black and white as you seem to believe.

              The fundamental problem with single-person coverage is that by and large healthy people choose not to buy it, but people who fear they are sick do. This, obviously, leads to a bad spiral: Healthy people not buying insurance drives the cost up, which makes healthy people even less likely (or able) to pay for it, which puts more and more of the financial burden on the sick. In fact, most single-person policies are now greatly subsidized by a carrier’s group policies. This creates the situation that leads to most of these denials: While you cannot deny for pre-existing conditions on a group policy, they are not covered on single-payer policies. This isn’t because carriers are evil, it’s simple economics: If they didn’t no one would by coverage until they had medical bills, and the costs would not be diffused by a greater population. However, because of the price spiraling described above people are now more and more only buying policies when they are afraid they are ill, and by then if they are in fact ill they are not covered. I have never heard a carrier deny that they do this, in fact they’re pretty up front (even cold) about saying they do it; why you say you can’t believe anything they say because of it escapes me.

              On a more general level, though, I’m not sure such hyperbole is helpful. The carriers are not helping the problem, but neither are the providers, or the consumers, or the government at this point. The system is out of control now not because someone is being evil, it’s out of control because the system is flawed.

              It’s easy to just say the carriers are evil and that’s that. Or, for that matter, that the government is trying to take over your life, money, and sell your children into slavery (if you’re on the other side of the isle). Or, for that matter, that doctors are evil because most procedures today are not necessary but put money in their pocket. But none of these things is accurate, nor is it helpful to solving what is a very large, very complex and very dangerous issue. It seems to me all it helps with is avoiding dealing with challenging issues and making hard, hard choices.Report

              • Avatar Art Deco in reply to RTod
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                says:

                It is not that the choices are all that hard. It is that they have to be made by dysfunctional institutions (e.g. the U.S. Senate); made by people with no vocation other than politics and with little regard for anything but their own self-interest; and presented to a press and public which houses a critical mass of people who cannot get it into their heads that medical services and risk-pooling services are as subject to constraints of scarcity and cost just like anything else you purchase.Report

  8. Avatar historystudent
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    says:

    Wanting to solve problems without resorting to state intervention is not necessarily simplistic. It isn’t a matter of “the good old days” per se. It is a matter of seeing that in many cases government has not been able to responsibly carry out its primary mandates but nevertheless wants to expand its sphere of influence into still more sectors. It is a matter of recognizing that many of our current problems actually stem from previous, unwise government legislation and regulation. It a matter of acknowledging that a ruling body with fairly constant constituent cogs — even one elected — with time develops its own agenda, apart from the people, and this can result in a government that wants to preserve and extend itself and its power by making the people within its borders (citizens and resident aliens) dependent upon it. This burgeoning of state power is an an extremely serious concern to those of us who value the ability to make our own decisions rather than look to the Nanny State to lay down the law about everything under the sun. Why should the federal government be able to tell me that I’m buying too much or too little health insurance? Why should the federal government try to control the Internet? Why should the government be involved in bailing out and then partially owning and managing businesses? And so on. Government without strenuous checks and balances (which we have lost to an unfortunate degree) is not content to remain stable; it, like any typical organization will energetically seek to increase its reach.

    You write this: “These aren’t easy questions to answer. Applying the “statist” pejorative to anyone who attempts to ask them doesn’t help either.” Asking questions is certainly a noble endeavor. However, if these questions are posed in such a way as to try to incite bias against those who would oppose the current mad rush to radically accelerated statism, then I would turn around the following: “It allows people to sit in their comfortable towers, surrounded by their absolutist theories, basking in the warm glow of their superior thinking – safe in the knowledge that their ideas will never be put to the test – that some impurity will always protect them from failure, allowing them to say always that if only their idea hadn’t been tainted it would have worked!” One can as rightly attribute this to those who write blog posts such as this, as to people who advocate less statism. Just because someone supports (or leans toward supporting) a huge program does not make that person any more constructive than those who prefer a different solution. Reliance on the state has not, in any sense, been proven as the better way to proceed.Report

    • Avatar Jaybird in reply to historystudent
      Ignored
      says:

      The State tends to try to solve all its problems through brute force.

      The old joke about brute force is that if it doesn’t work, you’re just not using enough. So, of course, it needs more government workers, more overtime, more funding, and more resources. Questioning whether we should fire some of the worse workers gets a violent response asking why you are attacking unions again and you don’t understand how without unions children would be dying in textile factories again and so on.

      Nope. We need more funding. More resources. More workers. More overtime. Surely the outcome will be different.

      And people who disagree want children to die (textile factory optional).Report

      • Avatar greginak in reply to Jaybird
        Ignored
        says:

        so i see, if , oh lets say, Head Start only has funding to serve 50% of all the children eligible, then increasing funding to service all the kids is…..?? brute force???? huh…..oh i see brute force is the phrase your ideology uses to make gove sound EVIL so therefore the phrase is correct. brute force sounds bad and all.

        that is an abuse of language to use such loaded phrase, that is detached from what is actually happening, to prove your ideological point. Is Walmart using brute force when they raise prices?

        maybe more of whatever could be the answer. we would have to actually look at the actual problem not just apply a generic philosophical answer.Report

        • Avatar Art Deco in reply to greginak
          Ignored
          says:

          It is not brute force, but since there is a body of research which indicates that the benefits of compensitory education programs dissipate after about four years, you might just close the program entirely. You might also leave the matter of common schooling to state and local governments and pursue the federal government’s particular vocation.Report

          • Avatar greginak in reply to Art Deco
            Ignored
            says:

            Correct it is not brute force.

            Ummmmmmm………head start is run by local groups, just funded by the feds. And there are some effects that have shown to last threw high school….and not to point out something so obvious but if the affects of preschool only last for a few years then that is the same as saying the programs are effective.Report

  9. Avatar M.Z.
    Ignored
    says:

    This seems to parallel Freddie’s rant from about a month ago. At some point, the area of intellectual dishonesty is enterred when relevant data is ignored or fallaciously explained away. You are indeed correct that a private safety net hasn’t manifested itself in the past, at least not one we would find effective. Widow and orphan funds are the notable exception, and they basically prove the rule. As far as public works go, if you look at the railroads, local government’s bribed the railroads to run tracks to their towns.Report

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