Healthcare will always be a thorn in the side of the GOP

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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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59 Responses

  1. Avatar Zach says:

    I don’t think the Tea Party supporters themselves would convert to this movement; they’re disproportionately rich and employed, and thus disproportionately insured (in terms of number of insured and quality of insurance). These are the people who follow Glenn Beck, remember, who claims that the American health system is the best in the world because everyone comes here for treatment.

    I agree that a fully socialized system (with freedom to purchase any supplemental coverage) is inevitable; I could see us adopt something like the Swiss system (but still allow insurers to profit) wherein insurers compete to provide a mandated standard of benefits as cheaply as possible.

    I like the idea of tacking on HSA’s, but I don’t know that it’s reasonable for HSA’s to work well as far as driving efficiency goes (I can’t make rational health decisions; I don’t expect other people to be able to either). It seems that they would work well to encourage use of complimentary preventative care and healthy lifestyles, and discourage unnecessary care.Report

    • Avatar Jaybird in reply to Zach says:

      Maribou, god bless her, has tried multiple times to explain the Canadian system to me and it seems to be one that makes sense.

      Everybody gets X. You’re a Canadian citizen? You get X.
      You want stuff on top of that? That’s what insurance is for. You want a semi-private room with a television, for example? Get insurance.

      So there are two tiers of health care. The one everybody gets… and then stuff above that. (Three tiers if you count the folks rich enough to come to the US to get stuff done.)

      I’ve long thought that two tiers of health care would be the ideal way to handle things in the US… but then I look at the biggest arguments made against the current system and see that they would work against a two-tiered system.

      Any system where these folks get X and those folks get X+Y will be one that is considered inherently unjust… because, surely, poor children deserve Y, don’t they?Report

      • Avatar North in reply to Jaybird says:

        Perhaps Jay. But when the value of Y is something smaller than basic healthcare the size of the group lobbying for everyone to get it gets smaller in both size and intensity.Report

      • Avatar Mark Thompson in reply to Jaybird says:

        This is why I think it would be easier to hash out a health care reform bill between Jane Hamsher and [insert raving libertarian here] than between the so-called “mainstream” left and right. Single-payer doesn’t scare me. Byzantine webs of mandates, subsidies, and committees do.Report

        • Avatar North in reply to Mark Thompson says:

          Well sure Mark. Hell, you and I could probably plop down and write out a decent bill on napkins over coffee. Thing is neither you nor I run the country. The country is run by a pair of elected committees, one executive and a slew of bureaucracies.
          I read a saying somewhere, likely Murphy, that the intelligence of a group is equal to the IQ of its lowest member divided by the number of people in the group. I sometimes worry that it is true.Report

        • Avatar Zach in reply to Mark Thompson says:

          Exactly. The number of backflips Democrats are doing to add dead weight to the bill in the name of making it more market-driven or less politically offensive is incredible. I don’t think the subsidies will be all that Byzantine, though. I assume you just plug your AGI and health expenses into a table and figure your monthly subsidy, and that it’ll be essentially automatic for anyone with a W2. I also don’t think mandates will be all that problematic, but enforcing federally mandated minimum levels of coverage will be.Report

        • Avatar Koz in reply to Mark Thompson says:

          “Single-payer doesn’t scare me. Byzantine webs of mandates, subsidies, and committees do.”

          Yes and no. Depending on the details, single payer might very well be better than some subsidy-mandate clusterf**k. But it’s still bad. What do you think a libertarian ought to be willing to horsetrade for it?Report

          • Avatar Zach in reply to Koz says:

            A future that doesn’t require increased taxation to afford increasingly expensive mandated government expenditures on inefficient health care.

            Getting rid of Medicare and Medicaid isn’t on the table (hard enough to modify at the margins); putting everyone on the same playing field as far as medical care goes seems more conducive to smoothly functioning free markets than dedicating a huge chunk of the economy to a Byzantine combination of public care, employer-provided care, and several flavors of individual coverage. A country in which employment isn’t tethered to health care is a better environment for libertarian policies to work, isn’t it?

            It also seems, to me, to be easier to introduce market reforms into a simplified single-payer system than it is to twist the current system about so that it’s some sort of functioning market that’s also not terrible.Report

      • Avatar Zach in reply to Jaybird says:

        Any system where these folks get X and those folks get X+Y will be one that is considered inherently unjust… because, surely, poor children deserve Y, don’t they?

        The keys to lowering costs are to deny unnecessary procedures, implement cost-effective preventative care, reduce preventable errors, and eliminate duplication of effort. The UK does the denial bit and gets some heat for it domestically, while Congressmen here pillory the NHS for not providing expensive and unproven cancer treatments that aren’t covered by most private American insurance policies anyway.

        The trick is getting to that point from where we are now, where the best possible medicine, proven or not, is available even if no one can afford it without the government picking up the tab. When the amount of money spent winning a 50% chance of extending an adult’s life would save a number of lives of healthier people, how do you make that call? Of course, this is what Ezekial Emanuel works on and he got called a Nazi for it and is now apparently too toxic to participate in public debates on reform. Suffice to say, it’s hard to see a bridge from death panels and Nazis to national health care given that a national system would have to make these choices publicly; insurance companies already make those choices, but apparently that doesn’t matter.

        That’s why I think X+Y is inevitable, but it will be in the form of the government requiring companies to provide X plus as much Y as they want, where X includes preventative care and companies cannot discriminate in any way (one price per policy; have to accept everyone) in terms of the X part of coverage.Report

        • Avatar Jaybird in reply to Zach says:

          “That’s why I think X+Y is inevitable”

          From my standpoint, it’s more likely to result in X being the only option. We won’t feel bad about poor child dying due to a bad whatever because everybody dies from bad whatevers.

          Well, except for the people who are rich enough to go overseas for treatment.Report

      • Avatar Koz in reply to Jaybird says:

        “Everybody gets X. You’re a Canadian citizen? You get X.
        You want stuff on top of that? That’s what insurance is for.”

        No. Some countries have that system but not Canada. AFAIK, if you live in Canada you get X. You want stuff on top of that, that’s what the United States are for. The difference is not trivial.

        First of all, there is obviously a significant amount of coercion of health care providers to get this to work. More than that there is a big practical barrier to trying the Canadian system here. The United States has no United States to sponge off of. We are the United States already.Report

        • Avatar Zach in reply to Koz says:

          Um…. Google: “supplemental insurance Canada”
          Supplemental insurance does just that: it is extra or additional insurance that helps you pay for things your standard insurance doesn’t cover. Combined Insurance pays cash benefits directly to you, not the medical provider, so you can use the money to help pay for out-of-pocket medical costs, lost wages or other unexpected expenses due to illness or injury.
          Canada doesn’t really sponge off the United States to a larger degree than the rest of, well, every other country in the world who we basically subsidize drug development for. Most of the treatment Canadians receive from American doctors is paid for by their Provincial coverage, I believe. The first study I found says that spending in the States is less than 1% of total expenditures, and that the extent of medical tourism is much lower than popular perception.Report

          • Avatar Koz in reply to Zach says:

            “Supplemental insurance does just that: it is extra or additional insurance that helps you pay for things your standard insurance doesn’t cover.”

            Yeah I know there are some exceptions. My understanding they mostly have to do with people who aren’t covered by gov’t health care or services that aren’t covered by gov’t health care.

            By “sponging off”, I’m not necessarily referring to who pays for health care services for Canadians in America, but rather the existence of them here in the first place. Canadians can come here, but there’s nowhere for us to go.Report

            • Avatar greginak in reply to Koz says:

              Wrong Koz- Americans are going to many other countries for health care. Some go to Mexico to buy meds they can’t afford here. Americans can get cheaper health care for some things in other places. I met a guy from New Zealand last year who said Americans go there for cheaper hip replacements. This is more common then is talked about.Report

              • Avatar Koz in reply to greginak says:

                That’s true, but not exactly what I was writing about.Report

              • Avatar Zach in reply to Scott says:

                The best surgeons in the world work at the best teaching hospitals in the world; the majority of which, in North America, happen to be in the United States. Those that can afford to will travel internationally to seek their services. This has nothing to do with the quality of health care experienced by the average Canadian or American or the viability of socialized health care in the States. There are research hospitals on par with the States’ top tier scattered throughout countries with purely socialized systems (UK, Germany, France, Taiwan, etc). I doubt the adoption of socialized insurance here would make the best surgeons leave the best medical schools in the world, given that completely socialized care hasn’t disrupted advanced medical research throughout Europe.Report

              • Avatar Koz in reply to Zach says:

                That’s a very important point, that has different consequences than you might suppose. The places where there is lots of cheap (relative to American standards) available private health care are downstream from the forefront of medical research, which is largely done in America. In this way America subsidizes health care all over the world and there would be substantial effects if that changed. For fiscal reasons we might want to lower funding for medical research anyway, but allowing for that foreign medicine is not as cheap as we think.Report

            • Avatar Zach in reply to Koz says:

              Like I said, all indications are that very few Canadians come here because of the tiny fraction of American care that’s on the cutting edge. The briefest research says that most Canadian expenditures are made by residents of border towns who live closer to American facilities than Canadian ones. These are private, for-profit facilities that are reimbursed by the Canadian government, so I don’t see where the sponging comes into play. I bet there are facilities in border towns that depend on Canadian customers to survive. Less than 1% of Ontario’s health spending goes to the US.

              I fail to see how you’ve made a case at all that Canada is somehow dependent on US facilities & personnel. I admit that I haven’t researched it very thoroughly.

              Also, and I mentioned this somewhere else, the sorts of drugs, procedures, and services that are deemed to fail the cost/benefit test in Canada and the UK aren’t available for the majority of insured and uninsured Americans now without paying for the whole thing themselves, having an unaffordable individual contribution, or getting their copay picked up by bogus, drug-company-funded charities. Treatments are denied by insurance companies because they aren’t proven to be very effective, too.Report

              • Avatar Koz in reply to Zach says:

                “….by residents of border towns…”

                That’s like 80% of the Canadian population.

                “I fail to see how you’ve made a case at all that Canada is somehow dependent on US facilities & personnel.”

                Because, whether it has to do with cutting-edge care or because the corresponding providers in Canada are already operating at capacity, the corresponding services (ie, timeliness etc.) in Canada are not available at any price. That’s a tolerable situation for Canada because Canadians can come here, but it’s not a tolerable situation for us because there’s nowhere for us to go.Report

              • Avatar Zach in reply to Koz says:

                Operating at capacity is a good thing. Nonzero wait times are a good thing. Elective surgery on demand is a bug in American health care, not a feature. There’s a point at which you pay too much to reduce wait times, and we’re way beyond that point. Canada’s too far on the other side of that equation, and the country’s spending money to fix the problem. The fact that we have surgeons available at a moment’s notice for nonemergency surgery is an indicator of waste in American care.

                It’s sort of amazing that precisely the same people who argue for the utilization of cost/benefit analysis in environmental policy will turn around and point to wait times and drug unavailability in public health systems as an indication of failure.Report

              • Avatar Koz in reply to Zach says:

                Forgive me for being a little bit frustrated at this exchange. You are talking about something else.

                I am talking about why the Canadian system is not plausible here. I don’t think you’re disputing my argument, but I don’t think you’ve internalized it either.Report

              • Avatar Zach in reply to Koz says:

                “Forgive me for being a little bit frustrated at this exchange. You are talking about something else.”

                Apologies. You said, “the corresponding services (ie, timeliness etc.) in Canada are not available at any price.” My response is that timeliness is not a requirement for feasibility, and that health care can be excessively convenient. The Canadian health system would survive even if America sealed the Canadian border. The less-than-one-percent of services accessed in the United States would instead be accessed with a little less convenience in Canadian cities. Wealthier Canadians could fly to socialized European hospitals instead of American hospitals and get the best surgery money can buy.

                Although I do suppose that sealing the Canadian border would devastate the Canadian economy and make public health care unsustainable.Report

              • Avatar North in reply to Koz says:

                Well Zach it’d shut the US down too. Canada is far and away the #1 energy provider to the USA. If the US stopped trading with Canada they’d have to invade it.

                The Koz point that I think you’re missing is actually the Megan Mcardle line that the private dynamic (comparatively) unregulated US market where all the drug companies make their money. The drugs that the rest of the world enjoys (or even makes) occur primarily because they’re sold in the US for profit and often only break even or in rare incidences sell at a loss in the rest of the world. This view states that if the US were to move towards any kind of healthcare reform then that market would vanish and the drug companies would no longer have a way of recouping the cost of developing drugs thus would stop doing so or at least slow down in doing so and thus the rate of medical innovation/development would slow to a crawl.

                This of course ignores the huge involvement of government in the drug research and development field both through government agencies directly and also indirectly through universities. It also is kind of non-falsifiable short of changing the US market and seeing but there it is. If you’re concerned about drug innovation as Megan is it’s an argument that causes a lot of concern.Report

              • Avatar Koz in reply to Koz says:

                “The Canadian health system would survive even if America sealed the Canadian border. The less-than-one-percent of services accessed in the United States would instead be accessed with a little less convenience in Canadian cities.”

                I don’t know where the 1% number comes from. You might be right though I’m still skeptical because of the number of recent high-profile incidents and the fact that such a large portion of Canadians live within an hour or so of the US anyway.Report

              • Avatar Koz in reply to Koz says:

                “The drugs that the rest of the world enjoys (or even makes) occur primarily because they’re sold in the US for profit and often only break even or in rare incidences sell at a loss in the rest of the world.”

                That’s a separate issue, and actually one where I have some sympathy with the other team. If the pharmaceutical companies can’t defend their intellectual property in the parts of the first world that actually respect it, eg, Canada, I can’t see any reason why we should be doing it for them.Report

              • Avatar Koz in reply to Koz says:

                “This view states that if the US were to move towards any kind of healthcare reform then that market would vanish and the drug companies would no longer have a way of recouping the cost of developing drugs thus would stop doing so or at least slow down in doing so and thus the rate of medical innovation/development would slow to a crawl.”

                As it relates to what I’ve been talking about in this thread there are two points:

                1. The costs for nonpharmaceutical medical research and innovation are filtered through as costs to patients in the American medical system and whichever third parties are financially supporting them. Allowing for that, US medicine is less expensive than you think. Or more accurately, produces more benefits than just the medical outcomes of American patients.

                2. US movement toward Canada-style collectivized medicine is implausible because there is no second-tier available for us in the way our system serves for Canadians.Report

    • Avatar Jivatman in reply to Zach says:

      @Anonymous

      “I like the idea of tacking on HSA’s, but I don’t know that it’s reasonable for HSA’s to work well as far as driving efficiency goes (I can’t make rational health decisions; I don’t expect other people to be able to either). It seems that they would work well to encourage use of complimentary preventative care and healthy lifestyles, and discourage unnecessary care.”

      Do you know exactly what milk should cost? Maybe. What about corn? Wheat? Possibly. What about how much a computer given it’s internal technological components? A house? A car?

      For commodities, you usually buy them unconsciously without regard for the price, assuming that the price is the market one. For a computer or car, you might read consumer reports. In any case, in buying a car or computer you can more or less assume it is fairly price. For a house you might talk to a retailer or get an assessment, and it’s likely that you actually haggle. But even if you buy it by the list price, you’re probably not getting drastically ripped off.

      Some medical care is, in fact, simple. Some medical care can cost more than the price of a house. Right now the only health costs that have gone down AND increased hugely in quality over time are Lasik eye surgery, Cosmetic surgery, and a few other things that are typically not covered by insurance. Somehow, the market IS making rational decisions about these…

      The price mechanism works. Really, it does. In 1920 – only 3 years after the soviet union began – Ludwig Von Mises identified the “Economic calculation problem” as the central argument against planned economies. That a central authority cannot possibly know the proper price of anything.

      Of course, health insurance is nominally free market, but in reality most states have one or two insurance companies. But most importantly, with insurance, no actual choice is being made with regard to what care is being bought, so the result is analogous in some ways.Report

      • Avatar Jaybird in reply to Jivatman says:

        That’s an excellent point.

        This stuff costs *SOMETHING*. Time and materials. If the time and materials costs more than insurance can cover, rates will go up. As rates continue to go up, people who don’t “need” insurance will drop out. As people who don’t “need” insurance drop out, insurance will only be purchased by people who use it… which means that the ratio of the cost of insurance to the cost of time and materials will approach 1:1 (plus, of course, a little bit of overhead for the insurance folks).

        If people stop getting enough money to cover time and materials, people will stop showing up and making stuff.

        And all of the stories in the world about how awful it is that poor little children can’t afford a tracheostomy will not change that. (I picked tracheostomy because it showed up on the most expensive medical proceedures page that showed up when I googled.)Report

        • Avatar Jivatman in reply to Jaybird says:

          Yes, and the purpose of my post was to demonstrate how any significant use of Health Savings Accounts, Health Allowance Accounts, single-payer, and anything else where people actually get to make their own medical decisions without a middle-man, WILL vastly improve the quality and cost of all healthcare.

          Here is a good example of what you would see if that were to happen
          http://online.wsj.com/article/SB125875892887958111.html

          Considering Dr. Shetty in India is able to charge 2,000 for procedures that cost between 20,000 and 100,000 in the U.S. without really skimping on materials or the education of his doctors, I think it’s pretty clear that “massive inefficiency” is an understatement when describing our healthcare system.Report

  2. Avatar North says:

    Well we’ll see E.D. Were I to place any bets I’d say that the current HCR bill is still slowly inching forward. The indicators in the House are flickering back to life. It’s entirely possible that the Dems in congress may still choose to run away from it but they’re starting to waver back into the passage position. If I were forced to put money on a likely outcome I still would say that the odds are that the House is going to whip themselves into passing the senate bill and a couple of the warts will be sanded off in a reconciliation bill before it’s sent on to Obama. A lot of it depends on whether Obama finally decides to lean on some legislators to get it done.Report

  3. Avatar trizzlor says:

    There was a hot thread here recently about the death of libertarianism, and while I understand that you’ve been supportive of centralizing health-care in general, I think that claiming such an act would be supportive of libertarianism would herald such a death.

    The problem is that issues like health-care, particularly for the elderly (who, let’s be honest, are basically spoiled goods as far as the market is concerned), play on our sympathies in such a way as to demand centralized solutions. Now, it seems like you’re claiming that some degree of centralization can actually be beneficial to libertarian thought, but historically that clearly hasn’t been the case – especially not when centralization is promised first with free-market solutions to follow.

    I’ve often tried convincing myself that something like the public option can still be compatible with free-market principles by introducing the government as simply another competitor with no unfair advantage. It would act like a temporary spur on competition in areas where markets tend to stagnate. It’s a fun game, but really just an experiment in self-delusion.Report

  4. Avatar Francis says:

    “any true market solution for healthcare”. A true market for healthcare would mean that some people would go without. The charity system is already incredibly rickety (read Gary Farber’s blog at Amygdala for some horror stories of his experience); eliminating the federal obligation imposed on ERs to provide service without regard to ability to pay would mean that people without insurance/cash would die of curable diseases and treatable injuries (because ERs would require proof of ability to pay before providing service).

    That’s a perfectly legitimate position to take and one that’s held by most 3rd world governments . It’s not a position that’s publicly advocated much in this country. You think “death panels” was bad, wait until the Democrats wheel out “dying in the streets”.

    If as a society we’re going to offer some level of care to everyone, there’s really only 2 effective solutions: put everyone in a single, government-sponsored pool, or require everyone to be in a private pool and impose regulations on the private pool (must accept everyone, no recission, no price differential for pre-existing conditions, limited ability to impose different prices within a pool). Essentially, the private pools become regulated utilities. Any other approach returns us to where we are today, with a massive free-rider problem absorbed by the taxpayer and unsustainable rate increases levied by the insurers as they try to address rising costs and changing characteristics of their pools.

    Frankly, the utility model is not a bad one. The shareholders of the utility get a guaranteed, but relatively low, rate of return, and the government gets to supervise the provision of services instead of providing the services directly.

    Most libertarians hate utilities, though.Report

    • Avatar Mark Thompson in reply to Francis says:

      I’m not a fan of utilities. I am a fan of school vouchers. I can imagine us instituting voucherized health care in a way that liberals would consider it essentially single-payer and libertarians would consider it essentially market-based. Indeed, Arnold Kling thinks such a system is inevitable.Report

  5. Avatar Koz says:

    “You think “death panels” was bad, wait until the Democrats wheel out “dying in the streets”.”

    The effectiveness of things like that are proportional to how much people fear them. Clearly the D’s would like to squeeze some political juice out of people “dying in the streets”, but if people don’t care or the scenario isn’t credible, it might not work.Report

    • Avatar Travis in reply to Koz says:

      If there’s ever an attempt to repeal EMTALA (the federal law mandating that emergency rooms treat patients regardless of ability to pay), you better believe that “people dying in the streets” will become an issue.

      About the only reason people aren’t in the streets right now is EMTALA. They know they can go to their local ER and get the care they need. Which, of course, is putting a tremendous stress on the nation’s ERs.Report

      • Avatar Koz in reply to Travis says:

        “If there’s ever an attempt to repeal EMTALA (the federal law mandating that emergency rooms treat patients regardless of ability to pay), you better believe that “people dying in the streets” will become an issue.”

        I have no doubt it will be an issue, it’s anybody’s guess how much traction that issue will have.Report

  6. Avatar Koz says:

    Federalism is quickly going out of style – ….

    In at least one context I’m a lot less federalist than I used to be. We definitely need the feds to crack the whip on the largely blue-state public-sector bloat. If California and Michigan are too big to fail we need to cut state employee pensions at least as much as UAW members.Report

    • Avatar Zach in reply to Koz says:

      We could just have the blue states keep the taxes they pay that subsidize the budgets of red states. That should hold most of them over for a long time. I get you on California, but Michigan’s per capita deficit isn’t all that bad. Looking at the data, current budget deficits seem to be correlated with the fraction of wealthy people in a state and not the largess of its welfare system. Obviously, California’s a totally different animal with the referendum system making reform impossible.Report

      • Avatar Mark Thompson in reply to Zach says:

        Do you have a link for this? As someone who likes to whine about regulatory capture, that strikes me as information that I need to have.Report

      • Avatar Jaybird in reply to Zach says:

        It’s always fun to see people come out and say “it’s my money, I shouldn’t have to watch the government spend it on other people!”Report

        • Avatar Zach in reply to Jaybird says:

          I don’t actually believe that this is a good idea; the point is that it’s a little odd to say the blue states are incredibly irresponsible when, in many red states, the difference between the money headed to DC and the money returned is greater than the entire state budget. Federal expenditures in Mississippi, for instance, are something like 20% of its GSP. If Mississippi received as much Federal spending as it paid in taxes, the state would need to more than triple the size of its budget to fill the gap. I don’t think it’s unreasonable to assume that all of this has a stabilizing effect on red state revenues and outlays during major recessions.

          Again, this is separate from the long-term insolvency facing California because of its immutable entitlements and citizens’ direct control over and refusal to raise revenues or cut spending. States such as Vermont and Oregon have generous social services and aren’t facing unreasonable deficits.Report

      • Avatar Koz in reply to Zach says:

        “We could just have the blue states keep the taxes they pay that subsidize the budgets of red states. “

        The blue states don’t subsidize the budgets of red states. It’s more plausible, as liberals sometimes argue, that blue state taxpayers subsidize federal government expenditures which go disproportionately to the red states.

        But the whole idea of “let’s keep our own money” is sort of ridiculous in the current environment considering the wide scope of federal responsibility.Report

  7. Avatar Rufus F. says:

    I spent my first 30 years in the US system and the last 5 in the Canadian system. The difference, so far, have been that there are less frills here. The waiting rooms are not as nice, my doctor doesn’t jawbone for thirty minutes about our lives, they don’t send you for unnecessary tests, and so forth. I’ll live. This year, I’ve been treated for both pneumonia and psoriasis, the care was excellent, and it cost me a total of $40.

    My conviction throughout this epic health care reform slog has been that the administration is going to totally screw this up now and the US is going to give up and adopt something like the Canadian system in about two decades time. Yes, doing it right this time would likely prevent that from happening, but that would require thinking more than a year into the future, and nobody in DC seems to be capable of that.Report

    • Avatar greginak in reply to Rufus F. says:

      First pneumonia then psoriasis, I hope psychosis isn’t next. Although psychokenesis would no doubt be cool.

      I don’t think you’ve been paying attention to the health care debate. It is axiomatic that only a free market health care system works. Your positive experience are clearly wrong, a national health program just cannot work.Report

  8. It looks like healthcare is a thorn in the Democrats’ side — or a pain in their arse.Report

  9. Avatar steve says:

    “Right now the only health costs that have gone down AND increased hugely in quality over time are Lasik eye surgery, Cosmetic surgery, and a few other things that are typically not covered by insurance.”

    These are procedures that meet the basic requirements for a free market approach, ie, both sides can walk away from the deal. You dont have to get a Lasik procedure or cosmetic surgery. Not so true for much of the rest of medicine. You can forego that emergency C-section because your wife is bleeding, but that has problems and results in other costs.

    SteveReport

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