DavidTC: Oh, and I totally ignored this, but you do realize that blaming a bunch of costs on insurance-required bureaucracy and then asserting that insurance could cover things is nonsensical.
It is trivially possible to get rid of the insurance bureaucracy if we'd just use insurance the way it's supposed to be used, i.e. to spread risk, as opposed to cover costs (and yes, the gov forces them to cover costs by regulating what types they can and can not sell and by making them cover things which everyone will run into).
Home Insurance is cheap, if you want to make it seriously expensive then force it to cover the cost of every changed lightbulb, you'll instantly have people checking to see if you bought the lightbulb, or have to hire people to install it for you. Then we'll have the insurance company making deals with the installers and so forth.
Similarly Home Fire Insurance would be murderously expensive and complex if you could buy it after your house has already burned down (i.e. no 'preexisting conditions').
If it's something that I have a 100% chance of needing (vaccinations), then insurance shouldn't be covering it. Either I should pay for it out of my own pocket (btw I'm strongly pro-vac), or, if we as a society decide we want to force everyone to do this (probably a good idea), then it's a good use for gov dollars.
Insurance is for things you *don't* run into every month, year, or even decade which break your bank if you do (and our example here was cancer so it qualifies).
The illusion that a 3rd party pays is one of the roots of how medicine has gotten so expensive, probably the best way to deal with that is Health Savings Accounts with insurance limited to just major medical.
Don Zeko:
Isn’t “using the power of the government to force other people to do something they otherwise wouldn’t” what every government everywhere does? Enforcing criminal law means forcing people not to rob and murder their neighbors.
Enforcement of any law can result in an agent of the state putting a gun to someone's head. There are times where that is the best solution, but there are few instances which have that moral clarity.
Lots of laws are passed in the effort to make people live their lives differently, but the gov is a gun, not a magic wand.
Having said that, I think it's possible, but we're not in enough pain. When the budget breaks we'll have to clean house, then we might see big time reform which priorities growth and sharply reduces gov meddling.
In practice, Parliamentary systems don’t overreach to the extent you are thinking.
How many European Parliamentary governments spend more of their GDP than we do? I think all but Switzerland, and that's without subtracting the GDP we spend on the military.
Granted it's not "one election", more like "one new massive entitlement per election", but also keep in mind the Dems were willing to put in place the ACA thinking it'd be popular no matter how unpopular it was... and because they knew (or believed) it'd be impossible to remove.
From that point forward, anyone trying to get control of ACA spending, no matter how budget breaking it is, is going to be accused of literally killing little old ladies. And, to be fair, that will be correct.
RE: Defense spending being 4% of GDP.
In 1960 it was more like 10%, basically it's been a linear line down with blips up for the wars.
http://www.usgovernmentspending.com/defense_spending
the current medical American system is so massively cost-inefficient in comparison that they could probably afford that pretty easily without that much strain to the tax base.
When we've tried this at a state level, the result has been costs explode until the budget breaks. What we got with the ACA was insurance reform, what we needed was cost of medicine reform.
The thing about a Parliamentary system is winning one election is enough to put into place whatever plan you want, there's no gridlock built into the system.
Se we would have followed Europe's lead in the 60's and 70's and built up these huge growth choking entitlement systems which are impossible to remove. Thus our average income would be a lot lower than it is now, and we probably would have dismantled the army a while ago.
To be fair, we're basically there now, it just took 40 years longer.
So... ouch. No 'super-power' army means lots more regional battles. No clue what that would mean for the middle East, or the countries bordering Russia, but probably bad things.
Chip Daniels: Markets do some things very well, but most often they do them well by excluding nonpaying customers from the market.
Yes, agreed.
Chip Daniels: Healthcare is rather unique in that we declare, as a matter of principle, that there are no exclusions to health care based on price.
That's an idea we need to stare down and get rid of. First, because it's not true anywhere, every society and system puts an upper limit on total health care dollars and society itself doesn't even have an infinite amount of resources.
Second because the cost of making us all equal means getting rid of future lifesaving medical treatments. New medical treatments become cheaper over time, normally much cheaper.
And, if we stare down the concept that we're going to give everyone in society a blank check, then we can have a sensible discussion about how to maximize health, including future-health.
Dark Matter: What they’re missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government’s “help” and mandates.
DavidTC: I have no idea what you’re talking about. There *are* multiple massive bureaucracies in healthcare sucking up all the money. I agree entirely. The problem is…these don’t exist because of the government.
We have massive government bureaucracies and regulation in creating all of the tools any medical personal use, in the drugs, in the education of the various medical personal, in the regulation of everyone involved, and yes, in the various lawsuits which spring up as lawyers look for billiables.
And yes, on top of that we have insurance companies, hospitals themselves, and any company over a certain size which has it's own bureaucracy. Anything which has anything to do with 'compliance', regulation, the law, or protecting yourself from a lawsuit ultimately goes back to the gov.
Dark Matter: Here’s another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication.
DavidTC: You do realize that most Americans cannot afford a random $10,000 expense, right?
Even with Credit Cards, bank loans, & insurance? Better question, how much do you pay for insurance right this moment? If you have a family, it's probably more. Even if it's through your employer, it being hidden doesn't mean it's less.
Great! So what gov program do you plan to cut to pay for that? Nothing? Every dollar the gov currently spends is absolutely critical? What about all the money that was supposed to be saved from the ACA? Or from ending the wars? Or how about the stimulus? Isn't the economy just humming along now and pumping up revenues?
There's always a good reason to raise taxes and get something. Similarly whenever there are local cuts, it's always either law enforcement or the football program which is held for ransom.
If pre-K is actually important, then evaluate everything the gov does and decide where the fat is (actually that's a good idea anyway)... except that never happens. Every program gains defenders and then it's written in stone, and as the gov consumes more and more of the GDP, our growth rate goes down.
We never eliminate programs, the gov and it's bureaucracy just grow and need more money.
And btw each of my kids had two years of pre-k for less than a fifth of what the gov supplies per pupil in elementary school.
In an emergency people need medical help immediately and other times they aren’t going to go to many different doctors to determine the best course of action.
Even ignoring the growth in 'immediate care' facilities (which might be local). How much of medical expenses are because of "emergencies"?
Further, one of the big problems with "comparison shopping" currently is it's basically impossible. The numbers are buried, difficult or impossible to find, and so forth. Imagine going to a food store where none of the products were labeled and the bill was sent to some 3rd party and not itemized.
This sounds like an invitation to being ripped off, but instead of dealing with that we object to the idea of making comparisons.
If we valued dog lives the way we value human lives then the market would indeed research and develop medical care for dogs that would be both highly efficacious and highly expensive. We don’t, so it hasn’t.
This is claiming that expensive cancer drugs don't exist (which is fine), but their radiology treatments were pretty in line with everything else.
The majority of our healthcare money is being spent on care for elderly upper middle income people (not rich people necessarily though they’re in there too- there’s just not numerically enough of them). Oh and we’re spending a vast amount of it on elderly people.
Agreed, if memory serves something like half your lifetime expenditure of HC happens in the last 18 months of life.
Which is why I think, if we're going to have gov supplied HC which we clearly are, we desperately need death panels or something similar.
But Congress, by whatever name we want to call them (UHC, ACA, etc) is amazingly ill suited to do anything to control these costs.
greginak:
Or we could look at the many examples of other countries that provide universal care and have good outcomes.
There are issues.
1) As far as I can tell, UHC doesn't make things cheaper, they control things via rationing (which is fine... if we can reasonably expect Congress to kill little old ladies by withholding care).
2) UHC somewhat decently holds prices in check, but it's never been known to reduce prices. If we're going to reduce prices then we need a lot more disruption than that.
3) Most UHC comparisons include "equality" and parts of our population don't (or at least didn't) have access to HC (maybe the ACA changed that).
4) UHC comparisons never adjust for our population being fatter and more murderous.
5) I talk with a lot of immigrants who grew up under UHC, and needing to bribe the doctor so you can see him is maybe an experience I can skip.
He already announced his judge pick list, that's going to make it hard to back out. The Right made WBush back down on his choice and go with their guy.
Having said that, if the GOP loses the Senate then all bets are off. Mr. Make-a-deal will make a deal with whoever is in charge.
...the general public’s unwillingness to let the poor die of treatable illnesses.
Resources are not unlimited, this is health care, people are going to die. If you want to call $100k a year a "treatable" illness then you're killing the ones who need $500k. If you call $500k treatable then we can take it to $5Million.
“Cash on the barrelhead or die” is, indeed, the free market approach to healthcare.
Charities have always existed, if healthcare were cheap it wouldn't be as big a deal.
People are going to die, no matter what system we use. The real question is whether we could save more people (and if they'd be better off) in a free market where the costs were 20x lower.
If the dog comparison is accurate, we're spending more than 90% of our healthcare dollar on overhead. Bureaucrats dealing with other bureaucrats. IMHO this is not value added, and that money would be much better spent on healthcare.
Republicans, according to Dark Matter, appear to have some sort of ADD or memory-based disability, and literally cannot remember basic economic concepts presented by the Republican party until someone reminds them!
It's a lot easier to remember the last 6 times you bought a "wonderful" used car from that salesman it turned out to be a lemon (and 'free isn't free') than to become a mechanic.
I expect most people (of either party) can't balance their checkbook and basic econ is way beyond them.
Bern's followers were mostly young, because if they were older they'd know better. 'If you're not a liberal when you're 25, you have no heart. If you're not a conservative by the time you're 35, you have no brain.' (Falsely attributed to Churchill)
Do you mean the system where, when a quarter of the population inevitably gets cancer, we let almost all of them just die instead of trying to treat it?
Cost to treat cancer in a dog via Chemo: Between $6k and $10k (and that's the entire cost).
https://www.petcarerx.com/article/managing-costs-of-cancer-treatment-for-dogs/1232
Here's another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication. http://www.dogster.com/lifestyle/10-things-dog-cancer
What they're missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government's "help" and mandates.
Reduce the cost of health care by 10x or 20x and suddenly far more people can afford it, and we as a society can afford to treat most people if not everyone.
From what I understand, Asian-Americans have gone from being Republican friendly to also being part of the Democratic Party very firmly because they see the GOP as being unfriendly to people of color.
Sure, absolutely, probably because the Moats! wing of the GOP is unfriendly to people of color.
But we're talking about Affirmative Action, which in California is banned. And the Dems, even with an unhealthy level of control, can't get that ban overturned. And the reason they can't overturn that ban is because the Asians won't cooperate.
Yet the GOP seems unable to see if this small little piece of advice because they might sincerely (but IMO wrongly) see affirmative action programs as racist.
Elsewhere on this page we go into what "affirmative action" does to Asians, i.e. holding them to a much higher standard because we need to keep their numbers in college down. I don't see how we can call that anything other than 'racist'.
I had high hopes for Arnold to be able to start bridging the divide, but in hindsight (even if Arnold had had the combined political acumen of Bill Clinton and Dick Cheney), I don’t think it could have been possible. Would the CA GOP of the time sign off to policies that had the assent of the CA Dems?
California needs policies which would have resulted in Arnold being hated, aka Scott Walker. He decided he didn't want that.
*Comment archive for non-registered commenters assembled by email address as provided.
On “The Catwalk to Citizenship”
"“Show me the man, and I’ll show you the crime.”"
- Lavrentiy Beria, head of Joseph Stalin’s secret police
http://quozio.com/quote/50853188#!t=1015
On “Will Wilkison: How political idealism leads us astray”
Seriously sounds like a Philosophy major... almost no practical words in there in terms of what to do.
Looking him up.... yep. Philosophy major
https://en.wikipedia.org/wiki/Will_Wilkinson
On “This Party Cannot Be Saved”
@davidtc
It is trivially possible to get rid of the insurance bureaucracy if we'd just use insurance the way it's supposed to be used, i.e. to spread risk, as opposed to cover costs (and yes, the gov forces them to cover costs by regulating what types they can and can not sell and by making them cover things which everyone will run into).
Home Insurance is cheap, if you want to make it seriously expensive then force it to cover the cost of every changed lightbulb, you'll instantly have people checking to see if you bought the lightbulb, or have to hire people to install it for you. Then we'll have the insurance company making deals with the installers and so forth.
Similarly Home Fire Insurance would be murderously expensive and complex if you could buy it after your house has already burned down (i.e. no 'preexisting conditions').
If it's something that I have a 100% chance of needing (vaccinations), then insurance shouldn't be covering it. Either I should pay for it out of my own pocket (btw I'm strongly pro-vac), or, if we as a society decide we want to force everyone to do this (probably a good idea), then it's a good use for gov dollars.
Insurance is for things you *don't* run into every month, year, or even decade which break your bank if you do (and our example here was cancer so it qualifies).
The illusion that a 3rd party pays is one of the roots of how medicine has gotten so expensive, probably the best way to deal with that is Health Savings Accounts with insurance limited to just major medical.
And I'll answer your other post later.
On “What Would a Parliamentary System Look Like in the US?”
Enforcement of any law can result in an agent of the state putting a gun to someone's head. There are times where that is the best solution, but there are few instances which have that moral clarity.
Lots of laws are passed in the effort to make people live their lives differently, but the gov is a gun, not a magic wand.
On “This Party Cannot Be Saved”
:Amusement: That is the problem, well put.
Having said that, I think it's possible, but we're not in enough pain. When the budget breaks we'll have to clean house, then we might see big time reform which priorities growth and sharply reduces gov meddling.
On “What Would a Parliamentary System Look Like in the US?”
How many European Parliamentary governments spend more of their GDP than we do? I think all but Switzerland, and that's without subtracting the GDP we spend on the military.
Granted it's not "one election", more like "one new massive entitlement per election", but also keep in mind the Dems were willing to put in place the ACA thinking it'd be popular no matter how unpopular it was... and because they knew (or believed) it'd be impossible to remove.
From that point forward, anyone trying to get control of ACA spending, no matter how budget breaking it is, is going to be accused of literally killing little old ladies. And, to be fair, that will be correct.
RE: Defense spending being 4% of GDP.
In 1960 it was more like 10%, basically it's been a linear line down with blips up for the wars.
http://www.usgovernmentspending.com/defense_spending
When we've tried this at a state level, the result has been costs explode until the budget breaks. What we got with the ACA was insurance reform, what we needed was cost of medicine reform.
On “This Party Cannot Be Saved”
I left out a few other sacred cows. "It's for the children" is another really popular one.
On “What Would a Parliamentary System Look Like in the US?”
Oh I wish. At this point it'd probably have to be his VP, but that would work.
Problem is I don't believe it short of him faking (or having) a heart attack.
"
The thing about a Parliamentary system is winning one election is enough to put into place whatever plan you want, there's no gridlock built into the system.
Se we would have followed Europe's lead in the 60's and 70's and built up these huge growth choking entitlement systems which are impossible to remove. Thus our average income would be a lot lower than it is now, and we probably would have dismantled the army a while ago.
To be fair, we're basically there now, it just took 40 years longer.
So... ouch. No 'super-power' army means lots more regional battles. No clue what that would mean for the middle East, or the countries bordering Russia, but probably bad things.
On “This Party Cannot Be Saved”
Very good. I think the formerly communist countries would be 2nd world.
In the 1st world, with total anti-corruption... they just wouldn't be able to see a doctor in anything like a reasonable amount of time.
"
Chip Daniels: Markets do some things very well, but most often they do them well by excluding nonpaying customers from the market.
Yes, agreed.
Chip Daniels: Healthcare is rather unique in that we declare, as a matter of principle, that there are no exclusions to health care based on price.
That's an idea we need to stare down and get rid of. First, because it's not true anywhere, every society and system puts an upper limit on total health care dollars and society itself doesn't even have an infinite amount of resources.
Second because the cost of making us all equal means getting rid of future lifesaving medical treatments. New medical treatments become cheaper over time, normally much cheaper.
And, if we stare down the concept that we're going to give everyone in society a blank check, then we can have a sensible discussion about how to maximize health, including future-health.
"
We have massive government bureaucracies and regulation in creating all of the tools any medical personal use, in the drugs, in the education of the various medical personal, in the regulation of everyone involved, and yes, in the various lawsuits which spring up as lawyers look for billiables.
And yes, on top of that we have insurance companies, hospitals themselves, and any company over a certain size which has it's own bureaucracy. Anything which has anything to do with 'compliance', regulation, the law, or protecting yourself from a lawsuit ultimately goes back to the gov.
Even with Credit Cards, bank loans, & insurance? Better question, how much do you pay for insurance right this moment? If you have a family, it's probably more. Even if it's through your employer, it being hidden doesn't mean it's less.
"
Great! So what gov program do you plan to cut to pay for that? Nothing? Every dollar the gov currently spends is absolutely critical? What about all the money that was supposed to be saved from the ACA? Or from ending the wars? Or how about the stimulus? Isn't the economy just humming along now and pumping up revenues?
There's always a good reason to raise taxes and get something. Similarly whenever there are local cuts, it's always either law enforcement or the football program which is held for ransom.
If pre-K is actually important, then evaluate everything the gov does and decide where the fat is (actually that's a good idea anyway)... except that never happens. Every program gains defenders and then it's written in stone, and as the gov consumes more and more of the GDP, our growth rate goes down.
We never eliminate programs, the gov and it's bureaucracy just grow and need more money.
And btw each of my kids had two years of pre-k for less than a fifth of what the gov supplies per pupil in elementary school.
"
Even ignoring the growth in 'immediate care' facilities (which might be local). How much of medical expenses are because of "emergencies"?
Further, one of the big problems with "comparison shopping" currently is it's basically impossible. The numbers are buried, difficult or impossible to find, and so forth. Imagine going to a food store where none of the products were labeled and the bill was sent to some 3rd party and not itemized.
This sounds like an invitation to being ripped off, but instead of dealing with that we object to the idea of making comparisons.
"
This is claiming that expensive cancer drugs don't exist (which is fine), but their radiology treatments were pretty in line with everything else.
Agreed, if memory serves something like half your lifetime expenditure of HC happens in the last 18 months of life.
Which is why I think, if we're going to have gov supplied HC which we clearly are, we desperately need death panels or something similar.
But Congress, by whatever name we want to call them (UHC, ACA, etc) is amazingly ill suited to do anything to control these costs.
"
There are issues.
1) As far as I can tell, UHC doesn't make things cheaper, they control things via rationing (which is fine... if we can reasonably expect Congress to kill little old ladies by withholding care).
2) UHC somewhat decently holds prices in check, but it's never been known to reduce prices. If we're going to reduce prices then we need a lot more disruption than that.
3) Most UHC comparisons include "equality" and parts of our population don't (or at least didn't) have access to HC (maybe the ACA changed that).
4) UHC comparisons never adjust for our population being fatter and more murderous.
5) I talk with a lot of immigrants who grew up under UHC, and needing to bribe the doctor so you can see him is maybe an experience I can skip.
"
He already announced his judge pick list, that's going to make it hard to back out. The Right made WBush back down on his choice and go with their guy.
Having said that, if the GOP loses the Senate then all bets are off. Mr. Make-a-deal will make a deal with whoever is in charge.
"
@north
Hillary isn't going to put a hard pro-life judge on the Supreme Court, Trump will.
"
@morat20
Resources are not unlimited, this is health care, people are going to die. If you want to call $100k a year a "treatable" illness then you're killing the ones who need $500k. If you call $500k treatable then we can take it to $5Million.
Charities have always existed, if healthcare were cheap it wouldn't be as big a deal.
People are going to die, no matter what system we use. The real question is whether we could save more people (and if they'd be better off) in a free market where the costs were 20x lower.
If the dog comparison is accurate, we're spending more than 90% of our healthcare dollar on overhead. Bureaucrats dealing with other bureaucrats. IMHO this is not value added, and that money would be much better spent on healthcare.
"
@davidtc
It's a lot easier to remember the last 6 times you bought a "wonderful" used car from that salesman it turned out to be a lemon (and 'free isn't free') than to become a mechanic.
I expect most people (of either party) can't balance their checkbook and basic econ is way beyond them.
Bern's followers were mostly young, because if they were older they'd know better. 'If you're not a liberal when you're 25, you have no heart. If you're not a conservative by the time you're 35, you have no brain.' (Falsely attributed to Churchill)
"
@davidtc
Cost to treat cancer in a dog via Chemo: Between $6k and $10k (and that's the entire cost).
https://www.petcarerx.com/article/managing-costs-of-cancer-treatment-for-dogs/1232
Here's another example: Dolly’s care cost around $10,000 for all tests, surgeries, radiation therapy treatments, and medication. http://www.dogster.com/lifestyle/10-things-dog-cancer
What they're missing is the multiple massive bureaucracies which only exist to deal with other massive bureaucracies, all created because of the government's "help" and mandates.
Reduce the cost of health care by 10x or 20x and suddenly far more people can afford it, and we as a society can afford to treat most people if not everyone.
"
@saul-degraw
Sure, absolutely, probably because the Moats! wing of the GOP is unfriendly to people of color.
But we're talking about Affirmative Action, which in California is banned. And the Dems, even with an unhealthy level of control, can't get that ban overturned. And the reason they can't overturn that ban is because the Asians won't cooperate.
http://www.slate.com/articles/news_and_politics/jurisprudence/2014/03/california_affirmative_action_ban_why_liberals_should_let_it_stand.html
"
@saul-degraw
Elsewhere on this page we go into what "affirmative action" does to Asians, i.e. holding them to a much higher standard because we need to keep their numbers in college down. I don't see how we can call that anything other than 'racist'.
"
@gabriel-conroy
RE: ACA
If you want to look at what how an actual free market would function for healthcare, examine the HC system we have for dogs.
"
@j_a
California needs policies which would have resulted in Arnold being hated, aka Scott Walker. He decided he didn't want that.
*Comment archive for non-registered commenters assembled by email address as provided.