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Sen. McCain has brain cancer

Wanting a healthcare reform that would result in rational incentives for consumers and providers and everybody in between, fostering greater competition, and (as such) lower pricing is simply not the same thing as "actively wanting fewer people covered."

You have to get past that thinking. I can't speak for the Koch Brothers, but I can speak for myself. And I can assure that you that I don't "actively want fewer people" with health insurance. I just have qualms with the way that you'd prefer going about that happening. In my mind, the best way to increase access to healthcare goods/services is for those people routinely buy to be affordable for the typical American consumer. Obviously, there will always be some goods/services which will be beyond our capacity to afford. And, for those things, an insurance model makes perfect sense. But not for everything -- and I'd say we can start there.

It's not an accident that, with very little in the way of subsidy or public policy involvement, we've been able to just about achieve "universal cellphone." That is to say, our national cellphone penetration rate is somewhere in the high 90% range. Why? Well, primarily because it's affordable. Is there some regulation there? Yeah, and that's OK. But the important lesson is that we've gotten that kind of "universal coverage" not because we've made it an entitlement, but because it's within most peoples' price range.

This doesn't mean that there's room for common ground on healthcare between, say, Rand Paul and Elizabeth Warren. But so what? There doesn't have to be in order to get a bipartisan national healthcare policy.

we already have universal coverage, which is why we need single payer. We pay infinetly more when people visit the ER because they do not have/can't pay a local doc. Unless you are prepared to start denying ER services?
 
It's not an accident that, with very little in the way of subsidy or public policy involvement, we've been able to just about achieve "universal cellphone." That is to say, our national cellphone penetration rate is somewhere in the high 90% range. Why? Well, primarily because it's affordable. Is there some regulation there? Yeah, and that's OK. But the important lesson is that we've gotten that kind of "universal coverage" not because we've made it an entitlement, but because it's within most peoples' price range.
I do recall a LOT of complaints from the right on "Obama phones", never mind the law to get phones to poor people was under Reagan and the law that added cell phone capability was under Bush 43. I believe there are 17 million "Obama phones" out there. That is a fair amount of the universal coverage.
 
we already have universal coverage, which is why we need single payer. We pay infinetly more when people visit the ER because they do not have/can't pay a local doc. Unless you are prepared to start denying ER services?

I'm pretty sure our options go beyond "something that resembles what we have now" and "single payer."

I think (I sound a bit like a broken record on this, I know) we should take some notes from what Singapore did. Everybody has an HSA they fund that is used to cover the vast majority of their healthcare expenses. Last I looked, something like 96% of all healthcare transactions (aside from retirees -- where they have something akin to Medicare) were funded by these accounts. And, rather than having something like Medicaid, they subsidize contributions into these accounts for low-income folks. Now, what they do for expenses beyond that is single-payer catastrophic insurance. Frankly, I wouldn't advocate that. I think it's perfectly reasonable (and, likely, better) that the catastrophic coverage be handled by private insurance. But I'd say it's pretty much neither here nor there as to why that basic arrangement seems to have produced desirable results.

The reason it has, I'd argue, is that consumers are properly placed in the mix and given all the right incentives. If somebody makes expensive choices and, as such, can reasonably expect higher healthcare expenses, they bear most of the burden of that. If somebody else makes more sensible choices and, as such, can reasonably expect lower healthcare expenses, they reap most of the benefit of that. That's a very good thing. But, in either case, they both have the benefit of a backstop for the big stuff.

I think this is the sort of direction we ought to consider heading. That doesn't mean every aspect of it, necessarily. But just the general framework. And, importantly, I think it offers room for bipartisan cooperation.
 
I do recall a LOT of complaints from the right on "Obama phones", never mind the law to get phones to poor people was under Reagan and the law that added cell phone capability was under Bush 43. I believe there are 17 million "Obama phones" out there. That is a fair amount of the universal coverage.

We have about 15 million more active cellphone accounts than we have citizens. And some 232 million citizens have accounts -- which is quite a bit considering young children, those who are in institutions of one kind or another, etc.

According to USAC's 2016 annual report, 11.45 million of the ~330 million active cellphone accounts in the US were LifeLine accounts.

I don't think I'd call that a "fair number." I'd call it a tiny minority of them -- about 3%, to be precise.
 
We have about 15 million more active cellphone accounts than we have citizens. And some 232 million citizens have accounts -- which is quite a bit considering young children, those who are in institutions of one kind or another, etc.

According to USAC's 2016 annual report, 11.45 million of the ~330 million active cellphone accounts in the US were LifeLine accounts.

I don't think I'd call that a "fair number." I'd call it a tiny minority of them -- about 3%, to be precise.

Here is where the discussion always hits the reef. Comparing healthcare to phones is difficult. If you had to buy a phone to save your live, you may not haggle quite as much. If you had to have a phone to eliminate the pain of a kidney stone, you may not haggle quite as much. If you had kidney stones I am skeptical you would wait on the great deal on Amazon to be shipped to you. When I had my attack, to change from phones to cars, I would have went across the street to the BMW dealer rather than drive 10 minutes to the Ford (or Chevy) and felt good about my decision.
 
Not only is the penalty very often significantly cheaper, the guaranteed issue and community rating provisions make it such that, if you ever need health insurance down the road, all you need to do is await an open enrollment period and, voila, you're good (and at roughly the same rate as you'd have been in had you always been insured, too!).
Yeah, right. You have a heart attack, you're going to wait for open enrollment? Car wreck? Tell the ambulance to take you home until you can sign up in November...

Of course, when the wife finds a lump in her breast, I'll tell her to hold off a few months and let it metastasize real good... make sure it's ripe...
 
Everybody has an HSA they fund that is used to cover the vast majority of their healthcare expenses. Last I looked, something like 96% of all healthcare transactions (aside from retirees -- where they have something akin to Medicare) were funded by these accounts.
Participation in (paying into) those HSAs is mandatory, isn't it?
I think it's perfectly reasonable (and, likely, better) that the catastrophic coverage be handled by private insurance. But I'd say it's pretty much neither here nor there as to why that basic arrangement seems to have produced desirable results.
It would have to be mandatory, wouldn't it? Or you just let 'em die if they don't buy it?

Bottom line is that guaranteed health care for all has to be paid for by all, albeit some to a greater or lesser extent depending on one's ability to pay. If the younger and healthier and wealthier chose not to, then it doesn't work.
 
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Yeah, right. You have a heart attack, you're going to wait for open enrollment? Car wreck? Tell the ambulance to take you home until you can sign up in November...

Of course, when the wife finds a lump in her breast, I'll tell her to hold off a few months and let it metastasize real good... make sure it's ripe...

Sounds like you want one of them socialist programs, ya bum. Why do we have to take care of you? This is my country, dammit
 
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I'm glad he's healthy enough to fly back. But to do so, in order to vote yes on this bill taking healthcare away from millions would be the height of hypocrisy right now. Hopefully he's going to vote no.
No such luck.
 
Sounds like you want one of them socialist programs, ya bum. Why do we have to take care of you? This is my country, dammit
I'm a baby boomer. We're the lazy, overweight, dim-witted ones who expect everything to be paid for by the following generations, remember?
 
Here is where the discussion always hits the reef. Comparing healthcare to phones is difficult. If you had to buy a phone to save your live, you may not haggle quite as much. If you had to have a phone to eliminate the pain of a kidney stone, you may not haggle quite as much. If you had kidney stones I am skeptical you would wait on the great deal on Amazon to be shipped to you. When I had my attack, to change from phones to cars, I would have went across the street to the BMW dealer rather than drive 10 minutes to the Ford (or Chevy) and felt good about my decision.

Relatively few situations calling for healthcare goods/services are genuinely urgent and/or life-or-death.

We can't turn the effects of market forces on or off based on our own preferences or out of convenience. There are reasons why healthcare has gotten stupid expensive. They aren't even all that difficult to understand, frankly. And the commonly expressed sentiment that technology is what has driven them so high doesn't bear a whole lot of scrutiny. There aren't too many industries and sectors that haven't been profoundly impacted by technology. And, in virtually every other case, the net effect of technology has been to reduce costs rather than explode them.
 
Relatively few situations calling for healthcare goods/services are genuinely urgent and/or life-or-death.

We can't turn the effects of market forces on or off based on our own preferences or out of convenience. There are reasons why healthcare has gotten stupid expensive. They aren't even all that difficult to understand, frankly. And the commonly expressed sentiment that technology is what has driven them so high doesn't bear a whole lot of scrutiny. There aren't too many industries and sectors that haven't been profoundly impacted by technology. And, in virtually every other case, the net effect of technology has been to reduce costs rather than explode them.
But the explanation I believe you will point to, insurance removing the consumer, does not make sense to me when we see how much more we pay than Europe or Japan where there is even less consumer power. That point, if it is yours, may have some validity. But the experience of the rest of the post-industrial world is there is far more at play.
 
Participation in (paying into) those HSAs is mandatory, isn't it?

Yes.

Bottom line is that guaranteed health care for all has to be paid for by all, albeit some to a greater or lesser extent depending on one's ability to pay. If the younger and healthier and wealthier chose not to, then it doesn't work.

Well, yeah, but the question really comes down to baseline responsibility. I mean, if somebody doesn't spend money for food or housing, then they're not going to have food or housing. But that doesn't mean that we need public policy dictating that people must spend X amount of money for food and housing.

Moreover, it's a misnomer to label what you're referring to as "guaranteed healthcare for all." Every kind of healthcare system necessarily features denials of requested service. This is precisely what I mean when I say that healthcare is fraught with all kinds of unrealistic demands and expectations -- which is a big reason why I think it's foolish for either political party to do anything which amounts to wholesale ownership of healthcare. It's been a political disaster for Democrats and will quickly become one for Republicans if they manage to get this bill into law.
 
But the explanation I believe you will point to, insurance removing the consumer, does not make sense to me when we see how much more we pay than Europe or Japan where there is even less consumer power. That point, if it is yours, may have some validity. But the experience of the rest of the post-industrial world is there is far more at play.

They do so at a cost, though. And I'm about 100% confident that the sorts of costs they endure to "enjoy" this are ones that the average American simply wouldn't abide. Public education offers a great case study along these lines. People gripe all the time about the quality of public education -- class sizes, facilities, teacher pay, etc. And the upshot of these gripes is pretty much always the same thing: more money. That's why our public education is (in many areas, certainly not universally) of dubious quality and (in virtually all places) no particular bargain.

Three things education and healthcare in America have in common are:

1) They are generally viewed as entitlements, if not rights
2) As such, they are both very heavily funded and controlled by government
3) They have both become unaffordably and unsustainably expensive

I don't think these things are coincidences.
 
Well, yeah, but the question really comes down to baseline responsibility. I mean, if somebody doesn't spend money for food or housing, then they're not going to have food or housing. But that doesn't mean that we need public policy dictating that people must spend X amount of money for food and housing.
That's just dumb. If I don't buy food I'll be hungry today. If I don't pay rent I'll be cold and wet today. But if I don't buy health insurance, I won't necessarily get sick today or even tomorrow. But when I do, I'm entitled to go to the emergency room and get the best care available. (Thanks Reagan.) If I don't buy food, I'm not entitled to walk into Jankos and get served if I can't pay for it.
Moreover, it's a misnomer to label what you're referring to as "guaranteed healthcare for all." Every kind of healthcare system necessarily features denials of requested service.
Okay, what kinds of care would you suggest we not provide? Marvin's knee, perhaps? Should he just man up and take some more Ibuprofen? It was good enough for my grandpa...
 
Relatively few situations calling for healthcare goods/services are genuinely urgent and/or life-or-death.

We can't turn the effects of market forces on or off based on our own preferences or out of convenience. There are reasons why healthcare has gotten stupid expensive. They aren't even all that difficult to understand, frankly. And the commonly expressed sentiment that technology is what has driven them so high doesn't bear a whole lot of scrutiny. There aren't too many industries and sectors that haven't been profoundly impacted by technology. And, in virtually every other case, the net effect of technology has been to reduce costs rather than explode them.
Every other developed country employs some form of "socialized medicine" to ensure that everyone gets quality health care, and their per capita costs are about half of ours. You claim this is unpossible, because [insert free market bromide]. Posts like this mostly prove that (1) people can succeed in business with only the most simplistic understanding of how markets work (or more importantly how they sometimes don't work); and (2) arguments against "socialized medicine" are most persuasive to people who know even less about health care policy than they know about market theory.

It'd be one thing if you honestly argued that we shouldn't do here what people successfully do everywhere else, because [conservative ideology]. But that's not what you do. Instead, you argue that what people successfully do everywhere else is unpossible, because [conservative ideology]. On this point you are not just wrong, but delusional.
 
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But that's not what you do. Instead, you argue that what people successfully do everywhere else is unpossible, because [conservative ideology].
I'm continually amazed at those who think free market principles can be applied to an unfree, broken market.

Yet people like crazed will then turn around and point to Singapore as a shining example, which mandates participation in HSPs. Free market??? Makes my head hurt.
 
I'm continually amazed at those who think free market principles can be applied to an unfree, broken market.

Yet people like crazed will then turn around and point to Singapore as a shining example, which mandates participation in HSPs. Free market??? Makes my head hurt.
crazed likes a piece or two of Singapore's system, but if you ask him (as I have) whether he'd like to see Singapore's system implemented here, he punts. (For the record, there are other systems I'd prefer to Singapore's, but I'd take Singapore's system over ours.) The main problem with crazed's hand-waving about Singapore is that you can't just pick the bits you do like and reject the bits you don't, because you need all the bits for a functioning system.

So, with Obamacare, almost everyone agrees that people with pre-existing conditions should be covered. But if you want that bit, then you need a requirement that everyone buy insurance, because otherwise insurance markets would fall apart, and no one would have coverage. But if you're going to mandate that people buy insurance, then you have to subsidize those who can't afford it. This isn't just the logic of Obamacare, it's the logic of every comprehensive health care system. (Oh, and by the way, like every other developed country, Singapore's government intervenes to control the prices that health care providers charge -- another thing that crazed claims is unpossible.)

Every comprehensive health care system in the world is some version of this basic three-legged stool. If you pull any one of the legs off, the stool falls over. Republicans don't care about this because they don't care about health care policy. They care about tax cuts. Everything else is bullshit.
 
Every comprehensive health care system in the world is some version of this basic three-legged stool. If you pull any one of the legs off, the stool falls over.
Of course. Which is why the Heritage Foundation laid it out that way.
Republicans don't care about this because they don't care about health care policy. They care about tax cuts. Everything else is bullshit.
If nothing else, the ACA has changed the landscape. It's now a given that pre-existing conditions have to be covered. What they (the Pubs) haven't figured out is how to pull that off without someone paying for it.

The sad thing is, the whole "health care system collapse" hysteria isn't real. The individual market is hurting, yes, and the policy requirements (pre-existing and no junk policies) have raised costs. But for the vast majority who get their health insurance through their employers, little has changed. Group plans have to take all comers, and most of them offered decent coverage.

It's the low wage, working class heroes (like myself) who don't have group coverage available who are over the barrel. Maybe I don't deserve it, but my wife has spent nearly all her working life in non-profit charities assisting the aged and infirm, and more recently providing direct assistance to dementia patients. People like her do deserve a break.
 
So, with Obamacare, almost everyone agrees that people with pre-existing conditions should be covered. But if you want that bit, then you need a requirement that everyone buy insurance, because otherwise insurance markets would fall apart, and no one would have coverage. But if you're going to mandate that people buy insurance, then you have to subsidize those who can't afford it. This isn't just the logic of Obamacare, it's the logic of every comprehensive health care system. (Oh, and by the way, like every other developed country, Singapore's government intervenes to control the prices that health care providers charge -- another thing that crazed claims is unpossible.)

Here's what is braindead about this. Why add in the profit margin for insurance companies when the govt can save tax payers money? Why are the Cons opposed to a government plan for all, with the option to purchase a private option for those who can afford it? That's how choice is supposed to work. Healthcare is already a basic right unless emergency rooms are turning people away, which I'm not aware of?

About free markets, there is no such thing. Truly free markets=monopoly. We should strive for competitive markets in all industries, many of which are currently duopolies. Competitive markets do not equal adam smith markets.

Whether everyone is covered or not covered, or there is insurance or a govt plan... none of this actually addresses the rising costs. Hospitals, pharma, treatment. No plan yet tackles the rising costs.

Currently there is a major profit incentive for prolonged treatment, not for preventive medicine and cures.
 
About free markets, there is no such thing. Truly free markets=monopoly. We should strive for competitive markets in all industries, many of which are currently duopolies. Competitive markets do not equal adam smith markets.
I agree with the thrust of your post, but to be pedantic, what economists call a "free market" would have no monopolists at all. Indeed, "free market" theory assumes that no one has any market power -- which is to say that no one has any influence over the prices they pay or the prices they charge, and all businesses operate at the barest margin over their costs necessary to attract sufficient capital to support the business.

I make this point because (as your post recognizes), very few markets in our modern economy even remotely resemble this idealized model from introductory economic textbooks -- a point which, by the way, introductory economics textbooks emphasize. Supposed "free market" enthusiasts have no understanding of the myriad ways in which actual markets differ from idealized markets. And they haven't a clue about how markets fail -- or even that they can fail -- so they're comically ill-equipped to talk about the inherently dysfunctional health care market. Instead, they spout platitudes that would earn them an F in an introductory macroeconomics course.
 
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I agree with the thrust of your post, but to be pedantic, what economists call a "free market" would have no monopolists at all. Indeed, "free market" theory assumes that no one has any market power -- which is to say that no one has any influence over the prices they pay or the prices they charge, and all businesses operate at the barest margin over their costs necessary to attract sufficient capital to support the business.

I make this point because (as your post recognizes), very few markets in our modern economy even remotely resemble this idealized model from introductory economic textbooks -- a point which, by the way, introductory economics textbooks emphasize. Supposed "free market" enthusiasts have no understanding of the myriad ways in which actual markets differ from idealized markets. And they haven't a clue about how markets fail -- or even that they can fail -- so they're comically ill-equipped to talk about the inherently dysfunctional health care market. Instead, they spout platitudes that would earn them an F in an introductory macroeconomics course.

that macro prof will tell you its BS

economy of scale exists. The more you produce the lower your cost+ barriers to entry.

I had an argument with an "anarcho capitalist" a few days ago. Scary shit.
 
that macro prof will tell you its BS

economy of scale exists. The more you produce the lower your cost+ barriers to entry.

I had an argument with an "anarcho capitalist" a few days ago. Scary shit.
Again, you're talking about what may be good for capitalists. I'm talking about what economists define as a free market. If anyone has market power, it's not a "free market". This remains true even if (in a particular sector in a particular place and time) economies of scale tend toward monopoly.

If circumstances are such that there is a "true monopoly" (think cable television), then the correct answer is to treat the resulting monopolies as public utilities (net neutrality). If the circumstances are otherwise, then the correct response is to break up the monopolies with antitrust or other laws.

But in no event does it make any sense to extol "free market" economic principles to defend markets where there is concentrated market power. This is a category error. Where there is unregulated monopoly there will inevitably be market dysfunction, and the owners of the unregulated monopolies will inevitably extract rents from everyone else, leading to a misallocation of resources (think health care).
 
I'm continually amazed at those who think free market principles can be applied to an unfree, broken market.

Yet people like crazed will then turn around and point to Singapore as a shining example, which mandates participation in HSPs. Free market??? Makes my head hurt.

There are several reasons why it's mandated:

1) It's too small a country that otherwise there would not be a critical mass.
2) Our 'social security' here is really a 'mandated' government held savings account -- where you get your money back after retirement with annualised interest. The mandated insurance comes out of your 'social security'. You can get private insurance on top of all this for better rooms at the hospital and more extensive coverage. (My philosophy is to eat right, drink more fluids, exercise five hours a week and have enough sex as possible and you can avoid a lot of the problems!!)
3) Due to the rapid ageing problem here, and the switch to chronic diseases as the major cause/cost of death, the cost has shifted rapidly into tertiary care -- so unless you are willing to let the citizens die (which becomes a moral and political challenge), the government will 'pick up the tab' especially at the tertiary care sector. Heading towards a universal healthcare platform. This has led to exponential growth in the Ministry of Health's budget -- and is expected to increase by 4 fold by 2028 from 2017.

Needless to say, there are serious concerns within the ecosystem and the multiple stakeholders including the various insurance companies.

My views and philosophy are that in order to bend the cost curve in the mid to long term, you need to address the patient care approach. Then add measurable, outcomes-based accountability up and down the stream.
Healthcare is currently driven by bureaucrats, politicians, actuarists/CFOs, technologists but not the clinicians. You can innovate with some expensive technologies like Big data, AI, cloud, robotics etc which do not look at the patient care itself but to look at quick wins albeit a marginal impact on the cost curve.

Its cart before the horse situation. So you can imagine what I think of Trump Care -- its just kicking the can down the road.... unless you want to get to that moral crossroad of letting people die as the rest of society watches on.
 
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I think conservatives fundamentally misunderstand the nature of people's interactions with health care providers.

The big deal is that people are to vulnerable to moral hazard, conservatives insist. If you subsidize a consumer product, then consumers will over-consume the subsidized product, thereby inflating the price of the subsidized product. This, conservatives say, is what's been going on since foolish liberals tried to help the elderly get coverage with the passage of Medicare. If only everyone bore their own costs (except for catastrophic events), then prices would be much lower.

Now, there are many problems with this misconception, but the one I want to talk about right now is the idea that subsidies will encourage over-consumption of health care services.

Anecdote​

Let's say I walk by the break room and see that there is "free" coffee and donuts today. This will substantially increase the likelihood that I'll have donuts and coffee.

Now let's say I drive by the hospital and see a big sign that says, "FREE COLONOSCOPIES!!!" Okay, well, I'm an old fart, and I'm probably due for a colonoscopy, so I probably ought to have one, and if I were smart I'd pull in and demand that they insert a large exploratory snake-like device deep into my colon. Yet somehow I suspect that's not what I'd do. ("Maybe I could get more coffee and donuts back at the office . . .")

Anecdote
Let's say a buddy has booked passage on a live-aboard dive trip in the Coral Sea that he can't make, so he offers me his airfare, room, board, and gear. If I can drag my big white ass back into a re-certification class, this will substantially increase the likelihood that I'll be sending you bitches unbelievable photos from places that won't be places any more when your kids can do that.

Now let's say that a buddy has been booked for quadruple-bypass surgery at a prestigious super-hospital, but he's decided that he'd rather become a Scientologist, so he offers me his space. ("Maybe I could get more coffee and donuts back at the office . . .") #leavingwhatagoodidea

Moral
Buying health care services is not like buying a new HDTV. Not only can you decide not to buy the HDTV, you actually want to buy the HDTV. Face it, it's hard not to buy the HDTV.

Meanwhile, I may need the colonosopy, but the real trick is persuading me to get one -- even with insurance and even though I need it. The real problem with healthcare is decidedly not that subsidizing my purchase of colonoscopies will ignite an inflationary spiral by inducing me to buy too many of them.
 
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I think conservatives fundamentally misunderstand the nature of people's interactions with health care providers.

The big deal is that people are to vulnerable to moral hazard, conservatives insist. If you subsidize a consumer product, then consumers will over-consume the subsidized product, thereby inflating the price of the subsidized product. This, conservatives say, is what's been going on since foolish liberals tried to help the elderly get coverage with the passage of Medicare. If only everyone bore their own costs (except for catastrophic events), then prices would be much lower.

Now, there are many problems with this misconception, but the one I want to talk about right now is the idea that subsidies will encourage over-consumption of health care services.

Anecdote​

Let's say I walk by the break room and see that there is "free" coffee and donuts today. This will substantially increase the likelihood that I'll have donuts and coffee.

Now let's say I drive by the hospital and see a big sign that says, "FREE COLONOSCOPIES!!!" Okay, well, I'm an old fart, and I'm probably due for a colonoscopy, so I probably ought to have one, and if I were smart I'd pull in and demand that they insert a large exploratory snake-like device deep into my colon. Yet somehow I suspect that's not what I'd do. ("Maybe I could get more coffee and donuts back at the office . . .")

Anecdote
Let's say a buddy has booked passage on a live-aboard dive trip in the Coral Sea that he can't make, so he offers me his airfare, room, board, and gear. If I can drag my big white ass back into a re-certification class, this will substantially increase the likelihood that I'll be sending you bitches unbelievable photos from places that won't be places any more when your kids can do that.

Now let's say that a buddy has been booked for quadruple-bypass surgery at a prestigious super-hospital, but he's decided that he'd rather become a Scientologist, so he offers me his space. ("Maybe I could get more coffee and donuts back at the office . . .") #leavingwhatagoodidea

Moral
Buying health care services is not like buying a new HDTV. Not only can you decide not to buy the HDTV, you actually want to buy the HDTV. Face it, it's hard not to buy the HDTV.

Meanwhile, I may need the colonosopy, but the real trick is persuading me to get one -- even with insurance and even though I need it. The real problem with healthcare is decidedly not that subsidizing my purchase of colonoscopies will ignite an inflationary spiral by inducing me to buy too many of them.
Good points. And the people that overconsume health care without a need are thought to have a psychiatric condition.

To be fair, I have encountered lonely elderly people who do things like going to the doctor for human interaction. We had them call the IRS when I worked there. It is sad. But I am not sure throwing everyone out of insurance is the solution.

Meanwhile the clinic down the road is having a half off on spleen removals so I am going to go give it a try.
 
Good points. And the people that overconsume health care without a need are thought to have a psychiatric condition.

To be fair, I have encountered lonely elderly people who do things like going to the doctor for human interaction. We had them call the IRS when I worked there. It is sad. But I am not sure throwing everyone out of insurance is the solution.

Meanwhile the clinic down the road is having a half off on spleen removals so I am going to go give it a try.
As you know, MtM, people in every other developed country see their doctors more often than we see ours, yet still they pay half as much. And we have more "skin in the game" than do those in every other developed country, yet we pay twice as much. You've posted these statistics before, but the people who need to know them still don't.

IMO, the real disconnect today isn't between left and right, but between who lives in objective reality and who doesn't. The ascension of Trump demonstrates how this has re-mapped the two major political parties.
 
To be fair, I have encountered lonely elderly people who do things like going to the doctor for human interaction. We had them call the IRS when I worked there. It is sad.
My wife used to run a small local United Way charity that helped the aged and infirm. Most of her clients were elderly homebound widows with mobility problems, and therefore had very little contact with the outside world. She would get calls regularly from people having "problems" with the wheelchair she'd provided, or with the taps in their accessible baths she'd arranged for, or whatever. Many times, when she showed up, she'd be greeted with tea and pastries; the wheelchair and the taps could wait. And it usually turned out there wasn't anything wrong with them.
 
My wife used to run a small local United Way charity that helped the aged and infirm. Most of her clients were elderly homebound widows with mobility problems, and therefore had very little contact with the outside world. She would get calls regularly from people having "problems" with the wheelchair she'd provided, or with the taps in their accessible baths she'd arranged for, or whatever. Many times, when she showed up, she'd be greeted with tea and pastries; the wheelchair and the taps could wait. And it usually turned out there wasn't anything wrong with them.

Thats why a lot of physical sickness of the elderly started from the psychological state of mind esp depression/loneliness.

What they do here in Singapore is to house the elderly in the lower floors of elderly designed public housing so that they hear sounds and smell of people and activities a couple of floors below.
 
I'm continually amazed at those who think free market principles can be applied to an unfree, broken market.

Yet people like crazed will then turn around and point to Singapore as a shining example, which mandates participation in HSPs. Free market??? Makes my head hurt.

Wait...when did I say that Singapore's healthcare system was a "free market"? It clearly isn't that and I never said it was.

For that matter, I've never even said it was precisely what I'd have us do. Rather, I think it's a general direction we ought to consider heading -- if for no other reason than it offers the possibility of common ground (which I think is very important).
 
So, you're okay with mandated participation in HSAs?
ISWYDT

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I'm pretty sure our options go beyond "something that resembles what we have now" and "single payer."

I think (I sound a bit like a broken record on this, I know) we should take some notes from what Singapore did. Everybody has an HSA they fund that is used to cover the vast majority of their healthcare expenses. Last I looked, something like 96% of all healthcare transactions (aside from retirees -- where they have something akin to Medicare) were funded by these accounts. And, rather than having something like Medicaid, they subsidize contributions into these accounts for low-income folks. Now, what they do for expenses beyond that is single-payer catastrophic insurance. Frankly, I wouldn't advocate that. I think it's perfectly reasonable (and, likely, better) that the catastrophic coverage be handled by private insurance. But I'd say it's pretty much neither here nor there as to why that basic arrangement seems to have produced desirable results.

The reason it has, I'd argue, is that consumers are properly placed in the mix and given all the right incentives. If somebody makes expensive choices and, as such, can reasonably expect higher healthcare expenses, they bear most of the burden of that. If somebody else makes more sensible choices and, as such, can reasonably expect lower healthcare expenses, they reap most of the benefit of that. That's a very good thing. But, in either case, they both have the benefit of a backstop for the big stuff.

I think this is the sort of direction we ought to consider heading. That doesn't mean every aspect of it, necessarily. But just the general framework. And, importantly, I think it offers room for bipartisan cooperation.


I've looked at the Singapore system. I don't understand why you believe it's really any fundamentally different than the ACA.

Almost all ACA plans are high-deductible, already. And a lot of employer based plans have been moving that direction anyway. I've had a HDHP w / HSA through my job for several years.

So, you want a high deductible system, with a govt subsidy, and (preferably private) universal catastrophic insurance. Doesn't that sound pretty familiar?

The reality is Singapore style would be a large shift leftward from the ACA.
 
I've looked at the Singapore system. I don't understand why you believe it's really any fundamentally different than the ACA.

Almost all ACA plans are high-deductible, already. And a lot of employer based plans have been moving that direction anyway. I've had a HDHP w / HSA through my job for several years.

So, you want a high deductible system, with a govt subsidy, and (preferably private) universal catastrophic insurance. Doesn't that sound pretty familiar?

The reality is Singapore style would be a large shift leftward from the ACA.

In the past Crazed has liked the fact that the Singapore system doesn't allow free healthcare, everyone has to make some form of payment. So even very poor people have to make a very small payment. He believes this prevents overuse.
 
In the past Crazed has liked the fact that the Singapore system doesn't allow free healthcare, everyone has to make some form of payment. So even very poor people have to make a very small payment. He believes this prevents overuse.

Not simply overuse, this puts consumers in the seat at the table they're supposed to be in...rather than instilling the mindset that their healthcare costs are some sort of shared burden (with the emphasis on the "shared" part). This encourages healthier lifestyle decisions, for one thing. It would also do a better job instilling something our healthcare system sorely lacks: competition (HBS' Michael Porter co-wrote a really good book a few years back discussing the lack of, and need for, competition in American healthcare).

FTR, I don't see Singapore's model as a panacea. I have my own set of qualms about it. But I do think it offers a place where we might actually find something else that's been sorely lacking: political common ground.
 
In the past Crazed has liked the fact that the Singapore system doesn't allow free healthcare, everyone has to make some form of payment. So even very poor people have to make a very small payment. He believes this prevents overuse.

Its means tested plus big programme for the elderly which makes its almost negligible.

As for treatments, we have two options -- private clinics (80% traffic) or we can go to gov't polyclinics (20%) which are extremely cheap because its highly subsidised -- for primary care.
Tertiary care, on the other hand, its 80% traffic into gov't hospitals and 20% private hospitals.

Most healthcare spendings are at the tertiary levels where the patients are more complex and are increasingly getting choked up by people going to A&E for treatment.
 
In the past Crazed has liked the fact that the Singapore system doesn't allow free healthcare, everyone has to make some form of payment. So even very poor people have to make a very small payment. He believes this prevents overuse.

I pay a little over $300/month for my health insurance. I've had health insurance, except for a couple of weeks here and there due to switching jobs, consistently for years. You put a gun to my head and I still couldn't tell you the last time I went to the doctor. This overuse argument is absolute BS. People aren't going to suddenly go to the doctor in droves because they have insurance. I'm not saying no one will go, I just don't think it will be this overwhelming flood of people.

And so what if more people go? How many times have you been to your doctor's office and not actually seen the MD, but saw the NP or PA instead? If more people do make appointments it could create a bigger demand for more NPs and PAs. These particular advanced degrees aren't as time consuming as medical school and they're a helluva lot cheaper.

Look at all the jobs the healthcare system has added since the creation of the ACA. You know, that job killing ACA.
 
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Not simply overuse, this puts consumers in the seat at the table they're supposed to be in...rather than instilling the mindset that their healthcare costs are some sort of shared burden (with the emphasis on the "shared" part). This encourages healthier lifestyle decisions, for one thing. It would also do a better job instilling something our healthcare system sorely lacks: competition (HBS' Michael Porter co-wrote a really good book a few years back discussing the lack of, and need for, competition in American healthcare).

FTR, I don't see Singapore's model as a panacea. I have my own set of qualms about it. But I do think it offers a place where we might actually find something else that's been sorely lacking: political common ground.

Thanks for the explanation, i saw you hadn't answered and wanted to try to present your opinion as well as I could. At least I didn't completely suck at it.

I will look up Porter's book. There are still consumers in healthcare, the employer. I know several physician groups in Bloomington have been forced out of IU's plan because they refused the rates Anthem set for them. Some were very large physician groups that caused significant disruption to the system. I know I switched PCP when the largest group at the time was forced out. I am not sure why Anthem telling physicians (or even better, medicare telling physicians) "we will only reimburse X" isn't considered a downward pressure on costs. I had an insurance statement lately where one test was $400, the allowable amount was $13. Granted that is anecdotal, but in that case it seems a consumer drove the price way down.
 
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