Not in law yet, and costs already rising for ObamaCare?

[c1ue]

http://news.yahoo.com/s/ap/20100423/...care_law_costs

WASHINGTON – President Barack Obama's health care overhaul law is getting a mixed verdict in the first comprehensive look by neutral experts: More Americans will be covered, but costs are also going up.
Economic experts at the Health and Human Services Department concluded in a report issued Thursday that the health care remake will achieve Obama's aim of expanding health insurance — adding 34 million to the coverage rolls.
But the analysis also found that the law falls short of the president's twin goal of controlling runaway costs, raising projected spending by about 1 percent over 10 years. That increase could get bigger, since Medicare cuts in the law may be unrealistic and unsustainable, the report warned.
It's a worrisome assessment for Democrats.
In particular, concerns about Medicare could become a major political liability in the midterm elections. The report projected that Medicare cuts could drive about 15 percent of hospitals and other institutional providers into the red, "possibly jeopardizing access" to care for seniors.
The report from Medicare's Office of the Actuary carried a disclaimer saying it does not represent the official position of the Obama administration. White House officials have repeatedly complained that such analyses have been too pessimistic and lowball the law's potential to achieve savings.
The report acknowledged that some of the cost-control measures in the bill — Medicare cuts, a tax on high-cost insurance and a commission to seek ongoing Medicare savings — could help reduce the rate of cost increases beyond 2020. But it held out little hope for progress in the first decade.
"During 2010-2019, however, these effects would be outweighed by the increased costs associated with the expansions of health insurance coverage," wrote Richard S. Foster, Medicare's chief actuary. "Also, the longer-term viability of the Medicare ... reductions is doubtful." Foster's office is responsible for long-range costs estimates.
Republicans said the findings validate their concerns about Obama's 10-year, nearly $1 trillion plan to remake the nation's health care system.
"A trillion dollars gets spent, and it's no surprise — health care costs are going to go up," said Rep. Dave Camp, R-Mich., a leading Republican on health care issues. Camp added that he's concerned the Medicare cuts will undermine care for seniors.
In a statement, HHS Secretary Kathleen Sebelius sought to highlight some positive findings for seniors. For example, the report concluded that Medicare monthly premiums would be lower than otherwise expected, due to the spending reductions.
"The Affordable Care Act will improve the health care system for all Americans, and we will continue our work to quickly and carefully implement the new law," the statement said.
Passed by a divided Congress after a year of bitter partisan debate, the law would create new health insurance markets for individuals and small businesses. Starting in 2014, most Americans would be required to carry health insurance except in cases of financial hardship. Tax credits would help many middle-class households pay their premiums, while Medicaid would pick up more low-income people. Insurers would be required to accept all applicants, regardless of their health.
The U.S. spends $2.5 trillion a year on health care, far more per person than any other developed nation, and for results that aren't clearly better when compared to more frugal countries. At the outset of the health care debate last year, Obama held out the hope that by bending the cost curve down, the U.S. could cover all its citizens for about what the nation would spend absent any changes.
The report found that the president's law missed the mark, although not by much. The overhaul will increase national health care spending by $311 billion from 2010-2019, or nine-tenths of 1 percent. To put that in perspective, total health care spending during the decade is estimated to surpass $35 trillion.
Administration officials argue the increase is a bargain price for guaranteeing coverage to 95 percent of Americans. They also point out that the law will decrease the federal deficit by $143 billion over the 10-year period.
The report's most sober assessments concerned Medicare.

In addition to flagging provider cuts as potentially unsustainable, the report projected that reductions in payments to private Medicare Advantage plans would trigger an exodus from the popular alternative. Enrollment would plummet by about 50 percent. Seniors leaving the private plans would still have health insurance under traditional Medicare, but many might face higher out-of-pocket costs. In another flashing yellow light, the report warned that a new voluntary long-term care insurance program created under the law faces "a very serious risk" of insolvency.

[Ghent12]

Re: Not in law yet, and costs already rising for ObamaCare?

Wait a second. Are you telling me that forcing me to pay a third-party that will pay for my aspirin and annual physical check-ups does not, in fact, reduce their cost to me? You mean third-party services actually add cost to the equation? Oh man, who would have known?

Are you also saying that an increase in demand leads to an increase in price? Those old laws of economics still work?

c1ue, I know you don't support the ObamaCare approach and, if I remember correctly, you support a third-party pay system using only the government. It seems, however, that all evidence points to the fact that third-party systems which pay for everything inevitably raise costs or lower quality or both. Real insurance is good, but that has long-since been replaced by "insurance" thanks to tax policies. Why the resistance to the fundamental force of the market on health care? That same force has had substantially positive effects not only on health care in the distant past, but also in one degree or another on the other 'essentials' such as food, clothing, and shelter. In fact, especially in the food and shelter categories, it is the influence of third-party factors (especially the government and the FED) which vastly distorts pricing, availability, and value.

[c1ue]

Re: Not in law yet, and costs already rising for ObamaCare?

Wait a second. Are you telling me that forcing me to pay a third-party that will pay for my aspirin and annual physical check-ups does not, in fact, reduce their cost to me? You mean third-party services actually add cost to the equation? Oh man, who would have known?

Are you also saying that an increase in demand leads to an increase in price? Those old laws of economics still work?

c1ue, I know you don't support the ObamaCare approach and, if I remember correctly, you support a third-party pay system using only the government. It seems, however, that all evidence points to the fact that third-party systems which pay for everything inevitably raise costs or lower quality or both. Real insurance is good, but that has long-since been replaced by "insurance" thanks to tax policies. Why the resistance to the fundamental force of the market on health care? That same force has had substantially positive effects not only on health care in the distant past, but also in one degree or another on the other 'essentials' such as food, clothing, and shelter. In fact, especially in the food and shelter categories, it is the influence of third-party factors (especially the government and the FED) which vastly distorts pricing, availability, and value.

G,

The reason I support having a government operated health care supply system as a safety net - NOT as the exclusive health care supply provider - is that health care is not a free market type good.

A free market presumes the ability to forgo the good/service.

There are many such categories: national defense, public utilities, regulation, etc etc.

If I use public utilities as an example: sure, theoretically competing electricity providers might be able to give you lower electricity costs. But is this worth trying given the massive investment needed for grid building/maintenance?

Furthermore while I have no issue with independent entities offering a better service/good for a better price - with health care you have neither the luxury of opting out, nor the price transparency, nor the ability to predict cost on an individual basis.

The present system is furthermore already skewed by the insurance companies: everyone knows that they might 'win' the health care lottery by catchng something prohibitively expensive, thus must buy insurance. If this is such a simple actuarial equation, then what benefit is having a private company or companies provide this? The 3rd parties are already with us.

Lastly health care is very much in line with public education. Love it or hate it, public education increases the base level of capability of the population despite likely segments of said population losing overall lifetime earnings.

Equally so, health care at all stages of life is equally a public good which enables a higher base level of productivity for the general population.

Obamacare is an abomination because it solves almost nothing:

1) It does remove some of the more egregious example of insurance company profiteering, but it does nothing to either offer a safety net alternative outside government buying private insurance.

Why can't the government just offer a bare bones insurance package if that's really all that is needed? Or sponsor a USAA type entity?

2) It doesn't address the health care provider side.

There is no price transparency.
There is no objective evaluation of performance nor efficacy.
There is not even official regulation of medical practice - it is all 'self monitored'

3) Obamacare also fails to completely address the public good issue. There are no standards for what should constitute minimum acceptable care.

[Rajiv]

Re: Not in law yet, and costs already rising for ObamaCare?

Ghent,

The problem in part has to do with the increasing disparities in income that have ocurred over the last thirty years as discussed elsewhere in these threads.

Due to various reasons, the ascendency of FIRE among others, has caused the cost of medical care to go up disproprtionately compared to other costs. Further the tremendous decline in real income that has occurred for 90% of the population has pushed the cost of medical care beyond the reach of at least 50% of the population, and an increasing stretch for the remaining 40% (of the 90%.)

So my belief is that without a mechanism for somebody to pay that additional burden, most in this country would be given very poor healthcare if left to market forces alone. Already many physicians are threatening to leave the work force if there is any reduction in their real incomes.

[don]

Re: Not in law yet, and costs already rising for ObamaCare?

Health-care costs are going up?

When did they stop going up?

Did I miss the moment?

Was the Health-care industry's lobbying millions wasted...or rewarded?

A real puzzler. :rolleyes:

[Ghent12]

Re: Not in law yet, and costs already rising for ObamaCare?

c1ue, I agree with all points except your definition of health care being outside the realm of a free market type good. Your definition that one must be able to forgo the good/service is either applied incorrectly or not applicable, in my view. In the most theoretically pure sense, it is a matter of supply and demand. One cannot go without food, but one can choose to never buy fish from the fisherman, or to choose fish from among multiple different fishermen. Similarly, one cannot really go without treatment for a broken arm, but one can choose among those offering to heal.

Your argument paralleling health care to education is an interesting one. In essence, you are correct in so much as the basic points you make are correct. However, the parallel does not stop at a general increase in productivity. Public education is, far and away, among the least effective uses of public funds ever conceived in some areas. The Washington DC school district used to epitomize this, spending an amount equivalent to the federal poverty rate for a family of 6 on every single child to ensure them a 58% chance of graduating high school. Things have improved drastically since Rhee took over in 2007.

I'm curious about how many will fall into a state of service decay similar to that suffered by so many public school districts throughout the country if and when we move onto a completely government single-payer third party system?

I would contend that every facet of health care, especially in the areas you have described, can be improved upon by gradually ending all of the government's well-intentioned but unsound policies. Unfortunately, we are well past the point of ever having that occur. This means health care can only get worse in aggregate as time goes on, with occasional strong leadership saving the system from brink from time to time (as Rhee is doing in DC). Virtually all of the cost problems associated with health care is closely linked to the I in FIRE, and the growth of that I in FIRE is a direct result of well-intentioned policy leading to its logical conclusion. Employer tax exemptions for health insurance -> more insurance -> stronger insurance industry -> creative use of "insurance" to capture more market -> health care price/cost bubble. When greater than 50% of a practitioner's time is spent dealing with non-patient issues, thanks both to the government and to the government-grown insurance industry, you know you have an inefficient system. More third-party entrenched bureaucracy has only one likely outcome in aggregate, and that is less efficiency in the form of quality, quantity, cost, or any combination.

Lastly, I will point to the examples where health care costs, including those you cannot realistically choose to forgo, are non-prohibitive in cost and perpetually declining or remaining relatively stable. LASIK/PRK, cosmetic surgery, and veterinary practices have not seen the price explosion experienced by the "insured" health care industry, and in many cases have seen extreme price declines over time. It is fair to say you can live without LASIK, but what about eyeglasses for poor eyesight? Even things as ubiquitous as eyeglasses have been hardly affected by the health care bubble in price because you can get "near-prescriptions" for less than $10 at Wal-Mart or online, and you can an exam for a prescription at a reasonable price as well. All products and services, even those absolutely required to live, are subject to the same laws of economics. When the demand is both regular and fairly predictable in aggregate, as virtually all health issues are (although real insurance is good to normalize the cost), supply will work its way to meet the demand via the standard profit motive that controls essentially all economic forces in aggregate.

Rajiv, I am in absolute agreement with you. But the solution cannot be to transfer the system from one third-party pay system onto another, which is seemingly the direction we are headed. The direction of the solution seems obvious: decouple FIRE from the equation except for its legitimate function as real insurance against risk. The manner in which you achieve that direction is the subject for intelligent, honest public policy wonks to attempt to figure out. However, we are not even headed in that direction. The government basically said, "FIRE, you were 80% complete in capturing the market so we're going to give you the other 20%, congratulations on your new gains!"

[c1ue]

Re: Not in law yet, and costs already rising for ObamaCare?

c1ue, I agree with all points except your definition of health care being outside the realm of a free market type good. Your definition that one must be able to forgo the good/service is either applied incorrectly or not applicable, in my view. In the most theoretically pure sense, it is a matter of supply and demand. One cannot go without food, but one can choose to never buy fish from the fisherman, or to choose fish from among multiple different fishermen. Similarly, one cannot really go without treatment for a broken arm, but one can choose among those offering to heal.

Certainly it is possible to forgo health care. I would point out, however, there are clearly documented costs both for not providing a minimum level of care:

1) otherwise minor conditions evolving into chronic ones
2) emergency care used by the uninsured
3) turning doctors from care providers to care deniers

There are others, but I think you get the drift. I have no issue with highly risky procedures like animal tissue transplants being in the realm of choice, but I do believe that some minimal level of health care such as vaccinations, checkups, general practice examinations, and the like should be universally available. From there, an expansion using the actuarial tables for more expensive treatments can be considered.

You did fail, however, to answer my other point: health care is the least transparent of all possible fields. Just try and compare costs of even mid-level procedures between hospitals, or attempt to gauge the cost effectiveness of one medication vs. the other. In the past, the doctor patient relationship was more personal and perhaps this was less of an issue; but today clearly has become one.

Your argument paralleling health care to education is an interesting one. In essence, you are correct in so much as the basic points you make are correct. However, the parallel does not stop at a general increase in productivity. Public education is, far and away, among the least effective uses of public funds ever conceived in some areas. The Washington DC school district used to epitomize this, spending an amount equivalent to the federal poverty rate for a family of 6 on every single child to ensure them a 58% chance of graduating high school. Things have improved drastically since Rhee took over in 2007.

I'm curious about how many will fall into a state of service decay similar to that suffered by so many public school districts throughout the country if and when we move onto a completely government single-payer third party system?

I don't disagree that public education has been an avenue for massive misuse of funds. But in truth, even a 58% graduation rate from high school is 10x greater than you might have seen in most poor areas prior to the advent of free public education. The problems of public education funds misuse, however, is one which can be at least addressed.

Health care from a national productivity standpoint still stands out as a problem: for businesses in terms of staying competitive while maintaining production in the United States as well as for individuals in terms of portability and cost effectiveness

I would contend that every facet of health care, especially in the areas you have described, can be improved upon by gradually ending all of the government's well-intentioned but unsound policies. Unfortunately, we are well past the point of ever having that occur. This means health care can only get worse in aggregate as time goes on, with occasional strong leadership saving the system from brink from time to time (as Rhee is doing in DC). Virtually all of the cost problems associated with health care is closely linked to the I in FIRE, and the growth of that I in FIRE is a direct result of well-intentioned policy leading to its logical conclusion. Employer tax exemptions for health insurance -> more insurance -> stronger insurance industry -> creative use of "insurance" to capture more market -> health care price/cost bubble. When greater than 50% of a practitioner's time is spent dealing with non-patient issues, thanks both to the government and to the government-grown insurance industry, you know you have an inefficient system. More third-party entrenched bureaucracy has only one likely outcome in aggregate, and that is less efficiency in the form of quality, quantity, cost, or any combination.

I agree that the field of health care is rife with government intervention - from tax breaks for corporations for health care insurance fees paid to Medicare.

But I think you'll find it a long row to hoe if you think any significant percentage of the population is willing to be thrown back into the "survival of the fittest" mode of operation. For one thing, I guarantee you that every single existing recipient of Medicare - and many of those about to go on - are going to fight such a process.

From my view, there is already huge amounts of money being spent for health care - and it is already 'baked in' to the system. My preference is for this money to be spent in a way which at least benefits the overall system as opposed to a Ponzi type of award for those who live longest.

Lastly, I will point to the examples where health care costs, including those you cannot realistically choose to forgo, are non-prohibitive in cost and perpetually declining or remaining relatively stable. LASIK/PRK, cosmetic surgery, and veterinary practices have not seen the price explosion experienced by the "insured" health care industry, and in many cases have seen extreme price declines over time. It is fair to say you can live without LASIK, but what about eyeglasses for poor eyesight? Even things as ubiquitous as eyeglasses have been hardly affected by the health care bubble in price because you can get "near-prescriptions" for less than $10 at Wal-Mart or online, and you can an exam for a prescription at a reasonable price as well. All products and services, even those absolutely required to live, are subject to the same laws of economics. When the demand is both regular and fairly predictable in aggregate, as virtually all health issues are (although real insurance is good to normalize the cost), supply will work its way to meet the demand via the standard profit motive that controls essentially all economic forces in aggregate.

Let's look at each of these areas you've mentioned:

1) LASIK: Yes, the price has fallen. But the cost is still very high. Instead of $3000 to $5000, the cost is now probably $1500 to $3000. Will it ever achieve $100? $500? I guarantee not. And as you've pointed out, LASIK is a luxury - there are plenty of ways to correct your vision which cost less: glasses and contact lens. This example - which I've seen before - is a poor one as it is both completely forgoable and has much cheaper alternatives.

2) Cosmetic surgery. Again, a completely forgoable practice in most cases. Given that cosmetic surgery is a luxury and not a necessity, it is unsurprising that the costs haven't gone up.

3) Veterinarian medicine. Again, while there are plenty of those who really care for their pets and will spend money, there are far more who either can not or will not. Just as pets are a luxury, so too is their medical care.

4) Eyeglasses. While you point out the Wal-mart option, I have a counter-example using the same store: in order to order contact lenses online, you must have a prescription. A 'near prescription' won't do. This costs $80 even at Wal Mart. The difference between buying contact lenses online vs. from an optometrist is 25% to 50% delta.

Similarly while you might be able to get a corrective glasses 'near prescription' at Wal Mart for $10, the glasses themselves will cost closer to $50 (+ tax). In contrast, my wife just ordered a pair of glasses over the Internet from China for $7.99 + $7.99 shipping.

Clearly what is going on with vision care is beyond simple market economics.

What if, on the other hand, you could go to a government facility - wait 2 hours, and get a prescription and pair of glasses for free.

Do you think that would change the market?

I've clearly stated that the Canadian model - where alternate forms of health supply are prohibited - is wrong.

My ideal solution is exactly to provide a minimum level of care - perhaps slow, perhaps inefficient, perhaps old-tech, whatever. But this level of care would then serve as a yardstick by which all other care can be measured whether it is in terms of service, of efficacy, of cost, or of whatever.

Those who choose private care and/or insurance are free to do so and are only penalized in the sense of their share of the government health care spending is forgone - though this can resume at any time for any reason.

[Ghent12]

Re: Not in law yet, and costs already rising for ObamaCare?

I'm not in disagreement on most points, but I see no outcome other than equally bad care on the current path forward. You are right that there will be resistance to clawing back the more socialized aspects of medicine, but such a process need not be done in a short period of time. After all, it took literally decades to fully develop this third party payer mess. It should be at least a decade or more to undo the damage caused by FIRE and government stimulation of FIRE.

I will address two key points.

Certainly it is possible to forgo health care. I would point out, however, there are clearly documented costs both for not providing a minimum level of care:

1) otherwise minor conditions evolving into chronic ones
2) emergency care used by the uninsured
3) turning doctors from care providers to care deniers

There are others, but I think you get the drift. I have no issue with highly risky procedures like animal tissue transplants being in the realm of choice, but I do believe that some minimal level of health care such as vaccinations, checkups, general practice examinations, and the like should be universally available. From there, an expansion using the actuarial tables for more expensive treatments can be considered.

You did fail, however, to answer my other point: health care is the least transparent of all possible fields. Just try and compare costs of even mid-level procedures between hospitals, or attempt to gauge the cost effectiveness of one medication vs. the other. In the past, the doctor patient relationship was more personal and perhaps this was less of an issue; but today clearly has become one.

I will point out that health care is only the least transparent because it is already subject to a massive third-party payment system. Look at all services that are absolutely necessary for productivity, such as auto-mechanics, and are also subjected to insurance but in a much more honest definition of the term; you will see that costs are transparent. Most Americans literally cannot live without cars, as they are essential to their employment, but even repairs covered by insurance have fairly transparent costs and estimates because insurance doesn't cover everything at zero or very low deductibles. The only real reason why health care is not as transparent as any other service is because of the third-party system that covers literally everything from aspirin to annual check-ups to cancer treatment (assuming you aren't dropped or meet your cap, etc.). I suspect your perception that the past had greater transparency is true, and I also suspect that there is absolutely no reason why it cannot be true again so long as we abandon the pursuit of third party payment systems for predictable, (initially) low-cost things.

There is no logical support for why I should pay any third party (insurance or government) for something as simple as an annual check-up which takes up to thirty minutes of my doctor's time on the high side. Yes, an annual check-up is a good idea, and yes everyone should theoretically get one per year. But the cost is so incredibly low, even at a few hundred dollars (per year, mind you), that I should never be required to "pre-finance" it by being forced to buy insurance or through my taxes.

4) Eyeglasses. While you point out the Wal-mart option, I have a counter-example using the same store: in order to order contact lenses online, you must have a prescription. A 'near prescription' won't do. This costs $80 even at Wal Mart. The difference between buying contact lenses online vs. from an optometrist is 25% to 50% delta.

Similarly while you might be able to get a corrective glasses 'near prescription' at Wal Mart for $10, the glasses themselves will cost closer to $50 (+ tax). In contrast, my wife just ordered a pair of glasses over the Internet from China for $7.99 + $7.99 shipping.

Clearly what is going on with vision care is beyond simple market economics.

What if, on the other hand, you could go to a government facility - wait 2 hours, and get a prescription and pair of glasses for free.

Do you think that would change the market?

I've clearly stated that the Canadian model - where alternate forms of health supply are prohibited - is wrong.

My ideal solution is exactly to provide a minimum level of care - perhaps slow, perhaps inefficient, perhaps old-tech, whatever. But this level of care would then serve as a yardstick by which all other care can be measured whether it is in terms of service, of efficacy, of cost, or of whatever.

Those who choose private care and/or insurance are free to do so and are only penalized in the sense of their share of the government health care spending is forgone - though this can resume at any time for any reason.

You and I both know that those eyeglasses aren't free, even if provided by the government for "free." The products themselves must be paid for, unless their makers are working for charity, and the logistics bureaucrat that stocked my local clinic with enough glasses needs his salary, as do the members of whatever oversight board that approved my request chit to receive said glasses.

The thing about your $15.98 Chinese glasses is that there are no costs beyond the $15.98. You paid the market price not only for the product but for the service to deliver it to you. The sub-$100 you pay for a full prescription is pocket-change unless your prescription changes. None of these costs for a life necessity justify any policy with the word "universal" in it. If you want to "even out the costs" then advocate legitimate insurance. If you want to lower costs, increase access, or improve quality, then how can any all-encompassing third party system ever help?

As they say, the Soviets were equal--equally poor.

[flintlock]

Re: Not in law yet, and costs already rising for ObamaCare?

I have always favored Clue's solution. Basic care and then better plans and service for those who can afford more. That's the way most other things are sold. Not everyone gets a Mercedes. Some of us are stuck with a Dodge. I just think some very basic level of care is appropriate for a nation like ours. I'm not talking free knee transplants and experimental drugs. Just basic care. The problem is who decides what "basic" is.

[c1ue]

Re: Not in law yet, and costs already rising for ObamaCare?

I will point out that health care is only the least transparent because it is already subject to a massive third-party payment system.

I disagree. The 3rd party system is perhaps one issue, but in my opinion the real issue is the complexity of medical care.

Unlike car mechanics where the majority of the work is replacement of standardized parts, medicine - like - law requires human judgement.

Is one medication better than another? Is the diagnosis correct? Is the benefit worth the cost? Is the risk worth the additional benefit?

Given this complexity - it is unsurprising that medical costs are impossible to compare. I've given the example before of my own eye surgery - where the actual operating doctor didn't have a clue with the actual surgery cost. If he doesn't know what his own surgery costs, how likely is he to know what other doctors charge?

The issue here isn't the insurance company per se, it is that the doctor's focus is on practicing medicine. Sure, you can change that focus to be more competitive, but then again introducing a profit incentive into medicine is absolutely one reason why costs are skyrocketing: pharmaceutical companies are an excellent example of this.

From my viewpoint, absolutely doctors should be paid well for their time and skills; having some type of reference point would go a long way toward curbing major existing systemic abuses.

As a friend of mine put it: a government employee may not be highly motivated, may only work from 9 to 5 and fairly inefficiently, and may not give a crap about me personally. But he will do his job dispassionately - my health vs. his profit is not a factor.

You and I both know that those eyeglasses aren't free, even if provided by the government for "free." The products themselves must be paid for, unless their makers are working for charity, and the logistics bureaucrat that stocked my local clinic with enough glasses needs his salary, as do the members of whatever oversight board that approved my request chit to receive said glasses.

I've never said the government glasses were free. You and I both know full well that thousands of dollars are paid every year by the government - which by definition is using our money - on health care.

What I'm saying is that instead of all this money going into an incestuous for-profit system with tons of 3rd party profiteers, that some of it should go into a health care provision system such as the existing national network of VA hospitals.

This national system can not and should not replace the private sector but instead serve as the health care safety net for the American people. By its very existence it will serve as a counterpoint to any private sector abuses much as the private sector in turn will serve as a counterpoint to government agency inefficiency or what not.

As they say, the Soviets were equal--equally poor.

Spoken like someone who has no clue what the Soviet system was really like.

A more accurate description was that everyone was equal, but some were more equal than others.

An anecdote: in the 80s, prior to 'perestroika', my mother in law made about 180 rubles/month. This was a very high wage comparatively - others would make perhaps 1/4 of that, because she worked for the state travel agency conducting Japanese tourists.

But with that 180 rubles, she could support her 2 children as a single mother, had the best health care available, owned her own apartment in the center of St. Petersburg, could (and did) send both kids to St. Petersburg State University - the same place Putin graduated from - and could eat out twice a week.

Today, she works the same job but could do none of the above except for the apartment. She had to sell the downtown one and bought a cheaper one in the near suburbs.

Not everything government sponsored is bad.

Not everything free market is good.

[Rajiv]

Re: Not in law yet, and costs already rising for ObamaCare?

Spoken like someone who has no clue what the Soviet system was really like.

A more accurate description was that everyone was equal, but some were more equal than others.

An anecdote: in the 80s, prior to 'perestroika',

Not everything government sponsored is bad.

Not everything free market is good.

Yes, that is something that most Americans who have been brainwashed (and I mean brainwashed) into an anti communist mindset (and the consequent demonization of anything "Soviet") are unable to see. In their minds Soviet Russia was an oligarchy, grinding the people into forced servitude and forced labour, epitomized by Imprisonments and Gulags (even though imprisonment rates are much higher in the US compared to Soviet Russia by almost an order of magnitude)

[Ghent12]

Re: Not in law yet, and costs already rising for ObamaCare?

This complexity argument is failing to convince me. People require professional service for hundreds of different reasons all the time, often for things so complex that the customers must simply trust the professional, yet these people are almost always able to shop around, to have a varying degree of price clarity, and access relatively proportional to wealth.

Also, something you said brings up two interesting questions.

As a friend of mine put it: a government employee may not be highly motivated, may only work from 9 to 5 and fairly inefficiently, and may not give a crap about me personally. But he will do his job dispassionately - my health vs. his profit is not a factor.

How often, would you say, that profit is a motivation over health for doctors?
Also...
What hospitals would remain if no profit motive existed in health care?

Spoken like someone who has no clue what the Soviet system was really like.

A more accurate description was that everyone was equal, but some were more equal than others.

An anecdote: in the 80s, prior to 'perestroika', my mother in law made about 180 rubles/month. This was a very high wage comparatively - others would make perhaps 1/4 of that, because she worked for the state travel agency conducting Japanese tourists.

But with that 180 rubles, she could support her 2 children as a single mother, had the best health care available, owned her own apartment in the center of St. Petersburg, could (and did) send both kids to St. Petersburg State University - the same place Putin graduated from - and could eat out twice a week.

Today, she works the same job but could do none of the above except for the apartment. She had to sell the downtown one and bought a cheaper one in the near suburbs.

c1ue, your anecdote was from the 80's. I have one from the 50's, if you'd like to compare. My grandfather was a sailor and would occasionally make port in Russian ports and would have to bring on some Soviet officials. To these officials, it was like boarding a magical alien world. They would see a Sears catalog and claim it to be western propaganda. "There's no way America has this much stuff!" they would exclaim. They would trade and barter all kinds of things just for the Sears catalog, because it was like porn to them; and they would sneak it out of the ship under risk of imprisonment.

You are right that not everything government sponsored is bad and that not everything free market is good. Good and bad require a moral calculus, and to me, government is a tool that can result in either good or bad outcomes and the 'free market' in aggregate is simply a force of nature, immune to such judgments. I'm not personally against limited, non-entangling social safety nets or government sponsoring of certain things that are considered valuable but not considered profitable. However, when it comes down to a matter of policy, why should anyone but those in the most need of a social safety net be "given" any service, whether vital or not? When it comes to matters of economics, to supplying what people are demanding, there is rarely a more efficient a system than to allow everyone to figure it out on their own under a free market.

I think the earlier parallel you brought up with legal services is potentially useful. The only time lawyers are provided by the government are to those unable to afford their own and only when they are defendants. However, at essentially no time is anyone required by law to get themselves a lawyer or to pay for retainment under threat of a tax penalty.

Rajiv, I would caution you about getting into a numbers game. There are great reasons to associate the word "Soviet" with horrible abuses of government power.

[flintlock]

Re: Not in law yet, and costs already rising for ObamaCare?

People require professional service for hundreds of different reasons all the time, often for things so complex that the customers must simply trust the professional, yet these people are almost always able to shop around, to have a varying degree of price clarity, and access relatively proportional to wealth.

I think this is key to keeping costs down. Right now there is no clarity whatsoever with regards to health costs. It is virtually impossible to shop around. Health care providers know this and take advantage of it. They quickly learn at what threshold insurance will pay out and are encouraged by their corporate bosses to push for any excuse to puff up the tests and procedures to maximize profits. Not all physicians do this of course, but more and more they are merely employees working for a larger entity. They want to keep their jobs AND they don't mind the bonuses thrown their way for meeting quota. My brother was at the doctor recently and saw on his chart when the doctor left the room, " Blue Cross, 15 visits max!". He was in for something else but casually mentioned some wheezing he had for the last few weeks. The doctor said it was probably just allergy and sent him on his way. Only when he got to the checkout they asked him when he wanted to schedule his MRI and breathing test. All for some wheezing! I've had similar experiences. Procedures ordered and only when I balk at the price does the doctor tell me " Well they usually don't work anyway, don't worry about it, there are cheaper alternatives." Of course they are trying to give you the best care possible. Problem is, we ALL can't afford it. There has to be something in between.

But just imagine hiring a plumber to come to your home where they won't tell you the price up front. What is that bill going to be? ha! The mechanic analogy is a good one. At times we are forced to trust people who are experts when it concerns something we know nothing about. And most of us really need a working car (or indoor plumbing). We are at their mercy to some degree. But like many can tell you, there is no mercy left in a lot of them. They'll go after as much as they can get. And I don't believe the health care field necessarily has any more integrity than a plumber when it comes to this type of situation.


Sometimes there is more than one way to fix a problem. How do we know that sputtering engine isn't just a loose plug wire? Or do I really need the engine overhaul? I see it every day in my business. Money calls the shots. Is the flickering light due to a loose wire or does the entire panel need replacement? I can assure you for a fact that the large corporate franchise electrician with massive overhead and advertising is going to find for the latter. A lot of the problem of soaring costs in health care boils down to the soaring lack of integrity in our society in general. People become corrupted. Then they rationalize away any guilt. " I deserve it". "Everyone is doing it". " If a professional athlete makes X amount, then I deserve it too because I have 15 years of education". Blah, blah, blah.

Put clear and upfront prices on health care and let the market decide what things are worth. In my experience people are almost never worth what they think they are.

[Rajiv]

Re: Not in law yet, and costs already rising for ObamaCare?

Rajiv, I would caution you about getting into a numbers game. There are great reasons to associate the word "Soviet" with horrible abuses of government power.

I would not disagree with you on abuses of power.

However my problem comes when we point the finger at someone, and refuse to examine ourselves with the same criticality. It is very easy to point out somebody else's faults, and yet at the same time excuse those very same faults in ourselves

[c1ue]

Re: Not in law yet, and costs already rising for ObamaCare?

This complexity argument is failing to convince me. People require professional service for hundreds of different reasons all the time, often for things so complex that the customers must simply trust the professional, yet these people are almost always able to shop around, to have a varying degree of price clarity, and access relatively proportional to wealth.

The difference is: you only need a liver transplant once. Most medical care beyond prevention is a one time thing.

When you get your brakes changed and get screwed, next time you do better.

When you get breast cancer - you either get treatment or you die. Rarely someone gets it twice or three times, but compare the number of brake changes in the average lifespan vs. the number of breast cancer incidences.

And as for price clarity: there is none. I've already mentioned an example: the doctors themselves don't know what is charged - how then are patients to when getting price quotes is impossible and the doctors themselves cannot help?

As for the difference between medicine and law: most people can go their entire lives without having to resort for a lawyer for anything beyond bureaucratic crap.

The same is not true for medicine.

Lawyers also only try to sell their time. In medicine, you are buying not just the doctor's time, but the testing lab, the nurses, the operating room, the anesthesiologist, the radiology MD, the surgeon, the pharmaceutical company etc etc etc.

And again, it isn't that it cannot be understood.

But it is ridiculous that something so commonplace cannot have an easy referent.

c1ue, your anecdote was from the 80's. I have one from the 50's, if you'd like to compare. My grandfather was a sailor and would occasionally make port in Russian ports and would have to bring on some Soviet officials. To these officials, it was like boarding a magical alien world. They would see a Sears catalog and claim it to be western propaganda. "There's no way America has this much stuff!" they would exclaim. They would trade and barter all kinds of things just for the Sears catalog, because it was like porn to them; and they would sneak it out of the ship under risk of imprisonment.

I fail to see how America having lots of stuff is relevant; America has been a wealthier country even since before the November Revolution. Russia was a very low grade 2nd world power in 1910; it clawed its way up to being a very low grade 1st world power and is now back where it was.

Your story could apply to any poor port in any other part of the world in that era: Somalia, India, China, Brazil, etc etc.

Rajiv, I would caution you about getting into a numbers game. There are great reasons to associate the word "Soviet" with horrible abuses of government power.

And in the near future, "capitalism" and "central reserve bank" will resonate with equal horror.