(Un) Affordable Care Act - the Uncomfortable Truth

[LorenS]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

Don't forget the airlines. Before de-regulation flying was enjoyable and you could fly nonstop to any major city in America, not just the ever-shrinking hubs. Changing trip parameters didn't cost more than the initial ticket. There were skycaps at the curb. No charge for luggage. I tell ya man, it was awful. Thank god it was de-regulated. Now with an infinite number of competing airlines, it's a flyers paradise!

Sorry,I don't remember the glory days of flying. I couldn't afford it back then. The few flights I did take (courtesy of the US Army) were smoke filled and had multiple layovers. It took me over 10 hours to get from Detroit to Ft Knox Kentucky.


People seem to have a huge problem separating the problems of deregulation with the issues of failure to enforce basic laws (corrpution). I know they are often correlated, but the causation is not there. It's not like all regulations have merit. It would be nice if we could #1 have an honest discussion as to which regulations are necessary, #2 which regulations are harmful, and then #3 honestly, fairly and consistently enforce the useful regulations.

What I see is nearly universal refusal to enforce even the most basic of laws, followed promptly by screams for completely worthless regulations to fix the problem. It's not like we've ever been "unregulated".

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

In the end I honestly believe that we will be forced to go to what right leaning advocates call a "socialist solution"

We won't do it out of ideology. We will do it out of necessity. The rest of the world is kicking our ass when it comes to health care costs. In a world where trade is global? We simply will not be able to afford this dysfunctional trainwreck.

So I say this to anyone who believes that an unencumbered "free market" can provide a better product at a better price: Quit making excuses and start putting forth reasonable and functional solutions. For FAR too long the right has done nothing more than provide a few talking points while protecting the status quo.

Time's short gentlemen better make a start soon.

Will

Don't be so delicate - what the left wants IS a "socialist solution". They call it "single payer." Isn't that a much more pleasant word than "communism"?

Does that seem like hyperbole? Well, what do you call a system where there is only one buyer? Where one entity, the government, buys all of a good and distributes it? When there is only one buyer, that means that everyone in that marketplace works for that buyer. Everyone in healthcare will be working for the government. When the government employs everyone in healthcare, then the government will decide how much to buy, who gets it, who produces it, etc etc.

How is that not communism?

And if you think that a communist solution is the right way to go for healthcare, then why not for all the other sectors of the economy? After all, the healthcare industry is simply made up of people who have a particular kind of expertise and offer healthcare goods and services for sale. This is the same as every other industry. Why not "single payer" food production? Single payer clothing production? Single payer housing? All of those are more important than health care.

I have posted on this site before a copy of a hospital invoice that I found in family documents. My grandfather went in for a surgery and a 12-day stay in the hospital in 1944. The inflation-adjusted cost of that in 2013 dollars was just over $1,000.

My friend's daughter had outpatient surgery on the tip of her finger when it got caught in a bike sprocket last year. Cost: $14,000.

What changed between 1944 and 2013 to create such an increase in medical costs?

Was it "unfettered capitalism" (i.e., people freely entering into mutually voluntary economic transactions with other people, without government interference or permission)? Was it a cutthroat medical marketplace where providers competed to win more customers by improving quality and cutting price?

Or was it things like enacting huge new government entitlements with guaranteed payments like Medicare and Medicaid? Passing tax laws that encouraged health insurance to become something provided by employers instead of bought by consumers? Requiring all emergency rooms to give free care to whoever shows up at the door, with no limit to how many times they show up or how expensive the care is? Allowing juries to award massive punitive damage awards beyond all reason that drove up malpractice insurance through the ceiling? And all the other ways that government penalized success, picked favorites, rewarded cronies, and handed out new "entitlements" in the medical arena? What in the hell was "unfettered" about that?

You can't talk about an "unfettered free market" in health care. There hasn't been one in this country for a lifetime. It is not an "unfettered free market" in health care that caused these prices to go through the ceiling.

I think what will happen in the next few years is that this latest "improvement" engineered by the left will kill off the remainder of the health care marketplace and the left will sadly shake their heads and say through their crocodile tears, "see how an unfettered free market behaves? Sadly we have no choice but to impose a socialist - er, 'single payer' - system. Unfortunately, the free market just doesn't work in health care."

And then once we have an abysmally expensive, uninnovative socialist health care system, the left will turn their attention to some other aspect of the economy that "unfortunately" will just have to be socialized. Perhaps the information technology industry - that's certainly been unfettered for way too long now, right?

[Mn_Mark]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

jpatter666 and t&binohio,

I am glad we have a few folks that are at least open to making changes. It seems like we have spent so much time in the past decade criticizing the present without actually laying out concrete, functional, and politically possible improvements. I'm more of a pragmatist than an ideologue. Maybe that is why the thought of nationalized medicine does not scare me.


Will

There's plenty of concrete, functional ways to get competition into the health care marketplace. It's actually very simple:

- get rid of government health care entitlements. People buy their own medical care on the marketplace.
- get rid of government mandates forcing hospitals to provide free emergency room care to whoever shows up without regard to ability to pay.
- limit medical malpractice awards to some reasonable low figure. You take risks when you have a surgery, there's no way around that.
- etc: simplify, eliminate government interference, eliminate tax laws that skew the marketplace.

Basically you could start by returning the laws to the way they were in 1931, before FDR. As I said in another post, my grandfather had a surgery and a 12-day hospital stay in 1944 that he paid for himself, at an inflation-adjusted cost of $1,000. We can go right back to that regulatory/entitlement environment for a start.

95% of people then will be able to pay for their medical care out of their pockets. You will buy catastrophic health insurance to cover the rare expensive emergency.

Those few people who genuinely can't afford even $1,000 for a 12-day stay in the hospital will rely on charity hospitals as they did in the past.

Meanwhile medical care will get better and cheaper every year when a real free market with real competition is operating. Just as it does in the tech world. Health care is just high tech for the human body. It should show the same improvements in quality and cost that all other technology areas do in a free market.


But those aren't politically possible, because as Moldbug puts it, America is a communist country now. We don't want free markets, we want free stuff. We want the government to pay for it. The left has convinced the great majority of people that if it weren't for the government, there would be people dropping dead in the streets of starvation and lack of medical care.

When even reasonable-sounding blue-collar people - who ought to have the common sense and belief in American traditions to know better - think that a socialist health care system is the way to go, there's not going to be any avoiding it. That's where we're going. We're going to have to find out the hard way.

PS: If you think our socialist health care system is going to look like those in Scandinavia, think again. We're not Scandinavia, full of homogenous populations of the whitest white people on earth. We're going to be more like Venezuela. So stop holding Scandianvian socialism in mind when you think "single payer", and start thinking Latin America - and ask yourself if you think that's really going to be better than the system we had in this country before the New Deal began warping the marketplace.

[jpatter666]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

There's plenty of concrete, functional ways to get competition into the health care marketplace. It's actually very simple:

- get rid of government health care entitlements. People buy their own medical care on the marketplace.
- get rid of government mandates forcing hospitals to provide free emergency room care to whoever shows up without regard to ability to pay.
- limit medical malpractice awards to some reasonable low figure. You take risks when you have a surgery, there's no way around that.
- etc: simplify, eliminate government interference, eliminate tax laws that skew the marketplace.

Basically you could start by returning the laws to the way they were in 1931, before FDR. As I said in another post, my grandfather had a surgery and a 12-day hospital stay in 1944 that he paid for himself, at an inflation-adjusted cost of $1,000. We can go right back to that regulatory/entitlement environment for a start.

95% of people then will be able to pay for their medical care out of their pockets. You will buy catastrophic health insurance to cover the rare expensive emergency.

Those few people who genuinely can't afford even $1,000 for a 12-day stay in the hospital will rely on charity hospitals as they did in the past.

Meanwhile medical care will get better and cheaper every year when a real free market with real competition is operating. Just as it does in the tech world. Health care is just high tech for the human body. It should show the same improvements in quality and cost that all other technology areas do in a free market.


But those aren't politically possible, because as Moldbug puts it, America is a communist country now. We don't want free markets, we want free stuff. We want the government to pay for it. The left has convinced the great majority of people that if it weren't for the government, there would be people dropping dead in the streets of starvation and lack of medical care.

When even reasonable-sounding blue-collar people - who ought to have the common sense and belief in American traditions to know better - think that a socialist health care system is the way to go, there's not going to be any avoiding it. That's where we're going. We're going to have to find out the hard way.

PS: If you think our socialist health care system is going to look like those in Scandinavia, think again. We're not Scandinavia, full of homogenous populations of the whitest white people on earth. We're going to be more like Venezuela. So stop holding Scandianvian socialism in mind when you think "single payer", and start thinking Latin America - and ask yourself if you think that's really going to be better than the system we had in this country before the New Deal began warping the marketplace.

...and welcome to the other side of the debate -- those who think a completely unfettered Ayn Randian environment will create the perfect solution. *You* can have your 1944 health care. Please refuse all modern drugs, equipment and care -- and don't forget to turn off the A/C. And by the way -- in 1944 there were serious price controls; a war was raging, remember?

Many of us want *solutions* not indoctrination. There are places where the government has a purpose. I prefer those purposes to be minimal, but when I exhaust the alternatives.....

Why do I feel that some level of national plan is now required? Because I see contradictory forces at work.

1 ) It's stupid to tie health-care to having a job. Like I've tons of money to spend on medical issues when I'm out of work.
2 ) It's too tempting for people to shortcut basic medical care to save money. This often hurts children.
3 ) The bureaucracy is insane. My wife does a short emergency visit and we're getting nickel and dime requests for payment six months later.
4 ) The US spends far more on health care than any other nation -- the results for our money are appalling.
5 ) We cover seniors who have mostly finished their contributions to society and leave children with the most to contribute to rot -- why? Children can't vote.

Obviously *something* is wrong.

Am I for "anything wrong with you we'll cover it"? No. But I have come to the conclusion that *some* level of basic coverage is required countrywide. You want catastrophic or high-quality coverage, fine, pay for that.

But the current system is untenable. You come up with a better system that helps the six-year old with a serious case of flu whose's mom is out of work, I'll listen.

"Meanwhile medical care will get better and cheaper every year when a real free market with real competition is operating. Just as it does in the tech world. Health care is just high tech for the human body. It should show the same improvements in quality and cost that all other technology areas do in a free market."

As someone who works in the tech world I had to howl with laughter at this. Sure things get cheap for stuff that is manufactured in quantity (often as a loss leader) -- but for all the complex, behind the scenes stuff that you never see (like in medicine) you should see what we charge....

[Penguin]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

There's plenty of concrete, functional ways to get competition into the health care marketplace. It's actually very simple:

- get rid of government health care entitlements. People buy their own medical care on the marketplace.

Alright, what do we do with retirees? Most of them cannot afford a new car let alone a week long hospital stay. If you are saying "just let them die" then do it. Don't be shy. But don't pretend that a solid majority of them will be able to do so, that's a fantasy I can't swallow.

- get rid of government mandates forcing hospitals to provide free emergency room care to whoever shows up without regard to ability to pay.

Easy enough to say isn't it. True story: a friend of mine had a motorcycle wreck. The hospital refused to treat him because he didn't have proof of insurance. He went home but then returned and begged them to do something for the pain. Again he was sent home. He died on the way. He was in his early 20's, prime of his life. His name was Kim. And this hideous episode happened while it was illegal to turn emergency patients away.

I shudder to think what would happen if these vaunted institutions of healing would do if they weren't restrained by this requirement. But again, if what you are saying is "Let the uninsured die!" then do so, don't beat around the bush. If nothing else at least I can argue with an honest opinion. We need more honesty in the debate. Too many hiding behind implications.

- limit medical malpractice awards to some reasonable low figure. You take risks when you have a surgery, there's no way around that.

I don't have a problem with placing restraint on how much liability a doctor/hospital has. This is a gray area. This is what representative government is for, to allow us input on the difficult decisions.

- etc: simplify, eliminate government interference, eliminate tax laws that skew the marketplace.

Specifics. You cannot guide policy from 30,000 feet. How's this for a specific proposal: Allow reimportation of drugs. Pass a law that dictates an equal price footing for all other than humanitarian relief.

That's the kind of concrete proposal we need. If there is one thing we don't need it is more braying about "eliminating government interference". No offense meant but this gains nothing for the debate. Some government interference is very much liked and some is indefensible. You can't lump them all together and expect to solve a lot of the problems we have without creating others which would turn out to be worse.

Will

[Woodsman]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

I don't know, tbh. But my heart lies with guys who actually produce things.

It's took me about 100 posts to start recognizing it but by 200 I understood it to be a reality. Most ideas here have to scale a "Great Center Right Wall" lovingly built and guarded by a small number of regular posters out of a 50K+ membership.

So from that perspective, "Producers" generally refers only to entrepreneurs, business owners/managers, accredited investors and anyone else who needs a hard distinction between themselves and people whose productivity is based primarily on physical and (limited forms of) intellectual labor.

No one who works in government, academia, the arts, the 'soft' sciences or any other domain considered by said Producers as unimportant can be considered productive. Generally, any domain whose output the Producers deem frivolous or that cannot be directly traded on a marketplace in exchange for cash or similar consideration is excluded from the definition. With the exception of union members (who are most definitely not Producers!), I have yet to determine if employees and other non-owners can be considered productive. Initial research indicates entry by these cohorts into the ranks of Producers is decided on an "at will" basis.

Similarly, for a potential solution to be considered "pragmatic" it must make it over the Great Center Right Wall. Those ideas that fail to make it are categorized somewhere between "impractical" and "immoral". This calculation depends largely upon the perceived limits such ideas may place on the freedom of action of Producers. A secondary consideration is the idea's potential to assist those persons assigned to non-productive, surplus populations.

Any idea identified as "left" is immediately removed from further consideration. The mere identification is sufficient for disqualification and there is no requirement of proof. This is so because Producers generally conflate communism, Bolshevism, socialism, social democracy, liberalism and the Democratic Party with each other and make no meaningful distinction among them. Anyone who persists in posting ideas identified as "left" should expect to receive regular notes of opprobrium until such time as the activity ceases.

It is also important to note that no similar guidelines are applied to ideas rooted in center right and conservative ideologies. These are generally considered "common sense," "free market" or simply "truth" and as such rightly cannot be labeled ideological. Furthermore, while criticism of center right ideas is not prohibited as such, it must be balanced by at least one equivalent criticism of the Democratic Party leadership, civil rights activists, labor unions, intellectuals and other fellow travelers. Failure to do so consistently is considered a marker of leftism and will be noted as such.

I understand this "modest proposal" is a something of a chore, but you can keep it simple if you just close your mind to any idea, regardless of its potential for good, that the Producers identify as leftist.

[LorenS]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

I think part of the issue is that there are two separate categories of medical bills. There are ones that you can "shop" for and ones you cannot.

Maybe it's time to start dealing with those separately. I would be more willing to go the socialized route with emergency care than the other kinds of medical treatment. I'm also fine with a certain base level of medical care for kids. I'm not too thrilled with the current scenario.

We can easily change many of the worst parameters of our current system. Just because it's easy doesn't mean that the corrupt players aren't able to easily stop it, though. That's been the key theme all through this debate.

Also, there is no such thing as single payer. Unless the Fed prints up the money for health care we're all paying, that makes it taxpayer funded, not single payer.

[DSpencer]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

Am I for "anything wrong with you we'll cover it"? No. But I have come to the conclusion that *some* level of basic coverage is required countrywide. You want catastrophic or high-quality coverage, fine, pay for that.

But the current system is untenable. You come up with a better system that helps the six-year old with a serious case of flu whose's mom is out of work, I'll listen.

I think establishing a minimum social safety net of free (tax-payer funded that is) clinics or some kind of vouchers would have been more politically acceptable and a much more realistic undertaking. The problem is that it doesn't really fix the cost problem. Catastrophic, as in financially catastrophic, is where the huge costs are. A huge amount of resources are spent keeping people alive for the final year of their life.

What about the six year old who needs dialysis? Do you "let them die"?

[don]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

my heart lies with guys who actually produce things.

+1

[jpatter666]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

I think establishing a minimum social safety net of free (tax-payer funded that is) clinics or some kind of vouchers would have been more politically acceptable and a much more realistic undertaking. The problem is that it doesn't really fix the cost problem. Catastrophic, as in financially catastrophic, is where the huge costs are. A huge amount of resources are spent keeping people alive for the final year of their life.

What about the six year old who needs dialysis? Do you "let them die"?

A six-year old? No. There is a significant amount of unrealized potential.
An eighty-six year old? Yes. Translation --the government-funded system will not pay for it. You have your own secondary insurance or can raise the funds, go for it.

I agree that the catastrophic final year costs are where a significant amount of the costs lies -- but there is nothing in the system that tries to limit that, so why are we surprised?

[shiny!]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

I think part of the issue is that there are two separate categories of medical bills. There are ones that you can "shop" for and ones you cannot.

Maybe it's time to start dealing with those separately. I would be more willing to go the socialized route with emergency care than the other kinds of medical treatment. I'm also fine with a certain base level of medical care for kids. I'm not too thrilled with the current scenario.

We can easily change many of the worst parameters of our current system. Just because it's easy doesn't mean that the corrupt players aren't able to easily stop it, though. That's been the key theme all through this debate.

Also, there is no such thing as single payer. Unless the Fed prints up the money for health care we're all paying, that makes it taxpayer funded, not single payer.

True, but if the government institutes price controls similar to medicare,

if the profit-driven insurance companies are driven out of the equation,

if people don't need to spend so much money on health insurance and medical bills,

if people don't need to ignore health problems because they can't afford to get treatment (ultimately costing the system more money in the long run),

I think three things would happen:

1. Adults would be healthier and children would grow up healthier, which would boost productivity.

2. People would have more disposable income, which would boost the economy.

3. Businesses wouldn't have to spend money on insurance for employees, which should lead to an increase in hiring.

I'm not good at crunching numbers, but it seems the increase in productivity should offset the increase in government expenditure (tax dollars) caused by single payer (or whatever you call it) healthcare.

This would take the economy into an upward spiral, as opposed to the sinking death spiral that the healthcare industry is causing now.

It has taken a long time for this libertarian to come to this way of thinking. If the I in FIRE hadn't been so greedy it wouldn't have come to this, but as the middle class is destroyed by FIRE, the current healthcare system is unsustainable except for the wealthiest.

In countries like Ecuador and Colombia, people pay around $50/month for their healthcare, with minimal fees for services.

[jpatter666]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

True, but if the government institutes price controls similar to medicare,

if the profit-driven insurance companies are driven out of the equation,

if people don't need to spend so much money on health insurance and medical bills,

if people don't need to ignore health problems because they can't afford to get treatment (ultimately costing the system more money in the long run),

I think three things would happen:

1. Adults would be healthier and children would grow up healthier, which would boost productivity.

2. People would have more disposable income, which would boost the economy.

3. Businesses wouldn't have to spend money on insurance for employees, which should lead to an increase in hiring.

I'm not good at crunching numbers, but it seems the increase in productivity should offset the increase in government expenditure (tax dollars) caused by single payer (or whatever you call it) healthcare.

This would take the economy into an upward spiral, as opposed to the sinking death spiral that the healthcare industry is causing now.

It has taken a long time for this libertarian to come to this way of thinking. If the I in FIRE hadn't been so greedy it wouldn't have come to this, but as the middle class is destroyed by FIRE, the current healthcare system is unsustainable except for the wealthiest.

In countries like Ecuador and Colombia, people pay around $50/month for their healthcare, with minimal fees for services.

I agree. And why should large companies get an implicit subsidy for their insurance (because they have large numbers of employees they can get a better price per employee). The current system works *against* the small business owner -- and the smaller you are, the worse it is.

[seanm123]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

Anecdotal on the Heath Insurance War and the battles on all fronts.


My co-worker recently informed me he was dropping our company insurance to go on his wife’s plan. They raised our deductible to 20% last summer and he also got nicked when he had a minor procedure done. The old switcheroo occurred on him when the anesthesiologist was out of network but the facility and primary doctor are in network etc, so he is a few grand lighter this year. He was miffed of-course. I told him to take a wait and see approach for the next few years until all of the leaves fall from the Heath Insurance shakeout that we are seeing today settle. However being a fool he only listens to his wife just like in 2008 when I told him to NOT buy that MASSIVE house that is now MASSIVELY underwater today.


Anyway his wife is a teacher in one of our finest public schools. When she went to check about adding him to her publicly funded heath care plan they came back with a counter offer of $10K for her to go on his plan at his company instead. To add a little more sugar they will give her and additional $5K next year as well.
Well they are (she is) taking the cash. I guess she needs some new shoes.


This will NOT end well folks.

[vt]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

My fear is a single payer system will be far more expensive than European systems, and far less efficient.

We know that Federal government workers receive twice as much of the income pie than any private workers save top management. A U.S. single payer system would be such a bureaucratic mess it could set back medical progress decades. Would SIEU agree to reasonable wages a single payer system would demand? We would also lose more doctors for a while.

The current system we have is not the answer either. We must replace that too.

This is America. We are leaders in science, in creating new industries, in GNP. We should be able to come up with a health care system that has reasonable costs, covers everyone, and runs like clockwork.

The challenge is to come up with a framework of a system that works. What ideas does this group have that could accomplish this?

Someone suggested that the military run the health care system. I don't think they can legally do that.

How about this for starters?:

Hire military veterans to run the health care system, hospitals, be the nurses and doctors in the new system. This system could be far more efficient than the current one.

To prevent lower income citizens from going to emergency rooms create neighborhood clinics staffed by nurse practitioners. A doctor could be stationed at one of these clinics, but close enough to be at an adjoining clinic in 5 to 10 minutes if needed.

Have a special government program to take good care of, at reasonable cost, to those with preexisting conditions that were not caused by their bad behavior, and not penalize everyone else with higher rates to cover them. Those preexisting conditions would have to be beyond the control of the patient; they cannot be self inflicted. If someone drinks too much, smokes, engages in risky behavior, eats junk food to excess; they have to pay the rate that befits their reckless behavior.

[aaron]

Re: (Un) Affordable Care Act - the Uncomfortable Truth

Medical costs have gone up with inflation. You can not export medical care, at least most of it. So, you are stuck with a limited supply. That supply of medical services is further limited by government and private collusion.

One solution might be to combine the system Canada has with the one Taiwan has. Both countries have a private insurance market, while the government provides a basic level of care to all. It keeps the poor from dying in the street and getting your car messed up, Mn Mark. It also keeps the U.S. off the list of third-world health care systems.


Single payer means you have a card, it allows you a list of medical services, the doctor bills the government.

And if you think that a communist solution is the right way to go for healthcare, then why not for all the other sectors of the economy? After all, the healthcare industry is simply made up of people who have a particular kind of expertise and offer healthcare goods and services for sale. This is the same as every other industry. Why not "single payer" food production? Single payer clothing production? Single payer housing? All of those are more important than health care.

The real question should be what is the point of a nation and a nations' wealth? Theoretically, the U.S. is much more wealthy than 50 years ago. Where did it all go? Where should it have gone? Where should go in the future?

I would love the U.S. to become rich enough that we can guarantee healthcare, housing, clothing, and education to everybody. I believe we are already at that point, we just have system so focused on personal greed that it is an impossibility.

Real "producers" (or whatever rand might call 'em) will still thrive. In fact, you may get even more of them since future inventors do not have to worry about such mundane things as food, clothing, shelter, etc.