Given the weight that health care reform plays in the current presidential campaign, I wanted to address what I humbly believe are the most significant issues in our current system.Any student of economics has learned that prices contain invaluable information that helps allocate scarce resources. One of the central caveats of our current health care system is the absence of price transparency. This is primarily driven by the existence of a third-party payer that finances the majority of health care costs.Such a system distorts both the supply and demand for health care. Given consumers do not pay the majority of costs, there are few incentives to cut back demand vis-à-vis rising prices, which leads to the overconsumption of health care goods and services. This also has severe implications for the supply-side of the health care sector as, in the absence of demand destruction, there are few incentives to focus on costs and efficiency, leading to an upward price spiral that is largely accommodated by consumers.Unfortunately, simply providing insurance for all Americans does little to address the above. Rather than cure the symptoms, we should focus more on the disease. The only way to incentivize consumers to respond to increasing prices is to have the majority of those prices paid by consumers. We have grown accustomed to the notion that the purpose of insurance is to pay our every routine health expense. On the contrary, the primary purpose is to provide financial assistance to low probability events, not for every doctor visit. (The emergence of high-deductible HSA plans is a huge step in the right direction)The government plays a very significant role in the supply of health care via overly-strict licensure laws (ever wonder why NCSU, among other qualified schools, does not have a med school?) and excessive regulation on insurance providers. To the second point, each state has its own laundry-list of mandates for insurance companies and their plans. On most states' lists are mandates that require inclusion of often-unneeded services, such as in-vitro fertilization, alcohol abuse counseling, chiropractic care and others that raise the marginal cost of insurance. This is like the government mandating all car companies include leather and AC in their cars, only to later complain that something must be done about rising car prices. Making matters worse, state governments restrict its citizens from purchasing insurance from out-of-state providers. This limits consumer choice and competition amongst providers, leading to higher prices than could be obtained in a free market. The federal government also has played a role in our insurance system. By structuring the tax code in a way that incentivizes insurance to be provided by employers, insurance is now predominantly employer-provided, which further limits the consumer’s choice of insurance provider and plan. This also has the ill effect of leading to a less flexible labor market, as employees may be reluctant to switch jobs or pursue further education if it means they lose their existing coverage. (this also leads to job-lock among seniors)Long, long story short, there are many, significant ways the government plays a role in our health care system. Expanding that role does little to address the above-mentioned problems. Before supporting either presidential candidate’s plan, I urge you to consider the often unrealized side effects government intervention imposes.[Edited on June 25, 2008 at 7:56 PM. Reason : .]
6/25/2008 7:55:25 PM
waaaaaayyy to loquacious to be humble.
6/25/2008 8:00:01 PM
i whistled for a cab and when it came near
6/25/2008 8:01:24 PM
Somebody move this to TSB, where it can be properly mocked and flamed.
6/25/2008 8:15:12 PM
yeah here in the lounge... we're serious and we care what you have to saybut we're not that serious and we don't care that much what you have to say
6/25/2008 8:18:07 PM
good summary hunt.HSA and the govt stepping out of healthcare is the answer. imo
6/25/2008 8:28:49 PM
1) the US is virtually the only industrialized country without a national healthcare system2) Americans pay more for healthcare than any other country in the world3) adverse selection causes private insurance to be disproportionately expensive---4) the US should adopt a national healthcare systemQED
6/25/2008 9:11:52 PM
^^^ oops, no idea how this landed in the lounge[Edited on June 25, 2008 at 9:12 PM. Reason : .]
6/25/2008 9:12:41 PM
operator error
6/25/2008 9:15:25 PM
6/25/2008 9:18:21 PM
as opposed to responding to a legitimate (albeit abbreviated) argument with "try harder"?
6/25/2008 9:21:08 PM
Your logic is based upon faulty premises, a complete disregard for alternatives, and capped with a non-sequitur conclusion. I thought my allusion to the Underpants Gnomes made that quite clear - apparently not.
6/25/2008 9:23:50 PM
^^^^^^1) Not sure this is necessarily a good reason to adopt a new system. 2) How does a national healthcare system address this other than shifting the burden. (On a side note, we also spend more on higher education. Additionally, we have higher disposable incomes, so it makes sense we would spend more on something we value so highly)3) This could be addressed with specifically targeted subsidies for pre-existing conditions without having to resort to scrapping the entire system as a whole4) Again, a nationalized health care system does not address the cost issue addressed in my original post
6/25/2008 9:27:31 PM
^^uh, the premises are all true, and saying the argument is non sequitur and showing that it is, are quite different[Edited on June 25, 2008 at 9:29 PM. Reason : ^now this is a constructive response]
6/25/2008 9:27:54 PM
^^it sounds like what you want to do is somewhat like the singaporean system (http://tinyurl.com/2tyxll) and i don't necessarily think that's a bad way to go, depending on how it's implemented--although i'd like to see something a little closer to the canadian model
6/25/2008 9:43:24 PM
1) Is utterly irrelevant. It may be true but has no logical relation to any of the other premises or the conclusion. Furthermore, it omits relevant information, such as, "The US also grossly subsidizes the national defense of every other industrialized nation of the world, thereby allowing them to avoid difficult and expensive decisions about budgetary priorities by placing them squarely on the backs of U.S. taxpayers."2) Fails to account for issues like an unhealthy American lifestyle, disposable incomes (as well as entitlement subsidies) which allow us to spend disproportionately more on end-of-life care, or a flawed incentive structure which emphasized remedial rather than preventative care. It is, in fact, an oft-repeated canard which neglects to compare apples-to-apples. 3) Is given completely without evidence, and, taken to be true, only indicates that the problem is with the status quo, not that we should adopt your proposed system whole cloth. Plenty of "national healthcare" systems in industrialized countries are a complete flop - one need look no further than the NHS in the UK for evidence of this.It therefore in no way follows that, "the US should adopt a national healthcare system".Which, incidentally, is the very definition of a non-sequitur argument. Thanks for playing.[Edited on June 25, 2008 at 9:46 PM. Reason : .]
6/25/2008 9:45:26 PM
^^ You have to actually make an argument before you can complain about people not accepting it.Listing premises and then a conclusion is not an argument. It is a literal non-sequitor.
6/25/2008 9:47:35 PM
6/25/2008 9:57:15 PM
6/25/2008 9:58:40 PM
6/25/2008 10:15:10 PM
Granted this is highly simplified and I haven't thought through most of the problems with it, but I think a good basic universal healthcare plan would basically be that any non-cosmetic surgery (plastic surgery, LASIK, stomach staplings, etc) above $2000 and any necessary medication above say $400 would be covered by government insurance as long as you got a yearly checkup (since preventive medicine is cheaper), and if you really wanted private insurance for the other stuff you could get it. That way it becomes much harder to game the system, and if your kid gets cancer you won't lose your house.Why am I wrong?
6/25/2008 10:26:14 PM
It's less generous than the current system, and far less generous than proposals on the table, for one. That being said, who determines what is "necessary?" How do you control inflation of costs? One of the problems of our current hybrid system is doctor reimbursements - Medicare constantly puts the squeeze on how much they'll pay for services to doctors and hospitals. The result is cost-shifting - more costs shifted to private consumers, and fewer doctors accepting Medicare.One pretty forseeable outcome of universal payer (which is essentially what you propose) is that one of the easiest ways for the government to cut corners is to simply slash reimbursements like they do now. The result is fewer doctors willing to take public clients, and thus longer wait times for service.
6/25/2008 10:32:08 PM
^^It doesn't address some of the fundamental problems that make healthcare so expensive in America.They are (in no particular order):1. Having the best and highest-paid doctors in the world 2. Paying for the newest and most expensive prescription drugs (in effect, subsidizing world healthcare by paying for the R&D of new drugs in the pipeline)3. Paying for the most cutting-edge equipment and experimental procedures4. High costs due to frivilous medical malpractice lawsuits, which causes doctors to overtreat patients and pay for expensive insurance plans to protect themselves5. A fat, aging, unhealthy population6. A lack of cost transparency that allows doctors (and insurers) to overbill7. Licensing laws that restrict competition and supply of medical practicioners as well as adding costs to existing practicioners8. Abuse of our emergency services by non-citizens as well as the uninsuredThere are other reasons that America is somewhat unique in it's healthcare situation. Costs will likely continue to escalate whether we nationalize or not. Hunt has some very good suggestions for alleviating this crisis.[Edited on June 25, 2008 at 10:53 PM. Reason : 2]
6/25/2008 10:51:23 PM
6/25/2008 10:55:36 PM
6/25/2008 11:04:50 PM
I blame fat people
6/25/2008 11:17:42 PM
6/25/2008 11:30:50 PM
6/25/2008 11:45:13 PM
6/25/2008 11:58:23 PM
Yes, I mistyped. I'd meant to say "costs incurred by medicare" shifted onto anyone with insurance, or more correctly, anyone not under cost caps.So, we have two problems. The first being that if, somehow as you insist, the costs of healthcare in America are uniquely high, rather than simply the costs bourne by consumers due to cost-shifting, then putting universal healthcare in place isn't going to solve anything.Meanwhile, we have a consumption problem. It is not a contradiction in terms to point out costs being higher for private consumers due to cost-shifting and meanwhile point out an incentive problem overall which occurs through any third-payer system which insulates consumption from cost. I know you feel oh-so-clever for pointing that out instead of making a substantial rebuttal (aren't intellectual shortcuts just so much easier), but this is not a contradiction. Costs can be shifted, inflating the cost on a class of consumers due to such, and costs can be inflated through a lack of incentives to wisely use healthcare.In other words - in case you don't feel like skimming through everything above - you can't get something for nothing. Medicare scrapes by through shifting costs onto consumers - a shell game. You don't get to do this in universal healthcare, at least without essentially introducing price controls, which as Econ 101 teaches us, leads to shortages. Which means no magical "cost savings" associated with universal healthcare.[Edited on June 26, 2008 at 12:17 AM. Reason : .]
6/26/2008 12:15:14 AM
the point of (1), which you were so quick to dismiss, is that national healthcare systems can work; if it didn't work, the rest of the world would be crying "privatization" instead of the US discussing "reform." if the US consumes more healthcare services than other countries, so what? so long as americans are willing to pay for the extra services, which apparently many are, there's no disconnnect.the question then becomes: is a single payer system the best way to provide coverage?well, if there's one payer and one risk pool, there's nowhere to shift the costs--if nothing else, this should lead to greater transparency. no, this doesn't necessarily reduce the consumption of healthcare services, but it doesn't necessarily increase them either. the french system, for example, starts out rather modestly, but pays more the sicker you are. note, i'm not advocating a government-sponsored HMO, but universal health insurance. you're right, universal healthcare can be a form of price control. but, that would only lead to shortages if the reimbursement rate was too far below the market rate and it can be counteracted by things like incentives for greater patient-loads. either way, doctors aren't going to stop practicing if they make $120,000pa instead of $140,000[Edited on June 26, 2008 at 1:38 AM. Reason : &]
6/26/2008 1:34:49 AM
Many countries have been crying "privatization" due to the shortcomings of a socialized system. Canada for one.
6/26/2008 1:42:50 AM
when canadians talk about privatization they usually mean something different
6/26/2008 2:02:25 AM
6/26/2008 2:08:02 AM
-I think reform needs to be undertaken to reduce the cost of prescription drugs- I think we need to end the frivolous excessive medical tort awards that drive up malpractice insurance; much of which is passed onto the consumer.- I think i major initiative needs to be undertaken to encourage people to stop eating like hogs and get some fucking exercise.- I think health insurance should be affordable to every american family whose bread winner is working a full time job. Rather it be required to be provided by the employer or through the use of a "health insurance" tax credit, i don't really care.Nonetheless I am fully against a gov't run universal health care system. Seeing how wonderfully other gov't programs are run and the bureaucracy to get shit done, i think it is stupid to turn health care into the same bloated form. I also do not approve of subsidizing through my taxes the lazy, fat, unproductive lifestyles of others. This includes those w/o health insurance b.c they choose not to have a job or those that continuously make unhealthful decisions b.c afterall why would health costs matter to them when the tax payer pays for them.
6/26/2008 2:13:36 AM
6/26/2008 9:23:24 AM
I am a fan of Social Darwinism
6/26/2008 12:36:52 PM
me too. I feel very strongly that charities and donations would do a better job and is more fair than taking your money and giving it to someone else.
6/26/2008 12:38:36 PM
nm[Edited on June 26, 2008 at 12:39 PM. Reason : double post]
6/26/2008 12:38:57 PM