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  1. #31
    pathwise dependent FDG's Avatar
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    lol @ americans being fixated on privatized healthcare. Good luck with ideology, we will keep up with being cured.
    ENTj 7-3-8 sx/sp

  2. #32
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    Quote Originally Posted by FDG View Post
    lol @ americans being fixated on privatized healthcare. Good luck with ideology, we will keep up with being cured.

    It's not "privatized." It wasn't a public good to begin with. And I LOL at Italy's deficit and structural unemployment rate. I had first-rate health insurance for the first 24 years or so of my life. Most Americans do.
    Who wants to try a bottle of merc's "Extroversion Olive Oil?"

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    Dreaming the life onemoretime's Avatar
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    Free market health care can't work because of economies of scale and inelastic demand. Providers could just charge whatever they wanted to, and would have complete control over profitability levels, while individual consumers would have little to no power. That would mean cutting even more people's access to health care, or only allowing access to the cheapest forms of health care, given the wealth distribution in this country.

    We'd be rationing health care based on how much money you had. Basically, the message would be that rich people deserve to live more than poorer people do. That's the kind of message that starts revolutions.

  4. #34
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    Quote Originally Posted by onemoretime View Post
    Free market health care can't work because of economies of scale and inelastic demand. Providers could just charge whatever they wanted to, and would have complete control over profitability levels, while individual consumers would have little to no power. That would mean cutting even more people's access to health care, or only allowing access to the cheapest forms of health care, given the wealth distribution in this country.

    First of all, health care was not nearly as rationed before Medicare and Medicaid and the rise of managed care. Secondly, much health care is not nearly as inelastic as you claim. A lot of it is elective. I have actually worked at a hospital, and I could see some of the reasons that the cost of health care is spiraling ever upwards. Paper-based medical records, outrageous malpractice insurance premiums (Pennsylvania, my home state, is supposed to be of the worst in Amerca), endless amounts of paperwork and red tape. It's not just greed, although the greedy love to get into that industry. You can get away with charging outrageous amounts if the bills end up getting paid by the government, gigantic insurance companies, or individuals so rich they can pay whatever they want for the best care.

    Also, there is no way for companies to "have complete control over profitability levels." You cannot possibly believe that.


    We'd be rationing health care based on how much money you had. Basically, the message would be that rich people deserve to live more than poorer people do. That's the kind of message that starts revolutions.
    Health care is not a right. It's something that needs to be paid for. The government is not supposed to be in the business of "sending messages," either. That's the same argument as "We can't legalize marijuana. If we do, then it's like the government telling kids it's OK to do drugs!" Government policy is not the place to peacock worldviews.
    Who wants to try a bottle of merc's "Extroversion Olive Oil?"

  5. #35
    Oberon
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    Quote Originally Posted by onemoretime View Post
    Free market health care can't work because of economies of scale and inelastic demand. Providers could just charge whatever they wanted to, and would have complete control over profitability levels, while individual consumers would have little to no power. That would mean cutting even more people's access to health care, or only allowing access to the cheapest forms of health care, given the wealth distribution in this country.

    We'd be rationing health care based on how much money you had. Basically, the message would be that rich people deserve to live more than poorer people do. That's the kind of message that starts revolutions.
    Karl Denninger and I beg to differ. Here's his take on it:

    Health Reform: Who Are They Trying to Fool?

    Here's the money quote, in two bullet points:

    • There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!
    • Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition. While it does not apply to services, it darn well should. Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change. Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

    Fix these issues and the rest of the health care economic woes mostly fix themselves.

  6. #36
    Dreaming the life onemoretime's Avatar
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    Quote Originally Posted by pure_mercury View Post
    First of all, health care was not nearly as rationed before Medicare and Medicaid and the rise of managed care. Secondly, much health care is not nearly as inelastic as you claim. A lot of it is elective. I have actually worked at a hospital, and I could see some of the reasons that the cost of health care is spiraling ever upwards. Paper-based medical records, outrageous malpractice insurance premiums (Pennsylvania, my home state, is supposed to be of the worst in Amerca), endless amounts of paperwork and red tape. It's not just greed, although the greedy love to get into that industry. You can get away with charging outrageous amounts if the bills end up getting paid by the government, gigantic insurance companies, or individuals so rich they can pay whatever they want for the best care.
    We also had very strong unions enforcing employer-provided health care before the Great Society programs. Insurance was non-profit, as were most health organizations. The HMO act of 1973 was specifically to inject a profit motive into health care, with the idea that it would improve care. It did the complete opposite, because of the inelasticity of demand for health care.

    Paperwork is a huge issue. I fully support all efforts to modernize health care bureaucracy.

    Malpractice accounts for 2% of overall health care costs, so it's a bit of a red herring. Malpractice premiums, while unfortunate for doctors, do not affect overall health care costs - doctors are paid what the market demands for them, regardless of their personal costs.

    A single-payer system has much more price-setting power relative to other forms of health insurance, as this is the nature of a monopsony. If a hospital tries to overcharge for unnecessary procedures, the single payer can just tell them to fuck off, since they have the force of law on their side. Insurance either has to pay or foist the cost on the consumer themselves; the health care provider never has to eat the cost, as at the very least they will be paid through bankruptcy protection (our existing universal health care system).

    Also, there is no way for companies to "have complete control over profitability levels." You cannot possibly believe that.
    Isn't that exactly what monopoly power is?


    Health care is not a right. It's something that needs to be paid for. The government is not supposed to be in the business of "sending messages," either. That's the same argument as "We can't legalize marijuana. If we do, then it's like the government telling kids it's OK to do drugs!" Government policy is not the place to peacock worldviews.
    Roads are not a right, they're something that need to be paid for. National defense is not a right, it's something that needs to be paid for. Fire protection is not a right, it's something that needs to be paid for. And so on and so forth.

    Plenty of things are paid for by the government - because they're in essence collective goods. Each member of society benefits more collectively from a vast road network (through its economic benefits) than they do individually from their own personal usage of the road system. National defense practically explains itself. Fire protection prevents individual fires from becoming massive city-wide fires, not to mention assures that all fires will be put out in good faith.

    Health care is the same way. We all benefit from a healthy workforce more than we do individually from our use of health care. Likewise, we're all paying much more (two times as much) as the next developed country in tax expenditures in regard to health care. What do we get for all of this? Somewhere from 14th to 30th in the world in all major health indicators.

    Like it or not, messages are sent by actions regardless of intent. The question is what are the messages to be sent? Is the legalization question that you mentioned problematic because it's sending a message, or because it's sending a message you disagree with? There's no question that legalization would indicate that the state takes a less harsh view toward cannabis use than before.

    If worldviews were not "peacocked", as you said, on a public stage, why would politics end up always devolving into a competition of ideologies?

  7. #37
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    I only have time to respond to some of these points.


    Isn't that exactly what monopoly power is?
    Who's the monopoly? Is there one health care company in the United States? Did I miss something? Also, even real monopolies don't necessarily hurt the consumer (although they obviously are bad for competitors). The price of gasoline fell about 90% during Standard Oil's period as a near-monopoly in the late-1800s.


    Roads are not a right, they're something that need to be paid for. National defense is not a right, it's something that needs to be paid for. Fire protection is not a right, it's something that needs to be paid for. And so on and so forth.
    National defense and property defense ARE rights. Those are the most basic things that a government must do. Roads technically are not rights, but the right to freedom of movement (except across private property) is. All of these are clearly enumerated or based upon common law. Health care is not.


    Plenty of things are paid for by the government - because they're in essence collective goods. Each member of society benefits more collectively from a vast road network (through its economic benefits) than they do individually from their own personal usage of the road system. National defense practically explains itself. Fire protection prevents individual fires from becoming massive city-wide fires, not to mention assures that all fires will be put out in good faith.
    These are all rights that would be required even if they were economically not sound. How is an individual's health care a collective good? Roads and national defense are collective inherently. Paying for my medical care is not.


    Health care is the same way. We all benefit from a healthy workforce more than we do individually from our use of health care. Likewise, we're all paying much more (two times as much) as the next developed country in tax expenditures in regard to health care. What do we get for all of this? Somewhere from 14th to 30th in the world in all major health indicators.
    I would absolutely benefit more from no government health care (and coordinately lower taxes) than I would from everyone being covered. I am 26 years old and in good health. I have a job at another hospital pretty much in the bag, and I will have excellent health insurance as part of my health benefits for the next year or so. After that, I will be in grad school and I will have good health insurance there. And after that, I should be making somewhere in the range of $100K per year in my early-30s, and more as I continue my career. I will have health insurance from those jobs, and I would be able to afford excellent private health insurance even if I didn't have a plan through work. How would I benefit from a single-payer system?


    Like it or not, messages are sent by actions regardless of intent. The question is what are the messages to be sent? Is the legalization question that you mentioned problematic because it's sending a message, or because it's sending a message you disagree with? There's no question that legalization would indicate that the state takes a less harsh view toward cannabis use than before.
    It's not the state's business to decide what adults do with their own bodies, nor it is the business of the state make sure all those bodies are healthy. Relying on the state for personal moral guidance is idiotic.


    If worldviews were not "peacocked", as you said, on a public stage, why would politics end up always devolving into a competition of ideologies?
    Because there is a GIGANTIC difference between "I disagree with this" and "This should be illegal." As soon as those become the same thing, precious liberties are lost, sometimes forever.
    Who wants to try a bottle of merc's "Extroversion Olive Oil?"

  8. #38
    Dreaming the life onemoretime's Avatar
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    Quote Originally Posted by oberon View Post
    Karl Denninger and I beg to differ. Here's his take on it:

    Health Reform: Who Are They Trying to Fool?

    Here's the money quote, in two bullet points:

    • There are no published prices. In no other line of work is it legal to do this. Nowhere. You can't sell someone a hot dog and tell them after they eat it what it just cost them. You can't hire a lawyer and have him tell you "I'll tell you what this will cost when we're done." You can't hire an electrician and have him tell you "I'll make up a bill when I'm done." In every line of work except health care, this is illegal. There are even laws for "major" consumer work (e.g. contracting, auto repair, etc) where they must give you a binding written estimate before beginning work!
    • Robinson-Patman makes it illegal to discriminate against like kind purchasers of goods in pricing decisions when the effect of doing so is to lessen competition. While it does not apply to services, it darn well should. Whether you are paying privately, you have private insurance or you're a Medicare patient if you need to have a breast reconstructed due to cancer the complexity of the procedure does not change. Yet it is a fact that the privately-billed amounts for uninsured ("rack rate") patients are often ten times or more that billed to insurers or Medicare. Try charging a cash purchaser 10x more for a TV than someone who finances that TV on your in-house credit facility and you would be shut down and thrown in jail.

    Fix these issues and the rest of the health care economic woes mostly fix themselves.
    Denninger is a great analyst of the markets, and is very good in a predictive capacity. He's a doomsayer par doomsayer, and I'll never ignore what he has to say in that regard. To use a medical analogy, he's a wonderful diagnostician. Those problems he points out are absolutely relevant to the conversation.

    He has a certain big picture myopia, however. He has no concept of politics being the "art of the possible". Most of his solutions, theoretically sound as they may be, are unworkable. Ninety percent of having a good idea is being able to implement the idea in the current environment, which Denninger seemingly cares not one iota about. He might rail against the system, but he can't seem to come up with any way to work within the system to bring about his desired changes.

    Instead, he'll just blame the corrupt politicians and administrators for not seeing what's so obvious to him, assuming that they're either less intelligent than him or simply bad people. It doesn't ever seem to come across that these people may be acting in their rational best interest. Not only that, but he has the common misconception that the government, particularly its regulatory agencies, is all-powerful. It's not - corporate America is de facto the most powerful force in this country, which is why it got most of the bailout cash that it wanted.

    He's absolutely right about those two cases being part of the problem. He's absolutely wrong that changing those policies would fix the system. It wouldn't. The profit motive still would lead the US system to having a much lower bang-for-the-health care-buck than any other developed country in the world.

    Neither of those points address the lack of coverage issues, just the cost issues.

  9. #39
    pathwise dependent FDG's Avatar
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    Quote Originally Posted by pure_mercury View Post
    It's not "privatized." It wasn't a public good to begin with. And I LOL at Italy's deficit and structural unemployment rate. I had first-rate health insurance for the first 24 years or so of my life. Most Americans do.
    It's not public health care that causes the deficit (unemployment is actually sufficiently low now around here).
    ENTj 7-3-8 sx/sp

  10. #40
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    Quote Originally Posted by FDG View Post
    It's not public health care that causes the deficit (unemployment is actually sufficiently low now around here).

    I didn't say that it did. Private health care doesn't cause the deficit here. I was laughing at the much worse public sector problems that your country has when compared to mine, since you took time out to laugh at our legitimate concerns about government-funded health care.
    Who wants to try a bottle of merc's "Extroversion Olive Oil?"

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