Contributors

Friday, January 13, 2012

Firing Your Insurance Company

A lot has been made of Mitt Romney's "I like to fire people" quote, but most of it is off base. In context, he said,
“I want individuals to have their own insurance. That means the insurance company will have an incentive to keep you healthy. It also means that if you don’t like what they do, you can fire them. I like being able to fire people who provide services to me. You know, if someone doesn’t give me the good service I need, I want to say, ‘You know, I’m going to go get somebody else to provide that service to me.’ ”
I agree with that sentiment, though I wouldn't state it with such dickish Trump-like bluster. But Romney's statement was made to discredit the new health care law and on that score he's wrong. In fact, the new law brings us closer to being able to fire our health care providers than the system we currently have.

Right now very few Americans are in a position to fire their health insurance company.

First off, the vast majority of Americans have no real choice for health insurance, because it's provided by their employer. You might get to pick from a limited set of options, but your company decides what those options are, and if you don't like them, the only way to fire your health insurance provider is to quit your job.

But Mitt doesn't get this, because he's a business owner and has never seen how health insurance works from the employee's viewpoint. Of course Mitt can fire his health insurance provider if their service sucks -- he's the boss. His employees have no such luxury.

And Mitt is also wrong if he thinks that the insurance company has an incentive to keep you healthy: the insurer's only incentive is to make their costs be less than the premiums the employer is paying them, while providing just enough medical care to shut the employees up.


In employer-based health insurance Employer A pays Insurance Company B to pay Medical Services Company C to provide health care to Person DThe amount of overhead and paperwork is insane, and there's no incentive for anyone to get anything right. The biggest incentive is for insurance companies to deny and delay medical care to employees who may not be working for the employer in six months or a year, or for employers who may not renew their contract.

People who pay for their own health insurance can ostensibly fire their provider. But practically speaking, it is all but impossible for anyone over 40 to fire their insurance provider. Insurance companies can turn you down for preexisting conditions, and everyone over 40 has preexisting conditions.The companies also have lifetime limits on coverage, and your insurance provider can fire you if you get too expensive for them. Since the downturn started in 2007-2008, there are literally millions of 40+-year-old Americans who have lost their jobs and health insurance, and can't get private insurance even if they can pay for it, because of preexisting conditions. If 40-year-olds can't get insurance, they're going to be in a lot worse shape by the time they're old enough to get on Medicare, and that will cost a lot more.

A lot of this is changing under the new law, and we'll have more protections and a greater ability to retain and switch coverage. Is it perfect? Nope; it's based on Mitt Romney's Massachusetts plan, after all. It could have been better, but the Republicans in Congress categorically refused to work with the Democrats. The Republicans' self-proclaimed goal was to make Barack Obama a one-term president, and they have done everything they can to torpedo the health care initiative.

In the long run, employers have no business paying for employee's health insurance. It's just an accident of American corporate history that it works this way. It's an unfair burden on companies, and it's a huge competitive disadvantage for American business. Everyone should be responsible for their own health care, just as they are for other necessities like food and shelter.

Yes, such a transition would be messy: it would require everyone who gets health care benefits to get an equivalent raise, and a subsidy for people who can't afford it. In addition, industries that cause health problems should also pay more taxes to counter those effects: that is, fast-food chains, and soda, alcoholic beverage and cigarette companies. There will be many sticking points. Companies will short-change employees, and over time employees will complain that their salaries aren't rising fast enough to cover the constantly-increasing cost of health care. And the right will oppose government subsidies for those who will never be able afford to pay for their own health care because they're stuck in part-time jobs like store clerks, bus-boys, hotel maids and cashiers. Millions of Americans are stuck in minimum-wage jobs that are totally necessary for our country to function, but jobs that will never pay well enough to allow someone to buy their own health care, a car or a house.

Our system is the most expensive in the world, but the aggregate quality of outcomes across all America is inferior to most of the developed world. Under our private insurance model annual cost increases have outstripped the rate of inflation by up to five or ten times, and for decades private insurers have totally failed to achieve the only service they supposedly provide: contain rising costs.

20 comments:

juris imprudent said...

A lot of this is changing under the new law

Bullshit. There is absolutely no provision for changing the employer-provided health insurance model, mostly because unions would oppose that. That is how the whole thing got started.

It would be great to untangle that, but certainly no one I've heard from on the Democrat/Liberal side has made that argument. They all want to go to govt-provided.

GuardDuck said...

Everyone should be responsible for their own health care

industries that cause health problems should also pay more taxes to counter those effects: that is, fast-food chains, and soda, alcoholic beverage and cigarette companies.

You do realize that those two statements contradict each other?

If one is responsible for their own health care they are also responsible for the effects of their own poor life choices - not a third party that did not force them to eat a big mac.


would require everyone who gets health care benefits to get an equivalent raise, and a subsidy for people who can't afford it.

So in other words, if you work hard, keep a clean record, show up to work and get a bit better level of training you can aspire to a job that pays the exact same but has the employer pay your health insurance rather than the tax-payers.....

Mark Ward said...

Bullshit.

Well, you'll find out soon enough, won't you? I take comfort in the fact that even if you are wrong, you will somehow still be right:)

they are also responsible for the effects of their own poor life choices

Except this is the one thing you guys don't get. We live in a society made up of people. We don't live in a vacuum. People that make those poor choices will affect us in the form of higher insurance rates and/or medical costs. The real problem here is the cost of medical care and inelastic demand. That's where the solutions should start.

juris "bully weasel" imprudent said...

Well, you'll find out soon enough, won't you?

Ok, so tell me what part of PPACA changed it such that my health insurance isn't tied to employment? Otherwise you are as full of shit as Nikto.

GuardDuck said...

People that make those poor choices will affect us in the form of higher insurance rates and/or medical costs.

Ahhh. So explain to me how some persons poor life choices will affect my monetary relationship with with a private business entity. Oh, and try to explain how that effect exists without the presence of some government law.

The interrelation you refer to is artificial, not a product of the free market.

Mark Ward said...

Good grief. Are you actually asking why, when millions of Americans eat too many cheeseburgers, our insurance rates go up? I'd be surprised if you are as the answer is quite obvious. But I'm certain, that somehow, it's the government's fault and if they just left well enough alone, the free market would sort it all out. Right? When are things not the government's fault? More importantly, when are things EVER the fault of a private business entity? Because it sure seems to me that it always (and most conveniently) leads back to the government.

Explain to me in detail how that happens. No regulation. No government interference. No insurance. We let the suppliers set the price according to the demand. Remember to factor in that some of these markets are monopolistically competitive so they will willingly not let the market go to its natural equilibrium and, instead, set higher prices to boost profit. Account for the inelastic demand. Now tell me how it all plays out. Go ahead and draw it out on a supply and demand diagram and let me know what you see.

GuardDuck said...

No mark, I'm asking you to think something through from beginning to end. I'm asking you to show me how Albert McFatties mcflurry addiction and its associated medical costs increase my insurance costs. Bear in mind that Nikto just told us how those evil insurance companies will deny coverage to Eddie McFattie without the government stepping in to make them take care of poor Eddie. So I guess the first thing I'm wondering is how the companies are denying coverage while at the same time the providing of that coverage is making my rates higher.

And spare me the good griefing you sanctimonious jerk, as we have seen numerous times here, you approach things from a different direction than others do and asking you to explain how you get from A to B is necessary to understand your argument.

Mark Ward said...

No mark, I'm asking you to think something through from beginning to end.

Projection/Flipping. Please dispense with the Rove bullshit, alright? Just because you don't agree with my solutions doesn't mean I haven't thought this through. We're not going to do the game where you put me on the defensive and micro-analyze everything I say in the hopes of finding a kernel of fault that you can turn into a boulder...while all the while ignoring the simple fact that the libertarian/laissez faire answer to this is a fucking disaster of a solution. So, when you respond to what I write below, give me your own points (supported with evidence) in response. Show me the economic analysis that I have requested above.

If someone has insurance and makes poor life choices, our rates go up because the insurance companies pay out (although they try to get out of it). As more and more people make poor choices (and many do because this country is overly indulgent), insurance companies have to think about their profits. In order to make more money, they raise their rates. That's how "poor life choices will affect your monetary relationship with with a private business entity." YOU end up paying for someone else's poor choice.

While we are on the subject of poor choices, many people also make poor treatment choices that are not cost effective. For example, medical technology has obviously been growing at a rapid rate. The cost for this is generally passed on to the customers...customers who may not always benefit from this new technology yet they seek it anyway. These bad choices on treatment lead to a created market that isn't really cost effective in terms of quality.

http://abcnews.go.com/Health/Wellness/technology-medicine/story?id=9864930#.TxMLrKVrNCg

And, as I have said repeatedly, many health care markets are relatively inelastic on the demand side. Let's say Albert McFattie doesn't have any insurance. In fact, let's say there is no insurance and suppliers provide directly to consumers. Albert's fatness means he has to get several specialized heart treatments. He finds a way to pay for them and, because this is a monopolistically competitive market, the suppliers can drive the price up...which they would do for increase profit. Now more people who made poor life choices are paying the high price...again, they have to because it's their lives...so these companies keep driving the price up. If you draw out a S/D diagram for such a market, you can easily see how consumer surplus is eroded. The market is not in its natural equilibrium and the burden is on the consumers...or you. Now, the market has directly effected your relationship with a private business entity. Maybe you've taken care of yourself your whole life but now you're 95 and need the same treatment. Now what?

So, with or without insurance, people's poor choices affect you. This is why the government needs to be involved because they can sometimes improve market efficiency. This is a great example of how one Mankiw's 10 Rules can work.

Now, the only way I can see the free market taking care of itself in this situation is if loads of people start dying. This would definitely have an effect on the demand side and prices would obviously fall. I'm sure there would be a few folks that would refuse treatment and die but most would beg, borrow, and steal to stay alive and continue to feed the ever spiraling cost of care.

Obviously, it's a fine line to walk. If the government is involved in controlling the cost of care, how much will innovation be harmed? One would think that people who work in health care markets want to help people more than make ridiculous profit but we both know that greed drives this country in many ways. I know I don't have all the answers but these are the hard facts about health care. There aren't any easy solutions but I'm certain that leaving it all up to the free market isn't one of them.

GuardDuck said...

We're not going to do the game where you put me on the defensive and micro-analyze everything I say in the hopes of finding a kernel of fault that you can turn into a boulder.

And enough with the Markadelpia bullshit where we have to spend six weeks arguing particle physics before we figure our our disagreement is about addition and subtraction. Your end point is suspect and I can't discuss it with you unless I know the path you took to get there.


our rates go up because the insurance companies pay out

So who is right, you or Nikto? Either they are paying out and there is no need for the government to force them to or they are not and they we can debate whether the government should interfere.

YOU end up paying for someone else's poor choice.

Ok, let's say you have an insurance company that is paying out and therefore charging higher rate because of the Albert McFatty's.

Then lets say I decide to start an insurance company that will fill a niche market to provide low rate insurance only to people who are healthy and avoid risky behaviors. I won't accept Albert as a customer and if one of my customers starts exhibiting signs of becoming an Albert then I drop him. Gosh, I can even offer other policies that charge a premium rate (think insurance for poor drivers) for Albert and others who are risky. My rates remain low and NOBODY is monetarily affected by other peoples life choices. Better yet we don't have people justifying government intrusion into peoples personal business.

But that hypothetical company doesn't exist and cannot exist. Do you want to know why? Because of government regulation.

So we have a situation where the government creates a problem, and then that problem is used as justification for more government intervention. Ad infinitim.

as I have said repeatedly, many health care markets are relatively inelastic on the demand side

And you are still using that term wrong. In addition you are completely ignoring the other have of the equation - regardless of whether or not the demand is inelastic an adequate supply can determine the price point.

monopolistically competitive market

Now we have a new term that you are using wrong. Regardless, what happens absent government intervention into a monopolistically competitive market? ...other firms enter the market and the benefits of differentiation decrease with competition; the market becomes more like a perfectly competitive one where firms cannot gain economic profit.

Again, you continue to focus on the demand side and ignore entirely half of the equation. If Super Special Cardiac Treatment Company is making so much money fixing all the McFatty hearts then pretty soon Heart Masters LLC, EKG Specialists Inc and Hearbeat Intl. will enter the market - ohh absent barriers to entry put up by government regulation.


Now, the only way I can see the free market taking care of itself in this situation is if loads of people start dying.

Demand side demand side demand side. You are like a broken record.

If the government is involved in controlling the cost of care, how much will innovation be harmed?

The only way a government can control the costs of a market is by price fixing - and price fixing only results in shortages. Hmmm - health care shortages.....how do you deal with that? Gotta make a list of who can receive some of the stuff that is in short supply. Gotta have people who are experts who decide who gets on the lists. Of course, because it's health care, and as you keep saying "it's our lifes", some of the people who don't get on the lists and don't receive care may indeed die. So - expert people....a panel...decides who lives or dies....death. Yes, let's call them death panels......

A. Noni Mouse said...

Mark has frequently asserted that before government "charity", poor people were starving in the streets. As usual, his "facts" are wrong.

The actual history of America shows something else entirely: picking your neighbors’ pockets is not a necessity of survival. Before America’s entitlement state, free individuals planned for and coped with tough times, taking responsibility for their own lives.

In the 19th century, even though capitalism had only existed for a short time, and had just started putting a dent in pre-capitalism’s legacy of poverty, the vast, vast majority of Americans were already able to support their own lives through their own productive work. Only a tiny fraction of a sliver of a minority depended on assistance and aid–and there was no shortage of aid available to help that minority.

Mark Ward said...

So who is right, you or Nikto?

It's not an either or thing. It's both, actually. Rates still go up when the McFatties of the world make poor life choices if they already have insurance. And there are McFatties who are denied coverage if they don't already have insurance. They still have to pay somehow as well and that also drives the price up because they keep feeding the market continuing the escalation of the price in health care.

Sometimes they pay out and other times they don't. So it's both there as well. They usually try to weasel out of it so they can make more profit.

But that hypothetical company doesn't exist and cannot exist. Do you want to know why? Because of government regulation.

No, that's not why it won't happen. Once you started your company, you'd start to look at the margin (remember, rational people think at the margin). You would soon realize that even if you refuse to take McFattie, you'd still be left with people who would develop health issues later who require expensive care. Just because they are healthy and avoid risky behavior when you sign them up, doesn't mean they won't change later. People are still going to need treatment of some kind and with the drive for profit comes higher prices for everyone, including you, a new supplier. So, a big part of the problem are the spiraling costs which is on the supply side. Speaking of which...

And you are still using that term wrong. In addition you are completely ignoring the other have of the equation - regardless of whether or not the demand is inelastic an adequate supply can determine the price point.

No, I haven't. The supply side is what drives the thirst for profit. With so many people demanding care, they have a captured audience. Nearly all of those people won't leave the market. Price points are determined by the margins and profit especially in these sorts of markets. I don't understand how you can ignore the demand side of this but perhaps it makes sense because that's where you your ideology meets reality.

other firms enter the market and the benefits of differentiation decrease with competition; the market becomes more like a perfectly competitive one where firms cannot gain economic profit.
...
then pretty soon Heart Masters LLC, EKG Specialists Inc and Hearbeat Intl. will enter the market -


Why is that when you guys don't fully understand a term that somehow it magically transforms itself into I don't understand? So funny...

From the Wikipedia link that you quoted...

In practice, however, if consumer rationality/innovativeness is low and heuristics are preferred, monopolistic competition can fall into natural monopoly, even in the complete absence of government intervention.

In monopolistic competition, a firm takes the prices charged by its rivals as given and ignores the impact of its own prices on the prices of other firms.

Mark Ward said...

The other thing to consider here is the issue of oligopolies. Firms will collude and form cartels that allow them to set prices higher than market equilibrium, thus further eroding consumer surplus.

The only way a government can control the costs of a market is by price fixing - and price fixing only results in shortages.

No. First of all, price ceilings are only detrimental if the price is set below market equilibrium. If it is set well above ME, then we don't see shortages.

Now, I'm not saying that the government should set the price of health care but something has to be done about the rising costs of care. Is your solution to stem the rise removing the government from the equation and letting the free market sort it out? Again, I want to see your evidence for how all of this plays out. The only way I see it working with that sort of solution is if people die. There simply aren't going to be enough firms to enter the market (due to how specialized this field is and the costs involved) to help bring costs down and even if they do, they will simply continue to charge high prices because people HAVE to pay them.

Yes, let's call them death panels.....

Yes, and they are currently sitting in the board rooms of insurance companies and health care providers who know they have buyers that aren't going anywhere.

Mark Ward said...

Noni, do you honestly think that article is an accurate assessment of history? Juxtapose their "facts" with the reality of poverty in the elderly at the time SS was started. Now compare it to the poverty in the elderly we see today. In fact, compare our standard of living today with people in the 19th century. If social programs were so bad, how come we have prospered so well? Currently, we are the sole superpower in the world.

And comparing 19th century economies to today's is silly considering the massive change in the global marketplace. Working hard today is different than working hard yesterday considering the loosening of trade regulations and the growing free markets around the world.

Picking your neighbors pockets...really? So taxes are now stealing...great. Here's a moment when I truly did wish this was a voice inside my head.

juris imprudent said...

The supply side is what drives the thirst for profit. With so many people demanding care, they have a captured audience.

You need to demand a refund from the institution that taught you that economics class - because you didn't learn a fucking thing.

Food or health care M - which one will the lack of it cause you to die first.

Sure, some people may have esoteric health needs - but let's talk about the average person, okay? The average person consumes fairly little health care in an average year. That same average person still has to eat every day. So, I think even you can follow this logic - food is more critical on a day-to-day basis to almost everyone. Yet where is our "food insurance"? Why do we consume food of our choosing (and that we directly purchased ourselves)? Where are our critical food providers? We all know that a bad diet leads to bad health - so why attack that from the wrong end?

You leap to stupid when it comes to health care - a mistake you can clearly see and avoid when applied to food. Would you try to learn something from that? I'm not saying you have to see everything my way, but for fucks sake - stop with the economic idiocy applied to health care markets. You just end up ranting like some street corner lunatic and I have no interest having any kind of conversation with such a person.

Mark Ward said...

You need to demand a refund from the institution that taught you that economics class - because you didn't learn a fucking thing.

Yawn...here we go again...just because you don't like the facts about health care markets doesn't mean you should take it on me.

Food or health care M - which one will the lack of it cause you to die first.

Which one is a competitive market and which one isn't? Food is inexpensive and easily obtainable because there are many buyers and sellers. Heck, if you really had to, you could go out and shoot food for free, right? Dialysis and medication for failing kidneys are not things you can hunt for or get on the cheap. So, your comparison isn't valid.

We all know that a bad diet leads to bad health - so why attack that from the wrong end?

Well, this is a good point and it's why the First Lady has made it a priority. If people took better care of themselves and ate better, there would not be such inelastic demand in some health care markets. Prices would go down as there would be less need. But now the question is how do you get people to make healthier choices? Tying this into food, many people that are poor buy the cheapest food. But it's that food that is the worst for you. This is why you see quite a number of overweight people that are poor. The only kind of food they can afford is the cheap stuff which is high in (pick a bad thing and it's in there). The fresh stuff and stuff that's better for you is always more expensive. So now what?

juris imprudent said...

just because you don't like the facts about health care markets

If you actually had facts I would be happy, but you don't. Instead you have whatever stupid shit pours from your lips and expect me to treat it as Gospel. Well fuck you - this is something where your ignorance will not be glossed over.

Which one is a competitive market and which one isn't?

Food is competitive, and the only reason healthcare isn't is because of the way we currently do it - via "insurance" which is not real insurance it is cost transfer. You can't have a competitive market structured the way our healthcare market is today. We could have more competitive healthcare markets - that is what I am arguing for. We only need to treat healthcare like we do food.

Dialysis and medication for failing kidneys

That is the only example you ever use. Don't you have any clue how flawed that is - to base your argument about all healthcare based on that one case? It would be like arguing about all food based on some people being allergic to peanuts - well my gawd, doesn't that just prove how bad peanuts are - they are poison! All food is potentially poison, because this one is.

Well, this is a good point...

LMAO, I laid the trap and you jumped in with both feet. You fucking idiot fascist - you would be only too happy to have a progressive Dept of Nutrition at the federal govt. Can't allow people to actually make bad choices you know.

Mark Ward said...

Instead you have whatever stupid shit pours from your lips

which essentially means I'm right and you don't like it because there isn't really a free market solution. Oh well...

You can't have a competitive market structured the way our healthcare market is today. We could have more competitive healthcare markets - that is what I am arguing for. We only need to treat healthcare like we do food.

Alright, then how do your propose we make this shift without damaging the economy? This is going to put many people in the insurance industry out of a job in an already tenuous economy. I'm not saying I disagree with your idea. I'm just wondering how it will be implemented.

And you still haven't adequately addressed the issue of inelastic demand. How do these markets become competitive if the buyers have barriers to leaving the market...meaning their lives? You've heard my view on how this plays out with direct buys from customers to suppliers. How does this play out in YOUR view? How does these markets become competitive? How does the price go down in critical care markets?

I use kidney stuff as an example because I'm good friends with a nephrologist and several people I know have had to have dialysis, transplants, and medications. There are many others, obviously. How about cancer? Heart disease? Diabetes? Imagine all the markets in these areas and demonstrate to me how the free market will distribute resources efficiently. Why would these suppliers lower their prices?

Let's pretend that I'm a supplier of critical care and you need the critical care otherwise you will die. The price for your care is 10,000 dollars. Let's also say that there are only a few places that offer the care I do so I get to set the price. New suppliers entering the market is difficult because of the specialized nature of the service and because of the cost to star up. When I start to make money, I get excited. I want a new house so now the price is 20,000 dollars. Are you going to leave the market? Is anyone else? Hey, my daughter wants a pony and riding grounds to parade her around. Now it's 30K. Leaving yet? Is anyone else? Remember, no government here to help you out or regulate it. It's a free market. Explain to me how the resources are distributed efficiently given this scenario.

LMAO, I laid the trap and you jumped in with both feet. You fucking idiot fascist

So, you're not trying to win the argument/prove me wrong/trap me? That's why you "laid a trap." That must also be why you didn't note or answer either of my questions. Voices in my head, indeed:)

juris imprudent said...

which essentially means I'm right

LOL, yep all about "proving who is right" and "winning the argument". I thought that was only supposed to matter to everyone but you?

No, you aren't right, and you don't have any facts. I don't think you would know a fact if it bit you on the arse. For example,

This is going to put many people in the insurance industry out of a job in an already tenuous economy.

Well boo-fucking-hoo. You concerned about those terrible people that work for evil insurance companies?

First off, the most important thing is to eliminate the tax incentive for businesses to provide health insurance so that you decouple insurance from employment. There are several ways this could be handled: 1) make the company payment part of taxable income (just like the wages they pay you) - this is done with some other employer provided insurance, 2) allow individuals to deduct health insurance payments from their taxable income (so you have an individual incentive to have insurance), and I'm sure there are other possible ways. None of that will cause insurance companies to have massive layoffs.

The next part may happen gradually, but it involves putting more cost under direct control of the consumer - just like the consumer does with food. Right now, the health care consumer with "insurance" only pays a fraction of the cost of service - so there is no need to worry if it is best value or not. People can't consume intelligently if they don't know costs and benefits, and in our current healthcare environment much of both are hidden. Health insurance needs to be for the big-ticket, risk-based items in our lives. That is the whole point of insurance to spread the risk of a major loss. Paying for routine shit isn't that. Paying for pre-existing problems also has to be separated out - and that may be the case where a regulated or Medicare system kicks in. [See, I can envision a part for govt to play.]

Most healthcare is not "I have to have this or I die". You can decide what is best for you, just like you do with eating. That doesn't mean you always eat the most expensive meal and also means you don't starve yourself.

And you still haven't adequately addressed the issue of inelastic demand.

You haven't proved inelasticity beyond one special case. Such cases which likely cost us less in total than we spend on cosmetic surgery. So, does that help put some perspective on it?

I use kidney stuff as an example

Because it is atypical of the majority of health care. Shit man, less than half a million people need dialysis. It is a special case, not an example of the routine world. If we only had to pay for those I think we could manage that pretty easily.

You've heard my view

Yes, that is your view. It is not a fact. Do you understand the difference?

Let's pretend

Instead of pretending, let's discuss reality - with facts and stuff. How 'bout that? Because your imagination is not a good source of factual data or behavior of real people in healthcare markets. That is, just because you want to fuck over everyone you can doesn't mean that the rest of the world has such a lack of ethics.

That's why you "laid a trap."

Yes, the trap was I led you into discussing what you want - the feds to decide what we should eat. Of course you will say that it is only a suggestion. What happens when no one follows that suggestion? Are you just going to say, oh well - we tried. Do you start to throw some fat/salt taxes at them? Do you ban offending items? Eventually you will want to force people to do what is best - because you actually think you know what is best for everyone. That is the trap - and it is rooted in your unblinking devotion to the state. Just as long as McDonalds isn't forcing you to eat another hamburger, right?

Mark Ward said...

You concerned about those terrible people that work for evil insurance companies?

Well, many have families but I was thinking in terms of the overall effect it would have on our economy and consumer spending if that many people lost their jobs.

allow individuals to deduct health insurance payments from their taxable income (so you have an individual incentive to have insurance),

You can already do this. We used to pay for our own insurance when my wife was a contractor and I was stay at home dad.

Paying for pre-existing problems also has to be separated out - and that may be the case where a regulated or Medicare system kicks in. [See, I can envision a part for govt to play.]

Good to hear. I agree.

Most healthcare is not "I have to have this or I die".

Most health care isn't Lasik either. I think there are some complexities to this that both of us aren't considering. For example, what if someone has slow growth cancer. They aren't going to die right away but treatment is still expensive. Remember, now we are dealing with millions of unique cases that all have nuances to them because no one person is the same.

Because it is atypical of the majority of health care.

Add in the other ones I mentioned. Heart disease if the number one cause of death in our country. In 2010, an estimated 785,000 Americans had a new coronary attack, and about 470,000 had a recurrent attack. About every 25 seconds, an American will have a coronary event, and about one every minute will die from one. As of 2008, around 11 million suffer from cancer. 25 million people have diabetes which leads to all sorts of other health issues. Now we are well over 10 percent of the population and I haven't even gotten into the various other issues that people have so you can't get out of the inelastic demand issue that easily,

Instead of pretending, let's discuss reality - with facts and stuff

So, my example isn't realistic? How exactly? You're going to have to do better than sarcasm in explaining how the scenario would play out in reality. You guys are always the ones that mouth foam about greed and corruptible human nature. Does that only apply to government types or does it apply to the private sector as well?

There's no way we can tell people what to eat so they will continue to make poor choices. Those choices will then have an effect on your life which is how this whole thing got brought up in the first place. So, now we are back to how to manage this most effectively in terms of cost. At least you have admitted that the government is going to have to have a role so that's a start.

juris imprudent said...

We used to pay for our own insurance when my wife was a contractor and I was stay at home dad.

If she was self-employed she might have been able to deduct the cost - from her business income, but not as a personal deduction. I'm not big on this aspect, people buy house/car/life insurance without tax incentives, but I figured I'd throw it in.

For example, what if someone has slow growth cancer.

First, if it is pre-existing I've already agreed that is not the standard case. Second, that is exactly the kind of thing you would insure against, isn't it? Which means lots of people will insure against it without ever having to collect (and in this case that is a very good thing).

25 million people have diabetes which leads to all sorts of other health issues.

I assume you are primarily concerned about Type I, since that is a medical condition not caused by lifestyle choices. It is also a fairly small fraction of the total. Or are you going for that no one ever has to bear the consequences for their decisions path?

So, my example isn't realistic? How exactly?

First, you assume zero medical ethics. Second, you assume that you are the only provider and that no one can enter the market if you arbitrarily raise prices. Third, you assume that it is life critical. I'm sure I could come up with more but certainly that must suffice to show how unrealistic your fervid little imagination is.

You guys are always the ones that mouth foam about greed and corruptible human nature.

I foam at the mouth about greed? No, that is your specialty. Greed and envy are two things you seem to be deeply familiar with.

Does that only apply to government types or does it apply to the private sector as well?

All human foibles apply to govt and private sector - again you are the one that asserts that govt is not corrupted by such.

Those choices will then have an effect on your life

On my life? No, on their lives. I know you Christians are all big on that brother's keeper bullshit, but that is between you and your imaginary friend in the sky.

At least you have admitted that the government is going to have to have a role so that's a start.

I made that point to circumvent your usual asinine complaint about me being completely anti-govt, so have a great big FUCK YOU. The govt has a number of roles to play not that that will ever stop you from mischaracterizing what I say.