Reply
Thu 17 Sep, 2009 07:10 pm
In order to understand what might be done about lowering health insurance costs, one has to understand why they have risen so much in the first place. first, let me state the obvious, which the media seems not to understand; health insurance is not health care. I mean this in two seperate but equally important ways. 1) That a person has health insurance, whether from the government or from a private insurer, does not neccessarily mean that a person will be receiving health care of an acceptable quality or in a timely fashion. 2) It is possible to purchase the services of health professionals and the products of pharamaceutical companies without using or having health insurance. For evidence of the former, I suggest you look into universal health care in Europe or Canada, where often posession of health insurance means little more than a theoretical right to receive healthcare at some time in the indefinite future, and even then of poor quality. For evidence of the latter claim, I suggest you research all of human history excluding the last few decades.
Now, you might be eyeing that second point very suspiciously; sure, its possible to buy healthcare without insurance, but who can afford it? That's right, today it is nearly impossible for the vast majority of people to afford healthcare without insurance. But why?
1. The very existence of health insurance itself.
What is the purpose of insurance of any kind? A person buys insurance to hedge against the occurance of an unlikely event: i.e. to reduce risk. this often works out for individual people: e.g. a ship owner who's ship sinks, a person who's house burns down, a person who contracts an exotic desease that's expensive to treat. However, it does not benefit the majority of people. Why does any insurance company sell insurance? They hope to receive more in payments for the people they insure than they have to pay out to those same people; that difference is their profit. If an insurance company fails to do this over an extended period of time, it goes bankrupt, right? Right. Therefore, every major insurer in existence is not paying out in claims more than it is taking in in payments, right? Right. What does this mean? It means that, as a whole, the customers of the insurance companies are paying more for the insurance coverage than they are receiving back in the form of actual healthcare; in other words, they would be better off without insurance, even at the high prices today. So why does everyone feel the need to have health insurance? It's making the insurance companies rich, and robbing them of a huge part of their income and giving them much less in return. What they are doing, though they don't it, is generously supporting the health of those whom insurance actually does benefit: the exceptionally sick.
So health insurance itself is simply a waste of money for most people, as they could spend less for the same care without it, but what other effects does this excessive insurance have on the price of health care? It makes it rise. Here's how. 1) A person with insurance is more likely to go to the doctor because of a stomach ache, or the common cold, or to demand some extra test, or some unneccessary medicine they heard about on T.V., than is a person without insurance. The insured person has zero incentive to efficiently use healthcare. This is higher demand, which means higher prices. 2) The bureaucracy associated with insurance is a significant expense for doctors and other medicial organizations.
This process becomes autocatalytic; as more people get health insurance, health care costs rise, and so more people think they need health insurance, and so costs rise more, etc., etc. Where did this insanity begin? Enter Johnson, yes, Johnson. Not only did he push America into an unwinnable war and accumulate massive debts, he tried to create the Great Society! Well, that sounds great! No. Among other things, he created Medicare and Medicaid, which were the original stimulus for the downward spiral (or rather upward, if we're talking about costs) mentioned above. It's not hard ot udnerstand this phenomena. When the government provide funds for people to buy something, which people otherwise would/could not buy that something, the price of that something rises for everyone, including the government: i.e. everyone once again through taxation. The most spectacular recent example of this was the housing bubbles, fueled by government actions which stimulated home buying. But don't get excited, the health care bubble isn't really a bubble, as there's no imvestment going on; it's just a perpetual ascent to profit-town for the insurers, and to penury for you and me. At the same time, tax breaks were offered to employers who would provide health insurance options to their employees, again taking the decision out of the hands of the actual customer, who could make the most efficient use of his funds re the purchase of care.
2. The partial monopoly granted by government to the insurance and pharmaceutical companies, by banning inter-state purchase of insurance and international purchase of drugs, resp.
3. The high costs of malpractice insurance
Alright, what do we do about it?
1. Abolish Medicaid immediately, which is unsustainable anyway
2. Wind-down Medicare; wind down rather than abolish because, inappropriate as the program is, its equally so to retract the promise made to retired people, who can't change habits and save like younger people on Medicaid can
3. Remove all tax incentives for employers to provide health coverage to their employees
4. Allow individuals to buy insurance across state lines, and drugs from outside the United States
5. Pass meaningful tort reform; I'm not a laywer (yet), so i'll leave the details to your imagination
6. Temporarily provide some relief to those who lose their insurance as a result of 1-5, until the transition (lower priced care, individually held insurance) is complete. This could take the form of a reorganization of the state (not federal) insurance systems for state employees. It would work as follows; anyone who wanted to enter the system would pay for it (no subsidy whatsoever) a fixed amount. The prices would be determined by an annual auction in which insurance companies would make bids. The winning bid would not be the lowest, but the one which was chosen by the majority of votes, with each member of the system casting one vote. Again, no mandates, no public funds, except for the office that would deal with the insurance companies once a year and conduct the votes. However, the great adantage of this plan is that it would promote competition among the insurance companies.
Or, we could burden the people with a multi-trillion dollar new entitlement program when we can't remotely afford the one's we have, while forcing everytone to join a federally operated system of dubious quality and motives.
Tough decision...:sarcastic:
@BrightNoon,
BrightNoon;91103 wrote:For evidence of the former, I suggest you look into universal health care in Europe or Canada, where often posession of health insurance means little more than a theoretical right to receive healthcare at some time in the indefinite future, and even then of poor quality.
Fascinating, then, that Europe and Canada have superior health statistics across nearly all measured domains AND lower costs per patient.
Their systems aren't perfect by any means, but they're BETTER than ours by a longshot.
@Aedes,
Aedes;91151 wrote:Fascinating, then, that Europe and Canada have superior health statistics across nearly all measured domains AND lower costs per patient.
Their systems aren't perfect by any means, but they're BETTER than ours by a longshot.
What are you talking about, where are you getting your "superior" health statistics from? Laughable. Lower costs are relative terms. In canada you are docked income even if you are not receiving medical treatment. So lets say if you never went to the doctor in oh five or six years, that whole time you were paying into the system and getting nothing in return. That to me means higher pay, not lower. Sure, the individual doesn't have to pay out of pocket, so in that sense yes it is lower, but like I said, it is relative. You are ignoring the other side of the issue. Canadians pay far more for their health care than they consume.
@Krumple,
Krumple;91153 wrote:What are you talking about, where are you getting your "superior" health statistics from? Laughable.
Laugh away funny guy. Published statistics from the WHO, UNICEF, the CIA, and the CBO to start:
https://www.cia.gov/library/publications/the-world-factbook/fields/2102.html
WHO | World Health Statistics 2009
http://www.unicef.org/sowc09/docs/SOWC09_U5MR_rankings.pdf
http://www.who.int/whr/2005/annex/annexe2a_en.pdf
http://www.who.int/whosis/whostat/EN_WHS09_Table1.pdf
for example:
Child Mortality (deaths under 5 years) -- of 189 evaluated countries, the USA was behind 39 others, including the entirety of Western and Central Europe, and even behind Poland, Hungary, and Cuba.
Neonatal Mortality -- US is 78th in the world
Life expectancy -- US is 42nd in the world
We're not just inferior -- we're WAY inferior. Of course our statistics are completely thrown by health disparities within our own country. Go figure.
@Aedes,
Aedes;91151 wrote:Fascinating, then, that Europe and Canada have superior health statistics across nearly all measured domains AND lower costs per patient.
Their systems aren't perfect by any means, but they're BETTER than ours by a longshot.
Health statistics in Canada and Europe are better, but who said anything about better
health care? Americans are fat, we eat mechanized pseudo-food much more than Canadians and Europeans; hence the shorter life-spans and so on. In any case, let's say in practice socialized healthcare does function better than would a free market (which we don't now have in the U.S.), functionality was one relatively unimportant aspect of my argument. Any thoughts on the other 99%? Re cost e.g.?
@Aedes,
Those deaths, are they directly related to lack of health care or something else? Mortality rates are the worse data to use to determine quality of health care.
@BrightNoon,
Canadians and Europeans are fat too, and they smoke and drink far more in Europe. Obesity rates are lower, but in the US the high rate is disproportionately produced by people who are poor.
---------- Post added 09-18-2009 at 12:12 AM ----------
Krumple;91160 wrote:Mortality rates are the worse data to use to determine quality of health care.
I completely disagree with this, in fact mortality is the gold standard outcome measure of any clinical trial.
@Aedes,
Aedes;91161 wrote:Canadians and Europeans are fat too, and they smoke and drink far more in Europe. Obesity rates are lower, but in the US the high rate is disproportionately produced by people who are poor.
Well smoking has been attributed to suppressing hunger. It is possible where there are more smokers that obesity could be lower. As far as poor goes, the cheaper food tends to be the type that is highly processed or low grade quality. Foods which cause people to over eat because of low quality will cause obesity for those whom are poor.
Aedes;91161 wrote:
I completely disagree with this, in fact mortality is the gold standard outcome measure of any clinical trial.
Yes I know, but it is a bad indicator. They use it because it suits their needs. It is not accurate for determining health care.
I even object to how we view health care in the west. Most practitioners are reactionary to disease management. Rather than using preventive medicine or practices for health. Doctors are not in the business of creating healthy society, they seem to be in the business of selling you disease management medicine.
Lobbyists have long since petitioned the government to help market their so called health pyramid diet. It is wrong but people think it is absolute. Wheat is considered the bottom of the pyramid and supposedly should be consumed the most. But you can't process wheat. Wheat MUST be fortified for the body to do anything with it. If you NEED to add something to a food to make it usable, something is wrong with it. Therefore in my opinion you shouldn't even eat wheat in any form, whole grain or not. Wheat has no nutritional value other than fiber. But you can get better fiber from vegetables or fruit.
Education is necessary for proper health care.
@Krumple,
I'd like to thank you Aedes, for your attempt to enlighten on the complexity of this matter. Unfortunately, it appears that once someone gets it stuck in their head that folks just want handouts, they all want to be lazy, despite the fact that this is more-often likely a reflection of of their own perceptions, they'll attribute it to everyone in need. This perpetuates the bitterness of such compassionate and advanced programs. I find the same accusations and vitriol, from the same people, when talking about anything where someone can snag the "no free lunch!"-banner.
I guess what I'm saying is that this is a battle lost from the get-go. Our country is too far saturated with ignorance on the issue - it's simply much easier, and plays to our anger, to pull out the "down with big government handouts"-flag rather than appreciate the subtleties that so many people have to deal with. Toss out whatever facts and statistics you like - it won't matter; any statement of fact can be called into question and impugned.
Anger finds an outlet; let's point at everyone who, by virtue of the broken system we have, cannot purchase insurance (or buy it outright) and call them lazy. It's much easier than admitting that while Capitalism is a fine philosophy, having
Healthcare for Profit is a bad idea; in any book.
Apologies in advance for the sarcasm here; it comes from my realization that we're far too backward and angry to take our place amongst advanced nations who've traveled this road to its logical conclusion. I'd hope to see us advance past this in my lifetime; this isn't going to happen.
Thanks
@Aedes,
Aedes;91151 wrote:Fascinating, then, that Europe and Canada have superior health statistics across nearly all measured domains AND lower costs per patient.
Their systems aren't perfect by any means, but they're BETTER than ours by a longshot.
Phony statistics by socialists who wish to take power. Almost each of these statistics are some sort of trickery.
The WHO rating with the US on place 37 is that way because it rates free market systems down.
Life expectancy is simply short because of obesity and the dietary culture of the US. In Japan, with one of the highest life expectancies, they have a very different fish-rich diet.
The cost of health care in the US is high because of illegal immigration and obesity.
Infant mortality is high in the US because children dying within 24 hours are not counted and the US is better at keeping them alive into that time.
Most of the uninsured are young people who rather have a nice car and people who would be eligible under existing government programs but can't be bothered with the paperwork.
@Khethil,
Khethil;91212 wrote:I'd like to thank you Aedes, for your attempt to enlighten on the complexity of this matter. Unfortunately, it appears that once someone gets it stuck in their head that folks just want handouts, they all want to be lazy, despite the fact that this is more-often likely a reflection of of their own perceptions, they'll attribute it to everyone in need. This perpetuates the bitterness of such compassionate and advanced programs. I find the same accusations and vitriol, from the same people, when talking about anything where someone can snag the "no free lunch!"-banner.
I guess what I'm saying is that this is a battle lost from the get-go. Our country is too far saturated with ignorance on the issue - it's simply much easier, and plays to our anger, to pull out the "down with big government handouts"-flag rather than appreciate the subtleties that so many people have to deal with. Toss out whatever facts and statistics you like - it won't matter; any statement of fact can be called into question and impugned.
Anger finds an outlet; let's point at everyone who, by virtue of the broken system we have, cannot purchase insurance (or buy it outright) and call them lazy. It's much easier than admitting that while Capitalism is a fine philosophy, having Healthcare for Profit is a bad idea; in any book.
Apologies in advance for the sarcasm here; it comes from my realization that we're far too backward and angry to take our place amongst advanced nations who've traveled this road to its logical conclusion. I'd hope to see us advance past this in my lifetime; this isn't going to happen.
Thanks
The fact that you have made ad hominem attacks and questioned the motives generally of anyone who is opposed to socialized health care, while competely ignoring any issue, demonstrates perfectly the tactic of the establishment. Congratulations.
Quote:Unfortunately, it appears that once someone gets it stuck in their head that folks just want handouts, they all want to be lazy, despite the fact that this is more-often likely a reflection of of their own perceptions, they'll attribute it to everyone in need
Ironically, that is a reflection of your own perception of your ideological opponents, which is flawed. Speaking for myself at least, opposition to 'big government' is far more principled; i.e. not constructed from an irrational or emotional contempt for the lazy. I believe in individual freedom, not statism in the interest of what is perceived to be the common good. I want a limited constitional republic, not a democracy. Everyone does not have a right to every problem; everything is not a public issue. I hold that personal health is not a public issue. And the constitution of course agrees, but I suppose that's just a anachronistic vestige of a less civilized time, eh? :sarcastic:
In any case, I'll take your avoidance of argument re the issues to mean that you are unable to put forth your position in a logical fashion. You might as well buy an Obama sign and start chanting 'health care now!' along with the other payed 'protestors.' All I hear is Baaaah! Baaaah! Baaaah! And that suppresses debate.
Aedes wrote:Canadians and Europeans are fat too, and they smoke and drink far more in Europe. Obesity rates are lower, but in the US the high rate is disproportionately produced by people who are poor.
The United States has a higher rate of obesity than any European country or Canada, and obesity is the prime cause of most health problems in developed nations. Obesity does not result from a lack of health care. Ergo, the higher mortality rates in the U.S. are not indicative or poorer quality healthcare. Furthermore, the idea that health is mostly the function of health care is absurd on its face. There are a multitude of factors. Anecdotally, I have been to several European countries, and I can personally attest to the fact they Europeans eat far less, and far healthier than Americans.
You also stated that the poor are more obese in the U.S. than the middle class or rich (very true); are you also implying that this is the result of a lack of access for the poor to health care? If so, you are incorrect. Simple carbohydrates generally, canned foods, fast food, etc, (all the most fattening and least nutritious food) is also the cheapest. Simple.
@BrightNoon,
Plus smoking is one of the greatest cost savers a health care system could hope for.
@BrightNoon,
How on Earth does that work?
Heavy smokers might generally die sooner, but they do so in the same percentage as non-smokers (100) and generally require hospital care for a greater proportion of their shorter lives.
@BrightNoon,
Brightnoon,
I don't quite know what to tell you; I've seen this argument go round and round with the same pitisome arguments; all which go nowhere. We stand on these ideals - all of us - and pit one against the other. I won't engage in the silliness; this is a philosophy forum, so let's keep it on the philosophical level.
I think it speaks of our inability to come to grow, it reflects our dissatisfaction and displaces angst and inner mirth towards people and ideas not the true source of our dissatisfaction; it also creates an 'enemy':
those people who want something for nothing. Does it need to be illustrated how flawed this is?
Most of what you responded with appears to be just an expression of angst against someone who seems to not share your view; which is understandable. Yet it fails to address the philosophical issues I brought up:
Healthcare for profit is a bad idea -and-
That much of the opposition to installing basic healthcare for all citizens comes from inner disatisfaction/disillusionment and manifest by the incessent bray of "It's not fair!!". [INDENT]Government
is too big - but if government is going to do
anything that's worthy of my tax dollars, I'd think
keeping us all alive is something I'll willingly contribute. If this is at all important - at all worthy of our hard earned dollars - then perhaps some of the other crapola we're spending it on should go.
[/INDENT]Let's not wallow in arrogant supposition. My view primarily consists of those I stated a few posts ago and are underlined above. I think it's important - I think it's high-time and I think we need to let go of calling "lazy" those who can't afford medical care because of this greed-saturated culture we've built; there are many situations that perpetuate millions of personal financial crisis, every day, because someone thought it was a "good idea" that medical attention was OK to be a For-Profit endeavor.
Thanks for your reply
@BrightNoon,
Khethil, if you think that a universal medical coverage would be cheaper, you are mistaken. If they make this health care plan mandatory it gives no incentive for any insurance company to charge less. They almost always charge more. The same thing happened when they made car insurance mandatory. The price of the most basic policy tripled. The only difference is, since you won't actually see these costs you won't be able to tell that you are actually paying more for it. It is great for the insurance companies and bad for consumers. Not only that but I guarantee that these companies will begin to discriminate just like the auto insurance companies do. If you have tickets on your record, they go against your pay rates charging you more for coverage. If you have any accidents or claims it goes against your pay rates charging you more for coverage. If you are young it goes against your pay rates. Originally it did not begin this way but the companies become more and more predatory towards consumers since the consumer has no options to NOT have insurance. Unless they want to walk, ride a bike or ride the bus, they MUST pay.
The same will happen with this health care plan. In the beginning they wont discriminate but I guarantee over time they will start. First they will discriminate against people who have medical accidents, calling them liablity patients. So for every emergency you have your pay rates will increase. If you have a terminal condition you are consider a liability and your pay rates will increase. If you are a certain age, your pay rates will increase. If you have certain habits that are considered harmful to your health, you will have pay rate increase.
Most of this will happen behind the scenes so you wont out right notice that you are paying more. Since it will be docked from your pay checks. But as your liability threat increases they will dock more and more pay from your income because they will consider you a higher risk patient on the system.
Ultimately what happens is, you pay much more than the amount of service you are receiving. Just like auto insurance. There are dozens of people who never get into accidents yet they are forced to pay for it. They never get any money back that they paid into for all the years they paid for it.
Insurance companies are predatory by nature. You really trust they have your best interest in mind? NO, they are for profit.
@Dave Allen,
Dave Allen;91269 wrote:How on Earth does that work?
Heavy smokers might generally die sooner, but they do so in the same numbers, and generally require hospital care for a greater proportion of their shorter lives.
Simple. Qui fumi?* Not just any random segment of the population. Smoking is taking a risk with ones health. In fact smoking is
proof that one has personalty attributes of willingness to take risk. Just like going to a heavy metal concert is a sign that the person probably likes heavy metal.
What do people who are willing to take health risks also do besides smoking? Eat unhealthy, drive irresponsibly (cause car wrecks), don't exercise, etc. In short: cause costs.
We cause half of our health care costs in the last years of our life. So we get
a segment of society that is most likely to cause costs finish themselves off before they will cause most of the costs.
If smoking were banned tomorrow all those people would live to receive cancer treatment and blood pressure medicine. That's why smokers don't cost us money, they saves us money. Smokers shouldn't even be paying sin taxes, they pay for their habit by removing themselves before becoming expensive.
*A probably mistaken latin translation of: Who smokes?
@BrightNoon,
You're right - I don't know any smokers who properly protect themselves from demonic possession.
@Dave Allen,
Dave Allen;91280 wrote:You're right - I don't know any smokers who properly protect themseleves from demonic possession.
Firefox spell checker screwed me over. Come on. Don't be silly. It's too low for philosophyforum.
@Krumple,
Krumple;91277 wrote:Khethil, if you think that a universal medical coverage would be cheaper, you are mistaken...
Hey Krumple,
I've not said - nor do I think - that the plans discussed thus far (or that have been in play recently) would be cheaper, per say (although such could be exactly the case). And I'd agree that insurance companies are predatory by nature - as with virtually any business entity; it's how economics operate.
You're correct on the car-insurance analogy you brought up. But whether or not such would be the same in a universal health care scenario
depends on how it was implemented. The entire industry, as is, is a bloated and complicated labrynth of third-party vendors, distributors and profit takers. What should cost $ .39 costs, easily, $100 or more. My experience and my wife's in the Medical Purchasing industry bears this out - there are thousands of examples.
Whether or not universal healthcare was achieved through mandated insurance, such along with gov't provided insurance or any other combination entails a trillion pros and cons I'm not qualified to try and delineate here. I do know our system is broken, I also know that the way that it's broken has placed us in a position where people can't get the basics of survival. I also know the nature of the beast with regards to For-Profit endeavors. Given our ingenuity and priorities, I believe universal healthcare in our country is achievable and direly needed.
Thanks
@Khethil,
I don't think any imposed answer to the health care issue will work. People just have to learn to take better care of themselves and I think they will once they can no longer afford to visit physicians whenever they feel like it.
The U.S., over the last 30 years or so, has become fantastically obese in all dimensions (not just fat), by
borrowing on the future. Borrowing for cars, travel, clothes, homes, food, and sick care expenses. It is all borrowed.
This game of borrowing and spending worked as long as the lenders (Japan, China, Britain, etc.), felt confident that they will get paid back. The game is over. The U.S. has defaulted on billions upon billions of dollars in loans and lenders will no longer lend to us. The only one they will lend to is the U.S. government, and even that is now suspect with the government devaluing the dollar, therefore decreasing the value of loans denominated in dollars. The debt to asset ratio is still at record highs and it will take a long, long time to pay off the debts that we have accumulated in order to indulge our lifestyle.
With that said, the people in the U.S. are going to have to go on a gigantic diet over the next two decades. Less travel, less waste, less stuffing their stomachs with food and drugs, less smoking, and yes, much less visits to physicians. Physicians are going to be forced to cut back on their lifestyles (e.g. plastic surgeons), as will everyone else. And people will just have to learn again how to take care of themselves. Many of my friends are not taking up yoga, Tai Chi, and other health practices.
So, I think things will reverse itself naturally, but where it all ends, I have no idea.
Rich
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