Here’s An Approach
By Mitch Berg
One of the things that’s been blocking single-payer health-care in this country – aside from the fact that it’s hideously expensive and, cherry-picked stats aside, tends to leave nations with lowest-common-denominator healthcare – is the hideous cost.
Madame Putin Hillary has an approach to that: hold a gun to peoples’ heads and make them pay:
The New York senator has criticized presidential rival Barack Obama for pushing a health plan that would not require universal coverage. Clinton has not always specified the enforcement measures she would embrace, but when pressed on ABC’s “This Week,” she said: “I think there are a number of mechanisms” that are possible, including “going after people’s wages, automatic enrollment.”
This – along with her play during the era of Hillarycare! to turn the Tic party apparatus into a sort of home-grown Stasi to build dossiers on Hillarycare!’s opponents – should make all you Democrats who’ve been yammering about “choice” for the past thirty years (to say nothing of all you “Ashkkkroft Libertarians”) rise up in arms against your presumptive nominee.
Shouldn’t it?
February 5th, 2008 at 1:02 pm
1. Neither Clinton nor Obama are proposing a single payer system.
2. “One of the things that’s been blocking single-payer health-care in this country – aside from the fact that it’s hideously expensive . . . – is the hideous cost.” Nice writing, plus wrong. In 2005 U.S. public health care spending (Medicare, Medicaid, VA, public employees, ect.) cost $2,884 for every man, woman, and child in the U.S. Other than Luxembourg and Norway, no other government spent as much per person on health care. Because the private health care system in the U.S. is so inefficient, even the most basic government health care costs and safety net programs, cost more than universal health care programs in other countries. Put simply, it costs a lot more to cover some people than to cover all people.
3. “cherry-picked stats aside”. If they were cherry picked, you could cherry pick your own all day long like I could. So come on, do you have any statistical evidence that the U.S. health care system provides better care?
February 5th, 2008 at 6:35 pm
Wow! Look at this:
http://news.wired.com/dynamic/stories/O/OBESITY_COST?SITE=WIRE&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2008-02-05-02-58-08
Fat People Cheaper to Treat, Study Says
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Preventing obesity and smoking can save lives, but it doesn’t save money, researchers reported Monday. It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
…
Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on. The cost of care for obese people was $371,000, and for smokers, about $326,000.
…
“We are not recommending that governments stop trying to prevent obesity,” van Baal said. “But they should do it for the right reasons.”
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Free snack cakes, smokes = cheaper healthcare for everyone.
Yay government healthcare!
February 5th, 2008 at 10:41 pm
RickDFL, I’d like to ask you a question. This subject interests me because I’ve never gotten a good answer from anyone on the left.
I’ll make it about health care but it could be about any government policy that pits the individual’s self interest against the interests of the government.
Most people believe they are entitled to more than they actually receive. Whether it’s true or not is beside the point. More than half the people think they’re better than average drivers, that they work harder for their money than average, that they pay more in taxes than they receive in benefits, that their kids are getting less education than they are paying for, etc.
If you have an absolutely fair way of distributing health care, more than half the people will think they got less then they should have. In a democracy, how do you prevent this dissatisfied majority from chucking out the ‘fair’ system and putting in a different, and by definition less fair, health care system?
February 6th, 2008 at 11:04 am
“In a democracy, how do you prevent this dissatisfied majority from chucking out the ‘fair’ system and putting in a different, and by definition less fair, health care system?”
You can not.
“Most people believe they are entitled to more than they actually receive.”
I disagree and frankly I think you insult Americans. Americas are amazingly willing to make do the best they can with what they have.
To your larger point. Our current health care system is protected by a powerful group of very wealthy vested interests (HMOs, insurance companies, Rx companies). These vested interests thwart the clear will of the majority who would prefer some form of universal basic health care. In every other industrial democracy around the world, some system of universal health care enjoys broad near universal public support.
February 6th, 2008 at 3:50 pm
Troy:
If obese people are cheaper to treat, they would be cheaper to treat in both a universal public health care system or in America’s fragmented private health care system. Nothing about the cost of treating obese people would make either system preferable.
February 6th, 2008 at 7:08 pm
I’m just pointing out that the question is being considered, RickDFL.
Doctors and patients don’t consider what would be “cheaper in the long run”. Only people concerned with saving money, and not lives, do that. That would be third party payers: businessmen and bureaucrats.
Who would run a “universal public health care system” again?
February 6th, 2008 at 7:24 pm
So what. Do you have a point?
February 7th, 2008 at 5:24 am
“To your larger point. Our current health care system is protected by a powerful group of very wealthy vested interests (HMOs, insurance companies, Rx companies). These vested interests thwart the clear will of the majority who would prefer some form of universal basic health care. In every other industrial democracy around the world, some system of universal health care enjoys broad near universal public support.”
Uh, say again? People would prefer a system which gave them everything and cost them nothing, which proves my point and should be obvious to a sane human being. There’s nothing ‘American’ about it. This is a democracy, you know. The ‘clear will of the people’ as expressed in actual votes for their representatives has so far rejected government run health care.
Americans are a unique people. You should get to know a few before before you decide what they think.
February 7th, 2008 at 7:02 am
None that you seem to be able to discern RickDFL. I would explain further, but it would be hopeless. You are about as dense as a person can be. *shrug*
February 7th, 2008 at 7:48 am
Nothing about the cost of treating obese people would make either system preferable.
Other than, of course, a decision from on high to curtail or stop their treatment, taking the choice out of their or their doctors’ hands.
Which is, of course, exactly what they’re talking about.
February 7th, 2008 at 9:14 am
Terry:
“People would prefer a system which gave them everything and cost them nothing, which proves my point and should be obvious to a sane human being.”
I disagree. I think people clearly understand that we need a system in which we all contribute a fair amount and which provides decent health care in return. They just want a more efficient universal system that provides better care to more people for less money.
Mitch:
“Other than, of course, a decision from on high to curtail or stop their treatment, taking the choice out of their or their doctors’ hands.
Which is, of course, exactly what they’re talking about. ”
No one is the article suggested curtailing obesity treatment. Moreover, if obese patients are less costly, then the payer, whether a private insurance company or a public program will have an equal incentive (and greater ability) to reduce treatment. If your HMO decides from “on high” to not treat your obesity, than it is out of your doctor’s hands.
As this article clearly indicates, treating obesity is limited in the private American health insurance market (probably more limited than than in the public program in Holland).
“Right now, some health insurers cover obesity treatments, but it’s far from universal. Physicians often don’t tackle patients’ weight problems during office visits, because they won’t get reimbursed for their time. And in many cases, prescription diet drugs aren’t covered.”
http://www.usatoday.com/news/health/2002-01-21-obesity.htm
February 7th, 2008 at 9:56 am
RickDFL mentions “health insurers”. I can hear the point going “Whoooosh!” right over his head.
February 7th, 2008 at 10:47 am
I certainly hear the air going “Whoooosh” between your ears.
February 7th, 2008 at 11:35 am
Well I think I understand your point of view (“universal public health care” is better than “current insurance driven private health care system” because it would be cheaper), but you fail to grasp mine (both are bad ideas, they remove decision making power from those affected).
RickDFL said: “So what. Do you have a point?”
I do and you don’t get it. You seem to have no clue about what I might be getting at. So I have air between my ears? No. Again, you’re pretty dense, RickDFL.
February 7th, 2008 at 11:57 am
“you fail to grasp mine (both are bad ideas, they remove decision making power from those affected)”
I can not fail to grasp, something you have not said.
If you have a third alternative feel free to propose it. I don’t see how you can avoid having either a private insurance system, a public social insurance system, or a combination of both. The number of people who can afford to pay for a serious health care issue out-of-pocket is vanishingly small. Even under the most “free market” approach (HSAs + high deductible insurance plans) under consideration, private insurance companies would still control most health care decision making.
Without vast wealth private individuals can only make decisions over relatively inexpensive healthcare options. But any of the above systems (private or public insurance) would and do leave them such freedom, precisely because they are inexpensive. Any of the above systems would want to regulate your choice over expensive options. But those our the options almost no one could access on an individual basis anyway, because all of the options would be unaffordable.
February 7th, 2008 at 6:32 pm
No, you fail to grasp it because I have not explicitly said it. My apologies.
“Even under the most “free market” approach (HSAs + high deductible insurance plans) under consideration, private insurance companies would still control most health care decision making”
With an interesting definition for “most health care decision making”, in my opinion. I must disagree. Most health care decisions are well within the financial realm of most folks.
Additionally, if markets were allowed to work on some of the expensive health care options, they may also succumb to market pressure and become less expensive. Right now, when prices are fixed by insurance companies, there is no pressure to come down into “affordable land”. The problem doesn’t get any better when the government gets to fix the prices either.
The problem in the article I linked was that government, doing statistical analysis on the costs of health care, found it was more efficient to allow people to remain “sick” with conditions that made them die earlier. So, do they subsidize research on these topics and possibly run into health care budget issues, or do they provide grant money only to people working on things that will save the government money? That is the least disturbing question that pops into my mind, but it is disturbing none the less.
When the wrong people are in control, these questions are asked. Who knows what answer they will choose? When the right people are in control, they don’t _exactly_ because the question runs counter to the whole point of having anything called “health care”.
February 7th, 2008 at 11:24 pm
“Most health care decisions are well within the financial realm of most folks.”
80% of all health care spending in done on the sickest 20% of patients. These people will all exceed their deductible, so 80% of all spending will be the responsibility of their insurance company. “Most” refers not to the number if individual decisions, but the amount of health care spending. Less total spending will be under control of individuals from of their HSAs and more spending will be under the control of the insurance companies once the deductible kicks in.
“Additionally, if markets were allowed to work on some of the expensive health care options, they may also succumb to market pressure and become less expensive.”
There is no empirical evidence in the health insurance market for this anywhere in the world. Almost everywhere, higher health care prices correlate with larger roles for private health insurance. For commodities and lots of services, free markets lower prices. In health care they raise them.
“Right now, when prices are fixed by insurance companies, there is no pressure to come down into “affordable land”.”
That is silly. Insurance as large scale purchaser exert tremendous and continuous pressure on health care providers to lower costs. They just can not do as good a job as the government. There are also under tremendous pressure to compete with each other to keep prices low. But the competition does not work to lower prices overall. The competition actually causes prices to go up through excessive costs due to underwriting, marketing, fraud, and administration.
“The problem doesn’t get any better when the government gets to fix the prices either.”
Again you have no evidence this is true.
I find your last two paragraphs just baffling. Are right-wingers just hostile in principle to ordinary empirical research? There is nothing “disturbing” about investigating whether certain obesity treatments would save a health care system money overall. It is a rather mundane empirical question.
You seem to hold the rather strange idea that a health system can only pay for treatments that lower costs in the long run. But that is just dumb. People are perfectly happy to pay for medical treatments if they will provide a longer happier life. The reason to treat obesity is that it helps people live longer and happier. It may cost money, but it is worth it.
February 8th, 2008 at 8:15 am
When you say decisions, I think decisions, not spending.
And an 80/20 rule? Empirical research my ass.
Your interpretation of what I wrote is dumb. Hostile to the “principle of empirical research”? Are you “hostile” to reading the article? They weren’t “investigating” “certain obesity treatments”, so please read the article again.
Pieter van Baal, an economist (!) for the National Institute for Public Health and the Environment in the Netherlands, said it was a “book-keeping exercise”. The efficiency of government in action.
“You seem to hold the rather strange idea that a health system can only pay for treatments that lower costs in the long run. But that is just dumb. People are perfectly happy to pay for medical treatments if they will provide a longer happier life.”
No, it’s not my “strange idea”. A “health system” can throw many wherever it wants, but it’s objectives don’t necessarily align with the “people”.
I can fully agree with “The reason to treat obesity is that it helps people live longer and happier. It may cost money, but it is worth it” but it does run counter to the “better health care is efficient health care” (an argument you use quite a bit).
I am done with “crazy interpretation” time for now. Thanks for the fun, RickDFL. 🙂
February 8th, 2008 at 9:34 pm
And an 80/20 rule? Empirical research my ass.
http://www.consumersunion.org/pdf/divide.pdf
See chart 1 page 14
Despite your own faith based evidence free beliefs about economics, most economists actually do engage in empirical research. The question of the cost of a given obese population is perfectly empirical, even if it does involve “book-keeping”.
“It may cost money, but it is worth it” but it does run counter to the “better health care is efficient health care” (an argument you use quite a bit).”
Being willing to spend money for a service does not run counter to wanting fair value for my money. You may not mind being overcharged about $3000 a year, but I do.