TCS Daily

Who Wants Health Insurance?

By Arnold Kling - December 15, 2005 12:00 AM

"Insurance really only works well when it is somehow mandated. There's no homeowners' insurance crisis or auto insurance crisis (well maybe just a little). That's because nearly all homeowners and drivers are required to carry it. You can't get a mortgage without insurance. In most states, you can't own a car without it, either."
-- William Tucker

Policy pundits are unhappy with the state of health insurance. What is the problem? After considering some alternative theories, I believe that the best explanation is simply that most people do not want health insurance.

The Icing and the Cake

The cost of health insurance has been rising, leading to well-publicized problems in the employer-provided health insurance system and increasing numbers of uninsured. But blaming insurance companies for that is like saying that the calories in a double-fudge chocolate cake are all in the icing.

The cake of health care expenses consists of health care services -- doctor visits, surgeries, and all the rest. The icing consists of health insurance -- administrative costs, profits and all that. In dollar terms, the icing represents less than ten percent of the iced cake.

Many proposals to reform health care finance mistake the icing for the whole cake. They act as if the cost problem is concentrated in health insurance per se, rather than the medical system as a whole. They make proposals to change the system of icing in various ways, with the most dramatic proposal being single-payer health care, with the government providing people with health insurance.

The reality is that re-doing the icing will not have much effect on the cake, as the icing is not the reason that the cake has so many calories.

On the Left, the arguments runs: Europeans have lower per capita spending on health care than Americans. Europeans have much more of their health care paid for by government than Americans. Therefore, we could lower our spending on health care by switching to single-payer health insurance. However that is like saying that because a fruit cup topped with powdered sugar has lower calories than double-fudge chocolate cake topped with icing, that we could have a low-caloried dessert by replacing the icing on the cake with powdered sugar.

Consider this list of factors that affect the cake of health care costs.

  • health insurance industry greed
  • health insurance industry paperwork, inefficiency, and overhead
  • asymmetrical information in the health care market (see below)
  • premium medicine -- expensive specialists and medical equipment

All of these factors are present, and they all contribute to the calories in the cake. But when we talk about the breakdown of the health insurance market, we need to ask: why now?

Have insurance company executives become greedier in recent years? Have they become less and less efficient? Have information asymmetries increased? Has there been an increase in specialization and use of high-tech medical equipment?

The first three possibilities are dubious, at best. But the fourth explanation holds up pretty well. For example, since 1975, we have more than quadrupled the number of gastroenterologists, pulmonologists, and diagnostic radiologists. Since 1980, the annual number of CT scans has grown from less than 4 million to more than 50 million and the annual number of MRI's has grown from 0 to close to 25 million.

Or consider the "natural experiment" of Medicare and Medicaid, which is a much thinner layer of icing according to New York Times columnist Paul Krugman and other advocates of single-payer health care. If the icing really is thinner, and if the icing is a big factor in the total calories of the cake, then total health care spending under Medicare and Medicaid should be noticeably lower than spending under private insurance, after controlling for population characteristics. Instead, if one uses other OECD countries as a control group, our spending on the elderly is as excessive relative to other countries as is our spending on those without private insurance. In fact, Medicaid and Medicare, which together cover less than half the U.S. population, absorb a higher proportion of our GDP than many other countries' single-payer systems that cover their entire population.

Massachusetts Governor Mitt Romney has a proposal to reform health insurance in his state. One interesting fact about Massachusetts is that per capita health care spending there is more than 20 percent above the national average of over $5000 per person. Do you suppose that is because insurance companies are greedier or more inefficient in Massachusetts than in other states? Or could it be because Massachusetts is home to top-flight medical schools and world-class hospitals, giving it an unusually high number of specialists per capita as well as plenty of high-tech equipment? I suspect the latter, in which case Governor Romney's proposal to tinker with the icing will probably not work.

The 50/5 rule and Asymmetrical Information

Krugman has pointed out, correctly, that 5 percent of the population accounts for 50 percent of health care spending. This suggests that in a health insurance pool, the sickest 5 percent could have their expenses paid by everyone else. In any given year, 95 percent of people would not be paid claims, but the sickest 5 percent would receive payments from health insurance.

The catch is that the cutoff for being in the sickest 5 percent is $10,000 of health expenditures. Real health insurance would have a deductible of $10,000 per person, so that the other 95 percent of people would not receive any money. Do you think that politicians will propose single-payer health insurance with a $10,000 deductible? Don't hold your breath.

We do not observe insurance policies with $10,000 deductibles in the market. There are two possible explanations for this:

  • asymmetrical information
  • people do not really want insurance

The asymmetrical information story is that people know too much, relative to insurance companies, about their risk of requiring expensive care. As Tim Harford puts it in The Undercover Economist,

"the insurance company only sells insurance to people who are confident they will use it. As a result, the insurer loses clients who are unlikely to make claims and acquires the unwanted clients who are likely to make costly claims, and then the insurer has to cut back on benefits and raise premiums...More and more people cancel their policies...

The curious conclusion, which is obvious in retrospect, is that an insurance policy depends on mutual ignorance."

This is a clever story, due originally to Nobel Laureate Joseph Stiglitz and much beloved in the economics profession, for why health insurance markets might break down. The very term "asymmetrical information" is esoterically cool. For example, it is the title of one of the best economics blogs around.

In reality, however, when it comes to forecasting our health care needs, consumers and insurance companies operate in an environment that more closely resembles mutual ignorance than asymmetrical information. Mark Pauly and Bradley Herring, who, unlike the many armchair theoreticians, have examined actual health insurance markets, find that insurance companies can pool risks reasonably well.

Recently, Alex Tabarrok commented on a number of markets where economists like to trumpet information asymmetries. His conclusion is that real people and real markets have found solutions to prevent the "adverse-selection death spiral."

Why Health Insurance is Nonexistent

What we are left with, then, is that people do not want real health insurance. I would gladly take a health insurance policy with a $10,000 deductible per individual, and I suspect that many of my wise, risk-averse TCS readers would, too. But we are in a tiny minority! Most people do not want to be responsible for the first $10,000 in medical expenses, and most people believe that an insurance policy that is expected to pay no claims 95 percent of the time is a bad deal.

I am willing to claim that no insurance market in history ever arose because of spontaneous demand on the part of consumers. Maritime insurance, which was one of the first forms of insurance, was demanded by creditors as a condition for lending money to shippers. Life insurance also initially arose to meet the needs of creditors who were lending money to pensioners.

Homeowners' insurance is standard because it protects mortgage lenders. Collision insurance for autos is optional if you own yours free and clear, but not if you still owe money to the finance company.

William Tucker is right. For the most part, people buy insurance because it is mandated by others. Insurance does not have a large natural market.

What we call health insurance also arose to meet the needs of creditors. In this case, the creditors were doctors and hospitals, who wanted assurance that they would be paid for service. Comprehensive, first-dollar health coverage, which is not really health insurance, protects suppliers, not consumers.

During World War II, employers entered the picture. According to Milton Friedman, they offered health care benefits instead of wage increases, because the latter were capped by wartime controls. My strong suspicion is that people like health insurance as it exists today because they mistakenly believe that they are getting something for free.

Tucker argues that government should mandate a low-premium, high-deductible health care policy. (In the Romney plan for Massachusetts, the only way to avoid such a mandate is to post a $10,000 "bond" that guarantees that you will pay your medical bills.) Ironically, this is a relatively libertarian proposal. It is relatively libertarian because the only realistic alternative is for government to continue to provide and/or subsidize the comprehensive "insurance" that is prevalent today.

In fact, I think that Americans are too mentally ill to accept a proposal as sensible as mandatory catastrophic health insurance. We will continue to act as if health care is something that should be paid for only by someone else, never by oneself.

We will forever be demanding the double-fudge chocolate cake, and expecting someone to come up with a way to get rid of the calories by messing with the icing. In that sense, mandatory catastrophic health insurance would be just one more attempt to mess with the icing. However, it might get people to pay attention to the calories that are in the cake.

Ultimately, I believe that America could use a commission to provide more information about the calories in the cake of modern medicine. In other words, consumers need data on the costs and benefits of various medical protocols. But as long as consumers are insulated from cost by the so-called health insurance that exists today, there is no incentive for them to pay attention to such data.

Arnold Kling is author of Learning Economics.


most people do not want health insurance is key to under standing
‘I believe that the best explanation is simply that most people do not want health insurance.’

This is the key to what the majority of people really want from nationalized healthcare. They really want a form of triage where those with very expensive illnesses are allowed to die. I am convinced of this from talking to people.

BTW I have an insurance policy with $5000 deductible plus a $5000 co pay per person per year. I also have home owners insurance on a home that I own out right. I wish that I could get just liability insurance on the home but I have not seen that offered.

I have a friend who is a big advocate of government provided health insurance.
‘I believe that the best explanation is simply that most people do not want health insurance.’

I agree. I have a friend who is a big advocate of government provided health insurance. He is also constantly complaining that he needs a job the gives him health insurance but I try to get him to buy his own heath insurance, and he refuses to even check on the price. He is single and makes plenty of money to afford heath insurance but he has had no health problems yet and so chooses not to get heath insurance. He even once worked for an employer who paid half of the premium and he still did not get the insurance because he said it cost too much and the deductible was too high (about $500 as if that was high) in other words he did not want to spend the money.

So democrats, am I supposed to fell bad if he gets hit with a $50,000 bill some where down the line?

I believe that the best explanation is simply that most people do not want health insurance.
Now to balance my other posts, I think that in the absence of government involvement in healthcare that people would give plenty to charities to get the job done, perhaps with a lower level of care but to an adequate level. Many charities were (mutual aid societies) and are (paying for recreation center etc.) a form of insurance, distributing costs. This runs counter to your idea that no one wants to pay for health insurance. Maybe it is simply that people do not like to pay for something that they cannot immediately see. Maybe this is the way out of the problem bring back the mutual aid societies where the natural elites in society get great social gain for funding the healthcare of others. Example Bill Gates is funding healthcare in Africa. If a need for healthcare existed in the USA it would attract many donors big and small.

BTW Thank you Arnold for the excellent article.

"Health Insurance" serves two purposes today
Great article. But I would add that the high pricing of first rate medical services is not an inherent problem. What we call "Health Insurance" today does two very different things - negotiates service prices, and provides actual insurance (risk spreading over time and members). Of those two, the price mediation is much more important and significant. Here's the data:

Consumption of over-priced services is a problem, but the problem is not the consumption, but the over-pricing, and that is separate from the insurance aspect. People may or may not need and/or may or may not want actual health insurance, but they most certainly want and need price negotiation, and they can't get one without the other today.

Some people don't need health insurance...
For many people who rarely have health problems, there are priorities other than high priced health insurance to pay for. Unless a person makes a lot of hospital visits, health insurance could hardly be considered a necessity.

"Cost/benefits of various medical protocols"
Dr. Kling,

I found this article interesting and insightful.

In your last paragraph you identify the need for data on the cost and benefits of various medical treatment regimens. I think you hit upon a salient deficit and opportunity.

Much of health care is routine or 'paradigmatic', if I can borrow a fuzzy concept from Kuhn. This is the result of past discoveries and innovations. As innovation marches forward, more medical treatments become paradigmatic, requiring less-skilled providers.

A paradigm surrounding a given treatment regimen can be expressed as an algorithm or decision tree. I see an obvious application for the web. In my vision, a more highly-skilled provider can create a treatment algorithm on the web, calling out all necessary evaluations, tests, etc. for given diagnosis, as well as, instructions for the treatment modality, drug therapy, etc.

A provider with lower skills can access the algorithm and follow it step-by-step.

Now it gets interesting:

At each clinical encounter the less-skilled provider administers the indicated test and/or treatment, as well as, outcomes from the previous encounter. What we have is a continuous feedback loop on the outcomes of each step in the regimen.

Combined with patient demographics, disease history, behavioral cues, (even genetic info???) we now have a health care innovation engine! A given treatment algorithm could be constantly refined for ever more specific application.

Example: Epicondylitis (Tennis/Golfer's Elbow)

If a 55-yr-old, diabetic female and a 20-yr-old, athletic male both present with epicondylitis, their treatment regimen will vary based on what doctor they choose, more so than their individual characteristics or their disease state. Yet, we know the female patient will respond very differently, probably more slowly than the male patient, in this example.

If we had a health care innovation engine, we might know, with useful confidence interval, how each would respond to different regimens. These two patients might receive very different treatments, which would provide the speediest recovery, if that were the goal.

Ah, but what if the goal was cost minimization. Again, a library of treatment protocol and their efficacies, would allow reasonable forecasts of treatment costs. The athletic male may want the treatment that allows him to get back in the game in 2 weeks and is not very sensitive to cost. The female may be on a tight budget and chooses a 6-week regimen of home exercises and ibuprofen.

This level of treatment customization is not barred by technology. We have the research base and the communication infrastructure. Much of the barrier originates within structures you have identified, third-party payer systems and medical hegemonies.

Unfortunately, providers do not realize that an innovation engine that placed protocol in a distributed, collaborative environment would be good for them. It would match disease level with the appropriate provider skill level. If I were an MD, I'd get tired of looking at the same rashes and upper respiratory infections, day in and day out. It would be rewarding for me, if I were an MD, to delegate the treatment of these common ailments and spend more of my time on the more challenging disorders.

MinuteClinic is taking a stab at this. I've been formulating my own system for musculoskeletal disorders. I hope to see the web leveraged in this regard. I believe we could see dramatic improvement in health care and associated costs.

Thanks for your excellent article and for allowing me to ramble, a bit.

Best regards,


we are not dependent on
You are probably right. Healthcare cost increases are mainly due to increased costs of the service itself. One argument is that these cost increases are mainly due to inefficient consumption or unnecessary expensive treatments. That argument supposes that increasing inefficient consumption causes increasing costs, but the most basic economic theorem is supply and demand. In other words if all those reputed expensive unnecessary costs were more and more readily available (more machines, facilities and trained personnel) then the increased supply should temper the demand and lower costs. What if we presuppose that during our lengthening lifetimes we are going to require more, not less healthcare. Sound reasonable? Well that means that demand will continue to go up and may go up really fast as more people fall into the more demanding healthcare ages. What are you going to do? Continue to ration it more through price increases and elimination of mandatory emergency services (only treat those that gots the ten thousand up front)? That does not sound reasonable to me, yet it is what continues to happen even though the republican congress is no longer preoccupied with searching for the true whereabouts of Clintons penis. Yea, the healthcare issue is even older than that story, and still not one tiny amount of action has been taken to address the availability and costs of healthcare by our elected officials. Your stance of educating people so that they are aware that they will have to pay more while receiving less from insurance companies is already happening whether people agree with the trend, educated or not. Universal, or mandatory health coverage might lower costs by spreading them further by eliminating all the costs that now have to be passed on to the insured and government. Since we are aware of the fact that we are all going to need increasing health coverage as we live longer and as more of us become the age requiring more healthcare, than what could possibly be a legitimate argument of reducing availability and increasing costs? Your economics with healthcare makes as little sense as your claim that we are not dependent on middle eastern oil. Like, tell the ambulance that he doesn’t need gas from the middle east to deliver the patient to the hospital because the hospital no longer runs an emergency room anyway.

In your choice on the $10K deductible
There is a third choice: a $10K deductible is simply too high. For lower to lower-middle-class people, a $10K deductible is basically worthless; spending that much in a year likely kills their net worth anyway, so why bother? You're better off declaring bankruptcy - after getting treated for whatever ails you. It's like the earthquake insurance I looked into briefly that is expensive and has such a high deductible - it comes to 80% of the replacement cost of my house - that it isn't worth the money.

For richer people, who may be interested in the wealth preservation offered by a high-deductible plan, the cost difference between a $5K deductible and a $10K deductible is likely not worth the savings; my impression of medical procedures is that they are either fairly cheap (flu, whatever), or Really Expensive (cancer, open heart surgery, anything requiring a multi-day hospital stay).

How to afford high-deductible health insurance
Health Savings Accounts are like 401k accounts. Money saved in these accounts grows tax-free. Under the HSA plan you can save, annually, an amount equal to the deductible of your health insurance policy.

Suppose we did have policies with a $10k, deductible. A young person would begin saving in their HSA when they entered the workforce. If they were able to sock away $1500 a year, they would soon have savings enough to cover a $10k deductible, should they become ill.

What is more likely is that they would be sitting on a 6-figure HSA when they become ill in their old age, which would allow them to pay for long-term care, chronic illness, or other events that are not insurable.

Back to the young person, just beginning to fund an HSA. Many insurance companies that are offering high-deductible plans are also offering hospital riders. If you are hospitalized and you don;t have enough in your HSA to meet the deductible, the rider kicks in and pays the difference. I think the hospital rider ought to be standard for folks just starting an HSA.

Yes, $10k is steep for the middle and low income strata. However, our esteemed author recognizes that most folks just don't want insurance. At least, they don't want it as badly as they want TV or internet access. The majority will have to begin taking responsibility for their own health care financing, before we see improvement in the number "covered" or the quality of care.

The deductible is still too high...
I'm well aware of the HSA, and have asked my work to start providing them as we already pay most of our health insurance through work.

Anyway, the problem is that, for expensive procedures, the $10K would not be a one-off. Let's say you get cancer and get chemotherapy. You're fairly young with $10K in your HSA, and blow through your $10K the first year. Now, your ongoing - and expensive - treatments continue through a second billing year. Congratulations! You've got a $10K debt as well as cancer. If the deductible was $5K, with the same money in your HSA, you have zero debt. (Also, it's hard enough to get young kids to put money into 401Ks, much less third-tier stuff like HSAs)

Frankly, for many of my relatives, it was expensive ailments when they were _young_ that were the problem, not old-age issues: things like sports injuries, injuries from car wrecks, general youthful stupidity like bar-fights, or cancers and miscellaneous disorders that could strike at any age.

What most people want is _coverage_. They don't want to live in fear that if they get sick, they'll get nailed with a ton of debt or have to go crawling to relatives or charity for relief. For better or worse, our employer-based scheme makes it look like you're independent and covered, and aren't one cancer away from pauperization. This is why people get scared by the job market getting more competitive, particularly since it's really tough to get private insurance if you and your children aren't paragons of physical perfection, ie most Americans.

Health Care for Everyone
You're all right. Nobody wants to pay for health insurance, especially me. But I do want health care. What should I do.

It's so easy for everyone to say what everyone else should do, and how great our system is right now, when you are healthy and don't need any medical care.

I'll be everyone who responded here is healthy. Just wait till you lose your job, and get sick and have to spend every penney you ever saved paying for the medical care you need.

Or maybe the solution should be to just let everybody die when they get sick.

Let people die?
Health care doesn't keep people from dying. It just changes what is written on the death certificate. Health care insurance is no substitute for preparing for the inevitable.

Say what??
I guess I should have rephrased my statement "maybe the solution should be to just let everybody die when they get sick". Of course health care won't keep people from dying, eventually we will all die.

What I should have said, and what I meant is, "should we just let all people suffer needlessly, and not try to extend their lives if it is reasonable to do? Don't we have an obligation as civil and moral society to see that doesn't happen? If a person contracts a contageous disease, should we just let him/her spread the disease throughout the country/world due to a lack of health care?

Is it only certain people who are entitled to medical care, and everyone else just has to take their chances? If you've spent all your life working and saving for retirement, should you then be required to spend our life savings on medical care, and then when that runs, just get thrown out onto the street to suffer and die?

Such is life for you Kokyuho? I'll bet you have insurance. Tough luck for everyone else. If you're not rich, you're nobody! Right?

Of death and the spirit...
I can march in lock step with you through the first third of your argument. I admit my, somewhat terse, reply was an oversimplification of what, I believe, is a primary underpinning of our obsession with health care.

I could not watch a friend or neighbor suffer an illness without offering my assistance. However, that’s just me. I do not know your “moral society”. I’ve never lived in one or read an account of one. I do know moral people and I believe it is the values of individuals that improve the lives of the poor, sick and afflicted among us.

That is the fatal flaw of any approach to universal health care. It removes volition. It takes the free will of a po****tion and subjugates it to “administrators” of health care. Again, I’ve never known a moral administration or bureaucracy. However, I do know humans to be generally self-serving, and many times humans are chosen as administrators and bureaucrats.

So, I’m stuck! I can rely on the benevolence of the po****ce to help the sick and needy, or I can rely on the wisdom and benevolence of an administrator/bureaucrat to care for the needy sick. Which should I choose?

I choose unfettered volition. This is why:

In a relatively unrestricted marketplace, that self-serving nature of mankind is harnessed by a profit motive to innovate. Innovation renders the improbable and impossible into the doable, routine and less costly. Example: Throughout the US, this very day, thousands of blocked arteries are unblocked on an outpatient basis. Before, it was high-risk procedure that could only be performed on a few lucky patients, in a few hospitals, by a few invasive cardiac surgeons. So, volition makes more health care available to more people

But my penultimate point is not the virtues of capitalism over socialism in the realm of health care. Anyone with a 3-digit IQ can see these. What has driven health care costs to such unruly heights is a morbid fear of death, in my humble, yet strongly held, belief. We cannot accept the end of life, yet we know this is irrational. We stave it off with every chemical, device, operation and incantation we can find.

Here’s where a free marketplace is blamed for exploitation. The poor, sick people are being deprived of medicines that could save their life! Or, perhaps not. Coronary artery by-pass grafts have been shown to prolong the lives of 3% of those undergoing the procedure. Coronary artery stents merely improve the likelihood that you will not have by-pass surgery (which wouldn’t have helped 97% live longer). Why so many procedures performed? Because, people demand the right to pursue a ***ile battle against the Grim Reaper.

In our fright, we lose an opportunity to palliate, ourselves and others. We cannot even consider weighing the cost/benefit of avoiding death. Is it worth it, in terms of the quality of my last days, to get the chemo, the radiation, the surgery?

Sure, the rich can buy more health care! Maybe they worked hard for their money. Maybe their parents did. Maybe they give to cancer research and the local hospitals. And, maybe their money won’t buy them one more **** day! And, maybe inventing an insurance scheme to redistribute some of that money to poorer people won’t buy them anymore time, either. Who can tell? Certainly not another bureaucracy.

There are a finite number of health care dollars to be spent in America. Assigning a bureaucrat to evenly divvy up the pie and distribute to those with the greatest need will only shrink the pie, leaving everyone with less. ‘What’s less than nothing?’ you may be asking. Reaching the end of life, having been convinced by MetalMD, that you’re dying from a case of “immoral society”, when, in fact, it’s just a plain-ol’ case of mortality.

If you want everyone to be more charitable, I’m afraid no insurance scheme will help you. If I want people to stop their morbid obsession with death, I can’t get it through deductible and co-pays. We’re treading into the realm of the human spirit. To lead a revival in this area will take us even further off the topic of this blog.

****! Now look what you’ve done MetalMD! You’ve gone and caused me to start preachin’!

Merry Christmas & Happy Holidays!


Thanks Ben, that was one heck of a sermon.
There is a lot there, and I'm not even sure I completely understand what you were trying to convey, nor if I am capable of responding in equally eloquent terms, but here goes.

The major problem I have with the current health care system is with the profit motive. Now I don't object to hospitals and doctors making a profit. That is the only way they can invest in new equipment to better treat the sick. Neither do I object to drug manufacturers, or medical equipment device manufacturers making a profit, for the same reasons.

I do object to the health insurers making a profit, because the profit they make does not benefit the health care system. They don't build new hospitals, or develope new drugs, to benefit the sick. The profit they make is strictly to divy up among the employees and share holders.

There is no justification for United Health Group to make a $4 billion profit (which incidently represent a greater profit margin then most of the major oil companies), which is not the result of greater efficiencies but rather by denying to treatment to those that need it and not insuring the sick people.

Another problem is the myriad of insurance companies providing insurance. This has caused a virtual nightmare for health care providers in navigating the various plans. It requires them to have extra people or a robust system in place to handle the paper work, all cutting deeply into profits.

So what is so wrong with a single payer system? The government already has one in place for medicare and medicaid, and it operates far more efficiently then the private insurers do. But fine, if you don't want the government to do it, fine pick one insurance company to handle it all. Just make it a non profit organization.

There will still be plenty of opportunity for health insurance companies to provide supplemental insurance, to cover deductible or items that might not be offered under a single payer system, as is the case now.

And what difference does it make if a government beaurocrat makes health care decisions or some similarly incompetent individual at a private insurance company?

The other problem that I have is it puts American business at a competitive disadvantage to other businesses around the world. (GM spends $1500 per vehicle to provide health care, Toyota around $200). What this does is force companies to move operations overseas, or just stop covering their employees.

The system right is seriously flawed, and needs to be fixed. It results in businesses, who provide health insurance to employees, and individuals who can afford it, to pay a disproportionate share of health care costs.

Individuals shouldn't be saddle with the added burden of figuring out how they are going to pay for health insurance if they should lose their job.

A single payer system is the perfect plan, and there is one already in place.

And a Happy Holidays to you too!


Advance toward a workable system...
...may be possible. But, I think you and I will have to discuss it over a beer, or four.

If you're ever in Chicago, drop me a line and I'll buy the first two rounds.


Well it would be nice to discuss it over a few beers, but I don't have any plans on going to Chicago.

Of course if you're ever in LA drop me a line.


"I do object to the health insurers making a profit, because the profit they make does not benefit the health care system. They don't build new hospitals, or develope new drugs, to benefit the sick. The profit they make is strictly to divy up among the employees and share holders."
If there were no profit in insurance there would be no insurers.
Health insurance companies are now trending towards real insurance with high deductables coupled with tax free savings accounts.
Don't forget insurance companies are the way they are becuase of thier regulatory environment.
And don't let hospitals and doctors off of the hook when they can charge whatever they want and have a single payor pay it (less frequent but led to our predicament).
Compare the laser eye surgery busisness with standard medical care. Most insurance won't cover laser eye surgery.

Overall, 36% of voters say the health care plan will be good for the country, up three points from last week. Fifty-one percent (51%) say the plan will be bad for the nation. The number of voters who believe the plan will be bad for the country has ranged from 49% to 57% since March.

Overall, 36% of voters say the health care plan will be good for the country, up three points from last week. Fifty-one percent (51%) say the plan will be bad for the nation. The number of voters who believe the plan will be bad for the country has ranged from 49% to 57% since March.

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