TCS Daily

Adding Passengers to the Titanic

By Arnold Kling - October 19, 2006 12:00 AM

"The biggest problem with American health financing is not that employers sponsor coverage. It's that employers decide whether workers get coverage at all. So, why not give employers the option of providing low-cost coverage to their workers through a new public program modeled after Medicare? If employers want to provide comparable private coverage, they can. But if they don't provide basic insurance, their workers should be automatically enrolled in the new Medicare-like program."
-- Jacob S. Hacker, Better Medicine: Fixing the Left's Health Care Prescription

America's systems for financing health care are breaking down. Individuals are increasingly unwilling to pay for health insurance. The employer-provided health insurance system is fragile. But Jacob Hacker and others who want to expand Medicare are proposing that the most rickety part of the financial structure be used as the foundation.

According to the 2006 report of the Medicare Trustees, the unfunded liability in Medicare over the next 75 years is $11 trillion. This is the gap between the promises that the system makes to future beneficiaries and the taxes that will be collected under current law to pay for those benefits.

Medicare is the fiscal equivalent of the Titanic, and its unfunded liability is the iceberg that lies ahead. Proposals to increase government's role in funding health care amount to adding passengers to the Titanic. Until someone figures out how government is going to pay for its existing promises in health care, it is not realistic to make new promises.

For our health care finance system, pooling our spending on health care is the problem, not the solution. Today, consumers are insulated from about 85 percent of the cost of their medical procedures. Instead, consumers ought to be responsible for more like half the cost of their medical treatments, so that they take cost into account when making health care decisions.

In American health care today, we take advantage of procedures, such as medications for heart disease and treatments for high-risk newborns, that have benefits far in excess of costs. But we also waste huge amounts of money on defensive medicine, futile late-stage care, and other procedures that are not worth the cost.

The only way to reduce the stress on our health care finance system is by utilizing medical procedures more cost-effectively. This requires several changes to our current health care system.

1. We need rigorous cost-benefit analysis of medical protocols. For heart disease, when is bypass surgery the best solution, when are angioplasties the answer, and when is treatment with medication most cost-effective? Is screening for colon cancer using colonoscopy the best approach, or would other procedures be most cost-effective for lower-risk patients? The United Kingdom uses a commission of experts to undertake this sort of analysis, and perhaps we could use something similar.

2. We need to rethink what it means to have health insurance for people under 65. The real need is for insurance against really expensive illnesses, of the kind that require tens of thousands of dollars of spending over a period of years. Discretionary care and minor expenses ought not to be covered.

3. We need to examine options for putting Medicare on a sound financial footing. Ultimately, this will require changing to a system where people save more in personal accounts for the inevitable high medical expenses they will incur as they age.

In short, consumers have to be confronted more often with the cost of medical treatment. Some people object that consumers cannot make optimal decisions with regard to their medical care. However, the policy choice is not between making optimal decisions and sub-optimal decisions. The choice is between making health care decisions without regard to cost or taking cost into account more often.

The decisions that we are making regarding medical care today are far from optimal. Pooling 85 percent of our health care spending leads to extravagant use of medical procedures with high costs and low benefits. To correct this, we need to increase the share of personal responsibility for paying for medical care.

Regardless of what the left wants, in the future Medicare is bound to contract, not expand. Chances are, Medicare recipients will face more and more restrictions on the procedures that Medicare will pay for, and service providers will face cuts in fees paid for by Medicare. There may be a role in health policy for a government program that is a safety net for people who cannot obtain private insurance, but that program will probably be very unattractive in terms of what it offers to patients and doctors.

Arnold Kling is an adjunct scholar at the Cato Institute and the author of Crisis of Abundance: Rethinking How We Pay for Health Care, published by Cato.



fresh idea for sinking ships
What about this idea? If liberals want a medical system, as they keep saying, like Canada, and Cuba and North Korea, here's how they could do it. Let there be a system available to liberals, BUT ONLY UP TO THE STANDARDS OF THOSE STALINIST SYSTEMS. But for the others, let there be a system that says, 'everybody else can just get their own private medical insurance to follow them around the country', kinda like Switzerland has, or Australia for their retirment visa people. Then let people voluntarily switch from one system to the other, and see which style people prefer.

Once again, government is the problem...
When people talk about the rising cost of health insurance, they usually point fingers at the insurance companies. They tend to forget the costs imposed by the government.

The government requires the treatment of prison inmates for free by the hospitals. The government requires that anybody who requests treatment in an emergency room get such treatment whether they can pay or not. The government requires hospitals to treat Medicare patients, whether the government will reimburse them for the full cost of care or not. The government requires that hospitals accept all forms of health insurance, whether the company serves twenty people or twenty million, and this requires hundreds of different forms and dozens of people who specialize in dealing with these different insurance companies to fill out the forms and see that claims are paid. One of the more obviously stupid government regulations are the licensing procedures for glorified technicians, many of whom really do not need an M.D. to perform their duties, but who are required to get it anyway to perform routine tasks.

Perhaps the most obvious issue is medical liability law, which has totally failed to adapt to the practices of tort lawyers. John Edwards and his ilk are driving doctors across America out of business with nonsense lawsuits. These sorts of lawsuits drive up the cost of liability insurance for doctors, and force them in to providing all sorts of unnecessary preemptive care to avoid malpractice lawsuits.

Now, we have the government stepping in to pay for prescription drugs. How soon will the costs for these products skyrocket now that consumers don't have to pay for them?

If the government would get out of the way, costs would drop overnight. Of course, then we would have to listen to the braying of liberals about how our health care system was less-fair than Cuba's...

Oh Boy -- Just like Canada!!!
" 1. We need rigorous cost-benefit analysis of medical protocols."

The Canadian system uses Government review panels to determine the cost-effectiveness of medical procedures. This means restricting access to life saving tests or procedures if -- in the Government's opinion -- your life is not worth the cost.

And guess what -- politically connected and wealthy people get treatment that is not available to normal individuals.

In addition -- people injured by medical malpractice or by their own stupidity can not sue doctors or hospitals in Canada -- so the lawyers don't get as rich as they do in the US.

Is this the system you propose for the USA?

Suggestions for a fresh approach
Arnold-- don't you think it's disingenuous to project our calculations out for 75 years? What branch of government has a 75 year plan? What, for instance, is the amount of the national debt, projected 75 years out from where we are going today? How come we never hear that argument at TCS?

Put another way, let's go back to October, 1931. Would we have been able to project the trends of the day and predict where we would be in 2006?

We all know Medicare-Medicaid is underfunded. But in practical terms shouldn't we be scuttling programs like the prescription drug benefit, which looks like it was only passed to hasten the demise of the program? This would seem to be an obvious first step.

Beyond that, to continue with your Titanic analogy, let's at least consider means testing. Why can't all the upper deck passengers just buy their own life vests, so we can think about the quality of care we can provide for those down in steerage?

I do agree that the core of any reform will be to address ballooning costs. As it stands you can go to the emergency room for an ingrown toenail, and come out with a bill for $1,500. This is insanity. The issue should be at the top of everyone's agenda.

If you're going to condemn a system
at least do it based on facts.

"The Canadian system uses Government review panels to determine the cost-effectiveness of medical procedures. This means restricting access to life saving tests or procedures if -- in the Government's opinion -- your life is not worth the cost."

Utter rot. The Canadian review boards, staffed by doctors not bureaucrats, exist among other things to sort out life saving or essential medical procedures from optional surgery or procedures.

"In addition -- people injured by medical malpractice or by their own stupidity can not sue doctors or hospitals in Canada -- so the lawyers don't get as rich as they do in the US. "

More utter rot. Of course medical malpractice suits exist in Canada. However the requirements for establishing a claim are higher than in the U.S. as the courts tend to frown on frivolous lawsuits in this area.

Arnold is correct that rigorous cost benefit analysis of protocols is needed. Conveniently he neglects to indicate who should do this and how they can be held accountable.

Does it tell you anything
that when government medical systems have been introduced they are overwhelmingly preferred by their citizens over a purely private system? The list of those OECD countries who have government health care systems is far more than just Canada, Cuba and North Korea. It's in fact the universal standard for industrial nations outside the OECD. It is in fact the United States which is the maverick in this regard.

Part of the problem in the U.S. is that it has neither a public health system, nor a private one, but an uneasy and unworkable mixture of both, hence the huge bureaucratic cost in getting the system to function at all.

A Market for Healthcare
There is another fundamental problem with Health Care. Health Care is viewed, legislated and regulated as an INSURANCE business. Health Care is not primarily an insurance product. Insurance products are designed to protect against unlikely or infrequent events, such as fires, death, auto accidents, etc…. Health Care is a consumer product, like toothpaste, hairdryers or automobiles. Healthcare products and services are needed and used REGULARLY throughout life. The healthcare industry should have the legal status of interstate commerce, and thus not subject to local insurance regulation. This change in legal status (plus tort reform) could lead to the formation of HPO's (Healthcare Purchasing Organizations). These national buyer coops would negotiate terms directly with health care providers on behalf of their members. The membership size of competing HPO’s could reach to 10’s or 100’s of millions, and would result in choices and negotiating leverage for consumers. Catastrophic insurance would likely be one of the products available. Businesses and other organizations would gradually exit the healthcare management business, other than matching contributions as part of overall compensation.

Federal and state legislative change that enables a competitive healthcare market is the solution. Give the healthcare consumer a competitive market, and they are more than capable of taking care of their interests.

When you say
"Give the healthcare consumer a competitive market, and they are more than capable of taking care of their interests."

this is only applicable where the participant in the market has full information or are capable of understanding that information. Given the highly technical nature of medical science and public health, this is not the case and is increasingly less the case. In fact, customer ignorance about medicine is rising, not declining, hence the rise of frauds such as homeopathy.

Medical health is indeed a service, but it is a fundamental error to assume that it will respond to market forces the same as any other service since it has different characteristics. Moreover, matters of public health cannot be left to individual discretion and market forces. You do NOT have the right to not refuse tuberculosis vaccines, small pox vaccine or for any other highly communicable and seriously crippling or fatal disease.

Surprise, people prefer a system where someone else pays the bills vs one in which they do
The trick is go forward a few decades, and see how people like their medical systems. Approval for govt run medical is down to under 20% in Britain.

American's get much better care, for similar costs. The solution is to get the govt out of medical care.

How many people understand how their car works?
How many people understand how their stereo or TV works?
How many people understand how food is grown and delivered to the grocery?

If the standard is, if the people don't understand, the govt must take over, is the one we are going to adopt, then we are doomed.

A better solution would be, if the people don't understand something, help the ones who care, get the information that they need. For those who don't care enough to educate themselves? Not my problem.

Why am I not surprised that roy's solution boils down to more taxes on other people?

indeed has a disfunctional system. So what? Now would you care to discuss public acceptability in all the rest of the OECD?

Thought not.

Why do you think it is that health care costs are viewed by the multinationals as a competitive cost advantage in Canada vs. U.S. even though they are paying their employees costs on both sides of the border?

As to costs, the U.S. has much higher bureaucratic costs than most of the OECD, precisely because of its confused mixture of systems.

Bottom line is this; no one gets refused admittance to a hospital in the rest of the OECD nations because they lacked health insurance.

In public health
my health depends upon your health. Hence, some health matters cannot be left to personal choice. Britain experienced a large dose of this insanity in the Down Syndrome scare from the MMR vaccine. The result? Thousands of supposedly well educated middle class folks refusing the vaccine and now Britain has a whooping cough epidemic.

So yes, the potential ignorance of others does give you, and I and all the rest of us a serious problem.

Good luck arguing this point with these guys
They see problems with anything that doesn't generate wealth for milionaires. They have no experience with a government funded healthcare system, but declare it doesn't work based on bogus horror stories.

To these guys, if you can't pay for it you don't deserve to live.

What? Didn't you read it? Roy didn't mention the 'T' word once!

OECD health care
It is a well documented fact that many have died waiting for life saving proceedures. The waiting list is months and years in some cases.

The Rational Consumer and Healthcare
"You do NOT have the right to not refuse tuberculosis vaccines..."

A rational consumer does not have a death wish, and typically would not refuse a life saving vaccine. A rational consumers wants choices for medical services. A rational consumer wishes to compare costs and benefits of needed products/services and then make the optimal choice. Gross Product in the US is mostly consumer based, and most consumer industries are non-inflationary and feature consistent innovation. As a rational consumer, I require efficiency and innovation from my healthcare vendors. While I have been frustrated for decades, I have not lost hope.

Quite right
Pauled. I really don't care to argue the point with them, and of course it's utterly useless debating with ideologues. I am more than content to allow current experience around the world to illustrate this one. The United States does many things better than anywhere else in the world. That in no way implies it necessarily does everything better, and health care is one of those areas.

What none of them understand is the public health care argument, i.e. the whole business of communicable diseases. In an outbreak of, say, ebola virus, how much right do you have to not be quarantined if you come down with it? Short answer, none.

I don't have a problem with a health industry where service is delivered by private individuals and companies. I have a great problem with a system, public or private, which does not provide essential health care on a universal basis.

What this lot doesn't seem to understand is that if you allow purely market forces to work, essential medical care becomes crowded out by the vanity desires of the rich (plastic surgery, etc.) After all, there's only so many doctors to go around, and you can earn more doing facelifts and b**b jobs for porn stars and Z-list actresses than you can as a GP in say Spanish Haarlem.

You claimed it
but are you denying that the same thing happens in the U.S.? Supply is always constrained, that's what the law of supply and demand means. Hence some will always go without. The issue is, which system allows the fewest to go without. Given the population in the U.S. which have no health insurance, that number per capita is higher.

Who said consumers are rational?
Tuberculosis is making a comeback in antibiotic-resistant varieties because people are selling off their prescriptions rather than finishing them. In the case of medical services, all too many have demonstrated they have no ability to make rational choices, as I've shown in my other posts on this topic, and hence constitute a menace to us all.

The notion of rational consumers with respect to health care is pure mythology, and the number of bogus health scares that surface practically every week is ample proof of this.

By the way
I'm making the presumption that you've been having fun reading my other posts on this in this forum. Don't expect it to get anywhere, just want to see if there's any new mythology on offer.

nothing new that I know of
I find it interesting that these guys assume that everyone is covered by either insurance or some government program. That is just not true. If you are a working-age, able-bodied male in this country you can not get covered by any government program in my state. Able bodied women can not get covered unless they are pregnant. Three months after the baby is born the coverage ends. I have had to pay for all immunizations for my children and, though there are programs to help, I know this is also a charged service.

In the end, in the U.S., there is no guaranteed medical help for those who are working poor with no insurance. Nope, not even for the kids in some cases. And this situation is getting worse not better as healthcare costs contiue to go up.

On the other hand, where is the incentitive to develop new vaccines, drugs, proceedures and technology in a government run (and limited) helathcare system? That arguement is real in my opinion and has to be addressed in any national healthcare plan.

I don't know the answers, but the U.S. is fast becoming a country where only those with a substantial income have the right to live; and I think that is just plain wrong!

It's disfunctional throughout the entire OECD.
That the US system is also dysfunctional, is not in doubt.

There is no doubt that the solution is not more govt control.

Canadian comment.
I haven't run the numbers on our Canadian health care plan, but it is experiencing increasing difficulty.

The major strength of our plan is that it costs much less to administer than the USA's multitude of insurance plans. Also, the problem with private plans is that they try to avoid or reduce legitimate payment - I had a private plan for a while and this was clearly the case. Also, my American friends have had similar experiences.

The great weakness of our Canadian plan is skyrocketing cost. This has been greatly exacerbated by the nonsense of our doctrinaire far left, and to a lesser degree by the health care unions and the medical establishment.

For example, there is absolutely no user fee for most of our health care services, so lonely people and hypochondriacs clog the system. Waiting lists are lengthened by these chronic abusers.

A flat ~$20 user fee for all doctors visits would help greatly, and perhaps ~$200 for emergency services.

I had to go to Emergency twice in the past year, both on a Saturday night. About 90% of the patients were there due to personal lifestyle choices. Their sense of entitlement was extreme and offensive, as they demanded immediate attention for their (largely) self-inflicted injuries from the overburdened medical staff - sincere, capable people with infinitely more education and dedication to society than those they served.

A reasonable user fee would drive home the message that there is no free ride.

Regards, Allan

It happens, but not to the same extent.

going without
The vast majority of those in the US who go without health insurance, do so voluntarily.

and you wonder why people compare you to eric.
"They see problems with anything that doesn't generate wealth for milionaires."

Nothing like a meaningless ad hominem to add light to the discussion.

Two entirely different issues.

go to wikipedia, and look up analogy
Then you can return, red faced, to the discussion.

It is indeed wrong
and you've put your finger on it. As I've tried to point out, the only answer to the gap problem is a universal health coverage. That's what the entire world except for the United States either has or aspires to have. That in no way implies that they don't have problems of their own, but those are usually problems of controlling cost.

A principal problem is that they do not provide sufficient capital funding, and hence waiting lines develop for non-essential and even sometimes essential service. This is to my view a part of the problem of non-investment in public infrastructure which has been going on now for about two decades.

Your statement about immunizations brings up an interesting point. The fact of the matter is that, economically speaking, I have an interest in your children and everyone else around me being immunized. Otherwise, my vulnerability to communicable diseases is much higher even if I have had the immunization.

Might I suggest that our problem here is that public health means taking a long term economic view as opposed to the short term ones which usually prevail? That's without even getting into the equality argument which you correctly raise at the end of your post.

As to incentive, that's a function of how the system is administered. Too low an incentive paid through drug plans and innovation does indeed suffer. But it's an administration question, not one of fundamental principles of a public vs. free enterprise health care system. Perhaps another question is, to what degree is the United States overcompensating drug companies for their products in the interest of retaining those industries in the U.S.?

What is clear is that health care costs are going to rise substantially over the next two to three decades in all countries. Principally this is because of the increasing age of our population. The problem in the U.S. is that without something being done, the net cost of the system will continue to rise at a rate far above the inflation rate. I don't see any sign yet that U.S. legislators are taking this issue seriously.

Costs are going up
independently of the things you mention (and I don't disagree with anything on your list) because of the increasing age of the population. I don't disagree either with your characterization of emerg clients either, having had similar bad, but also in honesty some good experiences.

I also agree about user fees, but even so, demographics are going to drive up costs heavily and are already starting to do so. As to hypochondriacs clogging up the system, it's Parkinson's Law, and a user fee would thin out many of the weeds.

simply can't afford it.

Very true
But it is hard to argue against the hard-liners without a very comphrhensive plan to deal with as many of the issues as possible.

As for legislators getting serious about it, not until a major helath crisis bites them in the butt.

Your the only one who has ever compared me to eric; and that comparison is insulting!!

In light of the fact that your posts are so often attacks against anything that doesn't fit your tightly wound little dream world, I would say you far more resemble eric's miror image than anyone here.

very few
If you want to be charitable, why not spend your own money and help them?

reality is not a dream
If you believe that the reason I take the positions I do, is because I want rich people to get richer, then you are sick.

I have challenged you based on your errors. I have pointed out your errors, but you don't care. Much like roy, you find a single study that reaches the conclusion that you agree with, and you declare that this is the only study that matters. Or you allow your person feelings and experiences to trump real world science.

Thats what
taxes are for, among other things.

You and I agree on most issues.

So what is your contention, that when I agree with you I am doing so for pure motives?
And it's only when I disagree with you that I'm doing so to make rich people richer?

Or is it that when I agree with you, I'm still doing so only to make rich people richer, but you take the same position out of pure motives?

Or is it that when I agree with you, that we are both taking those positions out of a desire to enrich the rich at the expense of everyone else?

Regardless, the minimum wage doesn't work, it only puts the poor on the unemployment lins.
Govt regulations against monopoly are unnecessary and are used to protect the politically powerfull from competition.
Govt regulation of medicine only serves to make medicine more expensive and harder to get.

These positions have all been PROVEN, time and time again.
Only those who let their wishes get ahead of their intellect still believe in them.

The problem
is ideology. Ideologues on the right presume that government is useless for nearly everything and those on the left presume it is essential for nearly everything. Too much of their reasoning is based on a priori statements or anecdotal evidence and the solutions are usually a one-size-fits-all approach.

As to the crisis, the health crisis is already upon us in terms of funding and access. But the pressure is being ratcheted up so slowly that there is no meaningful focus on it meaning that the situation will get far worse before something is done.

Your right
So try dealing with reality for a change.

Guess what, there are a very large number of uninsured who can't afford it and don't qualify for a government handout; that is reality. Remember that 1% is still 3 million people and the numbers are much higher than 1%. You may not want toe believe that reality, but it is reality.

On issues of life and death, no one should have to worry about what it will cost to live. But in your world, that is all that matters; that is not yet reality, but it is the reality you would like to see, according to the direction you take in your posts.

Now eric and roy would argue that no one should have to worry about paying for any essential service. Food, clothing, shelter, power, and health care should be available to all. That is a nice thought, but it isn't reality either.

You have not challenged me based on my errors; and when I've made errors I'm very quick to admit them. I don't know who you are talking about, but it isn't me. I showed you government statistics and you, with no evidence behind it, said they were contrived and not true. I never declared one study was the only one that mattered, but all acceptable, actual studies done on this issue point in the same direction; there is a large number of working uninsured. Some are by choice, but many have no real chioce.

Get some real grounding mark. Realize the world isn't all roses for a very large number of Americans. Also try to understand that your belief that leaving the poor at the mercy of a free-market system run amok is not going to help anyone but those who can already afford all necessities.

Big business needs checks and balances, like all human endeavors. Until you understand that you are living in a dream world and not reality.

Exactly on point
I agree completely.

We only disagree on governments part in economics
And what (if any) need the government has to help those who are destitute or nearly so.

On most other issues we may argue over semantics, but agree at the base. In fact, we aren't that far off on this issue as well; IMO that is why I drive you crazy on this. You think I need to take just one or two more steps to get in line with you, and I agree.

But you fail to realize those are steps I have decided not to take. I believe in compassion and believe that many people have to be force to show it on a large scale. Thus it must be done through either government or other organizations that can take what they need to get the job done and not be forced to beg for it.

You say-"Regardless, the minimum wage doesn't work, it only puts the poor on the unemployment lins."

I agree, to a point. But that is only for a few. The majority of the low-end laborers benefit and the othere do down the road when they are again employed.

You say - "Govt regulations against monopoly are unnecessary and are used to protect the politically powerfull from competition."

I agree, but point out that all human endeavors need oversight and the government is the only agent with the power to oversee large corporations.

you say - "Govt regulation of medicine only serves to make medicine more expensive and harder to get."

I agree; to a point. But some system that works to make sure all can get help when needed is a must. This is life and death and money shouldn't be the overriding concern.

No, taxes are for...
taking money from your neighbors to give to those whom you believe deserve it. The primary purpose of taxes is to make the people who vote for them feel good, knowing that they are getting all of these wonderful services out to the impoverished in America.

As an aside, most of the people who do not have health insurance fall in to one of three groups:

1) People who did not have health insurance for some portion of the year. Whether due to unemployment or a switch in jobs, even if you are not covered for a day you count in the government statistics.

2) Young people who are relatively healthy, and do not really need health insurance.

3) Entrepreneurs. I am stuck in this spot, and I also happen to be a diabetic. The issue of health care costs is critical to me, and I am tired of paying for inefficiency forced upon hospitals by the government.

The simple fact is that, in the event of some catastrophic illness, everyone can get medical care here in the United States. Even if they do not have health insurance. They may not be able to get the same level of preventative care, but if they break a bone or develop cancer, the government already has programs that rpovide for treatment.
The simple fact is that

Rights and Mythology
“the U.S. is fast becoming a country where only those with a substantial income have the right to live..”

If US citizens had a “right” to life, then all DEATHS would be unconstitutional. So far, there are no immortal US citizens that I know of, and the courts have not held that death is unconstitutional. The right to life under the US constitution means the right to PURSUE life, the right to make choices and not be unduly encumbered by ones fellow citizens. The right to life does not imply success (since all will eventually fail), only the freedom to take your best shot. Water, food and shelter are necessary for human life…but not guaranteed under the Constitution. Neither is healthcare. All of these “necessities” for continuation of human life must be earned. The Constitution promises opportunity, not results. And outside of our Constitution, there is only survival of the fittest and the vagaries of fortune. If there ever is a post apocalyptic era, the survivors will soon find what real life (ie…day-to-day survival against the odds) is all about.

Those who refer to consumer products as “rights” are the ones creating mythology.

The three groups
group 1 includes long term unemployed, and people who leave one job (with good health care, because of restructuring) and take another with bad health care or none. If they have bad pre-existing conditions, market health care is just about unavailable, as you know. Additionally, this group includes many people whose business don't provide health care, or who can't afford it.

Group 2 includes not only "young people ...who do not really need health insurance" but really young people, i.e., children. No health care means kids aren't treated routinesly in doctors offices, but only in life-threateing cases in emergency rooms. This is expensive for taxpayers and bad for patent.s

Group 3: entrepreneurs like yourself are essentially clobbered by existing policy. Rather than being part of a single-payer system, transparent and affordable, you're in the worst possible bargaining position with insurers. If you have a pre-existing condition -- I don't have to tell you that.

> The issue of health care costs is critical to me, and I am tired of paying for inefficiency forced upon hospitals by the government.

The main "inefficience forced on hospitals by the government" is the huge hole in health care coverage that forces emergency rooms into the doctors office business. That's forced not by government action, but by government non-action.

>The simple fact is that, in the event of some catastrophic illness, everyone can get medical care here in the United States.

and the result of doing things this way is the US has the highest per capital health costs in the industrialized world, and bad or terrible public health numbers.

I'd suggest you look into the economics here. You, specifically would b in a much better position in Canada.

realities a *****, not being able to afford something is not justification for stealing from your ne
Beyond that. Govt is the worst possible way to delivery charity. It's usefull mainly for those who want to feel good about themselves, without actually doing anything themselves.

If you want to help the poor, feel free to donate every penny you have ever made. If that is what makes you happy.

You are not free however to take money from your neighbor.

In every country where it has been tried, govt delivery of health care services has resulted in increased costs, decreased quality, and long waiting lines.

your faith in govt is commendable, if totally unsupported by the facts.
RE: Minimum wage - the problem is that they never get hired again. Once their labor is worth less than the minimum wage, they are out of the labor market permanently.

Govt is a total failure when it comes to overseeing major corporations. What ALWAYS happens, is that the regulating agency quickly gets captured by the regulated businesses, and then start to operate to protect the businesses, not the people. Competition is bigger than any company. Competition is the only thing needed to keep big companies in line. The threat that people will find an alternative if they don't like a company, is the best restraint in the world. One that is not corruptable by a few under the table campaign contributions.

As to medicine, how is making medicine, and medical care more expensive and hardr to get helping anyone. Check out how long the lines are to see any kind of a specialist in any country that has socialized medicine.

The original complaint
"They see problems with anything that doesn't generate wealth for milionaires."

I don't know if you were just feeling like being an a**hole today. Were PMSing. Or if this is what you truely believe.

If it is what you truely believe about me and the rest of us who don't worship at the alter of govt, then there truely is no difference between you and eric.

Costs: Symptom or Disease
As it stands you can go to the emergency room for an ingrown toenail, and come out with a bill for $1,500.

This isn't the problem. Its the symptom of a problem. The problem is that the entire system is built around the idea that the "customer" is completely seperated from the cost of the care they receive. Everyone, whether is the provider, the pharmacy, the manufacturer of the tools, drugs and bedpans is divorced from the normal calculus of supply and demand.

The Senate Finance committee had hearings in 2003 which included a graph entered as part of testimony showing how as a smaller and smaller percentage of costs have been borne by the recipient the real per capita cost of healthcare has skyrocketed.

Everybody's signing checks drawn on "somebody else's" account- with very little control- any surprise there's lots of dollars chasing healthcare?

There will always be diseases or events that will require care that will cost outside the range of a normal person's salary, cancer, diabetes, renal disease, dementia.

The trick is to return enough of the cost of healthcare to the point where you write a check from your own account and don't have to take out a loan to do it.

Now remember there are politically strong constituencies whose personal interests reside with care delivered without consideration for the vulgarities of economics.

How's a medical school going to charge hundreds of thousands of dollars for an MD if the graduate isn't assured of making an upper percentile income right out of the gate.

Means Testing: A Tax
If you reduce benefits provided by the government based on income or wealth ITS A TAX.

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