Oh, possibly I misunderstood The Tao’s Revenge – or possibly you did. Let’s get all the cards on the table before we go any further: what, exactly, do you mean by “rescission”?
Because, see, I’m reading this very differently than I think you intend, and want all terms clear before we spend a good long while talking past each other.
Rescission is canceling a policy. In the context of the healthcare debate it’s generally taken to mean canceling a health insurance policy when a patient develops an expensive condition.
Any disagreements with this definition? “canceling a health insurance policy when a patient develops an expensive condition”
You could address the fact that you are advocating spending more money, for worse results, and in the process, keeping tens of millions without healthcare.
Why do you endorse a system that is manifestly worse in every way? That’s what I’m asking. In any case, I don’t care about your happiness because it has nothing to do with this issue. Your anecdotes aren’t evidence.
You think its satisfactory because you don’t address that the country is spending far more, for worse results and in the process leaving tens of millions uncovered.
If you think that’s satisfactory, I suggest that makes you a really, really shitty judge of value. 
How about you address the specifics? There will be more rescission. There will be more people uninsurable. Why are those laudable goals for the country? Why would putting us even further behind every other industrialized first world nation be a good idea?
You obviously like this for ideological reasons, but what is the logic behind your ideology? Your stances will make the country worse. More people will needlessly die if you get your way. The only thing of value that would be added, is that insurance companies would be more profitable.
More rescission, more people priced out of the health care market, pre-existing conditions are back.
That’s the way I understand it.
“Oh, you have breast cancer? Well, we looked at your policy and we notice you didn’t report the acne you had as a teen when you signed up. Seeya!”
Note that they do this after accepting premiums for years. When they need to pay out is when they decide to care about acne.
And they will do more of this if across state lines is implemented.
That’s pretty good, but it’s open to a bit of equivocation: we’ve all heard the horror stories about an insurance company that let a guy keep making payments for twenty years, and then canceled the policy when he got sick because he supposedly failed to disclose something on his application back when, and you and I get up in arms about that, saying There Oughta Be A Law that limits the ability of insurance companies to pull that move: a reasonable timetable or something.
If that’s what we’re all talking about, then, hey, yeah, let’s change it. If not, I need a little more detail.
Sounds okay, but I’m asking for clarity for a reason: it seems like you’re out to justify quite a bit more change than the modest-seeming language suggests.
If you have a choice between a pizza from a place with half the cost, but tastes better to most people, and a slightly inferior pizza for 2x cost. Well you can prefer the latter, and more power to you.
However if we’re debating which pizza to order it becomes a question of which one the group wants.
Personally I’d like the UK’s system where everyone is covered, but if you want private too you can have it.
Right: you ask why I endorse it, but don’t care about my happiness. You also don’t care about the happiness reported by other folks. I’m thus out of answers.
You also suggest that the vast majority are really, really shitty judges of value. May I therefore suggest that you’re a really, really shitty judge of value?
My “ideology” asks 'em to compete against each other, across state lines, trying to beat each other by cutting profits, the way car insurers do.
Show me a poll: what does the group want?
Well I think that modest definition is all that’s needed. Actual cases of rescission over acne, and things the patient didn’t even know about demonstrate my original assertion that the market is not sufficient to regulate healthcare. If regulation is needed, and we institute a state race to the bottom against regulation then we only deprive ourselves.
You are fixating on a perceived insult. I didn’t say I don’t care about your happiness because I don’t like you. I think you’re a peach. I said it because your personal experience has no bearing on the overall question of healthcare for the nation.
You can walk across a busy street blindfolded and be none the worse for wear, but that doesn’t mean it’s a good way to cross it. Our system is worse than every other system in the first world. In costs, in results and in percentage of population covered. That it works for you, isn’t the issue. There are literally millions of people it doesn’t work for. And all those people aren’t stupid or lazy or worse people than you.
Popular opinion is subject to misinformation. The facts are that our system is more expensive, and worse in regards to coverage and results.
You should base policy decisions on facts, not what most people erroneously believe are the facts.
Car insurance has a maximum payout, so it is much easier to control for costs.
Health insurance can have a fit twenty-something get kidney failure and rack up 300 grand of bills one day without warning. It doesn’t respond to market forces the same way as widget sales.
Remember, paying someone’s medical bills isn’t profitable. So health insurance companies want to minimize the amount of payments necessary. Every sick person on the rolls is a net drag, and if a particular state allows you to snip them off the lists, that’s where they’ll go.
Competing against each other will have them lower costs for the healthy, it won’t have them insuring the sick.
Again, which state is it that you feel has an inadequate systems of insurance regulations? How are they inadequate? Explain it in detail please.
I haven’t suggested they wouldn’t pursue the most profitable path. I’m asking you the parade of horribles that will occur as a result. By the way, credit cards and insurance are subject to different laws and regulatory bodies. I work in this industry. I can assure you that right now, every state in the union has a complex and thick body of regulations governing insurance. Which is the one that misses the mark, since you’re the one making the claim that a stampede will occur toward it? What terrible things will result? Explain it in detail please.
Shodan’s solution makes perfect sense. The problem with healthcare is primarily that it has become so obscenely expensive that almost no one can pay for it directly out of their own pocket, yet pretty much everyone requires an expensive healthcare procedure over the course of their lives (and visits a doctor for minor things approximately annually). Couple that with rising obesity rates and unhealthy lifestyles, and it’s no wonder that insurance is ridiculously expensive and unavailable. If everyone was likely to total a car once or twice in their life, car insurance would be expensive too!
There is no pressure to keep costs down, and everyone feels like they are entitled to first-class, cutting-edge, super-expensive healthcare, even if they actually can’t afford it.
People on this board love to lambast people for buying expensive items that perform only 5% better, in an objective sense, than their much cheaper equivalents (like buying a used Toyota instead of a new BMW), but vehemently defend idea that everyone is entitled to $200,000 cancer treatments that only improve the mortality rate a few percent, or extend people’s lives a few years.
Healthcare politics in this country revolve around trying to figure out who is easiest to stick with the ever-increasing cost of healthcare, rather than attempting to reform the market so that market forces drive the cost of healthcare down, not up.
The attitude that everyone is entitled to healthcare beyond their means to pay for it leads to fraud, abuse, and distortion of the market - misallocation of resources into healthcare that could be more productively spent elsewhere.
I am opposed to government-run healthcare because I view the cost of healthcare as the major problem facing the country, and I have zero confidence in the ability of government-run healthcare proposals to actually reduce costs (as opposed to just spreading them around).
A real solution would be to decrease the cost of healthcare. This would automatically take care of a significant fraction of the currently uninsured, and make it is easier to subsidized the totally destitute that still remain.
I told you I didn’t know. But to make it simple for you to follow, take rescission, which we’ve been talking about in the thread. Some states allow rescission and some don’t. Some have different levels of flexibility for rescission, so they would probably all go to the state that allows them to cut the most sick people from the rolls, right? http://www.statehealthfacts.org/comparetable.jsp?ind=842&cat=7
As I said, I don’t know the specifics, but sticking with rescission, I assume they would move to one of the states that allows 3 years for misstatements. You can be fairly sure that no insurance company would run in New York, for instance, because it doesn’t allow rescission at all. Note that this means that people in New York would get worse coverage, because of that.
I’m a free market conservative so I’m fairly supportive of the concept of privately funded health care. At the same time, I do think that the current system in the United States is running out of time for various reasons and I even think it is making us less competitive economically.
However you fix that problem, Shodan is 100% spot on that you have to figure out how to control costs. Costs are rising more rapidly in the United States than any other country, but they are rising faster than inflation across the entirety of the Western world.
Across the entirety of the Western world, we are getting older, which means a shrinking working population is going to be paying for the healthcare of a growing retired population who are going to demand every last possible treatment.
I’m not saying Obamacare is going to cause rationing. I’m not saying the British or Canadians ration. I’m not saying universal single payer in the United States would result in rationing.
I’m saying they should. And if they don’t, I don’t care which fix you pick, it’s doomed.
I’ve been invested in a mutual fund since the mid 1980s that seeks to track the Health Care industry. In fact, since 1984 it has achieved over 16% annual returns. This isn’t a fluke or some smart wizard stock picker (it’s actually a passively managed index fund), it’s just a reflection of how health care costs (and this fund tracks both domestic and foreign) have been going up and will continue to go up.
If you aren’t willing to ration, and that does mean people who are terminally ill will not receive $800,000 in treatment that might extend life expectancy by 2 years, then you’re not being serious about how we as a society are going to pay for health care.
Could we reform prescription drugs? Probably.
Could we do something drastic, like extend Medicare to all 100% of the U.S. population and institute whatever Medicare tax would be necessary to fund it? Yes. In fact, if the public supports such a move, I think it’s better than the current system and vastly better than Obamacare. But unless it includes rationing, it’s no real fix at all in the long term.
Take my “out there” solution above, of extending Medicare to cover everyone. That would institute massive savings in Administrative costs, because Medicare is vastly more efficient than any private insurer. It would also remove the profit motivation of private insurance, so there is no profit margin overhead.
However, unless you actually get serious about controlling that Medicare reimbursement rate, and unless you allow Medicare to say “no” to certain types of treatments, even that would just be an initial improvement. Over the long span it would still be unsustainable without serious rationing.
I’m not saying a 35 year old guy with a family of 4 who comes down with Non-Hodgkins Lymphoma is left to die in the street. We can go to bat for guys like that. For one, terminal illnesses are rarer amongst his age bracket. Secondly, there is a stronger societal interest in keeping him alive (he has working years left, his continued survival as a working member of society prevents his wife and children from potentially entering the ranks of the impoverished.)
For a 75 year old man? I just don’t think he should get the same level of care for NHL. For one, the survival rate with NHL goes down for anyone over age 60. For two, the societal interest isn’t there, any of his children will almost certainly be adults and most likely his productive years are long past.
Finally, the simple fact is the moral impetus is not nearly as strong. A 35 year old man has a lot of worthwhile life left to life, sure maybe one year in the 75 year old’s life is just as valuable as one more year to the 35 year old man, but the 75 year old already has 40 more of those years under his belt. The 75 year old man has already lived his life, and when dealing with limited resources there needs to be a limit, under societally provided health care, as to how much money we expend on people whose lives are already lived, just to try and keep them alive for a bit longer.
oh, absolutely. Costs are always going to increase. If we wished to keep offering the most cutting edge treatment to the widest possible group of people (i.e. everyone) then it will become more and more expensive. As the population grows ever older the problem will become more acute.
My argument is that we still must ensure a good, basic level of treatment is made available, free at the point of delivery, to the whole population. Above that, the more expensive cutting edge treatments continue to be allocated on a basis of medical need and judged by an independent assessment of benefit vs cost. The very rich, and those able to afford the best private insurers should still be free to choose whatever the hell treatment they want.
My ideology (and it is an ideology, I freely admit that fact) is to make sure that whatever level of healthcare can be afforded by the state, must be made available to all on the basis of medical need and be free at the point of delivery. That level may need to be held at the current level of technology in order to maintain affordability but hey…that is still a heck of a lot better than a lot of USA citizens will ever get a sniff of.
That anyone can be bankrupted for the sake of a badly broken arm or emergency cardiac surgery, in a first world country, should be seen for what it is. A scandal.
I don’t agree entirely with you, but can I hug you?
The pragmatist in me agrees with this. I think one can value life and still think that it doesn’t make sense that we spend so much money to keep extend the life of elderly people by a couple of years. Especially when they are just going to spend those years in a nursing home, where they will consume even more health care services.
But I am uncomfortable with the way you have compared the value of lives. I know some people who are in the 70s who are pretty healthy and active and valuable (still employed, still important person’s in their families, still contributing to society). And I know some people in their 30s who have lives that really aren’t all that and may be even a drain on society. You willing to tell the 75-year-old retired schoolteacher that she can’t get a new hip, but the 35-year-old loser guy who flipped his motorbike popping wheelies can? Good luck with that.
And it is difficult to figure out what treatment is just going to prolong the inevitable and which treatment will be tantamount to a cure. There are people–not a whole lot, mind you, but some–who have Stage 4 cancer and are able to live productive lives indefinitely with the aide of modern medicine. There are some people who catch pneumonia and never really recover from it. Either of these people could be 30-years-old or 70-years old.
It’s not going to be as easy as having stricter age cut-offs. As people age, rationing will become increasingly multi-factorial and subjective. The more complex it is, the more arbitrary it will seem to people. And then the more controversial and potentially dangerous it will become.
Martin Hyde, before I compliment you on a well-thought-out response, I must ask if you have gotten clearance from Sarah Palin for what is clearly a death panel?
I agree. (Well, if you swap out that last word for “health insurance,” but that’s a quibble.) So we solve that problem federally, and then:
But that’s a separate issue: I’m okay with such a race – in hopes that it mirrors the one auto insurers are having – on other subjects, so long as there’s no such race on rescission. Just because we solve the rescission problem doesn’t mean we should step in to solve all the other problems.
It’s not exactly that I’m fixating on a perceived insult; it’s that you see my satisfaction as irrelevant, because it has no bearing on the overall question for the nation – and that you also see the overall satisfaction of the nation as irrelevant, because you’re figuring it’s erroneous. I can’t readily prove they’re right (since I simply default to giving folks the benefit of the doubt) and can’t even combat the latter argument by claiming my satisfaction ain’t erroneous (since you simply don’t care whether it’s true in my case), which leaves me with precious little else to say.