Dancing on the grave of health care "reform"

[SenorBeef]

@The_Other_Waldo_Pepper

Let’s recap: you said, falsely, that what I really meant was “let’s not do that stuff that’s being proposed at all, and let’s just do my agenda one step at a time”. I pointed out, accurately, that I was proposing we do the stuff that’s actually in the bill. You make statements when you should be asking questions – and you ask the wrong questions at other times.

I made my point badly. My own interpretation is that the main part of the proposal originally was the ban against pre-existing conditions, public options, mandate, and subsidies - there’s lots of reform to go along with that but originally that was the core. You were framing your argument in terms of wanting to take things one step at a time, to see how much each step bettered the problem. But you wanted to first try issues that were relatively minor compared to the aforementioned provisions. So I said that your concern isn’t really that we take it slow and do it one thing at a time, but rather, you want to try the ideas you favor.

The problem is, I think you’re missing the point of my argument. I don’t want to point at the insurer I think is best and recommend it for the whole damn country; I don’t have that much faith in myself, just like I don’t have much faith in top-down solutions from the government’s experts. My whole point is that I want the market to take a shot because I don’t want to field the questions you’re asking; I want the market to do that.

I think you’re missing my point. I assume that we agree that there are problems in the health care system - I’m not sure if you agree to the exact same set of problems - for instance, I view the fact that we spend more than any other first world country as a fraction of our GDP on health care by a large margin for similar outcomes as a big problem, you may not. I think it’s a pretty big deal if people paying their insurance premiums in good faith and are getting shafted by a company that basically stalls on paying anything and hope the person dies before they can bring litigation to get the service they’re entitled to, etc. - maybe you don’t. Presumably we agree that the state of health care has flaws and that we can make changes to try to address those flaws.

Anyway, from here, we assess what the problems are. And then we assess potential solutions. Your proposals do no such thing. You don’t identify a specific problem that your solutions will fix, and you don’t provide any evidence or even a line of reasoning as to why your solutions will fix those problems. You are just saying “eh the market will work them out somehow”. This is a pretty much useless view - it’s essentially a dogmatic response to a practical problem.

You say you want to remove antitrust exemptions from the companies. Fine. Which companies do you think would be in violation of these laws if not for that exemption? What practical results will come from removing this exemption? To what degree will that better the quality and/or costs of health care? If you can’t identify any problem or way your solution would work here, then why propose the “experiment”?

I don’t want to set the price for a can of Pepsi; my whole point is that I want the free market to do that. I don’t want to decide whether they should discontinue their cherry-flavored version or charge double for it; I don’t want to weigh in on whether they offer a better product than Coca-Cola does, either. If you ask me about any of that, my only answer is that I want market forces to supply the answer for me.

The current health care system is largely based on the free market. Obviously it is not a totally free or perfect market, but neither is your soft drink example. The government steps in and says Pepsi can’t put poison in their drinks, that they can’t make their cans out of lead, that they have to label their products with ingredients and nutritional info so that consumers know what they’re getting, etc.

The health insurance market is definitely somewhat distorted by the government. Tax incentives for employer based health care is a big one. But a lot of the important aspects of a free market are in action in the current insurance market. There’s competition, contracts, etc. To imply that the current system isn’t largely based on the free market is incorrect in my view.

I want consenting adults to make voluntary choices among genuine competitors because I don’t have any better ideas; if I did, I wouldn’t be advocating the free market.

The current set of competitors are genuine. Are 10 different insurance companies in one state not attempting to provide better and/or cheaper services than the others to win over customers? Why can’t competition happen on the state level? Do markets have some sort of minimum size before competition kicks in?

The. Majority. Of. Americans. Are. Satisfied. With. Their. Coverage.

Yes, repeat this all you want. Imagine there was a scam flood insurance company out there that sold millions of policies but wouldn’t actually pay out. Most people never have to deal with floods, and pay their dues, and assume they’re covered, so they’d list themselves as satisfied with their flood insurance. Only the people who got flooded and then got shafted would be dissatisfied.

Now - I’m not saying health insurance companies are a scam - but in this case just as most people don’t suffer flooding in their house, most people don’t suffer severe medical problems. But they have an expectation that if they do, they’ll be covered - that’s what they’re paying the premiums for, after all. But if most people knew the chances that their insurance company would find some way to screw them - some phantom pre-existing condition from decades before, an error in the paperwork, some liftime policy maximum hidden in a contractual addendum somewhere - they probably wouldn’t be so satisfied. But they won’t find out until they’re sick and need it the most.

You keep making this out to be too big an issue to be left up to consenting adults making voluntary choices among genuine competitors in a free market despite the fact that most people say they’re doing just fine. We don’t need a valid argument for a free market; we need a valid argument against one.

There are plenty against it. We pay way more money for similar health outcomes. We get shafted by insurance companies who are motivated to hassle sick and desperate people who paid premiums in good faith on any technicality. We have issues where people aren’t free to switch providers based on the quality of service once they’ve developed any sort of medical condition. We have companies that are hampered against international competition due to having to cover these costs, and even companies which can’t compete fairly against younger companies because of legacy healthcare costs.

You, like others, are arguing this in some abstract philosophical way, as if no attempt to distribute health care by different methods were ever tried in the real world. You essentially ignore that other countries achieve similar or better health outcomes for less cost - and quite frankly, the less they use the free market in their system, the better the results generally. Single payer has the best overall success rate in actual trials in the real world, in terms of cost, universal availability, and health outcomes.

Again, just ignoring the evidence and just advocating what feels intuitive is dogmatic - it’s the same as any other true believer. If your views are not amenable to evidence, what use are they? If you ask yourself “what evidence would change my mind” and can’t come up with anything, then your view is fatally rigid and worthless.

Then deal with those “dozens of reasons”, one by one.

“Dealing” with those issues means restricting the free market in some way. The incentives that make the free market work simply don’t align very well with what produces good outcome in health care. Again I raise the issue of public roads - do you think that we’d be better off with a free market road system, whereby all roads were developed independently and privately by whoever owned the land? Where they could set any rules of the road they wanted to for their particular segment, and charge whatever tolls they wanted?

If you have essentially a dogmatic belief that the free market is always the optimal solution, do you feel that a free market road system would be better than what we have? If not, why not?

(That said, I’m still mystified as to why folks think I have an “absurd mantra of the free market will solve all”. I’ve only ever stated the exact opposite, and folks with poor reading comprehension skills keep making the wrong claim sure as they can’t provide cites to the contrary.)

Presumably you are advocating that we “experiment” with a free market system because it will lead to better outcomes on average, right? How are you then claiming to state the opposite?

[Algher]

@Cort

The majority of Americans are also reasonably healthy most of the time. I’d be interested to know the actual percentage of Americans who are both satisfied with their coverage and have had cause to call upon their insurance company in any meaningful way.

This does not answer your question, but it does help highlight PART of the issue:

Health Care Reform

Seventy-six percent (76%) of those with insurance now rate their own coverage as good or excellent.

I have seen this type of data before. If you ask people what they think of health insurance companies, it is negative. If you ask people what they think of THEIR health insurance company, it is positive. Americans are a squirrely lot.

[Blalron]

People may like their private insurance, but they love their government run Medicare even more.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

Keep in mind that Medicare recipients are much more likely than those under 65 to have medical problems and thus have more actual experience with which to base their opinions.

[The_Other_Waldo_Pepper]

@SenorBeef

If you have essentially a dogmatic belief that the free market is always the optimal solution, do you feel that a free market road system would be better than what we have?

I don’t have such a belief. In fact, you quote me later in the same post to that effect:

(That said, I’m still mystified as to why folks think I have an “absurd mantra of the free market will solve all”. I’ve only ever stated the exact opposite, and folks with poor reading comprehension skills keep making the wrong claim sure as they can’t provide cites to the contrary.)

Presumably you are advocating that we “experiment” with a free market system because it will lead to better outcomes on average, right? How are you then claiming to state the opposite?

I deny that I claimed “the free market will solve all” – and you now presume that I merely believe it will lead to better outcomes on average. That’s certainly a more modest approach, but I’m still mystified as to why you’d reach that conclusion in the same post where you’re asking whether I have a dogmatic belief that the free market is always the optimal solution.

I think it’s a pretty big deal if people paying their insurance premiums in good faith and are getting shafted by a company that basically stalls on paying anything and hope the person dies before they can bring litigation to get the service they’re entitled to, etc. - maybe you don’t.

No, I think that’s a problem we definitely need to address. I just think it’s separable from the other issues; solving that problem has nothing to do with whether we eliminate the antitrust exemption, neither of which has anything to do with whether we change the rules for Medicaid eligibility, none of which has anything to do with whether companies should be allowed to discriminate based on pre-existing conditions. We can tackle each problem on its own merits – and if you don’t like the order I’m suggesting, that’s fine too. Let’s tackle the stall-until-they-die problem on its own terms.

Anyway, from here, we assess what the problems are. And then we assess potential solutions. Your proposals do no such thing. You don’t identify a specific problem that your solutions will fix, and you don’t provide any evidence or even a line of reasoning as to why your solutions will fix those problems. You are just saying “eh the market will work them out somehow”. This is a pretty much useless view - it’s essentially a dogmatic response to a practical problem.

It’s not “the market will”. It’s “the market might”. I want to give the free market a shot first; you could call that a dogmatic response, but it’s only what I want to do because I can’t yet provide any evidence. Once the market is up and running, I’m open to providing some other responses to a practical problem; I just default to giving the market a chance until the market has had a chance, unless I have a fine reason not to do so.

Again, just ignoring the evidence and just advocating what feels intuitive is dogmatic - it’s the same as any other true believer. If your views are not amenable to evidence, what use are they? If you ask yourself “what evidence would change my mind” and can’t come up with anything, then your view is fatally rigid and worthless.

My views are amenable to evidence. I want to see the evidence roll in under free-market conditions, whereupon we can then look at whatever problems remain – which might be all of 'em, but might not – and propose fixes.

“Dealing” with those issues means restricting the free market in some way.

Yes, it does. I merely want to provide a free market first, and then introduce those restrictions.

You say you want to remove antitrust exemptions from the companies. Fine. Which companies do you think would be in violation of these laws if not for that exemption? What practical results will come from removing this exemption? To what degree will that better the quality and/or costs of health care?

I don’t know. I haven’t seen anyone spell out a reason why it would hurt; it might help; a Democratic congressman just proposed legislation to that effect, and it sailed through the House with massive bipartisan support; why not see whether it helps solve any of the problems?

If you can’t identify any problem or way your solution would work here, then why propose the “experiment”?

Well, like I just said, a Democrat is the one currently proposing the “experiment”, and Democrats in the House of Representatives just joined a bunch of Republicans to vote in favor of it; I merely want to agree with them, I guess. That said, I propose that particular experiment whenever I don’t have a compelling reason to do otherwise.

The current health care system is largely based on the free market. Obviously it is not a totally free or perfect market, but neither is your soft drink example. The government steps in and says Pepsi can’t put poison in their drinks, that they can’t make their cans out of lead, that they have to label their products with ingredients and nutritional info so that consumers know what they’re getting, etc.

Exactly right. I believe I’ve made that point earlier – but, regardless, the point is that I’m fine with analogous regulations. I just don’t see how antitrust exemptions or barriers to interstate sales are analogous, is all.

Why can’t competition happen on the state level? Do markets have some sort of minimum size before competition kicks in?

I don’t know; I merely see no reason not to allow interstate competition and see whether it helps.

We get shafted by insurance companies who are motivated to hassle sick and desperate people who paid premiums in good faith on any technicality.

Again, I want to deal with that problem. Just not as part of an omnibus approach.

[kaylasdad99]

@The_Other_Waldo_Pepper

We don’t need a valid argument for a free market; we need a valid argument against one.

Piffle. I gave you one two days ago, and you ignored it. Or didn’t see it. In any event, you did not address it.

@kaylasdad99

No it’s not. The problem we should be dealing with is the fact that the provision and administration of payment to health care providers is being operated on a for-profit basis. As long as this is the case, the very function itself will remain incentivized to maximize profit, even when it results in harm to patients, whether it be financial or medical harm.

This is a valid argument against it being market-based at all, whether the market is “free” or whether it isn’t.

[kingbighair]

The Other Waldo Pepper - I have a request. Can you please give something like a 5-10 year outlook for what you think would occur if we implemented your free market plan? I presume it does not contain anything dealing with pre-existing conditions or assistance to the destitute? I’m just wondering what you think the market will accomplish.

[SenorBeef]

@The_Other_Waldo_Pepper

I don’t have such a belief. In fact, you quote me later in the same post to that effect:

I deny that I claimed “the free market will solve all” – and you now presume that I merely believe it will lead to better outcomes on average. That’s certainly a more modest approach, but I’m still mystified as to why you’d reach that conclusion in the same post where you’re asking whether I have a dogmatic belief that the free market is always the optimal solution.

I don’t understand what this line of argument is supposed to accomplish. You want to try the free market because you feel that it will have better results than either the current system or the current bills under proposal, right? For me to say that you’re saying the free market “cures all” is hyperbolic I suppose, but you do seem to be saying that you think the free market is the best option to try. I’m giving you the benefit of the doubt by assuming you think it’ll work out for the best.

No, I think that’s a problem we definitely need to address. I just think it’s separable from the other issues; solving that problem has nothing to do with whether we eliminate the antitrust exemption, neither of which has anything to do with whether we change the rules for Medicaid eligibility, none of which has anything to do with whether companies should be allowed to discriminate based on pre-existing conditions. We can tackle each problem on its own merits – and if you don’t like the order I’m suggesting, that’s fine too. Let’s tackle the stall-until-they-die problem on its own terms.

Some of the reforms are necesary for others, or synergistic. As I’ve said before, simply excluding pre-existing conditions puts insurers in a very difficult position, which means that more policies have to come along with it.

Within the decade, we’re going to be spending 20% of our GDP on medical costs, and it just keeps rising. This is a major economic crisis, regardless of the actual human suffering involved. What sort of time frame are we looking at to try your various experimental steps 1 by 1? Remove antitrust exemptions and give the market 5 years to work it out, and see if anything good happened? Then maybe let them compete across state lines for 5 years after that? We need substantial solutions to the issue and minor tweaks probably aren’t going to accomplish that.

Especially, since as I’ve said, you’ve demonstrated no reason to believe that either of those proposals solves a current problem that would likely lead to substantially reduced costs. We could try throwing a giant national coin into a huge wishing well too and see if that helps.

It’s not “the market will”. It’s “the market might”. I want to give the free market a shot first; you could call that a dogmatic response, but it’s only what I want to do because I can’t yet provide any evidence. Once the market is up and running, I’m open to providing some other responses to a practical problem; I just default to giving the market a chance until the market has had a chance, unless I have a fine reason not to do so.

I’m saying it’s a dogmatic response because you haven’t outlined specific reasons as to why your solutions address actual problems, and because you essentially handwave away any problems with the current system as not being flaws of the free market as it applies to health care. You refuse to answer why it is that there cannot be competition within states, whether there are companies out there currently acting like monopolies, etc. You have not demonstrated problems that will be solved by your proposed solutions, let alone how those solutions might actually impact those undefined problems.

And I again say that our system is largely based off the free market. Not totally free, and could be freer, but you can play no true scotsman with your definition of free market. Say we remove the antitrust exemption and allow interstate competition - someone later can say “well we haven’t tried the REAL free market yet because we haven’t removed tax incentives from employer based health care”, and if we removed that, you can say we haven’t really tried the free market because we have minimum requirements on what policies cover.

My views are amenable to evidence. I want to see the evidence roll in under free-market conditions, whereupon we can then look at whatever problems remain – which might be all of 'em, but might not – and propose fixes.

How can I respond to an argument you refuse to make? You won’t even say what problems your proposals will solve. You seem to more or less be saying “let’s just try this, just cause… maybe something good will happen”, and that’s way too haphazard a motivation for national policy on a very important issue.

This isn’t to say that cases can’t be made. I gave hypothetical examples earlier. The evidence could indicate that states with more insurance companies competing within their borders have lower costs. That would be evidence in favor of the idea of increased competition reduces prices. But your ideas aren’t based on evidence like that.

I don’t know. I haven’t seen anyone spell out a reason why it would hurt; it might help; a Democratic congressman just proposed legislation to that effect, and it sailed through the House with massive bipartisan support; why not see whether it helps solve any of the problems?

The reason it would hurt is because there would be a race to the bottom. The state which adopted the most lax laws that protected insurers against legal liabilities, that mandated the lowest requirements on what insurers actually provided, etc. would be where all of the insurance companies would be based out of. The quality of the insurance would likely go down, and the ability for insurers to fuck their customers would go way up.

As for why not just see if it works, as I said - you’re proposing that we stall an important national policy for years while facing a genuine crisis on the basis that hey, maybe it’ll do something. Sure, I can’t outline a specific problem it will solve or anything, but let’s give it a try and if it doesn’t work maybe we can try something else. The issue is too important for that sort of bullshit.

Exactly right. I believe I’ve made that point earlier – but, regardless, the point is that I’m fine with analogous regulations. I just don’t see how antitrust exemptions or barriers to interstate sales are analogous, is all.

And I’m not opposed to the measures. But there’s no reason that I’ve seen to think that they will significantly impact the problem. We’re WAY out of line - we spend upwards of 30-40% of our medical costs on administration. Do you realize how insane this is? A third of every medical dollar spent in this country is spent on having your doctors hire people to haggle with insurance companies to force them to pay the shit they’re supposed to pay. We spend double or triple what other countries that cover more people as a percentage of GDP - and obviously even more money in actual dollar costs. The system is way out of control and minor tweaking isn’t going to get us very far, and the years we spend trying to tweak one minor issue at a time are not only economically catastrophic, but really do genuinely affect the quality of life (or life at all) of millions of people.

I don’t know; I merely see no reason not to allow interstate competition and see whether it helps.

Right, it may even be a net positive, but there’s no reason to suspect it will have a huge impact. It doesn’t remotely touch so many of the other problems we have with the system, and even makes some worse (the state with the laws allowing the hardest screwing of the customers will now drag down the national average, etc), and there’s no reason to suspect it’s going to even start to cut into the gigantic differences between our medical system and some other first world system. We’ve let this problem linger and get out of control for so long that we don’t really have the luxury of minor tweaking over decades to see what works in isolation.
I notice you keep avoiding some of my questions. Can you answer my questions about whether a free market system of roads with private land owners would be preferable to what we have now? And if not, why not?

[SteveG1]

I think this was already brought up, as it relates to a free market, but I didn’t see an anwer (I could have simply misssed it).

The free market examples are usually those where a person has some choices - choic of service, type of service, competition among the vendors or providers, etc. The “nuclear option” is to simply not buy.

In the matter of medical care, and I will include dental care too, it can be a matter, quite literally, of life and death for the “customer”.

So, you have a “captive audience”. It’s the ultimate seller’s market. Couple that with various exemptions from anti-trust regulations, and the “embargo” (for lack of a better word or understanding) against going to Canada or Mexico for cheaper meds, and I think I can fairly say it is not, and never was, a free market to begin with.

[Fear_Itself]

@Starving_Artist

This country was founded on the proposition that the people should be able to get what they have collectively decided they want, and not what the political ruling class has decided is best for them whether they like it or not.

If that were true, we would have health care reform with a public option. That is what most people want, and were it not for the minority of 42 obstructionist Republicans, we would have it. Why do you support allowing the minority to force their ideology on the majority who do not want it?

[The_Other_Waldo_Pepper]

@SenorBeef

I don’t understand what this line of argument is supposed to accomplish. You want to try the free market because you feel that it will have better results than either the current system or the current bills under proposal, right? For me to say that you’re saying the free market “cures all” is hyperbolic I suppose, but you do seem to be saying that you think the free market is the best option to try. I’m giving you the benefit of the doubt by assuming you think it’ll work out for the best.

Well, we’ve been over the other half of the equation, too; maybe we’re just at an impasse? The idea is that I think it’s the best option to try until some evidence rolls in, and, well, here’s you repeating stuff back to me in this latest post:

How can I respond to an argument you refuse to make? You won’t even say what problems your proposals will solve. You seem to more or less be saying “let’s just try this, just cause… maybe something good will happen”, and that’s way too haphazard a motivation for national policy on a very important issue.

. . . and here’s me laying my position out again: I’m largely fine with “let’s just try this, 'cause maybe something good will happen” in situations where the majority of Americans are currently satisfied. In that context, I don’t mind giving the free market a shot if the worst thing the other side can say about such a plan is that it might not solve all of the current problems; that’s also pretty much my answer to kaylasdad, the current level of satisfaction coupled with the worst thing we can say about my suggested alternative.

I’m saying it’s a dogmatic response because you haven’t outlined specific reasons as to why your solutions address actual problems, and because you essentially handwave away any problems with the current system as not being flaws of the free market as it applies to health care.

I handwave 'em because the current amount of satisfaction means I don’t see a big problem we need to solve right now; I figure we can try the free-market experiment for at least a little while. You ask how long; I just want something, so long as satisfaction is high and the worst we can say of my alternative is “it might not help much”.

Which, to jump ahead:

@SenorBeef

I notice you keep avoiding some of my questions. Can you answer my questions about whether a free market system of roads with private land owners would be preferable to what we have now? And if not, why not?

Because I can say worse things about such an idea than “it might not solve all of the current problems”.

Some of the reforms are necesary for others, or synergistic.

Well, yeah, but that’s not relevant to the particular one I was batting back to you – about dragging out payment until the guy with a valid policy croaks. You brought it up, and I said that one is separable; it is.

As for why not just see if it works, as I said - you’re proposing that we stall an important national policy for years while facing a genuine crisis on the basis that hey, maybe it’ll do something. Sure, I can’t outline a specific problem it will solve or anything, but let’s give it a try and if it doesn’t work maybe we can try something else. The issue is too important for that sort of bullshit.

I don’t think it is. Satisfaction is pretty high for Americans in general and me in particular; that’s why I don’t mind running the experiment.

Right, it may even be a net positive, but there’s no reason to suspect it will have a huge impact … We’ve let this problem linger and get out of control for so long that we don’t really have the luxury of minor tweaking over decades to see what works in isolation.

Again . . . I’m just not seeing it. Most of us are doing fine; the actual human suffering involved seems relevant.

This is a major economic crisis, regardless of the actual human suffering involved.

Bwuh? I’m not entirely comfortable with that sort of reasoning.

[SteveG1]

@Fear_Itself

If that were true, we would have health care reform with a public option. That is what most people want, and were it not for the minority of 42 obstructionist Republicans, we would have it. Why do you support allowing the minority to force their ideology on the majority who do not want it?

I keep hearing that it works quite well in Canada, and Dr. Stephen Hawking himself says the British version works quite well also.

[SenorBeef]

@The_Other_Waldo_Pepper

Well, we’ve been over the other half of the equation, too; maybe we’re just at an impasse? The idea is that I think it’s the best option to try until some evidence rolls in, and, well, here’s you repeating stuff back to me in this latest post:

Again, you are just ignoring the piles of real world evidence we do have. There are a variety of countries which use a variety of medical systems. Some universal and public single payer systems, and others with various mixes of public and private sector care. You act as though we just landed on a new planet with no information about the history of earth, and we’re divising a health care system from scratch, just throwing out wild ideas as if no one has ever tried them before. The US has by far the closest system to a free market in the developed world, and our costs are by far higher than anyone else, and our actual health results are similar - when you consider our coverage is much worse as a fraction of the population, the average health result becomes even lower, for 3x+ as much money.

You also have not even attempted to make the case that our current system is not a free market system. Yes, there definitely is government interference in the market - as there is in any industry. But to say “oh, we’ve never tried a free market system” is specious. Unless you can at least propose reasons why we are not experiencing the benefits of the free market, and that specific solutions are worth trying because they have a certain potential substantial benefit, this line of argument is useless. As I said, with this vague, non-specific line of reasoning you could always go one step further. Sure, we get rid of the antitrust exemption and allow competition against state lines. Let’s say it doesn’t affect costs or quality that much. Then someone can propose a different idea, and you can just go “now wait a minute, we haven’t really tried a free market, because [insert industry regulation here]. So let’s just change that, and give the free market a try first…”

. . . and here’s me laying my position out again: I’m largely fine with “let’s just try this, 'cause maybe something good will happen” in situations where the majority of Americans are currently satisfied. In that context, I don’t mind giving the free market a shot if the worst thing the other side can say about such a plan is that it might not solve all of the current problems; that’s also pretty much my answer to kaylasdad, the current level of satisfaction coupled with the worst thing we can say about my suggested alternative.

But that’s not the “worst that the other side can say”. You are just ignoring large parts of my arguments now and repeating yourself. A race to the bottom is a very real consequence of allowing competition across state lines. Every state (especially in these economic times) wants to lure in big business. They have an incentive to set up their laws to make it the most appealing they can to an insurer. This includes making it hard to sue them (any such cases would take place in that states courts) for wrongdoing, minimum regulations on how much coverage insurers must provide, how they have to comply with the terms of their contract, etc. This is how credit cards work - one state says “ok, our state laws say you can jack people’s rates up unannounced on an existing balance” and everyone moves there, and the whole country (aside from credit card companies) is worse off for it.

I handwave 'em because the current amount of satisfaction means I don’t see a big problem we need to solve right now; I figure we can try the free-market experiment for at least a little while. You ask how long; I just want something, so long as satisfaction is high and the worst we can say of my alternative is “it might not help much”.

So now your proposals are even more undefined. We’re not even looking at specific problems to solve with your proposals, but now we have no idea when to decide whether those proposals are actually having a benefit. This is even more of a non-solution to any issue, and essentially just stalling.

Which, to jump ahead:

Because I can say worse things about such an idea than “it might not solve all of the current problems”.

Like what? I’m trying to get you to realize that while the free market is a great tool, and absolutely the best way to handle certain things, not all services or industries or infrastructures work best by it. If you can admit that having a free market road system would be bad for the country, you should be able to at least understand the idea that the free market may not produce optimal results when applied to every problem.

Well, yeah, but that’s not relevant to the particular one I was batting back to you – about dragging out payment until the guy with a valid policy croaks. You brought it up, and I said that one is separable; it is.

This is true, the issue could be addressed on its own.

Bwuh? I’m not entirely comfortable with that sort of reasoning.

Most of the objection to any sort of public option health care plan is that while it may benefit people, the cost to the taxpayer just won’t be worth it. There’s an assumption that this government run bullshit will just be too expensive to deal with. I’m saying that even if you (general you, not you specifically) have no interest in helping people that are screwed by the current system, you should have an interest in reducing the cost of medical care because within a decade it’s going to be 1/5th our of GDP, several times higher than most other countries. This is a crisis in both actual human terms (people getting sick and getting screwed, people unable to get access to health care, etc) and economic terms (we’re at a competitive disadvantage to the world because of how much we spend on health care relative to them, and it’s simply a waste of wealth to continue on in this way).

[The_Other_Waldo_Pepper]

@SenorBeef

You act as though we just landed on a new planet with no information about the history of earth, and we’re divising a health care system from scratch, just throwing out wild ideas as if no one has ever tried them before.

No, I’m acting as though we have a system in place where most people are satisfied with the health insurance they have – and some of the remaining folks are young and fit and don’t see any point in buying insurance but can get health care anyway. We’re not devising a health-care (and health-insurance) system from scratch; we’re modifying one that’s working just fine for most Americans, according to most Americans, in this here American democratic republic.

You also have not even attempted to make the case that our current system is not a free market system. Yes, there definitely is government interference in the market - as there is in any industry.

No, the antitrust exemption is a different kind of government interference. As with other industries, health-insurance companies are banned from engaging in false advertising or refusing to hire minorities and so on – but antitrust exemption isn’t like that.

But that’s not the “worst that the other side can say”. You are just ignoring large parts of my arguments now and repeating yourself. A race to the bottom is a very real consequence of allowing competition across state lines.

So include whatever federal minimum you think is required. Put any floor you like on that race to the bottom, if you’re worried that one of the states will go too far.

This is how credit cards work - one state says “ok, our state laws say you can jack people’s rates up unannounced on an existing balance” and everyone moves there, and the whole country (aside from credit card companies) is worse off for it.

Unfortunately, I’m as satisfied with my credit-card company as I am with my insurance company. But I’ll assume you have a point, and will merely argue that whatever federal minimums are now being required of the most lax state for credit cards can be analogized over to insurance companies.

So now your proposals are even more undefined. We’re not even looking at specific problems to solve with your proposals, but now we have no idea when to decide whether those proposals are actually having a benefit. This is even more of a non-solution to any issue, and essentially just stalling.

I wouldn’t go quite that far. I’m generally reluctant to look at the results – not just in commercial situations, but across the board. I believe, for example, that the accused should have a right to trial by jury, preferably in a situation where he can’t be made to incriminate himself and the authorities need a warrant to search his house; I couldn’t tell you how much of an improvement that would be in prosecuting the guilty or vindicating the innocent, nor could I tell you how long I’d want such a system to operate before we started picking at it.

Ditto for free elections; it’s not that I forecast a particular result, and it’s not that I could tell you how long we should have 'em until we start meddling. It’s merely that I want a number of baselines to be in effect, even though I can’t tell you who’ll get the most votes in years to come.

If we had a system that (a) lacked some of those baselines, and (b) had some problems, I’d want us to add in the rest of those baselines for at least a little while; how long? I couldn’t say; let’s say “until there’s public support for additional changes.”

I no more want to get into specifics about conviction rates or re-election rates or whatever under such a system than I want to aforementionedly call my shot on the price of Pepsi or tell a movie studio, hey, why not hire maybe half-a-dozen Oscar-nominated actors and put 'em in a film based on the long-running Iron Man comic book? I likewise don’t want to name timetables for companies that make air conditioners or personal computers; as with the insurance industry, I don’t want the government to step in unless the populace insists on a particular reform.

They don’t, yet. Not on the reforms the Dems are pushing in their omnibus, anyway.

And until they do, I’m not much for predicting results or setting up a timetable; I merely want the free market – plus whichever fair-play regulations you feel necessary – to play out until the public hue and cry shifts from “start over and debate this point by point, starting with the stuff that has the most bipartisan support” to “no, wait, I want Medicare for everybody”, or whatever.

Now, if the remaining problems involve separable issues, I’m all for dealing with 'em on a shorter timetable; in this case, say, involve what you and I have discussed about making the providers pay out (and you of course agree right here in this post that it “is true, the issue could be addressed on its own.”) And if you combine enough of those with free-market reforms, then maybe the crisis in human terms and economic terms gets mitigated. If it doesn’t, then the voters will step in when they see fit – again, I’m not much on naming timetables – for a bigger overhaul.

I’m trying to get you to realize that while the free market is a great tool, and absolutely the best way to handle certain things, not all services or industries or infrastructures work best by it.

Obviously I agree.

If you can admit that having a free market road system would be bad for the country, you should be able to at least understand the idea that the free market may not produce optimal results when applied to every problem.

Yep; it may not. Then again, it may. I’d prefer to find out; you’d prefer to go straight from maybe sixty-five years of antitrust exemption to a federal omnibus approach that lacks public support. You criticize me for not having a set amount of time during which to let the evidence pile up without the antitrust exemption; I criticize you for settling on “zero”. We’re probably at an impasse.

[kingbighair]

@The_Other_Waldo_Pepper

No, I’m acting as though we have a system in place where most people are satisfied with the health insurance they have – and some of the remaining folks are young and fit and don’t see any point in buying insurance but can get health care anyway. We’re not devising a health-care (and health-insurance) system from scratch; we’re modifying one that’s working just fine for most Americans, according to most Americans, in this here American democratic republic.

The Other Waldo Pepper (channeling his/her inner French princess) - “Let them have health care.”

[The_Tooth]

Every study I’ve read makes it clear that Americans are not satisfied when the opinions of those without insurance are factored in. Half of American bankruptcies are due to health care costs. How anyone can say these people are satisfied with that situation eludes me. Like I’ve said before: American health care is fine work, if you can get it.

[Gyrate]

@The_Tooth

Like I’ve said before: American health care is fine work, if you can get it.

And for everyone else, well, they’re poor and sick and will be dead soon anyway so there’s no point trying to win their votes.

[The_Tooth]

Yet they do try. “I despise you, now vote for me.”

[Shodan]

@The_Tooth

Like I’ve said before: American health care is fine work, if you can get it.

And 80%+ of the American public can get it.

Although polls have consistently shown that just over half of Americans think the health-care system is in need of reform, a substantial majority say they are satisfied with their own insurance and care.

Cite.

@The Other Waldo Pepper

@SenorBeef

You act as though we just landed on a new planet with no information about the history of earth, and we’re divising a health care system from scratch, just throwing out wild ideas as if no one has ever tried them before.

No, I’m acting as though we have a system in place where most people are satisfied with the health insurance they have – and some of the remaining folks are young and fit and don’t see any point in buying insurance but can get health care anyway.

THe problem - or one of them - is that we have a system in place that covers most people, with which most are satisfied except that it costs too much. And the reforms proposed either do nothing to address the factors driving costs up, or will make it worse.

According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period.

Obama claims otherwise, but most people know better than to believe him.

Regards,
Shodan

[SenorBeef]

@Shodan

And the reforms proposed either do nothing to address the factors driving costs up, or will make it worse.
Obama claims otherwise, but most people know better than to believe him.

Regards,
Shodan

Oh good, a non-sequitor to go along with the usual political snipes.

An increase in the federal deficit does not indicate that the cost of premiums or medical services will go up, nor does it even indicate that we will spend as much as a portion of GDP. If a subsidy is going to be provided to previously uninsured people, money that was either not spent before, or spent on a non-federal level by state funded medical aid programs, grants to hospitals, or hospitals simply writing off bills, then obviously those costs will be reflected differently in the federal budget. This is not connected to the point you’re trying to imply, that it would either increase the cost of medical care. In any case, 24 billion a year is not exactly a scary figure.

[Shodan]

@SenorBeef

Oh good, a non-sequitor to go along with the usual political snipes.

I am not sure what non sequitur you are talking about.

An increase in the federal deficit does not indicate that the cost of premiums or medical services will go up, nor does it even indicate that we will spend as much as a portion of GDP.

It means that we are borrowing money and spending it on health care. This increases demand. Increased demand leads to increased cost. This is simple economics. That money will have to be repaid, with interest.

And if Obama increases taxes, increases spending, and increases the deficit, then I am afraid you are wrong - it does mean that the cost is going up. Obama’s spending overall, health care spending in particular, and the deficit under his administration, are all growing faster than GDP, so your allegation about GDP is also incorrect.

This is not connected to the point you’re trying to imply, that it would either increase the cost of medical care.

It is directly connected to the point I was making, which was that

the reforms proposed either do nothing to address the factors driving costs up, or will make it worse.

In any case, 24 billion a year is not exactly a scary figure.

Not unless you are frightened by the fact that Obamacare does not do any of the things it needs to do - it does not cover everyone, it does not address the root causes of health care inflation, and it does, in fact, increase the deficit - directly in contradiction to the promise Obama made several times.

Maybe it doesn’t scare you that entitlements such as Social Security and Medicare and Medicaid and the overall cost of health care are growing out of control. Perhaps you shrug your shoulders and say “Oh well, it’s only a few hundreds of billions of dollars that my children and grandchildren will have to pay for.” I am not so sanguine.

Regards,
Shodan