Do teabaggers and town hellers not realize that the insurance industry already rations healthcare?

[joebuck20]

Or that they tell you what doctor you can go to, or decline certain types of treatment, or does any of the other evil things they say a public option or single payer plan would do? How do they justify the insurance industry’s practices?

[Euphonious_Polemic]

What are you joebuck20, some kind of socialist? You’re probably not even born in the US are you?
Down with joebuck20

Down with joebuck20

Down with joebuck20

<shouts him off the stage>

[Whack-a-Mole]

But at least you will have a CHOICE of shitty, over priced health insurance that screws you at the worst possible time!

That’s the important thing.

[Rhythmdvl]

Are you talking about the “two legs bad”-type protesters? Little rational debate is included in their chanting–they’re mostly regurgitating slogans on par with football cheers. “Dallas Sucks!” shouts the Packer fan, for no other reason than it’s fun and feeds into their reptilian sense of us-versus-them.

Unfortunately, among the crowds there are some folk who have legitimate concerns about a single-payer or other option (this is independent of what’s on the table) with regards to the rationing issues you raised. “Unfortunately” because their rational voices and concerns are not being heard, and are not framing the debate.

In theory (in theory), market and bureaucratic forces respond to different signals. Some prefer that rationing of healthcare and whatnot be driven by those forces at play in a free market. This will get prices right (“right” in the economic sense of the term) and yield the most efficient (“efficient” in the economic sense of the term) allocation of resources. The difference between decisions based on a free market and decisions based on a governmental mandate can be astronomical:

While you may agree with the current administration’s points of view and trust it to implement healthcare policy, would you be so interested in the public options being established and pathways being set during the first years of a Palin administration? That is, after 8 years of Palin, then 8 more years of Cheney, with Trigger leading in the polls coming into November…

[Wesley_Clark]

It appears a good number of them don’t even know that medicare is a government run single payer program.

Sad part is many of the teabaggers are geriatric. So many are on social security and medicare. I remember a youtube video of a man who was about 66 complaining about government intervention and the laziness of welfare recipients to a politician at a town hall meeting. The guy was too dumb to know that at 66 you collect social security and medicare. The eldery are the biggest welfare recipients in this country, and they make up a large number of these moron tea baggers. At least 35% of all government spending (at least a trillion easily) goes to the elderly for various pensions and health programs.

The average Fox News and talk radio listener is in their mid 60s. The average O’Reilly viewer is 71.

Yes, they are this clueless.

[villa]

@Rhythmdvl

“Dallas Sucks!” shouts the Packer fan, for no other reason than it’s fun and feeds into their reptilian sense of us-versus-them.

You appear to have misspelled Eagles fan.

This attitude amazes me. Back many moons ago, when I first moved to DC, I was sat in the garden of my friend’s home. The topic got round to UHC, which I supported. His wife attacked me for supporting rationed health care. She was first amazed when I said the price mechanism is a form of rationing itself, then got indignant and just repeated “that’s different, that’s not rationing.”

Indeed, it is different. We can move from a system where if you have cash, you get health care immediately, and if you don’t, you get none, to one where whether you have cash or not, you wait until it is your turn.

It’s perfectly legitimate to oppose that change, or to support something in between. But don’t act as if it isn’t rationed under any system.

[Whack-a-Mole]

@Rhythmdvl

Are you talking about the “two legs bad”-type protesters? Little rational debate is included in their chanting–they’re mostly regurgitating slogans on par with football cheers. “Dallas Sucks!” shouts the Packer fan, for no other reason than it’s fun and feeds into their reptilian sense of us-versus-them.

Unfortunately, among the crowds there are some folk who have legitimate concerns about a single-payer or other option (this is independent of what’s on the table) with regards to the rationing issues you raised. “Unfortunately” because their rational voices and concerns are not being heard, and are not framing the debate.

In theory (in theory), market and bureaucratic forces respond to different signals. Some prefer that rationing of healthcare and whatnot be driven by those forces at play in a free market. This will get prices right (“right” in the economic sense of the term) and yield the most efficient (“efficient” in the economic sense of the term) allocation of resources. The difference between decisions based on a free market and decisions based on a governmental mandate can be astronomical:

Astronomical? In health care that is turned on its head.

Here’s the raw fact, from the National Health Expenditure data: since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%. The rise in Medicare costs is just part of the overall rise in health care spending. And in fact Medicare spending has lagged private spending: if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.

SOURCE: Medicare versus insurers - The New York Times

* Twenty-two percent of privately insured people found that their plan did not pay for care that they thought was covered, compared with 9 percent of elderly Medicare beneficiaries.
* Nine percent of privately insured people had difficulty getting a referral to a specialist, compared with 2 percent of elderly Medicare beneficiaries.
* Medicare beneficiaries were more likely to be very confident in their ability to get care in the future as those covered by employer plans (60% vs. 37%).
* Thirty-three percent of privately insured people were unable to pay their bills or had been contacted by a collection agency, compared with 18 percent of elderly Medicare beneficiaries.

SOURCE: http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2002/Oct/Medicare-vs--Private-Insurance--Rhetoric-and-Reality.aspx

So, Medicare costs less and works better for its beneficiaries. So much for the free market sorting that one out.

As for framing the debate practically no one on the other side is “framing” the debate in anything like rational terms. Can you point to a comprehensive Republican health care plan? Can you point to the Town Hall discussions where people were arguing on a rational basis rather than ranting or shouting slogans?

Doubtless there have been some pundits out there trying to make a rational case for skipping a Public Option. They are sadly few and far between. Honestly I think the real problem lies in them having to assume “terrible things” from a Public Option and support that in the face of “terrible things” we know are happening right now and show no signs of abating.

I think it would have been healthy for a rational debate in Congress. Alas we are left with fearmongers in the pocket of the medical lobbyists.

[Wesley_Clark]

@Rhythmdvl

Are you talking about the “two legs bad”-type protesters? Little rational debate is included in their chanting–they’re mostly regurgitating slogans on par with football cheers. “Dallas Sucks!” shouts the Packer fan, for no other reason than it’s fun and feeds into their reptilian sense of us-versus-them.

Unfortunately, among the crowds there are some folk who have legitimate concerns about a single-payer or other option (this is independent of what’s on the table) with regards to the rationing issues you raised. “Unfortunately” because their rational voices and concerns are not being heard, and are not framing the debate.

In theory (in theory), market and bureaucratic forces respond to different signals. Some prefer that rationing of healthcare and whatnot be driven by those forces at play in a free market. This will get prices right (“right” in the economic sense of the term) and yield the most efficient (“efficient” in the economic sense of the term) allocation of resources. The difference between decisions based on a free market and decisions based on a governmental mandate can be astronomical:

While you may agree with the current administration’s points of view and trust it to implement healthcare policy, would you be so interested in the public options being established and pathways being set during the first years of a Palin administration? That is, after 8 years of Palin, then 8 more years of Cheney, with Trigger leading in the polls coming into November…

The problem with free market health care is that consumers are not good customers. The average citizen has no medical training, has the reading comprehension skills of a 14 year old and ‘needs’ medical care. You can put off buying a plasma TV. You can’t put off going into labor or getting heart surgery.

So the consumer market forces do not seem to work.

NOt only that, but health care costs are not distributed evenly across the country. When you break it down, it comes out to about $7000 per capita. However most people use little health care, and a few use tons.

The sickest 1% of the nation uses about 22% of health spending

The sickest 5% of the nation uses about 49% of health spending

The sickest 20% of the nation uses about 80% of health spending

The healthiest 80% of the nation uses about 20% of health spending

The healthiest 50% of the nation uses about 3% of health spending
So you have a situation where the sickest 1% of the nation (3 million people) uses about 700% more medical care than the healthiest 150 million people.

So market forces are not going to work too well in that situation. Most people need very little health care most of the time (the healthiest 240 million of us only use about $500 billion a year in health care).

For the truly sick, medical care is going to be a necessity, not a luxury. And they will not have the medical training or emotional dispassion to make good decisions.

Palin and Cheney wouldn’t have addressed health care issues if they were in charge.

[Ravenman]

@Rhythmdvl

This will get prices right (“right” in the economic sense of the term) and yield the most efficient (“efficient” in the economic sense of the term) allocation of resources.

And you realize that this “getting it right” process results in “rationing,” right? And that this is the way that things work now?

(I’m using the term rationing in a rather generous way, in that the availability of services will be limited based upon the ability to pay.)

[Jophiel]

That’s always been my hang-up with the “anti” public insurance folks. I never have a medical decision made now that doesn’t require the blessing of some insurance desk jockey. Who almost always changes it, saying that I really need the generic medication or I haven’t tried some over-the-counter remedy long enough to deserve the prescription my doctor says I need or there was no good reason for the tests the doctor said I should take to find out why I hurt.

Honestly, the only difference I see between an insurance guy being the gatekeeper to my medical care and the government is that the insurance guy’s job revolves first and foremost around the insurance company turning as large a profit as possible.

[Rhythmdvl]

Well duh it involves rationing. Don’t confuse me with a teabagger or a staunch free marketer who things Gwen is a great idea for a toy.

But also please don’t wrap intelligent and thoughtful right-wingers up in the same fishwrapper that one should use for the Beckians. That undercuts debate (in hand with their dictatorial tactics) and misses some valid points.

Furthering the argument, it’s not that the market is perfect now. Of course not. Nor is it the case that advocating for free market solutions over single payers (again, for lack of a better term) means that the poor and less well off can go suck it. But for the majority of Americans (er, I think the majority of Americans) who can afford ten to fifteen thousand a year on insurance, the preference for market-based healthcare rationing/decisions is rational.

As for who is shopping or educated, there are two responses. First, the market shouldn’t be that opaque, and proper information should be available. It’s not FDA-like in which a good amount of information and background is required to make informed decisions. Rather basic math and research/comparison ability should lead to the understanding of differences.

Second there are a lot of trained and informed people making these decisions. At companies across the country, every HR person or committee has to make a choice between healthcare plans. Of course it’s not every company and sure, lots of HR staff members are morans or don’t really put in the effort, but the point raised above about the market needing informed consumers is a good one; but there are informed consumers making decisions every day.

I can’t say I’m doing the best job defending the rationale–given my personal preferences I couldnt’ be said to have standing on this side. But I do have an appreciation for the non-shouty side of the debate, one that is unfortunately lost to the Beckian bleating.

[Whack-a-Mole]

@Rhythmdvl

Furthering the argument, it’s not that the market is perfect now. Of course not. Nor is it the case that advocating for free market solutions over single payers (again, for lack of a better term) means that the poor and less well off can go suck it. But for the majority of Americans (er, I think the majority of Americans) who can afford ten to fifteen thousand a year on insurance, the preference for market-based healthcare rationing/decisions is rational.

That’s the thing. It somehow seems rational but the numbers do not bear this out. It’s something people just figure must be better…somehow.

To wit:

This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

<snip>

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.

SOURCE: Medical bills prompt more than 60 percent of U.S. bankruptcies - CNN.com

Plus, as I showed above, people are happier with Medicare than they are with private insurance on a variety of measures.

So, again, people are advocating paying more for less and may find what they paid for comes nowhere close to meeting their medical needs at which point they are screwed.

As for who is shopping or educated, there are two responses. First, the market shouldn’t be that opaque, and proper information should be available. It’s not FDA-like in which a good amount of information and background is required to make informed decisions. Rather basic math and research/comparison ability should lead to the understanding of differences.

Second there are a lot of trained and informed people making these decisions. At companies across the country, every HR person or committee has to make a choice between healthcare plans. Of course it’s not every company and sure, lots of HR staff members are morans or don’t really put in the effort, but the point raised above about the market needing informed consumers is a good one; but there are informed consumers making decisions every day.

Apparently not. As I just noted over 60% of bankruptcies are health care related and most of those people were insured. Clearly people are unable to discern exactly what their insurance will cover till it is too late. That, or people make irrational decisions and opt for the cheaper plan hoping they won’t get really sick and roll the dice. You may say that is their own lookout except they still receive health care then pass their unpaid costs to you and me.

In the end we all pay for it anyway. May as well make it a rational system.

[Chronos]

The thing is, the free-market solution is precisely what Obama’s pushing. Adding another competitor to a market can never hurt, and the free market depends critically on people being able to choose between the competitors, and to switch between them as they will. From the free market point of view, the worst-case outcome for a public option is just that, as everyone claims, the government does a worse job than the for-profits, and nobody buys the public option. Of course, it’s also possible that the public option does better than the private ones and people flock to it, in which case we have a free-market success story.

[Der_Trihs]

@Rhythmdvl

While you may agree with the current administration’s points of view and trust it to implement healthcare policy, would you be so interested in the public options being established and pathways being set during the first years of a Palin administration? That is, after 8 years of Palin, then 8 more years of Cheney, with Trigger leading in the polls coming into November…

The problem with that argument is that scenario is pretty much what we have NOW. At least UHC would offer the possibility of something better than what we have now.

And after 16 more years of far right loony Republican control health care would be the least of our problems anyway.

[theR]

@Wesley_Clark

The problem with free market health care is that consumers are not good customers. The average citizen has no medical training, has the reading comprehension skills of a 14 year old and ‘needs’ medical care. You can put off buying a plasma TV. You can’t put off going into labor or getting heart surgery.

So the consumer market forces do not seem to work.

NOt only that, but health care costs are not distributed evenly across the country. When you break it down, it comes out to about $7000 per capita. However most people use little health care, and a few use tons.

The sickest 1% of the nation uses about 22% of health spending

The sickest 5% of the nation uses about 49% of health spending

The sickest 20% of the nation uses about 80% of health spending

The healthiest 80% of the nation uses about 20% of health spending

The healthiest 50% of the nation uses about 3% of health spending
So you have a situation where the sickest 1% of the nation (3 million people) uses about 700% more medical care than the healthiest 150 million people.

So market forces are not going to work too well in that situation. Most people need very little health care most of the time (the healthiest 240 million of us only use about $500 billion a year in health care).

For the truly sick, medical care is going to be a necessity, not a luxury. And they will not have the medical training or emotional dispassion to make good decisions.

Palin and Cheney wouldn’t have addressed health care issues if they were in charge.

What definition of “sickest” are you using? I think you’re equating the amount of dollars spent with the sickness of the person? In other words, the sickest person in the U.S. is the one that has spent the most health care dollars? If so, you should just drop the words “sickest” and “healthiest” from the comparison, because it’s not accurate.

[yorick73]

@Whack-a-Mole

So, Medicare costs less and works better for its beneficiaries. So much for the free market sorting that one out.

Medicare works so well because private insurance companies are paying for a large chunk of it. I have heard numerous physicians comment that they would go out of business if their practice consisted only or mainly of Medicare recipients. In fact, many doctors put a limit on the number of Medicare and Medicaid patients they will accept because the compensation is so low and has not increased much over quite a few years. So, yeah, it works great for those receiving it now because doctors can make up for their losses by taking patients with insurance or those willing to pay cash. What happens when we add millions more to the government rolls?

[Whack-a-Mole]

@yorick73

Medicare works so well because private insurance companies are paying for a large chunk of it.

Cite please for the numbers on this.

I realize there are “Medigap” private insurance policies which cover deductibles and such but not what I think you are talking about (and something that could certainly co-exist with a Public Option).

Medicare Part D is administered by private insurers but the government pays the bills. Again not what I think you are talking about.

About 20% are on Medicare Advantage Plans which is actually private insurance but guess what…it is heavily subsidized by the government. Seniors may be paying more out of pocket for this but FAR less than they would sans the subsidies.

So which is it?

[Whack-a-Mole]

@Whack-a-Mole

About 20% are on Medicare Advantage Plans which is actually private insurance but guess what…it is heavily subsidized by the government. Seniors may be paying more out of pocket for this but FAR less than they would sans the subsidies.

Here’s ironic for you…

Medicare Advantage plans actually seem worse in many ways to Medicare for the patients. Private insurance runs Medicare Advantage. Hmm…

The AMA conducted a survey of 2,202 physicians
about their experience with MA. Of the surveyed physicians
who have treated patients covered by MA plans
like HMOs and PPOs:
> Half indicated that they have received payments
that are below the Medicare FFS rate
> Three out of five reported excessive hold times
and/or excessive documentation requests
> Contrary to the widely reported claim that they
provide more benefits to patients, half have
experienced denial of services typically covered
in the traditional Medicare plan.

There are widespread reports of abuses and deceptive
marketing by agents trying to enroll seniors in MA plans.
The National Association of Insurance Commissioners
recently reported that 39 out of 41 states received complaints
about misrepresentations by insurance agents or
companies in marketing Medicare-related products.

SOURCE: American Medical Association (PDF)

[Voyager]

@Rhythmdvl

Furthering the argument, it’s not that the market is perfect now. Of course not. Nor is it the case that advocating for free market solutions over single payers (again, for lack of a better term) means that the poor and less well off can go suck it. But for the majority of Americans (er, I think the majority of Americans) who can afford ten to fifteen thousand a year on insurance, the preference for market-based healthcare rationing/decisions is rational.

The debate on the public option is not about the majority of Americans (who have employer subsidized insurance and are happy) but that large set who do not and are underserved. These are precisely the people who cannot afford $10 - $15 K a year.

As for who is shopping or educated, there are two responses. First, the market shouldn’t be that opaque, and proper information should be available. It’s not FDA-like in which a good amount of information and background is required to make informed decisions. Rather basic math and research/comparison ability should lead to the understanding of differences.

Those who believe this are wedded to the myth of the rational economic actor, which has been falsified by behavioral economists. Doing a rational job of buying insurance is not trivial, since it involves predicting the probability of expensive illnesses for the next year. If there is a small probability, and you have a cash reserve, you can get a high deductible but cheap policy. If there is a fairly high probability, getting a more expensive low deductible policy is better. My wife and I, with five degrees between us, think long and hard about the amount we put into our flexible spending account every year, and that is far less critical.
But the real disproof of your contention is the history of the mortgage market. Mortgages are far simpler and more transparent than insurance, and there is less forecasting involved. Yet a large number of people (under the influence of brokers) screwed the pooch on them. Why do you think this set of people would do better on health insurance?
If the private companies had to compete against a very clear public option, then we might see some improvement.

Second there are a lot of trained and informed people making these decisions. At companies across the country, every HR person or committee has to make a choice between healthcare plans. Of course it’s not every company and sure, lots of HR staff members are morans or don’t really put in the effort, but the point raised above about the market needing informed consumers is a good one; but there are informed consumers making decisions every day.

Sure there are, and some mortgages are just fine. Plus, many consumers have little or no choice, since their insurance is dictated by their employer. With full time staff and market power, the people making decisions in this case do a better job than almost all individuals, I’d say. That is why people with this type of insurance are fairly happy with it.

As for the comment on Palin, with a public option, I can switch to a similarly priced private plan if it became a problem. However, remember even the Tories back NHS, so single payer plans might be so popular even right wing administrations can’t screw with them. Remember how Bush crashed and burned when trying to mess with Social Security. So, I’m not too worried.

[yorick73]

@Whack-a-Mole

Cite please for the numbers on this.

I realize there are “Medigap” private insurance policies which cover deductibles and such but not what I think you are talking about (and something that could certainly co-exist with a Public Option).

Medicare Part D is administered by private insurers but the government pays the bills. Again not what I think you are talking about.

About 20% are on Medicare Advantage Plans which is actually private insurance but guess what…it is heavily subsidized by the government. Seniors may be paying more out of pocket for this but FAR less than they would sans the subsidies.

So which is it?

Yeah…that sentence was worded horribly. What I meant to convey is that doctors make up for their losses on Medicare patients by increasing the prices for those with insurance and those who pay cash. So, in effect, insurance companies and cash customers subsidize Medicare treatment to some degree.