You know, I’ve never known anyone with insurance and a copay to see a doctor for frivolous things. I have, however, seen plenty of people without insurance end up in the ER and even admitted to the hospital because they were unable to pay for medical treatment prior to the point when it becomes an emergency and the hospital has to treat you, whether you can pay or not. Just like I’ve seen people with jobs and dental insurance end up with missing teeth- they can’t afford to pay the difference between the insurance coverage and the dentist’s fee and therefore don’t have regular check-ups and get treatment earlier.
So, employers aren’t basically consumers? My employer is self-insured, the insurance company just runs the program. Do you think that private enterprise doesn’t look for the best deal? I know my insurance company negotiates lower rates with doctors.
That isn’t a free market? Unless you’ve somehow just come from 1900, you should know that regulating something doesn’t make it not a market.
You hard rightists are as fundamentalist as any Communist. The evidence shows that more government involvement makes for a more efficient system, but for you St. Ron said it’s socialism, I believe it, and that’s all there is to it.
Damn right. Forget about health, since these guys clearly don’t care about it for those who are irresponsible - as demonstrated by being poor. But it saves money to treat something quickly. My for-profit plan clearly decided that letting us spend whatever we wanted on preventative care saves them money in the long run. I bet any of us over a certain age can give examples of this.
This is a matter of faith to you. The facts are against it, but facts don’t count in your fantasy land, do they?
Exactly who wants to do this in the current US debate? There is a drive to force everyone to take insurance, but that is to get the young and healthy into the market, before they start needing more than they put in and then want entry. It makes perfect sense from their point of view, but society suffers as a whole.
I already explained why this is a bad analogy. Auto costs are capped by the cost of the car, and at a certain point there is the ability to get a new car with lower costs. Insurance is not about damage to your car, but rather about damage to you and to others.
But let’s assume that car insurance paid for catastrophic mechanical damage. Would it make sense for insurers not to cover regular maintenance? Say the consumer knew that if he left a problem go the insurer would a couple thousand bucks to fix things. If he fixed the problem now, he’d have to lay out a few hundred, perhaps. What do you think he’d do, especially if he was short on money? If you support catastrophic health care, then it makes good economic sense to pay for preventative care also.
This would lead to exactly the situation I mentioned above. How many $500 incidents do you think one family could handle in a year? Most insurance has a deductible, by the way, for all events, not for each. $500 a year per family is not much more than what is common practice now, and would be fine.
But setting up a system that discourages preventative care is stupid. As for bureaucratic nightmares, you’ve clearly not dealt with US insurance companies, which is tricky even if they’re not paying and you have a big employer on your side. Every doctor’s office in the US has at least one full time person doing insurance claims. That’s how it is in our free enterprise paradise.
In Canada, what happens to people who can’t afford dental insurance. Do they get it from the government, or do they become hockey players so they can lose their teeth honestly.? 
Why don’t you want to allow the markets to soar free with respect to “invasive procedures”? What exactly is the difference between these “invasive procedures” on the one hand–I assume you mean surgery–and things like correctly diagnosing life-threatening medical conditions, or properly prescribing powerful drugs with scary side effects that can nonetheless save people’s lives?
Not a very good analogy Sam. Even though auto insurance is mandatory in most states, according to the Insurance Research Council (PDF), the uninsured motorist rate is as high as 26% in some states (and the rate of uninsured motorists is growing), and one in seven auto accidents involves an uninsured motorist. Your solution will just perpetuate the status quo, with an unacceptable number of uninsured patients burdening emergency rooms for primary care.
Look, the OP is an unworkable libertarian dream. And yet, we cannot escape the fact that in areas of medicine untouched by either private insurance or government entitlement agencies (not regulatory agencies, which are a different matter entirely) costs are controlled quite well, and availability of care is expanding.
Again, think of this next time you hear an ad for Lasik surgery. A few years ago this was unavailable, then it was an expensive luxury. Now it is something people can get by paying a few hundred bucks out of pocket.
You’re missing my point. I didn’t intend for auto insurance to be the model to base health care insurance on. My point is that insurance sucks as a way to organize and pay for the health industry, and the only reason why it works at all in the auto industry is because it’s very limited in what it covers.
Imagine if it covered things like tire wear, or belt replacements. Imagine the paperwork that would be required to prevent fraud. Imagine how many tests you’d need before an insurance company would insure you, and how expensive insurance would be.
And if insurance covered tire replacement, there would be less incentive for people to take care of their tires, and less incentive for tire manufacturers to keep the cost of tires down. And people would always want the best tires - why settle for poor tires when you can have good ones if there’s no cost to you? So insurance companies would start choosing the kinds of tires you can have, and they’d have an incentive to give you the cheapest, crappiest tires around.
This is what the health care system is like under mandatory insurance with full coverage. Doctors and hospitals have no real incentive to control costs, and patients have no incentive to choose cheaper care or less care.
I have a vision plan through my work that pays for eyeglass coverage. My daughter therefore gets new glasses every year, and cost is no object up to the insurance limit. If I didn’t have that insurance, every year we’d be asking ourselves if she really needs new frames, and whether she really needs the $300 frames when there are $50 frames that will do the job just as well. Insurance breaks the connection between consumer and prices. Costs skyrocket.
In the auto industry, they can control costs somewhat because the car is only worth a fixed amount. Imagine how expensive it would get if you only received one car during your life and it had to be kept running. And imagine insurance covering every cost associated with keeping it running. What a mess that would be.
You can reduce much of the problem by limiting the scope of the mandatory insurance.
Employers are buying health insurance for their employees, who are the consumers. So, no, employers are not the ones consuming the health care.
Yes, some sort of minimal regulation can co-exist with the free market. The incredibly heavy amount of regulation (along with the fact that the government pays around 50% of the health care costs in this country) has led to a situation where we have anything but a free market in health care.
All the evidence I’ve read indicates that government involvement makes for a far less efficient system. The system we have today in the U.S. is so inefficient because of government involvement. The problems people bitch and moan about are mainly a result of government meddling in the health care marketplace and the health insurance marketplace. The evidence is clear. Those of you who favor some sort of single-payer system just don’t to actually examine how the current U.S. system works and why it’s flawed. You prefer to call it “free market” and then say that because the “free market” hasn’t worked in the U.S., we need to go to a single-payer system. Saying that the U.S. system even resembles the free market shows that you don’t know what you are talking about.
That’s a huge assumption. First, it’s a huge assumption that people would have more doctor’s checkups if insurance paid for them. I’m sure people on the margin would, but it seems to me that refusal to go in for checkups has more to do with fear of doctors and hassle than cost. Second, you’re making the assumption that regular checkups would significantly lower health care costs, and I don’t know if that’s true. Do you have a cite?
It seems to me that what auto insurers would really want to do if they had to cover catastrophic mechanical damage would be to limit *behaviour. Engines blow up when people over-rev them. Tires get worn faster when people spin them and corner hard with them, or don’t keep them inflated properly. Etc.
With mandatory health care insurance, pressure starts to build to control people’s behaviour. Anti-smoking laws, taxes on fatty foods, John Edwards’ mandatory ‘wellness’ crap, etc. I find that level of control over my life repugnant.
Why should health care be treated any differently in this regard than any number of other small financial problems that people raise. Sure, you could wind up needing five treatments in a bad year and be out $2500. But then, you could need to replace the roof of your house, too. Or you could get in an auto accident and have to pay out $500 in deductible. Or you could buy new glasses for the kid and they could get broken and you’ll have to buy another pair.
Free people are supposed to manage their own lives. They are supposed to save money for emergencies. Yet as soon as we start talking about the scope of government health care, some people come along who want to turn it into comprehensive program that protects people from any financial risk at all, rather than just preventing them from experiencing financially ruinous medical disasters.
They pay for their own dentistry. My mother doesn’t have dental insurance. I never had it for most of my life. You’d get a cavity, and oh crap you’re going to have to figure out how to pay for it. Most of the kids I knew didn’t have braces. Lots of wealthy kids did.
But the thing is, people can generally afford basic dental care. Having a cavity filled isn’t that expensive. Even a root canal or other fairly invasive procedure only costs a few hundred bucks. In comparison, when I went to hospital for simple X-ray to check my back for damage (there was none), the bill was $800. Covered by government health care, of course. My dentist charges something like $40 for an X-ray.
:dubious: Really?
Does your mother know how to read an MRI? Does she know how to do a CAT scan? What about dental x-rays? Eyeglass perscriptions? Can she perform a pap smear? Can she give a correct injection for certain shots?
And what do you consider an “invasive procedure?”
But, that’s what we’ve got now, with all the pros and cons that go with it, and on balance, it sucks.
As I wrote earlier, it seems to me that choosing “less care” means delaying treatment until the last minute, and there shouldn’t be an incentive to do that, because it results in more suffering and eventually higher costs. Is there another meaning I’m overlooking?
That sounds like your insurer’s fault for setting such a high limit. Couldn’t they decide to set a lower limit, offering you lower premiums in exchange for only covering the $50 frames? That’s how it works with auto insurance.
First, health care is a necessity. A leaky roof and a damaged vehicle are unfortunate, but not fatal.
Second, health care affects everyone, rich or poor, whether or not they own a home, drive a car, or have kids. You can estimate the costs of repairing a roof and factor that into your decision to buy a home, but you can’t decide not to be born because health care is too expensive.
I suggest you read a little more. Most (if not all) countries with more government involvement spend less to cover more of their populations, and obtain equal or better results by any objective measure.
Saying that government involvement makes for a “far less efficient system” suggests that you don’t know what you’re talking about, either. National health care isn’t some mysterious new invention that can only be discussed in a vacuum; you can look at countries where it already exists and observe that the alleged problems of government intervention are mostly fiction.
Naw, our free market approach doesn’t put sugar on its porridge.
How do you square this with how medicine behaves when it is really subject to the free market, not a distorted one?
Please note my Lasik example above, and tell me how costs are contained so well there - no insurance or government funds are generally applied.
How many people ever died because they had to wear glasses? Lasik is a convenient luxury, hardly comparable to chemotherapy or dialysis.
There’s no such thing as a free market. If the government doesn’t “distort” it, the more successful businesses will. The only real option you have is who will do the “distorting”; the government, which you can influence with votes, or a medical version of Microsoft, which you can’t.
Exactly. Just like HDTV sets, Lasik is a product where high prices are no cause for alarm. Early adopters pay ridiculous prices, everyone else goes without, and over time, the price drops so more and more people are able to afford it (although it’s still pretty expensive compared to even a lifetime’s worth of glasses). The key point there is “everyone else goes without”, which is fine for vision surgery and flat screens, but fundamentally unacceptable for basic health care.
Ok, I’ll think of it as a faulty economic argument. You and the other “free marketeers” in this thread are pointing at goods and services which have elastic supply-demand curves and trying to apply those lessons to goods and services which have inelastic supply-demand curves.
A good chunk of the health care market is not and never will be subject to price competition the way Lasik or television sets are. There are a number of reasons for this, but the primary reason is that if you need life-saving treatment, you will purchase it. You don’t get the luxury of waiting until the price comes down or another cheaper alternative is developed. In emergency situations, you effectively are dealing with a monopoly (the nearest hospital), unless you think that people who are bleeding to death have the ability to stop and comparison shop. Treatments which are under patent protection are another area of oligopoly/monopoly behavior.
The people in the thread who keep comparing elastic goods with non-elastic ones are simply showing that they’ve never taken an economics class.