TheAgitator.com
Mandatory Health Care
Thursday, June 25th, 2009Good, succinct video from the Independence Institute. Health insurance should be more like car insurance. You’re covered when things go very wrong, but when a third party is paying for things like check-ups and routine visits to the doctor’s office, you get some major pricing distortions.
I’m with you – screw poor people. They’re not as deserving as you are.
Way to completely and utterly miss the point, Sam.
This isn’t an argument against a safety net, or finding ways to make sure poor people get health care. The video and my post have nothing to do with that whatsoever.
It’s about the problems associated with most of the country–rich, poor, and middle-income–having a third party pay most of their medical costs. That drives up prices for everyone, including low-income people.
The video specifically is a criticism of Massachusetts’ plan, which forces everyone to buy into some third-party-payer system even if they have no need for comprehensive health care.
Radley,
I’m supporting you. I don’t think everybody should get health care. Some people are worthy, and others aren’t, and the way to aggregate that is money earned and who a person works for.
So Sam, first time to the site huh? I’m guessing you won’t be back either.
I’m with you, Radley. I think it’s a moral issue as a country that we can’t have people go bankrupt or have their lives ruined just to pay for a live-saving procedure, or, god-forbid, forego the procedure altogether and die for financial reasons. But covering everything all the time by the government is not the best option.
Unfortunately Sam has chosen to be a jerk rather than making an actual point.
But with that said, I do think that this video, and those who support similar positions, gloss over the two features of our current system that are so unsatisfactory. First, no rational insurer would ever choose to insure someone who had a chronic illness that might require continuous and potentially expensive care. So insurers do everything they can to make sure they keep sick people off of their rolls, but sick people are the ones who most need the benefit of insurance to cover their health care costs. I’ve yet to see a strong argument for why we couldn’t solve this problem simply by adopting community rating coupled with mandatory purchase of coverage – On average, premiums would go up, but that is the cost you pay for ensuring that the sickest people have access to the protection afforded by insurance. Any proposal that doesn’t acknowledge this is arguably a non-starter, because it involves simply throwing the sickest people under the bus in order to ensure more reasonable premiums for everyone else.
Second, its kind of crazy that health insurance is tied so closely to employment. This impedes employment mobility in all sorts of counterproductive ways, and also acts as a disincentive to the kind of entrepeneurship we desperately need. So some reform in which we improve the portability of insurance from one job to the next could be a step in the right direction, and having a public insurance option available may be one way to accomplish this.
How is it “being a jerk” to take the libertarian position? What are you guys talking about?
Earlier today, there was a thread on the site rightly observing that capitalism occasionally has bad outcomes, which in this case would be poor people dying because they couldn’t afford health care. But that’s much better than everybody paying more in taxes.
#6-
Huh?
Let’s look at what you wrote:
1) capitalism occasionally has bad outcomes
2) poor people dying because they couldn’t afford health care
3) that’s much better than everybody paying more in taxes
Can you explain how 1 = 2 because of 3?
Sam, you’re continuing to respond (via mockery, I guess) to an argument nobody (the video, Radley) here is making, even after Radley already pointed this out to you. So what’s your point?
And can we not pretend that the health care industry really has much of anything resembling capitalism? That “bad outcomes” are a necessary component of capitalism doesn’t mean that all bad outcomes are the result of capitalism.
Do you guys seriously not understand that feeding trolls leads to infestations.
and if we pass usury laws, the poor won’t be able to get loans. Is there an actually problem with people going uninsured in Massachussetts due to inability afford anything but the highest deductible health insurance plans, or is this more concern trolling for the poor?
US healthcare is the most “free-market” in the world yet doesn’t even crack the top 30 for quality of service (and even that doesn’t count the uninsured, which is a condition that doesn’t even exist in most countries) and is by far the most expensive. Heaven forbid we look at what the #1 one country (France) is doing right and why they’re able to deliver much higher quality care at a lower price.
Yeah, I know.
Trolled thread is trolled.
Troll? You flatter…
I’m simply observing that by getting the government out of health care altogether, you’ll create better outcomes, certainly better than ensuring that all citizens have access to health care. That would involve higher taxes, which is absolutely worse than a few poor people dying because they weren’t good enough to compete within a capitalist system.
I was just reading sams website. Interesting…
“Poor, Poor Libertarians
Wednesday, June 24, 2009
The problem that libertarians really have isn’t the incredibly poor marketing of their ideas. Rather, it’s the rest of us, who rather than bow before each and every libertarian we come across, just keep on walking. So damn you. And you. And especially you!
If you happen to read the linked article above, you’ll be able to discern incredibly quickly the real problem that libertarians have – they can’t market their ideas without condescending to anybody who thinks differently.”
I’m with you – screw poor people. They’re not as deserving as you are.
Wow. Has idiot season started already?
Radley, I’ll go you one better and say that the 3rd party payment system isn’t nearly as big as a problem as the barriers to entry imposed by doctor licensing. Car insurance, homeowner insurance, rental insurance are all 3rd party payment scenarios but don’t seem to suffer from the same problems.
There’s been a fair bit of discussion lately over at Cafe Hayek on this very topic. As I had posted there a while back: Things will be fine once Walmart can open their own hospitals.
Holy cow, this Sam character is just incapable of making an actual argument. “[sarcasm this, sarcasm that, I don't have a point, and I love strawmen].”
At least 5 and 10 make legitimat serious arguments even if we disagree.
“Troll? You flatter…” Seriously, kid, make less sense. Do it!
More likely that young and dumb Justin chooses not to have any health insurance (hey, I’m healthy, right?) and gets hit by that bus, but he is still going to be taken care of. Who pays in the end? Maybe Justin is a stand up guy and pays the total cost, or the taxpayer ends up footing the bill or some major portion of it. I know this happens, I’ve seen it myself.
Not a very convincing video.
This seems so obviously wrong. If Third Party Insurance Group covers the intermittently-employed, bacon-cheesburger-loving John Smith, and the coverage pays for open heart surgery but not for checkups or cholesterol meds, the outcome will be sub-optimal (to put it mildly) for both Third Party and Mr. Smith.
As it was explained to me, the problem is that once you have a genuine insurance plan, your insurer now wants you to get regular routine health care, because it will be much cheaper for them if you get that routine health care. Of course, the natural way for them to encourage you to get routine health care is to subsidize it, and before long you no longer have health insurance, you have a bone fide health management plan.
I agree that it would be nice if we separated these issues (and if the people stopped saying “health insurance” when they mean “health plan”), but this may be an unfortunate case where practicalities make it complicated.
Um, Radley, this is why we don’t feed trolls :)
The US healthcare system is screwed up. Both right now and will continue to be after all of the changes I’ve seen suggested are deployed.
Amazing how Canada, the UK, most of the EU, as well as a great deal of the world can offer Universal Health Care to varying degrees of success but the US’s system is just a huge pile of greed.
Just seems like the entire US system is setup to make a small handful of already rich people even richer while your normal Joe or Jill Smith gets completely screwed.
Give everyone state “health insurance” and charge them what they can afford to pay up to a point. Kill off the private insurance companies and get rid of most of the private hospitals.
PS – The US actually gives Universal Health care to both Iraq and Afghanistan. How ironic is that?
Is it really accurate to say health care should be like car insurance? Car insurance is one thing, which covers major accidents and the like, but it is distinct from car warranties. People with new cars have them covered under a warranty to do routine small maintenance that needs to be done to keep the car operating. Cars without warranties are usually run until they die, and then junked, and insurance may never play a role in their history at all.
Right now, it seems that health care coverage is an amalgamation of car warranties and car insurance type care: it covers both major accidents and also routine stuff. If you make health care coverage only like car insurance, what happens to the basic routine maintenance? Can you buy something like a “health care warranty”? Seems unlikely. So you’d have to pay for it out of pocket. Some people might be able to afford a form of insurance, but might not be able to pay for routine stuff out of pocket all the time.
O’Bama (via Night Line) stated that if you like your high deductible plan, you can keep it. I assume (if this is true) that it will trump whatever the 50 individuals states say in their insurance regulations.
So the video may be true for Mass, but is not true of the current proposal.
O’Bama (via Night Line) stated that if you like your high deductible plan, you can keep it. I assume (if this is true) that it will trump whatever the 50 individuals states say in their insurance regulations.
So the video may be true for Mass, but is not true of the current proposal.
Sorry, forgot to add great post! Can’t wait to see your next post!
a lot of people seem to agree that employer provided health insurance is broken. What doesn’t seem to enter the equation is that this was created by employers needing to provide benefits to entice workers in the Roosevelt wage control era. Because the govt intervened (wage controls), this was the unintended consequence.
Can you imagine what would happen if the govt or employers took over clothes purchases? Let’s say you have a 2 pair of pants and 3 shirt every month limit- you don’t have to mess with that shopping for a good price stuff, just go where you want. At first, it’d be great, but it’d start falling apart without accurate market input into the clothes purchases. I can’t build a scenario where any industry could survive under the system that healthcare has been functioning under.
I’m sure it’ll all be better in a few months, though…
Cherry-picked form Sam’s website:
I’ve made this argument before, and I’ll certainly make it again, but if Cokes were marketed like libertarianism is – “Drink a Coke, because we’re the best, and you suck if you don’t drink our product, and everybody who disagrees is a jerk, and wrong, and mean to us too.” – we’d never drink Coke, because we never would have heard about it, because it would have gone out of business about 12 days after the first factory opened. In other words: market your product better you morons. In other, other words, the world doesn’t owe you a parade, and you’re not going to get one just because you whine about how awesome you are.
Which leads me to the conclusion that Strawmen drink Coke. Thanks, I didn’t know that.
” Health insurance should be more like car insurance.”
That’s incredibly, terminally stupid. The insurance model is a faulty one for healthcare. There’s just no disputing that.
The way to solve the unaffordability of health care is to get Walmart interested in selling it and get government (at all levels) completely the fuck out of it.
I took the video to mean that mandating a certain deductible is wrong. That if you purchase health insurance, you’re good. So what’s to stop someone of offering $100K deductible health insurance for $20 a month? You get your health insurance card, you’re “covered”, and it’s only slightly more than not buying anyone at all.
Would the MA law saying you only needed less than a $100K deductible make everyone happy that agrees with the video?
Examples of non-government health care for the poor or those without insurance…
First of all nearly 20% of all the hospitals in the United States are run by Catholics that do not turn anyone away. There is also the Shriners that run childrens hospitals through out the country that provide medical services often times free.
I’ve already experienced socialized medicine in the military and through the VA… I prefer my private healthcare options.
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‘First of all nearly 20% of all the hospitals in the United States are run by Catholics that do not turn anyone away.”
Unless you need a therapeutic abortion. Then you’re SOL.
What the heck is a “therapeutic abortion”? Sounds like a fancy way to say that killing a baby makes you feel better.
First of all nearly 20% of all the hospitals in the United States are run by Catholics that do not turn anyone away.
Oh, they may not turn you away, but I’m sure they’ll send you a bill like any other hospital. Wildly expensive ER visits don’t make comprehensive health care.
#33, “therapeutic” actually means “relating to a cure or treatment of a disease” not “something that makes you feel better.” A therapeutic abortion is one that is performed to preserve the health or life of the mother. More broadly, it may also include the termination of a nonviable pregnancy, selective reduction of a multifetal pregnancy, or termination of a pregnancy likely to result in birth defects, death of newborn, etc.
#32, I don’t know how Catholic hospitals actually operate, but Pope Paul VI wrote in Humanae Vitae that indirect abortions are allowed in some cases so long as the direct purpose of the procedure is therapeutic to cure a life-threatening disease or condition like ectopic pregnancy, and in performing the necessary procedure the fetus is effectively terminated.
There’s some differences:
1) Car insurance companies can model risk and price plans accordingly depending on driving record and age and gender and such but still keep them competitive because the chances of any one person being in an accident are still fairly low and the expense of most accidents are also low. What high risk drivers pay isn’t that much more than low risk drivers, since ultimately everyone is pretty low risk. Health insurance doesn’t really work the same way because there’s various scenarios in which there’s almost 100% certainty that lots of expensive care will be required; preexisting conditions are one, and of course aging is another. For a certain portion of the population, sure, health insurance is comparable to car insurance; but for the remainder of the population, health insurance is more comparable to insuring a car that has no brakes or seatbelts.
2) In the event that you are in an accident, unless you’re the only person involved, your insurance company is usually an advocate on your behalf inasmuch as they’re trying to get the other guy’s insurance company to pay for things. That’s not true of health insurance, where you basically have an adversarial relationship with your insurer all of the time.
I’m somewhat ambivalent on the issue of nationalized health care. I do think there are some risks involved in terms of giving a nosy government control of your health and the possibility of stifling innovation in the medical sector by forcing prices to questionable profitability. But I really struggle to see the value of private health insurance. There’s so many flaws and unfortunate side effects and inherent contradictions that I don’t think can ever really be resolved in a private market. The fact is, some people are just not insurable, and in all likelihood, their numbers will be increasing as medical technology gains us greater insight into genetic precursors and such.
This is a decent critique. Would have been nice had libertarians and their Republican friends been serious about it during the 8 year run they had.
Now we’re going to fix the insane, totally exceptional healthcare problem the US has by importing a hybrid of what’s proven to work for every other modern democratic country.
As much as I hate the expansion of government, I’m a broke college kid who just got downsized. My parents are unreliable bums. I have back problems and my toes are going numb. I really could use a checkup.
“More likely that young and dumb Justin chooses not to have any health insurance (hey, I’m healthy, right?) and gets hit by that bus, but he is still going to be taken care of. Who pays in the end? Maybe Justin is a stand up guy and pays the total cost, or the taxpayer ends up footing the bill or some major portion of it. I know this happens, I’ve seen it myself.”
Then the problem is not someone failing to have insurance, but someone else forcing you to pay for their misfortunes.
I’d like to see examples of how the UK, Canadian, and French systems of government-pays healthcare “work” because I’ve seen plenty of examples of how they don’t. I’m not being sarcastic or anything here. I’m interested to know because I do also see fault with the car insurance model as health insurance due to the need for regular “maintenance” to prevent major calamity.
It seems to me, though, that the options (expensive with available care vs. “inexpensive” with limited care) are two sides of the same coin. Given the choice, I’d always prefer the market find a way, rather than the government. And many of the reasons our market can’t find a way is because the government has stuck its nose into healthcare for entirely too long already.
Also, why are so many people on this site eager to offer up our healthcare to the government? Is it because the federal government has managed Social Security, Medicare, Medicaid, Prescription Drugs, and Education so well?
Reponse to Matt D:
I think he makes some really good points.
On
1) To the extent the risk you will need expensive health care becomes a certainty, insurance is not the right model. Insurance works for low probability events. Buying health insurance after you get cancer is analogous to buying car insurance after the accident. This is one thing I like about the idea of a universal mandate – ideally everyone would buy insurance before an adverse event makes them uninsurable – at birth or before through their parents. When genetic testing or something like that breaks this model, I’m not sure what the answer is… there will always be a free rider problem because people will not get turned away at the ER. Being a libertarian, I wish I could imagine a plausible free market solution for this problem.
2) I don’t see how this is so different from say, life insurance. In that case, clearly the life insurance company also has an incentive to weasel out of paying. Why don’t we hear nonstop compaints about life insurance companies? My answer – the policy is relatively simple. You died, they pay. When your family sues the insurance company, they’ll win. This is what we need in health insurance – more simplicity instead of 200 page insurance binders. I have an HSA combined with a high deductible plan which may be a small step in this direction. I never fight with my insurance over small stuff like orthodics for my planters fasciitis or referrals to specialists because I am paying for 100% of it anyway through the HSA.
They work because everyone has access to healthcare at no up-front cost. The cost doesn’t increase if you’re dying or if you just need a checkup.
Poor people don’t die because they can’t afford the $5000 for the ambulance to hospital, the $500 bandage, or the $10,000 x-ray.
In terms of quality of health, the US is very low, and the countries with universal healthcare are significantly higher. That despite Americans paying significantly more than almost anyone else.
#42
I call bullshit. They FAIL because there’s no up-front cost. ambulances become cabulances for people who don’t have cars and need rides for minor issues. They FAIL because people don’t have to do for themselves and sponge off everyone else. If people don’t have a stake in something, they don’t give a shit about it.
people don’t talk about how the liberal welfare system is bringing Europe down. poor muslims are taking over inner cities and, since they don’t have to work, they have lots of free time to force their narrow views on the rest of the citizens.
the beauty of not being as much of a welfare state- when immigrants come to america, they’re expected to work. they don’t have as much time to be assholes because they’re too busy taking care of their families and being productive.
this is anecdotal, I know, but doctors working around here after starting in England say we’re in for a cluster…
Wasting an ambulance’s time is a criminal offense in many countries. In addition to that, the emergency operator makes a decision if an ambulance is deployed or otherwise.
I’m not sure what your odd remarks about Muslims has to do with a discussion about health care so I’m just going to mark that entire paragraph as ignorant racial slurs and move on.
The Doctor’s who move to the US do so because the money is better in the US. The US as I said pays the most for their healthcare in the world but yet supply some of the worst.
By your logic we should make schools private and require everyone buys “School Cover” from a third party, which they can then redeem at any local pay-for school of their choice.
The entire US system has a basis in greed and is designed to let the poor literally die.
“Access to a waiting list is not access to health care”
-Chief Justice Beverly McLachlin (Canadian Supreme Court)
Nothing, and I mean NOTHING the government runs works efficiently. States cannot run a DMV for crying out loud. I have no interest in having any government run my health care. They are not competent. And that’s b/c they do not have to depend on it for themselves. They have a different, “special” plan for themselves. In my opinion, politicians just want their headline, like “Obama’s Health Care Passes”… at which point he’ll appoint some moron to run it and move on without a second thought as to how well it will ever perform.
p.s. great post Mikel in #45; I couldn’t agree more.
The amount of money a person would be willing to pay for something is not a perfect indication of the person’s “level of need”, but it’s a pretty good one. One advantage of prioritizing resources based upon willingness to pay, as opposed to other measures of “need”, is that most other measures create perverse incentives for people to maximize “need”. If someone is willing to pay through the nose for something he doesn’t really need, the person may receive resources that would be better allocated to someone else. On the other hand, people who spend their money recklessly on things they don’t really need tend to run out of money, and so their ability to waste resources is limited.
From what i understand, European countries have plenty of complaints about health care and that it’s big topic in every election. You can say all day long that health care in the US sucks, but why do so many Canadians come to America for surgery? Usually because they are tired of waiting on a list.
Cancer deaths are twice as high in Europe that in the US. Mostly because of a lack of specialists due to government rationing. As stated above, the barriers to entry are the biggest problem we have in the US when it comes to health care. Hospitals have to get certificates of need, there is a limit to the number of med schools we can have in the US. The FDA constantly slows down the process to get new drugs to market. These are the issues that are plaguing us, not insurance companies.
France, UK, Norway, Austria, Sweden, and Finland all have lower Cancer deaths per 100,000 than the US does, but yet they also have Universal Healthcare.
In fact the ONLY country lower than the US that does NOT have Universal Healthcare is Australia and they have a much more liberal system than the US yet still (*which isn’t saying much).
Seems like I am able to point out holes with the US system using facts and figures but all people have against Universal Healthcare Systems are vague anecdotes.
For example “I hear everyone in Europe complain about Universal Healthcare!” Well no kidding, I hear everyone in the US complain about schools, taxes, public transport, local services, the US postal service, road works, etc, it is just natural to bitch about stuff that is “free.”
Are there waiting lists? Sure. But that is true in the US too since specialists, equipment, and time is finite.
I call shenanigans on #49. The US has some of the best cancer survival stats in the world … far better than those of the UK.
see: EUROCARE-4 studies bring new data on cancer survival
Mike Richards
The Lancet Oncology,
Vol. 8 No. 9 pp 752-753
Protip:
If you insist on making things up choose something that can’t be easily checked.
That piece of research costs money to access so it isn’t checkable.
The OECD Health Data from 2004 lists:
United States: 321.9 deaths per 100,000 peopl
Australia: 298.9 deaths per 100,000 peopl
Norway: 289.4 deaths per 100,000 peopl
France: 286.1 deaths per 100,000 peopl
Austria: 280 deaths per 100,000 peopl
Sweden: 268.2 deaths per 100,000 peopl
Finland: 255.4 deaths per 100,000 peopl
United Kingdom: 253.5 deaths per 100,000 peopl
View it here: http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer
Sorry, I have access to journals through school. I didn’t realize this particular publication required a subscription.
A brief synopsis is that the numbers cited above, although widely accepted and repeated, were merely projections for 2005. Upon viewing actual results from 2005 it emerged that the U.K. was near the bottom of the list, lagging behind even the underdeveloped portions of Europe. The U.S. had far better survival rates than Europe as a whole lagging behind only Norway, Sweden, and Finland. The researchers theorized that because people of Nordic descent have significantly lower incidents of cancer in the U.S. that genetic predispositions could be at play.
Obviously the results of a research study into one disease is far from adequate to recommend one course of action over another. It seems instructive in this case to at least acknowledge that there is some nuance to the way statistics are used, and sometimes misused.
“In terms of quality of health, the US is very low, and the countries with universal healthcare are significantly higher.”
I guess that’s why the Saudi Crown Prince comes to the US for his health care?
http://www.javno.com/en-world/saudi-crown-prince-heads-for-us-medical-checks_206767
Sam/Someone why not stick to golf?
rather than debate whether a universal healthcare system is better than an insurance-based healthcare system, why isn’t this discussion more about free-market solutions?
after all, this is a libertarian-dominated site isn’t it?
i’d like to hear someone debunk the old fee-for-service model as a completely free-market approach to healthcare.
i get sick. i visit a doctor. s/he treats me. i pay for the treatment.
what could be a better starting point for a discussion?
Monday morning links…
The Gernam concentration camp brothels
More on the EPA quashing their own climate skeptical report
White House: "not ruling out" middle class tax hike"
From Mankiw in the NYT, who says the gummint could make it’s own public option in…
“i get sick. i visit a doctor. s/he treats me. i pay for the treatment.
what could be a better starting point for a discussion?”
That IS where the discussion should start.
There is virtually NO transparency on price, quality and other measures of evaluation today. Much of the distortion is the direct result of government interference in health care markets.
The pursuit of consumer directed health care principles would be a place to begin. For example, health savings accounts (HSA) are needed. HSAs would allow people to save for future health care expenditures as they get older (when most health care dollars are consumed). Portability would also address most prior condition issues.
Unfortunately, we are not having an honest discussion about providing health care at affordable prices to as many people as possible (remember, many people who could get insurance refuse to purchase it).
Instead, we are discussing whether or not to give the government the power to make life and death decisions for us and distributing the cost in an inequitable manner across the citizenry. Rationing will be the order of everything. Once a bureaucrat makes the decision that from a cost-benefit perspective (i.e. cost to the government) you are no longer “productive” enough, then you will be “rationed” away.
Why do you think the Canadians and Brits come here for treatment? Because they would die waiting at home.
It’s your life. Why would you give the government this power over you?
Looking at the fee for service model, I enjoy asking doctors how much various services will cost. How much will this vaccination cost? How much will the physical exam cost? How much will the blood test and lab work cost? They never know and always retreat behind “your insurance should cover this.” The price signal is lost in this model and leads to astronomical cost problems. Going to the dentist is totally different. They always tell me what fillings, fluoride treatments, and exams will cost, even though my insurance will cover most or all of it.
it’s a fool’s errand to try fixing our healthcare system if we can’t even start with a cost/service discussion.
any american who expects any third party — whether it’s an insurance bureaucrat or a government bureaucrat — to pick up the tab for each and every one of his or her healthcare expenditures, has no business complaining when the bureaucrats ration medical services to hold down costs.
paying a monthly premium and a co-pay does not entitle any of us to gorge ourselves at an all-you-can-eat healthcare buffet.
[...] Mandatory Health Care [...]
[...] Radley Balko, the Independence Institute has a great little video on the problems with health insurance [...]