TC: Yeah, the Swiss. They’re a combo of a socialistic system and a free-market system. Everybody has to buy.”

You trust market systems where everyone is, by federal regulation, forced to participate? Okay. I can work with that.

“Ninety-nine percent of people would do that, even if I offer $2,200 or nothing.”

I’m pretty sure I’ve never seen a paper that shows people being that risk averse.

Alternatively, sure, there’s the model where you don’t see the bills at all, and it’s done on clinical priority.

Hopefully, 1. They catch the person(s) responsible for this and 2. He will have more empathy for those similarly victimized in the past.

The Public Safety Unions dictate, and the City Council majority codifies.

Yup! That’s how it works. And if the City Council majority gets uppity and decides otherwise, than the NEW City Council majority will know to toe the line.

The only workable solution is bankruptcy. Fight to eliminate ALL sources of municipal income and force the system to collapse in on itself. Unfortunately, if that strategy is successful the result will be cyclic expansion (when out of bankruptcy.) coupled with mass layoffs when the collapse occurs. Result? A ghost town. Which is where Vallejo is going.

The sustainable solution is to eliminate pensions and peg salaries to similar private sector jobs. A driver working at a private company doesn’t get a pension outside of their “401K plan”, why should a driver for the city get one?

I pay the same co-pay no matter what doctor I go to, and I don’t pay for anything above that. If I have a deductible (for example, $500 on ER visits) I know it will be immediately eaten up once I walk through the door. So there’s zero incentive for me to even ask what the price is for the procedures or the pills that the doctor calls for. And if I am only paying for it in the most indirect sense (i.e. adding to my employer’s overall bill and thus theoretically bringing my future wages down) I have no problem at all being over-treated. Yes, go ahead and run that expensive test to rule out the .5% chance of a rare genetic mutation. I’ll never see the bill.

If we had a more pronounced shift to HSAs, where the employer gives you a pot of money and you pay for basic care with your own dollars, I’d bet people would start to care a lot more about where their own money goes and costs would come down pretty quickly.

I hope you get a response from Vallejo PD. Let us know if anything happens.

#11 Bob

The Public Safety Unions dictate, and the City Council majority codifies. Personnel and benefits for current and retired employees still take up the lion’s share of the budget

- May 2012: Vallejo voters approve Parcel Tax increase for parks/open space
- Nov. 2011: Vallejo voters approve Sales Tax increase; re-elect Mayor
- Nov. 2011: Vallejo voters approve Marijuana Tax; DEA/State/VPD take action

Very, very unfortunate…

BTW, if I were the attorney in the Siri false advertising suit against Apple, that website would be bookmarked for the trial. I would just ask the Apple representative to ask Siri to “Remind me to put the gazpacho on ice in an hour” and laugh all the way to the bank.

There are better models. Like the Netherlands (which delivers a far higher percentage of care from private practice than America does, and has a system which encourages preventative care) or France (very highly rated and relatively cheap – the key is you pay for routine medical care, but the more serious the condition the smaller the percentage you pay. You might want to skip the sexually explicit murals in the doctor’s break rooms though…)

(Incidentally, the problems with England’s NHS are because it was chronically underfunded until about a decade ago, and it’s mortality indicators (as you’d expect) lagged the improvement by some years, especially in cancer (which is also usual). And now it’s being broken up in a way which has sent the care quality massively down again).

Q: What is the mortal enemy of the State?

A: Competition!

I can’t imagine why these all turned into phone calls, but it’s especially amusing to know that all of the above names are actually combinations of my various contacts invented by Siri, not real people.

Wait! Siri adds bogus contacts whenever it feels like it? Do you have to go in and delete them every once in a while? Or wonder things like “When did I add Seymore Butts to my contact list? Was I drunk?”

This is why “austerity” doesn’t work. Once you’re addicted to unions and their pensions, that’s where all your money will go.

My favorite line:

While several council members said generally they’re opposed to spending beyond the city’s means, they offered little in specific alternatives to avoiding it.

Yup. If they try to be responsible and stop the unions, they’ll be shredded politically. This is the bane of democracies, once people learn how to vote themselves into the cookie jar, politicians have no choice but to give out free cookies.

I agree I think something very similar to the Swiss system is going to be our endgame.

I do have one quibble with something Sen Coburn said when talking about that unnecessary CT scan.

“Market forces would have said, that’s stupid.”

Market forces have said it is necessary. The reason is because it is cheaper to do the CT scan than lose a lawsuit because you did not do one.

It is MEDICALLY unnecessary.

I’ve asked the same thing. “If I do this test, will it change the treatment?” If they say no, then I pass on the test. that is probably the single simplest question a patient can ask.

Radley, I think you accidentally linked to the last page of the article.