If you can read this, either the style sheet didn't load or you have an older browser that doesn't support style sheets. Try clearing your browser cache and refreshing the page.

(AEI Ideas)   How to turn Obamacare into FreeMarketcare in 4 easy(-ish) steps   (aei-ideas.org) divider line 119
    More: Interesting, FreeMarketcare, obamacare, sliding scale, health savings account  
•       •       •

2395 clicks; posted to Politics » on 03 Dec 2012 at 11:36 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



119 Comments   (+0 »)
   
View Voting Results: Smartest and Funniest

Archived thread

First | « | 1 | 2 | 3 | » | Last | Show all
 
2012-12-03 02:45:08 PM  

lennavan: 1. Deregulate the state exchanges, while capping subsidies.
2. Slowly shift Medicare patients into the exchanges.
3. Let more people buy insurance on their own rather than through their employer.
4. Move Medicaid patients into the exchanges.

It's actually 3 steps, as 2 and 4 are the same. Also, steps 2 and 4 have nothing to do with Obamacare. Medicare existed before Obamacare.

As for #3, does the author think people are prevented from purchasing insurance on their own? Of course not, what the author really meant was "don't force employers to give their workers health insurance." It seems the author thinks an employer who saves $10,000 a year on health insurance costs is just going to pay that person $10,000 more a year. They won't. They'll keep it for themselves.


The author doesn't think that. The author wants you to think that. Two big reasons for 'letting people buy insurance on their own rather than through their employer.' And neither of them has anything to do with better access to or quality of healthcare.
Moving the burden off the employer means more profit for the employer. Having individuals buy insurance instead of groups means higher rates and more profit for insurance companies.

I think, though, that one of the unintended consequences of all this bellyaching from conservatives about employer-offered insurance coverage is that they're making the argument in favor of universal single payer.
 
2012-12-03 02:48:25 PM  

The Reverend Smith: HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.

Not in the least.


That's right, I forgot. The free market never fails, we only fail it. Ipso facto, the failure of US healthcare proves it wasn't a free market system.
 
2012-12-03 02:49:31 PM  

entropic_existence: mrshowrules: Conservatives want free-market insurance. Liberals want single-payer. It is like one side wants to go swimming and the other side wants to mountain climbing so the natural compromise is either go swimming in your mountain gear or climb the mountain in a bathing suit.

I think liberals want affordable Universal coverage, but not necessarily single-payer. There is definitely a large-component that prefer single-payer, as the obvious model that they see to compare against is Canada's, but it has never seemed to me that they are generally 100% set on that model.


Literally any other model in the industrialized world would be better than what the US has today.
 
2012-12-03 02:54:54 PM  
FreeMarket care is always going to suck, and it's going to suck in two main ways:

1) The insurance model will always lead to the highest cost for the least service.

Insurance companies (like all free market businesses) want high profits and low costs. This makes them really bad gate-keepers to the health care system. And, that is their own health care job - acting as a gate keeper.

2) Our current education and licensing system for doctors encourages them to seek high profits, sometimes at the detriment to the patient.

Doctors leave medical school with huge debts. One of the quickest ways to change the debt into profit is to invest in testing and equipment. Unnecessary medical tests and unnecessary medical procedures make big money for medical corporations.

The odd thing is that these two factors ought to have checked each other, but they don't. What usually happens is that patients end up holding the bag for any uncovered costs. Medicine should not be a free market business, and the gate keeper for medicine also shouldn't be free market.
 
2012-12-03 02:55:47 PM  

Lawnchair: Zasteva: and the efficiency and risk distribution of private insurance for the more "exotic" stuff.

Then answer... would you make that *extra stuff* universal issue? Would you force companies to sell at community-rated rates to everyone, including people who are or are likely to be sick?


I think that's a decision that our society as a whole needs to make. But I would support that being covered by some mechanism that provides universal coverage. It could be mandatory insurance with subsidies for those who can't afford it, or it could just be rolled into the single payer system.

If you do it with insurance, then companies would have to sell at the same rate to everyone nationwide, and they'd be competing with each other on price, and all companies would have to offer the same policy options.

If yes, I'm still at a loss for what this gives us over just going single-payer altogether and being done with it?

In theory, the free market is inherently more efficient at allocating scare resources to the places where they will make the greatest benefit. So far the way they've done that is primarily though denying care. It may be that by the time we've controlled that market so much that they can't deny care, that they can't really improve on a single payer system. The way to find out for sure is to start with the single payer for basic care, offer a public option for insurance beyond that, and let private companies compete on an equal footing with the public option.

If no, then what the f are the actually chronically sick supposed to do?

I don't support the "let them die or depend on charity" arguments. But it is worth pointing out that sadly too many of the chronically sick get that way because of conditions that were treatable if dealt with earlier. Once we get a solid system in place we should have gradually have fewer chronically sick people, at least proportionate to the population.

Also, I think the medical industry as a whole pays too little attention to quality of life. I think a lot of people, if told honestly how horrible their treatment would be, how little it would extend their life, many of them might not choose the "save my life at all costs" option. Maybe I'm overestimating that -- most people aren't very good at understanding odds.
 
2012-12-03 02:56:17 PM  

nekom: 1. Deregulate the state exchanges, while capping subsidies.
I understand those words, but what on Earth does that even mean?

2. Slowly shift Medicare patients into the exchanges.
Why? What's wrong with Medicare as it is?

3. Let more people buy insurance on their own rather than through their employer.
Why? Employers can pool insurance and negotiate for much lower rates than an individual can. Part of the reason I still work where I do is because of my awesome benefits package.

4. Move Medicaid patients into the exchanges.
How is this different than #2? Is this idea so novel that it needed mentioned twice?


It means that they want to do to the insurance market what they did to the consumer credit market in 1978.

In 1978, every stte in the union had robust usury laws that capped the maximum rate of interest allowable on consumer loans and made it an actual crime to exceed it, and generally had pretty robust consumer protections for credit cards.

That year the Supreme Court ruled on a jurisdictional question: i cases where the lender was in one state, and the cosumer in another, should the laws of the consumer's state apply or those of where the loan company had its HQ?

They ruled in favor of the latter, the state of lender, and all hell broke loose.

South Dokota essentially went to credit card companies and promised they'd repeal their usury law and most of their consumer protection laws, if the credit card companies would agree to re-locate there. The companies did, and suddenly a "race to the bottom"was touched off among the states to see who could abandon thier consumer protections fast enough to appease and win the business of the big banks. When the race stopped, DE, NVand SD "won" the race, and our consumer lending protections were in tatters and things like 900% interest 'payday" loans became legal

Doing that to the insurance market has been an industry wet dream ever since.
 
2012-12-03 02:57:08 PM  

DeaH: FreeMarket care is always going to suck, and it's going to suck in two main ways:

1) The insurance model will always lead to the highest cost for the least service.

Insurance companies (like all free market businesses) want high profits and low costs. This makes them really bad gate-keepers to the health care system. And, that is their own health care job - acting as a gate keeper.

2) Our current education and licensing system for doctors encourages them to seek high profits, sometimes at the detriment to the patient.

Doctors leave medical school with huge debts. One of the quickest ways to change the debt into profit is to invest in testing and equipment. Unnecessary medical tests and unnecessary medical procedures make big money for medical corporations.

The odd thing is that these two factors ought to have checked each other, but they don't. What usually happens is that patients end up holding the bag for any uncovered costs. Medicine should not be a free market business, and the gate keeper for medicine also shouldn't be free market.


Very much this!
 
2012-12-03 03:02:06 PM  

entropic_existence: Zasteva: Sorry, In my earlier response I meant to add that I agree that preventative care is one of the most important parts of any health plan.

But since everyone needs it, and everyone gets it, what does insurance add? Only a middleman with profit motive who adds costs. They don't provide the health care, they just add overhead.

A single payer system is a far better way to handle things that everyone needs.

Arguably similar outcomes can be achieved for a similar cost using different approaches. Again just compare the Swiss model, which is insurance-based, with say the Canadian model, which is single-payer. Similar outcomes, fairly similar costs, totally different approaches. Insurance-based isn't necessarily bad, but it needs to be tightly regulated. In the Swiss health-insurance market, in order to be legally allowed to offer health insurance you have to offer a government mandated "basic" package. This basic package is well-described and is your baseline universal coverage of everything. By law this package cannot be sold at a profit by the company. Insurance providers are then able to create all sorts of premium packages that do generate profit. But the premium packages don't really give you better care, or access to different treatments or shorter wait-times. They just make you more comfortable in hospital stays and things.

So it works, but you have to be willing to have tight regulations on the market.


Obvious both work better than what we currently have. I suspect they both work better than ObamaCare will because ObamaCare doesn't seem to fully address the issues with cost, and isn't true universal coverage. But even ObamaCare is better than what we started with.
 
2012-12-03 03:05:03 PM  

DeaH: FreeMarket care is always going to suck, and it's going to suck in two main ways:

1) The insurance model will always lead to the highest cost for the least service.

Insurance companies (like all free market businesses) want high profits and low costs. This makes them really bad gate-keepers to the health care system. And, that is their own health care job - acting as a gate keeper.

2) Our current education and licensing system for doctors encourages them to seek high profits, sometimes at the detriment to the patient.

Doctors leave medical school with huge debts. One of the quickest ways to change the debt into profit is to invest in testing and equipment. Unnecessary medical tests and unnecessary medical procedures make big money for medical corporations.

The odd thing is that these two factors ought to have checked each other, but they don't. What usually happens is that patients end up holding the bag for any uncovered costs. Medicine should not be a free market business, and the gate keeper for medicine also shouldn't be free market.


In the current US health care market, health care services are not even what is being priced and traded. It is the patient who has become the commodity that is priced and traded.
 
2012-12-03 03:21:21 PM  

cameroncrazy1984: The Reverend Smith: HeartBurnKid: Nah, FreeMarketCare is what we had before ObamaCare.

Not in the least.

It's what Somalia has.


Way to go.
 
Ant
2012-12-03 03:34:18 PM  

entropic_existence: The Swiss system that they compare to in the article (I'm not sure the author of TFA really understands the Swiss-model, since deregulation isn't in line with how the Swiss do it) doesn't fit any of those three groups and is considered Universal coverage. Residents are mandated to buy insurance by law, the kicker is that in order to provide health insurance a company has to be registered with the proper Swiss authorities, and by law the "basic" coverage, which they must offer, can not have a profit. So many of the insurance companies are actually non-profits in Switzerland. You are allowed to build "premium" packages that offer more amenities, etc. And those can make a profit.


The term "non-profit" is confusing to moronic free market zealots. I've encountered way too many people who think that non-profit means nobody who works there gets paid.
 
2012-12-03 03:58:51 PM  
FreeMarketCare: Health care is a privilege of the rich. If the poor are going to die, let them do it, thus decreasing the surplus population. Greed broke our health care system. It can't fix it.
 
2012-12-03 04:14:12 PM  

nekom:
3. Let more people buy insurance on their own rather than through their employer.
Why? Employers can pool insurance and negotiate for much lower rates than an individual can. Part of the reason I still work where I do is because of my awesome benefits package.


Your employer may have an awesome benefits package, but many don't. I can choose between the gold plan and the tin plan, or I can get a new job.

Imagine if you had to go through your employer to get a car or a cell phone, and you had to change employers if you didn't like what was offered. The marketplace for those items would be distorted by the employer-go-between just like the health insurance market is distorted by employer provided insurance.
 
2012-12-03 04:23:18 PM  
Every time I see that AEI Ideas logo, I want to punch a baby.
 
2012-12-03 04:55:17 PM  

Lumpmoose: make me some tea: ObamaCare is already FreeMarketCare. I don't support the idea of putting Medicare into the mix. Leave it alone.

Yeah, if you want universal health care you must pick 1) "a windfall for the insurance companies" via the mandate, 2) competition against a public insurance option or 3) the end of private health insurance as we know it. In order to get some sort of healthcare reform passed, Obama compromised and picked #1, which was mostly a GOP idea that they then refused to vote for because they are premium grade assholes.

 

FTFY
 
2012-12-03 07:20:43 PM  
An actual intelligent comment to the article

Market forces work well in health care in many respects, but there is an 800-pound gorilla here which the Swiss understand (as does Avik Roy) but the author here seems to forget. Much of what goes into a health insurance premium is what the insurer has to pay the doctors and hospitals for services for its enrollees. When lots of insurers are trying to compete in a market with a few dominant hospitals, for example, the hospitals can essentially act as monopolies ("You insurance company X, I won't take your subscribers unless you pay me $100,000 for a hip replacement surgery,"). Research has shown that premiums are actually lower in the US when you have fewer insurance companies competing for exactly this reason - they have more negotiating power vs. the hospitals.

Switzerland has solved this problem (as has Medicare and Medicaid) by setting hospital and physician prices. They also set a basic benefit package. That frees up the insurers to compete on service, efficiency and lower administrative costs. In the US, until we solve that issue, dumping Medicare and Medicaid folks into the exchange will raise costs enormously because Medicaid pays hospitals and docs half of what private insurers do (and Medicare, about 3/4ths).


Of course the commenter was rather generous to assume the author every understood anything about what he is talking about, but it's certainly yet another reason why this is a terrible idea.
 
2012-12-03 11:00:55 PM  

Gwyrddu: An actual intelligent comment to the article

Market forces work well in health care in many respects, but there is an 800-pound gorilla here which the Swiss understand (as does Avik Roy) but the author here seems to forget. Much of what goes into a health insurance premium is what the insurer has to pay the doctors and hospitals for services for its enrollees. When lots of insurers are trying to compete in a market with a few dominant hospitals, for example, the hospitals can essentially act as monopolies ("You insurance company X, I won't take your subscribers unless you pay me $100,000 for a hip replacement surgery,"). Research has shown that premiums are actually lower in the US when you have fewer insurance companies competing for exactly this reason - they have more negotiating power vs. the hospitals.

Switzerland has solved this problem (as has Medicare and Medicaid) by setting hospital and physician prices. They also set a basic benefit package. That frees up the insurers to compete on service, efficiency and lower administrative costs. In the US, until we solve that issue, dumping Medicare and Medicaid folks into the exchange will raise costs enormously because Medicaid pays hospitals and docs half of what private insurers do (and Medicare, about 3/4ths).

Of course the commenter was rather generous to assume the author every understood anything about what he is talking about, but it's certainly yet another reason why this is a terrible idea.


It's not just Switzerland. Virtually every single developed country that has universal health care has implemented an all-payer system. Even farking Singapore, that bastion of free markety goodness, has done that. We are the only country on the planet that hasn't and that adamantly refuses to accept it.

/outside of Maryland that is
 
2012-12-04 01:20:37 AM  

Dinki: nekom: 1. Deregulate the state exchanges, while capping subsidies.
I understand those words, but what on Earth does that even mean?


I think it means that the states would be able to offer as many or as few services as they want, and the Federal government would have a hard limit on how much support they would provide. So just imagine what the exchange would look like in places like Alabama and Mississippi.


My guess: Keep the mandate to pay, require not services actually be provided, leave public office with a high paying job as insurance lobbyist
 
2012-12-04 02:04:03 PM  
while capping subsidies.

Which subsidies? The ones that go to the insurance companies?

I think whoever wrote this must be a dumb, rank-and-file conservative.
 
Displayed 19 of 119 comments

First | « | 1 | 2 | 3 | » | Last | Show all

View Voting Results: Smartest and Funniest


This thread is archived, and closed to new comments.

Continue Farking
Submit a Link »






Report