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(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  
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2395 clicks; posted to Politics » on 03 Dec 2012 at 11:36 AM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-12-03 10:23:01 AM  
ObamaCare is already FreeMarketCare. I don't support the idea of putting Medicare into the mix. Leave it alone.
 
vpb [TotalFark]
2012-12-03 10:26:49 AM  
Deregulation and cuts and get rid of Medicare. I didn't even need to read it.
 
2012-12-03 10:27:34 AM  
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?
 
2012-12-03 10:30:30 AM  

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. Obama picked #1.
 
2012-12-03 10:47:11 AM  

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.
 
2012-12-03 10:48:32 AM  

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


Currently, only insurance packages that meet certain criteria can be included in the exchanges. By deregulating the exchanges, all kinds of crummy insurance packages would become available to lure in unsuspecting customers.

Also "capping subsidies" is a dog-whistle for tax cuts (or preventing a tax increase).

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


Government pays for it.

3. Let more people buy insurance on their own rather than through their employer.
Why?


Because then, the employer does not have to pay its employees' insurance. Allowing them to make more profits and cut a few HR employees.

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


It's exactly the same as #2.
 
2012-12-03 10:50:57 AM  
Done in one
 
2012-12-03 11:17:11 AM  
What's the part where you intentionally hand over control of a state agency to the Federal government because you refuse to carry out optional work?
 
2012-12-03 11:39:56 AM  
Only three viable options:

1. Public option.
2. Single payer.
3. F*ck the f*ck off, you lost. Deal.
 
2012-12-03 11:40:08 AM  
The boat has a leak. Solution: drill more holes in the bottom of the boat.
 
2012-12-03 11:41:23 AM  
Wasn't the whole point to slowly remove health care from the free market? Is there a reason why we are pretending that the free market is going to do good things for health care? (Umm, if it were going to, wouldn't it have done it already?)
 
2012-12-03 11:41:29 AM  

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

It's exactly the same as #2.


Actually Medicare and Medicaid are different programs. Medicare is old people, Medicaid is poor people (including poor old people).
 
2012-12-03 11:43:59 AM  
Like, really embrace it. To the max.

ct.fra.bz
 
M-G
2012-12-03 11:45:11 AM  

iccky: Actually Medicare and Medicaid are different programs. Medicare is old people, Medicaid is poor people (including poor old people).


And Medicare is run at the federal level, while Medicare is handled by the states, with federal support.
 
2012-12-03 11:45:44 AM  

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. Obama picked #1.


A windfall for the insurance companies like the budget negotiations were 98% of what the GOP wanted back in 2010?

Be careful with Obama, that man is wily. It's awesome to watch.
 
2012-12-03 11:45:54 AM  

M-G: iccky: Actually Medicare and Medicaid are different programs. Medicare is old people, Medicaid is poor people (including poor old people).

And Medicare is run at the federal level, while Medicare is handled by the states, with federal support.


OK, fine. But what about Medicare?
 
2012-12-03 11:47:04 AM  
yes, i want my 80 year old mother to have to decide amongst various insurance coverages she should buy, that sounds like a brilliant plan. somebody give that CEO a bonus
 
2012-12-03 11:47:42 AM  
Let more people buy insurance on their own rather than through their employer.

I was unaware that people were not allowed to buy private insurance. Not able to afford it, sure - but unless this guy has a plan upping the wages of everyone in the country by 25% or so, I don't see how you 'let' more people do this.
 
2012-12-03 11:48:38 AM  
3. Let more people buy insurance on their own rather than through their employer.

I didn't realize people were being prevented from buying their own insurance? Damn Obama.
 
2012-12-03 11:50:46 AM  
i.imgur.com
 
2012-12-03 11:50:57 AM  
As long as the "decision makers" and "job creators" can skim a dollar or two off the top, times 300 million, then it's ok.
 
2012-12-03 11:51:43 AM  
Answer one question. Who benefits from adding a profit motive?
 
2012-12-03 11:51:46 AM  
The problem with the approach outlined is that it doesn't really address where the costs are coming from:

1) none of the participants other than insurance companies have any incentive to control costs (i.e., buyer isn't paying)

2) Insurance companies do have incentive to control costs to themselves, but not costs to the patient. And in addition they have a profit motive which incentivizes them to retain any savings they force from the providers rather than pass it on to the buyers.

Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.
 
2012-12-03 11:52:45 AM  

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. Obama picked #1.


Obama picked #2. The "IF THAT DAGBURN DIMMYCRAT VARMINT IS FER IT, AAAAAAAHHHHH'M AGIN IT!' crowd picked #1, and then blamed the dagburn Dimmycrat varmint.
 
2012-12-03 11:54:08 AM  
So, basically "Obamacare" becomes 'free market' if we end Medicare and Medicaid. Got it.
 
2012-12-03 11:54:40 AM  
3. Let more people buy insurance on their own rather than through their employer.

Wow. So, just LET people buy insurance on their own. It's that easy, is it? Well, how about that whole middle ground where health insurance is so ridiculously expensive that most people in this country can't afford it? THAT is the whole problem here--the lack of affordability of health care. The problem is I don't think "Obamacare" goes far enough to alleviate the problem.
 
2012-12-03 11:54:51 AM  
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.
 
2012-12-03 11:55:05 AM  

Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.


So you propose a massive increase in worker pay and Social security payments so that individual can afford all non-catastrophic medical costs out of pocket?
 
2012-12-03 11:55:17 AM  
Why would we want to do that? Free market isn't compatible with "everyone has access", and we've decided pretty clearly as a nation that everyone having access is the more important part.

Unless there's been some massive popular movement against free emergency rooms that no one told me about.
 
2012-12-03 11:56:39 AM  
I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.
 
2012-12-03 11:56:42 AM  

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?


I thought the whole point of exchanges was to make it easier to buy insurance by yourself instead of through your employer.

The issue with #2 and #4 is that the elderly and poor are uninsurable. If you were an insurance company, would you offer insurance to somebody who was old and frail? Of course not. It would be like offering flood insurance on a house that was already being submerged.
 
2012-12-03 11:57:04 AM  
All Obama needs to do now is allow Medicare/Medicaid to be sold 'at cost' on the exchanges. It is a back door into single payer.

All insurance companies add is hundreds of thousands of middle men who do nothing but add costs and deny care.
 
2012-12-03 11:58:13 AM  

make me some tea: ObamaCare is already FreeMarketCare


Done in one.

No click

No reading rest of thread.
 
2012-12-03 11:59:05 AM  

TomMalory: 3. Let more people buy insurance on their own rather than through their employer.

Wow. So, just LET people buy insurance on their own. It's that easy, is it? Well, how about that whole middle ground where health insurance is so ridiculously expensive that most people in this country can't afford it? THAT is the whole problem here--the lack of affordability of health care. The problem is I don't think "Obamacare" goes far enough to alleviate the problem.


This idea might be workable if the employers actually paid their employees the extra amount that they would have used for their health insurance, but I don't see either TFA or the link in TFA talk about that.
 
2012-12-03 11:59:37 AM  
This is one of those cognitive dissonance bombs that goes off when you have someone's who's been theorizing all this stuff for years sees it enacted by his 'enemy'.

He's suggesting, as many pre-Obama conservatives did, that we "follow Switzerland and Singapore". While not getting into the *extremely-heavy* regulation of both the insurers markup and doctor/hospital allowable fees that are part of the Swiss or Singaporean model. Those two systems have a veneer of consumer choice at the front end, which is why the Heritage/Cato/AEI guys grasp at them, but at their core, the strict regulation is the bigger part and puts them closer to the Beveridge states than to the US pre-PPACA.
 
2012-12-03 12:00:29 PM  

madgonad: All insurance companies add is hundreds of thousands of middle men who do nothing but add costs and deny care.

 

Won't somebody think of the middle managers?!

What is the ratio of positive to negative experiences when it comes to dealing with a private health insurer versus Medicare?
 
2012-12-03 12:00:45 PM  
Anyone who says "deregulate" without specifying what they mean is either trolling or willfully ignorant.
 
2012-12-03 12:02:04 PM  
More Americans would be acting as involved consumers.

Thanks for the laugh.
 
2012-12-03 12:02:27 PM  
1) Fark it up
2) Fark it up
3) Fark it up
4) Fark it up
 
2012-12-03 12:04:12 PM  

make me some tea: ObamaCare is already FreeMarketCare.


Not in the least.
 
2012-12-03 12:05:03 PM  

ex0du5: Anyone who says "deregulate" without specifying what they mean is either trolling or willfully ignorant.


Words don't have meanings to these people, they have emotions. "Deregulate", "job creators", "tax cuts" - these things have good connotations. "Regulations", "government oversight", "socialism"...these are bad. You use good words to describe what you're doing, and bad words to describe what other people are doing. It's delightfully Orwellian and they don't even realize that they're doing it.
 
2012-12-03 12:05:42 PM  

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


It means a state can decide the "subsidy" is capped at 0% of your income, and that to qualify for the exchange, a policy need only be issued by a company with a license to do business in the state.

Or are they saying that the Feds can cap that subsidy at 0%? Not that the next Randian Free Marketist Compassionate Conservative would ever think of doing that...

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


As someone else said, "we pay for it." The GOP has totally forgotten (or worse, not forgotten) why Medicare was created in the first place - because "old people" could not afford health insurance - they were priced out of the market, much the same way "all people" are now. They seem to think that old people can just conjure up some affordable coverage the same way they could magically withstand communism.

(NB: An ad this morning, I think sponsored by AARP, ended with the message "Tell Congress that guaranteed coverage for seniors is too important to cut." I nearly flipped my shiat - WHAT THE FARK ABOUT EVERYONE ELSE, whose coverage is far cheaper? But AARP sez: "Fark you youngsters. No single-payer for you.")

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.


I actually support this one. However, I don't think TFA realizes he's calling for unionization of a slightly different kind.

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


Infinitive pet peeve. Yinz needa learn some English in b'twynn all'ose Ahrnsitty burs.
 
2012-12-03 12:07:25 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?


1) How does deregulation address the cost issue that was agree by both parties to be the underlying problem that needed fixing by healthcare reform?

2) How does shifting costs to consumers from Medicare address medical care cost issues from #1 when Medicare has a lower per-patient cost than most or all private insurance? Also, how does it address the issue of cost of elder care making many older people uninsurable at a profit, especially when coupled with suggestion 1?

3) How does reducing customer bargaining power by limiting grouping address cost issues as stated previously?

4) How does pushing the poor off the cheapest per patient healthcare (private and government) option address cost issues and coverage issues?

Answer? None of those suggestions do anything but result in more expensive insurance that covers fewer people for fewer issues.
 
2012-12-03 12:08:15 PM  
I only skimmed through it... but it seems that the individual mandate wasn't even addressed by AEI. I thought that for all (non-rino) republicans, the individual mandate was the most evil of all things in the health reform because then people would have to eat brocolli. Why does AEI want all americans to be oppressed and forced to eat their veggies!
 
2012-12-03 12:10:05 PM  
The republican spin machine would make INGSOC jealous.
 
2012-12-03 12:11:59 PM  

The Jami Turman Fan Club: The issue with #2 and #4 is that the elderly and poor are uninsurable. If you were an insurance company, would you offer insurance to somebody who was old and frail? Of course not. It would be like offering flood insurance on a house that was already being submerged.


Actually I would. It is impossible to lose money in the insurance industry. You would simply have to offer the insurance at an amazingly high premium. You can absolutely offer flood insurance on a house that was already submerged. Those premiums are sure gonna suck though. That's the real issue. Not that no one would offer the insurance but rather the premiums would make insurance unaffordable.
 
2012-12-03 12:13:36 PM  

ex0du5: Anyone who says "deregulate" without specifying what they mean is either trolling or willfully ignorant.


Corollary: Anyone who says "deregulate" while simultaneously extolling the virtue of emulating a decidedly highly-regulated system (Switzerland) is certainly trolling.
 
2012-12-03 12:17:02 PM  
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.

5. Sell the peasants to China and India for cents on the dollar.

6. Profit.
 
2012-12-03 12:19:39 PM  

Pincy: 3. Let more people buy insurance on their own rather than through their employer.

I didn't realize people were being prevented from buying their own insurance? Damn Obama.


Woooaaa... I just bought insurance for my family because it was too expensive through work, I didn't know it was illegal to do that!
 
2012-12-03 12:24:12 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. Obama picked #1.


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.

Lawnchair: ex0du5: Anyone who says "deregulate" without specifying what they mean is either trolling or willfully ignorant.

Corollary: Anyone who says "deregulate" while simultaneously extolling the virtue of emulating a decidedly highly-regulated system (Switzerland) is certainly trolling.


Or stupid. I'm going to generally go with stupid.

The Swiss system does work quite well, they do still spend slightly more per capita than other Universal systems (France, the UK, Canada, Australia, Japan) but it is much closer to those than it is the US. Also, the real kicker is the average income and standard of living in Switzerland is WAAAAY higher than it is in the US. Things are expensive there but even with that factored in they tend to be much better off on average.
 
2012-12-03 12:25:37 PM  
The author talked about deregulation, then used an example of it working successfully, that required a much greater amount of regulation. These Obamacare articles seem to keep doing this. Am I totally missing something here?
 
2012-12-03 12:28:00 PM  
An "idea" from the American Enterprise Institute?

Let me guess...
 
2012-12-03 12:28:33 PM  
Interesting. I seem to recall that during the health care reform debate that Republicans were mostly just screaming "NO WE DON'T WANT IT," while Democrats were trying to get something passed that might look bipartisan. The Democrats didn't pass single payer like their base wanted, but enacted something that Republicans might have crafted 20 years earlier when they seemed to think they were elected to govern. So now we see conservates wanting to negotiate. How about 'no.'
 
2012-12-03 12:29:02 PM  

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

It's exactly the same as #2.

Actually Medicare and Medicaid are different programs. Medicare is old people, Medicaid is poor people (including poor old people).


I know they're different programs. I was responding to Nekom's question. The AEI is against Medicaid for the same reason as Medicare: It's government-run.
 
2012-12-03 12:29:58 PM  
So half the solution to the problem of PPACA being a massive government takeover of healthcare when it could be a free market system is to force two programs that are nearly half a century old into it? The fact that the old, disabled, and poor were covered didn't make the old system socialist too?

And the dirty little secret of the PPACA is that it will move more people away from employer-based coverage just by virtue of the fact that employers will have less negotiating power than the exchanges will have (many employers who keep insurance coverage will find it best just to do their plans through the exchanges) and the more agressive stance on companies using loopholes to get out covering certain employees has led to many saying that paying a fine is preferable to complying with the law.
 
2012-12-03 12:31:25 PM  
Healthcare is an industry that is supposed to provide for the well-being of the citizenry. It is regarded as an essential service (like water or police/fire), in that it must be provided to everyone equally all the time or people will die.

To privatize healthcare into competing fiefdoms for profit rather than public services for the benefit of the public, is to invite untold suffering, misery, confusion and death.
 
2012-12-03 12:35:21 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.


Of course, they'll keep it for themselves. And that's exactly what the AEI wants.
 
2012-12-03 12:35:38 PM  

The Reverend Smith: make me some tea: ObamaCare is already FreeMarketCare.

Not in the least.


Nah, FreeMarketCare is what we had before ObamaCare. And we saw how farked up that got.
 
2012-12-03 12:42:15 PM  

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


Not in the least.
 
2012-12-03 12:45:01 PM  

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

Not in the least.


It's what Somalia has.
 
2012-12-03 12:45:17 PM  

uksocal: The author talked about deregulation, then used an example of it working successfully, that required a much greater amount of regulation. These Obamacare articles seem to keep doing this. Am I totally missing something here?


No.
 
2012-12-03 12:50:20 PM  

pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.


Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.
 
2012-12-03 12:56:01 PM  
I think the most important thing is to make patients aware of actual costs. None of the costs are advertised or rarely stated up front, it's all handled by insurance. You can't have a free market if people are unaware of the economics.
 
2012-12-03 12:59:36 PM  
The guy basically wants to roll Medicare and Medicaid into Obamacare's mandated, subsidized, and regulated exchanges. It's not likely to save much money. But it will greatly change the role government plays in insurance. Right now, private insurance reimbursements are typically based on a percentage of Medicare reimbursement rates. If Medicare is privatized, reimbursement rates start being negotiated in a totally different, more chaotic, and not necessarily better way.

However, the basic idea that insurance should be de-coupled from employment is sound. I think Obamacare will get us there eventually, however the way pre-2009 Republicans (plus Democrat Ron Wyden) were offering was better and faster in this sense.
 
2012-12-03 01:02:21 PM  
I would love for them to put in #3 anyway. My employer plan sucks. Give me the tax benefit directly and let me buy my own plan.
 
2012-12-03 01:03:01 PM  
Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.

Not one.

so they say something stupid like

"All of them. Derp derp."

And I ask, even those that assure safe high quality medications?

They are so frigging dumb that they don't even know what they oppose.
 
2012-12-03 01:14:02 PM  

maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.


Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link
 
2012-12-03 01:14:43 PM  

Philip Francis Queeg: Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

So you propose a massive increase in worker pay and Social security payments so that individual can afford all non-catastrophic medical costs out of pocket?


No, a single payer system seems like a better way to handle the things everyone needs. The single payer can then put pressure on the providers to keep costs low.

Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

We should focus on what people need -- health care, and use the most effective means to pay for it (of which health insurance is only one possible mechanism). Once you are sick you don't need health insurance, you need health care, and the insurance company is only a drag on the system at that point.
 
2012-12-03 01:17:08 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.


i2.kym-cdn.com
 
2012-12-03 01:18:31 PM  

Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.


How would single payer remove the need for the victim of malpractice to be compensated?
 
2012-12-03 01:18:40 PM  

Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.


This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.
 
2012-12-03 01:20:22 PM  

lennavan: maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.

Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link


I've also had a lot of good responses asking them to define their terms.

"Obama is a ______!"
"What do you mean by ______?"
"...he's a _____!"
 
2012-12-03 01:21:29 PM  

austerity101: pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.

Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.


You mean doctors? Cause I doubt Congress will take the time to pass a bill for your colonoscopy or any other retarded thing you think they have to do in order for your doctor to do his/her job.
 
2012-12-03 01:23:32 PM  

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


I think what he's saying is that preventative medicine shouldn't be so expensive that you need insurance to get it.
 
2012-12-03 01:28:27 PM  

pippi longstocking: austerity101: pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.

Yes, but the alternative is that people get to tell us what to do. And we simply can't have that.

You mean doctors? Cause I doubt Congress will take the time to pass a bill for your colonoscopy or any other retarded thing you think they have to do in order for your doctor to do his/her job.


I think austerity101 was being facetious, but in general "the government getting between you and your doctor" is one of the chief slogans of the anti-single payer group. Of course, the alternative is the insurance company bureaucrat getting between you and your doctor.
 
2012-12-03 01:28:47 PM  

Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care.


DEFINE catastrophic a little better, please?

Does my aunt's Multiple Sclerosis count? She's been living with that for years, so it's not some surprise. But, the average annual cost of her care is roughly the most she's ever made in a year (so, yeah, from a financial optimization POV, she'd be better off dead).

Does my nephew-in-law's muscular dystrophy? I mean, it was a surprise when he was diagnosed with it, but not so much now.

Does the fact that I have a genetic 1-in-4 chance of the late-40s kidney cancer my mom had count as catastrophic? Since I can maybe sorta predict it?

The problem is there is no line. You can't divide out 'catastrophic' in any meaningful sense other than saying "okay, we'll set a $10k or $15k annual deductible". Which millions of Americans are already have, to no measurable salutary effect on the nation's health care cost issues.
 
2012-12-03 01:31:45 PM  

Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?


Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.
 
2012-12-03 01:33:42 PM  

Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.


I don't know if that's true. You can still sue a doctor even if
 
2012-12-03 01:34:50 PM  

qorkfiend: lennavan: maniacbastard: Everytime I ask someone from the DERP squat what regulations they want eliminated they can't name one.
Not one.
so they say something stupid like
"All of them. Derp derp."
And I ask, even those that assure safe high quality medications?
They are so frigging dumb that they don't even know what they oppose.

Well, they absolutely know what the oppose, they just don't know why. You can generalize this further. "You're against _____? Why specifically?" "Derp."

Here is video, pick your favorite topic: Link

I've also had a lot of good responses asking them to define their terms.

"Obama is a ______!"
"What do you mean by ______?"
"...he's a _____!"


My favorite I posted from that site awhile back was a woman who said something like "Obama is a Muslim. Obama is an atheist. Obama follows his zealot church pastor Rev. Wright." "What do you mean by that?" He's all three!
 
2012-12-03 01:36:41 PM  
Alright, I may as well continue after I hit the wrong button.

qorkfiend: Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.

I don't know if that's true. You can still sue a doctor even if


You can still sue a doctor for malpractice, even if your insurance covers 100% of the costs, right? Wouldn't that be the same thing here?
 
2012-12-03 01:36:41 PM  

Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.


That's not how liability works.
 
2012-12-03 01:37:20 PM  

qorkfiend: Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.

I think what he's saying is that preventative medicine shouldn't be so expensive that you need insurance to get it.


That's probably an even worse idea, if true. Preventantive health should not have to be a factor into most people's budgets; their plans (and a national plan) should absolutely take care of this for them. There is no universal savings of costs anywhere like robust preventative health.
 
2012-12-03 01:37:39 PM  

MasterThief: 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.


Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.
 
2012-12-03 01:39:04 PM  

Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?


The purpose of payment to a victim is 3-fold:
1. cover the cost of the future medical care required as a result of the malpractice
2. punish the perp (or provide a disincentive for them to commit malpractice, if you prefer)
3. compensate the victim for actual lost time, suffering, etc

Universal health care (however it is provided) would eliminate the need for #1; so then you can rely on the administrative action (fines, loss of license) or criminal charges to cover #2

#3 can either be part of some optional insurance someone buys, or still handled through civil courts. Since #1 and #2 are generally the largest components of malpractice suits, the cost of malpractice insurance would drop substantially.
 
2012-12-03 01:40:21 PM  
I support eliminating Medicare and Medicaid and forcing these people to buy insurance through the exchanges because such an idiotic policy would quickly bankrupt private insurance resulting in a national single payer system.
 
2012-12-03 01:44:08 PM  

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


Single Payer, Socialized Medicine, and medical savings accounts, and payment out of pocket are all health plans than do not involve insurance.
 
2012-12-03 01:45:01 PM  

entropic_existence: Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.


Even worse when the 'states rightsers' start getting involved.

In the US, credit cards were (until 2009 anyway) almost entirely regulated at the state level. But could be sold anywhere in the nation. The upshot is that virtually every credit card in the nation was issued in either South Dakota or Delaware (combined, they are about 0.5% of the nation's population, roughly PEI::Canada). Cards based outside those states simply don't exist. Citibank alone had more lobbyists in Pierre, South Dakota than there were South Dakota state legislators. Meanwhile, 99.5% of the nation had no voice in Pierre or Dover whatsoever.

Not surprisingly, this is exactly the model that many Republicans have said will somehow solve the nation's health insurance woes.
 
2012-12-03 01:47:59 PM  

entropic_existence: MasterThief: 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.

Yeah, I'm a Canadian, and while I like the Single-Payer system that we have instituted, I like the Swiss-system as well. The system is heavily regulated which actually ensures there is good solid competition. Unfortunately I think without real effort in the US to institute a system properly you would end up getting a half-assed approach crippled, by bullshiat right-wing ideology, that was fundamentally broken.


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.
 
2012-12-03 01:49:58 PM  

Scorpitron is reduced to a thin red paste: Zasteva:
Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care. Everyone needs those things and insurance for something everyone needs only adds overhead.

This is a horrible idea, unless you are coming up with a drastic new definition of what insurance is or should be. Preventative care is absolutely, 100% one of the most important parts of any health plan. And health plan = insurance. Period.


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.
 
2012-12-03 01:57:01 PM  
It's only free market if poor people die in the street of preventable causes. If they deserved to live, they'd have more money.
 
2012-12-03 01:57:49 PM  

Lawnchair: Zasteva: Insurance should be used only for catastrophic heath needs -- sudden onset of rare disease, car accident, complications at childbirth, etc... Not for eldercare or preventative care.

DEFINE catastrophic a little better, please?

Does my aunt's Multiple Sclerosis count? She's been living with that for years, so it's not some surprise. But, the average annual cost of her care is roughly the most she's ever made in a year (so, yeah, from a financial optimization POV, she'd be better off dead).

Does my nephew-in-law's muscular dystrophy? I mean, it was a surprise when he was diagnosed with it, but not so much now.

Does the fact that I have a genetic 1-in-4 chance of the late-40s kidney cancer my mom had count as catastrophic? Since I can maybe sorta predict it?

The problem is there is no line. You can't divide out 'catastrophic' in any meaningful sense other than saying "okay, we'll set a $10k or $15k annual deductible". Which millions of Americans are already have, to no measurable salutary effect on the nation's health care cost issues.


You can define the line medically and financially. How about this:

Imagine a universal single payer system has a list of routine checkups and things they expect everyone (or near enough as to not matter) will need. There should also be a list of uncommon but inexpensive things. That is all covered for free.

In addition, there is some kind of per person allocation per year for everything else. Maybe it's $10k, to pull a number from my nether regions. Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.
 
2012-12-03 02:05:33 PM  

pippi longstocking: I really don't farking get Americans. You rather have a for-profit pooling system, than a not-for-profit one that cost less and covers all...it's like you are all a bunch of morons.


It's a philosophy ingrained into our society. Left over from the Cold War. Capatalist vs Communist.

Then we won. So now profit is the only "proven" way of wining fights.
 
2012-12-03 02:06:03 PM  

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.
 
2012-12-03 02:09:52 PM  

Zasteva: Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.


Seems... unnecessarily complicated. Would you mandate community rating for that supplemental insurance? (Because nobody *wants* to sell insurance to the MS aunt, and very likely would rather not sell insurance to me with a possible genetic timebomb). And, what would you do with people who run up multi-hundred-thousand-dollar bills and haven't bought said insurance? Let them die? Go for the same crazy writeoff/cost-inflation model we have now?

I think what you may be proposing is something in the high-deductible-plan/HSA model. Which, again, a quarter of the nation is now on, and we haven't seen significant benefits. We've seen some better benefits in Singapore (who has a similar plan), but there are lots of other variables there. Like, doctors are capped on what they can charge for various procedures. And fully half the working population are 'guest workers' from abroad who pay in in their 30s but are kicked out in their early 50s.
 
2012-12-03 02:12:46 PM  

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.
 
2012-12-03 02:20:33 PM  

qorkfiend: Alright, I may as well continue after I hit the wrong button.

qorkfiend: Flab: Philip Francis Queeg: Zasteva: Also, if you get true universal coverage, then you call eliminate malpractice lawsuits -- it becomes a licensing or criminal issue. That will remove enormous costs from the system.

How would single payer remove the need for the victim of malpractice to be compensated?

Because the initial procedure didn't cost anything, so you can't sue for reimbursement of expenses for services not rendered.
Because additional medical care that the victim will require is still free of charge, the victim's claims of additional costs incured as a result of the medical error is greatly reduced.
Also ( this may depend on local laws), since the victim does not enter into a contract with the practionner, it may be very difficult to actually sue to begin with. The victim can only complain to the practionner's professional board to get his or her license revoked.

For example, in Canada, doctors still need to have malpractice insurance, but they rarely get sued for something other than trying to get into their patients' undies.

I don't know if that's true. You can still sue a doctor even if

You can still sue a doctor for malpractice, even if your insurance covers 100% of the costs, right? Wouldn't that be the same thing here?


Not quite.

In the US, you enter into a contract with a physician to get treatment, and get the insurance to cover the costs. In Canada, the physician enters into a contract with the government. Since the patient is not a party to that contract, it's more difficult to sue. You still can, but fewer people do. Particularly since a medical error is a lot less likely (barring gross neglect) to bankrupt someone, and the Canadian Supreme Court has severely limited the amount a person can claim as punitive damage, so unsurprisingly, lawyers are not as trigger happy as their southern counterparts.
 
2012-12-03 02:25:49 PM  

Lawnchair: Zasteva: Past that point, it's not covered by the universal single payer system. If you want coverage for things past that point, then you pay for health insurance that only kicks in after your per-person allocation has been used up.

Seems... unnecessarily complicated. Would you mandate community rating for that supplemental insurance? (Because nobody *wants* to sell insurance to the MS aunt, and very likely would rather not sell insurance to me with a possible genetic timebomb). And, what would you do with people who run up multi-hundred-thousand-dollar bills and haven't bought said insurance? Let them die? Go for the same crazy writeoff/cost-inflation model we have now?


If as a society we decide we want to cover people in those circumstance (and I think we should cover them), then there are a number of ways to handle that. Requiring people to have health insurance and subsidizing those who can't afford it would be fine.

I think what you may be proposing is something in the high-deductible-plan/HSA model. Which, again, a quarter of the nation is now on, and we haven't seen significant benefits. We've seen some better benefits in Singapore (who has a similar plan), but there are lots of other variables there. Like, doctors are capped on what they can charge for various procedures. And fully half the working population are 'guest workers' from abroad who pay in in their 30s but are kicked out in their early 50s.

yes, the HSA/high-deductible plan is similar on the insurance side, because the insurance company is only on the hook for a much smaller number of payouts (rather than payouts for everyone), so the premium cost is much lower.

But the big difference is the HSA requires that people save out of pocket, and does nothing for those who can't afford it. Having single payer for basic care (Medicare for all?) with a limit gives you the best of both -- the low overhead of government for the part everyone uses, and the efficiency and risk distribution of private insurance for the more "exotic" stuff.
 
2012-12-03 02:25:51 PM  

Flab: and the Canadian Supreme Court has severely limited the amount a person can claim as punitive damage


As have most state legislatures in the US, years ago. The punitive/pain-and-suffering cap in my state is only $200,000, and even the state AMA chapter thinks that's absurdly low (set over 20 years ago with no inflation adjustments) and is asking for it to go up.
 
2012-12-03 02:30:36 PM  

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?

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

If no, then what the f are the actually chronically sick supposed to do?
 
2012-12-03 02:32:00 PM  

make me some tea: ObamaCare is already FreeMarketCare.


No, it's not, and neither are TFA's suggestions or examples.

A free market means free of government influence, including financial assistance and special legislative protections. Even if you got rid of the PPACA, you still wouldn't have a free market in health care, mainly because of Medicare, as well as hundreds of thousands of regulations that already control health care to the finest detail.

Anyone who blames the free market for the problems the PPACA purports to solve might as well blame unicorns for causing cancer.
 
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.
 
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