Yeah, a good biz/owner perspective for a guy who is trying to continue to provide premium h/c insurance.
-XC
Having healthcare provided by the employer is a terrible idea, because healthcare needs have nothing to do with what labor provides. Of course, Obamacare won't fix the problem as it doesn't do anything substantive about costs. Just allowing Medicare to negotiate drug prices when purchasing would save ~$50B a year. My guess is that Obamacare is a poison pill to force a public option, basically buying Medicare coverage out-of-pocket. It won't be what you want if you can afford better, but it will be far better than being uninsured now (which means you pay far more than insurance companies do for the same service). I have a decent job at a healthcare provider, and my costs have just gone up and up for the last decade at a rate that defies logic. It's not like Obamacare is going to ruin something good. The whole system is fucked and getting worse. I think Obamacare is basically making sure that we are all fucked together, and hoping then we will be forced to actually fix the real problem, which is the insane costs.
I always suspected the provision that ensures insurance companies spend 80% of premiums on medical care was a cyanide pill slipped into the bill without the companies knowing. This will destroy them in the long-run and eventually force us onto some kind of nationally-run system more appropriate for a developed country.
I'm not sure, to fit that metric, increasing what they pay out for services has the same effect as reducing administrative costs. The effect could be that service prices just go up all around. Unless the public has another option to jump ship to, which in that case it might have the effect you suggest anyway.
Indeed, I realize now I wasn't very clear. I figured doing this would greatly hurt the industry since it effectively places a cap on salaries, bonuses, benefits (unless I'm not misunderstanding the situation). Or as you said, will raise costs at an even more astronomical rate forcing the electorate to give up on the quixotic "private sector will find a way to provide healthcare" idea.
turns out publicly provided healthcare means less regulation.
I think JV means administrative costs. Medicare and Medicaid administrative costs are far lower than private insurers. But the US system is pretty much proof positive that private healthcare costs more than public, when comparing the same service. Of course, quality of service is another issue. It seems private does better on the high-end care, and public does better on the low-end care. Which makes sense, when you are billing for profit, the high-profit margin care is where you are going to focus your energies. Low-end care is generalized and repetitive, which is just perfect for a public service that can buy in bulk, and seeks parity on costs and expenses. It makes me wonder if you couldn't have plans that created a hybrid of public care for outpatient medicine, and private care for inpatient care where competition and quality makes a difference. General care is dealt with in a very inefficient manner by private insurers, and there's not much money in it.
I would be shocked if Medicare/caid expenses are lower across the system. They may be lower on the government side, but that probably means that they've just shoved the costs on someone else. Warning, anecdote masquerading as data:
My family doctor now gives me a 50% discount on our BCBS rates on office visits because we pay cash at time of service. We essentially pay less than the gov't does for the same service. He's a small business, so I'm going to assume he understands his overhead picture. Back to my main point. You assert that the government can provide healthcare more cheaply. Please point out something else they provide more cheaply. crickets -XC
denmark, germany and france have lower healthcare cost percapita and better outcomes (based on life expectancy) then the US. in fact we have the worst bang for our buck of any industrialized nation.
Denmark - 5.5M people, single gene pool
Germany - 81M people
France - 65M USA - 311M I can't find the cite right now, but I know that in the last 10 years we've more than doubled public/private spend on medical research, that's a 7%/year increase. And in 2000 I think the US was spending more on medical research than the next 15 countries combined. So, I would, as usual, suggest two things. One - what works for small countries and companies does not always (or even often) work for large ones. Two - There is significant "free ridership" in the global healthcare market. Finally, ask yourself one simple question: if you get really really really sick with something serious you get on your G5 and fly to..... where? _XC PS - Not saying we are perfect, but baby/bathwater and all that.
It seems the me much of the private spend in centered in replacing drugs that treat chronic illness before they reach public domain. (not exactly a public good). solution to the "large country problem" -> federalism. 311 / 50 = 6.2 million well within reach. solution to the "heterogeneity problem" -> white folks need to stop pretending that being white is a genetically meaningful thing. (Seriously is there genetically meaningful way to include Italians, Greeks, Poles and the Irish in one group and exclude Mexicans, Jews and North Africans from that group? ) for your last question Canada is the answer and I would drive.
unless it could be cured pharmacologically in which case I would head south.
I'm not sure if there is something, but the rest of the developed world pays less for the same care when compared to our private care. Healthcare is a very unique service. The need for an individual is unknown, and profit, by definition, means that parity between costs and outlays is not the goal. Also, since doctors, not patients, choose the care, and as patients don't have the knowledge to choose the care, shopping around just doesn't work so well. But don't think that I am just criticizing private healthcare. Our system is a hydra of dysfunctionality, which includes price-fixing, monopolies, collusion, misguided regluation, and bureaucracy. Also, I don’t think there’s much logic for employers paying for it in this day and age. It worked when Generous Motors could pay grandpa enough to take care of grandma and their five kids, and when healthcare costs were somewhat limited by what they could do. These days, not so much. Also, we are subsidizing the pharmaceutical costs of much of the world. I bet a private police force might be cheaper, but I don't want one. I just want what works best. My guess is that a private/public hybrid could do better than what we have. But, that's not saying much.Back to my main point. You assert that the government can provide healthcare more cheaply.
Please point out something else they provide more cheaply.
Regulation means government telling private businesses what to do. Right? that is way libertarians say that it is evil? government regulation is meaningless when it is applied to governments if anything it would be called policy. there is a downside to this Chernobyl comes to mind.
Sometimes you have to wonder if the Obama administration set up the Affordable Healthcare Act to fail so that they (or later similarly minded administrations) could swoop in and enact a complete nationalisation of the healthcare industry once the terrible system collapses.
As I mentioned here, I think it might be a maneuver for a public option. However, I don't think Obama has any intention for nationalization. Some people said that about the banks and the auto industry. It's not really his politics. He let Geithner guide his response to the subprime mess. He's not really the caricature the GOP has made of him. He's a federalist, no doubt, but he also is a proponent of the status quo. IMO he wants to engineer a better way to pay for poor and lower middle class people's medical expenses. -And I think forcing the creation of a public option might be his stragegy.
This sentiment is inhumane. "If you get hurt or catch a disease, too bad." The dollars don't matter here. We have to provide care for everyone. Who can plan ahead for catching necrotizing fasciitis or being in a bad auto accident or some other horrible thing? And just because you had the misfortune to be stricken with some horrible thing means you should lose the ability to participate? Even a chronic condition like diabetes, you know, with real wages down in comparison to all expenses going up, it shouldn't be surprising that a person might forgo health insurance in favor of rent, food, shoes, etc. Not surprising, and certainly not contemptible. This kind of 'free market' thinking should be exposed for the fantastically immoral nonsense that it is. Of course there are going to be people that game the system, no matter what system is in place! But to deny legitimate expenses of lesser extents in an effort to stem illegitimate losses at greater extents is itself "just plain stupid." It is appropriately metaphorically cutting off the nose to spite the face - a self destructive overreaction with nothing more at its heart than spite.For example, one big reason that our rates are skyrocketing is that it is becoming illegal for CareFirst and all other health insurance companies to deny someone with a preexisting condition. ... This is just plain stupid; it violates the entire point of insurance and will result in people gaming the system.
"fantastically immoral bullshit" - interesting choice of words. Interestingly he provides, IIRC, a concrete example of waiting until you are sick to purchase insurance. Please tell me how denying them insurance is immoral? Is it more moral to do this for, say, a filling than for a broken leg? -XC
The morality/immorality is kind of irrelevant. It will be cheaper in the long run if everyone has insurance, and then these choices will be much fewer and further between. The huge downside is that there is no doubt that the transition to universal healthcare comes with some seriously rocky turf. I have no idea whether the law will turn out to be good or bad in the long run, as there are some good things in there and some mind-numbingly stupid things, but I think that it will take at least 5 years beyond the mandatory insurance date (beginning 2014, if I'm not mistaken) to make a determination. We need to find a water level then reevaluate without being ideological, which is very hard for both sides on this issue.
Morality is not at all irrelevant when discussing health care. My whole point is that there are some things that supercede fiscal considerations. Also you make it sound as if Dems and Repubs are equally guilty of ideology, but that's not correct. The ACA in its present form is a compromise of a compromise ad absurdum. Obama and Congressional Democrats didn't even start with something ideal - they started with something reasonable and had to go from there. What we have now is the minimum that they could get through legislation. Of course it's not perfect but it's a step in the right direction.
"it will be cheaper in the long run if everyone has insurance." People say that all the time, but I don't think it's true. At not if the word insurance means what I think it means. First, almost everything gets more expensive in aggregate if more is produced, even if individual items cost less. However, there are large categories of goods where the individual cost goes UP as more is consumed. Roads are an example everyone understands immediately. My bet is that h/c is in this camp. -XC PS - FWIW, I get a rash whenever someone makes the Aristotelian argument for philosopher kings to solve contentious political issues. So I am off to get some Gold Bond, thanks so very much! :-)
I don't see how you get philosopher king out of my statement. I think it's a pragmatic view. A philosopher king view is one which says we can solve this or that problem by rationality. I'm saying we need to give the law space to develop and fit into the system, then reevaluate what works and what doesn't after some period of years. That's empiricism, the opposite of strict rationality.
A call for a non-ideological solution to a political problem always reminds me of the appeal towards a disinterested class who can solve such problems. They don't exist, but it's a cultural reflex that seems to exist in a lot of places. I refuse to discuss empiricism, rationality, and structural culture without a turleneck and a pipe. _XC PS - I would argue that it's not rational to think that a large government program can be created from scratch and then, after five years, get a good course correction to make it work better. I am completely unable to think of any such thing ever happening in the US. The Donk's gave us 1200 pages of turd to eat, and eat it we will. And our children's children....
I'm not disinterested. I work in healthcare, and my livelihood depends on people having health insurance. The industry will implode sooner or later if costs aren't reduced in the near future, as healthcare costs, as I'm sure you're aware, have outstripped inflation since, like, the 60s, or something ridiculous. My point is that there has to be an engineering solution out there that one can search for dispassionately without screaming "socialist" on the one end or "fascist" on the other. Elitist or not, empiricism is the only thing that can help inform good policy making on this type of complicated issue. You're probably right that government programs are rarely cancelled once they are initiated. The problem (why we got this bill instead of any other) is that health costs are an important issue; it's not an invented issue like so many other political topics. It needed some solution, and this subpar exercise was the only thing that could squeeze through the cumbersome rules and procedures of Congress (cough...gifts to individual legislators districts...cough).I would argue that it's not rational to think that a large government program can be created from scratch and then, after five years, get a good course correction to make it work better. I am completely unable to think of any such thing ever happening in the US. The Donk's gave us 1200 pages of turd to eat, and eat it we will
But people have been arguing since before HMO's (remember how they were supposed to save money and fix the system?) that THE END OF HEALTH is right around the corner. Was it Menckin who said that "the dark shadow of tyranny is always settling on America and landing on Europe?" I will also note that the other areas where the federal gov't "helps" us all is in paying for college and making a market for home loans. Hows that all working out for us? How about we try LESS government for once, just for giggles? -XC