Here we go again

[aadler]

 
So, HillaryCare is back, bigger and badder than ever. Sure, central planning has failed everywhere it’s been tried. Sure, the ‘broken’ American health-care system is the envy of the world. Sure, Hillary crashed and burned the last time she tried to impose socialism onto a huge segment of the domestic economy. None of that matters: she knows what’s right, and she’s going to save us all. So, she is once again revealed as that most dangerous of ideological crusaders, as convinced of the rightness of her cause as she is oblivious to her own abysmal and frightening ignorance.

No surprise. First she was a pampered college student; then she was a lawyer; then she was a politician’s wife; then she became (openly) a politician. She’s gone her whole life without ever holding a job. How can she be expected to understand basic economic principles?

I completed a Master’s degree in Health Systems, a month before September 11th steered me into a new career track, and my observation is that the greatest threat to America’s health care infrastructure — greater even than malpractice lawyers — is government. Government dictates, government policies, government funding, all of it is harmful to a system that operated (and operates beautifully) on an economic basis. Governmentalize any segment of the economy, and that segment immediately becomes less effective.

The biggest problem, one that started with some employers offering health insurance as a benefit to get around artificially imposed wage limits during World War II, is that people now think of health insurance as a right … and that it should cover all their health care costs. In terms of economics, that is simply insane. Everybody is going to have health issues, and everyone will have to deal with them, just as we deal with groceries (no ‘hunger insurance’ that pays for all our food) and transportation (is gasoline paid for by ‘fuel insurance’?) and every other cost of living. Health insurance is supposed to cover unseen emergencies that go beyond a normal budget … and those who need it least will get it for the best price, because that’s just how supply and demand works.

Canadians cross into the U.S. to get better care than their bloated, inefficient government-controlled health system can provide. So, by all means, let’s remake ours to match the Canadian model.

That’s the Hillary plan. And I wish her exactly the same success she had the last time through.

Comments

[agilebrit.livejournal.com]

And I wish her exactly the same success she had the last time through.

You and me both.

IMO, the third-party payer system has been horrible for health care, because no one shops around anymore, they get told where and when and how they can go. I think insurance should be for catastrophic care, myself, and everything else should come out of pocket, but I'm from an era when that's how everyone did it.

[aadler]

That’s the problem with learning from experience: the people with experience are replaced by those who have none, and they’re all full of wonderful ideas that they just know will create heaven on earth. A nation which underwent fantastic growth through a mixture of democracy and free-market capitalism, is forced to submit itself to socialistic nanny-state dependency, which is always at least subconsciously — and often openly — hostile to the economic freedom responsible for the initial success. Meanwhile, those individuals willing to take responsibility for their own lives are compelled to accept inferior care and pay for those unwilling or unable to manage self-sufficiency.

[trinfaneb.livejournal.com]

To be honest, I have a hard time being optimistic about this issue. I used to work as a clerk in my library and had horrible pay but great health benefits. I used to grouse about how much those benefits took from my paycheck UNTIL I got into a bad car wreck and broke my pelvis. I only stayed in the hospital one night, but that and the follow-up care would have cleaned me out if not for my health insurance.

Fast forward five years later and I'm working part time in a professional position at the library. I have maybe 100 dollars a month of health care costs that I pay out of pocket because I have no longer have health insurance. But I'm taking home just about the same amount of money for working 32 hours as I was when I was working 40 hours a week in a similar professional position (don't have to pay for health insurance and some institutional costs when working part time). The end result is I have more time for myself these days and make about the same amount of money, but if something bad happens to my health, I'm screwed.

I'd like to see some better protection for people who have a hard time getting health insurance. Of course some addicts would eat up alot of money with this because of their frequent hospital visits, but I think regular people need some help. I have no idea how to make it work, but my grandmother gave her house to me when she got cancer late in her life. She was afraid she would have lost it due to her hospital bills. She was probably right.

[aadler]

And, without intending lack of sympathy for your situation, that’s just how life works. Anybody can be wiped out by the wrong illness or injury; I’m in the same boat, simply by membership in the human race. (And, at the end of it, we’ll all die regardless.) I simply can’t see how that situation can be improved by imposing impractical ideological imperatives onto what is ultimately an economic issue.

[draconin.livejournal.com]

The biggest problem [..]is that people now think of health insurance as a right

You say that it is not a right as if you were the authority. There are no rights but those which societies choose to grant. People talk about a 'right to life' for example: there is no such thing. Does the ocean worry about whether a drowning person has some sort of rights? Most civilised societies choose to grant a 'right' to life (although some supposedly civilised societies also reserve the authority to take that right away for criminal acts) and generally grant other 'rights' too.

If a society chooses to then it may grant a 'right to healthcare' and there is no reason to think of this 'right' as any less valid than any other within that society. In Australia for example, we have a government run system called Medicare which grants a certain degree of medical cover as a 'right', although I would call it a 'benefit' since I don't believe in rights. Anyone can go to the doctor and have most of the fee refunded by Medicare. Doctors have the right to charge above this base fee - most do to some extent and it is up to the patient to choose one whose gap (fee minus benefit) they can afford. Similarly many common drugs are subsidised by the government (the Pharmaceutical Benefit Scheme) and basic hospital cover is also subsidised (no choice of hospital, room or doctor unless you pay the gap).

Our system works quite well, thank you. The cost is quite large but it is one that our society has chosen to factor into its tax system and regards as thoroughly worthwhile. I'm not denying that there are problems with it, as there are with any system. However, what I have seen (via Hollywood admittedly) of the US system is NOT attractive. A system which allows members of its society to die painfully or to suffer needlessly through lack of easily obtainable treatments is not one which is either moral or IMHO sustainable in the long run. Particularly when those members who suffer and die are those who are least able to defend their 'rights' or lack of them.

[draconin.livejournal.com]

I should add here that Medicare only guarantees the basics. Some things (dental, optical, physio...) are not covered or only minimally. These are covered by free enterprise companies (Medibank Private, Hospital Benefits Fund) for which you must pay more. Your choice of whether to join or not and of what level of additional cover to purchase.

[aadler]

I’ll acknowledge at the start that I have as little first-hand knowledge of the Australian health-care system (or the Canadian, which I cited) as you admit to having about the American. I rely on news-magazine reports of the state of things in England, Canada, the Scandinavian countries — I had no opinion of Australia until you weighed in — just as you developed your impressions through the less-than-objective testimony of Hollywood. Within the U.S., though, surveys find that most Americans are satisfied with their own health insurance coverage … they’re just convinced (because the news media keep telling them so) that there’s a huge problem out there for multitudes not as lucky as themselves.

I could probably live with, and be content within, the Australian system. I’m glad I don’t have to, though; I genuinely believe that if we could just limit government interference, the problems in the American system would work themselves out through economic incentives. HillaryCare is another attempt to impose socialism, and that’s a philosophy for which I will never lose my ingrained suspicion.

[learnedhand-dj.livejournal.com]

I was going to waste a bunch of my time pointing out where you are wrong in your statements regarding the health care system in the country, until I realized that doing so would be pointless. You have obviously made up your mind about how health care should be delivered, and no amount of contradictory facts would likely persuade you otherwise. However, you might want to review the concept of supply and demand, as it has nothing at all to do with the actuarial tables used by insurance companies to set their rates.

[aadler]

In fact, supply and demand are central to the whole thing. Private citizens want to pay as little as possible (nothing, by preference) for the greatest possible coverage. Insurers want to provide as little coverage as possible (none, if they could manage it) for the greatest possible payment. Neither party gets what they would prefer; the actual cost is determined in the rough intersection between getting the most they’ll give, in return for the least you’ll give.

Actuarial tables are a way for insurers to calculate rates to their best advantage. If you knew — KNEW — that you would incur $100,000 in medical bills, you could pay $90,000 for full coverage and still come out ahead. If your insurer knew just as positively that you’d never incur any medical costs at all, they could give you $100,000 coverage for $100, and still come out ahead. It’s seldom possible for either party to be so certain, though, so on both sides it’s a calculated gamble.

As a plain fact, the more likely you are to collect on an insurance policy, the more they have to charge you for it. The less likely you are to collect, the more cheaply they can afford to provide the coverage you want. Insurance is, after all, a business, and any business has to make a profit to continue operating; if it doesn’t continue operating, it can’t provide ANY service at ANY price.

Incidentally, if you have reasoned arguments, present them. If you want to insult someone, do it openly. A disdainful sneer doesn’t really accomplish either one.

[midnightsjane.livejournal.com]

Canadians cross into the U.S. to get better care than their bloated, inefficient government-controlled health system can provide. So, by all means, let’s remake ours to match the Canadian model.
As Canadian, I have to say that despite the real problems in our health care system, I prefer to live in a country that provides one for all its citizens. I understand there are a great many Americans who have no medical insurance at all, and thus have limited access to health care.
Just my 2 cents.

[aadler]

Your country provides the system you prefer, and mine — at least so far — offers the one I prefer. So we’re both lucky.

We all have access to health care, though. The better able we are to pay for it, the greater the access, which is equally true of everything else. And the more robust our economy is — facilitated by not strangling it on endless government mandates — the more able we are to look after ourselves.

[texanfan.livejournal.com]

One of my great fears is what government control will do to private medical practice. There are already a huge number of doctors who don't take Medicare patients. They can't afford to do so. For many doctors (particularly GPs and OB/GYNs) practicing medicine is a losing proposition financially. Between the malpractice insurance and battling insurance companies it's becoming unmanageable. The system needs fixing, but I seriously doubt government is the solution.

[aadler]

You and me both. And amen.

[tessarin.livejournal.com]

I think all western countries will at some point need to reappraise how they provide health care as it seems none of the models currently in practice work. The NHS from personal experience is a disaster a mixture of 10% great care mixed with 90% dross and mediocre health care. I swear the amount of guessing that goes on rather than diagnosis.

The problem seems fundamentally related to health inflation which due to the nature of the beast runs at many times that of normal inflation. Thus it doesn't matter how much money you pump in the service gets worse. Those with more generous systems than here can increasingly not afford them so I think some rationing is inevitable. I think it will end up with the state providing free to all basic medical care but anything beyond that being covered by insurance.

[aadler]

I’m not as sure as you are that ‘health inflation’ automatically outstrips normal inflation, not without governmental interference. The newest and fanciest treatments, of course, are going to be the most expensive, but the same technological advances tend to lower the costs of established treatments (at least in relative terms).

As far as the model you suggest — or perhaps predict without necessarily recommending it — I’m not very optimistic about it. If the government provides free medical care to everyone, everyone will get the same substandard service. And insurance can take up the gaps only so long as it’s allowed to operate as a business, which it won’t be if (a) everyone is required to have health insurance (i.e., someone is compelled to provide it for them), and (b) the companies aren’t allowed to charge more to people whose treatments actually cost more. Both of which are key features of HillaryCare.