Wednesday, July 29, 2009

Down The Road To Socialized Medicine

Q. What is the market price for setting a broken arm in the US?
A. No one knows. The market has been distorted for so long that there's no way tell what a market price might be.

Reason Magazine has an interesting article on health care reform, and I especially liked these paragraphs:

Right now consumers are locked into the health insurance and health care plans that their employers choose, thanks to previous government meddling with the health care system and the tax code. Consequently, most consumers simply don't have a clue what their health insurance costs. They have no way to reduce those costs, and no incentive to do so, even if they could...

Third party payments are the main source of dysfunction in the American health system. "The devil systematically built our health insurance system," once suggested Princeton University health economist Uwe Reinhardt. As evidence, Reinhardt pointed out that it "has the feature that when you're down on your luck, you're unemployed, you lose your insurance. Only the devil could ever have invented such a system."

So the first step toward real reform is to give consumers responsibility for buying their own health insurance. The employer-based health insurance system must be dismantled, and the money spent by employers for insurance should be converted to additional income. This would immediately inject cost consciousness into health insurance decisions.

When I was growing up, my dad's insurance covered us for emergency room visits. A routine visit to a family doctor was paid out of his pocket, and it didn't happen often. Under the scenario above, a person could choose such a plan or could choose a costlier plan like those many HMOs offer, if any plan at all. It would be the consumer's choice.

Remember, though, that it was government that was touting HMOs as the so-called solution to health care complaints almost 30 years ago.

24 comments:

Forest said...

I totally agree with what you have written here.

I often feel like my health insurance is the customer and doctor is the provider of the service and I am just out in limbo between them.

Like you italicized in your post, let me choose what I want and my school district can just give me in income what it was paying for my coverage.

What would I personally choose? I am happy to pay cash for most of my medical needs. I only need insurance for the big stuff.

Darren said...

So say we all.

mazenko said...

"So the first step toward real reform is to give consumers responsibility for buying their own health insurance. The employer-based health insurance system must be dismantled, and the money spent by employers for insurance should be converted to additional income."

Uggghhhhhh! Exactly.

So, once again, I point out that the bi-partisan Wyden-Bennett plan, the Healthy Americans Act, would do exactly that. It would slowly reform and move people off Medicare and Medicaid - with seniors also paying for more of their own health care, such as office visits. It would relieve businesses of the burden of health care costs. It takes the McCain idea of tax deductions and turns into into a tax credit. It creates a larger risk pool of 300 million Americans to which all providers would compete. It allows individuals to purchase as much or as little insurance as he or she desires/needs.

It's so logical. It's so workable. Why doesn't this get the nod?

Call your congressman. Write your newspapers. Blog about it. Tell your friends. It is the answer.

Darren said...

It "creates" a risk pool? Methinks you left something out, perhaps a governmental role.

mazenko said...

It creates a "larger" risk pool.

Right now, Kaiser charges me, and my school district, roughly $1400/mth for their family HMO. They offer the exact same plan to the supermarket across the street and the city employees in our town for about $300.

We're all Kaiser. But Kaiser is profiting more off the school employees.

allen (in Michigan) said...

And perhaps mandatory participation as well?

It is the answer.

Doesn't that depend on the question?

For instance, if the question's how to have an ever-increasing cost of medical care coupled with ever-decreasing quality of care then it's definitely the answer.

By the way, the short-form of a "risk pool of 300 million Americans" is "a commons".

I don't want to sign on to anything that's preceded by the words "the tragedy of" and inevitably results in just that.

mazenko said...

Allen,

If you are OK with the current system of private providers/insurers, and that remains unchanged with the exception of restrictions placed by employment, what's the problem?

If the HAA instead give consumers responsibility for buying their own health insurance. The employer-based health insurance system is dismantled, and the money spent by employers for insurance should converted to additional income, then what's the problem?

I mean, other than your general opposition to any sort of change.

Darren said...

I'm against compelling people to purchase health insurance. Reasonable people might choose not to purchase any, and they should not be forced to.

mazenko said...

Are you also opposed to mandatory auto (liability) and homeowners insurance?

Darren said...

Homeowner's insurance isn't mandatory. Some might insist on it if you want them to lend you money, but it isn't mandatory just to own the home.

Auto insurance is only "mandatory" if you want to drive. Additionally, your having insurance protects me if you hit me, so I can see the need for it.

Requiring someone to purchase insurance as a condition of breathing air as a citizen of this country? Not even in the same ballpark.

Gina said...

I wish examples of where we do know the cost of a medical procedure would be made public. An example is tests for lymes disease. My insurance (Blue Cross) does not pay for the blood test that actually shows whether you have an active case of the disease (as opposed to just an exposure) - don't ask me the medical specifics because I can't give them and they are beside the point. I needed to have this test so I had to pay for it myself. I went online and found labs competing for my money via advertising because the test is not covered by most insurance companies. I actually got to search for the cheapest lab!

Last year I decided to go to a physical therapy doctor that does not take any insurance because I wasn't getting anywhere with covered care. I couldn't believe the treatment I received - absolutely the nicest receptionist, follow up phone calls to check on my progress, warm blankets and pillows during the sessions. I paid them directly and they treated me like a valued customer rather than as an annoyance (my typical experience with HMO facilities).

Regarding mandatory insurance - as a Libertarian I don't like the idea of mandatory. However, I think those that do not choose to buy insurance need to pay for their own care - no more free trips to the emergency room. You can go to the Doctor if you don't have insurance as long as you pay for the services. I don't know where people got the impression that you can't. The reason that people use the ER is because of the fact that they can go and pay nothing if they do not have insurance.

I read that Obama said in an interview the other day that people have $8000 deductibles and check ups have to be paid through the deductible. That is so bogus. When my husband was self employed we had our own plan. The deductible was $2500 for the whole family, but check ups and related tests were fully covered with a small copay. Our monthly payments were only about $250 for a family of three at the time. Also, we were able to opt out of maternity coverage - saving us money. When we decided to have a 2nd kid we were able to opt back in (must happen before conception). It was nice to not have to pay for coverage we didn't need. It's frustrating that we can't do the same with the lousy insurance options my husband's employer now offers. This is one reason why I believe in open choice rather than employer based insurance.

Sorry for the long post - I'm done.

maxutils said...

It's ridiculous to assume we're not ALREADY forcing people to buy health care. It's just disguised. Go ahead and get injured, and find yourself at an emergency room without ID. you will be treated.
Darren, I fundamentally agree with your argument, but it only works if we can become dispassionate enough to deny those without.

MikeAT said...

Darren

A bit of a technicality, but the liability insurance is only required if you drive on the public streets. I know guys with ranches who have vehicles only for onsite use….one guy has a 1979 VW Rabbit with no insurance, registration or inspection. Hey it don’t go off their land, so it’s no problem.

“mazenko said...
Are you also opposed to mandatory auto (liability) and homeowners insurance?”

As Darren said in the earlier post, homeowner’s insurance not mandatory. It’s a term in a contact, the mortgage you get from the bank. As long as you owe money to the bank on the mortgage, you they have to be covered. Similar to the required full coverage on a car loan. Don’t like it, don’t borrow money.
But I have a more basic question and it’s a bit of a radical one. Where in the US Constitution can you find something that justified requiring people in this country to buy insurance of any type just because we exist? If you drive on the public streets I can see states needing to require insurance of some type, but I think this is a little bit out of the width of “necessary and proper”. Any idea guys? ……a stupid question, I know, seeing most of the things the government funds each year is not Constitutionally mandated or permitted.

mazenko said...

So, are you against automatic enrollment of people in Medicare?

Darren said...

I'm against forcing people to pay taxes to fund the Ponzi scheme known as Medicare. It's just a "government option" health care program.

mazenko said...

Gina,

I'm with you on the labs and the transparency in care. However, I fought for months with an urgent care clinic who refused to provide me with the coding info they use to bill. When the Illinois Attorney General asked to see the records, the doctor's management company decided to void the charges. Hmmmmm.

I'm not sure why you think the high deductible stories are bogus. Because my employer-sponsored premiums for family HMO would cost me $14000 a year, I have my wife and two kids on a private plan through a low-cost insurance broker. For $220/mth, I have a $7000 deductible. This includes no office visits or prescriptions, and we get one well visit a year.

Incidentally, even the one "well visit" was a wash because my doctor discovered an ear infection during my four-year-old's well visit, so they billed us twice. The insurance company paid for the well visit, and I had to pay a $75 sick visit fee ... for the same visit. That billing practice is standard policy for the AMA and AAP. Hmmmmmm.

There also isn't "free care" in ERs. No one can show up and get free treatment - they will be billed. ERs only provide care for what is clearly an "emergency" if you have no ID or insurance. After that, if you get ER treatment without insurance, they will bill you and they will go to court for it and they will get their money.

Darren, Medicare is only a Ponzi scheme if someone ends up with nothing for their investment. Has that happened? My dad just had a hip replacement fully covered on Medicare - no waiting list. In fact, he was fast-tracked because it was so bad. Gotta love that government health care. I know he does.

Anonymous said...
This comment has been removed by a blog administrator.
Darren said...

Sorry, I don't feed trolls.

Gina said...

Mazenko,

We may live in different parts of the country that have different plans. In MD we had a good plan with blue cross that we independently purchased. Why you have such a high deductible I do not know. Perhaps you should look for a new plan. Seems crazy to pay that much for nothing to me. But, this may bring up another problem with the way health care insurance is run - why should we be limited by state lines with regards to purchasing insurance? There are better plans out there but stupid regulations prevent us from using plans available in other states. My cynical side suspects that insurance companies have successfully used the govt to prevent competition.

Ellen K said...

I agree. The layers of bureaucracy created by HMO's has raised costs. Remember, it was supposed to be the godsent program to say us money. My parents also had major medical for big things, but you could take every single other medical expense off taxes. Office visits were usually only around $25. But when doctors have to add staffing to decipher various policies, then get liability insurance to practice, those costs get passed along in higher prices. And when you add the many in this nation who get services for free at ER's and clinics and who then just walk away-those costs have to be paid some how. Electric, water bills and payrolls don't just go away. So the insured people pay more. I know people who make more than I do who don't ever buy health insurance. Yet they think this policy will be 'free'. When did the government ever give us ANYTHING for free?

mazenko said...

Gina,

The "across-state-lines" panacea is a myth. It's not "stupid regulation"s - it's company policies. And if there are legal restrictions, they are lobbied for by the insurance organization. Your cynical side is right. It's the insurance companies that are benefitting. That's the problem of health care/insurance being a for-profit business.

The plans I'm talking about are national organizations. They bill people what they want where they can. None of these companies will sell me the Wisconsin plan rates if I live in Colorado. And, it's not a matter of too much regulation, as Colorado is one of the more libertarian places in the country. Insurance is not over-regulated here.

And, I have shopped around, extensively, for years. As I noted, this is the low-cost plan. The sad thing is that we keep switching plans because each company raises our rates every year. Even though we file no claims. My family is quite healthy, and all we see the doctor for is well visits. Thus, we can begin to see the agendas and goals of the insurance companies. They charge me what they can because they can.

And, actually, I'm not paying for nothing. I am paying for protection from bills in the tens of thousands. I am getting what I paid for - catastrophic care. As Darren has noted, people really should pay for their standard care. Insurance is really about protecting yourself from cancer and major accidents and extended hospital stays, etc.

allen (in Michigan) said...

> If you are OK with the current system of private providers/insurers, and that remains unchanged with the exception of restrictions placed by employment, what's the problem?

What system of private providers/insurers would that be?

If there's some such phenomenon that's distinct and untainted by the largely socialized system we already have then give me the particulars because what I see is a medical care system that's burdened by free-riders, subsidies, market-distorting special interests that use the power of government to cut themselves sweet deals and regulators who are largely, if not entirely, free of the repercussions of the decisions they make.

The question isn't whether to have a private system or a public system but whether the last vestiges of the private system ought to be eliminated in favor of an explicitly and uniformly public system.

I know you've carefully blinded yourself to the massive intrusion of into the medical care system that's occurred at both the federal and state level preferring instead to see the vestiges of the private system as some sort of overwhelming bogeyman but from one end to the other there's not an area of the medical care system that isn't regulated, controlled, modified, subsidized and manipulated by government.

Your bogeyman is largely an artifact of the socialization of medical care.

HMOs, which used to be hailed as the answer to rising health care costs and wouldn't exist but for government interference in the market, are now the target of lefty umbrage.

The real irony is that HMOs are a microcosm of the future reduction of individuals under a government-run health care system into undifferentiated medical care consuming organisms. Well, OK, the future reduction of individuals who aren't politically-connected into undifferentiated medical care consuming organisms. It wouldn't really be a socialized medicine system if there weren't two tiers of service which is an objection that you can't even bring yourself to address.

I can understand why. One can hardly maintain the illusion of being compassionate and in favor of justice when you support something that's, by its nature, unjust and cruel but quite clearly the urge to feel morally superior trumps any considerations of caution or responsibility.

mazenko said...

Wow, Allen, if you really see the private health insurance industry as being victimized by the big bad government, then we are speaking two entirely different languages. If you don't think that companies like Cigna and Kaiser are operating very successfully in a system almost entirely of their own makeing, then you don't live in the world most of us do. But, it must be nice to live in relative financial and health security.

I do understand the issues of mandates and subsidies, and I don't discount the two-tier system. Actually, it's three-tier. There are really wealthy people who work for really wealthy and powerful organizations who pay nothing personally for nearly unlimited care. There are middle class workers who are restricted to employment-provided care, or whatever they can afford on the open market, as long as they aren't denied a policy or eventually priced out of the one they have. And there people who either can't afford any care, or are restricted to what society will humanitarian-ly grant them through Medicare or Medicaid.

allen (in Michigan) said...

Victimized? Hardly. The big health insurance companies, along with the HMOs, owe their existence to the federal government's interference in the market. Heck, if it weren't for the business expense deduction for health care benefits, turning what's pay-by-another-name into a business expense, there wouldn't be any such organizations. Insurance would be what it's alway been, a socially-acceptable gamble instead of what health insurance has become, an entitlement.

It's the subsidizing of health care benefits that's led us to this pass and you want to raise that subsidy to 100%.

Oh, and don't twist yourself into a pretzel trying to avoid the obvious truth of the inherently anti-democratic nature of socialized medicine. You might end up having to see a chiropractor which you can now do without getting a sign-off from some faceless, government clerk.