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Please realize that the current horrible insurance system is almost entirely a product of government regultory practice.

by javert 14y ago

_delirium 14y ago
I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all. In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception). Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.
- javert 14y ago
  Risk pooling is supposed to happen at the insurance company level, not at, e.g., the corporate level. i.e. the insurance company is pooling risk across a lot of individual clients. That this only sort of happens now is an offshoot of the regulatory system. Of course, a large company will always be able to negotiate slightly better rates. In a free market, whenever it is financially rational to insure someone, it would happen. So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things. And that's the way it should be. Nobody should force someone else to take care of them. People are not owed anything by the universe.
  - _delirium 14y ago
    Ah, well that's where we disagree. I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. Let's say there's a 1% risk of me being born with some condition. I think it's perfectly fair for me to pay 1% of the cost of treating that condition, whether I'm born with it or not. I don't see why I should pay 100% the cost if I get unlucky in the genetic lottery, or 0% if I get lucky. That's just upping the ante on a bet I wasn't even around to make. And that's the kind of pooling insurance usually does, but the mechanics of this particular risk are very hard for insurance to pool, because it happens to take place before I'm sentient enough to purchase insurance, unlike a tree falling on my house. If anything, it strikes me as exceptionally petty and greedy for people who have the misfortune not to need to undergo surgery for a congenital heart disease to be angry about having to pay for their 1/risk chance of it. I mean, I'm not even arguing anything particularly leftist here: F.A. Hayek made basically this argument.
    - javert 14y ago
      I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. What's wrong with it is that you're initiating force against me, and making my life manifestly worse. I mean, as someone who can pay for my own healthcare, this is what I get out of socialized medicine in the US: (1) Less money to spend on my own healthcare issues (2) Regulations that prevent my doctors from taking care of me in the best possible way (3) Regulations that prevent me from getting the best medicine (4) Anything medical is done in an extremely expensive and wasteful way That's what you're doing to me, in order to instill your notion of what is "perfectly fair." The U.S. medical system does not work effectively for the same reasons that the Soviet economy did not. It's likely only going to keep getting worse with Obamacare.
      - gtaylor 14y ago
        You know, these posts sound a lot like "I've got mine, screw you." Am I rare in that I wouldn't mind paying a little more if it'd mean that the country would be legitimately happier/healthier? Whether that be socialized healthcare, single-payer, or any combination.
- tsotha 14y ago
  >I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". But the government put some of those edges there in the first place. The biggest reason you have to have insurance in the US now is without it you're going to pay 5x what the insurance company pays for the same procedure. Because they're buying medical care in bulk and you're not. One way you could deal with that is form a co-op to negotiate prices the same way insurance companies do, but without the insurance part. But you can't, because it's illegal.
aqme28 14y ago
Can you explain this more please? I am under the impression that it's almost entirely the product of a bloated insurance industry and wouldn't mind some evidence set me right.
- javert 14y ago
  bloated insurance industry Which is a product of government regulation. Seriously. This is historically factual, and very clearly explained in [1]. [1] http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp http://www.theobjectivestandard.com/issues/2007-winter/moral...
noonespecial 14y ago
I'd say that the biggest problem is that insurance... isn't. People want to pay for it like insurance but have it act like: a shared cost equalization system, a tax feee medical saving/spending system, a group buy (collective bargaining) discount system, a network referral system, an emergency care guarantee, oh and every once in a while, a standard insurance policy.

Please realize that the current horrible insurance system is almost entirely a product of government regultory practice.

by javert 14y ago

Please realize that the current horrible insurance system is almost entirely a product of government regultory practice.

_delirium 14y ago

I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". I'm thinking particularly of major conditions. I think regular office visits could probably be paid for out of pocket, but the real money is going towards hospitals, and that's also where free-market solutions don't work at all. In particular, I don't see how an unregulated system would solve the correlation-across-lifetime problems. A friend of mine was born with a congenital heart defect, a "preexisting condition" since birth. In a free market, it actuarially makes little sense to sell him insurance at any kind of affordable rate, because the uncertain event already happened (he lost a particular lottery at birth). And in a really free market, that would apply to many more people, because rational insurance companies would require genetic screening before allowing coverage (which they currently can't), allowing them to uncover all sorts of less obvious genetic lottery losers. Put differently, the random risk being insured is, in large part, entire lifetimes, which the insurance market cannot handle, particularly if you think individuals should have some kind of choice (vs. some kind of setup where parents have to buy their offspring's lifetime health insurance pre-conception). Risk pooling across a large corporation's employees is sort of a hack to approximate the needed across-population risk pooling, in the absence of a true socialized risk pool. That hack has let he U.S. hobble through much of the post-WW2 era, since a large percentage of Americans had employment-for-life at large companies, but it's poorly suited to a world of freelancers and job-hopping.

javert 14y ago
Risk pooling is supposed to happen at the insurance company level, not at, e.g., the corporate level. i.e. the insurance company is pooling risk across a lot of individual clients. That this only sort of happens now is an offshoot of the regulatory system. Of course, a large company will always be able to negotiate slightly better rates. In a free market, whenever it is financially rational to insure someone, it would happen. So, someone probably couldn't get insurace that covers their preexisting condition (which wouldn't be fair to the insurer), but they could get coverage for other things. And that's the way it should be. Nobody should force someone else to take care of them. People are not owed anything by the universe.
- _delirium 14y ago
  Ah, well that's where we disagree. I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. Let's say there's a 1% risk of me being born with some condition. I think it's perfectly fair for me to pay 1% of the cost of treating that condition, whether I'm born with it or not. I don't see why I should pay 100% the cost if I get unlucky in the genetic lottery, or 0% if I get lucky. That's just upping the ante on a bet I wasn't even around to make. And that's the kind of pooling insurance usually does, but the mechanics of this particular risk are very hard for insurance to pool, because it happens to take place before I'm sentient enough to purchase insurance, unlike a tree falling on my house. If anything, it strikes me as exceptionally petty and greedy for people who have the misfortune not to need to undergo surgery for a congenital heart disease to be angry about having to pay for their 1/risk chance of it. I mean, I'm not even arguing anything particularly leftist here: F.A. Hayek made basically this argument.
  - javert 14y ago
    I can't control what genes I'm born with, and I don't think there's anything wrong with socializing those risks across the population. What's wrong with it is that you're initiating force against me, and making my life manifestly worse. I mean, as someone who can pay for my own healthcare, this is what I get out of socialized medicine in the US: (1) Less money to spend on my own healthcare issues (2) Regulations that prevent my doctors from taking care of me in the best possible way (3) Regulations that prevent me from getting the best medicine (4) Anything medical is done in an extremely expensive and wasteful way That's what you're doing to me, in order to instill your notion of what is "perfectly fair." The U.S. medical system does not work effectively for the same reasons that the Soviet economy did not. It's likely only going to keep getting worse with Obamacare.
    - gtaylor 14y ago
      You know, these posts sound a lot like "I've got mine, screw you." Am I rare in that I wouldn't mind paying a little more if it'd mean that the country would be legitimately happier/healthier? Whether that be socialized healthcare, single-payer, or any combination.
tsotha 14y ago
>I disagree; government regulatory practice is mainly taking some of the worse edges off the inherently broken model of "healthcare as insurance". But the government put some of those edges there in the first place. The biggest reason you have to have insurance in the US now is without it you're going to pay 5x what the insurance company pays for the same procedure. Because they're buying medical care in bulk and you're not. One way you could deal with that is form a co-op to negotiate prices the same way insurance companies do, but without the insurance part. But you can't, because it's illegal.

aqme28 14y ago

Can you explain this more please? I am under the impression that it's almost entirely the product of a bloated insurance industry and wouldn't mind some evidence set me right.

javert 14y ago
bloated insurance industry Which is a product of government regulation. Seriously. This is historically factual, and very clearly explained in [1]. [1] http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp http://www.theobjectivestandard.com/issues/2007-winter/moral...

noonespecial 14y ago

I'd say that the biggest problem is that insurance... isn't. People want to pay for it like insurance but have it act like: a shared cost equalization system, a tax feee medical saving/spending system, a group buy (collective bargaining) discount system, a network referral system, an emergency care guarantee, oh and every once in a while, a standard insurance policy.