6 ms·

Disinvesting In the USA

27 points by bensummers 17y ago

stcredzero 17y ago
There was a disturbing moment for me when a coworker just asked me out of the blue if I was for this Health Care Reform stuff. She had it all reduced to "you're taking money out of the pockets of some, and putting it towards the health care of others." Then when I tried to point out that 1 - that's how the current system works, and 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jingoism has replaced discourse. American Democracy no longer works. It's just a doppleganger of its former self.
- kiba 17y ago
  Why would the law of economics work differently in medicine?
  - wvenable 17y ago
    How much is your life worth?
  - camccann 17y ago
    Economic "laws" are a mixture of gross simplifications and statistical kludges, all of which describe patterns of behavior within some domain of limited parameters, at some scale of detail and timespan. Of course, the same can be said for pretty much any scientific principle! To expect a law of economics to hold in any arbitrary market is like expecting Kepler's laws of planetary motion to hold for any possible configuration of bodies. Whether a given law holds in the health care market, and why that may or may not be the case, is another matter, and a very complicated question to boot. The only thing that can be safely assumed is that anyone offering a pat, simple answer ("we need the government to do X so that the market will Y!") is oversimplifying.
    - kiba 17y ago
      I wasn't aware that the iron law of economic scarcity doesn't apply to medicine or that marginal utility is nullified. Statistical kludges? Wow, that's already way over my head.
  - run4yourlives 17y ago
    I'm not the op, but I believe he would be arguing that the basic microeconomic principle of Health Care being a public good dictates that this provision is a market failure. As such, like transportation and armies and education, the service is best provided - on a micro level - in something other than a free market model. Certainly, data comparing US expenditures on health care to other countries supports this.
    - kiba 17y ago
      "In economics, a public good is a good that is non-rivalrous and non-excludable." - http://en.wikipedia.org/wiki/Public_goods http://en.wikipedia.org/wiki/Public_goods I do not understand how medical goods can be considered public goods.(Or roads and security for that matters.) Are you forgetting to account for the various interventions that account for rise in medical cost? I believe I recall Medicare driven up demand, thus increasing cost due to people overusing Medicare. Insurance, instead of being used to cover emergency medical care, are now being used to cover medical visit and other regular expenses. We also have a medical cartel driving up costs by limiting the supply of doctors. Patent medicine is also adding to the cost too. Statistics are great and all, but we really should look into the unseen on why this is happening.
      - run4yourlives 17y ago
        Defining a public good is a method of classification based on opinion, often having little to do with a natural state. Few things in this world are truly public goods. Hell, even air can be excluded with a little thought. I'm interpreting the OP to be suggesting that choosing to define health care as a public good has obvious benefits that outweigh the notion that it should be left to the free market. You are coming from an opposite view that clearly sees little benefit in drawing any lines past the natural norm. Given that there is basically no country on the planet that operates in this method - spare maybe Somalia - I am assuming that the true definition of a Public Good is not the intent.
        cwan 17y ago
        There is a middle ground here. It is possible to provide universal healthcare without dismantling private markets under the guise of calling it a public good. The Swiss do it (and at a cost lower with better quality than the Canadian or American systems) - http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=2&scp=1&sq=Swiss%20Model%20for%20Health%20Care%20Thrives%20Without%20Public%20Option%20&st=cse http://www.nytimes.com/2009/10/01/health/policy/01swiss.html.... What is increasingly clear however, is that there are a number of models like the Canadian one which are increasingly unsustainable and unwieldy.
  - dandelany 17y ago
    First of all, F=MA is a law. Economics is a guess. Second of all, parent is not claiming that economists' predictions about the free market system do not apply to health care. He's saying that the field of microeconomics specifically predicts that in some scenarios, the free market system just doesn't work very well; that is, the market does not facilitate a scenario in which market participants efficiently distribute goods/services, and therefore do not benefit optimally from them. This is called market failure. Healthcare fits several of the criteria for a failing, nonefficient market. Namely: - Monopolistic competition. - Healthcare is a non-optional service. - Informational asymmetry - that is, doctors generally have more information about medicine, as well as about the specific medical state of their patient, than the patient does. For more information, see: http://en.wikipedia.org/wiki/Microeconomics#Market_failure http://en.wikipedia.org/wiki/Microeconomics#Market_failure http://en.wikipedia.org/wiki/Market_failure http://en.wikipedia.org/wiki/Market_failure [PDF] http://www.stevereads.com/papers_to_read/uncertainty_and_the_welfare_economics_of_medical_care.pdf http://www.stevereads.com/papers_to_read/uncertainty_and_the...
    - kiba 17y ago
      What about the possibility of artificially high barrier to entry, arbitrary regulations some which increases the cost of productions and some which block out firms? What about insurance being used to pay for everyday medical expenses instead of being used in only emergency? What about laws regulating the price of insurance? What about the effects of government welfare program on supply and demand?
    - bokonist 17y ago
      Almost every single "market failure" in the economic literature is really an opportunity for a business plan. All Arrow's paper shows is that certain naive structures for health insurance might not work out so well. But there are plenty of other structures that might work well. For example, here is the design for a better type of healthcare company: - The company by contract defines that 80% of all premiums must be applied to reimbursement, the other 20% of revenue pays for administration, marketing, and profits. - As a result, the company cannot profit by denying care. If they deny care, that money must be spent on another patient. - Since the money must be spent by contract, the company will be incentivized to spend the money in the way that maximizes the total health of the pool, so that they can attract more customers. The incentives of the insurance company and the patients are actually aligned. Unfortunately, in my state, and in most states, the above structure for a healthcare company is illegal. Regulations prevent it. So I hardly see healthcare as an example of "market failure" when regulations prevent the types of business plans that would actually work.
- patrickgzill 17y ago
  We haven't had a free market in US health care for years and years. So both you and your coworker are wrong.
  - stcredzero 17y ago
    I actually don't believe that we have a "free market" for healthcare in the US. My coworker apparently believes there should be.
- andreyf 17y ago
  You should stop and ask if a free market can work in providing health insurance. It doesn't work in funding local fire departments or police forces, for example.
- camccann 17y ago
  2 - the disparity in prices shows that the free market just doesn't work for American Health Care This is not intended as an attack on you, just in case it might sound that way, but: I wish people, when saying that "the market doesn't work for _____" would specify what their definition of "working" is. This is not a trivial issue! Markets are distributed systems that optimize economies for... the kind of behaviors that succeed in the market (in some respects resembling biological evolution, only less stupid and short-sighted). External forces and constraints on a market change the parameters that get optimized, sometimes in unpredictable ways, and there's no such thing as a market without external constraints warping it. Most of the time, when someone says "the market doesn't work" what they really mean is "I value parameters A, B, and C, but the market is not optimizing the economy to maximize those", but rarely do they indicate more than obliquely what those parameters might be. I agree (as do many people) that the current system is pretty terrible. But without specifying what it should be like, it's hard to talk about good ways to fix it.
  - andreyf 17y ago
    Great point! In health insurance, markets should work to minimize administrative costs - to minimize the amount people have to pay to be insured (cost) and maximize benefits. Currently, the market incentives are to do the exact opposite, while innovating on customer confusion, public relations, and lobbying power in Washington.
  - stcredzero 17y ago
    My sister just paid $2600 for an MRI. I just paid $860 for an MRI. Apparently, there are other places a few miles away where I could have paid $400 less for the same MRI. In Japan, the same MRI would cost $160.
    - natrius 17y ago
      "In Japan, the same MRI would cost $160." The upfront cost would be $160, right? I'd prefer to subsidize healthcare for people who actually need help. You and I are probably around the same place economically speaking, so why don't both of us just pay for our own healthcare?
- cwan 17y ago
  I'm confused. First off, let's accept that what Bray is talking about is healthcare. The problem is that there is a plurality of voters who seem to be saying they oppose the current legislation making their way through both Houses. On the other hand, not only do a majority of Americans want healthcare reform (http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/november_2009/when_pundits_compare_apples_to_oranges_one_look_at_health_care_polling http://www.rasmussenreports.com/public_content/politics/curr...) but most say they are happy with their own plans. Thus it's inaccurate to say that "a voting majority of Americans apparently want their government to provide them" [with healthcare] if in fact he's referring to healthcare. What confuses and scares me about the current legislation is that it assumes that everything that both the private and public sector in the US has done is wrong with the aim towards radical change for everyone. This ignores the multitide of things the US had done right - from healthcare innovation and research to even process innovation (e.g. Ambulatory surgical centers - an example can be seen in India though there are many in the US as well http://online.wsj.com/article/SB125875892887958111.html http://online.wsj.com/article/SB125875892887958111.html). There are those who argue that the healthcare system in the US is an example of failed markets ignoring the government incentives that favors employer provided healthcare, that the US spends more per capita on public healthcare than the Canadian government does, and the rather high costs of malpractice insurance. But let's say we even accept that it is a market failure and market failure alone, isn't there an assumption here that the US government wouldn't do even worse? (Again in the context that the government already controls Medicare) One of the basic policy arguments for public and universal healthcare is that it could encourage entrepreneurship. If that's the goal, why then does the Senate bill dismantle Health Savings Plans that effectively allow for coverage portability? Why force the additional taxes on businesses that employ more than a small handful of people - effectively discouraging hiring? Why is the CBO estimating that both plans would place an even greater healthcare burden on the economy than currently exists? If legislators are serious about reforms, why would they first not attempt to propose changes that optimize existing spending and changes that encourage competition rather than rushing monolithic pieces of legislation that few have read or understand? It would seem that the biggest beneficiary of existing legislation is not the uninsured who may or may not end up being covered by existing legislation but the SEIU.
- lionhearted 17y ago
  > 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jingoism has replaced discourse. Some reasons American medicine is very expensive: 1. Health insurance, but not treatment, is fully tax deductible. So if you buy your own penicillin, it's with after tax money, but if your insurance company buys it, it's pre-tax money. That's one of the reasons that health insurance is so widespred in America even for routine medicine like antibiotics and checkups. That's a major contributing factor in why the administrative costs are so high. 2. There's a shortage of doctors in America, and qualified doctors from other countries are not allowed to practice medicine in the United States. So there's good doctors from Canada, England, Japan, wherever that'd love to practice in the USA, but can't. This artificially inflates doctor's wages by restricting supply. 3. American doctors are typically required to get an undergraduate degree, medical degree, and do a below market, crazy hours residency in order to be able to practice medicine. That's 8-10 years of study and below market working to practice medicine. Now, medicine is very important and needs to be done right, but I don't believe for a second that a focused apprenceship couldn't teach a very specific kind of medicine - say arithscopic surgery - in just 2-4 years under a highly trained doctor, but this isn't an option. 4. The Food and Drug Administration requires new drugs to be proven not only for safety, but also efficacy. That's an incredibly high and expensive burden to meet - that means that drugs need to be proven to work to a certain standard, instead of just not harm. This adds years of development time and millions of dollars in cost to the new drug development cycle. Those are all legislated reasons that increase the cost of medical insurance, doctors, and drugs. They'd be fairly easy to remove - 1. All medical and health expenses can be written off taxes regardless of insurance. Employees can choose to convert som of their wages to a medical or health plan tax free to both the employer and employee. (Currently, under most circumstances, only employer-provided health insurance can is tax free) 2. Allow any doctor in a country with reasonably competent medical standards to practice in the United States. 3. Require that doctors be able to demonstrate that they can practice their area of medicine capably. Be flexible in how they demonstrate that. Note: This will incur high opposition from medical schools and current doctors who are currently enjoying the wage premium and had to go through the very long, difficult, and expensive system. 4. Change the drug standard from "safety and efficacy" to only safety. Drugs will come to market much faster and cheaper. There's plenty of people and organizations that will test proven safe drugs for efficacy for free or nominal cost once drugs hit market, and efficacy will get understood with time. Put this way - a proven safe but questionably effective treatment against heart disease being held off the market for five years and costing much more to get to market is not a good thing. If it's certainly safe, then let people make the decisions with their physicians, instead of having the FDA take such a strong gatekeeping stance. Technology has progressed such that we don't need government protection from ourselves as much any more. The current set of legislation has greatly increased the costs of doctors and medicine. Regardless of political position, and regardless of stance on other health issues, addressing these four points will make the medical system fairer, more effective, and and less expensive with relative ease. Admittedly, there's some powerful entrenched interests that are winning in the current arrangement, and will oppose these simple improvements.
- bokonist 17y ago
  The American Healthcare is a guild and cartel system, not a free market: http://intellectual-detox.com/2009/09/10/the-perfect-healthcare-plan-and-why-well-never-get-it/ http://intellectual-detox.com/2009/09/10/the-perfect-healthc... Jingoism has replaced discourse. American Democracy no longer works. It's just a doppleganger of its former self. What in the world makes you think American Democracy ever worked? Or that it was ever less jingoistic? Ever read an account of 19th century politics? http://books.google.com/books?id=8KwXAAAAYAAJ&dq=satans+invisible+world+displayed&printsec=frontcover&source=bl&ots=nTP4ye67US&sig=E2TAusjJW9ypdrPyCsCxH7Yhzfo&hl=en&ei=vVUPS7qSMc7klAftgKWxAg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAgQ6AEwAA http://books.google.com/books?id=8KwXAAAAYAAJ&dq=satans+...
andreyf 17y ago
This decision may be a little short-sighted. I have seen no proof that our political system ever worked any better in the past. During the Cold War, America constantly elected those perceived "less Communist", and invaded countries deemed as communist without much evidence [1], with political discourse almost completely unrelated to reality, and things turned out just fine (more or less). The point about customer confidence stands, however. 1. http://en.wikipedia.org/wiki/United_Fruit_Company#History_in_Central_America http://en.wikipedia.org/wiki/United_Fruit_Company#History_in...
eli_s 17y ago
Regarding US healthcare: The American system is broken and corrupt. Broken because it denies healthcare to millions who need it or financially bankrupts others. Healthcare is a basic human right - what exactly is the problem with having everyone pay a healthcare levy so that universal care can be provided? I live in Australia and my medicare contribution is ~$300 per YEAR. I have NEVER paid for a single doctor, or hospital visit in my life - the concept is utterly foreign to me. Corrupt because from what I understand big pharma has lawmakers either in their pockets or by the balls - not sure which. I hate the 'why should I pay for other people's health cover' line - it's something you only ever hear healthy people say.
- eli_s 17y ago
  Am I getting down voted by Americans who don't like having their system criticised or because people disagree with me?
  - DanielBMarkham 17y ago
    Beats me, but if you want criticism I'll give it a shot. Healthcare is a basic human right I'm unaware of any right that involves making other people take care of me by producing medicines, providing services, food, housing me, and tending to my disabilities. You can certainly argue that a lack of healthcare is a moral problem that good people solve so that all folks have as much healthcare as is feasible, but to say it is a right is to start trashing what real rights are, and healthcare, for all it's importance, is nowhere near being as important as, say, free political speech. This is a critically important thing to understand. So I agree that morally something must be done, but I felt you went way over the top with the language.
    - eli_s 17y ago
      "and healthcare, for all it's importance, is nowhere near being as important as, say, free political speech." I assume from this statement that you are either a) healthy and/or b) fully capable of paying for all you and your families medical needs - both now and in the future. "I'm unaware of any right that involves making other people take care of me by producing medicines, providing services, food, housing me, and tending to my disabilities." Australian doctors are highly paid. Their salaries are paid by every Australian tax payer whether healthy or sick. By sharing the burden all of society benefits. You would be much more inclined to agree that healthcare is a basic human right if you were both sick and unable to afford treatment. The standard of living in Australia is as good or better than in the US. My medical costs are $0. Regardless of whether I am visiting the doctor for a flu shot or having life saving heart surgery. Better systems are possible.

27 points by bensummers 17y ago

There was a disturbing moment for me when a coworker just asked me out of the blue if I was for this Health Care Reform stuff. She had it all reduced to "you're taking money out of the pockets of some, and putting it towards the health care of others." Then when I tried to point out that 1 - that's how the current system works, and 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jingoism has replaced discourse. American Democracy no longer works. It's just a doppleganger of its former self.

kiba 17y ago
Why would the law of economics work differently in medicine?
- wvenable 17y ago
  How much is your life worth?
- camccann 17y ago
  Economic "laws" are a mixture of gross simplifications and statistical kludges, all of which describe patterns of behavior within some domain of limited parameters, at some scale of detail and timespan. Of course, the same can be said for pretty much any scientific principle! To expect a law of economics to hold in any arbitrary market is like expecting Kepler's laws of planetary motion to hold for any possible configuration of bodies. Whether a given law holds in the health care market, and why that may or may not be the case, is another matter, and a very complicated question to boot. The only thing that can be safely assumed is that anyone offering a pat, simple answer ("we need the government to do X so that the market will Y!") is oversimplifying.
  - kiba 17y ago
    I wasn't aware that the iron law of economic scarcity doesn't apply to medicine or that marginal utility is nullified. Statistical kludges? Wow, that's already way over my head.
- run4yourlives 17y ago
  I'm not the op, but I believe he would be arguing that the basic microeconomic principle of Health Care being a public good dictates that this provision is a market failure. As such, like transportation and armies and education, the service is best provided - on a micro level - in something other than a free market model. Certainly, data comparing US expenditures on health care to other countries supports this.
  - kiba 17y ago
    "In economics, a public good is a good that is non-rivalrous and non-excludable." - http://en.wikipedia.org/wiki/Public_goods http://en.wikipedia.org/wiki/Public_goods I do not understand how medical goods can be considered public goods.(Or roads and security for that matters.) Are you forgetting to account for the various interventions that account for rise in medical cost? I believe I recall Medicare driven up demand, thus increasing cost due to people overusing Medicare. Insurance, instead of being used to cover emergency medical care, are now being used to cover medical visit and other regular expenses. We also have a medical cartel driving up costs by limiting the supply of doctors. Patent medicine is also adding to the cost too. Statistics are great and all, but we really should look into the unseen on why this is happening.
    - run4yourlives 17y ago
      Defining a public good is a method of classification based on opinion, often having little to do with a natural state. Few things in this world are truly public goods. Hell, even air can be excluded with a little thought. I'm interpreting the OP to be suggesting that choosing to define health care as a public good has obvious benefits that outweigh the notion that it should be left to the free market. You are coming from an opposite view that clearly sees little benefit in drawing any lines past the natural norm. Given that there is basically no country on the planet that operates in this method - spare maybe Somalia - I am assuming that the true definition of a Public Good is not the intent.
      - cwan 17y ago
        There is a middle ground here. It is possible to provide universal healthcare without dismantling private markets under the guise of calling it a public good. The Swiss do it (and at a cost lower with better quality than the Canadian or American systems) - http://www.nytimes.com/2009/10/01/health/policy/01swiss.html?_r=2&scp=1&sq=Swiss%20Model%20for%20Health%20Care%20Thrives%20Without%20Public%20Option%20&st=cse http://www.nytimes.com/2009/10/01/health/policy/01swiss.html.... What is increasingly clear however, is that there are a number of models like the Canadian one which are increasingly unsustainable and unwieldy.
- dandelany 17y ago
  First of all, F=MA is a law. Economics is a guess. Second of all, parent is not claiming that economists' predictions about the free market system do not apply to health care. He's saying that the field of microeconomics specifically predicts that in some scenarios, the free market system just doesn't work very well; that is, the market does not facilitate a scenario in which market participants efficiently distribute goods/services, and therefore do not benefit optimally from them. This is called market failure. Healthcare fits several of the criteria for a failing, nonefficient market. Namely: - Monopolistic competition. - Healthcare is a non-optional service. - Informational asymmetry - that is, doctors generally have more information about medicine, as well as about the specific medical state of their patient, than the patient does. For more information, see: http://en.wikipedia.org/wiki/Microeconomics#Market_failure http://en.wikipedia.org/wiki/Microeconomics#Market_failure http://en.wikipedia.org/wiki/Market_failure http://en.wikipedia.org/wiki/Market_failure [PDF] http://www.stevereads.com/papers_to_read/uncertainty_and_the_welfare_economics_of_medical_care.pdf http://www.stevereads.com/papers_to_read/uncertainty_and_the...
  - kiba 17y ago
    What about the possibility of artificially high barrier to entry, arbitrary regulations some which increases the cost of productions and some which block out firms? What about insurance being used to pay for everyday medical expenses instead of being used in only emergency? What about laws regulating the price of insurance? What about the effects of government welfare program on supply and demand?
  - bokonist 17y ago
    Almost every single "market failure" in the economic literature is really an opportunity for a business plan. All Arrow's paper shows is that certain naive structures for health insurance might not work out so well. But there are plenty of other structures that might work well. For example, here is the design for a better type of healthcare company: - The company by contract defines that 80% of all premiums must be applied to reimbursement, the other 20% of revenue pays for administration, marketing, and profits. - As a result, the company cannot profit by denying care. If they deny care, that money must be spent on another patient. - Since the money must be spent by contract, the company will be incentivized to spend the money in the way that maximizes the total health of the pool, so that they can attract more customers. The incentives of the insurance company and the patients are actually aligned. Unfortunately, in my state, and in most states, the above structure for a healthcare company is illegal. Regulations prevent it. So I hardly see healthcare as an example of "market failure" when regulations prevent the types of business plans that would actually work.
patrickgzill 17y ago
We haven't had a free market in US health care for years and years. So both you and your coworker are wrong.
- stcredzero 17y ago
  I actually don't believe that we have a "free market" for healthcare in the US. My coworker apparently believes there should be.
andreyf 17y ago
You should stop and ask if a free market can work in providing health insurance. It doesn't work in funding local fire departments or police forces, for example.
camccann 17y ago
2 - the disparity in prices shows that the free market just doesn't work for American Health Care This is not intended as an attack on you, just in case it might sound that way, but: I wish people, when saying that "the market doesn't work for _____" would specify what their definition of "working" is. This is not a trivial issue! Markets are distributed systems that optimize economies for... the kind of behaviors that succeed in the market (in some respects resembling biological evolution, only less stupid and short-sighted). External forces and constraints on a market change the parameters that get optimized, sometimes in unpredictable ways, and there's no such thing as a market without external constraints warping it. Most of the time, when someone says "the market doesn't work" what they really mean is "I value parameters A, B, and C, but the market is not optimizing the economy to maximize those", but rarely do they indicate more than obliquely what those parameters might be. I agree (as do many people) that the current system is pretty terrible. But without specifying what it should be like, it's hard to talk about good ways to fix it.
- andreyf 17y ago
  Great point! In health insurance, markets should work to minimize administrative costs - to minimize the amount people have to pay to be insured (cost) and maximize benefits. Currently, the market incentives are to do the exact opposite, while innovating on customer confusion, public relations, and lobbying power in Washington.
- stcredzero 17y ago
  My sister just paid $2600 for an MRI. I just paid $860 for an MRI. Apparently, there are other places a few miles away where I could have paid $400 less for the same MRI. In Japan, the same MRI would cost $160.
  - natrius 17y ago
    "In Japan, the same MRI would cost $160." The upfront cost would be $160, right? I'd prefer to subsidize healthcare for people who actually need help. You and I are probably around the same place economically speaking, so why don't both of us just pay for our own healthcare?
cwan 17y ago
I'm confused. First off, let's accept that what Bray is talking about is healthcare. The problem is that there is a plurality of voters who seem to be saying they oppose the current legislation making their way through both Houses. On the other hand, not only do a majority of Americans want healthcare reform (http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/november_2009/when_pundits_compare_apples_to_oranges_one_look_at_health_care_polling http://www.rasmussenreports.com/public_content/politics/curr...) but most say they are happy with their own plans. Thus it's inaccurate to say that "a voting majority of Americans apparently want their government to provide them" [with healthcare] if in fact he's referring to healthcare. What confuses and scares me about the current legislation is that it assumes that everything that both the private and public sector in the US has done is wrong with the aim towards radical change for everyone. This ignores the multitide of things the US had done right - from healthcare innovation and research to even process innovation (e.g. Ambulatory surgical centers - an example can be seen in India though there are many in the US as well http://online.wsj.com/article/SB125875892887958111.html http://online.wsj.com/article/SB125875892887958111.html). There are those who argue that the healthcare system in the US is an example of failed markets ignoring the government incentives that favors employer provided healthcare, that the US spends more per capita on public healthcare than the Canadian government does, and the rather high costs of malpractice insurance. But let's say we even accept that it is a market failure and market failure alone, isn't there an assumption here that the US government wouldn't do even worse? (Again in the context that the government already controls Medicare) One of the basic policy arguments for public and universal healthcare is that it could encourage entrepreneurship. If that's the goal, why then does the Senate bill dismantle Health Savings Plans that effectively allow for coverage portability? Why force the additional taxes on businesses that employ more than a small handful of people - effectively discouraging hiring? Why is the CBO estimating that both plans would place an even greater healthcare burden on the economy than currently exists? If legislators are serious about reforms, why would they first not attempt to propose changes that optimize existing spending and changes that encourage competition rather than rushing monolithic pieces of legislation that few have read or understand? It would seem that the biggest beneficiary of existing legislation is not the uninsured who may or may not end up being covered by existing legislation but the SEIU.
lionhearted 17y ago
> 2 - the disparity in prices shows that the free market just doesn't work for American Health Care (basic microeconomics) she just starts talking over me. Jingoism has replaced discourse. Some reasons American medicine is very expensive: 1. Health insurance, but not treatment, is fully tax deductible. So if you buy your own penicillin, it's with after tax money, but if your insurance company buys it, it's pre-tax money. That's one of the reasons that health insurance is so widespred in America even for routine medicine like antibiotics and checkups. That's a major contributing factor in why the administrative costs are so high. 2. There's a shortage of doctors in America, and qualified doctors from other countries are not allowed to practice medicine in the United States. So there's good doctors from Canada, England, Japan, wherever that'd love to practice in the USA, but can't. This artificially inflates doctor's wages by restricting supply. 3. American doctors are typically required to get an undergraduate degree, medical degree, and do a below market, crazy hours residency in order to be able to practice medicine. That's 8-10 years of study and below market working to practice medicine. Now, medicine is very important and needs to be done right, but I don't believe for a second that a focused apprenceship couldn't teach a very specific kind of medicine - say arithscopic surgery - in just 2-4 years under a highly trained doctor, but this isn't an option. 4. The Food and Drug Administration requires new drugs to be proven not only for safety, but also efficacy. That's an incredibly high and expensive burden to meet - that means that drugs need to be proven to work to a certain standard, instead of just not harm. This adds years of development time and millions of dollars in cost to the new drug development cycle. Those are all legislated reasons that increase the cost of medical insurance, doctors, and drugs. They'd be fairly easy to remove - 1. All medical and health expenses can be written off taxes regardless of insurance. Employees can choose to convert som of their wages to a medical or health plan tax free to both the employer and employee. (Currently, under most circumstances, only employer-provided health insurance can is tax free) 2. Allow any doctor in a country with reasonably competent medical standards to practice in the United States. 3. Require that doctors be able to demonstrate that they can practice their area of medicine capably. Be flexible in how they demonstrate that. Note: This will incur high opposition from medical schools and current doctors who are currently enjoying the wage premium and had to go through the very long, difficult, and expensive system. 4. Change the drug standard from "safety and efficacy" to only safety. Drugs will come to market much faster and cheaper. There's plenty of people and organizations that will test proven safe drugs for efficacy for free or nominal cost once drugs hit market, and efficacy will get understood with time. Put this way - a proven safe but questionably effective treatment against heart disease being held off the market for five years and costing much more to get to market is not a good thing. If it's certainly safe, then let people make the decisions with their physicians, instead of having the FDA take such a strong gatekeeping stance. Technology has progressed such that we don't need government protection from ourselves as much any more. The current set of legislation has greatly increased the costs of doctors and medicine. Regardless of political position, and regardless of stance on other health issues, addressing these four points will make the medical system fairer, more effective, and and less expensive with relative ease. Admittedly, there's some powerful entrenched interests that are winning in the current arrangement, and will oppose these simple improvements.
bokonist 17y ago
The American Healthcare is a guild and cartel system, not a free market: http://intellectual-detox.com/2009/09/10/the-perfect-healthcare-plan-and-why-well-never-get-it/ http://intellectual-detox.com/2009/09/10/the-perfect-healthc... Jingoism has replaced discourse. American Democracy no longer works. It's just a doppleganger of its former self. What in the world makes you think American Democracy ever worked? Or that it was ever less jingoistic? Ever read an account of 19th century politics? http://books.google.com/books?id=8KwXAAAAYAAJ&dq=satans+invisible+world+displayed&printsec=frontcover&source=bl&ots=nTP4ye67US&sig=E2TAusjJW9ypdrPyCsCxH7Yhzfo&hl=en&ei=vVUPS7qSMc7klAftgKWxAg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CAgQ6AEwAA http://books.google.com/books?id=8KwXAAAAYAAJ&dq=satans+...

andreyf 17y ago

This decision may be a little short-sighted. I have seen no proof that our political system ever worked any better in the past. During the Cold War, America constantly elected those perceived "less Communist", and invaded countries deemed as communist without much evidence [1], with political discourse almost completely unrelated to reality, and things turned out just fine (more or less). The point about customer confidence stands, however. 1. http://en.wikipedia.org/wiki/United_Fruit_Company#History_in_Central_America http://en.wikipedia.org/wiki/United_Fruit_Company#History_in...

eli_s 17y ago

Regarding US healthcare: The American system is broken and corrupt. Broken because it denies healthcare to millions who need it or financially bankrupts others. Healthcare is a basic human right - what exactly is the problem with having everyone pay a healthcare levy so that universal care can be provided? I live in Australia and my medicare contribution is ~$300 per YEAR. I have NEVER paid for a single doctor, or hospital visit in my life - the concept is utterly foreign to me. Corrupt because from what I understand big pharma has lawmakers either in their pockets or by the balls - not sure which. I hate the 'why should I pay for other people's health cover' line - it's something you only ever hear healthy people say.

eli_s 17y ago
Am I getting down voted by Americans who don't like having their system criticised or because people disagree with me?
- DanielBMarkham 17y ago
  Beats me, but if you want criticism I'll give it a shot. Healthcare is a basic human right I'm unaware of any right that involves making other people take care of me by producing medicines, providing services, food, housing me, and tending to my disabilities. You can certainly argue that a lack of healthcare is a moral problem that good people solve so that all folks have as much healthcare as is feasible, but to say it is a right is to start trashing what real rights are, and healthcare, for all it's importance, is nowhere near being as important as, say, free political speech. This is a critically important thing to understand. So I agree that morally something must be done, but I felt you went way over the top with the language.
  - eli_s 17y ago
    "and healthcare, for all it's importance, is nowhere near being as important as, say, free political speech." I assume from this statement that you are either a) healthy and/or b) fully capable of paying for all you and your families medical needs - both now and in the future. "I'm unaware of any right that involves making other people take care of me by producing medicines, providing services, food, housing me, and tending to my disabilities." Australian doctors are highly paid. Their salaries are paid by every Australian tax payer whether healthy or sick. By sharing the burden all of society benefits. You would be much more inclined to agree that healthcare is a basic human right if you were both sick and unable to afford treatment. The standard of living in Australia is as good or better than in the US. My medical costs are $0. Regardless of whether I am visiting the doctor for a flu shot or having life saving heart surgery. Better systems are possible.