Is it just me? health insurance related

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  1. Quote Originally Posted by Mulletsoldier View Post
    D, you used a newspaper as a reference, so maybe attacking methodology is not the best suited avenue for this discussion? As to John Stossel there, the WHO rankings consider 37 measures that take into account quality-of-care, and the rankings are generally quite systematic - obviously, Mr. Stossel has a bit of political slant himself. Anyway, the other study I quoted was a systematic review of case studies which more or less concluded with the same point I made above.
    The WHO study is a piece of **** to anyone with half a brain who reads it. One of their 'systematic' measures is to automatically upgrade health care systems because they are single payer, and then use that to conclude that single payer is better. Called begging the question. I may as well hypothesize that blondes are more intelligent than brunettes and when testing them automatically give blondes a ten percent hike in their grades. Wow, wonder what my conclusions will be...

    They also rate equality of health care higher or better than health care which is more variable, roughly meaning equally distributed ****ty health care rates 'better' in their study's methods than unevenly distributed but universally higher quality care. They also rate life span without correcting for nonhealthcare related issues that affect life span, which is rather convenient if you're the nation with a higher death toll due to car accidents, military deaths, and other nonhealthcare related deaths. Infant mortality is another bull**** figure because we bring more problematic pregnancies to term in the US than in other countries. We have higher infant mortality because more high risk kids are born here that would die in the womb or get aborted in other countries.

    So, relative opinions on the health care systems aside, the WHO report is a load of steaming bull**** that literally begs its own conclusions in various areas and deliberately uses slanted data. Using it for birdcage liner would do it too much respect. Quoting it as some kind of authority means you either haven't read it or are deliberately or through ignorance overlooking massive errors and biases that present.


  2. Quote Originally Posted by Mulletsoldier View Post
    At any rate, I can understand why you both endorse a private-sector system, and, as Easy said, it stems from differences between the countries themselves. No point in continuing to argue what we both "feel" is right.
    How do you with a straight face refer to the US as a 'private sector system'?

    You are aware that just under half the health care costs raised and settled in the US anually are paid by the government through our own single payer systems Medicare and Medicaid, correct? You are aware that the majority of the rest of the system is a third party payment system, mostly subsidized by employers via the government mandated HMO Act, which itself was a reaction to the situation that arose after WWII when the government froze wages and forced employers to offer other 'benefits' to compete for employees, and then the government made those benefits tax deductable for companies but not individuals essentially forcing the whole country into employer subsidized third party payment or government care, correct? You are aware that it is the government at the state and federal levels which stops proper risk tiering and mandates coverage for uninsurable conditions, as well as de facto outlaws a la carte coverage, correct? Yoiu are aware that it is the AMA via government mandate which essentially controls the supply of doctors in the US, correct?

    If so, please explain to me what kind of massively twisted and distorted view of the world one must have in order to view the US system as a 'private sector' system.
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  3. Never enough
    EasyEJL's Avatar

    You know, I could almost (really not quite, but much closer) be behind a universal catastrophic only coverage plan. It would be a lot cheaper at least than full sniffles/headaches/prescription coverage.

    damn bush for medicare part D
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  4. Quote Originally Posted by CDB View Post
    How do you with a straight face refer to the US as a 'private sector system'?

    You are aware that just under half the health care costs raised and settled in the US anually are paid by the government through our own single payer systems Medicare and Medicaid, correct? You are aware that the majority of the rest of the system is a third party payment system, mostly subsidized by employers via the government mandated HMO Act, which itself was a reaction to the situation that arose after WWII when the government froze wages and forced employers to offer other 'benefits' to compete for employees, and then the government made those benefits tax deductable for companies but not individuals essentially forcing the whole country into employer subsidized third party payment or government care, correct? You are aware that it is the government at the state and federal levels which stops proper risk tiering and mandates coverage for uninsurable conditions, as well as de facto outlaws a la carte coverage, correct? Yoiu are aware that it is the AMA via government mandate which essentially controls the supply of doctors in the US, correct?

    If so, please explain to me what kind of massively twisted and distorted view of the world one must have in order to view the US system as a 'private sector' system.
    That was a nice little diatribe. Apparently the differences between you and I stem from you being unable to read. Allow me to bold two statements for you:

    In terms of expenditures, the U.S., expenditure for its system is equal to the amount, or exceeds the amount, that Canada spends as a percentage of GPD, Easy.
    At any rate, I can understand why you both endorse a private-sector system, and, as Easy said, it stems from differences between the countries themselves. No point in continuing to argue what we both "feel" is right.
    Now, what do these statements mean? Two things: a) I am fully aware of the exorbitant involvement of the U.S., Government in Health Care provision, the substantially greater % of GDP the U.S., government spends on health care provision compared to Canada, and the per-capita tax cost; and b) I was making a statement about what both Easy and Adams would ideally like the system to be [private sector] - i.e., they were both criticizing the current [and predominantly] single payer system in favor of a completely privatized system. (This means they were "endorsing" it.) To that end, I understood and, to a certain degree, agreed with their motivation. Easy and Adams were pointing out the inadequacies in the current U.S., system, and promoting an all for-profit method; I saw their motivation.

    You may want to fully consider statements before acting pompous.

  5. Quote Originally Posted by EasyEJL View Post
    You know, I could almost (really not quite, but much closer) be behind a universal catastrophic only coverage plan. It would be a lot cheaper at least than full sniffles/headaches/prescription coverage.

    damn bush for medicare part D
    I don't think anyone is against a safety net except free market anarchists. The problem is designing that safety net to have as little impact on the market as possible. So the questions arise: how do you build the net but generally provide disincentives to use it; how do you do something which has been up until now impossible, that being control the cost of a government program? To the first question limited coverage with means testing and wagee garnishment are good starts. No tax guaranteed budget is another. That meaning, tally the bills for the year, then pay them. Don't tax everyone first. In so doing you essentially make a first purchase for them of the service and disincentivize marginal buyers to seek out private coverage. In much the same way people use the public school system with the justification of, "Why not, I'm already paying for it..." To avoid that payment has to come after use. As for controling costs, if payment comes after the fact I guess you could average returns on specific care categories and determine a return, below market to once more disincentivize use.
  6. Never enough
    EasyEJL's Avatar

    another option would be to "criminalize" risky behaviors IF you are accepting the safety net. Ever read the book Holy Fire by bruce sterling?
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  7. Quote Originally Posted by Mulletsoldier View Post
    You may want to fully consider statements before acting pompous.
    And on this point you're right, my bad, but from a guy who quotes the WHO report as an authoritative source, pot-kettle-black and right back at you.

  8. Quote Originally Posted by CDB View Post
    And on this point you're right, my bad, but from a guy who quotes the WHO report as an authoritative source, pot-kettle-black and right back at you.
    No, you are right: the WHO report certainly has its inadequacies, and I posted it in haste, as a heat-of-the-moment response.

    On the issue as a whole: I agree with your hypothetical plan above; I have no qualms with it whatsoever. My original criticism stemmed from the warped operation of the U.S's current system, and my defense of the Canadian system was based on the two as-of-now.

    My only concerns with a la carte coverage would be transparency; however, "transparency" is usually government-mandated, and this may have unintended consequences on the market.

  9. Quote Originally Posted by EasyEJL View Post
    another option would be to "criminalize" risky behaviors IF you are accepting the safety net. Ever read the book Holy Fire by bruce sterling?
    No, what's it about?

    Don't like the idea of criminalizing the behaviors. At root that means you accept the government's role in the area as legitimate, not one of necessary but minimal evil. That's one of the reasons why we're in our current state anyway. We ceded power over health care to the government. Now because 'we' bear the burden of health care 'we' have to have our options restricted and our lives intruded upon.
  10. Never enough
    EasyEJL's Avatar

    its science fiction, but the relationship is that people are able to have life extending medical procedures but how many / how often is dictated partially by you NOT doing risky behaviors.

    I'm not sure about criminalizing, but my problem with any universal coverage of any sort is that I dislike paying a premium for someone who (for instance) smokes cigarettes, eats wrong, etc.
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  11. Quote Originally Posted by CDB View Post
    No, what's it about?

    Don't like the idea of criminalizing the behaviors. At root that means you accept the government's role in the area as legitimate, not one of necessary but minimal evil. That's one of the reasons why we're in our current state anyway. We ceded power over health care to the government. Now because 'we' bear the burden of health care 'we' have to have our options restricted and our lives intruded upon.
    It also poses the very real possibility for discriminatory coverage provision/denial. "Risky behavior" can be an entirely subjective and arbitrary determination, and has the possibility to preclude certain population groups. It could be entirely exclusionary, and rule out coverage for certain individuals deemed to be "risky" as a function of their daily lives. For example, and to link to the other thread, the higher proportion of homosexuals with AIDS could naturally lead to homosexuality being deemed as "risky behavior"; when, in reality, there are myriad factors which lead to higher exposure.
  12. Never enough
    EasyEJL's Avatar

    Quote Originally Posted by Mulletsoldier View Post
    It also poses the very real possibility for discriminatory coverage provision/denial. "Risky behavior" can be an entirely subjective and arbitrary determination, and has the possibility to preclude certain population groups. It could be entirely exclusionary, and rule out coverage for certain individuals deemed to be "risky" as a function of their daily lives. For example, and to link to the other thread, the higher proportion of homosexuals with AIDS could naturally lead to homosexuality being deemed as "risky behavior"; when, in reality, there are myriad factors which lead to higher exposure.
    and yet whether its sticking a needle in your arm, or a genital somewhere, its a conscious choice you make. I don't see why people who choose not to do those things should pay extra to cover people who do - particularly pay for your own insurance as well as pay taxes for someone who for whatever reason has no coverage. If you a drug addict with no job and no societal value, the fact that you continue to choose to use drugs doesn't obligate productive citizens to pay for your housing, food and health care.
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  13. Quote Originally Posted by EasyEJL View Post
    and yet whether its sticking a needle in your arm, or a genital somewhere, its a conscious choice you make. I don't see why people who choose not to do those things should pay extra to cover people who do - particularly pay for your own insurance as well as pay taxes for someone who for whatever reason has no coverage. If you a drug addict with no job and no societal value, the fact that you continue to choose to use drugs doesn't obligate productive citizens to pay for your housing, food and health care.
    And the drug addict scenario may be a justifiable one, but the premise itself simply lends itself toward exclusionary policies. Once you give an administration the option to begin "criminalizing" personal behavior, with the consequence of coverage-denial, you will certainly have moral imperatives guiding policy decisions. I see what you are saying, but the concept as a whole would be nothing more than an outlet for moral puritanism to explicitly suppress certain groups within society of their personal freedoms. As I said, higher probability does not equal causation, and labeling this or that behavior as more or less dangerous than any other is entirely arbitrary. It would most certainly not take into consideration all the cultural, societal, and economic factors that: a) predispose people to certain behaviors in the first place, or; b) make the outcomes of those behaviors more probable. I am ardently opposed, despite whatever my moral reservations may be, to any entity regulating personal choices that do not directly harm anybody but the end user. This stands for drugs, sex, and whatever other act some certain group is bound to find reprehensible, due to whatever justificatory authority.
  14. Never enough
    EasyEJL's Avatar

    Encyclopedia Brittanica says insurance is

    a system under which the insurer, for a consideration usually agreed upon in advance, promises to reimburse the insured or to render services to the insured in the event that certain accidental occurrences result in losses during a given period. It thus is a method of coping with risk. Its primary function is to substitute certainty for uncertainty as regards the economic cost of loss-producing events.


    Insurance relies heavily on the “law of large numbers.” In large homogeneous populations it is possible to estimate the normal frequency of common events such as deaths and accidents. Losses can be predicted with reasonable accuracy, and this accuracy increases as the size of the group expands. From a theoretical standpoint, it is possible to eliminate all pure risk if an infinitely large group is selected.

    From the standpoint of the insurer, an insurable risk must meet the following requirements:

    1. The objects to be insured must be numerous enough and homogeneous enough to allow a reasonably close calculation of the probable frequency and severity of losses.

    2. The insured objects must not be subject to simultaneous destruction. For example, if all the buildings insured by one insurer are in an area subject to flood, and a flood occurs, the loss to the insurance underwriter may be catastrophic.

    3. The possible loss must be accidental in nature, and beyond the control of the insured. If the insured could cause the loss, the element of randomness and predictability would be destroyed.

    4. There must be some way to determine whether a loss has occurred and how great that loss is. This is why insurance contracts specify very definitely what events must take place, what constitutes loss, and how it is to be measured.
    #1 is why a single system for no $ for all people doesn't make financial sense. Its why there are different insurance rates in west virginia vs florida vs california. Different people fall into different risk categories, and pay a different premium for those. Whether based on age, race, blood test results etc. Its one of the built in disincentives to smoke or do other risky behaviors like staying obese - you'll save money on your insurance as well as save money on not spending on that habit. If you lose the financial disincentive, you are no more likely to quit smoking or binge eating, if anything less likely.

    #3 is the big kicker there tho. For particularly smoking and inappropriate eating, as well as other activities, "beyond the control of the insured" is quite relevant. Does anyone doubt at this point that smoking causes health damage? Then insurance covering health issues stemming from smoking is ridiculous, particularly if its not insurance whereby the smoker is paying out of his own pocket a premium for coverage based on his risk group, as he is knowingly doing something that harms his health.
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  15. Quote Originally Posted by Mulletsoldier View Post
    It also poses the very real possibility for discriminatory coverage provision/denial. "Risky behavior" can be an entirely subjective and arbitrary determination, and has the possibility to preclude certain population groups. It could be entirely exclusionary, and rule out coverage for certain individuals deemed to be "risky" as a function of their daily lives. For example, and to link to the other thread, the higher proportion of homosexuals with AIDS could naturally lead to homosexuality being deemed as "risky behavior"; when, in reality, there are myriad factors which lead to higher exposure.
    The problem with that is discriminatory practices are necessary for proper risk tiering. For something to qualify as strictly insurable you need to know the risk for a class but not necessarily for individuals, and it needs to be something largely out of your control. For example unemployment is not strictly speaking something you can get insured because the risk for being unemployed is not generally known and being employed is largely if not totally in your control.

    On the other hand, specific reasons aside, if being homosexual as a class means you're at high risk for this or that, you should pay more for insurance. Likewise for someone like myself, my family history of heart disease means I should pay more than other people. Proper pricing means proper risk tiering, which means insurance companies must be allowed to employ any effective criteria for distinguishing risk levels between individuals. Now that means different prices for gays, people with bad family histories, people of different races, etc. If you find that distasteful fine, but understand by eliminating the ability to use effective criteria you're just forcing people who would normally pay less to pay more, and those who would otherwise need to pay more get to pass that cost on to others.

  16. Quote Originally Posted by CDB View Post
    The problem with that is discriminatory practices are necessary for proper risk tiering. For something to qualify as strictly insurable you need to know the risk for a class but not necessarily for individuals, and it needs to be something largely out of your control. For example unemployment is not strictly speaking something you can get insured because the risk for being unemployed is not generally known and being employed is largely if not totally in your control.

    On the other hand, specific reasons aside, if being homosexual as a class means you're at high risk for this or that, you should pay more for insurance. Likewise for someone like myself, my family history of heart disease means I should pay more than other people. Proper pricing means proper risk tiering, which means insurance companies must be allowed to employ any effective criteria for distinguishing risk levels between individuals. Now that means different prices for gays, people with bad family histories, people of different races, etc. If you find that distasteful fine, but understand by eliminating the ability to use effective criteria you're just forcing people who would normally pay less to pay more, and those who would otherwise need to pay more get to pass that cost on to others.
    Are we speaking about for-profit, or the "safety net" scenario mentioned earlier? My opposition to criminalizing personal behavior was in regard to the denial of the safety net. Insurability as a premise necessitates the meeting of certain criterion, and the end user remitting his freedoms to betray those criterion, lest he remit his coverage as well. And so, this is of course necessary in an a la carte system. I was against the criminalization of personal behavior.
  17. Never enough
    EasyEJL's Avatar

    My thought of the "criminalization" part was more on the order of fines or something along those lines, perhaps even higher taxation on products like tobacco, alcohol, meals over 800 calories, anal lube, etc rather than so much actual jail time, with the point being recouping the additional cost that the groups who use those products cost the overall pool if we were to get stuck with effectively a single risk tier. Again, much less an issue with catastrophic only coverage as the odds of catastrophic events although still higher for some groups are relatively low odds to begin with.
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  18. Quote Originally Posted by EasyEJL View Post
    My thought of the "criminalization" part was more on the order of fines or something along those lines, perhaps even higher taxation on products like tobacco, alcohol, meals over 800 calories, anal lube, etc rather than so much actual jail time, with the point being recouping the additional cost that the groups who use those products cost the overall pool if we were to get stuck with effectively a single risk tier. Again, much less an issue with catastrophic only coverage as the odds of catastrophic events although still higher for some groups are relatively low odds to begin with.
    Ah. I see. I think there was some misunderstanding here, as all my comments about criminalization were in respects to the "safety net". For a safety net to operate properly under an a la carte system, it must disincentivize people from its use, but not preclude them. In the market, the private insurer then reserves the right to deny and/or charge people based on how that respective insurer determines risk. My point was merely that allowing the government to determine "risky behavior" on the level of this safety net would be nothing more than an avenue for tyranny.

    On the note of increasing taxes, I agree with it morally but disagree in principle. People should regulate their own behavior, and not be penalized for harming themselves. This type of parasitic behavior can then be normalized by the private insurers, by providing higher premiums for people who display this type of behavior.

    As I say, if a la carte is your preference, so be it; however, the risk-tiering cannot and should not occur at the "safety net" level, and be restricted to the for-profit sector.

  19. Quote Originally Posted by Mulletsoldier View Post
    Are we speaking about for-profit, or the "safety net" scenario mentioned earlier? My opposition to criminalizing personal behavior was in regard to the denial of the safety net. Insurability as a premise necessitates the meeting of certain criterion, and the end user remitting his freedoms to betray those criterion, lest he remit his coverage as well. And so, this is of course necessary in an a la carte system. I was against the criminalization of personal behavior.
    As am I. However if those behaviors are not criminalized in the safety net, or at least otherwise dealt with, it serves no purpose because it is just allowing the negligent to pass their costs on to society. If you are going to ask society to provide for your health, then society gets to say under what terms they will do so. If you remit freedoms when entering into a voluntary contract in the private sector, you surely must remit along the same lines when using the government to force others to cover you via public contract. Otherwise you are saying a private organization has the right to deny my coverage or charge more per risky behavior that I may have, but the publically funded system can't do the same thing.

    Where do you think all the risky people will go and 'demand' their 'right' to health care? That's another apsect of US context you may be missing, the welfare rights movement that happened in the sixties and seventies. You see, 'assistance' was usually there in some form or another, but frowned upon. Women on 'assistance' used to have to agree to things like having no make callers. Welfare offices used to make an effort to contact relatives and get them to contribute to a claimant rather than stick them on the public dole. Then the welfare rights movement began and encouraged people not to look on public assistance as shameful, but a right one should be glad to claim. They taught people how to overwelm welfare offices so as to avoid scrutiny and get their case through easily. They changed the very fabric of the US culture to where we now have a permanent underclass who not only received near permanent assistance from the government, but thinks it's their right to receive that assistance and that it's a good thing.

    I don't know if you've had a similar movement in Canada, but this one swept the US a while back and changed a lot of perceptions vis a vi public assistance.
  20. Never enough
    EasyEJL's Avatar

    Quote Originally Posted by CDB View Post
    I don't know if you've had a similar movement in Canada, but this one swept the US a while back and changed a lot of perceptions vis a vi public assistance.
    not mine
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  21. Quote Originally Posted by CDB View Post
    As am I. However if those behaviors are not criminalized in the safety net, or at least otherwise dealt with, it serves no purpose because it is just allowing the negligent to pass their costs on to society. If you are going to ask society to provide for your health, then society gets to say under what terms they will do so. If you remit freedoms when entering into a voluntary contract in the private sector, you surely must remit along the same lines when using the government to force others to cover you via public contract. Otherwise you are saying a private organization has the right to deny my coverage or charge more per risky behavior that I may have, but the publically funded system can't do the same thing.
    I see your point, but the issue here becomes: if coverage is stringently regulated in the safety net - presumably a safety net for catastrophic events, massive accidents, things entirely beyond the control of the citizen - then having it serves no purpose. In reality, it would be muddled with philosophical and practical issues.

    Philosophically, "criminalizing" inherently personal behavior at the federal level is a de jure if not de facto claim by the government to restrict your personal freedoms how it so chooses. Arbitrarily allowing a government to decide what constitutes "risky behavior" also means that any Tom, **** and Harry special interest group with a moral opposition to this or that behavior can lobby the government into changing the safety net how it sees fit.

    Practically, having the exact same or similar restrictions in the Government-mandated safety net as the private sector has one logical conclusion for a giant segment of the population: it would not only disincentivize the use of the single-payer safety net, but of health care as a whole. If I am some low-income Plumber Joe deemed to partake in "risky behavior" by both the Government and the private-sector, why would I pay to be denied? I would either: a) take my chances with the safety net, hoping to not be denied, or; b) I would remit healthcare as a whole. Sure, for certain segments of the population an option c) is always attain a better coverage, for a higher premium, but this again defeats the purpose of the safety net as a whole. Again, sectoralizing behavior with generally accurate but specifically inaccurate predictive systems means nothing more or less than institutionalized oppression and cluster-****, not unlike what we have now.

    In order for a safety system to be of any real logical or practical consequence, it would have to be Universal. Without being universal, the tyrannical regulation of personal freedoms vis-a-vis special interest groups would be rampant; as many or more people would be left without coverage as the current system; and we would give the government the right to say, "You can do this but not this and that". Considering Canada spends 10%/GDP on a universal system and American pays 15%/GDP on Medicaid/Medicare now, a safety net that would provide the following basics is feasible:

    • restricted physician visits
    • restricted hospital stays
    • restricted transport - i.e., ambulance travel only when necessary
    • only life-saving or major surgery - i.e., only life/death situations


    This means the free-market is free to disseminate health care however it so chooses via voluntary contract, and provide better service; however, it also means that discrimination is not systemized.

    Where do you think all the risky people will go and 'demand' their 'right' to health care? That's another apsect of US context you may be missing, the welfare rights movement that happened in the sixties and seventies. You see, 'assistance' was usually there in some form or another, but frowned upon. Women on 'assistance' used to have to agree to things like having no make callers. Welfare offices used to make an effort to contact relatives and get them to contribute to a claimant rather than stick them on the public dole. Then the welfare rights movement began and encouraged people not to look on public assistance as shameful, but a right one should be glad to claim. They taught people how to overwelm welfare offices so as to avoid scrutiny and get their case through easily. They changed the very fabric of the US culture to where we now have a permanent underclass who not only received near permanent assistance from the government, but thinks it's their right to receive that assistance and that it's a good thing.

    I don't know if you've had a similar movement in Canada, but this one swept the US a while back and changed a lot of perceptions vis a vi public assistance.
    No, I am aware of the context of public assistance in a contemporary debate. As I said, I have no qualms with my Canadian system, but: if the citizens of my country voted for an a la carte system, I would have no philosophical qualms with that either; provided the business practices of the insurance providers were utterly transparent.

  22. Quote Originally Posted by Mulletsoldier View Post
    IPhilosophically, "criminalizing" inherently personal behavior at the federal level is a de jure if not de facto claim by the government to restrict your personal freedoms how it so chooses.
    Not necessarily. If the criminalization is dependent on taking public funds then there is no prior restraint and it is a matter of choice, as with any other policy which may impose restrictions.

    Arbitrarily allowing a government to decide what constitutes "risky behavior" also means that any Tom, **** and Harry special interest group with a moral opposition to this or that behavior can lobby the government into changing the safety net how it sees fit.
    True, which is one of the reasons for the eventual failure of such systems.

    Practically, having the exact same or similar restrictions in the Government-mandated safety net as the private sector has one logical conclusion for a giant segment of the population: it would not only disincentivize the use of the single-payer safety net, but of health care as a whole. If I am some low-income Plumber Joe deemed to partake in "risky behavior" by both the Government and the private-sector, why would I pay to be denied? I would either: a) take my chances with the safety net, hoping to not be denied, or; b) I would remit healthcare as a whole
    Or, stop the behavior. It seems to me what you're getting at is that some people will fall through the cracks, choose not to have coverage, etc. Yes, that will happen. So what? Universal coverage is impossible, even in a system with universal coverage. Someone always falls through the cracks.

    Sure, for certain segments of the population an option c) is always attain a better coverage, for a higher premium, but this again defeats the purpose of the safety net as a whole.
    No it doesn't. The purpose of the safety net is to provide a last ditch option for the truly desperate and down and out, not to ensure universal coverage. As such a disincentive to use it must be built in. If it's not, people will default to it more and more until it is all that remains.

    Considering Canada spends 10%/GDP on a universal system and American pays 15%/GDP on Medicaid/Medicare now, a safety net that would provide the following basics is feasible:
    That ignores one of the reasons for the spending difference: more abundant supply here.

    No, I am aware of the context of public assistance in a contemporary debate. As I said, I have no qualms with my Canadian system, but: if the citizens of my country voted for an a la carte system, I would have no philosophical qualms with that either; provided the business practices of the insurance providers were utterly transparent.
    Good luck with that one, should it ever happen.

  23. Quote Originally Posted by CDB View Post
    Not necessarily. If the criminalization is dependent on taking public funds then there is no prior restraint and it is a matter of choice, as with any other policy which may impose restrictions.
    I see your point here, but you also need to take into consideration the nature of choice itself. The choices involved in a system like this, both from the end-user and policy level, are much more complicated than choosing where you want to eat cheeseburgers.

    Or, stop the behavior. It seems to me what you're getting at is that some people will fall through the cracks, choose not to have coverage, etc. Yes, that will happen. So what? Universal coverage is impossible, even in a system with universal coverage. Someone always falls through the cracks.
    Exactly. So if this is the case, than the proposed safety net would eat capital like a Cookie Monster, with no practical consequence. It either has to be Universal, or not at all. As I say below, I mean "universal" in application, not coverage.

    No it doesn't. The purpose of the safety net is to provide a last ditch option for the truly desperate and down and out, not to ensure universal coverage. As such a disincentive to use it must be built in. If it's not, people will default to it more and more until it is all that remains.
    I understand the thrust of the argument, but do you take into consideration how dangerously arbitrary this becomes. Who gets to decide who is "down and out"? You, me, the government? It is riddled with possibilities for tyranny and systematic oppression of whatever group the group in power so happens to disagrees with, which is why I am surprised you would support it. I agree it has to be last ditch, but a last ditch to be accessed by anybody. The point of the restrictions means that, whatever the person intends to do, they are only allotted so much from the safety net. You used up all your doctor visits? Too bad; buy coverage then.

    That ignores one of the reasons for the spending difference: more abundant supply here.
    That is certainly one of the arguments.

    In reality, I really don't disagree with too much of what you are saying.
  24. Never enough
    EasyEJL's Avatar

    The fact that the politicians can blithely throw around numbers like 1.6 trillion over a decade to only cover 25% of the people they say so desparately need coverage to me proves 2 things a) our politicians are idiots b) we need to work on the other elements of the healthcare system to where costs are more realistic. I still have no comprehension though as to why the government plan's cost is roughly 3x what I pay for healthcare including what my employer pays.
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  25. Quote Originally Posted by EasyEJL View Post
    a) our politicians are idiots b) we need to work on the other elements of the healthcare system to where costs are more realistic. I still have no comprehension though as to why the government plan's cost is roughly 3x what I pay for healthcare including what my employer pays.

  26. Quote Originally Posted by Mulletsoldier View Post
    I see your point here, but you also need to take into consideration the nature of choice itself. The choices involved in a system like this, both from the end-user and policy level, are much more complicated than choosing where you want to eat cheeseburgers.
    Not necessarily. In both instances it's a matter of which option serves your desired ends best.

    I understand the thrust of the argument, but do you take into consideration how dangerously arbitrary this becomes. Who gets to decide who is "down and out"? You, me, the government? It is riddled with possibilities for tyranny and systematic oppression of whatever group the group in power so happens to disagrees with, which is why I am surprised you would support it.
    I wouldn't if there was another way, but there isn't. In the end someone has to make a decision somehow, and what you're saying at root is you want to have a political solution but have it be apolitical in nature. Not going to happen. There are, as always, checks and balances and what not, means for assuring some kind of fairness in application. But the bottom line is you can't expect a lack of politics from a political system. Yes it has the weaknesses you describe, but that weakness is inherent to the system itself and can't be eliminated, which is why people must be disincentivized from using it as much as possible.

    I agree it has to be last ditch, but a last ditch to be accessed by anybody. The point of the restrictions means that, whatever the person intends to do, they are only allotted so much from the safety net. You used up all your doctor visits? Too bad; buy coverage then.
    Which is one of the reasons why I say a means test and payment post service is necessary. If instead of paying into a general fund and budgeting people had to pick up the tab yearly at the state level say, they'd be much more inclined to pick at every case and only let in people who really need the service. What's more, they're also far more likely to try and reclaim payment from those who used the system but really didn't need to. Say Joe Shmoe gets an operation and it turns out he slipped through, was perfectly able to afford his own coverage and just didn't have any. Well, Joe is having his wages garnished until he pays his bill.

    My way of approaching such programs is to first know why they fail and to try and limit that. Why these programs fail is overuse and lack of economic accountability (profit/loss test), plain and simple. As such what needs to be avoided is an ever expanding budget and lack of regard for costs. The nature of the system is irrelevant at that point. The key parts of the policy must be aimed at transparency of actual cost to tax payers, which means no general fund or budget of any kind, disincentives to use the system in general which means whatever standards are maintained in the private sector, the public option must be less accountable for quality, and the margin people 'earn' from using the system, such as what a doctor gets paid for doing a procedure on the public dole, must be less than what he earns in the private sector.

    That's the crux that few people get. To make such a system work in a place like the US where, unlike in Canada, it will or would otherwise be subject to massive demand, is to design it so people really don't want to use it, even those on the margins. Key to that is not forcing the population at large to pay for it beforehand, and freeing up the private sector and defining the public option in relation to that sector as always the worse of the two choices. If your health is a nail to be driven and the private sector offers a hammer, the government can only offer an awkward rock to use, and charge for it only after it's used.

  27. Quote Originally Posted by CDB View Post
    Not necessarily. In both instances it's a matter of which option serves your desired ends best.
    Definitely, but boiling down choice as a pick-'em scenario between two extreme options shallows the nature of choice as a whole. Choice is either absolute, or to the extent where it is relevant, it doesn't exist; and so, the government's de jure claim to regulate personal freedom enters.

    I wouldn't if there was another way, but there isn't. In the end someone has to make a decision somehow, and what you're saying at root is you want to have a political solution but have it be apolitical in nature. Not going to happen.
    I can see how you would take this as the gist of my argument, but it's not what I am saying at all. Wherever politicizing activity has the opportunity to occur, it will occur; therefore, your only option is to reduce opportunity for politicization wherever you can, cognizant of the fact it is still bound to occur. There are only two options that will even marginally remove opportunity from a political system, then: a) level the criteria of the thing you are applying, or; b) do not apply at all. Any other type of system will lead us directly back here.

    Which is one of the reasons why I say a means test and payment post service is necessary. If instead of paying into a general fund and budgeting people had to pick up the tab yearly at the state level say, they'd be much more inclined to pick at every case and only let in people who really need the service. What's more, they're also far more likely to try and reclaim payment from those who used the system but really didn't need to. Say Joe Shmoe gets an operation and it turns out he slipped through, was perfectly able to afford his own coverage and just didn't have any. Well, Joe is having his wages garnished until he pays his bill.
    And I see your reasoning here, and agree with it, but it fails to address something major: a la carte does not mean on-demand, and therefore these doctors, EMTs, emergency staff, secretaries, janitors and so forth are still being payed, even if they are not working. Assume that this system and everybody using it are de novo: no yearly-collection has occurred, so who pays the attendant staff? In this scenario, tax consumption is still occurring by staffing these non-for profit institutions, but the opportunity for political abuse is still rampant.

    I like your ideas of wage garnishment and the other disincentivizing options, but simply disagree in its application. I think averaging the amount of common health-related circumstances - GP visits, ambulance rides, days in hospital, and so on - and then offering restrictions slightly below that number disincentivizes the use of the safety net; as well, it provides even less opportunity for abuses of the system. The best option to ensure at least a marginally fair application, and reduce opportunities for abuse, both from a policy and end-user standpoint, is to level the criteria and provide a less attractive service than the private-sector will offer. In this respect, we are not submerging the drowning any further; you are not allowing people to drown whomever they disagree with; but you are also not giving them a tax-consuming lifeline in every situation.


    That's the crux that few people get. To make such a system work in a place like the US where, unlike in Canada, it will or would otherwise be subject to massive demand, is to design it so people really don't want to use it, even those on the margins. Key to that is not forcing the population at large to pay for it beforehand, and freeing up the private sector and defining the public option in relation to that sector as always the worse of the two choices. If your health is a nail to be driven and the private sector offers a hammer, the government can only offer an awkward rock to use, and charge for it only after it's used.
    Agreed, we only disagree in its application.

  28. Quote Originally Posted by Mulletsoldier View Post
    I can see how you would take this as the gist of my argument, but it's not what I am saying at all. Wherever politicizing activity has the opportunity to occur, it will occur; therefore, your only option is to reduce opportunity for politicization wherever you can, cognizant of the fact it is still bound to occur. There are only two options that will even marginally remove opportunity from a political system, then: a) level the criteria of the thing you are applying, or; b) do not apply at all. Any other type of system will lead us directly back here.
    I disagree. Option A is not really an option. 'Leveling' is just your political opinion as to what's reasonable. The nature of the system is political and politicization of the issue is unavoidable, period. If the government is involved, the issue is by default politicized. There's no way to avoid that.

    so who pays the attendant staff?
    No staff is maintained. Handle the procedures as a jury pool. Joe needs an operation and the state agrees to cover because he really is in need and deserving etc., you get picked, your institution handles it, submit a bill for services rendered and the state pays. No need to maintain staff, no need to keep a budget. Case decisions made the same way. Send them to doctors who are picked at random from a pool. Service is compulsary. Not ideal, but it's the only way to avoid budgeting.

    I like your ideas of wage garnishment and the other disincentivizing options, but simply disagree in its application. I think averaging the amount of common health-related circumstances - GP visits, ambulance rides, days in hospital, and so on - and then offering restrictions slightly below that number disincentivizes the use of the safety net; as well, it provides even less opportunity for abuses of the system.
    That's the point of it, to disincentivize use.

    The best option to ensure at least a marginally fair application, and reduce opportunities for abuse, both from a policy and end-user standpoint, is to level the criteria and provide a less attractive service than the private-sector will offer. In this respect, we are not submerging the drowning any further; you are not allowing people to drown whomever they disagree with; but you are also not giving them a tax-consuming lifeline in every situation.
    The application will be unfair by nature, no way to avoid that. When you say leveling the criteria I get what you mean, but here's the issue: no matter how leveled the system is, some putz will come out of the woodwork, or some snot nosed theoretician, is going to come up with some possible hard luck case that your system would let fall through the cracks. It's called irrational exclusion and inclusion. Put simply, name the welfare program, and we'd all be able to point to people who abuse the system and don't really need it, and people who we could get almost universal agreement were in genuine need but didn't qualify for some reason or another. This is why the tendency is to widen the net to catch more and more people, when eventually it catches everyone.

    By nature the system will be imperfect, any and every system will have irrational exclusions and inclusions. In order to keep the growth of the system in check one must accept this and thus the fact that some people will get screwed. The only other alternative is to progressively widen the net until there are no exclusions at all. And even then people will fall through the cracks or not get help they need and deserve, such as because of shortages and what not.

    To sum up, you can't avoid politicization of the issue or the criteria, nor can you truly level the way it's applied to make sure all who need help, get help. Attempts to do so merely widen the net when the necessary pressure to apply is really the other way, to narrow it. Meanwhile the politicized nature of the system itself serves as a deterent to use, forcing more people to accept their responsibility to insure themselves at their own cost.

  29. Quote Originally Posted by CDB View Post
    I disagree. Option A is not really an option. 'Leveling' is just your political opinion as to what's reasonable. The nature of the system is political and politicization of the issue is unavoidable, period. If the government is involved, the issue is by default politicized. There's no way to avoid that.
    I agree, and as I said, "therefore, your only option is to reduce opportunity for politicization wherever you can, cognizant of the fact it is still bound to occur." This is a far more maintainable and viable option than giving politicians the opportunity to restrict and exclude whoever they desire. Opinion and subjectivity always exist, and you can only minimize them. Which is why 'Option A' and 'Option B' are the only viable ones: they either give limited access to all or access to none, which are as binary as logically possible when dealing with humans.

    No staff is maintained. Handle the procedures as a jury pool. Joe needs an operation and the state agrees to cover because he really is in need and deserving etc., you get picked, your institution handles it, submit a bill for services rendered and the state pays. No need to maintain staff, no need to keep a budget. Case decisions made the same way. Send them to doctors who are picked at random from a pool. Service is compulsary. Not ideal, but it's the only way to avoid budgeting.
    As I see it, convening attendant staff on an ad hoc basis would be nothing more than bureaucracy followed to its painful and absolute conclusion; and the costs of convening these committees and pooling doctors would be excessive. Where would the doctors, staff, transport, institutions, etc., stem from? If none of these necessities are permanently state-run, we only have one logical source: the private sector; and, as you know, the private sector is not going to give up any of its provisions to the state. The logical conclusion is unnecessary cost in convening these individuals ad hoc, coupled with the extremely high costs of "borrowing" them from the private sector [the only solution they would allow]. Not only does compulsary service trample the rights of the citizens paying for the services of these doctors, the bureaucracy involved would most likely equal the cost of permanently staffing these individuals. Leading us to see that no safety net, from a consumption perspective, is most likely preferable to an ad hoc one.

    To sum up, you can't avoid politicization of the issue or the criteria, nor can you truly level the way it's applied to make sure all who need help, get help. Attempts to do so merely widen the net when the necessary pressure to apply is really the other way, to narrow it.
    Precisely, but: this would unfortunately allows the state to politicize and pander ad nauseam. There are no perfect systems, only those that are effective at reducing bias, and those that are ineffective at reducing bias. Allowing politicians to decide what constitutes "risky behavior" means nothing more or less than oppression, and you know this to be true. The fact is, removing access-criteria removes as many opportunities as possible for the "net" to by systemized for bias, and removes the opportunity for this or that special interest group to change the criteria at will.

    That's the point of it, to disincentivize use.
    Yes, I was agreeing with you there brother, which is something you may be missing. The safety net has two purposes: a) to disincentivize the citizen from its use, and b) to provide effective care for those that actually need it. Building access-criteria into the program ensures that biased politicians and special interests groups will never allow b) to truly happen; and having an ad hoc system means that a) will never happen, considering North Americans have not always been the most responsible when it comes to, "Have now; pay later". (see: recent destruction of the financial market.) Allotting, say, five hospital nights, five GP visits, five ambulance trips [whatever these numbers are predictive to be in the mean] and absolutely no more is certainly an effective disincentive as any [if people know they have five visits bar none, they will most likely put them to good use]. Further, not putting restrictions on whom exactly can access these services minimizes special interest group ****ery. Are things bound to occur, where people fall through the cracks; special interest groups crack through; abuse occur, etc? Yes, of course. However, they pose to be substantially less in this type of system.

  30. Quote Originally Posted by Mulletsoldier View Post
    I agree, and as I said, "therefore, your only option is to reduce opportunity for politicization wherever you can, cognizant of the fact it is still bound to occur." This is a far more maintainable and viable option than giving politicians the opportunity to restrict and exclude whoever they desire. Opinion and subjectivity always exist, and you can only minimize them.
    That's the thing, you can't. Think about it: what objective measure is there of who should and will get someone else's money? The only objective measure is voluntary trade and the price system which inevitably gets built. What you consider unpoliticized is to the next person totally politicized, and to the person next to him perhaps moderately politicized. Or in other words and whether by design or not, totally politicized. There is no objective criteria to be had when you're trying to bypass the pricing system, which is the only way to turn subjective values into socially relevant and objectively comparable cardinal numbers. Beyond that measure, which tells you if something is 'worth it' or not, there is only ethics and morals.

    As I see it, convening attendant staff on an ad hoc basis would be nothing more than bureaucracy followed to its painful and absolute conclusion; and the costs of convening these committees and pooling doctors would be excessive. Where would the doctors, staff, transport, institutions, etc., stem from?
    The private sector. For example, you're a doctor working in hospital X. A requirement of doing so in society, just as all citizens must do, is registering for the public call. Society decides Joey need his knee replacent, you're the randomly selected doc, which means you're it for now.

    the private sector is not going to give up any of its provisions to the state. The logical conclusion is unnecessary cost in convening these individuals ad hoc, coupled with the extremely high costs of "borrowing" them from the private sector [the only solution they would allow].
    Agreed, it is a form of slavery or at the very least involuntary indenturement. So what? So is jury duty. Seems to function okay and not crowd out the market for private arbiters. Once more I think you're missing the real danger, which is a permanent and maintained public option. Like a standing army, the end result of a standing medical complex will be an ever expanding tendency to use it, ever expanding budgets, ever expanding safety nets, etc. In order to function with minimal risk to the private sector the public option can't get a foothold. It must be convened when necessary and essentially destroyed after every action and rebuilt when needed.

    Not only does compulsary service trample the rights of the citizens paying for the services of these doctors, the bureaucracy involved would most likely equal the cost of permanently staffing these individuals. Leading us to see that no safety net, from a consumption perspective, is most likely preferable to an ad hoc one.
    The same argument would then have to apply to jurors, and we should therefore maintain a permanent pool of professional jurors.

    [QUOTE]Precisely, but: this would unfortunately allows the state to politicize and pander ad nauseam. There are no perfect systems, only those that are effective at reducing bias, and those that are ineffective at reducing bias. Allowing politicians to decide what constitutes "risky behavior" means nothing more or less than oppression, and you know this to be true. The fact is, removing access-criteria removes as many opportunities as possible for the "net" to by systemized for bias, and removes the opportunity for this or that special interest group to change the criteria at will.

    (see: recent destruction of the financial market.)
    Here is where you're going wrong though, let me explain my reasoning. It is the existence of a permanent over supply of cash and credit that caused/fueled the problem in the first place. Without the existence of The Fed and FDIC we couldn't have had this recent financial calamity. However, maintaining a permanent official Second Guessing The Market complex, otherwise known as The Fed, lead naturally to its use and eventually its abuse.

    Same with public education. The existence of a permanently funded complex lead to its eventual growth and crowding out of private alternatives. In a very real way you're trying to have your cake and eat it too. By establishing a permanent public option, budgeted and funded, you've already crossed the control lines necessary to stop its eventual burgeoning growth and collapse.

    The reasons for this are many. One, having a resource available without cost restrictions, of which there are none in government programs of this type, means the resource will always be overused. Attempts to budget will therefore always come up short from what people want from the system and thus will always grow. Two, permanent complex means empire building. The incentive is to bring in more people and money to show your competence to govern and move up the political ladder. Three, despite over use, economic inefficiencies means you will have within the system strange surpluses. The incentive will not to cut those, but to use them. Four, you've forced a default first purchase. The most basic axiom of economics is the law of demand. For any homogenous good value declines with each additional unit added to supply. A permanent complex means a permanent budget, which means a tax burden. What you are doing is forcing a 'first purchase' of health care on the part of the whole tax paying population regardless of the want in doing so and any utility they get out of it. This means you are automatically providing a disincentive to use the private sector.

    This last point needs to be illustrated, the best analogy I know of is cars. Say the government decides everyone needs the ability to commute. Most of us can afford it on our own, but there are forty million perpetually carless people out there who for whatever reason aren't caught by the existing mass transit system and so supposedly can't commute. A car tax is thus instituted and a permanent agency is established to get cars to the needy. A portion of the tax payer's money goes to run this agency, and they know it. Within that population are car buyers but more importantly marginal car buyers. Those are people who are sort of on the fence to one degree or another. Could buy a car, not sure of it though. Or bought a car, but hey not really a necessity. The existence of this group of people, and it is a perpetual group, means demand on the agency's services will only go up over time. And the fact that these people are paying into this service's existence and have a proportionately lower income because of it means they are much more likely than otherwise to use the system to get a car. It is this group of perpetually existing marginal users and the incentive to use the system created by charging them for it regardless of use that leads to the ever increasing demand on government services.

    It is because for any given set of market conditions there is always a group of people on the margin of buying service X who will forego the private option a take the public route because: 1, they're already paying; 2, because of 1 they have less income. What's more, their first purchase is always lower than market because the population at large bears the cost. Under normal circumstances in order to be incented to buy two cars for example, you'd buy one and, for the exact same year and model as a second purchase, would be willing to buy only if the price were much, much lower or your need was truly great enough to justify the second purchase and you could afford it. Most people don't need two cars, it's the kind of purchase where you tend to buy one and be done with it. As such when the public system offers you a purchase at X and the private system offers a purchase at much more than X, you've automatically biased a significant portion of the population from going for that second purchase. If the government offers you a new Civic at $2000 bucks because the population at large is covering the price difference, there are going to be a hell of a lot fewer people willing to pay the private dealer 13K for a base model.

    This affect snowballs and you get a situation where the majority of the population is for all practical purposes dependent on the public option, and the private market has shrunk in a distorted fashion such that the only people willing to use it are those who are willing to make that 'second purchase', who are willing to pay far more, and who have the dollars to back it up. Or in other words The Rich. And the second you turn a public service into a permanent fixture, that's the unavoidable tendency. Look at public education, a perfect example. It followed this pattern mercilessly to our current situation, even though no official nationalization of education took place. Look at public transit in places where demand actually manifests: cities. Who are the only people who can really afford to drive and park their own cars in cities? The rich. The rest of us walk, take subways or cabs. For the poor to lower class there publically subsidized options are the only real ones, the subways and bus routes. The permanent establishment of a public health care system will lead to the same inevitable result unless serious and massive disincentives to use it, or more correctly to use it and to provide it, are in place. That latter is key, because it is the increased incentive to rely on the public option coupled with the diffuse costs that allow its expansion beyond reasonable limits that lead to this eventualy result. As such there need to be disincentives to use and to provide, the latter being totally destroyed by the establishment of a permanent, budgeted system.
  

  
 

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