Greedy Goblin

Friday, February 24, 2017

The big health care question

The town halls of US congressmen are full of angry voters who don't want Obamacare repealed because it will make them uninsured. When it was introduced, it was full of angry voters who didn't want it implemented because it makes them impoverished. There isn't a replacement in sight and for a good reason.

If the health care providers are free to implement new, expensive methods, health care prices skyrocket. That's why I believe health care providing (the doctors and not the insurers) must be government employees. But this is besides the point, the debate of Obamacare is about how to finance the current for-profit providers.

This question can be simplified as: "will you take crippling amount of money from Adam, pushing him into poverty to pay for Bob's health care, or will you let Bob die in a curable illness". The answer is "moral", there is no objectively correct answer. Obama went with option A, designing a health care system where everyone is insured, regardless of the expected costs of his health care. The result is of course very high fees for everyone and insurance companies still going bankrupt.

Obama could make it implemented by flat out lying: "you can keep your doctor", "premiums will not go up". The skyrocketing premiums clearly contributed to the defeat of the Democrats. The problem of the Republicans is that they can't just lie their way back, since its obvious for every Obamacare recipient that they will lose their plan. This is what is told into their face in town halls: "I have pre-existing condition X and without Obamacare I couldn't get insurance and would just die, do you want that congressman?!"

I think they should just flat out tell the truth: "we believe in individual freedom, therefore we will not force several other people to be impoverished just to save your life. If your savings and charities can't pay for your health care, I can only pray for you." I would say it without hesitation (actually, I'd go for government providers, but even there there would be too expensive illnesses), but elected politicians obviously don't want to tell someone "sorry, I let you die" on TV. The problem is that the only alternative of that is some version of Obamacare. If someone needs $1M worth of health care to live, you can't save him without taking $1M from someone, that's clear.

I'll be very curious if Republicans will go anti-social on Obamacare or chicken out. The trick is that Obamacare is unpopular, since more people are forced to pay than saved (You need to take $20K from 50 people to pay for a $1M bill). So if they flat out stand up for their capitalistic beliefs, they get more votes. So the self-interest is there. Still, I wonder how many of them will look into the eye of a young girl in a wheelchair and say "sorry, I won't force 50 people into poverty to save your life".

"May you live in interesting times!"


Azuriel said...

The collective amnesia of everyone in regards to health insurance premiums is what gets me the most. Nobody seems to remember premiums shooting up in the 90s and 00s, nor how everyone in the private market basically had junk insurance, e.g. high deductibles with lifetime caps and/or rescission when you got sick. I don't know what the answer is in America - well, it's Medicare for all, but that won't happen - but it's absolute lunacy to suggest that whatever Republicans suggest ends up being better coverage for lower costs.

Smokeman said...

Heh. Yeah. The good part, is we have all this technology that can save people's lives. The problem is we have all this technology that can save people's lives.

People are self centered little bitches that want THEIR life and the lives of THEIR loved ones saved at all costs, but can't pay the bill for everyone to get that same treatment.

And of course, the massive profiteering. The free market fails when you can't make informed choices. It's hard to make informed choices when you're unconscious in a ditch.

Medical care, at the 80% level at least (The Pareto rule applies.)NEEDS to be treated like a common good and handled by the government. Private clinics can operate too, to fill the gaps, and the rich can pay for the final 20% if they have the funds.

Smokeman said...

So... to answer your actual question...

I think the Republicans will bail hard on repealing the ACA. The fact is, they have no better system... and they know this. Better (In their minds.) to waffle on it than to show their own, even worse, hand.

As long as Corporate America runs health care, it will be an economy destroying nightmare.

Anonymous said...

> "sorry, I won't force 50 people into poverty to save your life".

Alternatively: "Warren Buffett currently pays a lower tax rate than his secretary. That's absurd. Even Buffett himself says that it's absurd. So I'm going to strengthen the progressive tax system instead of removing the upper brackets. Now we've got billions in additional revenue."

"I won't force 50 people into poverty ... because I don't need to. Instead I'll tax Warren Buffett so that he can afford only fifteen mega-yachts per year instead of sixteen. And I'll use that money to provide regular check-ups and preventative care to poor children. And so we'll detect the problem early and treat it effectively. Now the little girl doesn't NEED a million-dollar emergency operation. Everybody wins."

Gevlon said...

@Azuriel: no. Back then people could just flip the bird and don't buy crappy insurance but shop around or simply put their money to a savings account and pay for your bills when you need. Now you are forced to buy a crappy insurance (or pay penalty)

@Smokeman: of course they have no better (coverage + price) system. But they could choose the second option and go with not forcing healthy people to cover for the permanently sick.

@Anon: there is a reason why Obama went the "force 50 people into poverty" way instead of the "tax Buffet" way. Hint: Buffet can just ran for Canada.

Anonymous said...

That's not quite how Obamacare works. The Affordable Care Act is an expansion of the existing welfare system that gets its funding by making the existing ensured pay for coverage they don't need. The underlying reason for that is different people are paying different amounts for same service. The consumer and insurance ends of the health care system are on different sides, and Obamacare is an insurance subsidy at the cost of the consumer. (It also makes everyone pay the same extra cost instead of higher incomes paying larger tax.) Poor and mostly immigrant people gained access to health care, but the average person loses access either from increased fees or being dropped by their physician. Replacing Obamacare will allow doctors to compete directly without being chained to certain insurers while allowing consumers to pay for the exact coverage they actually need, and many offices have been dropping government-subsidised insurers for several months now. The unneccessary coverage and costly overhead that comes with it is why people get denied for pre-existing conditions in the first place!

The reason there's no premade replacement is because Obama outright refused to allow any action to be taken during his terms.

>Still, I wonder how many of them will look into the eye of a young girl in a wheelchair and say "sorry, I won't force 50 people into poverty to save your life".
None of them, because they won't have to. They save the girl's life by allowing doctors to set prices, making them compete by offering better service at lower prices (right now doctors can do anything they want and Obamacare patients have no choice), and making higher incomes pay larger portion in tax.

Anonymous said...

The question that you should be interested in as a purely logical totally-not-politically motivated person is, why are procedures and medical treatment so much more expensive in the USA than in any other western country?

And we are not talking about the high end private surgery options, we are talking about the average cost across the entire USA being orders of magnitude higher than anywhere in the west for everything from hip replacements, to medication.

Perhaps if that was looked at, then it might not be so expensive for insurance.

Also by the way, people have no problem paying for other people getting treatment through their insurance, which works exactly the same way as any nationalised system, but, because its privatised, they pretend it isnt "Many people pay in, a smaller number take out"

Gevlon said...

@Anon: simple, the health care PROVIDING is free market, despite it shouldn't be.

Unknown said...

First: there is no such thing as health insurance, and in particular, no such thing as insurance that covers preexisting ailments.

The main idea of insurance is that people pay a small amount to cover a rare, big loss. Guess what, everybody gets ill, everybody dies. The whole idea is untenable.

In particular, there can't exist an insurance that covers preexisting health problems. Insurance is risk management, which totally fails when the chance of payout is 100%.

"Health insurance" should be treated the same way pensions are. Young people are healthy, they save money and have enough for treatments when their health fails 50 years later. There should be no government nor insurance interference, other than enforcing law and preventing scammers (like most of the oncologists, which charge hundreds of thousands for administering a drug that has very little chance of being effective and zero chance of curing the patient). If somebody dies in an accident with his children inherit the money. If he gets cancer he can choose to spend his life savings to extend his life by mere months or to leave the money to his children.

Free market is only possible when the customer pays for the goods or services. When the payer and the beneficient are not the same person the system turns pathological. The customer will want all that he can get, irrespective of its price or value, the payer will only care about reducing cost, irrespective of customer's wellbeing. And the real benefits go to the middle men: the medical professionals. They can lie to the patients about what the need and lie to insurers about how much it costs.

Unknown said...

"Make them compete by offering better services at lower prices". This is where your argument died, makes no sense

Anonymous said...

The only halfway real solution should consider 2 things:

1) Bringing down the immense costs of the US health care system, which is so damn big in part because it is privatized to a huge extend.

2) Make it a social system, similar to systems like Germany. Everyone pays X% of their wages into the healthcare system, doctors get paid on a standardized basis, the same goes for medicine.

I know some Americans will bitch about that because something something socialism but just implement it and see the miricale that is: no one gets poor through health insurance and also no one has to die because they cannot afford the treatment for a disease.

Phelps said...

This question can be simplified as: "will you take crippling amount of money from Adam, pushing him into poverty to pay for Bob's health care, or will you let Bob die in a curable illness".

This is the big myth that it seems that everyone overseas, and too many people in America, believe.

No one in America does of curable illnesses because they don't have money. None. At worst, you have mentally ill homeless people who do because they don't even try to get treated. If you try to get treated, you will be treated.

It's illegal to refuse medical service to someone who has a life threatening condition in America. Illegal. Doctors go to jail for doing it. If your disease isn't immediately life threatening, you will get treatment. If you don't qualify for Medicare (old folks coverage, universal) or Medicaid (indigent coverage, everyone under a certain income level) then there are tons of charities that will cover it (Americans are the most charitable people on the planet) and hospitals with Indigent Funds or Uninsured Patient Funds designated for people who can't pay.

No one dies of curable diseases in America because they can't pay. If you can't pay, someone else will. That was true before Obamacare, and will be true after Obamacare, because America is full of Americans.

Gevlon said...

@Phelbs: people die in curable illnesses because they don't know that they have a life threatening curable illness and don't visit a doctor when they feel ill. For example:

Phelps said...

Nothing in that article disputes my point. That family specifically refused help, over and over, and there's nothing that indicates that the women that dies of pneumonia would have gone to the doctor if she had insurance. (Remember, this is the bleeding heart socialist telling the dead woman's story, not the hard working waitress who didn't want to take time off work to go to the doctor.)

Gevlon said...

@Phelbs: the first rule of staying healthy is early diagnosis. People without insurance don't go to doctors when they have no serious symptoms. They develop illnesses to the point when they are uncurable. It's possible that then they get some government or charity health care but it makes them no good.

Phelps said...

Cancer is the only place that early diagnosis really has an effect on mortality, and even then only on certain kinds of cancers. (Prostate cancer, for example, has virtually no change in mortality between early and late diagnosis.) For pneumonia, getting to a doctor right away likely would have had no effect on her ultimate demise.

Gevlon said...

Untreated high blood pressure causes heart attack and stroke. Untreated diabetes causes kidney failure and blindness. These are just things from the top of my head. The point is: people without proper health care get into so bad condition that they cannot be saved when they are finally (self)-identified as life-threatened.

While formally no one refuses them treatment, the outcome is the same: they die, and they wouldn't if they could afford proper health care.

Phelps said...

In the long run, everyone dies. I see Americans with diabetes. It's not a lack of healthcare, it's a lack of healthy lifestyle. Same for hypertension.

Giving poor people free doctor visits won't make them healthier. Making poor people into middle class people will make them healthier, and that starts in their heads.

Anonymous said...

> I see Americans with diabetes. It's not a lack of healthcare, it's a lack of healthy lifestyle.

We don't need to actually prevent people from acquiring diabetes (which - as you say - requires changes in lifestyle and diet). The point is to detect it and give them a few thousand dollars of care (doctor visits, test strips, insulin, literature, etc). Instead of a million-dollar hospitalization for DKA.

Phelps said...

It's seductive reasoning, but the numbers show that it doesn't help. They get the thousands in treatment, eat even more donuts, and get the DKA anyways.

Smokeman said...

Anonymous said...

"...The point is to detect it and give them a few thousand dollars of care (doctor visits, test strips, insulin, literature, etc). Instead of a million-dollar hospitalization for DKA."

That would be awesome if it was only a few thousand dollars over the life of a patient. The Diabetes Industry in the US is a 250 billion dollar A YEAR industry. There are two industries to blame, the processed food industry and the medical industry. As long as both are held as untouchable icons of economic success, neither will be held accountable.

There is no winning here. You can't tell a guy in the US that he can't buy bags of Cheesy Puffs any more than you can tell them that they don't "deserve" unlimited health care.

The only possible solution is to reduce the cost of health care through social standardization (RE: Limiting free care and delays in free care.) You want unlimited care? Bring your wallet.

Smokeman said...

Phelps said:
"Giving poor people free doctor visits won't make them healthier. Making poor people into middle class people will make them healthier, and that starts in their heads."

That's not really all that accurate. Being "Middle Class" is no shield against being "unhealthy." You still have the Donut and Cheesy Puff industry conspiring through advertising... which, as a middle class person... you have more access to... driving you to make stupid choices.

It could be argued that being "Middle Class" gives you more access to health care, but does that make you healthier or does that make you more of a cash cow for the health care industry?

Anonymous said...

Well if the obese red states of flyover country no longer want their healthcare subsidized by the svelte coastal blue states then please, repeal obamacare. Who are we to stand in their way...

Unknown said...

There is a reason why humans form tribes, nations and ultimatively states. It is a social drive that makes humans form a "culture" or "civilisation".
It is the opposite of the myth of "let the free market regulate this and we will have paradise". This myth means only that the stronger prey on the weaker. A society a will only be desirable when the society protects the rights of the weaker.
Some services, as GG correctly points out, must never be put in the hands of the "free market". BTW, there is no such thing as a free market, Donald Trump demonstrates this very clearly as he wants to isolate the US from the grip of the free market.
As soon as someone reaches the top in a "free market" system, he will do anything to maintain this position, even changing the system so that if there are setbacks, the debth will get socialised... This is what happened all around the world when the banks messed up and collected public money payed by the taxpaying "poo" people...

Healthcare as such, even the development of new substances is not that expensive. What makes it expensive is the fact that producers DICTATE the prices whenever possible. Over 95% or more of the medical treatment could be done with the use of generics. Pharma producers always come up with "new" pills so that they can charge the price for a "new cure".

The problem i.e. in Germany is that private investors discovered hospitals in the 80's and started buying them from public owners. They then reduced the workforce in the medical segment, hired more employees in the administration and set a fixed ROI quota. While they were only making 8% in other segments, hospitals had to bring 12&, so capital was withdrawn until the quota was met.
Ofc when you want to make huge profits, you treat only cases where you get the most out of it. You then negotiate with healthcare providers about recompensation. They want to make bargains and offer to pay less for the most common treatments. Investors agree and their surgeons then do more of other treatments for which they negotiated a higher rcompensation...

Anonymous said...

It's interesting. For years people like Noam Chomsky gave analysis and criticism of the current global economic system, and are basically portrayed as satan by the right wing.

Steven Bannon sits on the stage at a conservative conference saying basically identical stuff, but dressing it up as "economic nationalism" and "for the tribe", and gets cheered.

Like I say, interesting.

healthypoot said...

The best health care system is simply a free market. We don't remotely have that in the US thanks to welfare and medicare.

Supply and demand. The only way prices comes down is if demand (usage) comes down. Right now the system is designed to waste and over-use a lot of resources.

I think all health insurance should be eliminated except for catastrophic insurance. People should simply pay for their health care as needed. Catastrophic would cover pre-existing conditions moving forward, but people with ALREADY existing conditions would be fucked. Too bad.

I don't believe that the taxpayers should be forced to pay for sick people. Some people are simply too sick, and the price of keeping them alive is too high. They should just die. It isn't heartless. The truly heartless thing is for that person to selfishly be a drain on society just to buy themselves a little extra time. Illness is a tragedy, but spreading the tragedy around doesn't help anything. If anything, it makes it worse, since people lose the incentive to make good decisions about health if they think their risks will be borne by others.

Provi Miner said...

The solution is complicated, first what is needed? the biggest problem is cost of unnecessary care mri for this for that and this other thing, when the doctor had a very good idea of what was wrong to begin with. However because the doctor "might" be wrong the doctor has no choice but to order unnecessary tests to avoid liability. The problem with fixing the liability issue is that it allows bad doctors to survive. And Doctors will generally protect doctors so getting them to self police is stupid. That leaves a whole host of not good options. Really the cure for health care is picking the "least" bad idea and running with it.

Anonymous said...

As a last resort, they would commit a crime and go to prison and get healthcare that way.