Hsieh criticizes coverage mandates for increasing costs, but the examples he cites — “lay midwives, orthotics, and drug-abuse treatment” — are all lower-cost alternatives. It’s better to have midwives handle routine deliveries, and save the OBs for more complicated cases, and it saves money. It’s better to buy special shoes rather than having to treat serious injuries (or pay for electric wheelchairs). It’s better and cheaper to treat drug addicts than to imprison them.
Yes, any mandate reduces individual liberty, but on a scale of liberty-infringement the proposed health care reforms are mild compared to Medicare.
Medicare doesn’t impinge on individual liberty at all (other than having money for it stolen from your paycheck) because no one is forced to use it.
The Massachusetts health care mess illustrates a point that I think has been ignored by universal health care advocates. Namely, that the US probably won’t adopt a program closely related to anything currently existing in the world. Maybe one of those many health care programs would work better than the current mess in the US, but IMHO that’s not what’s going to be adopted. One merely needs to look at Obama’s inability to control his own party in Congress.
The problem is that the real issue with health care in the US is cost growth not universal health care. Solving the latter while not solving the former merely adds cost.
Medicare doesn’t impinge on individual liberty at all (other than having money for it stolen from your paycheck) because no one is forced to use it.
By that standard you don’t have to use RomneyCare either — you have to buy a policy, but you don’t have to make any claims.
The problem is that the real issue with health care in the US is cost growth not universal health care. Solving the latter while not solving the former merely adds cost.
The two are related. To the degree that the private health insurance system has tried to address costs, it has done so by restricting its coverage to healthier/cheaper patients. That may look like cost control, but it’s avoiding the real question, which is how to provide good health care to everyone, including those who need it most, without unmanageable costs.
Once health care reform passes, and universal coverage is established as a baseline requirement, it will be harder for everyone — providers, insurers, and politicians — to hide from the cost issue. That’s already happened in Massachusetts, where (as Hsieh notes) they’re studying alternatives to fee-for-service reimbursement.
Plus, the health care bills that are being debated in Congress do include significant cost cutting steps; see this post by Peter Orszag for details.
The two are related. To the degree that the private health insurance system has tried to address costs, it has done so by restricting its coverage to healthier/cheaper patients. That may look like cost control, but it’s avoiding the real question, which is how to provide good health care to everyone, including those who need it most, without unmanageable costs.
Coincidentally, I was thinking that cheaper healthcare costs would result in more coverage. And I strongly disagree on what the “real question” is. To be blunt, if US health care were half or less what it currently is, we wouldn’t care whether there was universal health insurance or not. Legal US residents would just buy it, if they cared and weren’t already covered.
Well, Karl, the goal of Jim and the Statists (new indie band name) is to destroy the existing insurance market, rebuild the whole thing around cross-subsidization, and then slap the label “insurance” on it like you won’t notice. “New & Improved!” Of course it won’t be a real market because markets tend to reject things like cross-subsidization so that they can create a product whose expected value is worth more than what you pay for — thus establishing an equitable price point.
By rejecting the market, what’s going to happen in the slow-motion train-wreck of Obamacare will be that government will have its thumb on the scale so hard that any genuine information regarding the underlying costs of the production factors will be lost — the socialist problem will rear its ugly head resulting in shortages and surpluses. Most of the folks here will already have been loaded on the Soylent Green conveyor belt when the machine finally grinds to a halt, but I’m young enough that I’ll still be there to remember these days with a big, fat “I told you so” to whisper into the darkness.
It’s better to have midwives handle routine deliveries, and save the OBs for more complicated cases, and it saves money. It’s better to buy special shoes rather than having to treat serious injuries (or pay for electric wheelchairs). It’s better and cheaper to treat drug addicts than to imprison them.
No it’s not, Jim. You throw around this word “better” as if anywhere you’ve made a clear definition of it, but you haven’t, and on the fuzziness of the definition rests your (bogus) argument. Your statements are only true, if they are at all, on average. It’s better on average for midwives to do what look like ordinary deliveries, and restrict OB/GYN attendance to what look like complicated deliveries.
Sure, in a nontrivial number of cases, you’re going to find out you were mistaken, and what looked like an ordinary delivery turned out to be complicated, expert care wasn’t available, and both mother and child died needlessly. Oh well! But don’t worry, you are quite correct that on average this won’t happen very often, and on average things will work out fine.
I am certain the man contemplating the loss of his wife and baby will be comforted by your assurance that on average the state’s rules should’ve worked out fine.
Well what are you going to do (I imagine you saying)? Someone has got to decide whether to have the expensive OB there, or roll the dice with a midwife. Who’s it going to be?
And here’s a suggestion for you. How about you let the patient decide, hmm? How about you let the mother and father in question decide whether their delivery is just fine with a midwife, or whether they are willing to fork out the extra dough to have an OB present? Anything wrong with that?
Well, sure there is, if your and my tax money is paying for it. What did that Representative from Montana say about GM? Now that the taxpayers are footing the bill, GM loses the right to make its own decisions.
And that’s exactly what “public option” or “public health care” means. Because the taxpayers are footing the bill, Congress gets to meddle in those decisions, and they will, you bet. And because Congress by defiinition only cares about average outcomes, they’ll follow just the rules you suggest, and, indeed, as we see in England, all those folks who alas aren’t quite average are just going to get screwed.
Feeling average, are you? Go for it. But if you’re not so happy with being treated as a statistic, a nice little cog in the machine — if you think just maybe you can make better decisions about your life and health than a committee of lawyers in Washington (assisted purely altruistically of course by variious lobbyists), then this is a recipe for the misery that every experiment in top-down “expert” managed economic collectivism brings.
And here’s a suggestion for you. How about you let the patient decide, hmm?
The regulation that Hsieh is complaining about says that patients (in Massachusetts) get to decide, because insurance has to cover the midwife option (for example). It is Hsieh who is arguing that insurance companies shouldn’t have to offer patients this choice.
And that’s exactly what “public option” or “public health care” means. Because the taxpayers are footing the bill, Congress gets to meddle in those decisions, and they will, you bet.
The bill for the “public option” is paid by the insured, not by the taxpayers. It’s an option, so if you don’t like what is or isn’t covered, you can choose a different policy.
To be blunt, if US health care were half or less what it currently is, we wouldn’t care whether there was universal health insurance or not. Legal US residents would just buy it, if they cared and weren’t already covered.
Except that it wouldn’t be available to them — it’d only be cheap for the people who don’t need it. Less-than-universial health care lets insurance companies cheat by cherry-picking the cheapest patients.
One point with respect to Medicare. It can be extremely difficult to opt out of Medicare, because you might also be forced to give up Social Security benefits:
Hence, this herds the over-65 population into Medicare and has essentially destroyed all the private insurance alternatives to Medicare. (There are still private “Medicap” plans intended to supplement but not replace Medicare).
Of course, one is not technically *forced* to participate in Medicare. But the government incentives make it difficult for many over-65 Americans to avoid it.
There is a legal challenge to this rule, but I don’t think it has been resolved yet:
The bill for the “public option” is paid by the insured, not by the taxpayers.
New taxes will be used to prop-up the public option. Read the bill.
Read the CBO analysis. The public option lowers the deficit.
Paul Hsieh – why would anybody want to opt out of Medicare? I have a collection of aged relatives, and they all want, like and use Medicare.
Read the CBO analysis. The public option lowers the deficit.
How about I save my time and not read another useless CBO analysis? The problem is that the CBO has to make certain assumptions about reality that are grossly unjustified, but required by the laws of its existence.
Paul Hsieh – why would anybody want to opt out of Medicare? I have a collection of aged relatives, and they all want, like and use Medicare.
How about if they want to get fast medical care instead of waiting in line? Second, once Medicare benefits have been cut back to reasonable levels, will they still want, like, and use Medicare?
Read the CBO analysis. The public option lowers the deficit.
So what are the new taxes for?
The problem is that the CBO has to make certain assumptions about reality that are grossly unjustified, but required by the laws of its existence.
No, Karl, government programs always cost less than projected. /sarc
…why would anybody want to opt out of Medicare? I have a collection of aged relatives, and they all want, like and use Medicare.
Gosh, I don’t know, Chris, maybe some people just want to do their own thing. Really, are you that insular? I’ve met plenty of old people who complain about the inadequacy of their Medicare coverage. But none of them were related to you, so I guess they don’t exist!
Second, once Medicare benefits have been cut back to reasonable levels, will they still want, like, and use Medicare?
Well, those who are taking money out of the Ponzi scheme are, after decades of paying in, still likely to want to take the money out rather than spend their own money (in effect, paying twice.) It’s the one’s who are working and paying into the Ponzi scheme who are mostly likely to want out.
Karl Hallowell – I have seen no indications of people on Medicare having to wait longer for care any longer than folks on private insurance. This includes not just my personal experience but studies and reading.
Andrea Harris – if you are on Medicare, do you have to file a claim through them? I ask because I really don’t know. If you don’t have to file a claim through Medicare, then you can in fact do your own thing. Regarding “inadequacy of care” I thought that’s why there was a thriving market for Medicare supplemental coverage. Nothing in any bill up for a vote changes that.
Titus – you assume, without any facts, that Medicare coverage will be cut. Except no politician is proposing that – probably because they couldn’t get elected calling for cuts in Medicare.
Titus – you assume, without any facts, that Medicare coverage will be cut.
Straw man.
if you are on Medicare, do you have to file a claim through them? I ask because I really don’t know.
If you have a SS card, you’re automatically enrolled in medicare when you turn 65. Providers are required by law to file claims. You cannot, “do your own thing.”
Regarding “inadequacy of care” I thought that’s why there was a thriving market for Medicare supplemental coverage.
That’s for things that medicare doesn’t cover. It doesn’t help you with the things medicare is supposed to cover.
That should be “SS check” not “SS card”.
“I have seen no indications of people on Medicare having to wait longer for care any longer than folks on private insurance. This includes not just my personal experience but studies and reading.”
Every doctor I visit in Chicago has a sign on their door saying “we are not accepting any new Medicare patients”. You don’t think that has any effect?
What is happening with Medicare is disgraceful – the government dictates pricing, and when the doctors complain that the price is below the cost laws are passed requiring doctors to administer the treatment anyway.
Titus – you assume, without any facts, that Medicare coverage will be cut.
Chris, even if Titus said exactly what you claim he said, there’s one piece of evidence that on its own indicates Medicare will be cut. Namely, that the cost of the program is both increasing and forecast to continue to increase at a rate far faster than tax revenue for the US.
Titus – you keep telling me Medicare isn’t working. My relatives tell me it is. Who am I to believe – somebody I couldn’t pick out of a line-up or people I’ve known my whole life? Also, when AARP says Medigap Plans F, I and J pay 100% of these excess charges, that’s wrong?
David – I’m really not trying to be obtuse, but why would somebody want to change doctors at age 65? By then wouldn’t you already have a doctor?
Karl Hallowell – the whole point of this health care reform exercise is to reduce total costs, thus reduce the amount we have to pay to support Medicare, by reducing total health care costs.
Also, you may not like it, but we do have options with regards to Medicaid other than cutting benefits. For example, we stop taxing income for Medicare at around $90K. That can change. We could actually let people opt out (although I suspect damn few would).
Titus – you keep telling me Medicare isn’t working.
You’re confusing me with other commentators here. I’m the one who’s telling you that the machine of mutual cannibalism is slowly falling apart. You don’t see it now because your time horizon is, understandably, much shorter than mine. Your “Medicare” plan as it exists today largely does not concern me. By the time I’m old enough to even think about “Medicare” four decades will have elapsed, and all of today’s brouhaha will be irrelevant. When I look at these Congressional monstrosities being offered, I’m looking their future inexorable transmogrifications.
That can change. We could actually let people opt out
Hahahahaha…yes, the brain-trust of Pelosi, Reid and flavor-of-the-month would seriously let young people “opt out” and keep their payroll tax money. Good one!
Karl Hallowell – the whole point of this health care reform exercise is to reduce total costs, thus reduce the amount we have to pay to support Medicare, by reducing total health care costs.
Hsieh criticizes coverage mandates for increasing costs, but the examples he cites — “lay midwives, orthotics, and drug-abuse treatment” — are all lower-cost alternatives. It’s better to have midwives handle routine deliveries, and save the OBs for more complicated cases, and it saves money. It’s better to buy special shoes rather than having to treat serious injuries (or pay for electric wheelchairs). It’s better and cheaper to treat drug addicts than to imprison them.
Yes, any mandate reduces individual liberty, but on a scale of liberty-infringement the proposed health care reforms are mild compared to Medicare.
Medicare doesn’t impinge on individual liberty at all (other than having money for it stolen from your paycheck) because no one is forced to use it.
The Massachusetts health care mess illustrates a point that I think has been ignored by universal health care advocates. Namely, that the US probably won’t adopt a program closely related to anything currently existing in the world. Maybe one of those many health care programs would work better than the current mess in the US, but IMHO that’s not what’s going to be adopted. One merely needs to look at Obama’s inability to control his own party in Congress.
The problem is that the real issue with health care in the US is cost growth not universal health care. Solving the latter while not solving the former merely adds cost.
Medicare doesn’t impinge on individual liberty at all (other than having money for it stolen from your paycheck) because no one is forced to use it.
By that standard you don’t have to use RomneyCare either — you have to buy a policy, but you don’t have to make any claims.
The problem is that the real issue with health care in the US is cost growth not universal health care. Solving the latter while not solving the former merely adds cost.
The two are related. To the degree that the private health insurance system has tried to address costs, it has done so by restricting its coverage to healthier/cheaper patients. That may look like cost control, but it’s avoiding the real question, which is how to provide good health care to everyone, including those who need it most, without unmanageable costs.
Once health care reform passes, and universal coverage is established as a baseline requirement, it will be harder for everyone — providers, insurers, and politicians — to hide from the cost issue. That’s already happened in Massachusetts, where (as Hsieh notes) they’re studying alternatives to fee-for-service reimbursement.
Plus, the health care bills that are being debated in Congress do include significant cost cutting steps; see this post by Peter Orszag for details.
The two are related. To the degree that the private health insurance system has tried to address costs, it has done so by restricting its coverage to healthier/cheaper patients. That may look like cost control, but it’s avoiding the real question, which is how to provide good health care to everyone, including those who need it most, without unmanageable costs.
Coincidentally, I was thinking that cheaper healthcare costs would result in more coverage. And I strongly disagree on what the “real question” is. To be blunt, if US health care were half or less what it currently is, we wouldn’t care whether there was universal health insurance or not. Legal US residents would just buy it, if they cared and weren’t already covered.
Well, Karl, the goal of Jim and the Statists (new indie band name) is to destroy the existing insurance market, rebuild the whole thing around cross-subsidization, and then slap the label “insurance” on it like you won’t notice. “New & Improved!” Of course it won’t be a real market because markets tend to reject things like cross-subsidization so that they can create a product whose expected value is worth more than what you pay for — thus establishing an equitable price point.
By rejecting the market, what’s going to happen in the slow-motion train-wreck of Obamacare will be that government will have its thumb on the scale so hard that any genuine information regarding the underlying costs of the production factors will be lost — the socialist problem will rear its ugly head resulting in shortages and surpluses. Most of the folks here will already have been loaded on the Soylent Green conveyor belt when the machine finally grinds to a halt, but I’m young enough that I’ll still be there to remember these days with a big, fat “I told you so” to whisper into the darkness.
It’s better to have midwives handle routine deliveries, and save the OBs for more complicated cases, and it saves money. It’s better to buy special shoes rather than having to treat serious injuries (or pay for electric wheelchairs). It’s better and cheaper to treat drug addicts than to imprison them.
No it’s not, Jim. You throw around this word “better” as if anywhere you’ve made a clear definition of it, but you haven’t, and on the fuzziness of the definition rests your (bogus) argument. Your statements are only true, if they are at all, on average. It’s better on average for midwives to do what look like ordinary deliveries, and restrict OB/GYN attendance to what look like complicated deliveries.
Sure, in a nontrivial number of cases, you’re going to find out you were mistaken, and what looked like an ordinary delivery turned out to be complicated, expert care wasn’t available, and both mother and child died needlessly. Oh well! But don’t worry, you are quite correct that on average this won’t happen very often, and on average things will work out fine.
I am certain the man contemplating the loss of his wife and baby will be comforted by your assurance that on average the state’s rules should’ve worked out fine.
Well what are you going to do (I imagine you saying)? Someone has got to decide whether to have the expensive OB there, or roll the dice with a midwife. Who’s it going to be?
And here’s a suggestion for you. How about you let the patient decide, hmm? How about you let the mother and father in question decide whether their delivery is just fine with a midwife, or whether they are willing to fork out the extra dough to have an OB present? Anything wrong with that?
Well, sure there is, if your and my tax money is paying for it. What did that Representative from Montana say about GM? Now that the taxpayers are footing the bill, GM loses the right to make its own decisions.
And that’s exactly what “public option” or “public health care” means. Because the taxpayers are footing the bill, Congress gets to meddle in those decisions, and they will, you bet. And because Congress by defiinition only cares about average outcomes, they’ll follow just the rules you suggest, and, indeed, as we see in England, all those folks who alas aren’t quite average are just going to get screwed.
Feeling average, are you? Go for it. But if you’re not so happy with being treated as a statistic, a nice little cog in the machine — if you think just maybe you can make better decisions about your life and health than a committee of lawyers in Washington (assisted purely altruistically of course by variious lobbyists), then this is a recipe for the misery that every experiment in top-down “expert” managed economic collectivism brings.
And here’s a suggestion for you. How about you let the patient decide, hmm?
The regulation that Hsieh is complaining about says that patients (in Massachusetts) get to decide, because insurance has to cover the midwife option (for example). It is Hsieh who is arguing that insurance companies shouldn’t have to offer patients this choice.
And that’s exactly what “public option” or “public health care” means. Because the taxpayers are footing the bill, Congress gets to meddle in those decisions, and they will, you bet.
The bill for the “public option” is paid by the insured, not by the taxpayers. It’s an option, so if you don’t like what is or isn’t covered, you can choose a different policy.
To be blunt, if US health care were half or less what it currently is, we wouldn’t care whether there was universal health insurance or not. Legal US residents would just buy it, if they cared and weren’t already covered.
Except that it wouldn’t be available to them — it’d only be cheap for the people who don’t need it. Less-than-universial health care lets insurance companies cheat by cherry-picking the cheapest patients.
One point with respect to Medicare. It can be extremely difficult to opt out of Medicare, because you might also be forced to give up Social Security benefits:
http://www.usatoday.com/news/washington/2008-10-08-3161814306_x.htm
Hence, this herds the over-65 population into Medicare and has essentially destroyed all the private insurance alternatives to Medicare. (There are still private “Medicap” plans intended to supplement but not replace Medicare).
Of course, one is not technically *forced* to participate in Medicare. But the government incentives make it difficult for many over-65 Americans to avoid it.
There is a legal challenge to this rule, but I don’t think it has been resolved yet:
http://news.findlaw.com/andrews/h/hea/20091007/20091007_hall.html
New taxes will be used to prop-up the public option. Read the bill.
Read the CBO analysis. The public option lowers the deficit.
Paul Hsieh – why would anybody want to opt out of Medicare? I have a collection of aged relatives, and they all want, like and use Medicare.
Read the CBO analysis. The public option lowers the deficit.
How about I save my time and not read another useless CBO analysis? The problem is that the CBO has to make certain assumptions about reality that are grossly unjustified, but required by the laws of its existence.
Paul Hsieh – why would anybody want to opt out of Medicare? I have a collection of aged relatives, and they all want, like and use Medicare.
How about if they want to get fast medical care instead of waiting in line? Second, once Medicare benefits have been cut back to reasonable levels, will they still want, like, and use Medicare?
So what are the new taxes for?
No, Karl, government programs always cost less than projected. /sarc
Gosh, I don’t know, Chris, maybe some people just want to do their own thing. Really, are you that insular? I’ve met plenty of old people who complain about the inadequacy of their Medicare coverage. But none of them were related to you, so I guess they don’t exist!
Well, those who are taking money out of the Ponzi scheme are, after decades of paying in, still likely to want to take the money out rather than spend their own money (in effect, paying twice.) It’s the one’s who are working and paying into the Ponzi scheme who are mostly likely to want out.
Karl Hallowell – I have seen no indications of people on Medicare having to wait longer for care any longer than folks on private insurance. This includes not just my personal experience but studies and reading.
Andrea Harris – if you are on Medicare, do you have to file a claim through them? I ask because I really don’t know. If you don’t have to file a claim through Medicare, then you can in fact do your own thing. Regarding “inadequacy of care” I thought that’s why there was a thriving market for Medicare supplemental coverage. Nothing in any bill up for a vote changes that.
Titus – you assume, without any facts, that Medicare coverage will be cut. Except no politician is proposing that – probably because they couldn’t get elected calling for cuts in Medicare.
Straw man.
If you have a SS card, you’re automatically enrolled in medicare when you turn 65. Providers are required by law to file claims. You cannot, “do your own thing.”
That’s for things that medicare doesn’t cover. It doesn’t help you with the things medicare is supposed to cover.
That should be “SS check” not “SS card”.
“I have seen no indications of people on Medicare having to wait longer for care any longer than folks on private insurance. This includes not just my personal experience but studies and reading.”
Every doctor I visit in Chicago has a sign on their door saying “we are not accepting any new Medicare patients”. You don’t think that has any effect?
What is happening with Medicare is disgraceful – the government dictates pricing, and when the doctors complain that the price is below the cost laws are passed requiring doctors to administer the treatment anyway.
Titus – you assume, without any facts, that Medicare coverage will be cut.
Chris, even if Titus said exactly what you claim he said, there’s one piece of evidence that on its own indicates Medicare will be cut. Namely, that the cost of the program is both increasing and forecast to continue to increase at a rate far faster than tax revenue for the US.
Titus – you keep telling me Medicare isn’t working. My relatives tell me it is. Who am I to believe – somebody I couldn’t pick out of a line-up or people I’ve known my whole life? Also, when AARP says Medigap Plans F, I and J pay 100% of these excess charges, that’s wrong?
David – I’m really not trying to be obtuse, but why would somebody want to change doctors at age 65? By then wouldn’t you already have a doctor?
Karl Hallowell – the whole point of this health care reform exercise is to reduce total costs, thus reduce the amount we have to pay to support Medicare, by reducing total health care costs.
Also, you may not like it, but we do have options with regards to Medicaid other than cutting benefits. For example, we stop taxing income for Medicare at around $90K. That can change. We could actually let people opt out (although I suspect damn few would).
You’re confusing me with other commentators here. I’m the one who’s telling you that the machine of mutual cannibalism is slowly falling apart. You don’t see it now because your time horizon is, understandably, much shorter than mine. Your “Medicare” plan as it exists today largely does not concern me. By the time I’m old enough to even think about “Medicare” four decades will have elapsed, and all of today’s brouhaha will be irrelevant. When I look at these Congressional monstrosities being offered, I’m looking their future inexorable transmogrifications.
Hahahahaha…yes, the brain-trust of Pelosi, Reid and flavor-of-the-month would seriously let young people “opt out” and keep their payroll tax money. Good one!
Karl Hallowell – the whole point of this health care reform exercise is to reduce total costs, thus reduce the amount we have to pay to support Medicare, by reducing total health care costs.
So when are they going to start trying?