My previous post, Healthcare in America is Broken, How Did it Get that Way? elicited great response! This week week I hope to administer "the antidote" to the health care crisis.
@jrandom42 - of course Enron is an easy target. Doesn't regulation of social programs lead to corruption in the government? Just ask the federal government's pilfering of the Social Security Trust Fund.
@Vanessa – (if anyone complains about the excessive length of this response, blame Vanessa, she asked a million difficult questions!) : P
I think where we differ philosophically will answer most of your questions.
Here is where I stand:
I believe in limited government.
I don’t believe health care is a right.
I believe excess government spending, whether it is on education, arts, whales, military, health care, or donuts is immoral. How do we define “excess”? That is a philosophical discussion, and I’m going to focus on economics, so I won’t address that here, but in my book many of our current social programs fit the “excess” bill for me, and a universal health care program would add to that. I do not place a negative value judgment on the concept. Of course the notion of providing affordable health care to all is a nice idea, however, I cannot let every nice idea the government has sway me. I cannot cherry pick ways to vote myself more money or favors, which is what happens when we have people voting in social programs they prefer. I use the word prefer, because there are many people opposed to universal health care, and that is their right.
So, I will answer your questions from this vantage point.
You asked, “How would you make catastrophic insurance affordable?” As a result of deregulation, insurance will most likely be more affordable, however, there is no guarantee that it will be acceptable to everyone (but I propose Medicaid and Medicare also be deregulated for the poorest consumers). I think when people indicate they want better health care at much lower prices than they are actually worth, they show only a lack of understanding of economic principles. It would be as if you approached GM and asked them, “How are you going to make sure Cadillacs are affordable to everyone, when most people can only afford a Chevy Aveo?” It won’t happen, furthermore, to force GM to sell Cadillacs at reduced prices would be immoral and bankrupt the company.
You asked, “What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?” They will have to pay the difference out of pocket. I’m certain financing options would be available.
You asked, “How do people with preexisting conditions find an affordable policy?” I don’t know, however anyone else would find a policy. For example, there might be a health insurance company who seeks out moral people as part of their business plan. They could market their product as an increased premium for being pooled in with people of pre-existing conditions. I can see that many people of faith (as you mentioned in your post) who often try to help those in need would see this as a wonderful opportunity. The company would benefit from matching needs of many. In fact, that is a great idea, and I would probably go into the insurance business myself! So, anyone who reads this, free idea, it’s all yours.
You asked, “By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?” Yes, it would cost businesses who provide employees coverage more, and that is precisely the point. In my previous post, I indicated that the third-party tax system is a major contributor to increased costs, you can re-read that post, and if I wasn’t clear, let me know. Removing the tax code will cause employers to reduce their health care coverage, which is a good thing. It puts the cost of care back into the hands of the people who see the costs. There is nothing about this action that would cause prices to increase either, it would cause a decrease of costs because there would be more transparency, and more people would not elect unnecessary procedures.
You asked, “What happens to the quality of care if industry regulates the quality of its products itself?” I think what you are edging towards is that you might get some shitty companies. You'd be right. However, they will soon go out of business. No one likes being swindled.
Additionally, there is nothing about my plan that indicates the industry gets to solely regulate themselves. I have talked about this before, but there are many ways to control quality through unrelated private entities. Government appointed boards are not the only arbiter of quality.
Do you not make judgments of quality every day? Would you not trust a group of intelligent people like yourself to regulate the health care industry? In fact, if someone took a poll, I’d put you on top of the list! You are clearly intelligent and passionate about this topic, and I’d assume, committed to quality if you sat on a board. Additionally, I gave you some examples on a previous post. (J.D. Powers, The National Association of Realtors, etc.)
Furthermore, encouraging voluntary contracts would increase choice, quality, and options. A contract would clearly outline duties and expectations of both parties, hence, quality control, and reduce costly tort cases after care has been given.
You asked, “How is the consumer protected if they do not agree on the price?” I’m not sure I totally understand this question. The consumer protects themself. If they do not like a price, they are free to go elsewhere. If you mean, how do the impoverished get health care? I proposed that the current emergency care remain, and also, if the government wished to create an opt-in program where those who were taxed for health care received the benefit, that would be acceptable, provided the rest of the health care market was deregulated. I also mentioned consumers could choose programs by state. Under this option, there would be considerable choice, and ability to “vote” by using the state program whose costs and regulations you prefer. Furthermore, Medicare and Medicaid should be liberalized, this would allow low-income consumers more choice, freedom and reduced costs. To go into detail would take more space that I should take right now.
You asked, “Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)”
No, I would never consider that because it would be completely antithetical to economic thought.
As for the Swiss having the most market-oriented system, and their out of pocket costs being high has to do with a few things:
1. The market is a total ruse, and participation is compulsory, i.e. unlike any free market. For example, can you imagine going into a store and being required to buy something whether you felt like it or not, but by the mere act of showing up, you were forced to purchase? Do you know what that does to prices? Think about it. If everyone who walked into Target was forced to purchase just by showing up, it would dramatically increase demand for goods in Target, and therefore, prices for everything in the store. This is a basic economic truth. So, can you see, no actual market works that way?
So, prices are fixed within a band. If you are unfamiliar with the effects of price floors and ceilings, it is critical to comprehend here to understand why a fake market distorts prices, supply, and demand. Let’s say there are 10 men who need a job. 8 are willing to work for $5, 2 are willing to work for $4. An employer comes along, and is willing to pay 10 men $5. Everyone wins. However, let’s say the government passed legislation setting minimum wage at $8. Once workers hear about this, there will be at least 15 men willing to work for $8, whereas the employer won’t be able to afford even the 10 he started out with. He’ll have to lay off some people in order to break even. This is a case of too much demand and not enough supply.
As for price ceilings, which is what we see with health care, take this scenario: You are looking for an apartment and think LA is a good location because of rent control. You see an apartment you’d be willing to pay $500/mth for, but as luck would have it, it costs only $400! Then you notice 20 other people are on a waiting list for it since the price is artificially low. This is a case of not enough supply and too much demand.
So, with those examples firmly in mind, can you see how the fake market in Switzerland cannot work like a normal market? When there are price ceilings for services, and the government only covers a small portion of these services, the remaining costs have to be made up somewhere.
Medical care is not something you can create an artificial price for. For example, getting an MRI is not a right, it is a good. A good with value like anything else. There is technology required to build it, doctors needed to run it and interpret results, and technicians to keep it running and updated. If the price of this service is $1000, then who is the government to call it $500? Do they expect doctors to work for free? I suppose they do. Well, the point is, this is what has happened in Switzerland, but the costs must be made up somewhere, therefore, it comes out of pocket.
2. Another factor is that most Swiss citizens opt for the low cost, high deductible plan, whereas they could choose a higher premium, lower deductible which might theoretically lower their bills. I would argue this is a psychological issue - as they are led to believe their costs will be covered by the compulsory universal plan.
3. A third factor is that the Swiss plan is organized by geography, so that the healthy subsidize the less healthy. (With the exception of non-smokers, who enjoy a reduced premium.)
If you’d like, I’d be happy to discuss your preferred international model.
Like I said, the level of detail we are getting into requires far more detailed study and analysis. You are testing me, for sure!
I hope this clarifies some of my thought process, and if not, ask away...
To be extremely clear, you are not speaking to someone ignorant of the immense pain poor health care creates for patients and their families.
Additionally, I am terribly sorry for your personal struggles. If you'd like to talk privately, I would elucidate some of my own family struggles regarding the health care system, but do not feel comfortable doing it here.
You are bringing up difficult issues where there is one answer that is a cure-all. You have every right to feel frustration and outrage, however, a solution cannot be found in universal health care, despite many people wanting it so desperately.
The point of my post it to describe ways to improve health care overall, not to ensure every human being gets treated fairly 100% of the time. That is an unrealistic goal, and not possible under any system.
You may want to look into my solution for pre-existing conditions in comments to Vanessa. The healthy can subsidize the less healthy by choice, not only by force. I cannot imagine there would not be a group of citizens willing to participate in group health insurance where someone with pre-existing conditions would be allowed to participate as well.
In fact, many fraternal unions used to have such policies, where coverage was determined by whomever joined the union, which could be organized by various cultural interests, not health alone.
Bravo-even for a mere housewife, jk. No, this was laid out as a great foundation to a wonderful healthcare system. Universal socialized healthcare is NOT the answer and I get very frustrated listening to the people in favor of it.
It's nice to see all of your ideas out there although of course we both know that we disagree on some things.
I do agree with some of the proposed changes in your antidote. Greater transparency of cost might help to reduce overuse of services and resources and HSAs could be a helpful tool for medical expenses.
I do have a few questions about a few things.
-How would you make catastrophic insurance affordable?
-What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?
-How do people with preexisting conditions find an affordable policy?
-By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?
-What happens to the quality of care if industry regulates the quality of its products itself?
-How is the consumer protected if they do not agree on the price?
-Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)
Nicely written and research post. Looking forward to hearing your answers.
August 20, 2008 10:10 pm
Deadhedge
Where is the cost containment provisions? Massachusetts expanded coverage but their costs are much higher than projected since they didn't address volume-based system. The more providers do, the more they make.
Also, we have tons of high tech devices and drugs that are over-used when cheaper devices or drugs are just as good. We all want the latest and greatest and we'll demand it.
My wife went to a lactation specialist with our son. I found out that the lactation specialists bills both my wife and my son for the visit. That's an example of provider billing where I feel like they are double dipping.
I see that you have adjusted who's paying for health care to make it more equitable. But other than tort reform what's going to prevent provider costs and new technologies from continue to increasing?
I think it's important to accept that healthcare prices may rise, and that it's okay. Prices rise on everything else as well, partly due to inflation, but with other factors in play as well.
The problem that plagues the reasoning most people apply to this issue is that they expect by having the government pay for healthcare, the whole process will automatically get cheaper by cutting out some huge profit somewhere. I'm not sure that it would actually work that way. The government is by no means omnipotent and cannot guarantee perfectly free and cheap healthcare. You can't get something for nothing, not even from a government program. There are going to be costs to running that program.
Perfection isn't possible. What we have to aim for is not perfection, but the best possible solution. Some say that it's perfectly obvious that a government run program is that solution, but I don't think it's quite that simple. If you want a good product, you usually have to pay a premium for it, no matter who's selling it.
August 21, 2008 3:03 am
jrandom42
Didn't deregulation of the energy market lead to a dramatic reduction in its cost? Ask Enron!
@Vanessa - I think this comment form doesn't even allow the length of comment I just wrote. I'll just try to cut and paste sections, which might work better, since tackling one question might tackle another?
Here's Part 1 I guess:
I think where we differ philosophically will “answer” most of your questions. Here is where I stand:
I believe in limited government.
I don’t believe health care is a right.
I believe excess government spending, whether it is on education, arts, whales, military, health care, or donuts is immoral. How do we define “excess”? That is a philosophical discussion, and I’m going to focus on economics, so I won’t address that here, but in my book many of our current social programs fit the “excess” bill for me, and a universal health care program would add to that. I do not place a negative value judgment on the concept. Of course the notion of providing affordable health care to all is a nice idea, however, I cannot let every nice idea the government has sway me. I cannot cherry pick ways to vote myself more money or favors, which is what happens when we have people voting in social programs they prefer. I use the word prefer, because there are many people opposed to universal health care, and that is their right.
I will answer your questions from this vantage point.
You asked, “How would you make catastrophic insurance affordable?” As a result of deregulation, insurance will most likely be more affordable, however, there is no guarantee that it will be acceptable to everyone. I think when people indicate they want better health care at much lower prices than they are actually worth, they show only a lack of understanding of economic principles. It would be as if you approached GM and asked them, “How are you going to make sure Cadillacs are affordable to everyone, when most people can only afford a Chevy Aveo?” It won’t happen, furthermore, to force GM to sell Cadillacs at reduced prices would be immoral and bankrupt the company.
You asked, “What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?” They will have to pay the difference out of pocket. I’m certain financing options would be available.
You asked, “How do people with preexisting conditions find an affordable policy?” Similar to how anyone else would find a policy. For example, there might be a health insurance company who seeks out moral people as part of their business plan. They could market their product as an increased premium for being pooled in with people of pre-existing conditions. I can see that many people of faith (as you mentioned in your post) who often try to help those in need would see this as a wonderful opportunity. The company would benefit from matching needs of many. In fact, that is a great idea, and I would probably go into the insurance business myself! So, anyone who reads this, free idea, it’s all yours.
Milena - I agree with all your points on how can we maintain a high level of innovation, reduce costs, and provide coverage to anyone who wants it. Something needs to be done and every little effort is a step in the right direction.
I am dedicated to promoting health care transparency and helping consumers find the best value for health care services. My mission is to inform and educate consumers about health care prices and encourage a consumer driven market that will help lower costs, promote innovation, expand choiceds and increase patient access to better medical care.
I launched a grassroots initiative that enables consumers to post/share prices they paid for actual health care services. The website www.outofpocket.com, is a community search engine to help consumers look up prices, find out what others paid for similar services and find the best value for routine health care services.
But doesn't deregulation in social programs result in private corruption? Enron was just the tip of the iceberg. What about Countrywide? WorldCom? Boeing? We're already seeing the fruits of deregulation on a grand scale.
No, deregulation doesn't result in private corruption. You are mistaking correlation with causation. Just because private companies have committed fraud doesn't mean private companies always commit fraud.
You have provided the most obvious business failures in recent times, and I think, a cheap shot. Most private corporations are not committing massive fraud, they are mostly made up of honest, hard-working individuals.
Furthermore, I could highlight many more government fraud schemes. The point is, fraud is indemic in any system, not caused by a particular system.
Anyways, in my article, I clearly said anyone who wants the government handling their affairs, should have the choice, but I have every right to want private entities to run mine.
All right! What a great cause. I'm super excited about your site and can't wait to check it out!
August 21, 2008 10:42 pm
Matt
Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.
It's also worth noting that the American Medical Association supports universal health care.
August 22, 2008 2:44 pm
jrandom42
And what happens when that abuse threatens people's lives? Is it just a calculation between the cost of business or the cost of lawsuits resulting from deaths?
You asked, “By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?” Yes, it would cost businesses who provide employees coverage more, and that is precisely the point. In my previous post, I indicated that the third-party tax system is a major contributor to increased costs, you can re-read that post, and if I wasn’t clear, let me know. Removing the tax code will cause employers to reduce their health care coverage, which is a good thing. It puts the cost of care back into the hands of the people who see the costs. There is nothing about this action that would cause prices to increase either, it would cause a decrease of costs because there would be more transparency, and more people would not elect unnecessary procedures.
You asked, “What happens to the quality of care if industry regulates the quality of its products itself?” I don’t know. You might get some shitty companies. They will soon go out of business. Additionally, there is nothing about my plan that indicates the industry gets to solely regulate themselves. I have talked about this before, but there are many ways to control quality through unrelated private entities. Government appointed boards are not the only arbiter of quality. Do you not make judgments of quality every day. Would you not trust a group of intelligent people like yourself to regulate the health care industry? In fact, if someone took a poll, I’d put you on top of the list! You are clearly intelligent and passionate about this topic, and I’d assume, committed to quality if you sat on a board. Additionally, I gave you some examples on your own post. (J.D. Powers, The National Association of Realtors, etc.) Furthermore, encouraging voluntary contracts would increase choice, quality, and options. A contract would clearly outline duties and expectations of both parties, hence, quality control, and reduce costly tort cases after care has been given.
You asked, “How is the consumer protected if they do not agree on the price?” I’m not sure I totally understand this question. The consumer protects themself. If they do not like a price, they are free to go elsewhere. If you mean, how do the impoverished get health care? I proposed that the current emergency care remain, and also, if the government wished to create an opt-in program where those who were taxed for health care received the benefit, that would be acceptable, provided the rest of the health care market was deregulated. I also mentioned consumers could choose programs by state. Under this option, there would be considerable choice, and ability to “vote” by using the state program whose costs and regulations you prefer. Furthermore, Medicare and Medicaid should be liberalized, this would allow low-income consumers more choice, freedom and reduced costs. To go into detail would take more space that I should take right now.
@Vanessa - many people support universal health care, of course, I'm just arguing that doesn't necessarily mean it's right. Many people support the war too.
August 22, 2008 4:28 pm
jrandom42
There was a story about 6 months ago where a young girl died, because her health insurer denied the procedure, and then bowed to public pressure and allowed it. She died before it could happen, but her doctors did say that she would have lived, if they had gotten approval in a timely fashion.
I'm sure you feel the police will arrest those responsible for her death and bring them to justice.
@jrandom42 - life is terribly unfair. However, I'm not sure what you are asking me here. Do I feel the police will arrest those responsible? I cannot
predict the future, so I don't know.
I am not in a position to personally seek justice for this girl and her family. If there was wrong-doing causing bodily injury, this girl's family or others who are so inclined have the freedom to take legal action.
I think you are missing my point entirely, so I'll repeat it. Just because certain individuals or entities abuse freedom isn't grounds for eliminating freedom.
For example, if person A calls and threatens person B repeatedly, and argues that they are simply exercising their free speech, they would be wrong. They would be causing another person harm, and should have their freedom to take that action revoked. However, their action would not be grounds for eliminating free speech entirely! Do you understand where I'm coming from?
You keep offering horrible, isolated incidents which I do not disagree, should be dealth with through legal action, but I do not agree that they provide any logical basis for promoting unconstitutional behavior and restricting freedoms of all other honest people as a result.
If you are suggesting, by this horrifying story of neglect, that the government would somehow ensure things like you elucidate would never happened again, you are sorely mistaken.
August 22, 2008 5:57 pm
jrandom42
So what happens to healthcare when the insurer says, "Sorry, we can save your child's life, but it's not cost effective for us to do so. Accept it, make their last days as confortable as you can and move on."
Or as my wife has heard, "Sorry, we can't cover you because of your pre-existing conditions. good luck in finding someone who will."
@jrandom42 - forgive me, I meant to say, "there is no one answer that is a cure-all."
August 22, 2008 7:48 pm
jrandom42
"I cannot imagine there would not be a group of citizens willing to participate in group health insurance where someone with pre-existing conditions would be allowed to participate as well."
Well, Regence Blue Cross, Cigna, and HealthSouth has already chosen not to cover her, even when we offered to pay over $2,750/mo to get her covered. And these are only the biggest ones to turn us down.
According to a rep from Blue Cross, "We can spend our money more effectively than giving her coverage. It's not worth it to us to even think about covering her, since these conditions will probably be the cause of her death the end."
You say there is no cure-all. So who does decide how much the life of my wife, child or loved one is worth to save, especially when the conditions they suffer are cureable? How do you balance the decision of cost versus life? Or should I just "accept that this is the way it is, that these conditions will end up killing her without treatment, and move on"?
@jrandom42 - I apologize if you misunderstand that quote, to clarify, it is from the point of reference of the proposals outlined in my post, not the current state of affairs. I'm well aware people are currently denied care, which is horrible. My first post in this series was entirely based on that premise.
You are asking me questions of a highly philosophic and esoteric nature, of which I am not in a place to provide answers. These are distinct from issues of economics which I am addressing in my post.
Neither my plan, nor universal health care could guarantee your family anything. However, if you believe otherwise, my plan also provides that individuals interested in government-provided care should be allowed to use it. It would be unreasonable to deny people that choice.
However, there is a wealth of rational, logical, scholarly thought which indicates a system based on market principles (which we do not currently enjoy) would provide greater choice, quality, and reduced cost.
Sorry this is a monumental undertaking (if anyone is annoyed by this, Vanessa asked a number of great questions that deserve a response)
You asked, “Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)”
No, I did not consider that because it would be antithetical to economic thought.
As for the Swiss having the most market-oriented system, and their out of pocket costs being high has to do with a few things:
1. The market is a ruse, and participation is compulsory, i.e. unlike any free market. For example, can you imagine going into a store and being required to buy something whether you felt like it or not, but by the mere act of showing up, you were forced to purchase? Do you know what that does to prices? Think about it. If everyone who walked into Target was forced to purchase just by showing up, it would dramatically increase demand for goods in Target. This is a basic, accepted economic principle. So, can you see, no actual market works that way?
Therefore prices are fixed within a band. If you are unfamiliar with the effects of price floors and ceilings, it is critical to comprehend here to understand why a fake market distorts prices, supply, and demand. Let’s say there are 10 men who need a job. 8 are willing to work for $5, 2 are willing to work for $4. An employer comes along, and is willing to pay 10 men $5. Everyone wins. However, let’s say the government passed legislation setting minimum wage at $8. Once workers hear about this, there will be at least 15 men willing to work for $8, whereas the employer won’t be able to afford even the 10 he started out with. He’ll have to lay off some people in order to break even. This is a case of too much demand and not enough supply.
As for price ceilings, which is what we see with health care, take this scenario: You are looking for an apartment and think LA is a good location because of rent control. You see an apartment you’d be willing to pay $500/mth for, but as luck would have it, it costs only $400! Then you notice 20 other people are on a waiting list for it since the price is artificially low. This is a case of not enough supply and too much demand.
So, with those examples firmly in mind, can you see how the fake market in Switzerland cannot work like a normal market? When there are price ceilings for services, and the government only covers a small portion of these services, the remaining costs have to be made up somewhere. Medical care is not something you can create an artificial price for.
Getting an MRI is not a right, it is a good. A good with value. There is technology required to build it, doctors needed to run it and interpret results, and technicians to keep it running and updated. If the price of this service is $1000, then who is the government to call it $500? Do they expect doctors to work for free? I suppose they do. Well, the point is, this is what has happened in Switzerland, but the costs must be made up somewhere, therefore, it comes out of pocket.
2. Another factor is that most Swiss citizens opt for the low cost, high deductible plan, whereas they could choose a higher premium, lower deductible which might theoretically lower their bills. This is a psychological issue - as they are led to believe their costs will be covered by the compulsory universal plan.
3. A third factor is that the Swiss plan is organized by geography, so that the healthy subsidize the less healthy by force, not by choice.
If you’d like, I’d be happy to discuss your preferred international model.
Like I said, the level of detail we are getting into requires far more detailed study and analysis. You are testing me, for sure!
August 22, 2008 8:47 pm
jrandom42
My apologies. From reading the title of your post "The Antidote: How to Solve the Healthcare Dilemma", I misunderstood your premise.
I thought you were going to outline a solution to the problem of 47 million people without healthcare, and address how the market could overcome the barriers preventing those who couldn't afford or qualify for private healthcare insurance.
My mistake was in assuming that this was the real dilemma.
So, to question part of your reply to Vanessa, if the healthy choose not to subsidize care for the less healthy, and not forced to care for them, shouldn't we just simply shoot them and get it over with and move on?
@jrandom42 - I have provided what I believe is the best solution. I would not propose shooting anyone.
@Deadhedge - Now for your questions.
You asked, "Where is the cost containment provisions?" I have not included any, and I provided my reasons to Vanessa above (see price ceiling or MRI examples).
I philosophically oppose government subsidies, which is why my plan did not provide for that. When a doctor works, his education, training, time, and all the other elements that go into care cost something. I don't know what that price is. What I do know is that prices can only be determined by a market, where buyers and sellers decide. When the government interferes, it creats a host of other problems which I cannot outline here because of time and space constraints.
If I haven't answered your question from my point of view satisfactorily, please let me know.
@All -
I'm well aware my opinions are unpopular and my intention is not to unduly upset people, but to offer my point of view.
There is nothing that would ensure prices stay low enough for everyone to be satisfied with the result. That is life. Anyone who promises you that universal health care will be free and of better quality is lying. If they tell you it will be "low-cost" I believe that is a lie to, as we will pay non-price consequences by degraded care, rationing, wait times, etc.
With deregulation, these patients may have been able to get life-saving experimental treatments of their own volition. Instead they waited and perished. Again, deregulation would have solved this.
One thing I forgot to make clear, was when I proposed to "correct the tax code" by disincentivizing employer health care provisions, was to put the tax advantage into the hands of the individual, by giving tax credits to consumers who do have to purchase their own health care.
34 RESPONSES TO "THE ANTIDOTE: HOW TO SOLVE THE HEALTHCARE DILEMMA"
@jrandom42 - of course Enron is an easy target. Doesn't regulation of social programs lead to corruption in the government? Just ask the federal government's pilfering of the Social Security Trust Fund.
@Vanessa – (if anyone complains about the excessive length of this response, blame Vanessa, she asked a million difficult questions!) : P
I think where we differ philosophically will answer most of your questions.
Here is where I stand:
I believe in limited government.
I don’t believe health care is a right.
I believe excess government spending, whether it is on education, arts, whales, military, health care, or donuts is immoral. How do we define “excess”? That is a philosophical discussion, and I’m going to focus on economics, so I won’t address that here, but in my book many of our current social programs fit the “excess” bill for me, and a universal health care program would add to that. I do not place a negative value judgment on the concept. Of course the notion of providing affordable health care to all is a nice idea, however, I cannot let every nice idea the government has sway me. I cannot cherry pick ways to vote myself more money or favors, which is what happens when we have people voting in social programs they prefer. I use the word prefer, because there are many people opposed to universal health care, and that is their right.
So, I will answer your questions from this vantage point.
You asked, “How would you make catastrophic insurance affordable?” As a result of deregulation, insurance will most likely be more affordable, however, there is no guarantee that it will be acceptable to everyone (but I propose Medicaid and Medicare also be deregulated for the poorest consumers). I think when people indicate they want better health care at much lower prices than they are actually worth, they show only a lack of understanding of economic principles. It would be as if you approached GM and asked them, “How are you going to make sure Cadillacs are affordable to everyone, when most people can only afford a Chevy Aveo?” It won’t happen, furthermore, to force GM to sell Cadillacs at reduced prices would be immoral and bankrupt the company.
You asked, “What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?” They will have to pay the difference out of pocket. I’m certain financing options would be available.
You asked, “How do people with preexisting conditions find an affordable policy?” I don’t know, however anyone else would find a policy. For example, there might be a health insurance company who seeks out moral people as part of their business plan. They could market their product as an increased premium for being pooled in with people of pre-existing conditions. I can see that many people of faith (as you mentioned in your post) who often try to help those in need would see this as a wonderful opportunity. The company would benefit from matching needs of many. In fact, that is a great idea, and I would probably go into the insurance business myself! So, anyone who reads this, free idea, it’s all yours.
You asked, “By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?” Yes, it would cost businesses who provide employees coverage more, and that is precisely the point. In my previous post, I indicated that the third-party tax system is a major contributor to increased costs, you can re-read that post, and if I wasn’t clear, let me know. Removing the tax code will cause employers to reduce their health care coverage, which is a good thing. It puts the cost of care back into the hands of the people who see the costs. There is nothing about this action that would cause prices to increase either, it would cause a decrease of costs because there would be more transparency, and more people would not elect unnecessary procedures.
You asked, “What happens to the quality of care if industry regulates the quality of its products itself?” I think what you are edging towards is that you might get some shitty companies. You'd be right. However, they will soon go out of business. No one likes being swindled.
Additionally, there is nothing about my plan that indicates the industry gets to solely regulate themselves. I have talked about this before, but there are many ways to control quality through unrelated private entities. Government appointed boards are not the only arbiter of quality.
Do you not make judgments of quality every day? Would you not trust a group of intelligent people like yourself to regulate the health care industry? In fact, if someone took a poll, I’d put you on top of the list! You are clearly intelligent and passionate about this topic, and I’d assume, committed to quality if you sat on a board. Additionally, I gave you some examples on a previous post. (J.D. Powers, The National Association of Realtors, etc.)
Furthermore, encouraging voluntary contracts would increase choice, quality, and options. A contract would clearly outline duties and expectations of both parties, hence, quality control, and reduce costly tort cases after care has been given.
You asked, “How is the consumer protected if they do not agree on the price?” I’m not sure I totally understand this question. The consumer protects themself. If they do not like a price, they are free to go elsewhere. If you mean, how do the impoverished get health care? I proposed that the current emergency care remain, and also, if the government wished to create an opt-in program where those who were taxed for health care received the benefit, that would be acceptable, provided the rest of the health care market was deregulated. I also mentioned consumers could choose programs by state. Under this option, there would be considerable choice, and ability to “vote” by using the state program whose costs and regulations you prefer. Furthermore, Medicare and Medicaid should be liberalized, this would allow low-income consumers more choice, freedom and reduced costs. To go into detail would take more space that I should take right now.
You asked, “Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)”
No, I would never consider that because it would be completely antithetical to economic thought.
As for the Swiss having the most market-oriented system, and their out of pocket costs being high has to do with a few things:
1. The market is a total ruse, and participation is compulsory, i.e. unlike any free market. For example, can you imagine going into a store and being required to buy something whether you felt like it or not, but by the mere act of showing up, you were forced to purchase? Do you know what that does to prices? Think about it. If everyone who walked into Target was forced to purchase just by showing up, it would dramatically increase demand for goods in Target, and therefore, prices for everything in the store. This is a basic economic truth. So, can you see, no actual market works that way?
So, prices are fixed within a band. If you are unfamiliar with the effects of price floors and ceilings, it is critical to comprehend here to understand why a fake market distorts prices, supply, and demand. Let’s say there are 10 men who need a job. 8 are willing to work for $5, 2 are willing to work for $4. An employer comes along, and is willing to pay 10 men $5. Everyone wins. However, let’s say the government passed legislation setting minimum wage at $8. Once workers hear about this, there will be at least 15 men willing to work for $8, whereas the employer won’t be able to afford even the 10 he started out with. He’ll have to lay off some people in order to break even. This is a case of too much demand and not enough supply.
As for price ceilings, which is what we see with health care, take this scenario: You are looking for an apartment and think LA is a good location because of rent control. You see an apartment you’d be willing to pay $500/mth for, but as luck would have it, it costs only $400! Then you notice 20 other people are on a waiting list for it since the price is artificially low. This is a case of not enough supply and too much demand.
So, with those examples firmly in mind, can you see how the fake market in Switzerland cannot work like a normal market? When there are price ceilings for services, and the government only covers a small portion of these services, the remaining costs have to be made up somewhere.
Medical care is not something you can create an artificial price for. For example, getting an MRI is not a right, it is a good. A good with value like anything else. There is technology required to build it, doctors needed to run it and interpret results, and technicians to keep it running and updated. If the price of this service is $1000, then who is the government to call it $500? Do they expect doctors to work for free? I suppose they do. Well, the point is, this is what has happened in Switzerland, but the costs must be made up somewhere, therefore, it comes out of pocket.
2. Another factor is that most Swiss citizens opt for the low cost, high deductible plan, whereas they could choose a higher premium, lower deductible which might theoretically lower their bills. I would argue this is a psychological issue - as they are led to believe their costs will be covered by the compulsory universal plan.
3. A third factor is that the Swiss plan is organized by geography, so that the healthy subsidize the less healthy. (With the exception of non-smokers, who enjoy a reduced premium.)
If you’d like, I’d be happy to discuss your preferred international model.
Like I said, the level of detail we are getting into requires far more detailed study and analysis. You are testing me, for sure!
I hope this clarifies some of my thought process, and if not, ask away...
@jrandom42 -
To be extremely clear, you are not speaking to someone ignorant of the immense pain poor health care creates for patients and their families.
Additionally, I am terribly sorry for your personal struggles. If you'd like to talk privately, I would elucidate some of my own family struggles regarding the health care system, but do not feel comfortable doing it here.
You are bringing up difficult issues where there is one answer that is a cure-all. You have every right to feel frustration and outrage, however, a solution cannot be found in universal health care, despite many people wanting it so desperately.
The point of my post it to describe ways to improve health care overall, not to ensure every human being gets treated fairly 100% of the time. That is an unrealistic goal, and not possible under any system.
You may want to look into my solution for pre-existing conditions in comments to Vanessa. The healthy can subsidize the less healthy by choice, not only by force. I cannot imagine there would not be a group of citizens willing to participate in group health insurance where someone with pre-existing conditions would be allowed to participate as well.
In fact, many fraternal unions used to have such policies, where coverage was determined by whomever joined the union, which could be organized by various cultural interests, not health alone.
Bravo-even for a mere housewife, jk. No, this was laid out as a great foundation to a wonderful healthcare system. Universal socialized healthcare is NOT the answer and I get very frustrated listening to the people in favor of it.
Anyway, good job.
@Chris Ford - phew! I'm glad I got your Good Housekeeping Seal of Approval!
Seriously though, thanks for the thumbs up, I'm glad someone took the time to read this thing!
It's nice to see all of your ideas out there although of course we both know that we disagree on some things.
I do agree with some of the proposed changes in your antidote. Greater transparency of cost might help to reduce overuse of services and resources and HSAs could be a helpful tool for medical expenses.
I do have a few questions about a few things.
-How would you make catastrophic insurance affordable?
-What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?
-How do people with preexisting conditions find an affordable policy?
-By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?
-What happens to the quality of care if industry regulates the quality of its products itself?
-How is the consumer protected if they do not agree on the price?
-Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)
Nicely written and research post. Looking forward to hearing your answers.
Where is the cost containment provisions? Massachusetts expanded coverage but their costs are much higher than projected since they didn't address volume-based system. The more providers do, the more they make.
Also, we have tons of high tech devices and drugs that are over-used when cheaper devices or drugs are just as good. We all want the latest and greatest and we'll demand it.
My wife went to a lactation specialist with our son. I found out that the lactation specialists bills both my wife and my son for the visit. That's an example of provider billing where I feel like they are double dipping.
I see that you have adjusted who's paying for health care to make it more equitable. But other than tort reform what's going to prevent provider costs and new technologies from continue to increasing?
@Vanessa and Deadhedge - great comments and I need time to properly address them.
I think I'm taking for granted that readers will inherently understand that deregulation would lead to dramatically reduced costs.
In fact, each of your questions truly warrants another post altogether!
If you'll grant me the luxury of time, I will be sure to elucidate and explain further my rationale.
I think it's important to accept that healthcare prices may rise, and that it's okay. Prices rise on everything else as well, partly due to inflation, but with other factors in play as well.
The problem that plagues the reasoning most people apply to this issue is that they expect by having the government pay for healthcare, the whole process will automatically get cheaper by cutting out some huge profit somewhere. I'm not sure that it would actually work that way. The government is by no means omnipotent and cannot guarantee perfectly free and cheap healthcare. You can't get something for nothing, not even from a government program. There are going to be costs to running that program.
Perfection isn't possible. What we have to aim for is not perfection, but the best possible solution. Some say that it's perfectly obvious that a government run program is that solution, but I don't think it's quite that simple. If you want a good product, you usually have to pay a premium for it, no matter who's selling it.
Didn't deregulation of the energy market lead to a dramatic reduction in its cost? Ask Enron!
@Vanessa - I think this comment form doesn't even allow the length of comment I just wrote. I'll just try to cut and paste sections, which might work better, since tackling one question might tackle another?
Here's Part 1 I guess:
I think where we differ philosophically will “answer” most of your questions. Here is where I stand:
I believe in limited government.
I don’t believe health care is a right.
I believe excess government spending, whether it is on education, arts, whales, military, health care, or donuts is immoral. How do we define “excess”? That is a philosophical discussion, and I’m going to focus on economics, so I won’t address that here, but in my book many of our current social programs fit the “excess” bill for me, and a universal health care program would add to that. I do not place a negative value judgment on the concept. Of course the notion of providing affordable health care to all is a nice idea, however, I cannot let every nice idea the government has sway me. I cannot cherry pick ways to vote myself more money or favors, which is what happens when we have people voting in social programs they prefer. I use the word prefer, because there are many people opposed to universal health care, and that is their right.
I will answer your questions from this vantage point.
You asked, “How would you make catastrophic insurance affordable?” As a result of deregulation, insurance will most likely be more affordable, however, there is no guarantee that it will be acceptable to everyone. I think when people indicate they want better health care at much lower prices than they are actually worth, they show only a lack of understanding of economic principles. It would be as if you approached GM and asked them, “How are you going to make sure Cadillacs are affordable to everyone, when most people can only afford a Chevy Aveo?” It won’t happen, furthermore, to force GM to sell Cadillacs at reduced prices would be immoral and bankrupt the company.
You asked, “What happens to people whose costs are too low to meet the high deductible of catastrophic insurance but too high for the balance of their HSA?” They will have to pay the difference out of pocket. I’m certain financing options would be available.
You asked, “How do people with preexisting conditions find an affordable policy?” Similar to how anyone else would find a policy. For example, there might be a health insurance company who seeks out moral people as part of their business plan. They could market their product as an increased premium for being pooled in with people of pre-existing conditions. I can see that many people of faith (as you mentioned in your post) who often try to help those in need would see this as a wonderful opportunity. The company would benefit from matching needs of many. In fact, that is a great idea, and I would probably go into the insurance business myself! So, anyone who reads this, free idea, it’s all yours.
How can we maintain a high level of innovation, reduce costs, and provide coverage to anyone who wants it?
Milena - I agree with all your points on how can we maintain a high level of innovation, reduce costs, and provide coverage to anyone who wants it. Something needs to be done and every little effort is a step in the right direction.
I am dedicated to promoting health care transparency and helping consumers find the best value for health care services. My mission is to inform and educate consumers about health care prices and encourage a consumer driven market that will help lower costs, promote innovation, expand choiceds and increase patient access to better medical care.
I launched a grassroots initiative that enables consumers to post/share prices they paid for actual health care services. The website www.outofpocket.com, is a community search engine to help consumers look up prices, find out what others paid for similar services and find the best value for routine health care services.
Mona Lori
founder
www.outofpocket.com
But doesn't deregulation in social programs result in private corruption? Enron was just the tip of the iceberg. What about Countrywide? WorldCom? Boeing? We're already seeing the fruits of deregulation on a grand scale.
@jrandom42 -
No, deregulation doesn't result in private corruption. You are mistaking correlation with causation. Just because private companies have committed fraud doesn't mean private companies always commit fraud.
You have provided the most obvious business failures in recent times, and I think, a cheap shot. Most private corporations are not committing massive fraud, they are mostly made up of honest, hard-working individuals.
Furthermore, I could highlight many more government fraud schemes. The point is, fraud is indemic in any system, not caused by a particular system.
Anyways, in my article, I clearly said anyone who wants the government handling their affairs, should have the choice, but I have every right to want private entities to run mine.
@jrandom42 - also, just because some people abuse freedom, doesn't mean you should take freedom away.
@Mona Lori -
All right! What a great cause. I'm super excited about your site and can't wait to check it out!
Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.
It's also worth noting that the American Medical Association supports universal health care.
And what happens when that abuse threatens people's lives? Is it just a calculation between the cost of business or the cost of lawsuits resulting from deaths?
@Vanessa -
Here's Part 2!
You asked, “By changing the tax code to make individuals and businesses pay for coverage with post-tax dollars, isn't that making them pay higher costs for health care?” Yes, it would cost businesses who provide employees coverage more, and that is precisely the point. In my previous post, I indicated that the third-party tax system is a major contributor to increased costs, you can re-read that post, and if I wasn’t clear, let me know. Removing the tax code will cause employers to reduce their health care coverage, which is a good thing. It puts the cost of care back into the hands of the people who see the costs. There is nothing about this action that would cause prices to increase either, it would cause a decrease of costs because there would be more transparency, and more people would not elect unnecessary procedures.
You asked, “What happens to the quality of care if industry regulates the quality of its products itself?” I don’t know. You might get some shitty companies. They will soon go out of business. Additionally, there is nothing about my plan that indicates the industry gets to solely regulate themselves. I have talked about this before, but there are many ways to control quality through unrelated private entities. Government appointed boards are not the only arbiter of quality. Do you not make judgments of quality every day. Would you not trust a group of intelligent people like yourself to regulate the health care industry? In fact, if someone took a poll, I’d put you on top of the list! You are clearly intelligent and passionate about this topic, and I’d assume, committed to quality if you sat on a board. Additionally, I gave you some examples on your own post. (J.D. Powers, The National Association of Realtors, etc.) Furthermore, encouraging voluntary contracts would increase choice, quality, and options. A contract would clearly outline duties and expectations of both parties, hence, quality control, and reduce costly tort cases after care has been given.
You asked, “How is the consumer protected if they do not agree on the price?” I’m not sure I totally understand this question. The consumer protects themself. If they do not like a price, they are free to go elsewhere. If you mean, how do the impoverished get health care? I proposed that the current emergency care remain, and also, if the government wished to create an opt-in program where those who were taxed for health care received the benefit, that would be acceptable, provided the rest of the health care market was deregulated. I also mentioned consumers could choose programs by state. Under this option, there would be considerable choice, and ability to “vote” by using the state program whose costs and regulations you prefer. Furthermore, Medicare and Medicaid should be liberalized, this would allow low-income consumers more choice, freedom and reduced costs. To go into detail would take more space that I should take right now.
@jrandom42 - I'm not sure what you are saying.
If someone's life is being threatened, of course they should be defended, by police and/or through the judicial system.
@Matt - interesting post!
@Vanessa - many people support universal health care, of course, I'm just arguing that doesn't necessarily mean it's right. Many people support the war too.
There was a story about 6 months ago where a young girl died, because her health insurer denied the procedure, and then bowed to public pressure and allowed it. She died before it could happen, but her doctors did say that she would have lived, if they had gotten approval in a timely fashion.
I'm sure you feel the police will arrest those responsible for her death and bring them to justice.
@jrandom42 - life is terribly unfair. However, I'm not sure what you are asking me here. Do I feel the police will arrest those responsible? I cannot
predict the future, so I don't know.
I am not in a position to personally seek justice for this girl and her family. If there was wrong-doing causing bodily injury, this girl's family or others who are so inclined have the freedom to take legal action.
I think you are missing my point entirely, so I'll repeat it. Just because certain individuals or entities abuse freedom isn't grounds for eliminating freedom.
For example, if person A calls and threatens person B repeatedly, and argues that they are simply exercising their free speech, they would be wrong. They would be causing another person harm, and should have their freedom to take that action revoked. However, their action would not be grounds for eliminating free speech entirely! Do you understand where I'm coming from?
You keep offering horrible, isolated incidents which I do not disagree, should be dealth with through legal action, but I do not agree that they provide any logical basis for promoting unconstitutional behavior and restricting freedoms of all other honest people as a result.
If you are suggesting, by this horrifying story of neglect, that the government would somehow ensure things like you elucidate would never happened again, you are sorely mistaken.
So what happens to healthcare when the insurer says, "Sorry, we can save your child's life, but it's not cost effective for us to do so. Accept it, make their last days as confortable as you can and move on."
Or as my wife has heard, "Sorry, we can't cover you because of your pre-existing conditions. good luck in finding someone who will."
@jrandom42 - forgive me, I meant to say, "there is no one answer that is a cure-all."
"I cannot imagine there would not be a group of citizens willing to participate in group health insurance where someone with pre-existing conditions would be allowed to participate as well."
Well, Regence Blue Cross, Cigna, and HealthSouth has already chosen not to cover her, even when we offered to pay over $2,750/mo to get her covered. And these are only the biggest ones to turn us down.
According to a rep from Blue Cross, "We can spend our money more effectively than giving her coverage. It's not worth it to us to even think about covering her, since these conditions will probably be the cause of her death the end."
You say there is no cure-all. So who does decide how much the life of my wife, child or loved one is worth to save, especially when the conditions they suffer are cureable? How do you balance the decision of cost versus life? Or should I just "accept that this is the way it is, that these conditions will end up killing her without treatment, and move on"?
Talk about sucking big time.
@jrandom42 - I apologize if you misunderstand that quote, to clarify, it is from the point of reference of the proposals outlined in my post, not the current state of affairs. I'm well aware people are currently denied care, which is horrible. My first post in this series was entirely based on that premise.
You are asking me questions of a highly philosophic and esoteric nature, of which I am not in a place to provide answers. These are distinct from issues of economics which I am addressing in my post.
Neither my plan, nor universal health care could guarantee your family anything. However, if you believe otherwise, my plan also provides that individuals interested in government-provided care should be allowed to use it. It would be unreasonable to deny people that choice.
However, there is a wealth of rational, logical, scholarly thought which indicates a system based on market principles (which we do not currently enjoy) would provide greater choice, quality, and reduced cost.
@Vanessa -
Sorry this is a monumental undertaking (if anyone is annoyed by this, Vanessa asked a number of great questions that deserve a response)
You asked, “Did you consider Switzerland may have the highest out-of-pocket spending because it does have the most market-oriented system? (Also I think there are other factors in Switzerland such as the age and relative wealth of the population that might be driving that statistic up.)”
No, I did not consider that because it would be antithetical to economic thought.
As for the Swiss having the most market-oriented system, and their out of pocket costs being high has to do with a few things:
1. The market is a ruse, and participation is compulsory, i.e. unlike any free market. For example, can you imagine going into a store and being required to buy something whether you felt like it or not, but by the mere act of showing up, you were forced to purchase? Do you know what that does to prices? Think about it. If everyone who walked into Target was forced to purchase just by showing up, it would dramatically increase demand for goods in Target. This is a basic, accepted economic principle. So, can you see, no actual market works that way?
Therefore prices are fixed within a band. If you are unfamiliar with the effects of price floors and ceilings, it is critical to comprehend here to understand why a fake market distorts prices, supply, and demand. Let’s say there are 10 men who need a job. 8 are willing to work for $5, 2 are willing to work for $4. An employer comes along, and is willing to pay 10 men $5. Everyone wins. However, let’s say the government passed legislation setting minimum wage at $8. Once workers hear about this, there will be at least 15 men willing to work for $8, whereas the employer won’t be able to afford even the 10 he started out with. He’ll have to lay off some people in order to break even. This is a case of too much demand and not enough supply.
As for price ceilings, which is what we see with health care, take this scenario: You are looking for an apartment and think LA is a good location because of rent control. You see an apartment you’d be willing to pay $500/mth for, but as luck would have it, it costs only $400! Then you notice 20 other people are on a waiting list for it since the price is artificially low. This is a case of not enough supply and too much demand.
So, with those examples firmly in mind, can you see how the fake market in Switzerland cannot work like a normal market? When there are price ceilings for services, and the government only covers a small portion of these services, the remaining costs have to be made up somewhere. Medical care is not something you can create an artificial price for.
Getting an MRI is not a right, it is a good. A good with value. There is technology required to build it, doctors needed to run it and interpret results, and technicians to keep it running and updated. If the price of this service is $1000, then who is the government to call it $500? Do they expect doctors to work for free? I suppose they do. Well, the point is, this is what has happened in Switzerland, but the costs must be made up somewhere, therefore, it comes out of pocket.
2. Another factor is that most Swiss citizens opt for the low cost, high deductible plan, whereas they could choose a higher premium, lower deductible which might theoretically lower their bills. This is a psychological issue - as they are led to believe their costs will be covered by the compulsory universal plan.
3. A third factor is that the Swiss plan is organized by geography, so that the healthy subsidize the less healthy by force, not by choice.
If you’d like, I’d be happy to discuss your preferred international model.
Like I said, the level of detail we are getting into requires far more detailed study and analysis. You are testing me, for sure!
My apologies. From reading the title of your post "The Antidote: How to Solve the Healthcare Dilemma", I misunderstood your premise.
I thought you were going to outline a solution to the problem of 47 million people without healthcare, and address how the market could overcome the barriers preventing those who couldn't afford or qualify for private healthcare insurance.
My mistake was in assuming that this was the real dilemma.
So, to question part of your reply to Vanessa, if the healthy choose not to subsidize care for the less healthy, and not forced to care for them, shouldn't we just simply shoot them and get it over with and move on?
@jrandom42 - I have provided what I believe is the best solution. I would not propose shooting anyone.
@Deadhedge - Now for your questions.
You asked, "Where is the cost containment provisions?" I have not included any, and I provided my reasons to Vanessa above (see price ceiling or MRI examples).
I philosophically oppose government subsidies, which is why my plan did not provide for that. When a doctor works, his education, training, time, and all the other elements that go into care cost something. I don't know what that price is. What I do know is that prices can only be determined by a market, where buyers and sellers decide. When the government interferes, it creats a host of other problems which I cannot outline here because of time and space constraints.
If I haven't answered your question from my point of view satisfactorily, please let me know.
@All -
I'm well aware my opinions are unpopular and my intention is not to unduly upset people, but to offer my point of view.
There is nothing that would ensure prices stay low enough for everyone to be satisfied with the result. That is life. Anyone who promises you that universal health care will be free and of better quality is lying. If they tell you it will be "low-cost" I believe that is a lie to, as we will pay non-price consequences by degraded care, rationing, wait times, etc.
Here's a horrifying example of why regulation from the FDA is causing deaths.
http://online.wsj.com/article/SB121944789005365195.html?mod=opinion_main...
With deregulation, these patients may have been able to get life-saving experimental treatments of their own volition. Instead they waited and perished. Again, deregulation would have solved this.
@Vanessa -
One thing I forgot to make clear, was when I proposed to "correct the tax code" by disincentivizing employer health care provisions, was to put the tax advantage into the hands of the individual, by giving tax credits to consumers who do have to purchase their own health care.
GOT SOMETHING TO SAY?