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starbucks4ever (90.04)

A capitalist solution: free health care



June 05, 2009 – Comments (37)

Just wanted to make a point that will surely be anathema to our free-marketers, and to take my share of flak for it: a government-run health care system will not only be a good solution, but will also be MORE CAPITALIST than what we have now.

Why is that? Because the very idea of free market IMPLIES that every good or service has a known price. That has been true for most market transactions, and it is the reason why the market can work in the first place. So when the free-market fundamentalists say that health care has got to be market-based, you imagine something like a market for air travel: you make your travel plans, go to Travelocity or Expedia, research prices, make reservations, and enjor the benefits of competition between various airlines. Now, I am going to argue that this glorious picture is entirely bogus, and that health care is a very different case.

First off, the average customer has no medical knowledge. That means that when he walks into the doctor's office, the customer has no idea what treatment will be necessary. So rather than shopping in the market for medical services, as the Economy 101 textbook case would have it, the customer's role is to purchase a bundle of services assembled for him by the seller, without any idea about their effectiveness. In addition, the seller can always reshuffle the bundle as he sees fit. Just when the customer thought the course of treatment has been outlined more or less crearly, the "seller" can change his mind in a moment, and all of a sudden the customer's tour through the shopping mall aquires an entirely different direction. So the contents of that tour that you order is, by definition, unpredictable. To use the airline analogy, you just let Expedia design your tour without any idea whether they'll send you to Alaska or to Brazil.

Secondly, in the travel industry, you are always told the price of the tickets in advance. When you order a $500 ticket, you know that the airline will charge you exactly $500, and not a cent more. In the health care industry, on the other hand, the assumption is that the hospital will carry out every procedure that is deemed necessary during the operation, and your signature constitutes the agreement to pay an undisclosed amount, whatever it may be. Hmmm, that does sound like some crucial piece of information is missing, does it not?

The third difference is that a free market usually implies that you can reserch prices for free, or, in some rare cases, for a small fee. In contrast, health care system is a kind of "market" where the price quote can only be given to you after the diagnostics, which itself amounts to a lion's share of the total bill. In other words, by the time you get to look at your itinerary, and to find out that it will cost you $10,000, you're already on hook for $5,000 and there is no longer any point in changing your plans. 

Fourth, market participants are normally expected to make decisions while they are in a conscious state, and also any agreement will be considered null and void if it turns out that the buyer's signature was obtained under torture. I am afraid that too many visits to the hospital or to the emergency room fall under that category. Those who present this kind of transactions as a case of free market forces at work are carrying their market analogies a bit too far.

It also bears mentioning that a patient having a medical emergency does not have the luxury to take his time to be transported to a different facility, so if it's a market, then at any rate it's the kind of market where buyers have literally a few seconds to complete their shopping. If the typical customer is always rushed to a facility that is geographically closest, perhaps it wouldn't be an overstretch to describe the system of emergency health care as feudal, where every health care executive enjoying unlimited power in his little fiefdom. Where is the competition that free-market advocates are talking about?

All things considered, I think we must reject free-market allusions as largely irrelevant, and admit the simple truth that THERE CAN BE NO FREE MARKET IN HEALTH CARE. (For those who want a relevant model, I can suggest Clausewitz's "fog of war". Military analogies seem to be particularly suitable for describing customer experience in this industry, especially such attributes of warfafe as ambushes, minefields, requisitions, surrender ultimatums, and prisoner camps for the capitulating combatants). That is, there can be no free healthcare market on the individual level, just like there can be no notion of temperature for an individual molecule.

However, if we abandon attempts to track individual molecules, and focus on the aggregate, then we can in fact obtain enough information to make informed choices.

A government body that has pricing power and access to statistical data can build its relationship with medical providers on a totally different basis - on a socialist basis. Those who associate socialist health care with the Obamination that comes from the left wing of the Democratic party, are as detached from reality as the free-market fundamentalists. A socialized health care system does not mean another $1 trillion of handouts to HMOs, which the Illinois demagogue would like to accomplish. What it means it this: the payment system deals with aggregates only. No attempt is made to track expenses on the individual level. Medical providers are asked to treat everybody who comes to the clinic in exchange for a fixed annual payment from the government which covers their average operating costs for the year. Yes, taxpayers have to pay for this. But the amount of savings available to the taxpayers in the aggregate is staggering when you compare it to the savings available to them as individuals (even as motivated individuals making all the right choices). These savings come from 3 sources:

1) complete elimination of insurance companies (they are free of course to offer premium health care at a premium price, serving those who like to pay up for quality, but they have no role to play in the government-run hospital network),

2) complete elimination of billing departments, coding departments, collection departments, payment processing services, and other such clerical workers (once it's decided that government pays the hospital a fixed amount, nobody is interested to know if Smith should be charged more than Jones, or Jones more than Smith), and

3) elimination of unnecessary treatments that hospitals perform routinely in an attempt to milk the insurance companies.

This is the cheapest and by far the best solution. Gone is the problem of location-based monopolies: the government can break up such a monopoly by setting up its own hospital or simply by threatening to do so. Gone is the problem of hospitals who like to accept patients in the unconscious state to charge them $100,000 for an operation: the government can simply make a deal with a different hospital and then let those overly enterprizing individuals look for customers on their own. Finally, gone is the problem of HMOs working to deny services: Health Ministry officials receive their bonuses by meeting targets such as life expectancy and mortality rates, rather than by the number of patients denied treatment.

And now comes the crucial point: this socialist system is closer to the ideals of Adam Smith than the one we currently have. Under a socialist system the customers (taxpayers in the aggregate) possess more information than these same customers could ever gather on an individual basis, and have more power to resist monopolization than a bunch of free market agents screaming from pain in the ambulance car. Moreover, far from destroying competition, this system takes competition to a new level. In addition to the intra-species competition between private specialists that we have now, there will be an inter-species competition between the private and state-run health care - a competition that will give private providers quite a run for their money. They will be facing a new kind of competitor they never saw before - a competitor that does not need to keep track of coding and billing and payment processing, a competititor that does not have to employ a horde of clerks to coordinate its every step with insurance companies. This is the kind of competition that quickly flushes out mediocre private practices, leaving only the best and the brightest. At the same time the better part of the private sector that survives will keep the state officials in check, supplementing for the shortcomings of the official medicine, and offering consumers a choice between free treatment in a government clinic and a premium-quality treatment in a private clinic. And on top of that, there will be another intra-species competition, this time between different state-run clinics, competing for better medical statistics in their respective districts. And increased competition is always an excellent news for customers. The cries of indignation from our dedicated health care enterpreneurs only prove the validity of this suggestion: when you expose the corporate welfare types to the real market, and hear them scream, you know that you're doing something right.



37 Comments – Post Your Own

#1) On June 05, 2009 at 11:00 PM, motleyanimal (38.38) wrote:

Great post. Wal-Mart's $4.00 prescriptions did much to further the cause. We won't have affordable healthcare until we break the backs of the HMOs.

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#2) On June 05, 2009 at 11:18 PM, shueotts (< 20) wrote:

You can experience goverment run health care in all its wonderment in Canada.

But practically speaking-  From a physician who practices in a busy level 1 trauma center everyday, trust me, America would NEVER tolerate government run health care. No, America prefers the Burger king model of health care -"have it your way" -unnecessary, expensive, diagnostics test immediately with no wait.  In Canada, you wait and wait and wait and then get denied for the tests you want.


also, your plan calls for elimination of health care companies with a combined market cap of over 100b billion- not to mention the elimination of med mal attorneys neither of which seems very likely.

and last, didn't you hear?  our government has printed about all the money it fact, Medicare will be out of money in 2017, leaving ONLY the private sector to pay...or more borrowing. 

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#3) On June 05, 2009 at 11:34 PM, robstuck (< 20) wrote:

your post has no empirically verifiable evidence, has no specific exampes, and is full of exaggerations. if government healthcare is so great, why do canadians routinely come to the United States for healthcare?


also, there is no such thing as "free" healthcare. someone (taxpayers) are paying for it. It just levels everyone to the same crap. the doctors who went to harvard would be getting paid the same as the doctors who went to bumbleduck community college. thus, the quality of our healthcare professionals would go down the tube.


very very bad idea..

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#4) On June 05, 2009 at 11:41 PM, ByrneShill (82.09) wrote:

You guys get boned on a daily basis. In socialist canada, our system is half the price per capita and our life expectancy is 1 year more than you.

I don't need more mumbo-jumbo. If the socialist way has proven after 40 years that it is half as expensive and slightly more effective, then the heck with capitalism.

You can forget about a single-payer system in US though. Getting boned in the healthcare system is more important than a religion in yankeeland. Until then I guess we'll keep seeing those seniors coming by bus to our drugstores on week-end. They're always welcome here to spend their money on cheap drugs.

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#5) On June 06, 2009 at 12:16 AM, starbucks4ever (90.04) wrote:


I don't think we have to support every fraudulent business with 100 bln capitalization indefinitely at the expense of our health and sanity.  


There is plenty of evidence that of all developed countries, American health care system is the worst (which does not mean it can't have SOME bright spots).  

"also, there is no such thing as "free" healthcare. someone (taxpayers) are paying for it"

Sure they do. The question is where do you pay more: in Canada, via taxes, or in the land of the free, via insurance premiums, personal bankruptcies, denied treatment for the uncovered, out of the pocket, etc. 

"the doctors who went to harvard would be getting paid the same"

Why the same? If you're really that good, you can leave a state clinic and set up a private practice. There are always rich people willing to pay up for quality. But you'll need a stellar reputation, otherwise people will choose to be treated for free.

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#6) On June 06, 2009 at 12:27 AM, russiangambit (28.88) wrote:

> your post has no empirically verifiable evidence, has no specific exampes, and is full of exaggerations. if government healthcare is so great, why do canadians routinely come to the United States for healthcare?


Let me see. Canada and most other developed countries have healthcare basics for free or at minimal cost. For more advanced/expensive procedures they have to jump through the hoops, wait etc. However, they still have an option to go to a private hospital anywhere in the world (US, Asia) and pay out of pocket.

How is that worse than what we have in the US? We pay much more, we still have to jump through the same hoops to have the expense approved by the insuarance company. If Canadians don't want to wait they can always go to a private practice and pay for it and not wait.

The problem with the americans is that majority never lived in a foreign country and therefore cannot picture a system different from the US, whether it is how the elections are run, or helathcare , or education or military. And so it is very hard to convince them to look at the rest of the world for "best practices".

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#7) On June 06, 2009 at 12:51 AM, devoish (71.85) wrote:

Good for you, zloj

I know we don't always agree, but I am 100% with you here.

I completely agree it is time for Health Insurers to land in the dung heap of failed institutions.

Here is a link to a comparison of health and auto insurance that I have posted before that is on topic.

As you read through the "flak" you will see all the pitches from Frank Luntz work "The Language of Healthcare" marketing campaign.

Mind if I plug H.R.676 and I believe S.703 is a Senate version sponsored by Senator Bernie Sanders, Independent, Vermont?

Thanks for posting.

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#8) On June 06, 2009 at 1:07 AM, starbucks4ever (90.04) wrote:

"As you read through the "flak" you will see all the pitches from Frank Luntz work "The Language of Healthcare" marketing campaign."

You're right. I think I've already seem some :) What a great piece of propaganda, though!

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#9) On June 06, 2009 at 1:38 AM, portefeuille (98.88) wrote:

have a look at this post: Socialist Babies

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#10) On June 06, 2009 at 2:25 AM, peachberrytea (33.52) wrote:

hmm this is a pretty thought-provoking article... thanks for it. i'm not sure i agree with you on everything you wrote about, but you do address information assymetry in health care, and the fact that the free market needs some sort of oversight or regulation when information is assymetrical

 thanks again and recs from me

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#11) On June 06, 2009 at 2:31 AM, peachberrytea (33.52) wrote:

hmm it's asymmetric and not however i spelt it there.. sometimes i wish there was a function that'll let me correct my comments..


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#12) On June 06, 2009 at 3:23 AM, robstuck (< 20) wrote:

 Byrneshill said

"Until then I guess we'll keep seeing those seniors coming by bus to our drugstores on week-end. They're always welcome here to spend their money on cheap drugs."


HAHAAH.. they're welcome to come to your country and spend money on cheap drugs? The reason they're so cheap is because you're paying for them you vegetable! Not to mention the money they pay isn't going to you- its going back to united states and our drug companies.   

Having cheap drugs doesn't mean you have a great healthcare system. it means you are taking money from the healthiest and most productive citizens, and giving it to the laziest most unhealthy citizens (or immigrants). Why do they need these drugs, and why do they need help paying for them? Because they sit around all day eating junk food and fail to push themselves to become more healthy, better educated and/or find a better job.

I'm not willing to pay for every fat-ass in my nation to drive around in a powered scooter-mobile when he's 70 because he was too lazy to exercise and eat right. 



For the sake of argument however, lets just pretend for a second that state healthcare is better than say, a medschool grad with INCENTIVE to do a good job, bust his ass at a tough school, go the extra mile for his patients, and keep up good relations with them (knowing that his good work and relations is essential to his success in the future) and the united states enacted it. it would not be "a capatalist solution" as was the topic of this post. It would destroy our country and all the capitalism in it. 

General Motors Corporation provided "free" healthcare to all of their employees and look at where they are now. BANKRUPT. Why are they bankrupt? Because they couldn't compete with Japan or anyone else in the world due to their rising corporate welfare costs. The last thing the United States needs is more burden to hamper our economy. Welfare is already growing at a rate faster than our GDP. The snowman i made this last christmas is growing faster than our GDP and its gone. The fact is that I don't want to spend my hard earned money paying for some unhealthy obese person's healthcare (and the number of obese people is growing exponentially in the united states). If the United States enacted universal healthcare it would destroy our economy. 


Everyone close your eyes and imagine.. 

The year is 2040. The U.S. has enacted universal healthcare. The birth rate in the United States have dropped to 1.2 (the current rate in Italy). People who were told they would have state healthcare now can't receive it because they had no kids and therefore have no one to make money to pay taxes to contribute to their universal healthcare. With an employed population at 2, how could they support a retired population of 10? Sorry people but it just can't work. You combine this with an influx of immigrants from other countries traveling to the United States for their free healthcare (this will undoubtedly happen as evidenced by the canadian gentleman above, and is already happening in the u.s.- mexicans using our emergency rooms) and a decrease in physical activity and well-being and you have a recipe for disaster. 


I got an idea! Since marijuana is medication for my boring cartoons, arthritis and glaucoma, lets subsidize that too, and all of you reading can pay for it! thanks! and tell ya what, once i get high and you know i'll get the munchies, howbout y'all send me some unemployment checks so i can go buy a fat greasy big mac! cause you know working isn't any fun. wow this'll be great! just wait till i have a heart attack and need triple bypass heart surgery. pay for that too?




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#13) On June 06, 2009 at 4:05 AM, ChannelDunlap (< 20) wrote:

Rob I am so down with subsidizing pot.  The stuff is getting expensive.  I think the point you're missing though is that you already are paying for all the fatasses in America, via high insurance premiums, and additional out of pocket fees.  Where do you think the insurance companies get the money to pay for all this stuff?  My mother pays $300/month for her benefits and gets a $1,500 perscription every month for $10.  So where is the  extra $1190 is coming from? 

How is this different than the government taxing everybody to cover everybody?  The only thing that's different is you're not paying the insurance company's profits on top of everything else.   As far as I'm concerned, there is no room for profits in medicine.  As long as the healthcare industry has a bottom line to worry about, they will not have the patient's best interests at heart, and that is completely unacceptable to me.  Look at the pharmacutical companies making up diseases so they can release new drugs to treat them.  I have pretty decent insurance, but even with it, if I get majorly ill and require a lengthy hospital stay or procedures, it will break me.  And the uninsured?  Forget about it.  Healthcare is a joke and a nightmare.  Whats the figure, 60% of bankrupcies result from healthcare bills?  I cannot understand seeing this as a good system.

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#14) On June 06, 2009 at 4:06 AM, ChannelDunlap (< 20) wrote:

Oh yeah, I almost forgot.  Good article.  I never expected to see something like this TMF. 

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#15) On June 06, 2009 at 7:47 AM, wrparks (76.88) wrote:

The problem is the entire aregument is based on a straw man.  All the problems you outlined with our healthcare are caused by a lack of coherent market.  Doing away with the current system is not ending a free market system, in any way, form, or fashion.  This says nothing about how good your plan could be, but the argument is pure nonsense. 

Your first 3 condidtions apply most other markets we deal with on a daily basis.  Condition 4 is the only one unique to medicine.

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#16) On June 06, 2009 at 8:14 AM, pikerun2000 (< 20) wrote:

It all sounds good.  Governement run projects alsways have a pretty name and are fill with promises of great savings for the tax payer.


But when people start to realize they are paying higher taxes for this "free healthcare",  they will begin to go visit the doctor for every simple ailment and the costs will go up.  If it is bankrupting states that have tried it what do you think will happen if the fed imposes it on a national level? 



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#17) On June 06, 2009 at 11:36 AM, starbucks4ever (90.04) wrote:


GM got bankrupt for many reasons, but HMOs were the last straw that break the camel's back.


If the first 3 conditions applied to most other markets, you would come to a grocery store, pay $100 upfront, then seller would look at you, put some groceries in your bag, send you home, and then two weeks later a grocery bill would arrive, and that's when you find out that you purchased $3-a-pound tomatoes and $5-a-pound cabbage.



States have tried something different: they tried to expand coverage through HMOs. No wonder it failed. 


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#18) On June 06, 2009 at 12:10 PM, ByrneShill (82.09) wrote:

reason they're so cheap is because you're paying for them you vegetable!

Actually, the reason those drugs are cheaper is because the govt, being the biggest drug insurer in the country (in NA too, btw), can pressure lower prices on drugs. They hardball the big pharma, so either they lower their prices or their drugs aren't insured, which drives the consumer to the alternatives (gotta like free market!). So far every pharma has negociated in good faith. And although a part of what we pay for our drugs does go back to US, it is much less than it would if we had to pay the full price like you guys do.

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#19) On June 06, 2009 at 4:19 PM, Alex1963 (27.88) wrote:


Amazing post. rec from me. I'd also point out the increasing incidents of patients being forced from hospitals before their care is concluded whether indigent or insured. This does not save money but merely postpones costs til the next quarter as those same people likely return possibly worse than if they'd been properly treated to begin with. A moral and economic failing IMO. I frankly cannot imagine an industry more corrupt, short sighted and dishonest than the american health care system. I hope we all can agree that something needs to be done, whatever your politics may be. Like banking we not only have a sytem "too big to fail" but too powerful to need the satisfy the needs of it's customers. Particularly since most of us are still relatively healthy. They count on the myopic self interest of those who look into their own wallets rather than into their own healthcare future. I suspect most of those supportive of our current sytem have not themselves been thru the healthcare mill. Just like people with low cost car insurance. You think everything is fine and you're covered until you need it. Then you're too late to make any meaningful improvements as you watch the large print giveth and the small print taketh away. The reality is that if it weren't for the Boomers none of this would likely be on the table at all. But when the largest segment of the poulation runs into the corporate mentality which is heathcare today they see just how badly things have eroded. Sure their needs to be a better balance between the ridiculous expectations some have for the treatment they should recieve and the level to which their own neglect has aggravated their condition. But trusting your ideal level of care to a purely for profit sytem is equally unrealistic and IMO naive. Obama has made overtures to personal accountability in healthcare. Higher rates for smokers, the "discretionary" obese etc. I'd love to move past labels like captalist or socialist and concentrate on constructive solutions. And tho I respect the usefulness of studies and surveys I think that in this regard their is  merit in the anecdotal eveidence every one of us hears every week. people are getting royally screwed and in some cases, dying unnecessarily. There must be a better way.

But maybe it would take some of the emotion out of the dialogue to refrain expressing one's opinions about whether other countries are "better" or "worse" than ours and simply try to put together something which is unique to the U.S. A hybrid solution to assuage those who equate questioning our system with somehow impugning the country as whole. Which is just ridiculous IMO. 


  is right great and respectful discussion( for the most part excepting a few of the usual snarky posters of course) here Socialist Babies 


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#20) On June 06, 2009 at 4:24 PM, alexxlea (61.65) wrote:

"if government healthcare is so great, why do canadians routinely come to the United States for healthcare?"


Says the man who will end up flying to India to have an organ transplant.

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#21) On June 06, 2009 at 4:35 PM, Buckaneer (< 20) wrote:


I would be very interested in reading a point by point response to each of his claims and subpoints - BUT devoid of narratives, hypothetical stories, or other hyperbole.

 For clarity in the argument, list his points by assigning each a number, and offering a clear rebuttal to each.

 1A. His first claim

1B. Your response

etc, etc.


 When I was a college debator, we would LOSE the debate round when we didn't enumerate each point, and especially when we failed to respond to ANY claim made by the opponent - an unchallenged argument, although perhaps flawed, wins when not rebutted.

 SO, I look forward to reading a clearly delineated response to ZLOG's claims...... remember that the more specific examples, you use, the more credible your rebuttals are.


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#22) On June 06, 2009 at 5:07 PM, NOTvuffett (< 20) wrote:

Why can't the USA do something sensible like mandating that everyone carry catastrophic coverage, and helping those that are truly needy?  I don't want to pay if your kid gets the sniffles.  Already paying for his education and little Johnny can't read, lol.

Why are drugs expensive?  Because it can cost hundreds of millions of dollars to get them to market.

You would think that the streets and gutters were filled with the dead and dying around hospitals that turned them away according to some on here.

There is no free lunch.

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#23) On June 06, 2009 at 6:04 PM, cmoney85 (< 20) wrote:

zloj~  Thanks for the post, you bring up some great points and thoughts.  I have just a few things to point out.

1.  I have high deductible health insurance, so pretty much if I got to the dr I  pay for it.  So I only go if I have a seriouse problem.  However I know people with "free insurance" from thier employeer who dont have to pay a dime, so they go everytime they have a cough.  If you give everyone "free" care your going to have a lot more people showing up at the dr which is going to require more cost.  You'd have to moke a copay or something.

2.  I work with UPS, Fedex, and the Post Office, the post office is a joke, the way they are setup they could easily wipe the floor with UPS and Fedex with their rates and service, however they are governement backed, they can't fire bad worker and/or lazy workers, it takes them for ever to adobt to new technology and market trends.  So they are losing billions and way behind.  Thats pretty typical for any government ran "business". 

3. you still will have people who can't afford the taxes, so the burden will be passed on to those who make more, or else companies.

So those are my 3 concerns.


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#24) On June 06, 2009 at 6:49 PM, NOTvuffett (< 20) wrote:

Amen cmoney85, why do we want the people running the post office or the department of motor vehicles controlling our health?

People pay more for FedEx or UPS because they know it will work.  If the post office misses a delivery, I have to drive a few miles.  Three windows, two people manning them and two are closed even though there is a person there.  Everyone standing in a long line.

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#25) On June 06, 2009 at 6:52 PM, starbucks4ever (90.04) wrote:


The problem with illetarate little Jonny is not that he's studying for free. If you take a congenital idiot to a private school, the result will still be the same. Too may people think that everybody can be taught, this is simply not true.


I actually agree on point 1, sort of. Maybe it will make sense to demand a $20 cash payment from those who come with an ordinary cold, in some version of "the law does not deal with trivialities". Then again, maybe it's not such a bad thing if you can see a doctor more often. Profilactic visits can save quite a lot of money in the longer term. 

I also agree on point 3. Yes, it my be less than fair to the top decile. But after all, life is never fair. Bill Gates is financing more than his fair share of public education, defence, etc. Overall, I believe the taxpayers win more they they lose, though some may lose more than they win. Currently, the tax code is skewed so heavily in favor of the rich that I don't see it becoming a major issue anytime soon. If it becomes an issue, we can always make this particular tax regressive, making sure that Bill Gates doesn't overpay too much. Again, the point is to generate savings by eliminating HMOs; how that pie is to be distributed among taxpayers is a matter of fiscal policy, and should be the subject of another post.


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#26) On June 06, 2009 at 7:15 PM, NOTvuffett (< 20) wrote:

zloj, I agree that not everyone can be taught to the same standard, but the dropout rate in many urban areas is over 50%.

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#27) On June 06, 2009 at 9:15 PM, Donnernv (< 20) wrote:


Just to pick up on your comment "...the tax code is skewed so heavily in favor of the rich..."

I'd be quite interested in specific citations supporting this conclusion.  Otherwise, it's just mouthing the unsubstantiated whining of the lower income classes.

I have beaucoup facts spotlighting the idiocy of this statement.

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#28) On June 06, 2009 at 9:28 PM, Alex1963 (27.88) wrote:


Perhaps because even with a high school education there are few decent jobs for urban residents. I live next door to a low income area and am quite familiar with the entrenched hopelessness and the vicious cycle of the urban poor. How about you?

If you grew up poor and say black and nearly every one around you was poor & most of the men had been to jail, many of the kids you grew up with were either in gangs, being pressured to join them or dead, what might you do? The sad truth is many of these kids quite honestly don't expect to live long and figure they may as well drop out and deal drugs and have a taste of some kind of success before they are killed by a rival or just a stray bullet. They may be from a single parent households with little supervision and that parent may work 2 jobs and have no energy to give their kids the direction they need. Or may not have themselves experienced a supportive environment to even know how to emulate it. Or be from a culture which places less emphasis on education but more on working hard and helping the family. It has a lot to do with the environment. I maintain that if you took all the urban, and american poor and scattered them across the country in middle or upper class neighborhoods in one or 2 generations the success rate of these folks would rise dramatically. Put the parents and kids in areas where they don't have to fear for their lives, where people are hopeful. Where they mght get a leg up from a neighbor of friend. Have access to a decent school and they aren't spending countless hours every month traveling to decent groceries, hopspitals, Drs, getting to work because none of these things are in their neighborhoods. It would be transformative. And I suspect many people with deep seated biases would realize that at least some folks aren't like they thought.

IMO too many people look down on the urban poor as welfare addicts and think these people are lazy and jaded. They never bother to go thru the mental exercise of trying to imagine that life and how hard it would be to apply yourself when the odds are they will never go to college or get a decent job. Sure they see the occasional exception but that's what it is -an exception. Most of these folks are penalized by society for their accents and poor english, they may have a poor work ethic and if they can get a decent job they may struggle with an unfamiliarity with a professional environment. And sometimes they'll quite bluntly have a major chip on their shoulder which in many cases is totally understandable considering the messed up system which basically sets them up to fail. By the time half these kids are in their teens they are either scam artists or struggling against the urge to steal or deal or whatever they have to do to get by. No wonder most people probably think any minority driving a nice car is drug dealer or dishonest-because we all know they couldn't possibly have actually gotten around the system honestly right? It's tragic and wrong. It's a miracle anyone from that environment ever gets out to make something of themselves. 

I would hope anyone cognizant of this injustice as you are is supportive of the measures put forward to try and help these people. Many measures don't work or are abused by the chronically lazy. This is simply the cost of trying to rectify a system for minorities and urban poor which has now existed for generations. It's a culture which will be very hard to break but that is all the more reason to keep at it.

What worries me is when people make statements like yours is that they may be thinking-"these people ar hopeless. They have a "free" education and throw it away". Instead of asking why would a person with a chance at an education no  atter how crappy throw it away and how can we as a society try to rectify this. You have to 1st assume that most people really are alike. We want to feel like worthwhile members of society with a shot at reward for our efforts. To be respected and valued for our contributions no matter how modest. Forget the moral imperative to try and level the playing field. It just makes economic sense. As the numbers of undereducated and urban poor grows so do the health care costs, policing, incarceration costs and so on. I've know many people from this community and very few of them wouldn't jump at the chance to do worthwhile work (not McD's) but it's hard to get a shot. Especially if as a stupid kid you got in trouble with the law.

I don't know you and I hope you don't take this as a rant against you personally. I speak here about thos emillions of people who are too quick in my view to write these people off as beyond or beneath help. Often from having absolutely no personal knowledge. Just a vague but very real and damaging bias with no basis in fact and no trace of empathy or sympathy. If a society is measured by the way it treats it's prisoners I would say it is also measured by it's efforts to better the least fortunate. Once enough people are on board with that concept then we can move on to the practicalities of costs, rewarding efforts, penalizing abusers etc.  

Best to you


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#29) On June 06, 2009 at 9:32 PM, s50 (72.71) wrote:

take circumcision for example, In america sadly many people get it done because it can be done. Since it costs money, it must be good, right? The hospital/doctor wouldn't want to do it just to profit, would they? But yet every country with national healthcare says they will not pay for it because it's positives don't outweigh the negatives.

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#30) On June 06, 2009 at 10:10 PM, wrparks (76.88) wrote:

Your three conditions listed above:  Lack of market knowledge, upfront pricing, and avaiaible research.  These would all three be taken care of by a free market.  I recongnize the difficulty in point 4 of a incoherent purchaser and have no solution.

But, people lack knowledge of the market daily and still the market works fairly well.  Do you know how to milk a cow and operate a tractor?  Do you know what it costs to do so?  But, you know what a gallon of milk is worth because the market tells you. 

In a free market, upfront pricing and researchable prices would become available.  You would be able to know what any procedure would cost up front.  They would probably also include a price if the procedure had complications, or they could just increase the base price and that would cover the cost of complications in the aggregate.  There is nothing inherent in healthcare that prevents these two conditions, it's only our current system that doesn't allow it.  You are acting as if our health system is a free market when that is far from the truth.  That's why this is an entirely spurious strawman arguement.  

There are very good arguments to be made on both sides of the topic, but this is not one of them.


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#31) On June 06, 2009 at 10:30 PM, starbucks4ever (90.04) wrote:

"But, people lack knowledge of the market daily and still the market works fairly well"

It works fairly well overall because the segments where they do have this knowledge work well enough to ensure a high average. But the segments where they don't have this knowledge don't work nearly as well, and health care is a perfect example of that.

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#32) On June 06, 2009 at 11:07 PM, 4thebird (< 20) wrote:

we already have restirected care system in this country.  my sister could not get any one to help her with a heart problem.  she was not sick enough to stay in the hospital, but too sick to live.  she died 2 weeks before her first appointment.  It took her over 4 months to find that one.

 Alot of doctors will refuse to take on a new patient if they know they are on medicare. 

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#33) On June 06, 2009 at 11:53 PM, AbstractMotion (< 20) wrote:

Regarding the first point, there's no need for anyone buying insurance to have an incredible in depth knowledge of medical science to choose a coverage plan.  I don't know your professional background, but a lot of highly technical fields generally have ethical codes associated with the profession.  Doctors provide medical advice and are legally bound to honestly disclose risk and treatment options.  Buying insurance is simply a matter of deciding on the maximum coverage you want and how you'd like to pay for it, that's it.  We also live in the information age, there's a ton of free sources and non profit organizations that can advise people on such issues.

Second point, unfortunately the medical field is frought with risk and such clauses are necessary.  It's not as if the situation would be any different in a single payer system, you'd just have a different payer.

Third, well that's what you tend to pay a medical doctor for, their diagnostic skill.  Most of us will get sick and visit a doctor at more then one point in our life, if we feel like we payed too much or didn't like the experience we have that option.  Likewise we can generally who will preform a procedure assuming there isn't an extreme amount of urgency to it.  Otherwise I don't see it as much different from having your car break down in the middle of nowhere and having few options for where to it get it serviced.

Fourth, I'm not sure exactly what you're implying here.  Doctors are required to treat you if you're unconcious and your life is at risk.  Being broke might be difficult, but being dead leaves you with even fewer options.  I don't think the torture characterization is really valid, it's true that being in pain tends to encourage some irrationality, but I'm pretty the practice of inducing it would be considered highly unethical and illegal if that's what you're implying.

On top of it I'll add that the argument that having more then one provider should add some great amount of administrative overhead is a ridiculous in this day in age.  We can pay with damn near everything in this country by swiping a card and putting minimal effort into it, the medical system is currently an exception because record keeping and billing are done in such an archaic fashion.  I'd be fine with the government providing standardized registry and routing services for a minimal free, really our identification system in general needs an update in this nation.


All that said the problems with our healthcare system has a lot to do with how the regulation of it is structured.  Right now the insurance industry is regulated almost entirely at the state level, aside from being inefficient this also adds a lot of overhead costs to upstart companies, and to top it off works directly against any kind of unified set of standards.  Likewise I don't think states have the same ability to impose tight regulation as the federal government does.  Proper regulation and mandated coverage would do a lot to get prices under control and eliminate the conflicts of interest that exist in our medical care system.  I also think it would help if doctors were required to lay out prescription drug information and options for treating conditions.

Like it or not half of this problem is the preference we've given to the elderly in funding and treatment here in the states too.  They require lots of medication, longer hospital stays and more regular treatment.  In many of the socialized countries this is where the rationing occurs, once you're over 65 you aren't a high priority of heart operations and so forth because it's such a costly bracket that adds very little in terms of life expectancy from cutting edge operations.  We do the opposite here in the states and cover EVERYTHING for our elderly population, leave everyone else with the bill and then force them to fund their own coverage on top of it.  As a previous poster said, there's no free lunch and when you shovel in money to a particular segment of the system it gets preference.  How is anyone suprised we have  viagra, fen-phen and PAD medication?  These are the big problems in the US, being too old or being too fat that's where the money is.  If we continue piling money behind such causes, the industry will continue focusing on them.  Even more so if there's next to no money to be made off real condition due to heavy pressures to control prices.  I like how we basically convince ourselves that we're past the point of ever making hard decisions again in this country and try to solve any problem just by throwing money at it no matter how futile it might be, then complain that there's none left for areas that really could use it (like our education system).  You know why things were so great in the 1960's?  Because LBJ hadn't passed the medicare act and congress hadn't increased SS funding until the 70's and 80's.  It all adds up overtime and now the average taxpayer is buckling under the weight of the system that was never practical or sustainable to begin with.

Links: (1) (2)





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#34) On June 07, 2009 at 8:33 AM, wrparks (76.88) wrote:

"It works fairly well overall because the segments where they do have this knowledge work well enough to ensure a high average. But the segments where they don't have this knowledge don't work nearly as well, and health care is a perfect example of that."


 Yes, imperfect knowledge puts limits on the markets efficiency.  Fine, that could be a contributing factor here.  But, frankly, the level of problems we see in healthcare is not attributable to lack of consumer knowedge and directly attributable to a lack of a healthcare market.  That's what I'm getting at.  There is no market for your healtcare needs.  None, zero, zip. 

You get to choose from maybe 3 state sponsored providers , who have all their plans set by the state, and their profit margins set by the state, so, why would they want to cut costs since their margins don't go up at all?  Many, such as BCBS in NC are non-profits because that is the only way the state will let them exist.  Where is the profit motive since any cost cuts do not affect their incomes?  Why make billing simpler when there is zero incentive?  Why should they lower prices, since we really don't have any choices in providers?

It's simple, we have a worst of both worlds system with state control of private capital and companies.  We know that doesn't work.  See Fannie and freddie for more examples.  But, don't pretend that it's a free market failure.

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#35) On June 08, 2009 at 4:23 PM, Gemini846 (34.47) wrote:

I had to rec this for one reason. The concept that the aggrogate could determine efficiency more than the individual. That statement is hard to argue with. See the problem with health care (in addition to the many things you mentioned) is that you have multiple tiers of care.

1) Routine preventative care that everyone needs. Either the government (federal or local) or private practice can provide these to everyone cheeply.

2) Advanced "specialist" care which costs more and may improve quality of life. (IMO this is what we are fighting about most).

3) Elective Procedures based on advanced specialist care. (Surgery for instance to unclog arteries). This is VERY expensive.

4) Emergency Care - Nobody really pays this out of pocket. Wealthy people have insurance, poor people either have medicaid or they just get the hospital to write it off based on threat of bankrupcy filings.  Hospitals have to treat you (this is socialist in nature, but even cold blooded libertarians would have a hard time arguing against it. Not treating people in emergencies is a moral thing).

5) Cosmetic Care - Should be all out of pocket. Does this type of thing exist anywhere else but the US? (Does it need to?). Do Europeans have doctors running around passing out B12 shots for weight loss? Just curious.

So in my list its items 2 and 3 that we are most arguing over. Doctors don't perform extra tests to bilk the insurance companies as much as they perform them to not get sued. Test xxy is useful for discovering 0.02% of cases that end up being a problem. Europe skips this test for most patients. American doctors are afraid of law suits so they order the test.

States that have started to institute malpractice reforms are seeing care improve. For instance. In Florida the amount you can collect for Brain/spinal Trauma during birth is capped at $100,000. In fact any injury where the care required will excede that is automatically granted the maximum so the lawyers are largely un-needed. If your costs for treatment end up exceding this amount then the state pays for the treatments. This reduces the costs of mal practice insurance for OB's and gives the doctor the power to inform the patient on which tests they recommend.

What I would like to see is insurance portability.  I should be able to buy insurance from whichever company I choose much like car insurance rather than be locked in to whatever my employeer has to offer.

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#36) On August 19, 2009 at 1:49 PM, PaulTomkins (< 20) wrote:

I hope you will re-post your thoughts at as many places as you can now that the debate is heating up again!

Great post.

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#37) On August 19, 2009 at 4:11 PM, ReadEmAnWeep (86.90) wrote:

"your post has no empirically verifiable evidence, has no specific exampes, and is full of exaggerations. "

 I believe he started the post by saying:

"Just wanted to make a point"

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