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Over the next few years, the U.S. healthcare system will be in the hands of academics from Cambridge, Massachusetts. New CMS Czar Donald Berwick was a member of the Harvard Medical School faculty. Joe Newhouse, who has been the senior adviser to Medicare for as long as I can remember, holds appointments in three different schools at Harvard. David Cutler, Dean of Harvard’s Undergraduate College, seems a good bet to lead the Independent Medicare Advisory Board. Countless of their colleagues and former students have taken key policy making positions in Washington.
I know most of these scholars. They are brilliant as a rule and are acting in the truest sense of public service. None of them are socialists in the usual sense of the word; they do not believe that the government is an efficient provider of most goods and services. I don’t think they want the government to provide health care either. They have never called for government ownership of hospitals or suggested that physicians join the civil service. But whether they realize it or not, they are the vanguard of a movement bringing socialized medicine to America.
My Cambridge colleagues are mostly economists and know a lot about how markets do and do not work. They have learned from economic theory and practical observation that free market health insurance is imperfect. Fearing adverse selection, unregulated insurers take steps that leave some individuals uninsured, while other individuals choose not to buy insurance and free ride off of taxpayer subsidized charity. Most economists (myself included) agree with this diagnosis of the problem with insurance markets.
Academics have proposed many fixes to these market failures. Conservatives like Stanford’s Alain Enthoven and Wharton’s Mark Pauly favor some sort of voucher or direct subsidy with which individuals can buy their own private insurance. Unfortunately, Wharton is hundreds of miles from Cambridge and Stanford is on the wrong coast. The preferred Cambridge solution is a combination of greatly expanded government insurance and a tightly regulated private insurance market. This is the essence of Obamacare.
But this solution does not end with a government takeover of health insurance. There isn’t a public or private health insurer anywhere in the world that doesn’t directly intervene in the delivery of medical care. Socialized insurance necessarily leads to socialized medicine, and if the government controls well over half of the insurance sector through Medicare and Medicaid, and tightly regulates the rest, it is only inevitable that it will also seek to control how health care is bought and sold. And I don’t think it will make much difference whether it is Democrats or Republicans in control. The temptation to set the rules for 17 percent of the GDP is too great.
Let me give you one example. Nearly 20 years ago, academics (from Harvard, naturally) devised a new way to pay physicians under Medicare. They anticipated that improvements in productivity would allow physicians to bill ever increasing amounts that would threaten Medicare’s long term solvency, so they crafted some rather clever rules to calibrate fees, while keeping both physicians and Medicare on an even keel. Those rules are still in place, but they have never been implemented. Every year, doctors protest and Congress overrides the rules. So the best laid plans of academics are cast asunder, doctor enjoy ever higher revenues, and Medicare faces insolvency. (Fees per “unit” of service actually fall, but the number of billed units increases at a faster rate.) This same issue is going to plague Obamacare. To take another example, I helped redesign a physician payment scheme in Alberta with the goal of increasing competition. The provincial government adopted part of the scheme and omitted key details. Now I fear that competition is going to be stifled.
The Obama administration has hired an army of academics to implement the new reforms. They bring with them the finest Cambridge pedigrees and promising ideas. They will write the first draft of the rules and academics everywhere will nod in approval at the cleverness of our colleagues. (Some of us may even enjoy seeing our own pet ideas turn into policy.) But in the fullness of time, the rules and regulations that will govern our health care system will bear the imprint of politicians more than academics. It is the nature of the beast.
My Cambridge colleagues do not favor socialized medicine. But I fear that the regulatory behemoth they have been entrusted to manage is too big for them, despite their talents. Ten years from now, we will look back at these days as the beginning of the end of market-based medicine in America. And my colleagues will only be able to look back, shake their heads, and say “it wasn’t supposed to turn out this way.”
UPDATE: My brother Joel reminded me that there are some parallels to be drawn with “The Best and the Brightest.” As chronicled by journalist David Halberstam, these were the Harvard whiz kids enlisted by Robert McNamara to modernize the Defense Department. I doubt whether these academics ever envisioned that their hard work would help McNamara wage war against the Vietnamese.
It is not well known but a young Alain Enthoven was one of the McNamara whiz kids. After serving as chief executive of a defense company, Enthoven took an interest in health care and, especially HMOs. He developed the principles of managed competition while a professor at Stanford. Enthoven’s ideas formed the intellectual foundation for Bill Clinton’s health reform proposal. But after reading the reform legislation, Enthoven commented “Of the 1700 pages in the Clinton proposal, Congress should throw out 1700 of them.” This is a sad reminder that when academic principles meet political realities, the politicians always win.
David Dranove is the Walter McNerney Distinguished Professor of Health Industry Management at Northwestern University’s Kellogg Graduate School of Management, where he is also Professor of Management and Strategy and Director of the Health Enterprise Management Program. He has published over 80 research articles and book chapters and written five books, including The Economic Evolution of American Healthcare and Code Red. He has a Ph.D. in Economics from Stanford University.
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Nate, I epitomize the dissatisfied self-employed American, yet I’ll bet dollars to donuts I work harder, take more risk, and have stronger family values than your squinty-eyed right wing ass! Health care & insurance reform is not only about helping the poor, who you assume, (as most AM radio addicted far right wingers do) deserve to be poor due to their laziness. It is about helping young working class productive Americans like me remain productive, healthy and solvent. I’m willing to pay for what I use, willing to be required to uphold my end of the bargain by making healthy dietary & exercise choices. What I’m not willing to do is keep working harder while seeing insurance execs & HMO execs & doctors getting filthy rich in our status quo. I’m under no illusion my post will affect your thinking, so I’ll have you know that when our economy collapses & the s**t hits the fan, its people like you I will show no mercy. You better have a good home security system in your gated community, and a lot of guns, because unlike most of the liberals you hate so much, I’m not afraid to go to war with fascists like you. You are a disgrace to what America is supposed to be and one day I’m gonna make you pay for it
@P.Short
-it must be nice being able to write such wonderful statistics from a country that is only 14% of total US population, not to mention that our illegal immigrant estimated population as of a couple years ago is about half of your total population.
Everything else equals, having a complete “socialized medicine” system is much cheaper to operate,that being said, what you’re ignorant of is the fact that our (social services, education,health care,prison) systems are flooded with third world country citizens. Considering that the current administration is blatantly refusing to enforce federal immigration law, you can understand why I am opposed to “everyone, everyone” having “insurance” when there is apparently no end in sight to the future influx of people.
So continue looking down at us from that island of yours, while you guys deal with the boatpeople here and there. Just try to imagine, though, what it would feel like to have the world demand their “basic human right”.
As someone who lives in a country with ‘socialised medicine’ I find many of the comments extraordinary and wonder why so many Americans argue against their own interests in regard to their health care. As far as most Australians are concerned (more than 80% approve of our ‘socialised system) we have an extraordinarily good health care system. Despite the rhetoric of some US Republicans, we have access to new drugs, excellent medical and surgical services, new technologies and so on. I haven’t even heard of a death panel! Most importantly we spend about 50% of the amount the USA spends (about 9% of GDP)and everyone, everyone, has health cover. Australians believe I think, that health is not something that can be left to the ‘market’ whether it is free or not. Health care is something that is a basic human right. It is strange to listen to the rhetoric of Americans regarding their personal freedoms and rights and contrast this with their health care system. Most Australians are very concerned with the establishment in this country of American health companies because we have seen and read what they (and the politicians they have bought) have done to your health care system. I can only suggest that if Americans actually listened and saw what health care systems can be (like Australia’s system) instead of being bombarded with, and tricked by, the partisan bleatings of companies, doctors and politicans supporting the appalling system you have, you may be able to catch up with the rest of us.
Where is it that we come from?
Our forefathers defined certain unalienable rights. Life, Liberty and Pursuit of happiness. The constitution enforces these rights and the right to protect ourselves.
Government is empowered by our taxes to protect our common defense.
Among the rights we are guaranteed are not clothing housing or health insurance. These are included in our pursuit of happiness and liberty to seek and earn live the life that we choose.
Over time individuals of faith have felt the duty to assist others who have been born or found themselves with less fortune to rise to a better life than they would otherwise have. They gave gifts and developed organizations to improve the effect of their gifts. Locally Individuals and groups of individuals developed missions to work locally and afar to help others. They maintained their missions. Their gifts were appreciated.
Some of those gifts were joined together to develop funds to ensure that if an individual within the group suffered an illness or injury, that they would receive care and their families would not suffer loss of all they had worked for through their life. The individuals within the group did not expect that minor injury or illness would be paid for by others but were assured that serious illness and expenses were covered. There was no expectancy of profit by any concerned. This insurance was a safety net. Individuals felt the responsibility to maintain the fund for the future and were cognizant of their own vulnerability and potential need at some point for coverage. They knew that reckless use of those funds would mean that in the end the insurance would no longer be available to them.
In simple matters of health provision, care was simple and providers would sometimes give benevolent care or exchange services for those who could not pay. Individuals maintained autonomy, responsibility and gratitude as members of a social group. It was not socialism but independent individuals working together. Perhaps it was not always equitable. Consequences were certainly felt early. Individuals certainly felt the rewards of altruism and the shame of ignorance of the needs of others. These along with the vulnerability that but for the grace of God, instructed their behaviors.
Today in our deserved attitude and capitalistic insurance industry the values of the past are gone. . .Capitalism has taken root and individuals care not about their decisions to spend or of their responsibility to the group. . .this industry can not survive without draining individuals and those who are the ones for whom the insurance began are precisely the individuals who will not have adequate coverage.
Mr Sader,
I pay the majority of my Health Insurance with the company contributing about 30 percent of the premiums. Oh, No doubt it is expensive.These hospitals and insurance companies are so enormously deceptive and manipulative that they fear any form of transparency.
Hospitals and Insurance companies have it all backwards from a free market that Presents the costs of services up front; to a industrious system that thrives on hidden contractual agreements.
Amazingly enough I think the the Health Industry as a whole still is so involved in their own Profit making schemes that patients are not to have a say in their Health.Making Patients Cash Cows for provider and insurer alike.
More Prospective Patients are tired of the high Demand for excessive fees without results.However, the expectation for payment regardless of results is un becoming for a free market model. The private industry is expected to be accountable for failures and short Comings.They Do Not Charge the Customer for a product and/or service that is not of the Custoners making! However, This industry has a habit of charging patients and Their surviving families for preventable Staph infections, Medical Errors, and failures to rescue. Fair? I think Not! Such unaccountability is what makes Hospitalization so dangerious and the emergence of Patient Safety Advocates to protect the patients interests.
If the industry is so oblivious of progressive Patient Safety measures. Than it will have to be those patients that will need to pressure Hospitals to do the right thing by lowering the spread of Staph Infections and Medical Errors.
“If you poll specific to some of the more questionable mandates 80%+ would drop the mandate.”
80% would oppose being taxed, but 100% want the benefits they get from other
peoples taxes. Dropping a mandate makes that type of coverage more expensive for those who need the mandate. Not requiring universal coverage of pregnancy makes having babies more expensive, not requiring cancer coverage makes that coverage more expensive for cancer victims, not requiring everyone to pay for eduction makes education more expensive for those who have kids.
“Has it been a failure at financing the payment of healthcare? Not at all, it has accomplished that task quite thoroughly.”
Sure, anyone can finance anything by raising premiums 6-10% per year. Duh.
“Has it failed at providing low cost healthcare, sure it has, but that isn’t the role of insurance companies.”
No, that’s the role of a government run single-pay system.
“How can you even begin to claim private insurance failed to control cost when liberals have been shifting cost and piling on expenses since 1965?”
Like covering preexisting. Let’s just allow insurance to cherry pick, that’ll keep costs low.
Peter, Ohio passed a law that Deps have to be covered until age 28. A plan has a 27 year old adult child of an employee come on the plan with serious illness and rates go up 20%. Are you really saying it is private insurance’s fault they didn’t prevent that 20% rate increase and Medicare is better becuase that wouldn’t happen under Medicare, which is true, Medicare doesn’t take any dependents. Do you see how faulty your argument is?
“Nobody is saying ALL insurance is parasitic or has no value”
Um, yes they are Peter, Quack said exactly that as have numerous other liberals. There are 10s of thousands if not more no thinking liberals that would outlaw insurance tomorrow if they could. I would guess millions actually.
“but private healthcare insurance has largely been a failure”
At what? Has it been a failure at financing the payment of healthcare? Not at all, it has accomplished that task quite thoroughly. Has it failed at providing low cost healthcare, sure it has, but that isn’t the role of insurance companies. That is the problem with liberals, you bastardize an industry into something it was never meant to be then jump all over it for failing to achieve your goals. By simple logic insurance is a terrible mechanism to provide social services, but that is exactly what liberals tried to do though. If anything has failed it is liberalism not private insurance. Liberals failed to provide healthcare through private insurance carriers, something anyone with an ounce of common since has been telling them since 1905.
“it has failed to control costs for it’s premium payers.”
In communist Russia they make a lot of jokes about the cars people were forced to drive. Was it a failure of the Russian auto industry to make the cars people wanted when the government required they only make a specific vehicle? How can you even begin to claim private insurance failed to control cost when liberals have been shifting cost and piling on expenses since 1965?
“But then you say private insurance could controls costs if the government would only allow it to be more selective, impose more rationing, keep payout caps and eliminate mandates – all the things patients (including Medicare patients) don’t want.”
You’re making Maggie arguments Peter. Every poll ever done on the subject members overwhelmingly would give up mandates for a cheaper policy. If you poll specific to some of the more questionable mandates 80%+ would drop the mandate. No one ever asked Medicaid to underpay nor Medicare. No one ever asked Medicare to pass a law saying private insurance is prime, in fact many people would prefer for their medicare to be prime or atleast have the option to choose them self. Nothing in that quote is accurate.
“If Medicare operated like private insurance you’d see 6% to 10% compounded rate increases per year – how would your grandma like that?”
Again Peter you have no idea what you’re talking about. Your arguing a level of insurance you don’t have any comprehension of. You wouldn’t even begin to know how to compare the inflation of private insurance to Medicare, and until you grasp what goes into inflation you can’t argue one plan does a better job then another controlling inflation. Typical liberal ignorance and why liberal written bills always make things worse. If Medicare operated like private insurance we would save 40 billion dollars right off the top. That makes up for a lot of supposed 6-10% increases. The double digit rate increases year after year have more to do with regulation then plans ability to control cost.
“Without insurance companies how would seniors fill in all the gaps of the poor public plan they are forced to have?
So you find Medicare such a poor public plan that private insurance needs to “fill in all the gaps”? Why then are you always saying how we’re spending too much on Medicare now; that it’s insolvent? Do you want Medicare to also “fill in all those gaps” and become more “insolvent” as you put it? Nobody is saying ALL insurance is parasitic or has no value (if piece of mind is a value), but private healthcare insurance has largely been a failure (stop lose possible exception?) because it has failed to control costs for it’s premium payers. But then you say private insurance could controls costs if the government would only allow it to be more selective, impose more rationing, keep payout caps and eliminate mandates – all the things patients (including Medicare patients) don’t want. Then you tell us how you build your business fighting private (not self funded) healthcare insurance companies and how they don’t offer value and are paid too much. If Medicare operated like private insurance you’d see 6% to 10% compounded rate increases per year – how would your grandma like that?
vote conservative in November and you can start
“you want to go more left”
No. I want to go more right. Right, as in the opposite of Wrong.
Margalit, your projecting again. The only one dealing in absolutes is you.
“Why are the only options Colombian Cartels free markets or Communist non-markets? ”
It’s not, we already have a very mixed, left leaning market system, we are far more regualted then we are free. You want to take us further left to non-markets, I don’t recall you ever offering any free market or deregualtion suggestions. Everything you propose is more regualtion and less freedom then you want to complain those that disagree are advocating free market chaos.
“Why is the only alternative to the miserable system we have now, a felcher staffed Gulag public clinic?”
Once again you try to define the middle as far left then push even farther. majority of people are happy with their current coverage and don’t want to lose it. It’s only people like you trying to advance political agendas that label it miserable and needing wholesale replacement. Every poll out there says people oppose what you passed and you went to far, yet in your opinion you still didn’t go far enough.
“Why should insurance companies have either license to exploit as they please or be totally dismantled?”
They are already heavily regualted and there is next to no exploitation yet you cry for more regualtion. Again we are already closer to communist like regualtion and you want to go more left.
Your entire agenda is built on dishonesty and distrortion. You try to make it sound like we are living int he wild west with no law and your only proposing some minor regualtion for the good of the community. That was 1960s, you have already distorted the system to the breaking point. We don’t want any more of your regualtion, big government solutions that don’t work. That fact is black and white.
“There is a limitation on the willingness of the poor to support the rights of the rich to get richer, particularly when they realize that their own way to riches is blocked by greed, avarice and sheer callousness. If you leave enough people behind, and for multiple reasons we are doing that now, this entire bubble is going to explode.”
This is a joke, there is no right to be rich, only the opportunity, unless your a democrat politician in Detroit, Cleveland, or other liberal strong holds. Those getting left behind are suffering the results of their own poor decisions and liberal policy. Why should the average person who is less educated and puts forth less effort then 30 years ago be guaranteed a higher minum wage? You reward failure and bestow rights that don’t exist then are shocked at the perverse outcomes. The three pillars of your ideology is what shot you in the foot and your finally starting to feel it.
Nate, why does everything have to be black or white?
Why are the only options Colombian Cartels free markets or Communist non-markets?
Why is the only alternative to the miserable system we have now, a felcher staffed Gulag public clinic?
Why should insurance companies have either license to exploit as they please or be totally dismantled?
Why can’t we look at countries that use health insurance companies, or sick funds, a bit more creatively and a bit more fairly?
Why do we have to make the assumption that this country cannot possibly provide quality health care for all its citizens?
Why are the only income options for doctors 600K or 60K?
Perhaps those who become doctors just so they can make 600K and up shouldn’t become doctors at all. And yes, there are plenty others, equally talented, who will step in once the expectations are reset.
Why the simplistic and completely unrealistic assumption that poverty is a transient self-inflicted or self-perpetuated condition?
There is a limitation on the willingness of the poor to support the rights of the rich to get richer, particularly when they realize that their own way to riches is blocked by greed, avarice and sheer callousness. If you leave enough people behind, and for multiple reasons we are doing that now, this entire bubble is going to explode.
May I suggest that in the long run you are shooting yourself in the foot.
Nate,
I don’t know as if I’d like to see insurance companies banned entirely, maybe just regulated like a public utility, with the government limiting how much of a profit they can make, how much they can pay their staff, minimum benefits they must provide, and maximum premiums they can charge.
“How would you feel working 12 hour days 5 days a week treating over weight people with self inflicted illnesses who consume needless amounts of care because it doesn’t cost them anything?”
I already do more than this, far more. I have to waste unconscionable amounts of resources. As a former missionary, it galls me. But it’s what I have to do to stay in practice, and ahead of the lawyers. Sadly, this is America, and self responsibility no longer exists.
“And make $60,000 a year for doing it.”
I make more than this, thank God. But not a whole lot more. Certainly nothing close to an orthopedic surgeon or an ophthalmologist. And I WOULD do it for 60K a year, if I had perks and bennies to compensate for it.
“That would be the public system yoiur asking for.”
No, that’s not what I’m asking for. I’m asking for a system where people get what they need, not what they want. A system in which we don’t waste resources proving negatives, treating what doesn’t exist, testing for what isn’t there, and making excuses for people’s bad behavior. I want a system in which I don’t have to buy my patients’ medications for them. A system in which I don’t have to rely on drug company samples to keep my patients alive. A system in which people stay in the hospital, nursing home, or in home health for as long as they need, not when their insurance/Medicare/Medicaid run out. A system which pays to help people stop smoking before they get lung Ca or COPD. A system that treats obesity before they get DM, HTN, HLP, and DJD. I could go on….
“I don’t think we could find enough doctors to staff such a system.”
Don’t bet on it. Many of us go to medical school for rather idealistic reasons, not to get rich. If money was what I loved, I wouldn’t have gone in to medicine. I’d have gone into a money-handling job. Yes, I make a comfortable living, and that is all I want out of life. I don’t need or want any more. Money may be the prime motivator for most, but not for all people. My prime motivator is to do a respectable, useful job for a decent wage. I would like to produce at least as much value as I consume. That is about the best any of us can do, unless we are geniuses like Franklin, Gauss, Archimedes or Edison. I freely admit that I am not. So, yeah, I do think we could find people who would do it, and do it well. I know them. They do a good job because they want, need to do a good job, not because they are showered with money. They do it because it is integral to their self-respect as decent human beings. I work with them every day.
How would you feel working 12 hour days 5 days a week treating over weight people with self inflicted illnesses who consume needless amounts of care because it doesn’t cost them anything? And make $60,000 a year for doing it. That would be the public system yoiur asking for. I don’t think we could find enough doctors to staff such a system. MD as Hell would you sign up for that? bev would you pratice in such a system?
” health insurance companies are parasitic. They extract resources from the health care system, without adding any value in terms of goods or services.”
Without stop-loss insurance how would smaller employers self fund their benefits? Without self funding how would they offer affordable insurance? I think there are a number of lefties on this blog that would also disagree with you claiming Kaiser doesn’t add any value.
Without insurance companies how would seniors fill in all the gaps of the poor public plan they are forced to have?
Can you name any country in the world that has a 100% public system without any insurance companies? The only ones I know are communist countries with very poor systems, systems far below the US standards. There is not a sustainable public system in the world. Most of the existing public systems are moving towards more private insurance becuase they can’t deliver the care their citizens want at an affordable price.
While your plan looks great on paper it can’t exist in reality
“There isn’t a public or private health insurer anywhere in the world that doesn’t directly intervene in the delivery of medical care. ”
What part of this do people not understand? If you don’t want anybody coming between you and your doctor, then pay cash or stay home. If you want my help to pay for your care — through public or private system — you better brace yourself for some guidelines.
I don’t want to hear any doctor crap about not wanting to practice evidence-based medicine – if you’re not doing EBM, what ARE you doing? And don’t go having a hissy fit if somebody asks you why you are deviating from standard of care — you got a reason, just say so.
Nice pice. Funnily enough, I wrote a closely related piece, entitled “The Best and the Brightest,” on Aug. 31. A shame I hadn’t seen this earlier.
http://www.avikroy.org/2010/08/best-and-brightest.html
My point: health insurance companies are parasitic. They extract resources from the health care system, without adding any value in terms of goods or services.
Large amounts of resources are also wasted practicing defensive medicine, inappropriate end of life care, useless treatments, useless testing, self-inflicted sickness from poor lifestyle choices, for-profit clinics and for-profit hospitals.
The purpose of the health care system is not to get filthy rich, but to deliver the best health care to the most people. This includes a robust public health system, not just an acute illness system. I will let others worry about Fannie and Freddie, African nomads (the Tuareg?), the USPS, and cocoa growing farmers.
Now, back to treating the straw people…
“But sadly, the vast majority of conservatives evade the logical consequences of their ideology.”
uuuuuhhhhhhh, just when I think we are making progress. Quack, I find it very hard to beleive more then a couple conservatives could tolerate a conversation with you. I’ll give you the benefit of the doubt, how have you come to the conclusion the vast majority evade the logical consequences? I can’t think of a single conservatibve person I know who denies poverty. Most of them welcome it, we see poverty as motivation to work hard so you are no longer living in poverty. We don’t see poverty as a label you are born with and forced to die with like liberals, we see it as a place you are in at a time and usually the result of ones own actions. I once again must call BS on your projection. Another quack comment another dead strawman….the slaughter must stop
Warning, I am going to ask you a very leading question with the full intent of turning your answer around and using it against you, think very carefully before you answer this;
” That is my point. Insurance companies provide nothing of value.”
So we should do away with auto insurance and homeowners insurance? And life insurance to I suppose becuase all three provide nothing of value?
“A non-profit quasi-government entity could do much better,”
Like Freddi or Fanni? Those have worked great for the mortgage industry. Sallie has made college so affordable. Maybe we should model Indian Health Services? Maybe we should copy State Worker comp insurers, those have been raging successes. I can’t think of a single successful non-profit quasi governmental agency that has been successful despite their having been dozens. If I missed on let me know, USPS? I can name a dozen failures off the top of my head. Is it possible you are wrong about this conclusion?
@Nate: Very well, you at least are an honest conservative. You are OK with the extremes of wealth and poverty. I admire your honesty. But sadly, the vast majority of conservatives evade the logical consequences of their ideology.
I am aware that insurance companies do not provide medical care. That is my point. Insurance companies provide nothing of value. They shuffle the money around, taking an ever larger cut of it. They provide no value-added product or service. A non-profit quasi-government entity could do much better, paying the administrators civil service level salaries instead of bazillion dollar bonuses. Even the drug companies and device manufactors, who make out very well, provide valuable products, ditto the for-profit hospitals, clinics, and nursing homes. But being corporations, they are not a form of free enterprise. They are on the government dole like all the others.
in related and similar news forshadowing what it is to come;
“Instead of achieving its stated goal of 90% private-sector job creation, ARRA did the exact opposite. More than 95% of any jobs created have been in the government sector (fully outlined on Recovery.gov and confirmed by the Congressional Budget Office).
The original document outlining job creation estimates is no longer available on whitehouse.gov. It was replaced with an “updated” document three pages shorter and without the industry-specific job targets originally outlined. Christina Romer, the now-departed head of the Council of Economic Advisors, wrote the original report based on the private-market analysis done by Mark Zandi of Moody’s. Like most economists, neither of these two have experience with spending multipliers, unlike Harvard’s Robert Barro, whose research suggests their multipliers are at least 100% too high.”
I always found it odd that the actual results 1-3 years later never get a fraction of the coverage passing the bill does. MSM will write endlessly about how great some new healthreform bill will be but never bother to look at the complete failure of the previous 10 bills to do anything they claimed.
wow you liberals are mass killing strawmen. You would think you would learn to make cleaner arguments and fewer mistakes instead of creating opposition arguments to attack.
Margalit your the one that claimed free markets don’t exist. This was obvious hyperbole and I called you on it. No one said anything about modeling the US Economy after nomads. You made a sloppy argument then an even sloppier cover up. Your over the top partisian propoganda gets you in a corner and your reaction is to go even further over the top. If people like you and Quack could have intelectually honest conversations things might actually stay ingaging. Instead first chance you get you run off to make beleive then argue about the scenery there.
“Exactly what regualtions do the nomads in Africa suffer under margalit? Independent farmers in South America answer to what government agency?”
Yes, Nate. This makes perfect sense. Let us model the entire US economy after the extinct nomads in Africa and the poppy seed farmers in South America.
Can’t wait for the machetes and Cartels to materialize in Kansas….
This week, none other than extermination company Terminix ranked New York as the nation’s bedbug capital. The firm based the ranking on the volume of calls to its offices around the country. New York surpassed Philadelphia, Detroit, Cincinnati and Chicago, which rounded out the top five cities.
Over the last three years, Terminix said, the company’s commercial bedbug business more than doubled, with a significantly Herve leger higher number of calls from individual householders.
” GOP establishment and in the right-wing media called individual mandates socialist when it was a Republican proposal.”
GOP are still politicians and right wing media are still journalist. With a rare exception both are classes of people so stuipd and uninformed they can’t get real jobs and contribute anything to society. I don’t care nor measure what either of them do. I care what the conservative citizens of the country think. I know very few conservtives who read Heritage and even fewer who care what they say.
“How can you write a piece like this without addressing the fact that for profit insurance companies are dictating what medical services should be provided to patients and doing so based primarily on a desire to keep the bulk of premiums collected in their coffers or distributed to their shareholders?”
Juliette, maybe becuase the vast majority of people are not covered by for profit insurance companies. Government covers a large chuck, 50% of those with private group insurance are self funded and 50% of those with fully insured are covered by non profit. Maybe 15% or so of people are covered by for profit insurance companies. Basic facts would help your argument if you got them right.
“Has an insurance company ever actually provided any health care to anyone? I think not.”
THis is really scary Quack, I would have thought in medical school they tought you who provided care and who didn’t? What exactly did you get your M.D. in? How many insurance companies have M.D…..that’s right none there not doctors D… A.. You provide the health care and insurance companies finance it, if you can’t grasp that no wonder your lost.
“Too bad there’s no such thing as a “free market” anywhere.”
every developing nation has the majority of it commerace in free trade. Exactly what regualtions do the nomads in Africa suffer under margalit? Independent farmers in South America answer to what government agency? When I sell stuff online how is that not a free market? I pay no taxes, I have no license, half the time they don’t even know who I am. Blogging is a free market.
The rest of your comment makes even less sense then the quoted inaccuracy.
” They also don’t concede the consequences of extreme wealth and poverty,”
You love beating strawmen don’t you quack. You can’t cut and paste one time in the history of this blog that someone has denied consiquences to wealth and poverty. In your sad world unless someone starts every post saying I accept poverty has consiquences they are denying it. M.D. treating only strawmen of their Quack induced injuries.
I would point out that our current system, corporate capitalism, is not the “free market.” In a truly “free market” there are no corporations, as a government granting a corporate charter is government interference in the economy. So there is no personhood for corporations and no limited liability for their shareholders and executives. Something goes right, they get the profits. Something goes wrong, they all pay with their equity, personal funds and their freedom (i.e. prison) until the debt is paid. I see no one on this board, nor in the media, advocating for honest, clean capitalism. They also don’t concede the consequences of extreme wealth and poverty, as I mentioned above. This is the fundamental intellectual dishonesty of the “free market” crowd. So, let’s be honest that we are all arguing for a mixed economy of some kind. We are just arguing over the distribution of risk, benefit and detriment.
This is fascinating. First time I read one of these debates from beginning to end where I didn’t say anything 🙂
So academics don’t know anything, and that coming from other academics, and the Government of course doesn’t know anything and every time someone tries to fix something, that someone is by definition a Socialist, because “fixing” implies shackles on the, so called, free market, which is the only entity with the prerequisite wisdom and intelligence to always be right on every account.
Too bad there’s no such thing as a “free market” anywhere. I guess various folks define a market as “free” if it does not impose any restrictions on their personal needs to accumulate wealth.
So back to Dr. Vickstrom’s comment way up above, if you’re OK with babies dying in the gutter, or alternatively, if you do not travel in areas with gutters, all is well. Otherwise, your “free” market is restricting my freedom and it has to go away.
@Exhausted,
I second that. The F-O-R must go, especially the profits of third party leeches like insurers. Has an insurance company ever actually provided any health care to anyone? I think not. Continue the struggle, comrades!
Paolo:
what, are you looking for a different answer than what I have been saying here since I first starting commenting?
Take the F-O-R out of profit in health care. Watch the bastards/roaches who feed on this run for cover and search for new feeding grounds. It is that simple.
“First, one of the best healthcare delivery systems in America is socialist by definition: Veterans Health Care.”
No, it is not a socialist system by definition. Veterans were government employees. They are provided health care coverage as employees and retired employees through their employer.
Mr. Holt,
Where is my post from yesterday?
To the author:
How can you write a piece like this without addressing the fact that for profit insurance companies are dictating what medical services should be provided to patients and doing so based primarily on a desire to keep the bulk of premiums collected in their coffers or distributed to their shareholders? Not every free market endeavor has to be an ethics-free zone. In the health insurance market, middlemen are making profits based on a model where neither the providers nor the consumers are satisfied, neither have real bargaining power, and neither are able to exit the relationship freely.
You say you agree with the current assessment of the problems with the American health insurance market – what are your solutions? Vouchers? Really? Why should tax money be used to purchase health insurance based on a corporate model where maximizing profits is the legally mandated goal above all else? This is an an industry famous for rampant consumer abuses and bureaucratic obstacles. It is also an industry free from the fear of being sued for any real damages because federal law shields most health plans from liability. How is this a free market enterprise with such a gross imbalance of information and power in the contracting process, and no checks on abuses built in to the system?
I don’t begrudge you the point that large bureaucracies – government run ones or otherwise – distort best practices and veer toward political expediency. But defending a model where shareholder interest are placed far above the physician-recommended treatment needs of seriously ill patients is neither an ethical nor intellectually genuine position. At least include free market fixes to empower patients – or, if you prefer, consumers – to have a fighting chance when purchasing and utilizing health insurance. Maybe throw in some bargaining power for the physicians.
At some point it would be lovely for experts such as yourself to to try and craft solutions with the patient who requires the right care, at the right time at the center of the policy solutions put forward.
Craig Vickstrom: Your comments reflect Dr. Arnold Relman’s prescription for a healthcare/medical services system outlined in A Second Opinion. Excellent exposition of the facts and issues by someone with hands-on knowledge of most aspects of the USA healthcare system.
Medical services and their financing are, as others point out here, activities with many externalities, ergo appropriate for socialization of financing and for much of medical service delivery.
The point on externalities is that private economic activity almost never, if ever, accommodates the impact on society of negative externalities nor captures positive externalities such as the reduction or elimination of contagious disease.
Public health services funded and delivered through governmental and private means have been essential to eliminating contagious disease as the primary cause of death in the USA in the early to mid 20th century.
Public health measures more broadly considered include diet. Diet impinges directly on broad swaths of the USA economy and private enterprise, primarily the fast food industry, food service industry and the processed foods industry, very significant elements in the USA economy. Adequate pursuit of public health therefore enters into an even larger realm of politics and of other industries outside of the medical services and medical services financing realms, large as those are.
However the relatively poor showing of the USA in regard to measures of population health status depend more on diet and “lifestyle”, e.g. suburbanization and its negative consequences in regard to a sedentary, rather than physically active, life of the average suburbanite, than on the availability and quality of medical services which obviously are generally excellent in the USA, albeit far too expensive.
Therefore topics such as diet and the need to inform the public adequately about diet run counter to the interests of this very large group of private entities in the USA economy. However a part of lowering of costs of medical service delivery and more so the elevation of health status are dependent upon such public health initiatives.
Paolo is too kind in regard to Nate’s commentary. That commentary may be sincere, it probably is in fact although constrained by his political prejudices and work experience, but unfortunately the facts he attempts to adduce and the analysis he provides are no better than nonsense written by the average extreme rightist nutcase.
/Agree with Paolo, IOKIYAR, no matter what be the policy. My suggestions for reform would be: no for-profit hospitals, clinics or insurance companies. Physicians, hospitals, and politicians without conflict of interest (physicians don’t own their testing equipment, hospitals not employing physicians, and politicians no longer accepting bribes – otherwise known as “campaign contributions”). Physicians on salary as state or federal employees. Torts go to the state or federal government, or whoever does the physician licensing. Free higher education to anyone entering any health occupation (stop the need for money). Enforce proper use of medical resources (no more ER visits at 7 PM for sore throat. Emergency room for…emergencies. Imagine that.) Patients responsible for their own health. No drug abuse, smoking, or obesity. If they engage in chronic self-injurious behaviour they have to pay higher co-pays and do not get any heroic procedures or life-sustaining measures, unless they want to pay it all out-of-pocket. And finally, a BIG investment in PUBLIC HEALTH. Sorry to shout, but public health is really where it’s at, not in the acute treatment of illness. How does that sound for austerity? When I practiced in a mission hospital on the edge of the Sahara, restrictions were much harsher than this, BTW.
@ExhaustedMD: I actually agree with most, if not all of your complaints. Even the part about politicians being corrupt and narcissistic and bureaucracies being inefficient.
My question to you is: if you were a law maker or a policy maker, what would you do specifically to fix the problems you have identified? Complaining about how everything sucks and how life is unfair and insisting that everybody should be fired or thrown down a cliff does not solve any problems.
@Nate: I am sure that you and a few other bloggers have always called the Heritage foundation a socialist think tank. I give you points for honesty and consistency. My point is that nobody in the GOP establishment and in the right-wing media called individual mandates socialist when it was a Republican proposal.