Economics

What Difference Does Health Insurance Make?

Almost everyone thinks we should insure the uninsured. I don’t recall even a single dissenter. Yet it is precisely when everyone agrees on something that thinking begins to get very sloppy. So let me be the devil’s advocate and challenge the idea.

Why do we want to insure the uninsured? Forget about the costs, for a moment. Are there any benefits? What are they? I can think of four candidates. If people are insured:

  • They may get more health care.
  • They may get better care.
  • They will enjoy protection from the financial effects of catastrophic illness.
  • They will be less likely to be free riders on the charity of others.

The first three items are “it’s for his own good” benefits and, frankly, the case for them is pretty lame — especially in the context of RomneyCare and ObamaCare. If you expand the demand for health care but do nothing to increase supply, people in the aggregate will not be able to get more care. One person’s gain in care will be offset by someone else’s loss. (At least that tends to be the case, when the principal currency patients use to pay for care is time and not money.)  Since the costs of non-price rationing will rise in the process, the whole exercise must make society as a whole worse off.

The same objection applies to the idea of “better care.” Better care for one person must be obtained at someone else’s expense, if the supply of medical resources is unchanged.

[I suppose you could make an additional argument: If we insure the uninsured, they will have a better chance of getting a “fair share” of health care. In other words, care will be distributed more equally. While that argument makes sense in the abstract, it doesn’t work if you segregate the previously uninsured into plans that pay providers below-market rates — as both RomneyCare and ObamaCare do — and cause them be pushed to the rear of the waiting lines. See below.]

As for financial protection, it’s not worth much if you don’t have any assets. If you do have assets, who is to say that health insurance is more valuable protection, say, than flood insurance or homeowner’s insurance?

That leaves us with item four: it’s in our own self-interest to insure the uninsured. This argument has been used frequently by the Obama administration. Here’s Gov. Romney:

The state was giving over $1 billion away in free health care, much of it to people who could’ve paid something but were just gaming the system. You won’t be surprised that a lot of Democrats thought we should give them even more. I took on this problem and hammered out a solution that took a bad situation and made it better — not perfect, but it was a state solution to our state’s problem.

The Washington Post Fact Checker gave Romney three Pinocchio’s for that statement. (See explanation of the ratings.) Here’s why.

Give Romney credit for reducing the number of uninsured. An Urban Institute report found that the number of higher-income Massachusetts residents without insurance — the potential free riders — fell from 5.2 percent before RomneyCare was enacted to 1 percent in 2008.

But the number of Massachusetts residents using private insurance has remained roughly unchanged, as has the percent of state residents who are either uninsured or using public insurance plans. (See page 36 of the report). As the Fact Checker explains:

If one of the goals of RomneyCare was to reduce the state’s burden of subsidizing health care, it failed. Romney’s plan instead shifted much of the free-rider costs to a pair of newly formed government agencies called MassHealth [Medicaid] and Commonwealth Care, which provide free and reduced-price insurance.

The Kaiser Family Foundation offered the following assessment:

Health centers experienced a significant reduction in the number of uninsured patients, but these reductions were more than offset by gains in the number of patients with insurance, particularly MassHealth and the new Commonwealth Care program.

Many of the newly insured patients in fact were health centers’ previously uninsured patients; that is, to a considerable degree, health center patients remained in place while their source of financing shifted from uncompensated care funding to patient-related revenue.

Romney campaign spokeswoman Andrea Saul said the reform still made the free-rider situation better, because people using Commonwealth Care pay at least a portion of their premiums:

“This is good in and of itself — promoting personal responsibility and ownership — and it also means that people are being asked to pay what they can afford, which reduces the free riding problem,” Saul said. “Frankly, there is no dispute that the Massachusetts health-care reforms took the problem of uncompensated care and made it better.”

To which, the Fact Checker responded:

This slight uptick in personal responsibility may be commendable, but that has been accompanied by a rising cost of state-subsidized health care. The Boston Globe projected that the price tag for Commonwealth Care alone would reach $1.35 billion by 2011, up from just $158 million in 2007.

Add that to the $475 million the state spent on its Health Safety Net program (which reimburses hospitals for those who have no insurance at all), and you get more than $1.8 billion for those who can’t or won’t use private insurance. The bottom line is that Massachusetts has continued “giving over $1 billion away in free health care.”

And remember, this isn’t Rush Limbaugh or National Review saying these things. This is The Washington Post! The Fact Checker concludes:

Romney appears to have conflated the fact that his program reduced the number of uninsured with fixing the problem of free riders. He deserves credit for giving Massachusetts the lowest rate of uninsured in the nation, but his state remains saddled with equal or greater costs for those who can’t or won’t buy insurance.

Sign off: People who think that the case for insuring the uninsured is rock solid may want to re-read this Health Alert and consider how weak the case actually is.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

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  2. You can usually or typically trust the opinion of a Dr. when you go to them for help. Can’t always give an insurance salesman the same status because they usually end up getting the better end of the deal. Sure, they need to make a buck like the doctor does, but really; at the last few bucks an elderly family can afford. They usually end up having to dump the policy after investing heavily into it over a period of years. Look to KeyToLaw.com for help if this is your situation.

  3. I suspect the majority of people prefer the dignity of living-wage work, and the ability to afford coverage, over needing assistance. But it doesn’t have to be a case of something for nothing. That is, any more than it is now, with policy-holders paying for expensive un-reimbursed hospital care in a society that doesn’t allow people to die in the streets (vs. die slowly from cancer if they can’t afford the treatment). Able-bodied people could be required to pay into the system on a sliding scale if they want coverage from it, or at least commit to some community service in exchange for benefits.

  4. I was in a poor country some forty-five years ago that I can name — Korea. There was no electricity or plumbing outside urban areas, many houses had thatched roofs and most of the country at that time still wore the traditional Korean clothing. I was assigned there as an X-Ray Tech in a small Army medical detachment and spent most of my off-duty time working with English conversation programs, including two or three small groups of doctors and nurses planning to go to the US at some time, as well as a group of High School students.

    Since the country was too poor to furnish free public education for everyone students were expected to pass entrance tests as early as middle school to continue with the public schools. There was a small professional and merchant class who could afford private schools, but unlike the US those were typically for students not academically able to pass the public school entrance exams.

    All this is simply to underscore the measure of poorness that country was dealing with at that time. As everyone now knows, the Republic of South Korea is one of the economic powerhouses of Asia and is a model of success in many areas, including health care. It seems their health care system has developed very much along the same lines as their schools (which I think furnish free public education through the university level).

    Here is a link to an informative summary of Korean health care and the reader can decide for himself if that attitude of “give people something for doing nothing it is not long before nobody wants to do anything” is a self-evident as it sounds. I think not.

    http://askakorean.blogspot.com/2010/01/healthcare-system-in-korea.html

    This is not a fluff piece. There is plenty of criticism, including a spirited conversation in the comments section. Lots to think about here.

    But that business about poor people getting should not be getting “something for nothing” is ignorant, retrograde savagery with a cold-blooded, mean-spirited attitude. I’m sure there are a few bootstraps cases who would argue that “if I can do it, then anyone should be able to do as well.” But my experience is that most people who have seen what it means to go without basic health care up close and personal, have exactly the opposite idea.

    I might add that tour guides are not the most reliable sources of reliable information and opinions.

  5. I was in a country a few years ago that I will not name. There was a lot of poverty there. While on a tour I ask the tour guide if the poor people had any kind of welfare system to help them. He replied there wasn’t because their government had found out if you give people something for doing nothing it is not long before nobody wants to do anything. How long is it going to take our government to figure that one out.

  6. Well, at least the 13% of grandmas who lost their shirt before Medicare, when healthcare was relatively basic and cheap. So until there’s a viable, convincing replacement that wouldn’t result in millions of seniors trying to pay fat premiums and/or substantial out-of-pocket costs, I suspect there’s not going to be much support for eliminating it. Reform to minimize abuse, maximize efficiency, and have wealthier retirees pay more coinsurance, maybe.

  7. that stat was for people over 65. It was used as a reason we needed Medicare, to prevent the 13% of grandmas that lose the shirt off their back due to medical care

  8. You noted that “Prior to Medicare 13% of seniors were unable to pay for the healthcare in their lifetime. After Medicare that is now up to 19%.”

    If “in their lifetime” is literal, then that could include before retirement age? Otherwise, I wonder why those 65+ would have trouble if everything is supposedly taken care of, without the need for any additional assistance. I’d think you’d have to look at a person’s collective financial picture, and what income is left over for the premiums and extraneous expenses, even after 65 in some cases.

  9. I am a licensed insurance agent and I have heard all the reasons why and why not to insure the uninsurable. There are pro’s and cons to the debate. If we insure everyone, the cost of private health insurance would sky rocket and many would rather pay a penalty than pay for health insurance. As of June 2010, the industry took a big hit when insurance companies were required to insure ALL children no matter what their medical background. This change was good but tore apart the industry for the agents. The up side is children in need of health insurance can now get the coverage they need. What will happen next. Election time is getting closer and will the next President throw out the Health Care Reform or keep it? Who Knows?

  10. how has the cost of healthcare gone up for seniors? Their premium and deductible are tied to inflation. And they added part D coverage drastically cutting their cost

    Median worth of 170K actually does mean most have money

    problem can be fixed, get rid of medicare before we turn into Greece, Italy, Spain, EU

  11. “the median net worth of households headed by someone 65 or older was $170,494 in 2009. That’s 42 percent higher than the same-age household in 1984”.

    And presumably this includes the value of the primary residence. Not surprising that there was an increase (even for those with modest homes) from 1984-2009. But that doesn’t mean there aren’t lots of people below the median, or that most seniors have big bucks to spend when many basics have also gone up since 1984. Like the costs of healthcare. Maybe one reason the number of seniors unable to pay has risen. Regardless, the claim that it’s mostly the fault of Medicare (and an inherent problem that can’t be fixed?), would need some substantiation.

  12. “Fortunately, the Affordable Care Act now prevents this unethical behavior from insurance companies.”

    What’s unethical about cancelling a policy someone lied to get? Most people would say lieing to get the policy was unethical and the carrier is justified in cancelling it.

    Should someone be allowed to get an auto policy for a pinto when they drive a Benz then when they get in a crash demand their Benz be fixed?

    Or should an 80 year old be able to buy life insurance claiming they are 45 and expect to still get the benefit when they die?

  13. “45,000 people die annually in the U.S. from lack of health care coverage and INCLUDING rescinsion of policies.”

    This number is bogus and can’t be supported with any real science. It’s a propoganda study and nothing more.

    “the Affordable Care Act now prevents this unethical behavior from insurance companies.”

    There are very very few unethical cases of insurance companies dropping people from coverage. On the other hand there are tens of thousands of cases every year of people lying on applications to either get lower rates then they are entitled to or to qualify for coverage they are not entitled to. Funny people like you never mention that unethical problem which is 10,000 times greater. Again its a propogandist argument.

    ACA solved the problem by these people now not being insured at all, not much of a solution now is it?

    “And in 2014, insurance companies can no longer deny customers because of pre existing conditions.”

    Only in the individual market can they do that now. And again you didn’t solve the problem, a kid under 18 not being able to purchase a policy now due to PPACA is not an acceptable solution to pre-existing. Not being able to afford a policy in 2014 is not going to be an acceptable solution to guarantee issue. Killing a market does not make the market more accessable.

    “If you have done your research, you know that currently, the most insignificant mundane illness constitutes pre existing condition, which locks many people out.”

    Not so smart Sally, I sell insurance every day, and your 100% ignorant of the facts, mundane illness does not lock people out and I know becuase I sell people with mundane illnesses policies all the time. Its time for SallyNotSoSmart to do a little reserach not brought to you my MSNBC or the Democrat policy.

    “and for some reason, you have done a complete about face. Whatever could that reason be?”

    It was a terribble idea. Some people are smart enough to learn from their mistakes and the mistakes of others, the rest of people are liberals.

  14. Mr. Ogden, you don’t have to be rude to make your points . 45,000 people die annually in the U.S. from lack of health care coverage and INCLUDING rescinsion of policies. That was my original statement. If you don’t think rescinsion of policies is a real problem, just look up lawsuits filed by individuals who were dropped when diagnosed with cancer. Fortunately, the Affordable Care Act now prevents this unethical behavior from insurance companies. And in 2014, insurance companies can no longer deny customers because of pre existing conditions. If you have done your research, you know that currently, the most insignificant mundane illness constitutes pre existing condition, which locks many people out. The Republicans proposed what almost exactly looks like the Affordable Care Act in 1992 (not the Mitt Romney plan, don’t confuse them) and for some reason, you have done a complete about face. Whatever could that reason be?

  15. “woes of capitalism i/o market failures”

    I’m lost, I thought you were trying to justify your comments on free market failures. Have you given up and now just want to attach markets in any form then project that failure on free markets?

    The way you bounce around is very confusing. We very clearly were having a discussion on free markets, or markets with some sembalnce of freedom and now you want to argue that the failure of a communist market in China is proof that capitilsm and free markets don’t work?

    “6 billion doses of antibiotic medicine each year ”

    The US has 300 million people, majority of whom don’t take any antibiotics in a year. That means the vast majority of these 6 billion doses are not happening in the US. Yet you claim this is a valid argument for the failure of free markets and capitalism?

    Antibiotic misuse in Cuba = Failure of US Free Markets

    Am I understanding you correctly?

  16. The list is rather a homemade gathering of woes of capitalism i/o market failures in the economical sense. As I already said, and I cannot bring up more energy as you are a true believer. But the Anitbiotics example you disagree with actually can well be considered market failure, it falls under the “Bounded rationality” category.

    But what is more interesting is that you indicated in your eyes, I lost respect. Does that mean, Nate, you would baecome impolite, unpleasant and unleash insults on me? OK, but what would CHANGE after you lost respect?

  17. Maybe its time for Liberals to stop using the broke grandma boogyman?

    From SFGate

    the median net worth of households headed by someone 65 or older was $170,494 in 2009. That’s 42 percent higher than the same-age household in 1984.

    But the median net worth of a household headed by someone younger than 35 was a mere $3,662 in 2009 – 68 percent lower than it was in 1984.

    All numbers are based on U.S. census data, adjusted for inflation and expressed in 2010 dollars.

  18. Why do we tax young people who make the least when they are just starting their independent lives in order to support seniors so they can protect their assests? Wouldn’t we as a society be further ahead with our young keeping more of their money as they are starting off in life and seniors dieing broke?

  19. Here comes SallyNotSoSmart again;

    “Before Medicare and Medicaid, people’s savings were wiped out and they were left destitute paying for their medical care.”

    Let me correct your latest factual butchering.

    Prior to Medicare 13% of seniors were unable to pay for the healthcare in their lifetime. After Medicare that is now up to 19%. That is almost a 50% increase. So SallyNotSoSmart, how successful was Medicare when it increased the problem 50%?

    45,000 people what? Do you liberal talking points you cut and paste leave that blank so you can just fill it in for the specific argument your trying to make at the time?

    Exactly how many a year have their policies rescinded SallyNotSoSmart? Hint your 45,000 number is a joke.

  20. Before Medicare and Medicaid, people’s savings were wiped out and they were left destitute paying for their medical care. And when they reached the end of their funds, they did indeed die or live in destitution! Should people work their whole lives to become destitute because of needed medical care? Remember disabled and elderly people aren’t likely to replenish their savings by working after high medical costs wipe out their savings. It is a foolish and ridiculous case to make that private charity will do the job that Medicare and Medicaid is doing. Do you not know that over 45,000 people annually in the U.S. because of lack of health coverage or insurance decisions to rescind coverage. Where is the private charity?

  21. would only providers take care of the poor or would we also rely on the current and historical care takers of the poor?

    Churches
    Employers outside of insurance
    Communities
    Non Profits

    Prior to Medicare and Medicaid it wasn’t like we had people dieing in the streets from lack of care. Providers, Churches, and communities did a much better job of providing for the poor and at a fraction of the cost as government has done.

    To John’s point we can work our way back there. The first step would be to turn all health insurance into high deductible true insurance. Force consumers to engage providers again on cost.

  22. User fees are conceptually okay but at this late stage in the game there are at least three flies in the ointment I can think of (not counting insurance, either mutual or for profit).

    1) Payroll taxes constitute the main revenue collection method for medical care,

    2) Employee “contributions” to group insurance and

    3) HSAs and MSAs (together with co-pays and direct cash transactions with providers) are the only remnants that remain of what might otherwise become your “user fees.”

    I read somewhere that about fifty cents of every health care dollar “comes from the government” which has little or no meaning, thanks to a byzantine tax, authorization and payout system involving Medicare, Medicaid, the VA, vouchers, indigent clinics and who knows what else. Most recipients of health care have no idea what it really costs, and I suspect neither do most providers. Billing in most cases derives more from coding systems than actual arithmetic involving payrolls, supplies and other identifiable overhead expenses. And by the time the insurance, accounting and tax components are taken into account the end result is something of a Hail Mary pass. Good luck figuring out what a proper fee might be.

    Aside from that, I rather like the user fees approach. It reminds me of Robert Porterfield’s Barter Theatre.

  23. User fees for food do not work fine. Hunger was very widespread in the USA in the 1930’s, and it would be more widespread today without food stamps.

    User fees for housing do not work for the homeless certainly, who are not a huge number but are still a tragic group.

    In this case you somewhat missed the point of my post. My ‘package deal’ would be that doctors and hospitals could set their own fees, if they also organized their own way to take care of the poor.

    Also the government would not set the standards for taking care of the poor. Not every poor patient would get bypass surgery.

  24. hasn’t OWS shown in the matter of a month socialism doesn’t work? How about user fees for housing? Or food and water. Those are both more immediate needs then health care and user fees work fine.

    ” If everyone has low deductible insurance, then fees do not bother or restrain them.”

    But it bankrupts the providers who can’t afford to meet demands, HMOs showed how this plays out. NHS and other socialized systems also show the same, How do you want to ration if you give everyone all the free healthcare they want, or low deductible healthcare?

  25. None of the posts so far dig deep enough into why insurance of some kind seems so necessary.

    There are ultimately only two ways to pay for health care:

    a. The patient pays (i.e. user fees)

    b. The community pays (i.e. public hospitals with global budgets)

    Other than in New York City for about 50 years, American medicine has settled on option a – user fees.

    No one is bothered by user fees for haircuts, because in a pinch you can cut your hair at home and long hair does not hurt you.

    But user fees for health care do raise sticky issues, because user fees either make some patients stay home (to their detriment, mostly), or drives other patients into bankruptcy.

    The informal solution right through the 1950’s was for doctors and hospitals to act as ‘closet socialists’ — collecting full fees from those who could pay, and giving charity care to those who could not pay. It is one way of getting around the painful situations that user fees create.

    Universal insurance is another way of getting around user fees. If everyone has low deductible insurance, then fees do not bother or restrain them.

    Although I am generally on the side of open socialism, I am curious on what would happen if doctors and hospitals were offered a “package deal”–

    the government would stop controlling your fees, but you would be responsible for giving decent treatment to the poor.

    There would have to be some federal money involved, but given directly to those providers whose location caused them to be swamped with poor patients.

    There would be no mandates to buy insurance, and no federal dollars going to insurance companies as premium subsidies.

    Anyone curious about the user-fee issue should read Prof. Robert Evans or Joseph White for fuller discussion.

    Bob Hertz, The Health Care Crusade

  26. this idiot doesn’t even know what a market is. McDonalds is a free market? How is one company or one reactor a market?

  27. since you admit you would not agree with some of these, cable TV a free market when municipalities grant monopolies, which ones do you agree with, most of these are a joke written by someone that doesn’t know the meaning of a free market.

    A free market doesn’t mean someone will never get a bad deal or even robbed but the market will deal with those individuals.

    rbaer, I disagree with a lot of what you say but usually your inteligent about it. I lost a lot of respect for you with this link;

    “The Drug Industry: According to Dr. George Silver, a professor at the Yale University School of Medicine, about 22 percent of the 6 billion doses of antibiotic medicine each year are overprescribed, resulting in 2,000 to 10,000 unnecessary deaths annually. ”

    How in the hell is doctors over prescribing antibiotics a free market failure? Who ever made this list is a blathering idiot. Most of those 6 billion doses were in communist and non free market countries.

    Sad rbaer sad

  28. “you livertarians need these regulations anyway, because otherwise, how could you excuse glaring market failures”

    The day you can show me a free market failure I’ll answer youre question on how to explain it. In fact I’ll make it even easier for you. The day you show me the failure of a partially free market that was the result of free market principals I’ll answer it for you.

    “it was market failure because there really wasn’t a free market”?”

    This is where educated people look at the cause of the failure and figure out what caused it. Lets look at a relative example for this blog;

    There is not a market for children under 18 to purchase individual health insurance. So, is this a failure of free markets, with so many insurance companies why are none selling it? Or was there something else that caused the semi free market to fail?

    There use to be a market for these policies then it disappeared, almost over night, last year. It disppeared When PPACA passed. PPACA made insurance for those under 18 guarantee issue. So we can draw a direct link between PPACA’s requirement for guarantee issue policies for those under 18 and the disappearance of the market.

    So rbaer, was this a failure of free markets or a death caused by over regualtion?

    See how easy that is.

  29. Aha, so you are OK with anyone fixing the sink, but you are not OK with the unlicensed pilot (interestingly, you did not talk about unlicensed HC professionals). And how about the unlicensed plumber fixing gas lines, or the uncontrolled restaurant?

    Fact is that most sane people want some kind of societal control for a lot of services and products , e.g. that food services are sanitary, that HC facilities and providers have some kind of oversight, that pilots are trained – yes, one can often wonder whether certain regulations go to far. But Nate, you livertarians need these regulations anyway, because otherwise, how could you excuse glaring market failures other then repeating: “No, it wasn’t market failure from insufficient regulation, it was market failure because there really wasn’t a free market”? The absolutely free market has become the libertarians’ utopia, like communism is the utopic stage of Marxist theory. You will never have absolutely unregulated markets for major parts of a highly developed society. But you can always postulate. And dream.

  30. professional regualtion and licensure are not the same thing. To what level they are enforced is also a major variable. How many unlicensed doctors are there praticing versus how many unlicensed plumbers advertising on craigs list? In plumbing, which is not a totally free market becuase their is some regualtion, at your own risk you can hire anyone to fix your sink, if they are not licensed or insured your taking a risk, i.e. free market.

    In medicine most people probably couldn’t find an unlicensed doctor if they tried.

    The term free market, not understood by liberals, is always misused by liberals. We have very very few free markets in the US. That being true the left and uneducated liberals still love to blame free markets for everything. basic labor would be an example of one of the few free markets. If I hired someone to scoop dog poop from my back yard its free of regualtion, that would be a free market. Most other markets are regulated so prior to blaming “free markets” for any ills you must really examine what caused the problem.

    Your misleading attacks on free markets are unpleasant to those interested in accurate and honest debate.

    Depends which free makret your trying to reestablish. Do I want unlicensed pilots, not really. Do I need the State to tell me who I can hire to cut my hair or give me a massage, no I don’t. If your talking about shutting down the State Board of Massage, Barbers, or Cosmotology, I do know the names thank you, then yes it would suffice.

  31. So Nate, even if I am not funny, I am at least not thoroughy unpleasant in my posts.

    I think that your position – no free market because there is pfrofessional regulation by state, federal and other entities – is untenable, even for libertarians. What about plumbers, builders, pilots etc.? No free market there either?
    Or does it just suffice to close down 2 or 3 government agencies, even if you cannot name them, to reestablish the free market?

  32. “if patients came with what is essentially cash to me (unlike now), then I have the opportunity to offer value as part of the equation and I would be in competition for their business. I would probably make less money on each services provided, but the greatly diminished cost of providing the service would more than make up for it. Win Win.”

    Nothing, not even insurance companies, is preventing you from providing your services on a cash basis. If you want to “compete on value” accepting only cash you can do that right now, you just have to wean yourself off the insurance addiction.

  33. Me thinks you are trying to be disagreeable just for the sake of being disagreeable. Or your understanding of the current system is lacking. I, as a provider of services, compete for no one’s business on the basis of value. Ever. Nor can I – my contracts with insurers forbid it. Rising deductibles and co-pays cannot “do anything” for something that doesn’t exist. Just because I used the term “debit card” does not automatically make the concepts the same. Try and read with understanding.
    If my charges were mine to choose (unlike now), and if patients came with what is essentially cash to me (unlike now), then I have the opportunity to offer value as part of the equation and I would be in competition for their business. I would probably make less money on each services provided, but the greatly diminished cost of providing the service would more than make up for it. Win Win.

  34. This is successful?

    the evidence shows that if you create an American-style healthcare system the result will be denial of care and huge costs for the taxpayer. If the bill is passed, coming generations will not forgive us for taking the “National” out of the NHS.

    Financial pressures, flat budgets until 2015 and an ongoing £20bn savings drive mean that at least 20 to 30 hospitals (10% of hospitals in England) are facing bankcruptcy in their current form and soon would be forced to shut or reduce services significantly. The Department of Health is already discussing handing the management of 10-20 hospitals to the German firm Helios. It is inevitable that people will link the closures to the NHS reforms.

    The latest proposals remove the cap on private patients being treated by NHS hospitals. Waiting lists are already growing, and will get worse as more capacity is used for private patients. The situation becomes desperate when hospitals in financial difficulty make up the deficit by taking on more private treatment.

  35. NHS is so succssful they are considering american style reforms, need to do some more reading there Ms. Smart.

  36. HAP the WHO is clueless quacks that can’t add their way out of a grade school math book., The 34 ranking is propoganda and has no basis in reality and meaningful science.

    You might also want to factor in sustainability, how do you think greek healthcare is going to look 5 years from now?

  37. ” the invisible hand cannot simply bring up the supply when there is more demand for medical services. Is he a heretic in the church of the free market?”

    Realize you were trying, unsuccesfully, to be funny but some people might actually believe we have a free market so I will correct you. free market can’t increase supply when government regulation constrains it. i.e. you need a license from the government to be a doctor. To get that license you must first pass training also constrained by the government.

    Hey bashing free markets is always an easy laugh for those not very well informed though.

  38. “Preferably a debit type card, tied to a spending account that is managed to include incentives and disincentives.”

    Insurance already has a debit card feature, it’s called payment caps with deductibles and co-pays as incentives/disincentives. Hasn’t done anything for “competition” or cost control. BTW, insurance needs risk management, health care does not.

  39. #3 is more than “for their own good”. If you are in an accident & the police force you to go to the hospital you can be on the hook for tens of thousands of dollars from testing even if there is nothing wrong with you.
    But this is moot. as your earlier post on the dog knee shows, the USA is no longer in the medical business. The sad thing is it’s going to be miserable for the elderly to have to travel overseas for checkups/treatment.

  40. No one said anything about having NO insurance. Insurance is needed for risk (see John Ballard’s post above). But for the non-risk portions of the health care world, it is possible to design a system in which, for most working folks, something other than insurance is the payment mechanism. Preferably a debit type card, tied to a spending account that is managed to include incentives and disincentives. The money in the spending account does not all have to come from the patient – instead it would come from a combination of the employer, the employee, and the government with the government portion progressively alloted based both on income and on age and possibly on condition. Patients would bargain for and/or search for the best health care deals. Providers would price their services competitively for the first time since the 1960s. Patients reaching Medicare age would be given the option to continue with the spending account.
    For those who are unable to contribute monetarily to their own health care, something similar to FQHCs are the answer for outpatient care, just make it easier to form one so that there are more. Inpatient and speciality care would have to be handled via medicaid for now, although in some markets it would make sense to have medicaid take over public hospitals and simply provide the care.

  41. Devise a health care system w/o insurance. Make it work for 25 y/os as well as 50 y/os.

    Steve

  42. For those who (like me, I admit) don’t take time to read the whole comment thread and go directly to the end, this by rbar deserves to be repeated.

    https://thehealthcareblog.com/blog/2011/11/07/what-difference-does-health-insurance-make/comment-page-1/#comment-134045

    “…I was once recruited to a private (nonprofit) MSG. It turned out that there was not enough demand for me and my 2 freshly recruited colleagues from the same specialty, but the system decided to give a generous guaranteed salary to all of us for a few years because 24 hour coverage was needed for the new hospital that – you may have guessed it – was completely unneeded overcapacity (the other hospital around the corner from the competitor always had empty beds and BTW was fine in terms of quality). Why that oversupply? Because it was a suburban area with a very high percentage of private insurance. Doctors are no saints – many if not most go where the money is…”

    And every time I see another of those direct-to-consumer TV ads for drugs, “free scooters” and the like, all I can think about is drug costs and tax dollars. Every dime of the advertising costs is “recovered” by rolling the costs as yet another journal entry on the P&L statements. And the only revenue sources are tax dollars, co-pays and retail sales. (And unlike Medicare parts A and B, Part D was passed with no provision for funding, which has added and continues to add vast amounts to the much-discussed “federal deficit.”)

    Lord. Lemme outta here before I puke.

  43. I quite agree with Sally Smart but not perhaps so vehemently. Greed is there for sure, but greed can aslo apply to all of us who expect “cheap”, state of the art care. American culture and thinking with regard to healthcare, from the “man and woman on the street” perspective is “have it available when I need it”, “don’t charge me a lot”, “someone else should pay” and “give me the best you got”! Well, that is a pipe dream and everyone knows it. The least we could ask of ourselves is to employ basic health wellness strategies every day. Maybe if we did we would find plenty of dollars available for those who for no fault of their own need care. There is something Americans can do but non-complinace in basic prevention and in following doctors orders is woefully absent.

  44. But unless you take the next step, and denounce programs that transfer tax dollars to private insurers to purchase health care for citizens, your statements ring hollow.

    “price gouging” Really? By who other than Pharma? Please give a specific example that does not involve a pharmaceutical company.

    Competition? Please provide a specific example of competition within our system. There is no competition, there is no free market that you can claim to have failed. It is IMPOSSIBLE to have competition in a market in which the service is paid for by someone other than the consumer of that service and in which the price of said service is not determined by the provider of the service.

  45. Sorry, there’s an elephant in the room. The model of providing healthcare to every citizen works very well in other countries (contrary to what you have been misled to believe). The difference is that these countries prohibit price gouging and control costs. Compare the costs of various medical expenditures among the United States and a few other industrialized nations and you begin to see something is rotten in Denmark, er..uh..the United States.
    There is no invisible hand of competition, but a very visible fist of greed.

  46. Most patients would simply not know how to spend their HC dollars wisely, which is a challenging task for anyone, given uncertainties of the future, health history, risks. And there may be people who may not need that many HC dollars, while others need fortunes to treat their cancer or injury.

    BTW, I realize am appalled that Mr. Goodman apparently believes that the invisible hand cannot simply bring up the supply when there is more demand for medical services. Is he a heretic in the church of the free market?

  47. As usual the discussion conflates health care with insurance.
    These are not the same.

    ►HEALTH CARE is about medicine and healing.

    ►INSURANCE is about managing risk.

    In both cases a vast assembly of individuals and companies are dedicated to their respective missions.
    Those two missions are not the same. Often, in fact, they work at cross-purposes.

    Good health care should be as much a part of our lifestyle as safe drinking water or properly-engineered roads and bridges. Instead it is being handled as though it were a brand name soft drink, beer or wine.

    It is a mistake to imagine that health care costs can be lowered by insurance. Costs may be shared in accordance with good risk management and actuarial formulas, but underlying costs will always begin with health care professionals, not insurance professionals.

    http://youtu.be/5J67xJKpB6c

  48. The WHO ranks the US 34th in terms of health outcomes yet we spend the most per capita on health care. Most of the countries that outperform us in terms of health and efficiency insure all of their citizens in one way or another. It’s correlation not causation but those systems are worth another look. America is exceptional in a lot of ways, healthcare is not one of them. Time to stop pretending that we can come up with a better solution than everybody else and try some things that seem to work for others.

  49. People no not need health insurance, they need health care. There are alternatives – FQHCs for example. Dr. Mike the private practice physician has no desire and no room in his practice to see more patients with low paying insurance. Dr. Mike the FQHC physician would love to see more government insured and uninsured patients. It’s the same me. It is always so convenient to make an argument that leaves human nature out of the equation, especially when the argument is made by someone who thinks they are immune to their very own human nature and therefore superior to to heartless health care professionals who also happen to be in the business of medicine.
    Massecheutts is “giving away…health care”? I wasn’t aware they employed any health care providers in direct patient care. Doesn’t that mean that other providers gave it away for free, or that Massecheutts gave away health insurance? These don’t mean the same thing.

  50. It only proves the demand for care never goes away. The necessity is not proven.

  51. What? Oversupply? How is that possible with government mandated certificate of need crap and every other government intervention that has driven costs and utilization through the roof?

    Medicare is a heard of cash cows with USDA prime branded on them waiting to be milked over and over.

    The HC dollars need to be in the patient’s pocket, not Uncle Sugar’s pocket.

    Uncle has a hole one pocket, and a gun in the other one.

  52. The flaw in Mr. Goodman’s argument, that keeping the uninsured without access to care allows the rest of us to get access to care, ignores the inevitable, we will all need care. It’s a when not an if.

    “The bottom line is that Massachusetts has continued “giving over $1 billion away in free health care.””

    The above statement proves that the need for health care never goes away, it’s just deferred. Access and cost are two separate issues. Now that access is largely solved it’s up to MA to get control of costs.

  53. Just a reminder to everyone, John Goodman has health insurance. It appears that health insurance has some value.

    Steve

  54. It appears that Mr. Goodman has never heard of overutilization and of misdirection of resources due to our current money driven system. There is plenty of completely unwarranted surgery and angioplasty that we would go as well (or even better) without – in other words, we can put doctors to better use than doing unnecessary multilevel lumbar spine fusion surgeries.

    And as a personal example of misdirection of resources, I was once recruited to a private (nonprofit) MSG. It turned out that there was not enough demand for me and my 2 freshly recruited colleagues from the same specialty, but the system decided to give a generous guaranteed salary to all of us for a few years because 24 hour coverage was needed for the new hospital that – you may have guessed it – was completely unneeded overcapacity (the other hospital around the corner from the competitor always had empty beds and BTW was fine in terms of quality). Why that oversupply? Because it was a suburban area with a very high percentage of private insurance. Doctors are no saints – many if not most go where the money is (I became bored and transferred to an academic department, in a city where I am needed, and on my income level, I can tolerate a near 20% paycut).
    Our “system” needs to get the HC dollars to where they are needed – and medicare does an OK job with that, with the exception of end of life care and some fraud/overuse.

  55. And, your solution is precisely WHAT?

    “Sign off: People who think that the case for insuring the uninsured is rock solid… ”

    Red Herring. As is your custom.

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