Economics

Grubernomics

Gruber OptimizedIn the giddy days after the passage of ACA, I was chatting to a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; ‘Healthcare post Obamacare’ or ‘Radiology in the new era.’ Talks warning us that we were exiting the Cretaceous period.

He spoke about variation in healthcare, six sigma, fee-for-value and ‘paying doctors to do the right thing.’

‘How?’ I asked.

‘I just told you, we need to pay doctors for value and outcomes.’ He smugly replied.

‘How?’ I asked again.

He did not answer. Instead he gave me the look that one gives an utter imbecile who doesn’t know the difference between a polygon and a triangle.

My thoughts drifted to the great polar explorer William Shackleton, stranded in Elephant Island, Antarctica, with his crew looking at the night sky in negative sixty Fahrenheit.

‘Sir, what are we going to do so not to freeze next to the penguins?’ One of his crew asks.

‘We need to get out of here.’ Shackleton replies, thoughtfully.

‘Well thanks Captain! That’s what I call strategy. Why hadn’t I thought of that?’

Yes, why hadn’t I thought of that? Let’s just pay doctors to do the right thing. So damn obvious, eh! Except Shackleton probably would have said what I had hoped that economist would have acknowledged: ‘I don’t know, you imbecile.’

‘We need this’ is not a strategy. Just because we articulate a problem doesn’t mean the first thing that strikes us is the solution. Neither hope nor desire is either strategy or solution.

Was this economist, a wonk working with complex equation and models, one of the voters Jonathan Gruber was alluding to? Or was he in the ‘know’?

Actually, neither of the above. He was an aspiring technocrat; an emerging type of quantitative scholar who has over intellectualized the social sciences. He thinks he can rationally engineer society, just as an engineer builds a structurally sound bridge. For him the line between data-driven opinion and opinion-driven cherry- picked data is blurred.

He is smart. Very smart. He is not disingenuous or intellectually dishonest. Nor is he brainwashed. He has been commended all his life for post hoc rationalization of his opinions by an audience that listens to the same music. It’s not that the ends justify his means, it’s that the ends define his intellectual means.

Such people do not like arguing. If you question the solution too much they will quote something like ‘people who say it cannot be done should not interrupt those who are doing it.’

They are rarely ever challenged epistemologically. Occasionally, they’ll say ‘now let me play the Devil’s advocate and ask, how our new system can have problems.’ This ends up being a comical affectation of objectivity.

They are rationalists but treat numbers with the same reverence as Galileo’s captors treated god. The gods are different. The certitude in their omniscience is the same.

Technocrats are well meaning, as are people who have boundless faith in them. But being well meaning counts for rabbit droppings when it comes to the objective truth. Reality doesn’t care about our sincerity. Reality is what it is.

What’s the provenance of such optimism in technocracy?

I believe this is a phenotype of rational ignorance. It’s a heuristic. When we want to have our cake and eat it, we say ‘SOS, Technocrat. Get working!’

Few have the time to find out whether the technocrat’s solutions are really solutions or an introduction to another set of problems. More importantly, even fewer have the inclination to do so, particularly if the technocrat is building our perfect world.

There are prescriptions for technocrats. Classes in epistemology, philosophy of science and introduction to Karl Popper. Perhaps an elective with the 30-hour-week French technocrats.

But I doubt much will work. We want them to be fixers, Pulp Fiction’s ‘Wolf’ character. If they honestly told us ‘on the one hand this and on the other hand that,’ if they prefixed every plausible with a wide range of plausibles, if they spoke not about solutions but problems in solutions, they’d be branded as defeatists, as unprincipled waverers and be out of a job.

If our technocrats are falsely certain it is because we cannot bear the burden of uncertainty. It’s because we want solutions, not hear about trade-offs. Even as you are reading this you may be wondering ‘so that’s the solution?’

Every certainty, every point estimate stated without a confidence interval, every solution proposed without projecting its unintended consequences, is misleading. In the swagger of certainty lies not a lie but a truth: we cannot handle the nebulous and the messy. It is nihilistic. We want simple solutions to complex problems.

This is not a right-left issue. This is an issue of democracy, where people with different preferences, want different things, but do not wish to lose anything in the process of getting more. Politicians happily oblige our Disneyland fantasy. And the technocrats start working on the science that pretends to deliver it.

So ladies and gentlemen, the fault lies neither in Gruber nor in our academic stars but in our unresolvable contradictory desires. We want both security and freedom.

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Paul Slobodian
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Peter1, Overspending in US healthcare is estimated by Rand at 30%….others like Nortin Hadler think it may be as much as 50%. That is likely a large contributor to why US healthcare expenditures are higher than those in Europe. Another reason is that Europeans are accepting of the delays and rationing that help control costs there…..not so for Americans….we like to take responsibility for things ourselves….and that is why most of us highly value our 401ks and our high deductible plans linked to HSA’s. Our employees would try to lynch me if I told them we were replacing our 401k… Read more »

Peter1
Guest
Peter1

“That is likely a large contributor to why US healthcare expenditures are higher than those in Europe. ” Paul, less utilization is argued as not the driving force in European lower costs, I’ll let you do your own Goggling. What does drive prices here is are “the prices stupid”, a quote from an article you can also find. I know that wealthy corporations (like insurance companies) can embellish their employee benefits such as 401k matching and health care, but that does not include most employers. I bet you also have one of those “cadillac plans” and probably a big bonus… Read more »

Paul Slobodian
Guest

“Contract law has existed for ages. I don’t know of a good substitute for contracts. Do you?”

Contracts enforced by the judiciary or mutually acceptable substitutes like arbitration are essential to free markets….where supplier and customer freely enter an agreement without coercion. Otherwise we end up with no one trusting anyone except family and friends…..a huge impediment to economic development and prosperity….as we see in many countries like Afghanistan and South America.

Allan
Guest
Allan

Peter1 writes: “Sounds like he would have no problem with single-pay system of health care.” Yes, that would be the left’s soundbite interpretation. Do you really want to live your life on soundbites? I guess it is a hard habit to change when the alternative requires thinking and understanding. What you did was extract an outlandish out of context portion of Hayek’s ideas so you could feel exonerated even though he tells a completely different story. In this chapter Hayek is trying to relate security and freedom. You seem to like the nanny government of collectivists that provides a false… Read more »

Allan
Guest
Allan

In chapter 9 Security and Freedom Hayek makes a case for specific state intervention where the state is well off. He makes a distinction between two types of security and “that this distinction largely coincides with the distinction between the security which can be provided for all outside of and supplementary to the market system, and the security which can be provided only for some and only by controlling or abolishing the market.” He continues: “There is no reason why in a society that has reached the general level of wealth which ours has attained, the first kind of security… Read more »

Peter1
Guest
Peter1

@ Allan, “…the case for the state helping to organize a comprehensive system of social insurance is very strong.” Sounds like he would have no problem with single-pay system of health care. Hayek is also quoted as saying, “…that a limited democracy might be better than other forms of limited government at protecting liberty but that an unlimited democracy was worse than other forms of unlimited government because “its government loses the power even to do what it thinks right if any group on which its majority depends thinks otherwise”.” He also said: “free choice can at least exist under… Read more »

Paul Slobodian
Guest

Bob,

re your statement “But hispitals are setting their own prices all the time, at least for the uninsured and those out of network.”

Agreed, but this represents a tiny share of their revenue…most prices are set by medicare or often dominant health insurers (medicare rate +x%).

An interesting aside: the lowest prices often go to Candians who flee delays up north and come here for procedures. It is big business for health care systems along the border….and they offer great prices to attract the business….a real market….providers free to set prices and patients shopping for value.

Bob Hertz
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Bob Hertz

Paul, I agree that doctors are hamstrung in many ways about their fees. But hispitals are setting their own prices all the time, at least for the uninsured and those out of network. Read any of articles on Megan Rothbauer, who was taken in an emergency of an out of network hospital — which charged her over $300K for a few days, and still collected $150K from a stupid insurer. The American way of reducing health care inflation is pretty darned brutal. A few patients get just creamed with price gouging bills, and either go all the way to bankruptcy… Read more »

Paul Slobodian
Guest

Hayek in Road to Serfdom agreed that the state has a duty to ensure for all citizens “a minimum of food, shelter and clothing sufficient to preserve health and the capacity for work”. That is all I have found so far. The modern state does provide such items….in one way or another…..that doesn’t mean that these programs completely destroy markets where suppliers or providers set a price and purchasers freely choose what to purchase and from whom to purchase. Unfortunately in health care physicians and hospitals have for the most part lost their freedom to set their prices for their… Read more »

Peter1
Guest
Peter1

“Unfortunately in health care physicians and hospitals have for the most part lost their freedom to set their prices for their services” Surely you jest. What role do insurance companies have in setting prices by way of reimbursements? Hospitals in areas with limited competition have enormous power to set prices, even against insurance. Hospitals also are gobbling up outside clinics to stifle competition and raise prices. Do you then assume that “chargemaster” is the proper price? It appears you think the higher price is the correct price. “The rise of high deductible plans linked to health savings accounts has been… Read more »

Paul Slobodian
Guest

Peter1 Medicare and Medicaid fixed prices represent 35-40 percent of all US healthcare payments (source cms.gov for 2012). And most insurers agree to medicare + a fixed percent. Furthermore, the set up severely hinders creative bundling of services (only fixed procedure codes)….another anti free marketplace option of almost all other services and product providers. I agree with you that many regions have anti competitive features, such as a single hospital system giving the provider huge power to impose higher prices. State regulations have the effect of limiting cross state competition so many many regions have only a few insurers….often with… Read more »

Peter1
Guest
Peter1

“Free markets places have been shown over centuries to be the best approach to efficiently allocating resources and being a catalyst for innovation’ Paul, can you give me an example of health care in a free market industrialized country that beats single-pay on costs and access, surely if it’s so attractive someone would be doing it? If the U.S. is mostly “free” market health care why then are it’s costs about double of single-pay countries? Health care risk is the risk, the only way insurance limits their own risk is to pass it on with a reduction in benefits when… Read more »

Paul Slobodian
Guest

Peter1 Yes, good points……very similar to the 1970’s when many went from traditional pensions to 401ks. How are factory workers going to buy stocks and buy bonds and annuities….they must have this provided for them by people much smarter……and the sceptics were right, as it was hard to do back then…..but the financial services industry developed products aimed at that factory worker….including low cost Vanguard index funds….that allow the factory worker to beat the so-called smart guys. The same will happen in health care….it is happening since now as high deductible plans have grown to 30% of the private market…..and… Read more »

Allan
Guest
Allan

Paul, I would like to add that what Peter1 uses as an argument is invalid. Our costs for television sets and refrigerators is higher as well. What does that mean. It means our market economy made us wealthier so that individuals could spend more. But what Peter1 is comparing is not a single-pay vs a market place rather a multiple of different systems compared to a system that is fundamentally controlled by government in a partial marketplace. [Canada is single-payer. Maybe there is another one or several single-payer nations, but I don’t think there are many if any others truly… Read more »

Peter1
Guest
Peter1

“very similar to the 1970′s when many went from traditional pensions to 401ks.”

“Why 401ks have Failed”, Forbes.

http://www.forbes.com/sites/johnwasik/2013/04/24/why-401ks-have-failed/

Yes, just more risk transfer hokus pokus. But we’re not talking about pensions, we’re talking about health care.

Peter1
Guest
Peter1

More on 401ks as I can’t link two sites on same post without being delayed.

401k raiding due to financial problems. Certainly very prevalent after the 2008 bank/Wall Street sub-prime fraud.

http://www.washingtonpost.com/business/economy/401k-breaches-undermining-retirement-security-for-millions/2013/01/14/f54a0e90-5e70-11e2-8acb-ab5cb77e95c8_story.html

Paul Slobodian
Guest

Peter1
Thanks….yes you did limit your claim about insurance to health care…sorry for misreading it….

My interest right now is arguments about why health care can’t be a marketplace….so for now I don’t want to get into a debate about the efficiency of government single payor systems….

Peter1
Guest
Peter1

Is Canada’s system not a “marketplace”? How about Germany’s, France, Great Britain, Taiwan?

Paul Slobodian
Guest

Peter1,
re: The words “fair” and “insurance” in health care are diametrically opposed.

Would appreciate an explanation why you say that….does your statement apply to life insurance, auto insurance, liability insurance too? I might have been ill advised to use the word “fair” as it is interpreted in such wildly subjective ways by all of us….but I will wait for your analysis.

Peter1
Guest
Peter1

Paul, my sentence said “health care”, but in respect to auto insurance the fact that it is mandatory AND has government control/regulation speaks for how fair it would be without a referee.

Tell me why other health systems in more governmentally controlled countries are not “efficient” marketplaces when they do it for about half of what we do it for? Is your local government water/sewage system “efficient”? How about your fire department or police force?

Paul Slobodian
Guest

Saurabh, re health care marketplace: “But healthcare is different. Even Hayek acknowledged that.” Would appreciate it if you could help me find where Hayek said or suggested that. Also, I’d be most interested in what leads you to think that. I used to believe that….most people believe that. I began to ponder that many years ago when I was on a health insurance board and concluded that it is true health care was/is not a proper marketplace….but that the only hope of using healthcare resources efficiently as well as fairly is to remove the elements that bolux it all up… Read more »

Peter1
Guest
Peter1

“but that the only hope of using healthcare resources efficiently as well as fairly is to remove the elements that bolux it all up from operating as a proper marketplace.”

Spoken like a true insurance insider. The words “fair” and “insurance” in health care are diametrically opposed.

Saurabh Jha
Guest
Saurabh Jha

Paul,

Seeing the comments later, Hayek’s sentiments on healthcare have been correctly identified.

That is Hayek considered healthcare no different to public education. Admittedly, there were no PET scanners in that time.

Why healthcare is different? I’ve been quite influenced by Arrow’s work (Uncertainty and Welfare Economics of healthcare).

http://en.wikipedia.org/wiki/Kenneth_Arrow

I’ll certainly explain in a future submission, but the Austrian School are big in to information problem, which one would incur with multiple payers.

Allan
Guest
Allan

Saurabh, Your statement about Kenneth Arrow is enlightening. I think it may explain some of the philosophical incongruities I find with your approach to healthcare. If I am correct you might be weighting Arrow’s statements on information asymmetry more highly than I believe warranted (Of course you could be considering other distortions.). Some believe that information asymmetry requires government intervention. Is that true? To answer that question only requires one to ask, doesn’t government face the same problem of information asymmetry? Does government have an answer? Obviously I don’t think so and believe government could improve the asymmetry problem better… Read more »

Saurabh Jha
Guest
Saurabh Jha

Allan, I would not infer from Arrow’s thesis that markets are worse than government intervention. As Friedman warned, the government comes with its own set of incentives. Asymmetry of information is bridged by trust. But the kicker in the thesis is the predictability of need and quantity of medical services. Left to the market this will lead to tiered segmentation, as in India. Thing is, it works in India, but it won’t work here. My skepticism of markets is not philosophical: I see no ‘right’ to healthcare, as in ‘right to freedom of worship.’ I do see a problem in… Read more »

Allan
Guest
Allan

Yes, Friedman, the best of the best. “Asymmetry of information is bridged by trust.” A wise statement Saurabh, that points in the direction of the doctor/patient relationship. The market has to be tiered. We cannot all see the best doctor or have the luxury of a ten O’clock MRI. We cannot even agree upon what healthcare is. Fortunately we are a rich country so we have the ability to offer high quality medical care to the entire population, but I am sure that if I avail myself of a bit of extra luxury paid for at my own expense that… Read more »

Peter1
Guest
Peter1

“We cannot all see the best doctor or have the luxury of a ten O’clock MRI.”

First how would you “tier” best doctor, worst doctor? Isn’t competent doctor what we all want and should have access to? What medical care in your market “doctor/patient” relationship would you deny to people who need medical care? Would you triage based on finances?

Saurabh Jha
Guest
Saurabh Jha

Allan: “I don’t understand enforcing something that comes naturally”

Contracts. It would be a legal nightmare enforcing these.

Peter: “Would you triage based on finances?”

The segmentation would result on ability to pay.. India is instructive in this regard. I’ll write more about it sometime.

http://blogs.bmj.com/bmj/2014/09/04/saurabh-jha-the-sunnier-side-of-indias-free-market-for-medical-imaging/

Allan
Guest
Allan

I cannot say who the best doctor is for everyone nor can anyone else. Invariably in the minds of some there is always a need to fight when things are divided up even if the division is done at random. All sorts of unjustified complaints and solutions are created to satisfy the mob mentality. Tiers in this case have to do with finances. To some extent tiered healthcare exists everywhere. The ACA tiers patients. Take note the number of people placed on Medicaid, a substandard program. Others are tiered based upon age, Medicare where wasted funds are the norm. “What… Read more »

Allan
Guest
Allan

Saurabh, for me to understand what the problem is you would have to go into greater detail. For now I can only guess. I assume you are considering contracts between insurers and patients. There are always the bad apple problems seen in everything we do, but outside of those bad apples I don’t see the problem. We had severe problems with HMO’s, but those problems were mostly created by government. As you well understand a contract is an agreement between parties where each party is legally bound to provide something to the other party. The contract is then generally recorded… Read more »

Peter1
Guest
Peter1

“I would like to see all patients have the opportunity of care that is a step above Medicaid.”

Medicare?

Allan
Guest
Allan

“Medicare?”

Peter1, the ACA has caused people to lose their employer sponsored healthcare and they have ended up on Medicaid. My goal would be to provide the opportunity for care that is better than what the ACA has left these people with.

Allan
Guest
Allan

Because of the ACA a lot of companies have dropped coverage that was good for their employees. Those employees earning less than 138% end up on Medicaid.

That is known as an unintended consequence even though the administration was notified of these types of problems in advance.

Allan
Guest
Allan

Yes, Peter1 fixing things frequently can be a good way to go, but this piece of legislation has so many problems that I fear it can never be fixed. Additionally the fixes to the many problems that exist create new problems.

The law was very poorly written with holes throughout. Considering that it was pushed though without bilateral agreement and deeply involves the entire population this bill should be replaced.

Peter1
Guest
Peter1

“Peter1, the ACA has caused people to lose their employer sponsored healthcare and they have ended up on Medicaid. My goal would be to provide the opportunity for care that is better than what the ACA has left these people with.” Allan, I’d have to understand the circumstances why some people lost employer coverage to Medicaid. Obviously their employer income was so low they qualified for Medicaid (the poorest of the poor). I’d also have to know what type of coverage they were getting from their employer. Under the ACA these people would probably have qualified for a 100% subsidized… Read more »

Peter1
Guest
Peter1

Above “if not Medicare” should read, “if not Medicaid”.

Peter1
Guest
Peter1

“Because of the ACA a lot of companies have dropped coverage that was good for their employees.” How good could it have been if they can’t afford to continue to insure their employees. Why would they drop what they were providing, unless they’re gaming like this: http://reason.com/blog/2014/10/22/how-obamacare-helps-employers-game-the-s This appears to be a problem: “Because the ACA is built on the assumption that individuals with employee benefits have coverage, it prevents individuals who accept employer coverage — however barebones and inadequate — from qualifying for premium tax credits and cost-sharing reduction payments. Even an offer of “adequate” and “affordable” coverage can… Read more »

Peter1
Guest
Peter1

Saurabh, I would not consider India to be a modern industrial nation – would you? It has tremendous potential but severe problems to overcome. I’ve been to India, large disparity between rich and poor – maybe if middle class here keeps getting hammered we’ll be able to say we mirror India. What a success story that would be. But paying cash does limit what can be charged. Would you advocate paying cash for house purchases to lower the cost of housing? You might look at Japan with highly controlled medical prices. Japan cut the reimbursement for MRI drastically – the… Read more »

Saurabh Jha
Guest
Saurabh Jha

Interesting discussion! Neither Peter nor Allan are the types to cede any ground! I’m ideologically more inclined towards Allan’s camp – i.e. influenced by Hayek. But healthcare is different. Even Hayek acknowledged that. Can you have a marketplace in healthcare? Sure, in theory and in practice. Will a meaningful market place survive in the long run? I doubt it. That is I doubt that a market place can be enforced. Blatant inequality of treatment will get attention from the media. Central to Peter’s argument is that healthcare is a right. A right cannot be unequal. This premise is the beginning… Read more »

Peter1
Guest
Peter1

Saurabh, health care, public transportation, public education, needs government controls and subsidies to provide the widest access for the most possible people, we just haven’t put “public” in front of heath care yet.

The U.S. has created a hodgepodge of government support for health care that creates a class system of access for patients which continues to embellish providers and insurance but which does not control costs. Patients are getting slammed by all sides, higher spending for subsidies, higher costs for care and higher cost sharing for the insured.

No amount of Hayek or Smith will improve this.

Allan
Guest
Allan

Yes, I am not sure which book I read it in but I remember Hayek saying (paraphrase) Intervention in the healthcare arena can occur, but with as little effect on the marketplace as possible. Targeted subsidies are one way to limit the effects on the marketplace. The question of health care being a right is always at issue. I can’t see it as a right for numerous reasons. We can’t even define the limits of healthcare. I am extremely sympathetic to that desire because of the way I was raised. But equally important is the recognition of what the state… Read more »

Bob Hertz
Guest
Bob Hertz

Note to Peter! and Allan: Please keep up the debate, but let me add this point. In the world of cars, the millions of persons who cannot afford a Mercedes can get a $5000 used car. They can even pay per ride to Uber. We do not spend ten seconds worrying about their right to transportation. The same is roughly true with housing. There are millions of used houses, trailers. et al., although in affluent cities the poor can afford nothing. Any ways, health care has a profound “Cadillac Effect.” If Brain surgery costs $75,000 like a Mercedes, there is… Read more »

Allan
Guest
Allan

Bob, what debate? It is pure nonsense. Without a marketplace we cannot develop what you call a secondary market. Prices in healthcare vary tremendously and there are frequently many ways to skin a cat. Sometimes one will see a very expensive medication that replaces the earlier version. The big difference? The new medication is taken once a day while the old one is taken three times per day. As long as insurance pays for the once a day version the once a day version will be the drug of choice for almost all except for the uninsured that have to… Read more »

Peter1
Guest
Peter1

“I can see you are not well versed in economics.”

Read Mark Blyth.

Allan
Guest
Allan

Has Mark Blyth stated that a marketplace cannot exist if there are any type of subsidies which is the question at hand or are you just name dropping?

Peter1
Guest
Peter1

Did Smith or Hayek?

Allan
Guest
Allan

Yes, Hayek made such a statement. Socialism had yet been invented when Adam smith was around.

lawyerdoctor
Guest

BTW, I’m not nearly as smart as many of the folks on this blog, I didn’t go to Yale or Harvard, and I don’t have an undergraduate degree in philosophy or a PhD in economics . . . I just see actual patients in an actual hospital. But how in the heck am I supposed to be paid to see ER patients based on “metrics and outcomes”? If I see only 2 patients a day and then spend 2 hrs each documenting on their 27 page EMR that they don’t have firearms in their home, have had a pneumovax 7… Read more »

Granpappy Yokum
Guest
Granpappy Yokum

My question exactly.

If we’re no longer going to be paid for volume, won’t the goal be to see as few patients as possible?

Charles Kenney
Guest
Charles Kenney

I love this post because it’s so honest and raw. It gets to the heart of the matter in a way. My colleague Dr. Jack Cochran and I would argue that preserving and enhancing the careers of physicians is a prerequisite to achieving the kind of access, quality, equity and affordability our country needs. In a couple of weeks Jack and I head to Orlando for the IHI annual forum — always a great learning event. At our session one of the things that will happen is that we will tell a story about something Jack did when he was… Read more »

Allan
Guest
Allan

Wouldn’t a real marketplace for healthcare services do a reasonable job of figuring out what those services are worth?

Peter1
Guest
Peter1

Worth to who, those who could afford the price or those who could not?

Mercedes Benz’s have a market price but few can afford to pay. So what’s a “real” marketplace in health care?

Allan
Guest
Allan

Anyone that can afford the premiums in Obamacare and more since a real marketplace would cause prices to fall considerably.

Additionally targeted subsidies can be used while still preserving the marketplace. In essence subsidies is something the ACA is doing though I think it could be done better

Peter1
Guest
Peter1

“since a real marketplace would cause prices to fall considerably.”

But you haven”t described your “real” marketplace.

“Additionally targeted subsidies can be used while still preserving the marketplace.”

Wouldn’t subsidy defy your “real” marketplace?

Allan
Guest
Allan

” described your “real” marketplace.”

A willing buyer and a willing seller.

“Wouldn’t subsidy defy your “real” marketplace?”

No. Read Hayek.

Peter1
Guest
Peter1

Mercedes has willing buyers and willing sellers. If we gave subsidies to buyers of Benz’s would that be a “real” marketplace too?

Allan
Guest
Allan

I don’t understand your point.

Do you know why subsidies are used?
Do you know the ACA uses subsidies?

A targeted subsidy can promote individually held insurance among those that are otherwise unable to purchase insurance. It permits one lacking the funds to purchase healthcare insurance which seems to be desired by both the left and the right.

Peter1
Guest
Peter1

“I don’t understand your point.” You rarely do. “Do you know why subsidies are used? Do you know the ACA uses subsidies?” You should know by now that the answer to that is yes. “A targeted subsidy can promote individually held insurance among those that are otherwise unable to purchase insurance. It permits one lacking the funds to purchase healthcare insurance which seems to be desired by both the left and the right.” You seem to want it both ways – willing buyer, willing seller for a “real marketplace” – and subsidies. My point about Mercedes (cause you missed it… Read more »

Allan
Guest
Allan

Nonsense, Peter1, A person that is given a subsidy to make him able to purchase insurance can still participate in the willing buyer and willing seller arrangement. See Hayek and Adam Smith. Your second point is off the wall. The majority of Americans have held health insurance for decades despite micromanagement by government agencies that boost the price of insurance sky high. It seems to be almost a universal thought that health insurance is needed. Your desire seems not to want health insurance, but prepaid insurance. Using a frequent analogy, that is like ‘insuring’ gas and oil for one’s car.… Read more »

Peter1
Guest
Peter1

“See Hayek and Adam Smith.”

Holding up economic theory books is like holding up a bible and claiming it is the truth on life.

Allan
Guest
Allan

I can see you are not well versed in economics. You said: “You seem to want it both ways – willing buyer, willing seller for a “real marketplace” – and subsidies.” My statement was true and I provided you with Adam Smith who is thought by many to be the founder of modern economic thought (he was a philosopher) and Hayek who actually said what I paraphrased. I’ll bet you will find pretty much the same thing in Paul Krugman’s textbook on economics written with his wife. You are just chained by your ideology. You also said: “By the way… Read more »

Perry
Guest
Perry

“Anyways, I read that Gruber or a firm he headed had received over $4 million for what sounded like a meaningless study of Health Care Plan D choices by seniors.”

Kind of a double standard for Medicare fraud isn’t it?

Bob Hertz
Guest
Bob Hertz

What bothered me the most in the Gruber stories was not his “kiss and tell” about the ACA. The invention of You Tube will create many of these moments for both political parties — just ask Mitt Romney about ’47 per cent’. I am sure that what Ev Dirksen or Lyndon Johnson used to say about legislation after having a few drinks was not so elegant either. Anyways, I read that Gruber or a firm he headed had received over $4 million for what sounded like a meaningless study of Health Care Plan D choices by seniors. The looting of… Read more »