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Five Steps to Real Health Care Reform

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Although the bill currently being considered by Congress is being advertised as health care reform, it actually includes very little in the way of real reform. It is a thousand-page disaster which attempts to address problems which were created by government regulation with more government and more regulation at an enormous cost. There are real problems with high costs and millions of citizens with no health coverage, but raising costs even higher and mandating insurance for those who cannot afford it, enforced with draconian penalties is not a rational solution. It is a crude attempt to address the symptoms without looking at the causes. It's like giving a patient with skin cancer some makeup to cover his unsightly moles instead of removing them and curing his cancer.

The root problem in health care in America today is massive over-regulation, government interference in the marketplace and a lack of essential competition which would keep the costs of care and insurance reasonable. Past attempts to address problems in health care have consistently taken the wrong approach and have built on each other to create a tottering house of cards where everyone pays too much and the quality of service is too low. Real reform cannot be achieved by adding more bad ideas on top of old failures. Real reform requires tearing down all the old, failed measures and starting over again. It requires creative thinking and charting a course which is almost exactly opposite of what Congress and the President are currently considering.

We need to start over from scratch, tear away the mistakes of the past and really rethink how we manage health care in America today. It can't be done overnight, but here are five simple and powerful ideas which would be the beginning of substantial change in the right direction.

• Insure individuals, not groups. The current system of giving businesses tax credits for contributing to employee insurance takes away free choice and discourages competition which would encourage insurers to provide better service. Plans are picked by company management based on price rather than on benefits and service quality. Employees then have to pick only from the plans their employers offer, which may often be only one plan and is rarely more than three. This eliminates the force of free market competition. If individuals picked and paid for their own insurance, the better plans would get more customers and the insurers with poor service and benefits would either improve or go out of business. Prices would also be lowered as insurers worked to attract more customers, because insurers could no longer count on guaranteed large pools of customers from group plans. Businesses which no longer had to pay for health insurance would increase salaries so that employees could pay for themselves. This would also help with the problem of the uninsured, because many of those currently uninsured are self-employed and cannot find competitive plans, because most insurance is currently marketed to groups rather than individuals. Give individuals a tax credit only if they purchase insurance themselves. Encourage people to self-insure and eliminate regulations like HIPAA which give special protections to group plans. Insurance companies will rise to the challenge by providing better and cheaper coverage and more variety of plans.

• Eliminate coverage mandates. Currently there are over 1900 regulations requiring health insurance companies to cover specific ailments, most of them ones which are more common among older patients and many of them quite rare. The insurance companies lay off the cost of this coverage on the general customer base which massively raises the price for the young and healthy who make up about 40% of the uninsured. Eliminating these mandates would lower the price of health insurance sufficiently for that group such that they could afford to be insured. Instead of mandating what conditions insurers have to cover, let customers pick plans based on the level of coverage which they feel meets their needs. There will be a market for full-coverage insurance and competition to keep the price of premium plans low. No private or public system of insurance will ever exist without some rationing of care, but in a free market, consumers will be able to decide in advance what areas they are willing to sacrifice and where they want to focus their coverage, rather than having those decisions made by their employer or the government. Consumers could still be protected from abusive practices by a private certification system which would analyze plans and certify the quality of coverage offered, and the market could be made more accessible and competitive through nationwide internet-based insurance shopping.

• Privatize Medicaid and Medicare. One of the largest factors in the inflation of health care prices is that so much of the money in the industry comes from Medicaid and Medicare and prices are set at the rate which the government is willing to pay rather than by competition in a free market. Private insurers are then expected to pay for services from doctors and hospitals at the same inflated rate. Medicare and Medicaid costs have increased at about twice the rate of general inflation since the programs were started in 1965. The result is that the price of these programs has doubled every 7 years until today they are 50 times as expensive as they were at their inception. For comparison, the cost of most other goods and services has increased by an average of only 8.5 times in that same 44 year period. We have people being billed $25 for an aspirin because the price of that aspirin is not based on the current market price, but on a schedule of Medicare/Medicaid prices which factors in that enormous level of artificial inflation. Hospitals and insurance companies then follow those pricing trends. Elimination of Medicare and Medicaid as they now exist would force hospitals and doctors to price competitively because insurers would refuse to pay for overpriced products and services. Instead, Medicare and Medicaid should exist only as government payment plans which would subsidize the purchase of private health insurance or health services for the poor and the elderly.

• Free the health insurance marketplace. State and federal laws currently place a huge number of restrictions on the kinds of health insurance available to consumers. One result of this is that regulations make insurance much more expensive in some states than in others. If consumers could shop for insurance in an unrestricted nationwide market then they could spend their money in Wyoming where a good plan costs $1500 instead of New Jersey where an equivalent plan costs $5000, or more likely, expensive plans would go down in price so that people everywhere could afford them. Similarly, eliminating many of the current legal restrictions on insurance companies would encourage the creation of alternatives to traditional insurance, like health care cooperatives and hospital-based medical plans where customers could subscribe to health care services from a specific source instead of having to go through an insurance company at all. Eliminating the regulations which prevent health care providers from marketing their services directly to consumers would lead to substantial reductions in costs from increased competition.

• Open up free trade in prescription drugs. One of the factors which keeps the price of health care high is the inflated cost of many prescription medicines in the United States. Government regulations protect pharmaceutical companies from having to compete in a free market by prohibiting private or commercial importation of drugs. This lets pharmaceutical companies charge more for their products in the United States to offset the lower costs they charge in other countries. The result is that on average drugs cost 30-40% less outside of the US and the price differences are much larger for the newest and most effective drugs. If consumers could buy their drugs outside of the US or if pharmacies could import their drugs from other countries — many of which have even higher quality standards than we do here — prices would go down substantially for American consumers who are currently paying far too much and subsidizing the low cost of drugs in other countries.

These five steps won't solve every problem in our health care system instantly, but they will eliminate most of the really serious problems, almost all of which originate in over-regulation. Our current system is designed to keep insurers and health providers from having to compete in the free market, a practice which limits consumer choices and keeps prices artificially high. Make them compete and the qualify of their product will become better, at a lower price.

There are a few things which these proposals cannot address directly. Free market changes do not guarantee a solution to the large number of uninsured, most of whom are uninsured by choice. Many of them will take advantage of lower-priced plans aimed at their part of the market, but there will continue to be a problem with those who are difficult to insure because of preexisting conditions and those who just don't want to pay for insurance. Those who cannot qualify for private insurance at a reasonable price would have to be made eligible for some sort of public subsidy under an expansion of Medicaid. The cost of doing this would still be enormously less than the proposed cost of Obamacare. Those who choose not to be insured could be dealt with under a gap insurance system where if they went to an emergency room their treatment would be covered, but they would be required to repay Medicaid for that treatment on an extended payment plan.

Right now no one is considering this sort of real, fundamental reform of the health care and insurance system as a comprehensive plan. However, there are a number of bills, which include many of these ideas, being proposed to essentially reform the health care reform plan before it even passes . Among these is a bill from Senator Ron Wyden (D-OR) called the Healthy Americans Act which would take the idea of Health Exchanges in the current proposal and use them as a way of transitioning from group plans to individual insurance. Another idea is the Pharmaceutical Market Access and Drug Safety Act, which would open up imports of pharmaceuticals to create a competitive market. It was proposed by Senator Byron Dorgan (D-ND) and has 29 bipartisan co-sponsors, but is stuck in committee. There's even a bill to privatize Medicare with a voucher system proposed by Representative Marsha Blackburn (R-TN). These are all good ideas, but they are being left by the wayside as congress looks at the proposed 1000 page plan which meets President Obama's requirements, but offers little real reform and just expands and makes even more expensive and less efficient the current system.

The plan currently being considered is not health care reform. It is more of the same on a larger and more expensive scale. Real reform means going back and starting over and figuring out what we've been doing wrong and then doing it right. That means reintroducing free markets to the health care and insurance industries and putting choice and control back in the hands of the people. Real changes like the five proposed here will reduce consumer costs and improve the quality of care without massively expanding government or increasing taxes. Ideas like these ought to be part of the debate and not shoved aside in the headlong rush to impose more of the same failed ideas on an ever larger and more expensive scale.

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About Dave Nalle

  • Telus

    Step 1: First and foremost, we must lose the triumphant exceptionalism “Big Lie” notion that American healthcare is best in the world. It’s not, not even close. “Best in the world” is an “I got mine” firewall to prevent any meaningful change, by those who have healthcare, those who provide healthcare, and those who profit from healthcare as it is. Our healthcare system sucks for Joe Average , and G-d forbid the nursing homes ever get their meat hooks into his carcass before he croaks!

    Step 2: Provide for national disease prevention, nutrition, rehab, prenatal care and emergency surgical care *only*. America is a casino, and it will game $1T a year into $2T+ in a NY”, once all 350M suckers are taxed into the casino. The only reason our healthcare costs are so *low* is because not everyone can pay yet. Read Economics 101.

    Step 3: Pay Americans to shop Canada for their pharmaceutical drug prescriptions. Americans pay anywhere to 500% or more for their prescriptions than Canadians do, and once in the hands of a national healthcare program’s unlimited price point, look out!
    The only reason our pharmaceutical costs are so *high* is because it’s a protected monopoly. If we legalized marijuana, half of the prescription demand would disappear.

    Step 4: Pay Americans to travel to Cuba and Thailand for their medical care. Cuban medical care is as good as any in the world, at a proven cost less than 1% of the American system! Thailand is not far behind at 10%! Nothing lowers medical care costs faster than COMPETITION, the same outsourcing the Elites use when they sent 316,000 manufacturing jobs offshore last month. Let Big Med taste the same whip!

    Step 5: Tax and spend locally. The Federal government has 95% administrative overhead costs in most programs, less than 1/3rd of your healthcare taxes will actually go to healthcare, of that 1/3rd, hospital LLPs, HMOs and drug companies will skim another 2/3rds off in administrative overhead and profits. ***It’s like pouring your water on the ground before you drink it.***

    But not a single one of these common sense suggestions will be offered or voted on by either party because, again, America is a casino and our ‘government’ is a mafiosa, extortion on the tax installment plan.

  • http://www.republicofdave.com Dave Nalle

    Telus, your 5 step alternative seems rather paranoid and based on faulty assumptions, most notably that US health care is not of superior quality. We may get low bang for the buck, but the facts really do bear out the notion that the results of our system are superior for those who are insured.

    I do like the idea of using international sources as a way to apply competitive pressure, though. Similar to what I proposed for drugs.

    Dave

  • zedd

    Dave,

    The truth is we’ve simply got to buckle down and pay for one “another’s” health. If we are human and therefore humane, we simply must. There is no debate. It comes with the territory.

    You cant make it be about big government or some fantastical fun evil to spout against (in order to feel engaged). Dig a litter deeper my friend. You must to look out for the next guy at least in the most fundamental way if you are a human. Make sure he doesn’t die needlessly. It’s what we humans do…. Make sure he isn’t suffering physically needlessly.

    If you cant handle it, or its just much too much to require of you, turn in your homo sapien card and join the ranks of the sick loosers, move into a cave somewhere unknown and count your pennies until your demise, because you don’t get it.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    A “homo sapiens” card. I like that.

  • http://www.republicofdave.com Dave Nalle

    Zedd, read the article. You clearly didn’t.

    I don’t see the desirability of mindlessly throwing good money after bad for healthcare “reform” which doesn’t actually reform the basic problems.

    Dave

  • Arch Conservative

    You forgot a step Dave.

    No more health care for illegals.

    Ever!

  • http://www.republicofdave.com Dave Nalle

    Arch, that’s one thing which the current proposal actually has covered.

    Dave

  • http://ruvysroost.blogspot.com Ruvy

    Dave,

    This article is the most wrong-headed piece of trash I have ever seen you produce. You ignore the basic fact of lifes that make all insurance work, and you allow the basic tactic that allows health insurance companies to make money – cherry-picking.

    All insurance is a bet of one kind or another. Life insurance is when the life insurance company bets that you will live – putting off the day it has to pay your heirs – and your heirs bet that you will die – hurrying the day when they will collect on your passage to the other side of the veil.

    Health insurance companies bet that you will be healthy – meaning that they do not have to pay doctor’s bills; you hold that insurance on the certainty that you will get sick – requiring the health insurance company to ladle out cash.

    Cherry-picking has nothing to do with fruit, and everything to do with NOT paying out money to anybody. A health insurance company that is betting that you will stay healthy only wants to insure super-healthy folks, and guard against loss by restrictive provisions that refuse to cover certain illnesses and chronic conditions.

    And your article only pushes and insures that sick people do not get the treatment they need because the insurance companies do not want to bet with them that they will be healthy. So, diabetics die, epileptics have continuous seizures until they die from exhaustion, narcoleptics sleep their lives away, cancer patients die from cancer, and so on and so forth. Until it is your wife, your daughter or your mother who is the sufferer, the invisible hand of the free market is a fair ruler. Once that invisible hand slashes through your life like a scythe bringing only death and pain, the picture changes radically.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    That is a good comment, Ruvy. Nailed it on the head.

  • http://www.facebook.com/tolstoyscat Cindy

    Dave,

    Please show me one example of where a free market existed and worked.

    Please show me how this government, despite all balances of power and rules of law and constitutional protections, can ever result in anything but being overbearing.

    It doesn’t help to say, it’s all the government’s fault. Free markets do not exist and never have (except in third world states) without having had input from govt subsidies and special considerations.

    I like what Zedd said, and what Ruvy said here:.

    Once that invisible hand slashes through your life like a scythe bringing only death and pain, the picture changes radically.

    Noam Chomsky discusses how Adam Smith’s ideas are responsible for starvation in Crisis and Hope: Theirs and Ours

  • http://www.futonreport.net/ Matthew T. Sussman

    “Please show me one example of where a free market existed and worked.”

    I have a SimCity 2000 save file around here somewhere. Shit, where’d I put that?

  • http://www.republicofdave.com Dave Nalle

    Cindy, if neither the government nor free markets can do anything right, then you’re left with nothing at all. Which is the nonsensical thinking which has caused me to largely ignore anything you post.

    Dave

  • http://handyfilm.blogspot.com handyguy

    These ‘ideas’ and the ‘analysis’ of health care they are based on are just … wack. Nuts. Insane. Not connected to the real world.

    Dave shows very little understanding of what makes insurance work, what makes costs go up and down, how real people in the real world deal with health care needs.

    The Democratic plans may be flawed; but this seems to have been designed for Planet Pluto.

  • http://www.republicofdave.com Dave Nalle

    This article is the most wrong-headed piece of trash I have ever seen you produce. You ignore the basic fact of lifes that make all insurance work, and you allow the basic tactic that allows health insurance companies to make money – cherry-picking.

    From what I’ve seen they’re already cherry picking. If you bring prices down and make the companies more competitive then it creates a viable market for plans which cover more severe conditions. They won’t cherry pick if they have an opportunity to make profit. And I did suggest that there’s a role for the government in covering the gap between what insurance companies can cover profitably and what the relatively small number of uncoverable cases require. And that would still cost less than what is currently being proposed.

    Another idea occurs to me on this issue, which is certainly one of the few serious concerns with any private solution, but I hesitate to mention it without more consideration. Just musing off the top of my head, but since insurance is all about percentages and probabilities, what if insurance companies didn’t ever actually deal with individual customers? What if they had to make all decisions in the aggregate rather than on the basis of individual cases? I bet there would be a way to implement it, and it would solve the problem you raise fairly elegantly.

    Dave

  • http://www.republicofdave.com Dave Nalle

    Handy, I guess I’m not alone in my insanity and out of touchness. Every thing I propose her has been proposed by others as well, and as noted towards the end of the article, these same ideas have been proposed as amendments or alternatives to the current healthcare proposal, mostly by democrats.

    So if I’m insane and out of touch and confused and unfamiliar with insurance, I’m in good company.

    Or maybe you’re just missing the point.

    Dave

  • http://www.facebook.com/tolstoyscat Cindy

    Cindy, if neither the government nor free markets can do anything right, then you’re left with nothing at all. Which is the nonsensical thinking which has caused me to largely ignore anything you post.

    Dave, If there are wolves surrounding you and they’re going to eat you, pretending they aren’t isn’t a great option. Is there some reason besides hope that either govt or free markets must work?

    Doesn’t sound like a very confidence inspiring–they must work because that’s all we have?

    We also have self-governance Dave, voluntary association, and direct democracy. We are already set up for it. Get used to the idea, it’s in the zeitgeist now.

  • Clavos

    what if insurance companies didn’t ever actually deal with individual customers? What if they had to make all decisions in the aggregate rather than on the basis of individual cases? I bet there would be a way to implement it, and it would solve the problem you raise fairly elegantly.

    Actually, in a well-run corporation, that’s exactly what happens. The health insurance company negotiates the package(s) for the group up front with management. If management is on the ball during the negotiations, they make sure that the cherry picking is off the table, ensuring that pre-existing conditions (for example) are not part of the package.

    I speak from experience. When I worked in industry, I sat on the management committee that negotiated benefits, both with the unions and with the suppliers of the benefits.

  • http://thingsalongtheway.blogspot.com/ Lilith (the destroyer)

    ahhhhhh

  • http://thingsalongtheway.blogspot.com/ Cindy

    LOL akismet was blocking me, dammit.

  • http://ruvysroost.blogspot.com Ruvy

    In all truth, Dave, I did not look at the Obama proposals at all. I looked at yours.

    I was a licensed insurance agent for a while(not a particularly successful one – I don’t enjoy selling bad news), and had to study insurance law and concepts to get that license. So I do have a bit of understanding of some of the why’s and wherefore’s being discussed here.

    Epilepsy and narcolepsy are both far more common disorders than you realize. Asthma and bronchiolitis are very common in the States, due to, amongst other things, the effect of smoking on the lungs of small children.

    If an epileptic admits to being one on a driver’s license app, say, he will always be in the highest risk pool for casualty insurance, on the assumption that any accident he is in will be his fault because he will have lost consciousness due to a seizure. For this reason, epileptics will tend to deny having epilepsy on any and all applications where immediate testing will not take place. So, even though if it is found out, it will invalidate the casualty insurance, epileptics generally keep quiet and take the risks (their own form of risk insurance).

    Those mandates you complain of developed because of the cherry picking by health insurers. Since Americans do not like the idea of “socialized mdicine”, the solution has been piece by piece mandating of some kind of equity legislation preventing insurers from “discriminating” against diseases, disorders and the results of bad medical treatment, like the widespread prescription of diethylstilbestrol (DES) in the 1940’s and 1950’s as a pregnancy drug.

    The real problem is that the whole “health care” system in America (and Israel) is not about either “health” or “caring”.

    The problems are:

    1. that insurers have taken over the health care business, resulting in far less time spent by doctors with patients;
    2. hospitals insist on using expensive disposable items when it would be far cheaper to sterilize and reuse;
    3. American (and Israeli) medicine is symptom and pill-based, rather than based on finding the cause for a particular set of diseases, and curing them.

    Thus, a whole series of diseases comes from insufficient water consumption – arthritis, high blood pressure, heart disease and a whole bunch more. Water consumption is a preventative – but how many billions of dollars of drug sales would go down the drain if these diseases were prevented? Lots of rice bowls turned over.

    These problems are far deeper than “universal health care”, which is at best a band-aid for a “health care” system that is wrong-headed to begin with.

    Having said all this, the solution you get at in comment #14, what if insurance companies didn’t ever actually deal with individual customers? What if they had to make all decisions in the aggregate rather than on the basis of individual cases? is the precise concept behind group coverage, and put simply, expanding the Blue Cross, Blue Shield concepts of group coverage, and allowing a number of private companies to compete in offering them to the public, while making health insurance mandatory for all individuals above the age of 18, would provide a good band-aid to a bad system.

  • http://www.republicofdave.com Dave Nalle

    We also have self-governance Dave, voluntary association, and direct democracy. We are already set up for it. Get used to the idea, it’s in the zeitgeist now.

    Mob rule, demagoguery and ultimately vicious autocracy. Yay!

    Dave

  • Bliffle

    The article states:

    “…attempts to address problems which were created by government regulation with more government and more regulation at an enormous cost.”

    Contrary to evidence. The insurance companies are de facto monopolies and oligopolies, which has been facilitated by the governments hands-off policies. The government never launches an anti-trust suit against the health industry, partly because successive administrations have slashed Dept. of Justice budgets and payrolls, and partly because of wrong-headed statutes like the 1945 McCarran-ferguson act which forbids the Feds from regulating ALL insurance companies.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Correct. It’s unthinkable that Dave should complain about excess regulation when there had been none. The abandonment of a vigorous anti-trust policy has been one of the most critical elements which have contributed to our downfall. It’s beyond me that our government has been as complicit in this whole affair, allowing what was once a responsible corporate entity become a Frankenstein monster.

  • Bliffle

    The article states:

    Insure individuals, not groups. The current system of giving businesses tax credits for contributing to employee insurance takes away free choice and discourages competition which would encourage insurers to provide better service. Plans are picked by company management based on price rather than on benefits and service quality. Employees then have to pick only from the plans their employers offer, which may often be only one plan and is rarely more than three. This eliminates the force of free market competition. If individuals picked and paid for their own insurance, the better plans would get more customers and the insurers with poor service and benefits would either improve or go out of business. Prices would also be lowered as insurers worked to attract more customers, because insurers could no longer count on guaranteed large pools of customers from group plans. Businesses which no longer had to pay for health insurance would increase salaries so that employees could pay for themselves. This would also help with the problem of the uninsured, because many of those currently uninsured are self-employed and cannot find competitive plans, because most insurance is currently marketed to groups rather than individuals. Give individuals a tax credit only if they purchase insurance themselves. Encourage people to self-insure and eliminate regulations like HIPAA which give special protections to group plans. Insurance companies will rise to the challenge by providing better and cheaper coverage and more variety of plans.”

    Insure individuals, not groups.” but this is exactly the wrong solution. Individuals have no power against the monopolies that rule the insurance industry. People MUST group together to get a fair price and not be relentlessly exploited. That’s one of reasons that employer sponsored health insurance has worked, because the company has the power to represent it’s group of employees. that’s why affinity groups like TIAA-CRF work. All youpropose is to further reduce the powr of people in their struggle with monopolies.

    Then the paragraph goes into a series of proclamations of the standard fantasy scenarios of traditional Unregulated Free Market dreamers:

    “… the better plans would get more customers and the insurers with poor service and benefits would either improve or go out of business.”

    Not at all. Merges and Acquisitions among competitors will reduce THEIR risk and pool all premium income under an even bigger monopoly managed by an even more voracious predatory CEO.

    ” Prices would also be lowered as insurers worked to attract more customers,…”

    Dream on.

    “…Businesses which no longer had to pay for health insurance would increase salaries so that employees could pay for themselves.”

    You gotta be kidding! What employer would voluntarily increase pay? Would you? No, you’d put the savings from elimination of insurance into your own pocket. And that’s exactly what happens.

    “This would also help with the problem of the uninsured, because many of those currently uninsured are self-employed and cannot find competitive plans,…”

    There will be no increase in ‘competitive’, by which you mean ‘inexpensive, I suppose, plans, for the simple reason that mergers and acquisitions will DECREASE competition.

    “Encourage people to self-insure and eliminate regulations like HIPAA which give special protections to group plans.”

    Self insurance is only practical for the very rich. What schlub can save money for a multi-million dollar cancer treatment?

    ” Insurance companies will rise to the challenge by providing better and cheaper coverage …”

    No they won’t. They will do what they have always done: merge and acquire, lobby politicians to allow their predations on unprotected people, and demand subsidies and handouts for health programs that never materialize.

    All the dreams and fantasies of the Unregulated Free Market notion are swept aside by the bitter record of experience.

  • http://www.republicofdave.com Dave Nalle

    Contrary to evidence. The insurance companies are de facto monopolies and oligopolies, which has been facilitated by the governments hands-off policies.

    You say potato, I say potato. In truth the development of monopolies has been facilitated not by the lack of government interference, but by direct government interference in the industry. They have actually encouraged consolidation through regulation, not through a hands-off policy. The insurance industry is one of the most heavily regulated in the nation, mostly at the state level, but those regulations have discouraged competition and pushed the industry into the hands of a few big players.

    The government never launches an anti-trust suit against the health industry, partly because successive administrations have slashed Dept. of Justice budgets and payrolls, and partly because of wrong-headed statutes like the 1945 McCarran-ferguson act which forbids the Feds from regulating ALL insurance companies.

    Ah, so you’re not just ignorant, you just aren’t thinking in the right terms. The reason the feds stay out of regulating insurance is because it’s so incredibly heavily regulated at the state level.

    Correct. It’s unthinkable that Dave should complain about excess regulation when there had been none.

    You call 1900 specific mandates of coverage “none”? You’re kidding, right?

    The abandonment of a vigorous anti-trust policy has been one of the most critical elements which have contributed to our downfall. It’s beyond me that our government has been as complicit in this whole affair, allowing what was once a responsible corporate entity become a Frankenstein monster.

    I agree with you that the failure of anti-trust policing is a factor, but policies which take away competition and make it harder to start new businesses in the industry play a large role in encouraging monopolization.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    That’s not what I’m saying. There had been none before. It was totally unregulated.

  • http://www.joannehuspek.wordpress.com Joanne Huspek

    Your points are all grounded in common sense and sound good. I wonder why Congress couldn’t come up with something half as insightful.

  • http://www.republicofdave.com Dave Nalle

    “Insure individuals, not groups.” but this is exactly the wrong solution. Individuals have no power against the monopolies that rule the insurance industry.

    It’s not the job of individuals to deal with monopolies. If they truly are monopolies then the government should deal with them. But in fact, the other elements I proposed like allowing the purchase of insurance from other states gets rid of the monopoly problem and reopens competition, because it would allow new players into the business and remove the geographical restrictions which create monopolies. There are hundreds of insurance companies in the nation. The problem is not monopolies, it is that group plans and state regulations limit who can sell to specific markets. These pseudo-monopolies are created by government overregulation.

    People MUST group together to get a fair price and not be relentlessly exploited.

    Mindless anti-capitalist bullshit. If the market were opened up then companies would have to compete and if they tried to exploit customers they would lose them to a competitors.

    That’s one of reasons that employer sponsored health insurance has worked,

    Except that it hasn’t worked and is responsible for our sky high insurance costs. It delivers workers as captive market to insurers and gives them no freedom of choice and no ability to opt out or escape from exploitation. You are arguing FOR the monopolies you say you hate.

    because the company has the power to represent it’s group of employees. that’s why affinity groups like TIAA-CRF work. All youpropose is to further reduce the powr of people in their struggle with monopolies.

    You are amazing. Now companies which are just looking at the bottom line are the good guys, defending the workers? Spare me the hypocrisy.

    Not at all. Merges and Acquisitions among competitors will reduce THEIR risk and pool all premium income under an even bigger monopoly managed by an even more voracious predatory CEO.

    How will removing the conditions which encourage merger and monopoly cause this? More nonsense. Additional competition from opening up access to the marketplace will bring in new players and by nature reduce cost.

    You gotta be kidding! What employer would voluntarily increase pay? Would you? No, you’d put the savings from elimination of insurance into your own pocket. And that’s exactly what happens.

    So you’re saying that you think employers could actually get away with telling employees that they were taking away subsidized insurance and giving them nothing at all in its place? What planet do you live on? Employers would happily give workers $200 a month to keep them from bitching about losing $500 a month in insurance benefits.

    There will be no increase in ‘competitive’, by which you mean ‘inexpensive, I suppose, plans, for the simple reason that mergers and acquisitions will DECREASE competition.

    You have yet to offer an explanation why removing the restrictions which have made mergers necessary and allowing new competition into the market would have the exact opposite of the natural effect one would expect.

    Self insurance is only practical for the very rich. What schlub can save money for a multi-million dollar cancer treatment?

    As was clear from the context I was talking about selecting insurance, not being an insurance company.

    No they won’t. They will do what they have always done: merge and acquire, lobby politicians to allow their predations on unprotected people, and demand subsidies and handouts for health programs that never materialize.

    The idea of the changes I proposed was to end the conditions which have made these practices the standard. If you take away the corruption which government allows the conditions you complain of then the rules of the game will change.

    All the dreams and fantasies of the Unregulated Free Market notion are swept aside by the bitter record of experience.

    Except that there is no experience of a free market in insurance, so you’re just babbling about something we’ve never even tried and advocating more of the same mistakes that got us here.

    Dave

  • Lumpy

    How about we just make health insurance illegal and just pay for our medical care – or not. It worked fine 100 years ago and it would be sure to bring prices down.

  • http://twitter.com/tolstoyscat Cindy

    To Dave,

    Except that there is no experience of a free market [in anything], so you’re just babbling about something we’ve never even tried and advocating more of the same mistakes that got us here.

  • http://drdreadful.blogspot.com Dr Dreadful

    So you’re saying that you think employers could actually get away with telling employees that they were taking away subsidized insurance and giving them nothing at all in its place? What planet do you live on?

    Earth, I believe. Where exactly what you describe has already happened at hundreds of companies.

  • Bliffle

    Dave says:

    “I agree with you that the failure of anti-trust policing is a factor, but policies which take away competition and make it harder to start new businesses in the industry play a large role in encouraging monopolization.”

    No. Competition is diminished by monopolies that exercise anti-competitive actions against potential competitors.

    The anti-competition measures that the government takes are at the behest of the monopolies. For small companies it is better to join the oligopoly than to compete.

  • http://www.republicofdave.com Dave Nalle

    Ok, so end it. Break the unholy alliance of monopolist and government by taking government out of the equation. That’s what I’m talking about here.

    Dave

  • Arch Conservative

    Apparently our thug in chief thinks he has all the answers when it comes to health care and that the American people have no right to demand that time and consideration in proceeding with any type of health care reform.

    [Gratuitous vulgarity deleted by Comments Editor]

    Barack Obama……..the worst thing that has ever happened to this nation.

    Even with the mainstream media in his pocket his support is crumbling.

    “Hope and change?” Yeah they thought Mussolini was great in the beginning too…..whatever happened to him?

  • http://www.republicofdave.com Dave Nalle

    The latest poll shows public opinion rapidly turning against Obama. USA Today/Gallup has 50% of the public against Obamacare and only 44% for it.

    Dave

  • http://handyfilm.blogspot.com handyguy

    For some on the left, myself included, an ideal reform package would remove the illogical connection of getting your health insurance through your job.

    But because 180 million people currently do get their health insurance through their employer, the administration thought it would be too disruptive to tear that up and start over.

    This also allows the administration to keep repeating, “If you like your current insurance you can keep it.”

    All big legislation is full of compromises and flaws. But we still haven’t seen the final version of this legislation — it’s a work in progress.

    However, it makes more sense to me to talk about revising the current bills than to throw out oddball ideas that have not the slightest chance of being enacted, as this article does.

    And where does the main Republican argument [such as there is] fit into this? The GOP basically says, we have the best health care system in the world now — why mess with it? Dave apparently does not agree.

  • http://www.republicofdave.com Dave Nalle

    For some on the left, myself included, an ideal reform package would remove the illogical connection of getting your health insurance through your job.

    Handy, that’s the FIRST thing I identify as a problem in this article. The grouping of the insured and limiting of their choices that goes with it is a huge part of the problem. It takes all pressure off of the insurance companies to compete.

    But because 180 million people currently do get their health insurance through their employer, the administration thought it would be too disruptive to tear that up and start over.

    IMO a terrible mistake. All this bill does is more of the same fiddling and sticking on of bandaids. For real reform you need to rethink things from the ground up.

    And where does the main Republican argument [such as there is] fit into this? The GOP basically says, we have the best health care system in the world now — why mess with it? Dave apparently does not agree.

    Not exactly. I just see that there is a difference between the healthcare system and the system by which we gain access to that healthcare, which does have a lot of problems.

    Dave

  • http://handyfilm.blogspot.com handyguy

    Dave’s post about the Gallup Poll led me to look up the full article. Some interesting stuff.

    Obama’s overall approval rating on RCP is 56% approval, 38% disapproval, so about 12% of Americans like him better than his health policy. Some other factoids from USA Today/Gallup:

    Two-thirds of Americans approved of the jobs Jimmy Carter and George H.W. Bush were doing at six months, but both would lose their bids for re-election.

    And though the younger Bush and Bill Clinton had significantly lower ratings at 180 days — Clinton had sunk to 41% approval — both won second terms.

    At 55% overall, Obama’s approval rating is a tick below that of George W. Bush at six months. It is well above Clinton and Gerald Ford, who was hammered for his pardon of Richard Nixon.

    At the top of the list is Harry Truman at 82% — buoyed by the end of World War II — followed by Lyndon Johnson, John Kennedy and Dwight Eisenhower.

    Ronald Reagan may provide a closer parallel to Obama. Both took office as the nation’s economy was in perilous times. Reagan was at 60% at six months, but his standing slipped below 50% by the end of his first year in office as the jobless rate swelled.

    It would take two years and economic recovery before a majority of Americans would approve of his presidency again.

  • Clavos

    Handy,

    I think the Republican posiyion is more along the lines of “We have the best health care in the world, but we agree that the health care distribution system sucks and needs fixing.

    At least, that’s the sense I get from the pronouncements of the Republicans in congress.

  • http://www.republicofdave.com Dave Nalle

    Exactly, Clavos.

    Dave

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    What good is healthcare if it its distribution that sucks? It’s like saying I have written a masterpiece except that no one will ever read it.

  • Bliffle

    Bingo.

    Great theories; P*ss poor empiricism.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    It’s by design, Bliffle, not incompetence. The private insurers are in it only for the money. They have a vested interest in not insuring the many. That’s why distribution sucks.

  • http://handyfilm.blogspot.com handyguy

    It’s ok for companies to have profit as an incentive. But they have also had an incentive to deny coverage.

    The permanent ban of the concept of a “pre-existing condition” is one of the best things about the reforms being proposed. No one will be able to be turned down for insurance coverage because of their health.

    Insurance companies are actually on board with this. There are other problems with the bill[s], but this part is near-miraculous.

  • Clavos

    this part is near-miraculous.

    Not it’s not. They’re being offered quid pro quos which will make them even more profitable than they are now; bet on it.

    Otherwise, they wouldn’t go along with it.

    But it’s nearing moot, anyway, the peasants are on the verge of revolt because of the deficit; Obama will back down in a matter of days, at most weeks, and allow more time for debate instead of pushing it through in the next month; he’s already getting a lot of pressure, not only from Reps, but also from the Dems in congress, who are afraid of the campesinos.

    With time to actually discuss, we might even have a workable solution instead of the shit being pushed now.

  • Clavos

    The private insurers are in it only for the money.

    Doh! What other reason is there for being in business?

  • http://handyfilm.blogspot.com handyguy

    Motivating the insurance companies with profitable ‘quid pro quos': sure, it’s how the system operates. But if we actually end up with ‘pre-existing conditions’ as a dead concept, that’s a good thing, no?

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    This wasn’t an attempt to knock-down the profit motive, only to identify the problem. It was you who brought up the notion of imperfect distribution. Well, there it is.

  • Clavos

    Sure handy. But it’s not “near-miraculous.” I suspect we’re not gonna like the quid pro quos when they finally come out.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    The Can’t-Do Nation.

    Reminds one of Robert L. Heilbronner’s classic, An Inquiry into the Human Prospect (1974), where the author questions human ability to respond to the many crises and challenges posed by modernity.

    It’s almost prophetic, come to think of it.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    A well-balanced, down to earth article.

  • http://www.republicofdave.com Dave Nalle

    I love the picture, Roger. The protest is pure astroturf. They’re all wearing ACORN uniforms. Manufactured protest funded by the unions and with protestors who are likely paid to be there. That’s what the Democrats have reduced democracy to.

    Dave

  • Bliffle

    The head of Kaiser was on radio yesterday and said that if all US citizens were under Kaiser they would all be covered AND total costs would be reduced.

    He also said that required paperwork requires 7000 paperwork jobs at kaiser, and that currently about 12% of providers (mostly high paid doctor and nurse time) costs are for paperwork submissions required by insurance companies.

  • http://takeitorleaveit.typepad.com/ roger nowosielski

    Dave,

    I think you meant to post your #52 on another thread, the one with Cindy in it, celebrating and dancing.

  • Clavos

    My physician brother in law puts his (he has a large organization with 20 or so docs, several of whom are his partners) paperwork costs closer to 20%.

  • Bliffle

    Dave:

    ” The reason the feds stay out of regulating insurance is because it’s so incredibly heavily regulated at the state level.”

    Not at all. The feds passed the McCarran-Ferguson act in 1945 because it was felt that insurance was a sort of utility , rather than a normal for-profit business. That income would equal outgo plus operating costs, and costs would be kept low. Wringing huge profits was not in the plan, but when the insurance companies found themselves in that position they quickly became voracious. The states had to step in, and chaos resulted in addition to abusive monopoly operation. The chaos actually helps the monopolists because the states are so disorganized. Corrupt, too, as we in CA can attest from the giant “Chuck Quackenbush” fiasco a few years ago.