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.
Article comments
— go to most recent comments1 - 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.
2 - 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
3 - 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.
4 - roger nowosielski
A "homo sapiens" card. I like that.
5 - 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
6 - Arch Conservative
You forgot a step Dave.
No more health care for illegals.
Ever!
7 - Dave Nalle
Arch, that's one thing which the current proposal actually has covered.
Dave
8 - 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.
9 - roger nowosielski
That is a good comment, Ruvy. Nailed it on the head.
10 - 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
11 - 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?
12 - 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
13 - 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.
14 - 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
15 - 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
16 - 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.
17 - 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.
18 - Lilith (the destroyer)
ahhhhhh
19 - Cindy
LOL akismet was blocking me, dammit.
20 - 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.
21 - 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
22 - 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.
23 - 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.
24 - 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.
25 - 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