Forget high insurance rates, forget the feds paying for it; pay for it yourself with cash or barter.
Forget government involvement. Forget even the insurance companies. Why not return to the traditional purely free market way of seeking and providing health care through direct payment to the doctor for services rendered?…
Article comments
26 - Clavos
Why can't we all just have the plan that Congress has now?
Damn good question, Doc.
Why has no one on the Hill proposed it?
27 - Winston Apple
As I pointed out in a piece here on Blogcritics two days ago ("A Public Option Even Blue Dogs and Republicans Can Embrace"), having patients pay directly for health care is an important piece of the puzzle. The other piece is making insurance work the way it’s supposed to work - kicking in only when expenses become catastrophic.
28 - Eric Dondero
Clavos, actually Mexico ranks right at Number 50 out of 190 Nations worldwide for economic development; which puts them at the top of "second world" a far cry from really run down third world Nations like the Sudan, Bangladesh, and Zimbabwe.
29 - Glenn Contrarian
Doug -
You posted: "Your a hypocrite if you expect everyone else to pay for universal healthcare but you won't even chip in for your own brother. Pathetic. Typical liberal, only charitable with other people's resources then has the audacity to act like you have moral superiority."
You put a lot of assumptions into your insult, Doug - like (1) I have the money to help, and (2) I don't have others in my family I'm already helping.
FYI, for the past ten years I've been a Foster dad for medically-fragile children. Three are living in my household as I type this reply to you. One child is a low-functioning autistic tube-fed 17 year-old who doesn't even recognize himself in the mirror (and he's literally a screamer), the second is a 14 year-old tube-fed child with fetal alcohol syndrome, and the third is a 17 year-old girl with epilepsy, serious memory issues, and (we suspect) the victim of sex abuse by her natural father.
We DO help out our extended family - but my brother is NOT the one with the greatest need. The ones with the greatest need are our extended family in the Philippines who cannot afford the kind of health care system you propose. Perhaps YOU are lucky enough to afford Mexican health care (just as I am lucky enough to enjoy Philippine health care and have done so more than once), but millions are not so lucky.
In addition to the help we already provide to pay for my extended family's health care, we are also currently paying for two of them to attend college as well. The ONLY thing we expect in return from them is to help others in the family to finish their education too.
Doug, if there's one thing I've learned over the years online, it's to not assume moral superiority over those who think differently than I. Maybe you ARE morally superior to me - I'm in no position to judge. However, I did NOT insult you...but you took it upon yourself to insult me.
That in and of itself says a lot about you.
30 - Glenn Contrarian
Clavos -
"Why has no one on the Hill proposed it?"
Actually, that plan is PRECISELY what Hillary Clinton proposed in her campaign...and was in large part why I was an alternate state delegate supporting her.
31 - roger nowosielski
Glenn,
I just happen to think that Doug is only testing the waters. Once you press him on the issue, he tends to become reasonable. And I sure hope this is one of those occasions. For his sake.
32 - Doug Hunter
Glenn,
I must give credit where due, your priorities are much nobler than I expected. The underlying point remains though. You prioritized your life and helping your brother with health insurance didn't quite make the cut (admittedly for good reason). Would you not allow others the same opportunity to choose their priorities? Is it the government's job to step in and take the money you were spending on education and redirect it to healthcare if that's not what you yourself chose?
What you should understand is that I'm not spending my days trying to figure out how to most offend and insult people I disagree with. It may be hard to understand because your worldview is so much different, but I truly am deeply offended by any political view that puts the government in more control of my life. I don't like it when the government steps in against my opinion and, oddly, I'm just as pissed when they mandate something I personally agree with. The only time I'm happy with the government is when they voluntarily reduce their authority, remove their regulations, or admit a situation is none of their business (you see why I seem so angry now as that happens so rarely!)
Anyway, you end up being a symbol not a person to me. A symbol of the forces I am powerless to influence. I can't grab the ear of the president (although it's quite a target), or congress, or any supreme court justices to tell them my individualist views, yet they daily continue to make decisions that influence my future and that of my family. In that impotence I lash out at who I can get to listen... and that's you Glenn.
33 - Clavos
Eric,
Rankings mean nothing to the millions upon millions of Mexicans at subsistence level, earning less than $5 a day and living in makeshift shacks without electricity, running water or sanitation facilities.
Mexico's economic development is meaningless to more than half its population, who never derive any benefit from it.
I've lived and worked in and with the Mexican "economy" my whole life, it's controlled by less than 10% of the population and truly benefits much less than half of the people.
It's Third World, regardless of the spin the Mexican government feeds to the rest of the world to earn their "ranking."
34 - Glenn Contrarian
Thanks, Doug -
You posted: "...your worldview is so much different, [and] I truly am deeply offended by any political view that puts the government in more control of my life."
You hit the nail on the head - it's a worldview that separates us.
You see Health Reform (which gets rid of 'preexisting conditions', allows greater choice of doctors than most HMO's give, and includes a public _option_) as the government putting more control over your life.
Whereas I am offended that in America we treat the health of the population as a _commodity_ rather than a constitutional right (remember "life, liberty, and the pursuit of happiness"?). Instead of seeing government controlling people's health choices, I see it as simple good sense - because if we had the type of system that _every_ other modern industrialized democracy on the planet has, then NO American citizens would have to make choices between mortgage payments or health insurance payments.
Not only would the burden be taken away from the American poor, but if we had single-payer like the other democracies do, think of how much CHEAPER our businesses could sell things domestically AND internationally. Why? Because if we had single-payer health care, each and every business in America would no longer have to pay ANY insurance premiums, and they would quickly and substantially downsize their HR departments.
Think about it - the automakers spend more on health insurance for their workers than for steel for their cars...and I think the same goes for Boeing. All of that waste and unnecessary expense could be dispensed with...and our exports become that much more affordable to the rest of the world.
So it's not really about becoming a "nanny state". It's about that old Quaker State commercial: "You can pay me now, or pay me later". Doctors must follow the Hippocratic oath, so they WILL treat people, including those who have no money...and someone must pay - you and me. ALL the other modern industrial democracies found that it's CHEAPER and BETTER to just go ahead and pay for it up front. That's why we're thirty-fifth now (we were thirtieth last year) on the list of countries by life expectancy...and out of the top thirty-five, ALL of them have some form of Universal Health Care except for Jordan (#27), Bosnia (#29), and America (#35)...even though NOT ONE of those countries spend even sixty percent per capita of what we already do.
Our system is broken. It needs to be fixed...and there is NOTHING wrong with using a system that is PROVEN to be better AND cheaper. There's nothing at all wrong with Universal Health Care...except that the right-wing pundits tell you "It's SOCIALIST!!!!"
One last thing - this is not directed at you because I don't know your personal opinion, but when you listen to your friends on the right wing, remember that anyone who claims to be 'pro-life' yet isn't raising hell about how the HMO's deny life-saving care...truly is a base hypocrite.
35 - Doug Hunter
I've expressed my opinion on the healthcare rankings before. It's not reflective of the quality of healthcare you receive if you can afford insurance here. A large percentage of the criteria have nothing to do with 'quality' of care but who pays for it, etc. If I knew I had some disorder, say cancer (and I had insurance), there are but a tiny handful of countries if any where I would receive as advanced, speedy, and expertly administered treatment as here in the US. I really think you're being misleading with the blanket statement that other systems are 'better'. Those type of statements usually depend on where you stand. If you can afford it I'd argue that our system is top notch, if you can't afford it then systems where someone else pays for you seem like a much better deal I'm sure.
Under a government run system, medical advances will slow down and infrastructure will crumble. How could you look at what government does and come to a different conclusion? This nation is already essentially bankrupt. Under a single payer scenario there would always be tough budgetary decisions to make but the mandate would be to ensure everyone has coverage (not to make sure everyone has the most advanced treatments).
When it comes to upgrading equipment and facilities those 8 and 9 figure price tags can pay for a helluva lot of very basic medicine for the poor. Same goes for advancements. The conservative $200+ million price tag on developing a new drug would sure pay to manufacture a bunch of existing ones at $.07 a pop. Again, when your budget is being slashed and your mandate is to ensure everyone has a prescription filled I can tell you exactly what is going to happen... and it ain't the development of the new drug.
That's the thing that is rarely (and can't accurately be) taken into account. What will the cumulative effect of the slowing of medical progress be on the country 10, 20 and 50 years down the road not just in the US but in the entire world? Very few people even attempt to factor things like that in, but that's a standard way I try and look at things.
The principle also applies to different methods of wealth redistribution. It may be comforting and seem nice to redistribute what you have now, but if that takes resources out of the hands of those that would grow them into those that simply consume and 'waste' them could you not be worse off in the long run? It's certainly an imperfect analogy but it's along the lines of what would happen if Bill Gates had donated his first millions to charity then not been able to buy the technology he needed to develop Windows, never became a billionaire, and never put the tens of billions of dollars into the Gates foundation.
All that being said, healthcare should be a much higher priority than 90% of the crap the government is into right now. Is there a way we could reprioritize and make sure everyone has a humane level of healthcare without killing off the engine of progress in the country or forcing our kids into further servitude of the Chinese? Certainly. I just don't feel the current options on the table adequately do that.
36 - Glenn Contrarian
Doug -
Your question:
"Under a government run system, medical advances will slow down and infrastructure will crumble. How could you look at what government does and come to a different conclusion?"
I answered that already in my reply to you. No matter what the rhetoric is, the numbers come out to this: America is thirty-fifth on the life expectancy list, the top twenty-seven ALL have Universal Health Care of one sort or another, and NONE of them pay even 60% per capita of what our government ALREADY does per capita.
Government CAN do it better, because the top twenty-seven countries - modern industrialized democracies all - have proven it. That's why their people live LONGER and pay LESS to do so.
Those are the crucial numbers, Doug. If another country pays a LOT less and their people live longer, then they're doing something BETTER than we are...and is it really so unpatriotic to emulate a system that helps your people live longer at a much-reduced cost?
37 - Mark
Government CAN do it better, because the top twenty-seven countries - modern industrialized democracies all - have proven it.
Glenn, the argument is that those countries piggyback on the innovative power of American capitalism.
38 - Doug Hunter
"the argument is that those countries piggyback on the innovative power of American capitalism."
That is accurate in a way. We may be 35th in healthcare but pick a random timeframe, say 1985 to the present and 34 Nobel prizes in Medicine have went to Americans while the rest of the world including the 34 countries that are supposedly our superiors manage a combined total of 21.
US dominance in medical breakthroughs extends far before 1985 back into the 1940's and 50'. If we had decided to be less capitalist and divert our resources to redistribution instead of research and innovation how much worse would medicine worldwide be now?
No one can answer that question accurately (and for the most part people try to ignore it), but it is part of the tradeoff you make when you choose the security blanket of socialism over freedom. It's but one of the fundamental disadvantages I have when discussing this topic. The bleeding hearts have real people that need help now, I have hypothetical future potential. You know who's going to win the hearts and minds there.
39 - Doug Hunter
Glenn,
I see you are determined to stick to the life expectancy figure as the be all and end all of healthcare. I know you are smart enough to understand that the healthcare system is only a part of the picture when it comes to lifespan. Unless your universal healthcare will make us stop driving into one another at 70MPH, cure morbid obesity, and cause youngsters to stop shooting each other in the face we'll continue to lag those other countries.
There is evidence and discussion to support the idea that life expectancy isn't the entire picture. For example, life expectancy varies within the US a significant amount even under the same system. Life expectancy from 65, after most of the homicides and accidental deaths are behind you, fares much better for the US. Also, under the universal system in Australia those of Aboriginal descent live to only 59.6, almost 20 years behind the average Aussie, even though they receive an equal per capita share of the health spending. (and you thought our minorities had it bad)
40 - roger nowosielski
I like the fact, Mark, that you're trying to expose the false dichotomy between private and "public" interests, especially as represented by the rather naive belief in the beneficial workings of liberal democracies.
One would think that our conservative friends are our chief enemy, but that picture is far too simplistic. The hard task before us is to convince our liberal friends, the people of good will, such as Glenn.
41 - Glenn Contrarian
Mark and Doug -
On the subject of medical research - so...are you then espousing the idea that it is good for the American people to effectively subsidize the medical systems of the rest of the world? Especially when said subsidization is a definite detriment to the physical and financial health of the American people?
And Doug - you'll always be able to find this or that single statistic that goes against the general trend...but that single statistic (or even a set of several statistics) does NOT disprove the overall trend.
Picture this - you're a manager in the Big Leagues...and your team's in 35th place. The top twenty-seven teams are doing something you're not. They're doing it better, for less than two-thirds the budget you're already spending. Problem is, your financial backers are insisting that your team is already the best.
But their insistence doesn't make it so.
Yes, that's an overly simplistic way of putting it...but you do see my point.
42 - Glenn Contrarian
Roger -
A 'false dichotomy' between public and private interests?
Me, I'm not so well-versed in logical terms. Could you please spoon-feed me an explanation...and also please tell me what you think about corporate inertia, the tendency for corporations to act in their own best interests even when their own company members disagree with those 'best interests'?
43 - roger nowosielski
Good point about inertia, Glenn, rarely if ever mention anymore in the analysis.
As to the rest, I'll get back to you later.
44 - Doug Hunter
"On the subject of medical research - so...are you then espousing the idea that it is good for the American people to effectively subsidize the medical systems of the rest of the world? Especially when said subsidization is a definite detriment to the physical and financial health of the American people?"
Is helping out the world a bad thing? Whose the caring, giving, world citizen now? Secondly, I don't think it is a detrement. Innovations, since they spread worldwide, are not able to be ferreted out with statistics by country. Perhaps those 34 nobel prizes (with some serious breakthroughs in major diseases) contributed to knowledge and solutions that added 2 year to the lifespan of everyone on the planet. Let's also say the very best universal government systems add 2 years on top of whatever knowledge they have.
That means countries other that us get 2+2 = 4 years of lifespan while we only get the 2.
Now, if we had decided to redirect funds from research into paying for care for everyone from the outset we would get 2 years like everyone else. (the same end result as the other scenario for us) but the other 6-7 billion humans would be worse off for the lack of our discoveries.
Now, speaking of false dichotomies, it's not impossible to have world class R&D and guaranteed healthcare for everyone (look at the UK for instance). The problem is we're bankrupt, we don't have the funds to pay for it and we will be drawing from somewhere. I suggest that redirecting funds from medical R&D and infrastructure is a low hanging fruit. As a liberal, I think you'd understand as, like education, it is something that pays dividends down the road that are valuable but difficult to precisly pin down.
Before we add massive new programs and new spending I just want someone with some gonads to give an honest assessment of what we'll have to give up to get it. If it means our kids will have to decrease their standard of living to pay for it say that. If it means we'll have to ration care in order to cut costs say that. If it meant cutting defense spending, ending wars, and closing a few overseas military bases (and you want to get me on board), then say that. Just don't expect me to believe we can get something for nothing, that makes me think you are either lying or stupid.
45 - Glenn Contrarian
Doug -
When you get on an airplane, they tell you that if the cabin loses pressure, adults should put on their own oxygen masks first and THEN help their children.
And of course you know that this is because if one doesn't take care of oneself first, one is far less able to take care of others.
By making the altruistic rationalization that it's okay that we pay so much more because we're helping the whole world, you're ignoring the fact that medical bills are a major factor in half - HALF! - of all bankruptcies in America.
Your altruistic rationalization is a Republican talking point...and is NOT the real reason the Republicans are against real health reform. MONEY is the reason, Doug. That's why I mentioned 'corporate inertia' to Roger, because said inertia forces corporations to do what they can to grow, to thrive. Altruism has NOTHING to do with it.
BTW - when it comes to 'something for nothing', we do NOT have to 'ration' health care. THAT, sir, is what the HMO's are ALREADY doing - just ask any of the millions whose claims were denied. I ask you, Doug - who denies more claims? Medicare...or the HMO's? I think you know the answer.
It's not 'something for nothing'. It's an initial investment in making things better for the American people as a whole. It works for ALL the other modern industrialized democracies on the planet, and it will work for us.
And a side note - I may be retired military, but our defense budget is bloated beyond belief. That, and we've already spent more on the Iraq war than we would have spent for universal health care for all Americans. But of course the Iraq war was 'patriotic' and 'socialized health care' isn't....
46 - Doug Hunter
"Your altruistic rationalization is a Republican talking point...and is NOT the real reason the Republicans are against real health reform. MONEY is the reason, Doug."
Look in the mirror. Your 'altruistic' rationalization for taking other people's resources is just a talking point put out by a select cadre on the left. Your foot soldiers in democracy are just people looking for a handout and jealous types wanting to stick it to the man. You're not on any moral high horse.
That's one thing I've never understood. Somehow you twist your logic around so that wanting freedom, self determination, and the ability to control your own resources is greedy and selfish whereas wanting to control other people and take their resources is virtuous. Complete nonsense.
Say it is about money, what's your point? You want to take it, they want to keep it. You don't trust them to do the right thing with it, they don't trust you. They, just like you, prioritize their spending and asset allocation with their best intentions, you think you could do a much better job. Your side cares about their money just as much as they do, the only distinction I see is that it is there money to start with.
At the end of the day, my feeling is that each individual should decide how to spend their lives, their money, and their time. You don't, you think the government should dictate those things. I find that sick and offensive.
47 - Doug Hunter
The objection... is not that they try to make us think as they do, but that they try to make us do as they think. - HL Mencken
Ditto for liberals.
48 - Glenn Contrarian
Doug -
"Your 'altruistic' rationalization for taking other people's resources is just a talking point put out by a select cadre on the left. Your foot soldiers in democracy are just people looking for a handout and jealous types wanting to stick it to the man." and "At the end of the day, my feeling is that each individual should decide how to spend their lives, their money, and their time. You don't, you think the government should dictate those things."
'Looking for a handout'?
Of course, of (i)course! How stupid of me! How could I possibly think that the fact that the top twenty-seven countries on the life-expectancy list ALL have UHC - each for less than 60% of what we already pay per capita - would have ANYthing to do with the Democratic support for health reform?
How could I possibly think that ensuring real health reform would really help my oldest son who can't get health coverage due to his pre-existing condition (rheumatic fever) and my brother who was told yesterday that he's likely to lose half his left foot (and he can't afford health insurance at all).
Doug, it's NOT about government 'running our lives'. It's about the REALITY that the nation as a whole functions better if the population is healthier and longer-lived. Right now my son and my brother pay taxes - but when they declare bankruptcy because they can't afford their health care, and when the state starts providing disabled-support care for my brother, what happens to the tax income of the states, and of the federal government who loses two more sources of tax revenue?
Doug, that's why UHC works in ALL the other modern industrialized democracies...and for FAR cheaper than we're already paying. UHC is NOT a 'handout' as you so callously refer to it - it's the government ENABLING someone to work more effectively for a longer period of their lifetimes (not to mention the fact that businesses would no longer have to spend billions to subsidize their employees' health care).
Face it, Doug - the facts are against you. You don't want this 'socialized health care' - not because it won't work better (because it's proven that it does), but because the idea of it offends you.
It's your pride and your contempt that are blinding you - because the reality of the numbers don't back you up at all.
49 - Eric Dondero
Thank you Clavos for editing my article. And thank you to all the commenters.
This is the first, of what I hope to be many future articles favoring free market economics/libertarianism, here at BC.
50 - Doug Hunter
You,re just going in circles now. Everyone has a stat. Everyone has a sob story.
I really like the part about living longer so you can work more and pay more taxes. A little window into your mind. I would agree to disagree but you'll no doubt break that truce and resort to using the government to force to your will.
51 - Doug Hunter
Another comment lost to cyberspace.
Anyways, I did have one more question. Glenn, if you believe your own words then what prevents you from implementing this solution in a free system without government interference. If you can provide such quality care that it alone adds years to ones life at 60% cost with preexisting conditions and covering everyone then certainly you could initially start by only covering paying customers and those without preexisting conditions for even less, say 50%. At that price I'd be the first one to sign up and you'd quickly put insurance out of business. You could gradually raise rates to 60% of what people were previously paying while expanding to cover everyone.
Note: You'll find the answer in what I like to call the liberal 'invisible hand'. You probably didn't even know you guys had one. That's the magical force that make you believe something that doesn't work on a small, voluntary scale will work when endorsed and mandated by ever larger levels of government. Even when you have failures at the national level you usually just blame it on an externality... if only there were one world government then all our problems could be solved! (or at least we would have nothing to compare your failures to)
52 - Glenn Contrarian
Doug -
"If you can provide such quality care that it alone adds years to ones life at 60% cost with preexisting conditions and covering everyone then certainly you could initially start by only covering paying customers and those without preexisting conditions for even less, say 50%."
"If" we can do it for 60% of what we're already paying? Yeah, we can - because ALL the other modern democracies are ALREADY doing it. The only reason we can't do it...is because the Republicans say we can't do it.
And the idea is, Doug, ensure EVERY American citizen is covered. You know why? Because you and I and EVERY American citizen DOES pay for the heath care of the uninsured...because when they go the the ER and they can't pay (at rates often 3X higher than regular care that would have prevented the ER visit), then WE the taxpayers DO pay it.
It's a "pay me now, or pay me later" thing, Doug. The taxpayers eventually pay for the health care of the uninsured in any case...and it's a LOT cheaper to provide the preventative care than to pay for the ER visit(s) that the preventative care would have prevented.
As I said before, the REAL reason you don't support health care for all Americans is that you are offended at the idea that your tax dollars are paying for the health care of others...never mind that if all Americans are required to have coverage, less of your taxes will go to pay for their care.
But you choose to be offended by the idea - and I can't help you with that.
53 - Doug Hunter
I'm sorry, rereading my #51 I wasn't very clear. The question was intended to be, what prevents you from simply starting such a plan within the framework of a free system? What special magic does having the government enforce your plan provide?
(I certainly think superior care at 60% cost or less would sell very well in the free market if it were real. Get Soros on board and call it Liberal Nonprofit Healthcare, Inc. Again, I'll be the first to sign up if it were real. Personally, I think you're bluffing. The reason your plan won't work in the free market is because it doesn't work period. Government will either hide the true cost or enforce rationing that the free market does not. If there is some other explanation then that is what I was looking for.)
54 - Clavos
And still the health care discussion omits the most important cost-saving measure: tort reform.
Not to the point of denying people the right to sue, but certainly to the point of significantly limiting attorneys' share in awards, making losers pay costs, limiting the size of awards to actual financial losses, including loss of future earnings, but not for "pain and suffering," the category of award most subject to abuse by juries.
55 - Dan Clore
I'm not a blogger, but I don't mind seeing my name in acknowledgment of using me as a source of information.