Unlike conservatives, I see a problem. Unlike Liberals, I don't think the Public Option is the answer> by Taliesin
(libertarian)
Friday, December 11, 2009
As Congress votes and drafts and trims the Health Care Bill, I would like to address the root problems of our present issues with Health Care in this country. Common liberals seem to believe if government pays, the people will not. Remember that government pays for everything with money taken from the people. You are the people. You are paying for these programs. Your neighbors are paying for them. Government sees a new way to justify control. This is government imposing a program where they can justify knowing everything about you, and even deny coverage for political reasons. Think it can't happen in this country? Power hungry people are the same everywhere.
I am of a conservative bend, yet I differ from the "main street conservatives" on one important aspect of this issue. I think our current state of health care is flawed. However, I do not agree with government intrusion into the equation to the extent of a Public Option. I believe in small, passive government. I don't believe Democrats want to help people. On the contrary, I believe the Public Option circumvents capitalism in order to establish control. Control limits liberty, or self-determination. I believe limiting liberty is hurtful. So, by my count, the Public Option is intended to hurt people. But the current system is nonetheless broken. For me, the problem is simple to break down. I see 3 crippling problems with present health insurance practices:
Cost of care
Monopoly
Limited access
Each problem has a solution and all three intertwine, so the solution is close to a lynchpin. I believe the free market system self-corrects. This self correction is not accomplished by self-governance. So the role of government is one of oversight. By analyzing each of these points, we see the solution. Government can limit the aristocratic problems caused by unfettered Capitalism, and the market adjusts to health by default.
The root of the problem is the cost of care. For a regular doctor's visit, the insured pay a small co-payment. Would you pay $15 or $20 just to check if everything is okay? Sure, it's worth it. Just like the price of an oil change is worth it compared to the price of engine failure. However, with no insurance the same visit can easily be $100. Most people can't afford to pay $100 for every ailment. Which symptom is worth $100? A cough, flu-like symptoms, or a chronic pain can warrant a visit, or just be a minor glitch in an otherwise healthy body. Many serious diseases seem mild when they are curable. If it gets to the point where any laymen can see there is a serious problem, usually it is too late. I had a friend who lost his father just one month after back pain turned out to be spinal cancer. It took a while before it became evident it wasn't just a pulled muscle or a pinched nerve. By the time doctors became involved, it was far too late. In this economy, or any time really, if the cost is $100 a pop just to see someone, and the cost goes up for any prescription or test, many of us would opt to stay in bed and hope our immune system can handle it.
So how did it get this way? The one word answer is insurance. Providers of any product or service charge what the market can bear. That's Business 101. Without insurance covering most of the visit, people don't go to the doctor and the doctor has to lower prices, close up shop, or pre-screen patients by ability to pay. Like any price, the maximum allowable ceiling is limited to what people can pay out of pocket. The mortgage bubble and credit bubble that has lead us into this sorry economic mess is a prime example of what I'm talking about. People have never bought more home than they could afford. Saying the banking industry forced people into homes they couldn't afford, is to completely fail to describe the housing market. People, common everyday Jane's and Joe's, buy a mortgage (not a house) for what they can afford PER MONTH. The total price of a home can be $200,000 or $400,000, if the monthly payment is $1,500 they buy it based on that monthly payment. If there was no mortgage industry, houses would cost several thousand dollars. Anyone with a modicum of historic knowledge knows this. It's a trick of interest rates and repayment time, nothing more. We have paid the same ratio of our income for the same products for a long time.
Health care is no different. Insurance began as a way to avoid the cost of catastrophe. Catastrophe is never in the budget. A car accident is catastrophic; car insurance exists to limit the financial impact. However, the body is not a car where loss is limited to accident or theft. The body will fail to work at some point, and can do so for a large number of unseen reasons. Some of those reasons are unavoidable. In the auto industry, there is a warranty which is limited by mileage and age and provable maintenance, and then there is insurance for unforeseen damage. With health insurance, both aspects are combined and the demand is for a limitless warranty. As the health insurance companies saw the economic advantage to preventative care, they began to cover it, leading to higher costs for insurers but the same costs to consumers. As the market began to rely on the higher price tags paid for by insurance companies, the uninsured became boxed out of the game. Add in the cost of malpractice and equipment, we start to need more money to pay for the same problems. How many doctors would order an x-ray for a cold if they weren't pressured to make sure it wasn't early pneumonia to avoid a lawsuit? This creates demand for more testing machines at a hefty cost which health providers could not afford without the large bills paid by insurance companies. The machine would not have such a huge price tag if no one could afford it. Hence, the insurance industry creates its own necessity. And once anything becomes needed as opposed to wanted, it leads to the second huge problem of health care.
The monopoly of health coverage is multi-sided. Primary is the source for affordable coverage. Often, the most inexpensive coverage is the one your employer picks for you. That means the insurance company only has to cut a sweet deal with employers to get exclusive rights to their employees. Then the employees are captive to whatever prices said company charges. Removing health insurance as an employee benefit, wages must rise to compensate. I know that I have seen wage increases that did nothing more than cover higher insurance premiums. Remove the monopoly-like relationship between wages and health insurance within a company, and this solves two issues. Imagine if these insurers had to reach all citizens individually instead of just cornering the market through businesses. With greater competition in the insurance industry, premiums would drop to become more attractive to a wider audience. This happened with auto insurance, and we saw it with telecommunications as well. As providers of services fight to become competitive, prices drop. We don't need a public option for that. All that is needed is to enforce anti-trust legislation.
If any person can buy any package directly from the provider, it is only a matter of time before one innovative company starts a price avalanche. Anyone old enough to remember the telecommunications price wars of the late 90's can understand this. For younger audiences, there was a time when calling across the country from your home phone could cost over $1 a minute, calling further than your local town would start at 20 to 30 cents a minute. Now, many of us have unlimited calling through an internet provider for one monthly rate. Observe the battle that has unfolded in the cell phone industry. There was a time when cell phones charged per minute, and then they started competing to offer more free minutes. After fiddling with calling circles and unlimited nights and weekends, we are starting to see fully unlimited service. Now we will see the unlimited services become cheaper. In a few years, cellular service will cost the same as land line service. This is what the free market does. The only involvement government should have is to prevent any small group from dominating the market to the point where they can dictate price. Did the government create a state phone company, or government run internet service to drive down prices? No, all the government did was impose limits so that no single company could dominate the market and the market managed itself. The only time the market cannot manage itself in any industry is when the government turns a blind eye, intentionally so at times, to consolidation and monopolize. We have anti-trust legislation. If it needs tweaking to regulate this industry which is often literally needed to live, then so be it. This leaves one final problem with health insurance.
That third, huge problem with insurance is pre-existing condition clauses. If you have a chronic disease, you have a problem. Health care has become so expensive; no one can afford to go it alone if they need medical care to live a normal and productive life. If one has Diabetes, there are two options, extend your life by getting medical care at whatever price is demanded, or die. If you don't have insurance the cost is high. Health insurance is not like anything else. If you become permanently injured by an accident, or get Diabetes, Epilepsy, or Crohn's, you will continue to have that condition, regardless of any insurance you have. If you lose your job, or have a gap in coverage, you are severely compromised by the cost of an uncovered condition. Now, your employer cannot refuse to hire you based on these conditions, why should an insurer be able to refuse service? I know some would argue that Health Care is not like a job. I contend that it is to the extent that in order to live and pursue happiness one must be in relative good health. If someone needs wheelchair access to work, the law provides that such access is mandatory. If any business refuses to sell or provide its services to someone based on race or disability, they are subject to penalties.
Who makes the wheelchair affordable? Why, it's Medical Insurance! What allows diabetics to continue to provide for themselves and their families in a similar manner to non-diabetics? Again, Medical Insurance! Look at the problem from this perspective and we see that the solution to our Health Care Crisis is already in place. This is about equal access to care. There is no Public Construction Option for businesses to fit their buildings with wheelchair access. There are laws requiring telephone lines are part of new construction because of the needed aspects of phone service. Does the government support that need by paying for installation? No. Why must there be a Public Option for health care?
There is a free market solution. Remove unequal access to services, limit the monopoly of the market and the market will correct itself. The only thing that insurance companies are worried about is losing market share. If all insurers are required to provide the same access for the same cost to every person, all insurers will find a way to profit. Maybe everyone pays more for a time. But wait and watch them lower prices to compete. Wait until they frantically search for cost effective solutions for treating chronic conditions. Again, all government must do is utilize anti-trust enforcement and the problem will fix itself. Anyone who says differently is blinded by dogma or greedy for money or power. These are simple questions. Do you want control of the services you pay for? Would you rather continue to pay the Attorney Generals to lower your costs by enforcing laws at the same rate you already paying them, or would you rather add to the bill by also providing for everyone's medical care?
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"Remove unequal access to services, limit the monopoly of the market"
I can't tell if you are FOR or AGAINST liberty. All in all, there are also those like myself, who want the abolishment of economies, and so go your healthcare costs... as well as all billings. In fact, there goes monetary discrimination, right? Do we who want the abolishment of economies and ownershipism (state, private, or ANY)... get freedom to avoid economies and ownership? No. Not a single other living creature on the entire planet... does ownership or economies. Why do capitalists? See the pyramid scheme symbol on the back of the USA dollar? Columbian Freemason, yes? And where is the USA gov? District of Columbia (your spellings may vary). See the servitude (inequality) infestation in capitalism? Sure ya do... its everywhere. Lots of folks working FOR things but few working WITH (equality).
You/we HAVE TO get the AmWay coupons (greenbacks) completely out-of the USA healthcare system. Operate more like the USA military supply system, and USA public library. Everything belongs to "team" and no money or entitles of ownership are used... only custodianships. Its time to level the pyramid scheme called capitalism... and abolish economies so such inequality and rat-racing can never happen again.
Larry "Wingnut" Wendlandt MaStars - Mothers Against Stuff That Ain't Right (anti-capitalism-ists) Bessemer MI USA
In answer to your first question, monopoly and exclusion of equal access is limiting liberty. A monopoly is the economic version of a tyranny. Exclusion based on pre-existing conditions limits the individual by removing portability. Fear of limits keeps people from the freedom to abandon situations that may otherwise be detrimental, in order to retain a single benefit. I do not believe in unlimited Capitalism simply because the evidence indicates a tendency towards monopoly. We hoard. It is that simple. That behavior is in no way limited to Capitalism. The strength of Capitalism is not based on the abuse of power, but in wide access to power.
The abolishment of economy is a pipe dream. It has been tried. Russia collapsed. China has moved away from it and prospered. Simply put, Communism does not work, never has, and never will. No species is altruistic. Your theory that no animal does ownership or economies is unfounded. Animals do territories and breeding rights, even eating rights. Animals fight fiercely for these things. The hierarchy of the animal kingdom is observable.Even in communal "hive" species, the individual hives are fiercely territorial hierarchies.
Do animals use fiat currency? No. But the parallel behavior represented in human society by economy is evident.  Idealists suppose that only humans do horrible things for pleasure. I disagree. The brain chemistry of all species provides pleasure for eating, propagation of species, and shelter. Economy simply alters the terms of the same dance. Instead of violence, we commonly use money to obtain dominance. When people use methods similar to animals to achieve dominance and privilege, we call them monsters.
Your supposition is based on dogma, a belief in a concept that disregards any contrary evidence. Custodianship is ownership. You can anecdotally observe this at any government bureaucracy. Benevolence is what is lacking in any human system and no system solves that, even careful screening can miss a well placed mask. One greedy bastard in a benevolent system will surround himself with similar personalities and the system will corrupt. Oligarchy, aristocracy, bourgeois, party member, alpha, priesthood- the list goes on. All these terms describe the same archetypical group. Again, in Russia, the custodians enjoyed more privilege.
That is all economy is. It is marked territory, displays of strength in order to enjoy privilege. Capitalism does not exclude from access to territory or privilege anyone based on birth, membership to exclusive groups, or personal ideology. Capitalism is based on opportunity and the desire for ownership and access to better things. Better things are usually harder to obtain, therefore limited supply is given to those who show ability to earn them. In the animal kingdom this ability is demonstrated through strength. In humans it is demonstrated through money. Strength is based on the ability to purchase. Even in matters of strength the ability to buy a bodyguard or weapon provides opportunity to win based on more than muscular genetic luck.Â
In short, your comments, based on your dogma, are not worth anything in reality. If you really succeeded in removing economy, you would still see the same problems. The natural dominant/submissive paradigm would simply be displayed in another medium.
You know, there are three great problems to your solution.
One, you are confusing the difference between a product that you buy with a service. A can of food or a cell phone plan has a price point. Pricing above that point generates profit. Pricing it below that point does not. The prices rarely alter that much. It's simple and efficient to let "free markets" determine the lowest price that people will pay that generates enough profit to make it worth the while of a company to offer the product.
MEDICAL CARE AND INSURANCE DO NOT WORK THAT WAY.
I'm assuming, from your completely out-of-touch with reality description of how "easy" it would be to reduce healthcare costs, that you do not work in the insurance industry. The very basis of an insurance concern is it's risk pool -- how much money is being taken in by those covered vis-a-vis how much is being paid out.
In the "old days" , if you had a crippling condition you were pretty much done for if your family couldn't take care of you. You advocate "equal access regardless of medical condition", which poisons the risk pool.
If I have ten people, in good health, paying $100 a year , I have $1000 to cover medical costs for those ten people. My risk per person in good health is 25% , so I can expect to pay out at least $250 a year in benefits. Since I buy medical care in bulk, hospitals give me a discount. I end up having to pay some differences, my associated costs, and of course, some kind of profit. Still it's quite profitable, if I only take people I know are in excellent health.
The same people with the same price with UNKNOWN health is much dicier. Now I may have one person who blows through my expected $700 profit margin. But that's okay, because on average I still make money year over year, right? But your suggestion is I take people who I know have serious, serious health problems that are likely to cause me to spend way more than I take in from my pool.
That translates to , basically, charging everyone else to support the sicker members of society. Very statist. Not very libertarian.
The second problem, of course, is that the pricing point of insurance is tied to the cost of the medical services. I don't see medical school, MRI scanners, or hospital equipment getting any cheaper, or nurses easier to hire. Hospitals have tons of fixed costs and equipment that must be kept on hand even if they don't need it at all times, and the costs inheirent in this are passed along to the consumer and insurance company. No matter how "free market" you make things, if you expect prices to go down you are ignoring the truth. Accountants, laywers, plumbers and bricklayers can all play with their pricing to attract business, but it is not going to drive the cost down that much.
The biggest problem I have with your solution is the concept that there's a monopoly on health coverage. There is certainly a monopoly on insurance coverages, but that's hardly important as it used to be. United Healthcare, Aetna, Cigna, and the other biggies are in all 50 states, Medicare, Medicaid, and Commerical Insurance alike, I assure you. If you are suggesting that individuals should be able to get coverage as cheaply as a company, I would point out the reasons companies get it more cheaply is that they allow for grouping and organization of claims, members, and provide the insurance company repeat and steady business. It is not as easy to manage a million separate members going all over the country, or route the claims to the correct hospitals, or ensure the billings go to the right specialist group, etc.
Lots of things look very simple to fix when you don't know a lot about them.
Posted By: Scott McMorran
Date: 2009-12-30 12:19:04
Taliesin:
Although I think your article is seriously flawed there are FOUR  points you make that are so INACCURATE I feel compelled to address them briefly.
Cost of Care:
 There are, of course, many health care cost drivers, but all serious analysis of health care costs will quickly arrive at the same conclusion. The leading driver of health care cost is not "profit mongering", research, new; procedures, drugs or equipment. It is cost-shifting caused by GOVERNMENT PROGRAMS. Cost shifting on such a magnitude that it is in reality the only place one need to look to solve the problem.
Monopoly by Insurance companies:
 There are HUNDREDS of health insurers in the United States. One small change in current ERISA law would open a flood gate of interstate sales of Health Insurance. If this suggestion were implemented any claim of MONOPOLY would be laughable.
Employer Provided Coverage:
Employer provided Health Insurance is the most cost effective delivery mechanism for this product. Why? It affords a coverage opportunity to the demographic that is most likely to not have coverage, the young, and provides it with a tax deductible employer subsidy. Any other delivery mechanism would cause huge increases in the uninsured. The young and irresponsible would simply not bother to buy the coverage if they had to go out into the market and do it on their own.
Pre-Existing Conditions:
This is a somewhat complicated topic to discuss, but the use of a "pre-ex" to any degree is in reality a dinosaur of the past. In 1996 Congress passed the Health Insurance Portability and Accountability Act (HIPAA) which eliminated the problem of a "Pre-Ex" for millions of Americans as they switched jobs, and as a result, their insurance coverage.
  Here is where the topic becomes a bit complicated. If a person finds themselves without coverage for an extended period of time they could find themselves with a "pre-ex" attached to their new coverage. I say could becausethe vast majority of people who have no coverage don't have a pre-existing condition that would limit their benefits.
The only purpose of a "pre-existing condition clause" is to keep people from waiting to buy insurance until they have a claim. Here's what would happen without this safeguard for the insurance company. If the insurance company had to issue coverage to anyone who applied 10's of millions would immediately drop their coverage and only re-apply when they had a claim. This is exactly what happened in the State of New York when they passed their version of Health Insurance Reform back in the early 1990's. Young, healthy people all over N.Y. read the fine print and realised they could drop coverage until they had a claim and then re-apply. And that is exactly what they did.
Would State Farm issue you homeowners insurance if you called them and said, "My house is on fire, would you insure me ?" Of course not. Similarly, why would we ask a health insurer to issue coverage on a person with newly diagnosed cancer.
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