Open thread Jan 17, 2014 Dan Crawford | January 17, 2014 8:05 am Tags: open thread Comments (36) | Digg Facebook Twitter |
you could be right about the dull party. certainly I have found something better to do.
but the danger of a “good story” is that people will accept it for “the” truth.
i bet if you looked hard enough you’d find that some of those people no longer reporting themselves as “looking for work” have just run out of unemployment benefits, or gone on welfare, or slowly winding out their lives living on their “savings…” or selling dope. or baby-sitting my daughter’s dogs for sub sub sub minimum wage while she takes her ph.d. and works as an unpaid assistant to her boyfriend who can’t afford to hire anyone because he isn’t making enough money in his business which has been reduced to survival level by the masters of economic theory who think that’s the way it’s supposed to work.
i suppose i might be one of those no longer unemployed because
because i am one of those whose life expectancy has gone up, you see, so they raised the retirement age, see, because “it’s obvious,” see, that if “we” are going to live longer we can all work longer, see
except that there aren’t enough jobs, and aren’t going to be, according to the people who predict such things… and that’s why we need to cut SS benefits, see, because there won’t be enough workers to pay the tax to pay for Social Security, see…
and the tragic thing about this reasoning is that for some people, many people, it “makes sense.”
IF we are going to spend more of our careers unemployed… and this is the reason CBO gives for the Newer Bigger Projected Shortfall in Social Security, cutting benefits would be exactly the wrong thing to do.
Much smarter would be to raise the payroll tax. Sure, you’d be spending (a tiny bit) more, as a percent of your wages on SS. But You can live a lot better on that tiny bit less while you are working than you will be able to live on those smaller benefits when you are old and can’t work… or can’t find a job.
But don’t try to explain this to people.
Coming soon, massive insurance company bailouts. People ranting about socialism have it all wrong. Obamacare is a corporate welfare scheme for insurance companies, pure and simple. They are the “takers,” and they can’t lose:
Robert Laszewski—a prominent consultant to health insurance companies—recently wrote in a remarkably candid blog post that, while Obamacare is almost certain to cause insurance costs to skyrocket even higher than it already has, “insurers won’t be losing a lot of sleep over it.” How can this be? Because insurance companies won’t bear the cost of their own losses — at least not more than about a quarter of them. The other three-quarters will be borne by American taxpayers.
For some reason, President Obama hasn’t talked about this particular feature of his signature legislation…
Cynthia, your own comment referenced lists the cause: “… while Obamacare is almost certain to cause insurance costs to skyrocket …”. In this case you totally ignore the cause “…Obamacare…”and effect “… is a corporate welfare scheme for insurance companies,…” ignores the before Obamacare condition of the industry.
You seem to think that the “industry” input to writing the law would not be to protect themselves from the known and predicted impacts on them of its implementation. You also seem to ignore the known and predicted impacts on the overall user communities. Is it ideological naivete or plain denial?
Umm, are you guys aware that the reinsurance fund is funded by the insurance companies through their customers, not the government?
Do you both think that insurance companies will write policies with the idea that not making a profit is a good thing?
WASHINGTON—With the Affordable Care Act now making it possible for a greater number of Americans to purchase medical coverage, the nation looked back this week and fondly recalled a simpler time when its health care system was broken beyond any hope of repair.
Describing a more innocent period in the country’s history—before opponents of the act temporarily shut down the government, and before the disastrous rollout of the new insurance exchanges led to widespread public exasperation—citizens shared with reporters their warm memories of what they called a bygone golden era.
“Back then, if you couldn’t afford health insurance and got really sick, you went bankrupt, plain and simple,” said Dominique Otis, a Modesto, CA mother of three. “They didn’t have this whole mess of lower-cost options, or all these subsidies you might or might not qualify for based on your income. People didn’t have to deal with any of those headaches. They just went ahead and died of preventable causes.”
“Those were the good old days, ya know?” she added with a sigh.
According to nostalgic sources, there was a time when Americans who lost their jobs and the benefits that came with them simply went without insurance, and that was that. During this halcyon age there was reportedly no way anyone who was out of work could afford health care, and if people had a serious preexisting condition, they knew for certain they would never again qualify for decent coverage.
Harkening back to that less complicated past, citizens noted, for example, how parents who had no way to pay for their newborn baby’s much-needed surgery never even bothered getting their hopes up, but simply accepted that their child would never have a first birthday party.
As they spoke with reporters, many Americans reminisced about the comfort they once took in the predictable dysfunction of this status quo.
“When I had esophageal cancer and needed $180,000 worth of treatments not covered by my health plan, I knew immediately I’d lose my house,” said 58-year-old Tobias Czwerda of Braintree, MA, who smiled as he flipped through snapshots of the Christmas he and his family spent in a homeless shelter. “Yes, sir, things were simpler then. You knew in advance that no matter how much you argued with your insurance company, in the end it would always come down to the same two options: pay or die.”
“Call me old-fashioned, but there was something reassuring in that,” he added…….
Yes, E Michael, the so-called “reinsurance program” is funded by the insurance companies through their customers. However, roughly 70% of these costumers are getting health insurance that is partially funded by the taxpayer. I don’t have the exact figures, but the taxpayer funding of this particular program is quite enormous. What’s even worse, which you failed to mention, is how the so-called “risk corridor program” is funded. This program is mostly, if not, completely funded by the taxpayer.
Government has done a disservice to Americans, over many decades, making U.S. health care, by far the most regulated industry, much more expensive.
Reducing the cost of health care through deregulation will free-up enough money for taxpayers to afford subsidizing catastrophic health care or pre-existing conditions.
How to reduce medical costs:
1. Limit medical lawsuits and awards, to lower malpractice insurance premiums and unnecessary medical tests.
2. Lower standards to practice medicine (to increase labor)
3. Allow insurance companies to sell health-care policies across state lines (currently, average health care insurance ranges from a low of $1,254 in Wisconsin to a high of $8,537 in Massachusetts).
4. Allow innovation (example below);
Kaiser Microclinics At 50% of the Cost of a Full-Service Hospital
Two doctors working out of a microclinic at a mall could meet 80% of a typical patient’s needs. With a hi-def video conferencing add-on, members could even link to a nearby hospital for a quick consult with a specialist. Patients would still need to travel to a full-size facility for major trauma, surgery, or access to expensive diagnostic equipment, but those are situations that arise infrequently. The per-member cost at a microclinic is roughly half that of a full Kaiser hospital.
Um, no, the risk corridor program is not funded completely by the taxpayer.
And this type of program is not new, yet somehow there are people that think it is:
“The Congressional Budget Office, in its overall cost estimates for the Affordable Care Act, assumed that the inflow and outlfow would be roughly the same, so that the risk corridor program as a whole would be budget neutral. Even if CBO’s prediction is wrong, and the government ends up spending more than it raises, the difference is likely to be modest. The formula for payouts calls merely for government to share in high losses or gains, not to take them on completely. It’s enough to protect the insurers, the thinking goes, but not enough to cause a massive outlay. Meanwhile, lower-than-expected premiums are likely to save the government much more money than the risk corridors would ever pay out.
Conservatives might object to reinsurance and risk corridors on principle, regardless of amounts involved. That would be a perfectly legitimate argument, except for one thing: Reinsurance and risk corridors are already a feature of some government programs, most prominent among them Medicare Part D. The reinsurance and risk corridors in Obamacare and Medicare Part D are remarkably similar, except that Obamacare’s are temporary and Medicare Part D’s are permanent—which is to say, they are still part of the program.
What’s that? You haven’t heard Republicans attacking Medicare Part D an insurer bailout? Maybe that’s because of one other, obvious difference between Part D and the Affordable Care Act. Only one of them was signed into law by a guy named Barack Obama.”
Jeff Jacoby writes in the Boston Globe:
Imagine the sort of car you’d drive if government regulations made it illegal to sell any automobile that didn’t feature 380-horsepower direct-injection V6 engines, computer-controlled electric power steering, eight-speed automatic transmission, four-wheel-drive, automatic climate control, “smart key’’ technology, touch-screen navigation, backup cameras, LED headlights, acoustic glass, surround-sound stereo, and leather seat stitching.
If those were the minimum requirements every car had to meet before it could be sold, would you commute to and from work every day in a Lexus LS 460 or some other luxury vehicle? Well, you might, if the steep price wasn’t an obstacle. But it’s more likely you wouldn’t be driving at all. If the government barred you from buying anything but a high-end car, you’d probably have no choice but to rely on the bus or subway, or to find a job closer to home.
Increase the number of amenities that a product or service must include, and more consumers will be unable to pay for that product or service. That is why one of the simplest strategies for making health insurance more affordable is to reduce the minimum number of benefits that insurers are required to cover.
In every state in the union, legislators and regulators drive up the cost of healthcare by making insurance policies more comprehensive. Rather than allow the free market to determine which medical services health plans will cover, states force consumers to pay for an array of covered benefits they may not need or want.
Re your 1
Explain how tort reform enacted a decade ago in several states has not impacted health care costs in those states one iota.
Ah, the old credit card scam.
There is nothing to prevent insurance companies from selling across state lines as long as they meet the requirements of the individual states.
Your thought is a race to the bottom, and the results are clearly shown by what happened in the credit card business.
EMichael, you’re in denial. Government has driven-up the cost of health care to ridiculous levels and hence the “Affordable Care Act.”
Do you even know the prices of health care?
Difference is that your thought of minimum coverage is different than mine or just about anyone else.
Problems start when your gamble on what coverage you need is lost, and I and others have to pay for the cost of your lost gamble.
geez. I am aware of the cost of healthcare in the US.
Unlike yourself, I am also aware of the cost increases in US healthcare before anyone ever heard of the ACA.
EMichael, when you go to the store, do you pay whatever price an item is selling for, no matter how ridiculous?
Silly question, Peak.
You cannot compare healthcare to other markets. Read some Kenneth Arrow. You cannot control costs in a system if people outside the system can use the system. And no one I have ever met(or hope to meet) would keep people outside of the healthcare system from accessing the healthcare system.
I can point you to 20 or 30 civilized countries in the world that do not have our healthcare cost problems. Every single one of them has more government involvement in healthcare than does the US.
In the free market, prices of goods fall and quality rises. Health care is also a good.
Or, maybe you want this type of system:
The British health care system:
“A quarter of a million people are waiting more than 18 weeks for treatment on the NHS, new figures show…for a range of treatments including oral surgery, rheumatology and geriatric medicine. This means that nearly 10% of patients are not being treated within the government’s waiting list target.
Civitas, the think tank, blames the monolithic nature of the National Health Service for “putting the patient last”.
It argues that the “customer” of the NHS business model introduced by Tony Blair and continued by Gordon Brown is the health secretary rather than the patient.
State control: staff pay is set centrally, capital expenditure is constrained, IT is a top-down programme and availability of drugs, such as expensive cancer treatments, is centrally determined.”
With lower prices and higher quality subsidizing catastrophic health care or pre-existing conditions will be affordable. Otherwise, there will be rationing.
Everything you are proposing has been done in the US for at least a decade, yet costs skyrocketed. Ever think to look at facts instead of ideology?
And would I prefer to have the UK healthcare rather than ours? In a NY minute.
World Health Organization Ranking; The World’s Health Systems
3 San Marino
18 United Kingdom
26 Saudi Arabia
27 United Arab Emirates
36 Costa Rica
Oh, and we spend twice as much as the UK
EMichael, your statements are dishonest and not supported by the facts. Also, U.S. health care has become more regulated, not less regulated.
Moreover, the WHO rated U.S. health care #1 in the world both in labor (e.g. doctors, nurses, etc.) and capital (e.g. hospitals, medical equipment, etc.).
60% of the WHO rating criteria is based on equality. It seems, you prefer a much worse, but more equal, health care industry.
Here’s what an MD said about the WHO:
Dr. T said…
“The WHO healthcare rankings are worse than useless: they are outright lies. The WHO relies upon self-reporting from each nation. Does anyone believe that Cuba or China provide truthful data?
The WHO rankings also overemphasize “coverage” (where the US ranks very low since we have many uninsured people who have to pay at the time of service — gasp!).
The reason we have fewer MDs per capita than Europe is that our mostly self-employed doctors work 60-80 hours per week while government-employed European doctors work 35 hours per week. This is another worthless comparison that the WHO uses to slam the US.
The WHO also ranks the US low for neonatal deaths because we have the strictest reporting standards of any country in the world. If a 30-week-gestational-age premie dies after a week in the NICU, we call that a neonatal death. Most of Europe calls that the equivalent of a stillbirth: they pretend the premature baby wasn’t born alive.
I could go on, but I think the point is made that we should ignore WHO healthcare ratings.”
Here’s what another MD said:
“How do you incentivize someone to take on 12 years of post-high school education, take on over $100,000 in education debt, work 80+ hour weeks, be responsible for life and death decisions for patients every day, pay for medical malpractice insurance, and work every day knowing that you can lose everything you worked for if the patient you are seeing right now sues you?”
And the son of an MD:
“Dad worked 80 hours a week on average, including three weekends a month on call. Few breaks for holidays. We rarely saw him during the week. Divide $250k a year (just guessing – he wasn’t one to talk about money) into 4,000 hours a year and you get about 60 bucks an hour. Out of that salary:
– 25% or more went to taxes
– $70-80k a year for malpractice insurance to protect his family and practice from all the worthless patient lawsuits by crooked lawyers.
– Salary for his administrative staff to process and follow up on reams of insurance and government paperwork.
– Costs of OSHA and other compliance overhead to run his clinic and x-ray machine.
I’m not saying we didn’t live comfortably. He took good care of us. Rather than credit his salary, I’d say God blessed him for all the pro-bono work he did for patients that couldn’t afford care but still took up his time. And trips to Africa on his own dime for medical missions.
I don’t know if these MD’s in other countries are as overlawyered and overregulated as US doctors are.”
Anecdotes upon anecdotes. I love the “worthless lawsuits” thing, btw.
Wonder why Texas healthcare costs have not gone down since those worthless lawsuits no longer exist there?
BTW, this is offensive,
“EMichael, your statements are dishonest and not supported by the facts”
Let me know which facts you think are wrong.
And shooting the messenger is absurd but I love the way you shoot the WHO yet somehow felt OK with:
“Moreover, the WHO rated U.S. health care #1 in the world both in labor (e.g. doctors, nurses, etc.) and capital (e.g. hospitals, medical equipment, etc.).”
EMichael, we shouldn’t ignore economics. From article:
“Suppose you couldn’t raise prices, you couldn’t control costs, and you were morally obligated to meet the needs of customers who were eager to sue if anything goes wrong. This aptly describes the economics of a doctor’s practice today.
By occupation, I am a cardiologist and have been in practice for almost 30 years. For 17 years I helped build a large cardiology group practice and seven of those years I was its managing partner. Therefore, I am very familiar with the business of medical practice and the affect of government regulation. Politically, I long ago registered in the State of California as “None of the Above” because Independent is a political party in this state.
Most consumers consider healthcare a “right”. Somehow, Americans should have a right to excellence in health or better healthcare or easy access. But what most consumers really mean by a “right” is that healthcare should be “free”. That means someone else should pay for it. Some seniors feel that their Medicare payroll tax has already somehow invested in a “trust fund” and therefore their care should be free. Of course, the trust fund is a fiction, and the monies that working Americans pay into Medicare go to pay the expenses of current beneficiaries.
Physicians provide services of a similar if not more important kind. However, they are not reimbursed for the time they spend. They are not reimbursed for being more skilled or more efficient or more effective. They are reimbursed by the type of procedure they perform. If a doctor is deemed by his customers to be better than another doctor, reimbursement is still the same…Both at good hospitals and bad hospitals, a fixed fee is paid for every admitting diagnosis.
If you come through the emergency room and are identified as having pneumonia and are admitted to an ICU only to die 6 hours later, the hospital gets $4300. If you are more fortunate and survive in the hospital to be released 16 days later, the hospital gets $4300. It is, therefore, easy to understand why hospitals have no hope of reaping any profit from sick patients under this Medicare system.
Physicians are paid only for the face to face time they spend with you. They are not paid for any preparation for that visit or any services that may come after you leave the office. With the endless forms required for documentation of your visit by Medicare, physicians spend a considerable amount of the visit time either typing into a computer or filling out a form regarding the visit. If they do not, and cannot document the level of service they provide, Medicare can audit them and accuse them of committing fraud…The regulatory compliance under HIPAA and the new privacy guidelines create enormous additional paperwork burdens which represents an unfunded mandate… I employ two wonderful nurse practitioners who help me manage my patients and provide services for them in a manner much better than I could ever hope to accomplish myself. However, unlike the paralegal in my attorney’s office, these nurses cannot submit independent fees to Medicare.
As private physicians look ahead, they see nothing but more regulation. There are already 130,000 pages of federal regulation plus state laws, and this will only grow, probably exponentially. They see nothing but more risk with the criminalization of practice and the constant worry about whistleblowers. They see inevitably that there will be less reimbursement for their services. They see less job satisfaction, and they are running out of ways to adapt.”
Over 100,000 pages of government regulations created enormous inefficienies and raised costs substantially. So, of course, prices had to rise, one way or another. Current health care reform is the final nail in the coffin to bankrupt the private sector and take it over.
More people would buy health care if it was more affordable (without lowering quantity and quality). Yet, everyone should have health care insurance, because anyone can become injured or sick.
This “what most consumers really mean by a ‘right’ is that healthcare should be free” is supposition and conjecture on your part.
“Some seniors feel that their Medicare payroll tax has already somehow invested in a “trust fund” and therefore their care should be free. Of course, the trust fund is a fiction, and the monies that working Americans pay into Medicare go to pay the expenses of current beneficiaries.
Yes Virginia there is a Medicare TF. Why would you believe there is not one? The taxes collected and in the TF are currently being drawn down; but, it still exists to date.
I could not care less about that doctor’s letter. Let him drive a truck. Oh, wait. There are regulations there, too.
Well, let him practice medicine in a country who has decided to follow libertarianism. Course, in the history of man there hasn’t been one, but maybe he can start his own with people that listen to a guy complain that is making $500,000 a year(cardiologist in Cal if he is any good at all) and think he is not an ass.
you agreed with me on another thread, so i feel a need to cut you some slack here, but
everyone agrees about the “efficiency” of the free market. but it’s not quite as efficient as you seem to think. people don’t sit around and write regulations just because it’s fun and they hate businessmen and doctor-businessmen. they are attempting to solve problems that the free market has not solved or cannot solve.
as long as you ignore the basic problem… and you do… you are just another windbag politician trying to stampede a foolish public into acting in your interests, if not it theirs.
so go back and see if you can even recognize that there is a problem with the way health care has been practiced in this country, and the examine your proposals, or anti-proposals, and see if there is a realistic basis to believe they will solve the problem or problems, or if you are just appealing to the Great God Pfree Mmarket
As for the poor doctor who only made sixty dollars an hour… a quarter million a year because he worked so many hours. I worked that many hours a year and only made about a tenth that. so my guess is that the doctor could work fewer hours and still have had an adequate… some might say rich… lifestyle. i will not cry for him.
and as for malpractice insurance… we do have courts and juries and they are supposed to decide the cases on the merits. i am sure honest and good doctors can make mistakes. but that’s what they buy insurance for. the idea is not to punish them, but to compensate the injured patient.
i don’t want to make this too long, but i would feel better about the possibility of humans to “reason together” if you were able to revisit some of your basic beliefs and see if you can even see that the other guys have a point of view worth addressing.
[and for what it’s worth, i agree with you that obama care is an invitation for abuse by the insurance companies. but my answer would be “single payer” which i think could be made to work WITH “free markets,” just not law of the jungle free markets.]
oh, and about getting paid “only” for face time and not for “preparation time..”
there is nothing specially unfair about this. i got paid for the job i did, and the preparation it took me to do the job right was my problem. the doctor gets paid quite handsomely for his face time. the preparation time is assumed. the doctor needs to stop whining. he is doing very very well compared to most people. wanting it “all” is childish greed.
Coberly, I think, people who create regulations can be ignorant of all the consequences, or opportunity costs, of a particular regulation.
Moreover, they can be ignorant that the totality of all the regulations can be counterproductive to economic growth.
They may focus on the good and discount the undesirable effects. It makes no economic sense to spend $1 for $0.50 of benefit, for example.
I suggest the following as an exercise in testing the value of government regulatory effectiveness. First, find a local plot of land. Small is OK. Even a backyard will suffice. In the early spring prepare the ground/soil in two halves. You know, break it up a bit. Add some organic fertilizer, etc. Same for both sides. Plant some of your favorite vegetables. Two or three types will do. Maybe some carrots, broccoli and green beans. Whatever is your preference. Now be sure to carefully mark off the two halves so that each half is equal in all measures.
Now here’s the key to the exercise. During the growing season treat one half of the garden plot with a liberal amount of DDT. You don’t want those nasty pests destroying the crop. Keep the other half untreated. Keep the harvests clearly separated. The DDT half should prove to be more abundant than the other. Keep that half for your personal use. You’ll have enough vegetable so that you can give the untreated half away to your neighbors who will appreciate your generosity.
Let us know how the experiment works out. If the results seem unclear it may be necessary to carry out the study for several consecutive years. Good luck and enjoy your home grown treats. But please remember that you share only the untreated half of the garden. That goes for your family as well. You want to enjoy the abundance of the treated half yourself.
Sorry, that address of that comment should read Peak Trader.
Jack, why don’t you and your neighbors sell your houses and give your money away to the government to fight global warming, e.g. eliminating the coal industry (while Al Gore lights up his mansion and flys in his private jet). Then put up tents and live on the sidewalk. You can use a magnifying glass to heat the tent 🙂
I think we would be better off cutting the subsidy going to your profession and skew it towards primary care. You deserve a bit of humility.
My recommended program has the more focused intent of eliminating hazardous waste.
sorry to see I had no effect on that lock box your head is in.
don’t feel too bad. it’s a common disease.