Coyote Blog

Just remember... Our Congress will be sure to exempt itself from the crappy health care system that they impose on the rest of us. They'll set up a cozy little system so they and their families will continue to get the very best care with virtually no out-of-pocket expenses for themselves.

Of course, that's just because they are so much more worthy than the people who vote for them.

I disagree with your sentiment. I believe universal healthcare is actually in the interests of Republicans and those who favor small government. Please see my reply to your post here: http://bit.ly/18WDov

Is it possible that some fraction of uninsured make enough money to pay for insurance, but decide not to buy it and instead buy a fancier car or whatever?

I don't understand why people keep ignoring the fact that the private health care system in the US receives huge subsidies via the tax system (i.e. health premiums are not taxable benefits).

This is not a debate about government funded healthcare. This is a debate about whether the government funding should be provided to private healthcare providers or to private insurers. Providing funding directly to the private healthcare providers should, in principal, always be cheaper.

I also think it is a mistake to ignore the fact that employer insurance programs only work because the healthy employees subsidize the less healthy employees (i.e. employer insurance programs are a form of income redistribution).

As for medicare, I think there is a lot of money to be saved if they eliminated the need to test for eligibility. A universal program would eliminate that bureaucracy.

Also, I suspect that most uninsured by choice people are uninsured because they know that laws required that they be treated in a case of emergency and, if they have no assets, they can ignore subsequent bills.

Raven says "I don’t understand why people keep ignoring the fact that the private health care system in the US receives huge subsidies via the tax system (i.e. health premiums are not taxable benefits)."

And with that you betray just how extremely left wing you are. In most things, we don't consider a lack of tax to be a "subsidy". Subsidy is when someone gives you money, NOT when they decide not to take it.

I can understand how a liberal would have trouble understanding the difference between giving someone money and just not taking their money to start with.

Russell,

Foregone tax revenue is a subsidy when it is applied selectively. In fact, the numerous special exemptions in the US tax code are all attempts by the government to control the economy by favouring certain types of spending (the government uses this approach to funnel money to the wind energy scammers).

If the government did not provide this incentive then people who choose to self insure would have more money in their pockets because the overall tax rates could be lowered while raising the same revenue.

Anyone who believes that the state has no role to play in health care funding should be calling for an end to all special treatment for health care expenses in the tax code with the extra revenue distributed in across the board tax cuts.

Insisting on keeping the private health insurance tax subsidy while criticizing a direct health care subsidy is a bit contradictory.

This is a front to try and save the broken Medicare program, especially for the sick. After three years of treatment, one is driven to the inferior Medicare from COBRA as my dad was. I covered the rest. This small thing is an indication that people on Medicare need more medical attention than those that are not. The government is trying to draw from a larger pool of healthy to subsidize the sick. I did it for my dad but I am not willing to do it for others.

Yes, we need to take care of our seniors and Medicare was ok until the government started borrowing from it. To solve the issue, we need to start by separating health maintenance from actual catastrophic health events (as someone posted on another topic). We should only cover catastrophic events. We need to find a way to increase the competition in hospitals (6.2% inflation) or even price control like they do with funeral homes for these events. Health maintenance type insurance could work like a tax sheltered savings account where profits are tax free. This can be used for office visits, diabetes, mental health issues, etc.

Sadly, because the people who need Medicare are a huge percentage of voting population, I do not see it being fixed for all of us. The best course is for the healthy to stall this and other bills until we go into a “hand to mouth” system and the needed benefit cuts are forced while we eliminate Medicare.

Not Sure,

"Money that’s never been taken away from a person is not a subsidy"

Yes it is if tax system discriminates against different types of spending.

The mortgage interest deductibility is a huge subsidy that transfers wealth from people who do not own a home or have paid off their mortgage to people with a mortgage.

IOW, non-mortgage holders pay more taxes than they should. Do you really think this is fair?

The only time your logic applies is when a tax reduction is given no matter what the money is spent on.

DB,

It is important to distinguish between a public provider insurer and public health provider. The VA system is an example of a public health provider and it is something which should be avoided at all costs.

A public insurance provider that pays for private health provider is no different from a mandatory employer health insurance plan except it cuts out the private insurance companies.

Not Sure,

Fine. A tax deduction granted for certain types of spending is *equivalent* to a subsidy for all intents and purposes.

At their core, tax deductions transfer income from one group of people to another based on the ideological preferences of the government that introduced the tax deduction.

For example, is a tax deduction given to companies with union work forces "fairer" than a subsidy given to those same companies?

Is a tax deduction given only to companies who are "carbon neutral" simply a matter of letting them keep what they rightfully earned?

That is why I say it makes no sense to protest transfers of wealth via direct spending while ignoring equally large transfers of wealth made possible with tax deductions.

Total government expenditures: $75

Jim should only need to pay $37.50 but pays $50
Joe should pay $37.50 but only pays $25

Net consequence of the tax policy: $12.50 is taken from Jim and given to Joe.

This is amusing. "Not Sure", are you being deliberately obtuse?

Raven's point, which is completely correct, is that the government is providing incentives for behaviors through differing tax treatments. Call it a "subsidy", "taking", "giving", or whatever. The impact is clear. The market is behaving in ways it would not otherwise behave if health care benefits were taxed equivalently to other benefits.

Is that really so hard to understand?

Folks here seem to be missing the real issue: Health care in the US is fundamentally broken.

Yes, there are surveys of people who say they are satisfied with THEIR healthcare. But there are also surveys saying that healthcare reform is one of the main priorities for many folks. The reality is that surveys don't really tell you much.

So, what do we look at instead of people's perception of healthcare? How about actual data... like dollars spent vs. people covered? The US spends ~ 17% of GDP on healthcare. It's one of the highest percentages in the world, yet many people aren't covered (you can quibble over the numbers, but it's in the 10s of millions... and it doesn't really matter if folks are illegal or not, they get treated if they show up in an ER no matter what... ERs are NOT efficient mechanisms for delivery of health care... the result is that the costs increase for everyone!). Even people that have insurance are not covered the same... how many folks have comprehensive prescription plans? How many have comprehensive dental plans? How many folks end up going broke because of unexpected medical bills? How many people that have insurance choose to NOT take a new job because of things like "pre-existing conditions" clauses? Does this system make sense?

People have to get past the idea of "rationed" health care... it already IS! It's rationed by economics. So, why not admit that the system is broken and that we can get a better bang for the buck?

Other countries have done this. Taiwan implemented universal health care in 1995. Anyone can go see any doctor... no gatekeeper. They get drug benefits, vision care, kidney dialysis, inpatient care, outpatient care... their one payor system produces some of the lowest administrative costs in the world (<2%). Total cost for this comprehensive system: < 9% of GDP... in other words, they spend ~ half of what the US spends as a percentage of GDP and they have a system that covers every single person with COMPLETE health coverage.

So, why stick with the broken and demonstrably more inefficient system that limits health care such as we have in the US right now????

Bruce

Have enjoyed seeing the back and forth very much. I'd like to participate so here goes.

BDAABAT "Health care in the US is fundamentally broken."

Where to start? (like his first phrase this general statement puts Bruce's in a box labeled "Oh not this again".) Big general statements tend to do that. Then a tip of the hat to the fact that surveys have limited use and specify no real direction (not what their for) followed by an emotional if calm appeal to the magnitude of the problem (don't know the real number but it's sure way up there) along with the warning not to dwell on these nonsensical magnitudes (no quibbling). Probably good advice since no source for the number is offerred.

As far as foriegn solutions, the high school students love to play the game of "But it's legal/moral in other countries!" The pressing problem for us and the U.S. is that for all the attempts to specify, fund, organize and eliminate problems our government (which is what we have to start with) has never succeeded (in what could be commonly called success). All the problems it solves become legacies of institutionalized beurocracy. For each case of "We're from the Govt and we're here to help you." there are precious few examples of "Our work here is done."

Economics always kick in and a long line of (only recently) needy individuals And their businesses and interests spring up to feed at the trough.

Rant is over.

Still Bruce's post was refreshing to see as an example of how the left refocuses the debate to "We Got to Do somthing." just when the debate was narrowing down to some interesting distinctions.

E

E: So, is your assessment that things in the US are just peachy? That having the highest percentage cost for healthcare while millions go uninsured and millions more are underinsured is a good thing? Does it provide US workers with a competitive advantage compared to other countries? That as a result of all of this spending, we have modest health statistics (like overall longevity [#45], like infant mortality [#29]... especially for poor people who don't have insurance)?

Am just pointing out the obvious... that other countries have dealt with the problem head on and come up with BETTER solutions that turn out to be much more cost effective. Taiwan created a new health care system in 1995 and their system objectively works much better than our system. Everyone is covered. There are no gatekeepers to care. Actual costs for this comprehensive system is <9% GDP. US costs for crappy care for most and no care for many is ~16% GDP. We're not getting much value for the investment.

Am not suggesting that the US just adopt another countries solution for healthcare. I AM suggesting that we're NOT getting good value for what we spend and that it makes sense to look at alternatives. Other countries have started from scratch to create a system to best meet their needs. There's no reason the US can't do this as well.

From my perspective, it makes little sense to pay billions of dollars for healthcare, a BIG part of which is paid for with tax dollars, and NOT get much bang for the buck.

Bruce

Bruce;
My assesment is that your making claims about having the highest percentage cost for healthcare while millions go uninsured and millions more are underinsured is rather meaningless. You can look elsewhere in this terrific blog to find details of how infant mortality is calculated differently in other countries for myriad reasons. For similar reasons it is meaningless to pine about all who are uninsured when many of them, making their own decisions about health care, spend less on it than "The Great One" thinks they should. One can always copy and paste frightening magnitudes of terrible consequences of thoughtless neglegence into a handy screed and demand that action be taken. Give me a break. We've all heard it and are tired of stepping in it.

Yes we can and must do better, but your rhetoric does nothing to move the subject long. It only ratchets up the intensity and emotional volume.

And as for
"There’s no reason the US can’t do this as well"
That is precisley what we are discussing here. And if you notice there is a great deal of thoughtful doubt that the government can do anything better than real markets.

By the time our heroes out in D.C. are voting for one perpetual motion machine over another the opportunity for analysis has long passed.

Let's calmly bring down your claims and wishes to just one specific thing at a time. This is certainly the only way they can be reasonably addressed.

E

Elliot: not sure where you got the idea that my tone was emotional or anything other than calm. I'd sincerely appreciate some clarification and education. Show me the data that has you so convinced of your position.

So, there really aren't people (tens of millions) who don't have insurance in the US? Is that what you are suggesting? Or, are you suggesting that there are millions of uninsured folks who COULD really afford health insurance, but choose not to purchase it?

If you don't like %GDP as a comparator, what metric would you suggest? Or, are you suggesting that survey feedback is the metric of choice?

FYI: I've had the opportunity to work in large urban hospitals in the East and West coasts. I've been involved in the care of many, many folks who have not had insurance. I've seen the effects of people who don't have insurance and have let their small health problems blossom into very large and expensive health problems. I've seen people in the emergency room who routinely use the ER as their "clinic" because that's the only care they have access to. They know they can't be turned away if they go to the ER. That's a pretty crappy way to provide "care". It's also an extremely expensive way to provide "care". What's your suggestion to deal with this situation? What would you do to ensure that these folks get better and less expensive care?

I've also been a patient who has had to navigate the health system... and I've done this as someone familiar with the process and who has the luxury of health insurance. It's not a pleasant experience. It's not efficient. It's not well implemented. It's seemingly designed to prevent access to resources... because it is! I've also had folks try to do "wallet biopsies" because I DID have insurance. Some health providers have incentives to order tests, run scans, or order equipment that isn't strictly needed, but they have a financial incentive to do so.

I'm explaining this on purpose... in a calm tone.

I've got imperfect information, but that information and experience across a broad spectrum of the health care in the US suggests that health care in the US is fundamentally broken.

Am really curious... what options would suggest to deal with the provision of health care in the US?

Bruce

Hope I did not shut down the discussion.

Did find a recent post that had myriad links in the Comments section.

http://online.wsj.com/article/SB124640626749276595.html#articleTabs%3Darticle

Do check it out.

E