tag:blogger.com,1999:blog-13522238.post3317003565054452850..comments2024-03-28T17:53:43.541-04:00Comments on DarwinCatholic: Why Conservatives Oppose "Universal Health Care"Darwinhttp://www.blogger.com/profile/08572976822786862149noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-13522238.post-20559897623115349062009-04-01T11:37:00.000-04:002009-04-01T11:37:00.000-04:00Before opting for Naationalized Health Care I ask ...Before opting for Naationalized Health Care I ask you to go to www.haveblackstonewilltravel.com and read the section Heghmann v. Sebelius. Have all the facts before you make a decision. I welcome your comments at Twitter.com/Montesque.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-15867745236283379872008-07-24T17:44:00.000-04:002008-07-24T17:44:00.000-04:00I am sympathetic towards a policy of public fundin...I am sympathetic towards a policy of public funding for healthcare, but very skeptical of those wielding political power controlling the system and making the pertinent healthcare decisions. I tend to distrust power structures, especially when matters of life and death are involved.<BR/><BR/>An underlying problem in this debate is that the powers of the US government are ill or vaguely defined. Our government does much it doesn't need to, much of which it shouldn't do, so when an increase is made of the scope of government power, it adds to the confusing jumbled mess of proper jurisdiction and authority and tyrannical (even if benevolent) usurpation.<BR/><BR/>We may need to have a big government; we do need to have clearly defined powers of what government can and cannot do.Kyle Cupphttps://www.blogger.com/profile/14607703830461449390noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-67352223887648803692008-07-24T14:50:00.000-04:002008-07-24T14:50:00.000-04:00Correct. It can be difficult and the choices can b...Correct. It can be difficult and the choices can be limitted.<BR/><BR/>Though this would only be worse if we had to leave the whole country in order to try to get different coverage.Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-91243372186022218312008-07-24T14:05:00.000-04:002008-07-24T14:05:00.000-04:00I would hardly call it a choice. In the situation...I would hardly call it a choice. In the situations I have been looking for a job, I generally only have 1 or 2 offers to pick from at any given time. Benefits may factor into the choice, but are never part of the negotiations. I either accept what they offer in health insurance or I don't. As a regular employee, they can't make a special exception for me. Exercising my 'choice' by leaving my current employer and going to a different one can only be exercised so often, and with a great deal of hassle. I can't just switch like I do with auto insurance, housing insurance, ect.Jeremy and Jessiehttps://www.blogger.com/profile/02908993421347308335noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-11173437762710318232008-07-24T11:23:00.000-04:002008-07-24T11:23:00.000-04:00To an extent, but you do choose your employer -- a...To an extent, but you do choose your employer -- and often the benefits involved are a very key part of picking an employer. I know several people who sought and stuck with state or federal jobs because the benefits offered were so good (and their family situations required extensive benefits) despite the fact that the actual salary was below market. <BR/><BR/>Similarly, many people decide between small business/startup positions and positions at large stable corporations based on the difference in benefits.<BR/><BR/>Finally, good employers often do offer several different plans. For instance, at the corporation that I work for you can pick a PPO or a health savings account with high deductible insurance. You can also pick one of a number of deductible/copay options under the PPO. <BR/><BR/>Smaller companies may not offer as much choice, but again, that is one of the things that employees should consider in changing employers.<BR/><BR/>So it's not as much of a choice as I would like it to be. (I'd much rather see a completely individual or community based insurance system with assistance as necessary for those not able to afford it.) But there is definately choice.Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-31733189173030943882008-07-24T10:09:00.000-04:002008-07-24T10:09:00.000-04:00DC, We don't have choice in our insurance. I am ...DC,<BR/> We don't have choice in our insurance. I am employed, therefore I have to take my employers insurance plan. I cannot eschew my employers plan for another (nor could I afford to, but the reality is that I am not allowed to). This is different from direct deposit, because once the money is under my control, I can do whatever with it. <BR/><BR/>Health insurance is not really subject to market conditions, I am only the user. I don't make the purchase decision.Jeremy and Jessiehttps://www.blogger.com/profile/02908993421347308335noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-81081440031054488602008-07-23T20:25:00.000-04:002008-07-23T20:25:00.000-04:00Thanks for the link and response, DC. I'm at work ...Thanks for the link and response, DC. I'm at work currently, but I will respond more completely later.Matt Talbothttps://www.blogger.com/profile/04911902305036328082noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-21467428417050882502008-07-23T17:49:00.000-04:002008-07-23T17:49:00.000-04:00I suspect that one of the best ways of dealing wit...<I>I suspect that one of the best ways of dealing with the issue would be either expanding what kinds of care an RN can provide, or else having a two tiered MD system where it was signficantly cheaper and easier to become a generalist than to become a specialist.</I><BR/><BR/>There are already programs that offer student loan forgiveness to GPs willing to practice in remote areas; AFAIK this doesn't apply to specialists unless they're willing to practice as GPs. The problem is that they can't make enough money, in a dispersed rural practice, to cover their malpractice insurance.Not a wine critichttps://www.blogger.com/profile/00962849509867116489noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-2706200025129569982008-07-23T17:11:00.000-04:002008-07-23T17:11:00.000-04:00Hmmm. Now you've got me curious on what the regul...Hmmm. Now you've got me curious on what the regulations on this are. Though googling around mostly turns up a bunch of places trying to sell insurance.<BR/><BR/>The one that particularly sticks in my craw is that I recently was looking over statements from our two year old's checkup and the total amount billed for all her vaccinations was around $300, of which the insurance company paid around $30. I think one of the vaccinations they paid something like $3. Now, I'm dead sure we never paid less than $30 for any given vaccination when paying cash.<BR/><BR/>I'd always assumed this was simple price negotiation. (For instance, at the technology company I work for our large corporate customers often pay only 50% of list price.) But if there are laws restricting that and it's some other kind of discount I'm wondering what it is and why individuals generally don't get it.<BR/><BR/>Do you know of any good online resources about this?Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-50921422888403295552008-07-23T16:43:00.000-04:002008-07-23T16:43:00.000-04:00Those are cash discounts, not trade discounts.Not ...<I>Those are cash discounts, not trade discounts.</I><BR/><BR/>Not necessarily, at least in Texas. There was a while when we were first here when I was paying cash (at the counter, in advance) for doctors visits, and although our local clinic chain offers a 10% discount off list if you buy their membership card, you still pay the "list" price. Now that I have corporate insurance, I get the statement from the same clinic showing how much the clinic billed and how much the insurance paid. The insurance is often paying anywhere from 50% to only 10% of the list price for the care.<BR/><BR/>So if it's a "cash discount" it's one that not necessarily available to people who pay cash -- and is received by insurance companies that pay on Net 30 terms.<BR/><BR/>On increasing the supply of doctors:<BR/><BR/>I'll certainly grant that it's not a simply problem, so I'm sorry if I was being flip. Also the current glut of specialists is pretty much a result, I think, of the desire of doctors to make sure that they get a secure position which will pay off their medical school expenses.<BR/><BR/>One can't simply push up the supply while the cost of becoming a doctor is the same and the means of getting to a doctor is the same. I suspect that one of the best ways of dealing with the issue would be either expanding what kinds of care an RN can provide, or else having a two tiered MD system where it was signficantly cheaper and easier to become a generalist than to become a specialist.Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-7197093391726062692008-07-23T15:39:00.000-04:002008-07-23T15:39:00.000-04:00Those are cash discounts, not trade discounts.Ther...Those are cash discounts, not trade discounts.<BR/><BR/>There are several economics arguments involved regarding doctors. Given the incredible cost and time commitment to be a doctor, adding uncertainty to the ability to recieve recompense would seem to act as a disincentive to pursue becoming a doctor. Whether the incentive of easiness to receive a degree is enough to overcome that is disincentive is a question that shouldn't be addressed so flippantly. As it presently stands, some who can't get into American medical schools go overseas to receive medical training and then are recognized in the U.S.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-80400917411138151762008-07-23T14:55:00.000-04:002008-07-23T14:55:00.000-04:00(iv) disallow the charging of different rates for ...<I>(iv) disallow the charging of different rates for the same services to different people.<BR/>This is already against the law. Cash discounts for prompt payment are not.<BR/>(1) force doctors and hospitals to provide a written menu of their charges for various services<BR/>Hospitals are required to do this by law. </I><BR/><BR/>I believe that Dandelion is referring to the well known practice of having negotiated prices with insurance companies, and then having much, much higher rates for individuals. Effectively, this would mean telling health care providers that they must pursue a list price only strategy rather than a negotiated relationship sale.<BR/><BR/>It is, in a sense, a market restriction, but one designed to create an open competitive market, rather than a closed competitive market.<BR/><BR/><I>(2) open more medical schools and create more doctors<BR/>There is no indication that we have a shortage of doctors. Most agree we have too many specialists.</I><BR/><BR/>"Shortage" is a relative term, but in general if one increases supply while the demand remains fixed, the cost goes down. It's a fairly straight forward point.Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-68659726469921208852008-07-23T13:46:00.000-04:002008-07-23T13:46:00.000-04:00To address some things briefly:(i) allow individua...To address some things briefly:<BR/><I>(i) allow individuals to take the same tax deduction for health insurance that businesses can already take,</I><BR/>Even proponents believe this is more symbolic than real.<BR/><BR/><I>(ii) create a national market for health care insurance instead of a bunch of state by state markets</I><BR/>This is more a marketing issue. Differencing in premiums advertised are more reflective of the percentage change allowed in the quoted price and the underwritten price. When we get to hc expenditures per capita, we see a relatively narrow band between the states unlike the quoted premium differenciations you see in many state to state comparisons.<BR/><I>(iii) drop all the mandates that require health insurers to include in their plans things like coverage for depression and birth control and let the market decide what plans should include,</I><BR/>This is more an accounting issue and on the issurance side tends to make things more expensive. In California, insurance premiums went down after earthquake coverage became compulsory, assuming you took both earthquake and homeowners insurance.<BR/><I>(iv) disallow the charging of different rates for the same services to different people.</I><BR/>This is already against the law. Cash discounts for prompt payment are not.<BR/><I>(1) force doctors and hospitals to provide a written menu of their charges for various services</I><BR/>Hospitals are required to do this by law. <BR/><I>(2) open more medical schools and create more doctors</I><BR/>There is no indication that we have a shortage of doctors. Most agree we have too many specialists.<BR/><I>(3) define a "Basic Plan" that includes a standard and reasonable minimum set of coverages and require all insurers to offer it at whatever price they wish - this allows easy price shopping by consumers. </I><BR/>This is presently required by most states. Typically a state will require a standard quote be filed with the state outlining the plan and its costs for a standard individual. This quote can be modified by underwriting. Employer sponsered (not purchased) plans have more options.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-39711876863414091182008-07-23T10:37:00.000-04:002008-07-23T10:37:00.000-04:00Dandelion,I suspect you're dead on with your sugge...Dandelion,<BR/><BR/>I suspect you're dead on with your suggestions on turning health care into a real market. i, ii, iv and (1) are the ones that have struck me as particularly key in the past.<BR/><BR/>The other thing that would probably be fairly key would be authorizing RNs (or some other class of less expensive medical personnel) to do basic diagnosis and dispense a limited range of prescriptions -- so that people don't have to pay for 30min with an MD in order to get their kids an anti-biotic for an ear infection.Darwinhttps://www.blogger.com/profile/08572976822786862149noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-53115728630156607572008-07-23T10:15:00.000-04:002008-07-23T10:15:00.000-04:00The market works well, if we would just let it wor...The market works well, if we would just let it work. Health care costs would fall dramatically if we would do just four things: (i) allow individuals to take the same tax deduction for health insurance that businesses can already take, (ii) create a national market for health care insurance instead of a bunch of state by state markets, (iii) drop all the mandates that require health insurers to include in their plans things like coverage for depression and birth control and let the market decide what plans should include, (iv) disallow the charging of different rates for the same services to different people. <BR/><BR/>There are three other little tweaks that would also help: (1) force doctors and hospitals to provide a written menu of their charges for various services, (2) open more medical schools and create more doctors, (3) define a "Basic Plan" that includes a standard and reasonable minimum set of coverages and require all insurers to offer it at whatever price they wish - this allows easy price shopping by consumers. <BR/><BR/>The problem is that every one of these changes will kill a sacred cow of a very powerful lobbying group: insurers, or doctors, or hospitals, or medical service providers that want their service to be required in all health insurance plans, etc. <BR/><BR/>The problem is not that health care is somehow immune from market forces. The problem is that powerful lobbying interests have convinced our elected representatives to pass laws that sell us out and make them rich by protecting them from market forces.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-22368080333176343092008-07-23T08:25:00.000-04:002008-07-23T08:25:00.000-04:00Whenever I hear Obama or John Edwards or anyone el...Whenever I hear Obama or John Edwards or anyone else whine about X million people in this country don't have health insurance, I have a pretty hard time getting worked up. Surely, there are some who are hard off. <BR/><BR/>But as a twenty-something who worked hard to get a good job with good insurance, I can't help but to notice all of my peers who don't have insurance. There's my brother who sits around playing video games and in his garage band all day. I've got a cousin-in-law who hasn't held a job for six straight months in her entire life. In fact I don't know when the last time she was actually employed was. There's highly academic friends who see work as below them so they string together internships while making enough waitressing to pay the rent.<BR/><BR/>A lot fewer people would be whining about health care if they followed this simple maxim: Get a freaking job!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-16450634349801537352008-07-22T17:46:00.000-04:002008-07-22T17:46:00.000-04:00The Blackadder Says: My problems with universal he...The Blackadder Says: <BR/><BR/>My problems with universal health care start with the name. No system of health care is really universal, and people are denied care in Europe and Canada as well as in the United States. The term therefore serves less as a description than as a bit of propaganda, like No Child Left Behind, or the Fair Tax.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-13522238.post-70391284178718362352008-07-22T16:55:00.000-04:002008-07-22T16:55:00.000-04:00Just a couple of annecdotal comments:I had a frien...Just a couple of annecdotal comments:<BR/><BR/>I had a friend, a doctor in the Air Force, who was stationed in England and got to see socialized medicine up close. He said there was no way he'd want to practice medicine in that sort of environment.<BR/><BR/>When my husband had a rare form of lymphoma I was on an email list of patients and caregivers for that particular disease. Many of the list members who lived in Canada told us that it was difficult for them to get timely treatment. And in fact, if the government run health care system didn't approve a particular treatment, you weren't allowed to get privately even if you were willing to pay for the entire cost of treatment yourself. Many made trips to the U.S. for treatments.<BR/><BR/>This doesn't sound like the sort of system I'd want to live under. I'd be afraid that in no time at all treatment for the elderly or handicapped would have a low priority or would be denied as not cost effective.Catholic Bibliophagisthttps://www.blogger.com/profile/10697706672495544901noreply@blogger.comtag:blogger.com,1999:blog-13522238.post-36650536803062335242008-07-22T16:27:00.000-04:002008-07-22T16:27:00.000-04:00Regarding your last point, Ramesh Ponnuru made a v...Regarding your last point, Ramesh Ponnuru <A HREF="http://corner.nationalreview.com/post/?q=MjIwMmI2OGQ1Nzc0MmEzZjhjZTY5Y2M4OTAzOWYzN2Y=" REL="nofollow">made</A> a very similar argument. Once the program exists, good luck getting rid of it.Anonymousnoreply@blogger.com