"Affordable" health care advocates explain this please.

Mike, you raise an interesting point, one which is absolutely elemental to the healthcare problem in this country.

As you observed, "insurance" classically has been what people buy to provide against the unforeseen. In fact, the "fortuity doctrine," which is the principle that your homeowner's insurer will pay you if your roof blows off in a hurricane, but not if it develops a leak because it's old, is a central principle of insurance. That's the "old school" type of medical insurance our parents had when they had "major medical" or "Blue Cross/Blue Shield." It covered you for hospitalizations, operations, BIG stuff that people couldn't afford. And the "fortuity doctrine" is the reason "pre-existing conditions" usually aren't covered by health insurers. (The way that defense goes is that, if something already was wrong with you when you bought the policy of insurance, it cannot be an "unforeseen event" or "fortuity" that the policy covers, so too bad for you.)

And that is precisely what's wrong with the healthcare delivery system in this country. In order to reduce the BIG stuff, we have to provide a means to deliver preventative care, which is much, much cheaper than waiting for an acute insurable event.

That's why HMO's were never a good fit for classic insurance and insurance companies, who don't understand "prevention" as anything other than what an insured does to lower its premiums for its particular "risk."

Preventative care is the key to controlling costs, and to delivering care to the entire population. Insurers, if they are going to be a part of the solution, will have to get their brains beyond one of the most basic principles of insurance to do that.

"Preventive care will reduce costs." Sounds good on paper but fails in practice. People are going to die of something and it's going to cost to take care of that something at some point. The question here is: Who pays for medical care? The answer should be: pay for your own. Exceptions: the poor. Why? its good for everyone.

How do we do that? Simple, if marxian economics is your thing, take health care costs (16% of $15 trillion) and tax everyone using the same progressive rates we have now which will equal their "fair" portion of the bill. Why? Coincidently, all income taxes are about 16% of our $15 trillion economy therefore, most people can expect to double their federal tax bills less the amounts they spent on medical expenses, insurance and legal suits out-of-pocket to pay for socialized health care.

Our top marginal tax rate will be 70% like it was in the 1970's. (That worked out so well for us.) I suspect that soon afterward there won't be any doctors or researchers who will give a damn. Who wants to be educated for 14 years after HS earning a pittance for your skills in that time frame and then not have an opportunity to cash in at the peak of your career? Good care will be hard to find. The quality goes out the window along with practical expediency.

As with every economic service there is a trade off between speed of performance, quality, and price. Pick any two for optimization. You simply cannot optimize all three under any system.

Right now we have an optimal mix of quality and performance but cannot care for all classes uniformly because of price. But remember, under marxian rules, you can expect price to be optimized but with declining quality and speed of performance.

As it stands, the poor actually do get care as a result of charity and the government. I think the system is optimized now except for a few cracks. Let's just work on the cracks, not reinvent the wheel.

Mike, you always come up with something interesting, in this case, your tax predictions.

And frankly, if universal healthcare would cause tax rates inevitably to reach 70% for any statistically significant portion of the population, I think it would be a very strong incentive to pare down the plans or kill the idea completely.

OTOH, it could be complete BS, in which case it won't go anywhere, because this time around, real data talks and BS walks. All this is on the table for the next several months, so, if you really think you have a sound fiscal argument, I think you have a duty to submit it to as many people in the various working groups as you can, together with the sources of the facts on which it is founded.

If your analysis is verifiable and is as inevitable as you claim, you will make headlines. If not, it'll fall by the wayside like all the other freep and Fox "chicken little" talking points.

Stock, it wasn't intended to be a chicken little talking point. What I am saying is that the cost of our current health care is about the same cost as the current total cost of taxes. That is merely a true CURRENT accounting of the cost. (The sky has already fallen!)

If the left wants to make it "fair" by their definition, i.e. sock it to the rich, then expect your taxes to double LESS the amount you are paying now for health care. That does not amount to a doubling of taxes for everyone. It also assumes that the corporation will not be a part of the plan; the system will shift from an indirect/third party payer to a single payer. That is, the government will take over the whole ball of wax and the people will pay directly in a progressive structure. I don't think that's what's going to happen, Obama and the dems don't have the guts for that.

Healthcare is expensive. But it is paid for NOW by the public indirectly. A direct payment analysis would yield the scenario I suggested RIGHT NOW. Currently, every family pays for healthcare through their purchases from corporations in the price of the items they buy. A true accounting of their own health care expenses would shock most people. I would prefer that they be shocked. If they were to pay directly, market forces would bring down costs on the low end due to that sticker shock and their desire to economize.

Affordability won't be the issue for the Obama administration. Expanding benefits for all while shifting costs to those who are wealthy will be their only concern.

"My point is that insurance is for a catastrophic calamity. It should have a high deductible and pay out only for catastrophic events in health that are clearly defined."

Exactly as I view insurance and my premium for me is $264 per quarter which gives a $5k deductible (then 80-20). Below this and I am "self insured". Preventive care is something I take responsibility for by exercising, eating right and getting reasonably spaced physicals which I pay for. When I was younger, once per 10 years, now once per 5 years, when I hit 55, maybe once per 2 years.

My wife and child are on a separate policy with lower deductible ($500 then 80-20) at $1360 per quarter. Having female plumbing means more appts, thus the separate policy.



"And that is precisely what's wrong with the healthcare delivery system in this country. In order to reduce the BIG stuff, we have to provide a means to deliver preventative care, which is much, much cheaper than waiting for an acute insurable event.

That's why HMO's were never a good fit for classic insurance and insurance companies, who don't understand "prevention" as anything other than what an insured does to lower its premiums for its particular "risk.""


HMO's as I remember them when I was in the corporate world were good for family preventive maintenance medicine, but were not good at the "catastrophic" big ticket care items. The approval process for these procedures seemed to cause many problems for the insured. From the insured standpoint, I am only going by what co-workers who had families and first hand experience said. I had neither a family or catastrophic care necessary at that time.

I did work in the EDI claims and remittance side of the business at the time and I know firsthand how ALL the payers, the blues and HMO's alike, hated like heck to pay out claims. Trying to work with them on a daily basis was very frustrating since they were gods in all things and we were merely irritants trying to get their money away from them to those pesky providers.

It always seemed to me that a mix of the good from each payer system is what was needed, but they knew their business well and knew which side they were making money on and wouldn't give that up.

None of the left's "solutions" address affordability: Preventive care merely defers costs. Universal coverage expands total costs. Costs shifted to the wealthy always come back around to the rest of the classes.

Where's the affordability issue addressed?

Affordability can only be addressed by reducing services, quality of services, or the time it takes to be served. Period. The left should stop lying to the people that this is an affordability issue. Say what it is....a seizure of the property of the wealthy. It's marxism, communism, socialism. Take your pick.

Expand medicare and medicaid if you want universal coverage and tax the general populace or business world for it. That's the only solution. The rest of the solutions just reduce benefits for those willing and able to pay.

You have got to pay or play. C'mon dems, pull the trigger on it. Do it now. Tax businesses for it. (You'll never tax the general populace, you don't have the guts!). C'mon you jackasses, Put the last nail in the coffin of the US free market economy. Just do it. Stop pussyfooting around. What are you worried about?

The way HMO's got started for the same premiums as "major medical" policies was that they recognized that preventative care does just that: it reduces the risk of "catastrophic" illness, thus lowers the exposure to those really BIG costs. In fact, the only way it worked (indeed, the way the HMO barons got obscenely rich) was that acute illness was so far reduced that the savings easily paid for the preventative care. So, in effect, "major medical" is a healthcare dinosaur.

And, since preventative care is the only way to fix the ER problem, it's going to be the HMO model that will be used for the universal program in whatever form it ultimately takes. From the pieces of the working session that I saw yesterday, what it'll end up being is a system where everybody will have the option of staying with the private insurance they have now or choosing the "public option," which will be the gov't-offered alternative.

And Chuck Grassley expressed concern that existing insurers not be "crowded out" by the public option, which, to me, is Senate-speak for, "we know the public option will be so much cheaper that it will drive the private underwriters out of the business." Brings a little tear to my eye. How 'bout you?

Mike, the flaw in your doomsday logic is that preventative care actually does prevent acute illness, not just defer it.

For example, if somebody with a respiratory condition, like chronic allergies, can avoid serial hospitalizations for acute pneumonias by getting immunotherapy, then dies 45 yrs later from a heart attack, there surely have been net savings from the preventative care. The repeated acute episodes are avoided, not merely deferred. There are thousands of conditions like that.

It's pretty basic, it's what made the HMO barons VERY rich, and it's time to extend those efficiencies to everybody. The whole population will be healthier, and it will be much cheaper per capita to attain that.

stockingfull wrote:Mike, the flaw in your doomsday logic is that preventative care actually does prevent acute illness, not just defer it.

For example, if somebody with a respiratory condition, like chronic allergies, can avoid serial hospitalizations for acute pneumonias by getting immunotherapy, then dies 45 yrs later from a heart attack, there surely have been net savings from the preventative care. The repeated acute episodes are avoided, not merely deferred. There are thousands of conditions like that.

It's pretty basic, it's what made the HMO barons VERY rich, and it's time to extend those efficiencies to everybody. The whole population will be healthier, and it will be much cheaper per capita to attain that.

OMG, If preventive care lowers costs then why have HMO premiums risen so much ?

The big picture says otherwise. If people live longer as a result of preventive care, then it is certain that they will incur more cost to the system. It's a matter of economics and inevitability.

If you want preventive care, fine. But be honest about what you are doing. You are nationalizing, socializing, communizing and marxianizing 16% of the economy.

Sell it honestly so the people can decide. You are selling this as affordable health care. It will be no more affordable. It will be more widely available but the quality and service will be compromised. If you told the people what it really costs and made them pay their fair share as, for example, defined by the progressive tax code. They would still balk at it's price. If you make business pay for it, as they do now, but extend benefits to those who are not currently covered, you will destroy the competitiveness of big business in a global market and possible destroy most small employers.

Where is the transparency that the Obama administration promised us?

Say what it is.....communism.

We could just go to the soylent green (I believe it`s something like that) anyway everyone reports for extermation at a certain age. Huge savings in health care, I suppose you could also extermanate younger people with illness also. So the incentive would be to keep yourself healthy until your time is up. No problem, think of all the money that will be saved.

Just say what it is.

Why is that so hard for democrats?

Just say what it is.

What is it?

I'll tell you "what it is," Mike.

The direct implication of your position is that you don't want people to live longer. Why don't you just come out and say it?

OTOH, we Democrats do.

If health care is just for the privileged that little social security mess will disappear also. I think you guys are on to something.

Yeah, bill, remember when it came out that one of the tobacco co's had been consulting with the Czechs or some other former iron curtain gov't on how much they'd save in retirement stipends if they didn't discourage smoking?

And you'd have to look a very long time in the tobacco industry to find a Democrat. So it sure looks like the old "shorter lives save money" thesis is being dusted off in the GOP, at least in Mike's corner of it.

OMG

Is there any limit to how absurd you can be?

Say what it is.

You don't have the guts.

You are a communist and you propose the seizure of the assets of one class to provide benefits to another class.

You are proud of it, so just say it.