On Health Insurance Reform

As things heat up in the health care debate, I found this article a very good reminder of some of the shortcomings of the system we have in the U.S. today:  “You Do Not Have Health Insurance” by James Kwak.

The point of insurance is to protect you against unlikely but damaging events. You are generally happy to pay premiums in all the years that nothing goes wrong (your house doesn’t burn down), because in exchange your insurer promises to be there in the one year that things do go wrong (your house burns down). That’s why, when shopping for insurance, you are supposed to look for a company that is financially sound – so they will be there when you need them.

If, like most people, your health coverage is through your employer or your spouse’s employer, that is not what you have. At some point in the future, you will get sick and need expensive health care. What are some of the things that could happen between now and then?

  • Your company could drop its health plan. According to the U.S. Census Bureau (see Table HIA-1), the percentage of the population covered by employer-based health insurance has fallen every year since 2000, from 64.2% to 59.3%.
  • You could lose your job. I don’t think I need to tell anyone what the unemployment rate is these days.
  • You could voluntarily leave your job, for example because you have to move to take care of an elderly relative.
  • You could get divorced from the spouse you depend on for health coverage.

For all of these reasons, you can’t count on your health insurer being there when you need it. That’s not insurance; that’s employer-subsidized health care for the duration of your employment.

And the bottom line:

The first-order problem is that as long as your health insurance depends on your job, your health is only insured insofar as your job is insured – and your job isn’t insured.

Now I don’t claim to know what the solution is; but I definitely agree that there are problems with our current ‘health insurance’ model.  The employer-based system was a bit of an accident in the first place, and at this point I would think that many businesses would be relieved to be out of it, particularly those that have to compete with firms that don’t have to worry about such problems.  It would be great to see more creative thought going into how to improve the situation for both employers and individuals.

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Comments

  • Jim  On August 10, 2009 at 8:11 am

    I would suggest that you start with Charles Krauthammer’s column of August 7th which offers two very reasonable actions that this administration will not address. You can find it here:

    http://jimspoliblog.blogspot.com/2009/08/krauthammer-common-sense-reform.html

    There is lots of creative thought out there, it is just that no one will look at it because of such a strong desire for single payer.

  • Jim  On August 10, 2009 at 2:05 pm

    Here is another good set of ideas from Darryl Issa, a San Diego County Congressman.

    http://www.nctimes.com/news/opinion/perspective/article_978d18b0-af9f-5678-a28e-1e81b51ecb74.html

    No shortage of good ideas, just of a desire of our Democrat controlled Congress to look at any of them!

  • Curt  On August 11, 2009 at 9:56 am

    Thanks for the links. I’d like to see a few more facts and figures around malpractice, and the actual costs and payouts as a percentage of the overall spending to get a sense of what kind of difference tort reform could make. It does make sense that a certain amount of medical treatment is being prescribed for ‘defensive’ reasons.

    I do think that there are inequities between employer-provided health plans vs. individual plans (in terms of pre-existing conditions, etc.). Krauthammer’s suggestion to tax these benefits would probably be one way to start to even that playing field (not a popular one, but there has to be some way to pay the bills!).

    I also understand that there is a near monopoly in many areas for health insurance – if we’re going to stick with private plans, then that needs to change somehow. See: http://www.consumeraffairs.com/news04/2006/04/ama_insurance_study.html, which states: “in 95 percent of markets, a single insurer had a market share of 30 percent or greater, and in 56 percent of the markets, a single insurer had a market share of 50 percent or greater.”

    I don’t think many Democrats are actually all that interested in ‘single payer’ but certainly the so-called ‘public option’ is important to some (and perhaps that is seen as the first step toward single payer, rightly or wrongly).

  • Jim  On August 11, 2009 at 11:52 am

    The President has confirmed his desire for “single payer” many times in the past, although he seems to be waffling on it now, perhaps because if he admits that as his goal he will probably get nothing!

    Barney Frank has confirmed his desire for “single payer” within the past week or two. These are two pretty good bellwethers for the Dems!

    I think you are underestimating the desire for “single payer” on the part of Dems. Seems to me that is the reason for the phrase change – for which the Dems are becoming famous – from ‘Healthcare Reform” to “Insurance Reform” – the earlier phrase was easier to attack than the latter. I am always amazed at how intelligent Dems can accept these tactics!

    Would you like “single payer”? Only yes or no answer is acceptable, then you can share your reasons if you like.

    And I would be happy to share with you why “single payer” is not what we need in this country!

  • Curt  On August 11, 2009 at 1:30 pm

    I am not in favor of single payer at this time. I think it would be too great a change for the U.S. system, and just may not work well culturally here either. That said, I do think there are some serious problems with our current ‘insurance’ system that need to be addressed, both in terms of overall costs and issues of coverage.

    There are some crazy stories coming out however about folks who somehow seem to be under the impression that Medicare is not a government program! There is an awful lot of confusion out there, and misinformation that’s hard to cut through.

    I personally think that the Republicans are at least as clever as the Dems at naming their various initiatives!

  • Jim  On August 12, 2009 at 9:09 am

    Point is not the name. It is “changing” the name based on polls. I can’t think of an instance where the Republicans did that!

    The “cleverness” of the Dems is amazing as Michelle Malkin points out in this blog entry:

    http://michellemalkin.com/2009/08/12/the-illustrated-guide-to-obamacare-human-props/

    Since you use the qualifier “at this time” in your above response, I will take your answer as “Yes”. But you didn’t supply any reasons why you would like this. Can you offer some reasons why “single payer” would be a good system? I agree that culturally it is a problem in the U.S. – look at the townhall meeting taking place – where big government is frowned upon, but setting that aside tell me why it is good.

    I will start by telling you why it is bad:

    IT IS NOT AN “INSURANCE SYSTEM”! It is WELFARE by another name – I have coined the phrase HEALTHFARE, you may have noted, for this reason.

    Why do the Dems not sell it as WELFARE? Because it would never pass in Congress! And the Dems would not add to their POWER!

    Tell me it is not WELFARE. Or if you do agree with me that it is, then why will the Dems not sell it on this basis? Why the obfuscation?

  • Jim  On August 12, 2009 at 10:36 am

    Just received The Atlantic web version with a great article in it by a businessman, David Goldhill, who points out the folly of the current system and of BHO’s proposed fixes. Very much worth the read before continuing the discussion:

    http://www.theatlantic.com/doc/200909/health-care

  • Curt  On August 12, 2009 at 5:03 pm

    Thanks for the Atlantic article link – indeed, very good. I agree with his core statement: “I believe if the government took on the goal of better supporting consumers—by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can’t afford care—we’d find that consumers could buy much more of their care directly than we might initially think, and that over time we’d see better care and better service, at lower cost, as a result.” The trick is how to achieve some sort of bi-partisan consensus on moving in that direction.

    The reason I added “at this time” about single payer is because I would like to see if we can’t work out some improvements in our current system of public and private players. If that can’t be done, if it proves impossible, then I reserve the right to change my views.

    I think the whole ‘town hall’ approach is pretty suspect, but in my view what’s happening now is not all that different from Bush’s approach to Social Security in 2005. We’ll see if it’s fated to the same end.

  • Jim  On August 13, 2009 at 6:44 am

    We agree on Mr. Goldhills core statement. Getting power “back” into the hands of the consumer is the answer – Government interference is what has caused the current problems as he clearly explains, and more Government involvement is not the answer!

    I think your drive towards potential “single payer” is because you feel everyone should have “insurance” – WELFARE or MANDATES by the Government in my terminology – and he seems to cover the WELFARE problem with some Government involvement. I didn’t see that he addressed the MANDATE problem. I believe alternatives should be made available for everyone, but if they chose not to be covered let them be. They will share in the costs in some way, much as they do now through increased costs of all medical related items due to our societies covering healthcare for all residents regardless of their ability to pay, through Government MANDATES to hospitals that they cannot turn anyone away.

    By the way, I really don’t think our current system is very bad even in our treatment of poor people who cannot afford “insurance”. Do you?

    You don’t have to depend on “town hall” meetings to understand what is going on among the population. Read the polls. Watch BHO’s popularity dwindle. This is not happening because of pharma and insurance organizing – they support the legislation!! – but because the “grass roots” – not “astro turf” as the Dems ignorantly claim – does not like what is going on.

    Your analogy to Social Security may be correct, but for opposite reasons. On Social Security people did not want change because they do not understand that it is also a WELFARE system – a most stupid one if I might say – since it is a “flat tax” on the workers and unqualified distribution of the funds to elderly – I know because I now receive it in addition to my 6 figure income!

    Now that really makes a lot of sense, doesn’t it!

  • Curt  On August 13, 2009 at 8:48 am

    Jim asks: “By the way, I really don’t think our current system is very bad even in our treatment of poor people who cannot afford “insurance”. Do you?”

    It’s true that virtually anyone can get emergency treatment, which covers some cases. But it also seems to be true that for ‘longer term’ issues the lack of insurance is a leading cause of bankruptcy. In general I think our system can provide decent care, and innovate in certain ways, but at the same time it’s very expensive (the Atlantic story talks about a semi-private room billed at $7,000 a night!. He mentions that it’s probably discounted heavily for Medicare, but how many people can afford such costs for very long even at 50% off?). It was also troubling to read about how most hospitals did not seem to want to implement some basic sanitary improvements.

    For any insurance system to work well, you need some level of mandate to get the full population into the system, similar to auto insurance or home insurance. But there’s a difference from those markets, in that a car can only cost so much to replace, likewise a house, but it’s hard to put a price on a life, and the potential healthcare costs to keep someone alive even for a relatively short time can be pretty astronomical.

    So it seems like we have a situation where many people must be willing to pay into a system where a few of the worst-off cases will end up consuming most of the services. There are many scare stories floating around about the ‘death panels’ and so forth, which even if completely unfounded reflect this anxiety about how to deal with the situation.

  • Jim  On August 13, 2009 at 2:01 pm

    Everything you say leads to getting control of costs so the anecdotal references you make to “bankruptcy”, $7000 a night rooms, et al, would become more rational and therefore under control and affordable.

    Do you really believe the Government would do this? David Goldhill doesn’t. He and I think costs would only go up leading to very serious “unintended consequences”. (You might search for information on financial problems England’s NHS is having and will continue get more serious.)

    I do not consider the “death panels” scare stories. BHO has said his plan will not increase the deficit – correct? He has suggested he can save enough money from MediCare to cover additional costs – correct?

    How could this happen without significant decreases in treatment of seniors? How could this happen without “panels” setting treatment policies for doctors, reducing the $$ spent on treatment? This fear is not unfounded at all – listen to BHO and it is quite rational.

    You may not like the term “death panels” but our President has said – not directly, but as I have explained – they will exist! Give me a term you would be happy with and I will pass it on to Sarah Palin!

    Being a senior citizen, I am very sensitive to this as I hope your parents and you are! We all need to be very careful – not in a rush, which, by the way is another question I have for you: WHY THE RUSH?

    Anyway, I think we should think through non-Government alternatives like those proposed by David Goldhill.

  • Curt  On August 13, 2009 at 2:29 pm

    I think Obama is at least trying to open up the question which is truly hard to deal with: just how much healthcare are people entitled to?

    Even with the best private system and health savings accounts and so forth, the question doesn’t go away. If you are very ill, and the money runs out, what should happen? This applies to seniors, and to everyone else.

    Whoever is paying the bills I think has some right to at least examine the potential effectiveness of treatment, and to aim for some level of efficiency. An insurer will do this, the government will do this.

    I agree that we should not rush into big changes. But rather than talk about “death panels” I’d like to see more serious discussion trying to resolve or at least explore the tradeoffs around the entitlement issue.

  • Jim  On August 14, 2009 at 7:23 am

    WSJ has an interesting editorial on Obamacare this morning: “Obama’s Senior Moment.

    http://online.wsj.com/article/SB10001424052970203863204574344900152168372.html

    Now I realize they are probably not a source you pay a lot of attention to, but I think they are one of the most respected center-right opinion sources extant. They don’t like the term “death panels” either and I think they are in error, but to the more significant point: they believe this plan would lead to “single payer” (as the House and Senate bills are structured today) and “single payer” leads to rationing, and rationing leads to eliminating treatment for the elderly. It is really quite logical and they give the British NHS as an example.

    But if you don’t believe rationing would happen. then what about this:

    “Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life’s cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonsocopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare’s holes—and Medicare is still growing by 11% this year.”

    I think pursuing the free market fixes with minimal Government involvement, as Mr. Goldhill suggests, is the way to solve this problem, and BHO should get off his fetish for the goal of Government healthcare for all. It may cost him his Presidency!

  • Jim  On August 14, 2009 at 8:25 am

    Sorry to inundate you with columns, but two important ones were published today.

    Charles Krauthammer explains the truth about “prevention”, a tact the administration seems to be taking this week. What he says makes sense!

    http://www.realclearpolitics.com/articles/2009/08/14/the_preventive_care_myth_97889.html

    And Peggy Noonan, who I think is the best writer in the pundit class, though I disagree with her often over the last two or three years as she left W and leaned more and more towards BHO, writes the best overall analysis of what we are all doing and BHO’s situation, that I have read.

    http://online.wsj.com/article/SB10001424052970203863204574348811502576156.html

    Do read Ms. Noonan, it is great writing. Her closing paragraph:

    “I always now think of a good president as sitting at the big desk and reaching out with his long arms and holding on to the left, and holding on to the right, and trying mightily to hold it together, letting neither spin out of control, holding on for dear life. I wish we were seeing that. I don’t think we are.”

    Poetry!

  • Curt  On August 14, 2009 at 12:49 pm

    The WSJ article gets at what I see as the interesting question:
    “From the point of view of politicians with a limited budget, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?”

    One could change this slightly to: “From the point of view of private insurers with a profit goal, is it worth spending a lot on, say, a patient with late-stage cancer where the odds of remission are long? Or should they spend to improve quality, not length, of life? Or pay for a hip or knee replacement for seniors, when palliative care might cost less? And who decides?”

    I see the distinction between political decisions and private market decisions, but in the end the problem seems remarkably similar. What ‘right’ do people have to healthcare? If one cannot personally pay, and the insurer has hit its limits, then how & where do we draw the line?

    I personally would lean toward trying to put it more in the individual families hands. But to achieve better transparency on the issue, I think there is a need to get more information available to people about the costs, benefits and risks of various treatments.

  • Jim  On August 15, 2009 at 5:56 am

    I disagree strongly with your insurance analogy! And it seems to me we have had this discussion before.

    Insurance companies want to SPEND AS MUCH AS POSSIBLE ON EVERY OCCURENCE – (excepting fraudulent claims, the detection of which causes you and all on left to think they don’t want to pay anything!) – because they can then raise their rates and make MORE PROFITS!

    Think of insurance as any other commodity in the free market. It works by precisely the same set of rules.

    The difference with Government is the drive becomes political, and that leads to disaster!

    Now don’t overreact and think I am saying that they just simply pour money at every occurence. Of course that does not happen because they must monitor suppliers of healthcare as well as consumers to eliminate the potential fraud on both sides.

    But within good business practices, they will not hesitate to pay what it takes to cure a patient because it increases their SALES!

    Does all that make sense?

  • Curt  On August 15, 2009 at 1:05 pm

    I’m happy to get more into the economics of the insurance providers, but before that I’d really like to hear your opinion on my question about health care entitlement or ‘rights’.

    Is a senior covered under Medicare entitled to unlimited health care? (Note that this could include very expensive treatment that has little proven impact, or even under the best case only extend the life of the patient by a year or less). If yes, how do we pay for it? If not, what limits might apply? How should it be decided?

    I believe similar questions also apply to a non-senior who has hit the private insurance limits (most policies have annual and lifetime caps). What are these people ‘entitled’ to?

  • Jim  On August 15, 2009 at 3:43 pm

    The problem is my answers will stop the conversation! But, here it goes:

    Where did this entitlement to Healthcare come from? There is none. I read the constitution recently and did not see it mentioned.Medicaid and Medicare should not exist.

    Now, if you want to “create from whole cloth” an entitlement, I would like to ask you why don’t we get first things first – such as:

    #1- everyone should have an “entitlement” to water – 3 days without it and you die.

    #2-everyone should have an “entitlement” to food – 3 weeks without it and you die.

    #3- everyone should have an “entitlement” to housing – this can hurt you much more than healthcare if not taken care of!

    So why is there a healthcare entitlement when it is #4 on the list.

    It is the mechanism to gain control, power, wealth, etc for the left elite who find it easier than competing in the market place, and they desperately want it to control us.

    Now, how is that for getting to basics!

    To specifically answer you question in the vein you were probing for:

    Everything should always be done to preserve life. No limits and no decision makers, except the doctor and the patient. It does not matter what it costs. And it should not be welfare, which, since everyone else is paying for it will always have limits. It must be left to the individual!

    When affording it becomes a problem, man is a very inventive creature and will figure out a way to achieve what he needs. Have a little faith!

    I’m interested on your reaction to what I said about insurance companies and how they operate. Did it make sense? If it didn’t make sense to you, since you are a businessman, I again have to believe you are letting ideaology pur yourself in a “parallel universe” that does not exist, a major problem with the left!!

    Waiting anxiously for your comments on the above!

  • Jim  On August 16, 2009 at 11:20 am

    One of the pundits I read regularly is a local columnist in the San Diego Union Tribune” Ruben Navarrette. I would describe him as center left, a little left in my opinion because of his Latino heritage. We agree on most things, but his attitude towards immigration is not one.

    “Our ‘Gimme’ Society” is a column on “entitlements” that I think is appropriate to by last comment. This is what I worry about. Do you?

    http://www.realclearpolitics.com/articles/2009/08/16/our_gimme_society_97908.html

    His most important comment: “Even if they get the short-term economic aid they’re seeking, they’ll lose their self-sufficiency in the process and become dependent on an unresponsive bureaucracy. That’s not good. In fact, it’s dangerous.”

  • Curt  On August 16, 2009 at 7:08 pm

    Thanks for spelling out your thoughts on the entitlements question. I don’t see how Medicare/Medicaid will go away any time soon (despite fiscal shortcomings), so I still think we have to deal with this question one way or another. But I do find it nearly impossible to see how we can afford any type of unlimited ‘entitlement’ to healthcare – there have to be some financial limits.

    Your point on insurance companies is interesting… it seems clear that the mere fact of Medicare has greatly enlarged the spending on healthcare, and that insurance companies do want to increase profits through more spending (as long as their insured pool is ‘mostly healthy’ or at least mostly employable). We see a similar phenomena with Bush’s prescription drug program and Obama’s deal with ‘Big Pharma’ – why wouldn’t they be happy to accept guaranteed big spending for their products?

    Since Medicare has been around for over 40 years, it is a pretty well-established part of the market. So for those who claim that America’s system is the ‘envy of the world’, how much is that is due to Medicare’s subsidization of healthcare…?

  • Curt  On August 17, 2009 at 1:38 pm

    An interesting view from Ross Douthat in the NYT op-ed today:

    “In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.

    “That’s supposed to be the Republicans’ job. They should stick to doing it.”

    Full article is here: http://www.nytimes.com/2009/08/17/opinion/17douthat.html

  • Jim  On August 18, 2009 at 7:28 am

    Glad you see my point on Insurance. I see Medicare and the fact that our healthcare system is ‘envy of the world’ as completely unrelated. The only thing Medicare has done is increase the medical services costs on all of the rest of us. It is a “HIDDEN TAX”. Politicians love to preach “no new taxes” and then develop these “HIDDEN TAX” systems. Some day people will realize what is going on!!

    Our system is the ‘envy of the world’ because it is a free market system (as much as possible with the Government interference) and that leads to great strides forward in technology and in people like you and I – our desires to stay well – driving the free market to develop things for us.

    By the way – I am not suggesting Medicare and Medicaid go away – that is not possible at this point – and that is why we are fighting so hard against Obamacare. If it ever gets implemented it will be with us forever because people get used to such things. Social Security is the best example of this. However, I do wish we could “privatize” most of these systems in some manner – W tried but the left wouldn’t let him and the right does not feel strongly enough about it – “third rail” and all of that!.

    Socializing medicine may be the new “third rail” if Obamacare is shot down!

    You didn’t respond to my question as to why heathcare is the desired entitlement. Why not water, food, housing, ? I would really like the Government to pay for my groceries!! (With the growth in the food stamp “industry” they may be before long!!!)

    I will read you NYT articla and comment later – today I have to visit the dentist and am limited on time.

  • Jim  On August 18, 2009 at 7:56 am

    By the way – I liked the fish bike too!!

  • Jim  On August 18, 2009 at 9:02 am

    Had a chance to read the Ross Douthat – I’m sure you know he is the token NYT center right columnist who replaced Bill Crystal – and am not sure I understand his last two paragraphs.

    He seems to be assuming that “grandma” is going to have to be told “no” at sometime in the future because Medicare – as structured now – cannot support itself as demographics are changing.

    Why does it have to be “as structured now”? I do not understand why he does not talk about the potential of “reform” in the Medicare system – an idea which has been proposed continually on the right since Obamacare has been pushed – as a test vehicle for the future of healthcare.

    I have no idea what this “reform” would be, but wouldn’t it be wise to “walk” with Medicare before we “run” with Obamacare which has the potential to break the country and economy!

    Is he implying that the Republican base is the elderly and therefore “That’s supposed to be the Republicans’ job. They should stick to doing it.”? I’m not so sure the Republican base is the elderly. Haven’t seen statistics, but groups like AARP who are supposedly representative are certainly not the Republican base!

  • Curt  On August 18, 2009 at 3:00 pm

    My take on Douthat: I think he’s saying that given that traditionally Republicans have been wanting more fiscal responsibility, then it’s odd for them to be in a position where they seem to be criticizing moves to control Medicare costs (it seems nearly like an endorsement of an unlimited entitlement). Politically however we’ve seen that the elderly are not excited about moves to control those costs, so I can understand that it may not be a place where politicians of any stripe want to find themselves.

    I think most everyone can see that we need to re-structure Medicare in some way, but just as Social Security was a touchy subject, so too is Medicare…

    I’ve been trying to think about the whole right/entitlement question, and I don’t really understand it to be honest. The initial Bill of Rights focused in many ways on what the limits of the federal government would be, along with specifying just a few explicit rights of people (leaving it clear that it was not a comprehensive list in the 9th amendment: “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”).

    I think that a civilized society does try to ensure that no one dies for lack of a drink of water, or for a meal. And obviously government programs are one way of making that happen, through re-distribution. But once a program is started, a feeling of entitlement seems to grow, and there is little talk of any corresponding responsibility that might go with it.

  • Jim  On August 18, 2009 at 6:47 pm

    Re Douthat: belief in LIFE – both at the beginning and the end – is why Republicans criticize moves to control Medicare costs (Obama has clearly said he will pay for Obamacare by eliminating costs (we interpret this as LIFE) and this is unacceptable. So we are not blessing unlimited entitlements, just uninterferred with LIFE.

    We agree Medicare must be restructured. How about Social Security? Have you figured out yet that it is just a huge transfer of wealth from the young to the elderly? And it cannot go on forever! We must privatize in one way or another!

    My take on rights/entitlements is that the Constitution ensures us equal opportunity only, not equal results. As soon as you eliminate the results, accepting some pain for a segment of society along the way, then you see the value of equal opportunity. But you have to accept that some will suffer.

    Equal opportunity, not egalitarianism, is the answer. This lifts all boats, instead of sinking all of them to the lowest common denominator.

    What did you think about Ruben Navarette and the “Gimme Society”. I think he had some good points.

  • Curt  On August 19, 2009 at 9:34 am

    I’m not really following your logic here: it seems to me that one interpretation of what you’re saying is that every dollar spent on Medicare is life-enhancing… that there’s no way to cut costs without endangering life. Or is the issue not with the cuts themselves but the intended use of the cuts?

    I think Navarette’s column made some good points about the freedom of young people to choose their destiny, and that it’s sad to see them not realize what they’ve got!

  • Jim  On August 19, 2009 at 12:03 pm

    I agree with your interpretation of the main point in Navarette’s column. Sadly, Obamacare will further enhance this lack of realizing what they’ve got.

    I also agree logic of this discussion is difficult to follow. Here is how I see it – and I don’t think the argument is inconsistent:

    Medicare is going broke. (In a few years!)

    Something must be done to not allow this to break our country.

    I say we must “reform” – whatever that means – Medicare to a point where it is a self-perpetuating system. (I don’t even know if this is possible, but will assume it is until we prove it isn’t.)

    Then we can talk about total healthcare reform. Does that make sense?

    BHO and the left want to “reform” total healthcare immediately.

    This will increase costs and he has clearly said this increase will be at least partially paid for by a decrease in Medicare costs (this has to mean rationing-how else would costs go down with our demographics!

    Any decrease in Medicare costs by definition will be endangering quality of life or life itself. I see no other alternative to get the savings.

    The issue is the cuts and the timing.

    If my plan would work there is no risk to Medicare being at least as good and affordable as it would be under Obamacare – and maybe we could figure out away to keep the services equivalent to today even with changing demographics – and not endanger quality of life or life among the seniors!

    I will stop and let you comment if that makes sense,

  • Curt  On August 19, 2009 at 6:00 pm

    I guess I’m still unclear on what your plan is for Medicare reform. It seems to me that there must be some excess costs in the current system (how much, I don’t know)… I also suspect that some treatments and tests are in fact probably doing more harm than good (or at least have a very high cost/benefit ratio).

    That said, I agree that some more comprehensive reform of Medicare (not just ‘cost cutting’) is needed.

    This article from John Mackey, CEO of Whole Foods, has attracted a fair amount of attention:

    http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

    I would support most of his proposals.


    Finally, I found this conclusion from Arnold Kling to be pretty much on target, despite all the political theater going on…

    “I continue to describe what is happening now as a non-debate over non-reform. Both sides are fighting harder to entrench the status quo than for any meaningful change. Maybe the Democrats will take our already-socialized system and make it a few degrees more socialized. Maybe they won’t. From my perspective, it’s much ado about nothing. I certainly don’t think that keeping the existing private health insurance system in place is anything to write home about.”

    from blog post at: http://econlog.econlib.org/archives/2009/08/a_readers_quest.html

  • Jim  On August 20, 2009 at 7:47 am

    Sounds like you agree with my logic at some level. As I indicated, I do not know exactly what “reform” is necessary, but I would start with the obvious – MEDICAL TORT REFORM – which I am sure is a large percentage of the costs – particularly the 80% of our money spent in the last year of life (I would assume doctors are very careful at this point in a persons life – lots of extra tests to cover any potential law suits).

    Of course, the Dems won’t even mention this. Do you understand this? I would appreciate justification from a Dem/Obama supporter.

    The second area I would attack would be any Federal Mandates on Insurance or States – I am totally ignorant of any facts in this area but hear this being referenced often on both sides as a large cost factor.

    Etc, Etc, Etc.

    I really don’t believe it is “brain surgery”. We are just watchin “POLITICS AS USUAL” which we were promised would not be seen in this administration.

    I have heard alot about John Mackey’s column. Will try to read this and comment if appropriate.

    I agree in general with Arnold Kling – not so much that we have an “already-socialized system” – I believe the free market still has most control. Will also read his column and comment.

  • Jim  On August 20, 2009 at 1:44 pm

    Mackey’s 8 points are great, most discussed above in our dialogue.

    Kling seems to understand what is going on. Glad he did not agree with his writers former insurance executive (who you must take with a grain of salt since he is being interviewed by Bill Moyers) re insurance company operation – competition takes care of the phantom problem he references.

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