Letters to the Editor

Boon to business

August 28, 2012

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To the editor:

In the United States, tens of millions, probably even a majority, of employees still receive health care coverage paid for at least in part (and in most cases primarily) by their employers. And, if I’m not mistaken, employers provide such partial or complete coverage in addition to paying half of the payroll taxes for Medicare and Medicaid.

Imagine an alternative like that of Britain, France, Canada, Denmark and other first world countries: universal health care available to everyone, paid for by everyone, with employers off the hook. No more man-hours of research seeking the private plan that is good enough to satisfy employees yet affordable for their company.  No more hassles with insurance companies, health insurance paperwork, expensive record-keeping, negotiations with employees or unions over level of health-care benefits, etc.

Also, no more worries by employees about losing those health care benefits if they quit their jobs or get laid off or fired, any more than Medicare recipients worry about losing their benefits if they move to another state; they would be completely portable. If I were an employer, I would welcome getting the health insurance monkey off my back, and I could probably lay off half my human resources staff in the bargain, because their workload would be so substantially reduced.

Comments

Abdu Omar 2 years, 8 months ago

"If I were an employer, I would welcome getting the health insurance monkey off my back, and I could probably lay off half my human resources staff in the bargain, because their workload would be so substantially reduced."

Could this be a problem and one of the reasons we don't do what the writer seeks to accomplish?

labmonkey 2 years, 8 months ago

What is the tax rate in these nations? No thanks.

chootspa 2 years, 8 months ago

Their per capita health spending is less than that of the US, even when taxes are taken into account. Yes, please.

George Lippencott 2 years, 8 months ago

Are we doing apples and apples? I am told that there are costs associated with the NHS buried in other parts of the British Budget. (Capital, Employee, Administrative, etc).

just_another_bozo_on_this_bus 2 years, 8 months ago

I'll take slightly higher taxes if it means elimination of jacked-up insurance premiums to overpay insurance companies' CEO's and other executives running extremely inefficient organizations designed to deliver profit to stockholders rather than healthcare, and be able to reduce the amount we spend on healthcare (highest in the world for poorest coverage) that would allow us to reduce a major component of our national debt.

jhawkinsf 2 years, 8 months ago

I too would take slightly higher taxes in return for all the benefits you describe. But I suspect we will wind up with significantly higher taxes coupled with few, if any of the benefits you describe. More government bureaucracy usually begets nothing more than more government bureaucracy.

just_another_bozo_on_this_bus 2 years, 8 months ago

Bureaucracy exists for a purpose. Sometimes it's done well, sometimes not.

But just throwing out the term "government bureaucracy" as if it's some sort of expletive does nothing to advance a solution to one of the most vexing problems we face.

jhawkinsf 2 years, 8 months ago

"throwing out the term government bureaucracy as if it's some sort of expletive ..." There are many terms I could throw out that is somewhat suggestive of something necessary, yet unpleasant. How about "root canal", "turn your head and cough", "pap smear". Yes, all necessary, yes, all unpleasant. But if I add the word "more" to each of those, then we might question if there is a cost/benefit reward.

just_another_bozo_on_this_bus 2 years, 8 months ago

But if there were a single-payer, medicare-for-all plan, it would not mean an increase in bureaucracy. As a matter of fact, It'd probably bring about a decrease, since insurance companies are much less efficient in their use of bureaucracy than the government is in its medical coverage.

jhawkinsf 2 years, 8 months ago

I'm not against trying something different. The current system has so many flaws, fixing it might be beyond hope. What I'm against is saying that because strategy "A" is hopelessly flawed, that means strategy "B" will solve those problems. What about strategies C, D, or E? And even if strategy B has been successful elsewhere, doesn't mean it will be successful here. There are too many variables. And as I said before, government, from my experience means both necessary and unpleasant.

I've told the story before, of the interview on NPR of a Senator whose name escapes me. He told of how when discussing medicaid, cost projections were so far underestimated that had the true costs been known at the time, he doubted it would have passed. Is medicaid good? Sure. Is it worth the cost? I don't know.

Now you're suggesting there will be less bureaucracy. Will that really come to pass? I don't know. And you say government bureaucracy is more efficient than business' bureaucracy. I doubt that is true, but even if it were, that might be like me saying my root canal hurt more than your root canal. I'm not sure saying something like that will make either of us feel better about root canals.

just_another_bozo_on_this_bus 2 years, 8 months ago

"And you say government bureaucracy is more efficient than business' bureaucracy."

It's been widely documented that the administrative overhead of medicare is considerably lower than that of private insurance companies.

And no matter what form of healthcare system we have, there will be bureaucracy involved. Bureaucracy is a necessity of modern human existence. It can be done badly, or it can be done well, but it will always need doing.

just_another_bozo_on_this_bus 2 years, 8 months ago

"I've told the story before, of the interview on NPR of a Senator whose name escapes me."

He probably opposed it then, and would still oppose it now (because it might prevent tax cuts for the wealthy or the development of a new fleet of fighter jets.)

jhawkinsf 2 years, 8 months ago

That Senator voted in favor of it, as I recall the interview.

chootspa 2 years, 8 months ago

We could just evaluate every single other industrialized nation in the world. Lower health costs in all of them, and nearly all of them have better health outcomes. The most efficient spending for outcomes generally happens in those countries that go full single-payer. Nah. Let's just pretend that government bureaucracy is much worse than our current web of profit-driven insurance bureaucracy. I'd prefer my doctor make health decisions based on billable hours instead of evidence of efficacy, because that's the 'merican way.

jhawkinsf 2 years, 8 months ago

As I said, there are many variables. Let me give you an example. On another thread, just a few hours ago, one poster mentioned that he had gone to LMH with what he said was a hurt shoulder but suspected was a sunburn (don't ask me why he felt a trip to the ER was necessary). Anyway, he said LMH performed every heart test they could think of. It's "care" like that that will drive up health care costs, regardless of whether we're talking insurance companies, single payer, medicare, medicaid, Obamacare, I don't care what you call it. The underlying problem is that type of care given for those symptoms. Then again, I can take an educated guess as to why LMH might behave in that way. Fear of lawsuits should the sunburn really be something else. Now to the variables, do all those countries have a similar legal remedy such as our own, or will we adopt the same legal remedies that they all have, assuming they are all uniform, and acceptable to us. Maybe they are all uniform and maybe we will be OK with adopting their remedies. But if not, then having single payer, Obamacare, etc. without legal reform might produce a worst of both worlds rather than a best of both worlds. How do you feel about giving up your right to sue, should malpractice happen? Do a majority of Americans feel exactly as you feel? Unless you can definitively answer that last question in the affirmative, your solution has problems.

jafs 2 years, 8 months ago

He didn't say he suspected sunburn at the time he went.

Apparently he had a sore shoulder, and was worried about a possible heart attack.

Of course the ER would take that seriously, if the symptom mimicked possible heart problem symptoms.

jhawkinsf 2 years, 8 months ago

"Apparently ..." - He didn't say he was there because he suspected a heart attack. While I agree that may have been his concern, it's not what he said in his post. What he said, was what he said.

But my response stands. LMH's response to perform every possible test is more to protect itself from possible future litigation than it is to provide quality care. In the opinion of "Dr." jhawkinsf.

jafs 2 years, 8 months ago

Yes, and he didn't say he thought it was sunburn at the time.

He said he now thinks it was sunburn.

Dr. Dr. give me the news, I gotta bad case...

It's a combination of the two, I would think. Studies have shown that "tort reform" does little to lower health care costs, but does of course limit the ability of patients to hold doctors accountable.

jhawkinsf 2 years, 8 months ago

I had a close relative who was a dual resident (dual citizenship, as well) of the U.S. and a European country that provided single payer health care. When it came to routine care, yearly glasses, checkups, that sort of thing, this relative always availed herself of services in Europe. When it came to having surgery, she opted to have it here. She cited the high incidence of mistakes by doctors who were then not held accountable financially. She was of the opinion that because they weren't held responsible financially, they were sloppy in their work. Admittedly, that was a few decades ago, so maybe things have changed. While this is just one story by one relative, I think I've seen a dozen shoes of the "60 Minutes" type that spoke about doctors who practice defensive medicine. I don't pretend to know the answer. Yes, our current system is broken. But I'm skeptical that anyone really has the answer. So when they say "single payer" or "Obamacare" or "medicare for everyone", suggestive of that being the solution, I say "yeah, yeah".

chootspa 2 years, 8 months ago

The reason we'll never do this is in part because big businesses like being able to offer a benefit that smaller businesses can't afford, and they're the ones that pull the strings of the legislators. Another part is because it would completely remove the health insurance industry. They've made a giant wad of cash being the middle man for all our health transactions, and that's not something they want to give up. Also communism, death panels, and my aunt's cousin's great uncle's friend's brother's sister-in-law once had to wait for an inconveniently long time in Canada for something that I'm gosh darn sure would have been treated immediately in the US.

Flap Doodle 2 years, 8 months ago

Google "NHS scandal" and be enlightened.

tbaker 2 years, 8 months ago

Mr. Haight is wrong. He thinks more government is the solution when in fact it is the source of the problem.

Employer sponsored health care is one of the biggest reasons why healthcare costs are spiraling out of control. It is a relic / bad idea from WWII and it should be done away with.

The tax exclusion for employer-sponsored health insurance is the largest tax break in the federal tax code. In 2007, the revenue loss to the federal government was $147 billion, nearly twice the size of the projected loss from the second-largest revenue loser, the mortgage-interest deduction. (IRS)

Workers who do not obtain health insurance in an employment setting face a concomitant tax penalty when purchasing coverage. They must purchase insurance with income that has already been taxed at marginal rates as high as 50 percent. As a result of the tax break for employer sponsored insurance, consumers who seek to choose their own health insurance plan must often pay twice as much for less coverage. That hefty tax penalty discourages many workers from seeking insurance on the ‘‘individual’’ market. (Cato)

We need to change the model to large tax-deductible Health Savings Accounts. Put the money currently spent by employers “on behalf of” their employees into the hands of the people themselves so they can make their own choices in a market free from government manipulation.

boltzmann 2 years, 8 months ago

While I don't necessarily agree with your solution, I do agree with you that employer sponsored health insurance is an WWII anachronism and decoupling of insurance with employment is a good idea. One of the problems that it would fix is the issue of contraceptive coverage. On on the one hand employers should not have to provide coverage that is at odds with their own ethical or religious standards, but on the other, employees should not be forced to conform to ethical or religious standards that they don't share merely because our society puts the burden of insurance on the employment. Decoupling of insurance from employment would solve that conflict of rights.

jafs 2 years, 8 months ago

The above is a mishmash of different things.

Employer sponsored health insurance isn't synonymous with tax breaks for it, so one could easily have it without tax breaks.

I see no evidence that employer sponsored health insurance is the reason for high health care costs in the post.

It is true, of course, that employers started offering health insurance to employees because of government limits on wage increases.

I wonder how exactly one would "put" the money employers spend on health insurance directly into employees' hands without government action? When employers stop offering health insurance, they don't usually increase salaries by a similar amount - that would kind of negate the reason they're stopping the benefits, which is to save them money.

tbaker 2 years, 8 months ago

Jafs: “Employer sponsored health insurance isn't synonymous with tax breaks for it, so one could easily have it without tax breaks.”

Incorrect. It is synonymous. That’s why they do it. Employers are able to deduct the first dollar of spending on employee healthcare plans, and employees get a “benefit” paid for with income they are not taxed on.

Jafs: “I see no evidence that employer sponsored health insurance is the reason for high health care costs in the post.”

I provided the reason. I will explain it again. Only about 10% of Americans buy health insurance for themselves. Because of the old WWII-era price controls, if employers take money out of your check to buy health insurance for you, then you don’t have to pay income tax on that money. If you decide to buy it for yourself, you will do so with post-tax dollars, greatly increasing the cost. Since most people do not pay for healthcare themselves, they are not sensitive to cost or value (the two signals that regulate free markets.) When health providers demand higher prices, the people (not paying the bills) could care less what their employer has to shell out in costs. Absent the normal free market forces in the employer-sponsored health insurance arrangement, people end up losing an ever-greater portion of their income for a healthcare benefit that covers less and less and requires higher co-pays. With no market forces to regulate their behavior, healthcare providers can arbitrarily raise prices and the insurance companies have no choice but to pass on the cost to the employer-sponsored plans. Imagine what getting a water heater installed in your house would cost if we had plumbing insurance for the past 75 years.

If we changed the law to give individuals the same tax advantage employers now get when it comes to money spent on healthcare, the market forces of cost and value (now absent) would be in play.

Jafs: “I wonder how exactly one would "put" the money employers spend on health insurance directly into employees' hands without government action?”

Why do we need “government action?” Whats wrong with the idea of individual people taking their own pre-tax dollars and shopping the market for coverage that suites their individual needs? Portable healthcare plans that move when and where the person does that have nothing to do with whatever employment they may have. Whats wrong with giving the person a choice? Accept a reduced paycheck and employer-sponsored healthcare, or keep your entire paycheck and buy it yourself with the same tax deduction your employer would otherwise get. Whats wrong with making the 1st dollar of healthcare spending tax deductible for individuals?

jafs 2 years, 8 months ago

They may or may not choose to offer it without tax breaks, but they're not synonymous.

Not really. I understand your point about after-tax dollars, but the rest seems off. For one thing, there's a relationship between health care costs and health insurance costs, so even though it's not as direct, people pay more in premiums when costs go up. Also, pretty much every health insurance plan I've ever seen has limits on provider charges, which are often lower than the prices listed by providers. So there's a built in limit on simply increasing provider charges.

Unless you require employers to give employees the money they're spending on insurance in salaries, they won't do it. They'll just stop offering insurance. Also, part of how insurance costs are kept down has to do with the size of the groups involved.

I'd prefer to simply remove all tax breaks, for individuals and businesses, rather than adding another one, but I have no problem with the idea of parity between policies for both groups.

If you're employed, why don't you ask your employer if they'd be willing to let you opt-out of the insurance plan you're in, and just give you that money in salary instead? I think it's extraordinarily unlikely they'd do that.

Also, employer sponsored (and paid for) health insurance is rapidly becoming obsolete anyway - a recent study found that less than 1/4 of jobs in this country were "good" ones, with decent salaries & benefits. Decent benefits included employer sponsored health insurance, even if the employee had to pay for it in part.

tbaker 2 years, 8 months ago

  1. It is synonymous now. Speculation doesn't change that.

  2. Sorry it seems off. It is what it is. The facts speak for themselves.

  3. If we change to the model I suggest, you wouldn't need to "force" employers to give the employees the money they already spend on employee healthcare. It's in the compensation equation already. Thats what the labor market will do. Companies who don't pass the $$ to the employees will lose the employees to the companies who do.

  4. I'm in favor of letting individuals spend tax-free dollars on healthcare for the same reason I feel food items shouldn't be taxed - it is a life necessity. Furthermore, hundreds of millions of people healthcare shopping for themselves will generate a lot of competition in the market place and result in cost reductions and innovation making things better for all healthcare consumers. What we have now is a near-monopoly. Remember how expensive long distance phone calls were before they broke up AT&T?

  5. Extraordinarily unlikely? Hardly. Since I have Army retiree healthcare, I decline my company healthcare plan and get an extra $350 every 2 weeks, for example. Like I said, companies who think they can keep what they used to spend on healthcare and not pass it on to employees under the model I favor will ultimately lose the employees. I hire and fire everyday Jafs. The little 800 person software company I work for is constantly trying to improve the compensation package to attract and keep good employees. Losing employees to competitors is very harmful to production, terribly disruptive, and costs us more in lost revenue and lost opportunity in the end then the compensation package does. You assume the worst out of employers when there is no rational reason for them to behave this way. Check your stereotypes.

  6. You are right about the decline in employer-sponsored healthcare. It costs too much for a lot of new/growing businesses to offer as a benefit anymore. The overhead costs in my company are staggering. Profit margins are very tight. The near-monopoly by the large corporate hospital chains / healthcare providers have means they can almost dictate to insurance companies what they charge. Instead of a few big healthcare providers and insurance companies in collusion fixing prices and screwing all of us, I think we should force them to deal with hundreds of millions of people who are very sensitive to cost and value and have their own pre-tax dollars to spend on healthcare, shopping for it across state lines, totally portable with no connection to an employer. That would restore the market forces that would increase quality and reduce price.

jafs 2 years, 8 months ago

It's not "synonymous" - synonymous means the same thing. Employer sponsored health insurance isn't the same thing as tax breaks the employer gets for that.

I presented facts, you presented assertions.

Are you kidding me? Most jobs don't offer health insurance at all, the idea that somehow companies will have to pay salaries at that amount is ridiculous, especially when there's high unemployment - employers aren't having to compete much for employees at all these days.

The idea that the "free market" is a good one for health care is a bit debatable, in my view. But, it's not surprising that a libertarian would advocate for that.

I would be willing to bet that your experience is extremely rare. Are there good employers? Sure, but they're in the minority right now. My wife works for a company that offers good salaries and benefits as well, but I wouldn't claim that represents the majority of employers. As I said, fewer than 1/4 of jobs right now offer decent salaries and benefits.

I doubt that your version of that relationship is correct. Many providers accept less than they'd like, in order to get a customer base through insurance. Every statement I've ever gotten from a health insurance claim shows the nominal cost being higher than the cost after the insurance company brings it down to their accepted level of reimbursement.

I agree that we might have some forces of competition, etc. if we paid directly for care, rather than through insurance. But, consumers often choose lower quality for a lower price, so I'm not at all sure that we'll get higher quality and lower prices. And, as I've said, I doubt that most employers would simply give the insurance premiums back to employees as salary.

Anybody else have experience with this? I'm curious if other people have tried to opt out of employer insurance and gotten that money as salary instead?

Richard Heckler 2 years, 8 months ago

The potential savings on paperwork alone, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

http://www.pnhp.org/facts/single-payer-resources Physicians for a National Health Program

You can bet the health insurance industry is blowing lots of healthcare dollars at the political conventions.

livinginlawrence 2 years, 8 months ago

If you are less inclined to read up on single-payer health care systems than you might be to, say, watch a movie about them, I suggest you check out PBS' "Sick Around the World" documentary.

classclown 2 years, 8 months ago

just_another_bozo_on_this_bus

'll take slightly higher taxes if it means elimination of jacked-up insurance premiums to overpay insurance companies' CEO's and other executives running extremely inefficient organizations designed to deliver profit to stockholders rather than healthcare, and be able to reduce the amount we spend on healthcare (highest in the world for poorest coverage) that would allow us to reduce a major component of our national debt.

August 28, 2012 at 9:23 a.m

=============================================

If this is to be paid for through taxation, then what exactly is to be taxed to ensure that everyone pays?

Sales tax?

George Lippencott 2 years, 8 months ago

We spend about $7K per year per head on health care. If all 200,000,000 of us now on employer provided insurance received government supplied health care at no costs at current levels it would require about 1.5 trillion to meet that obligation. So of we equally distribute the cost to our taxpayers we would each see a tax increase of between $10,000 and $15,000 per year depending on efficiencies (if any). Of course we could stick the rich with those costs.

If you do not like my numbers what are yours.

Scott Morgan 2 years, 8 months ago

Snapshot 8-28-12 Think of LMH right now. Now imagine what LMH would be like with the same folks running our DMV were manning the operation.

Nuff said.......

Windemere 2 years, 8 months ago

Agree with tbaker. With auto insurance, doesn't competition/free market forces help keep insurance rates down? That's what would happen if the government corrected the problems it created through heavy-handed, ill-conceived policies. Allow health insurance providers to compete across state lines, enact policies that de-couple health insurance from place of employment (e.g. tax reform tbaker describes), change regulations that force people to see an expensive MD for a routine health issue like an ear infection vs a lower cost option like a clinic staffed by health professionals who are not MDs, and some type of tort reform, e.g. loser pays, so that malpractice insurance rates are not sky-high due to jackpot justice from lawsuits. The bottom line is that the "waste" in our healthcare system is inflated payments due to the fact that there are insufficient market pressures to keep the prices down.

There is no free lunch. The ACA may cut some waste, but make no mistake, government entities will then decide what type of care you can receive. They will take costs/"waste" out of the system, which will mean reduced care for millions of people. (Yes, realize that insurance companies do that now, but there are many of them; in a true free market, they will compete to offer more benefits for less cost. When the government takes over healthcare policy and decides healthcare protocols, there is no incentive to provide better service for less cost). Before we go down that road, the US ought to give free markets a chance. Hasn't happened in my lifetime.

jafs 2 years, 8 months ago

Health insurance can be sold across state lines if the states agree to it. Libertarians generally don't favor federal government policies that infringe on states' rights, without which you can't make states allow that.

Employer sponsored and paid for health insurance is rapidly becoming obsolete.

I'm a bit uncomfortable with the idea of less qualified and trained people treating illnesses. Well trained doctors make more than enough mistakes already.

Tort reform has been shown not to affect health care costs much, but limits the ability to hold doctors accountable, which I don't like.

I think the real reasons for increasing health care costs at amounts much greater than inflation and wage growth aren't clear yet to me.

tbaker 2 years, 8 months ago

I'm not uncomfortabel with people being able to make their own decisions. I don't need government forcing me to see someone with 12 years of higher education to prescribe motrine for a sprained ankle. Who I see fdor that should be my decision.

jafs 2 years, 8 months ago

As far as I know it's not "government" but rather groups like the AMA who set guidelines for credentialing.

It is illegal to "practice medicine without a license".

There are many over the counter pain relievers - why would you need to see a doctor at all for that?

Seems to me that libertarian ideals rest on a very well educated/informed population who are very assertive. Unfortunately, that's not what we've got right now.

I might agree that with such a population, market forces would operate to create quality at reasonable prices, though.

Think of car repair shops - many routinely rip people off, because people aren't well informed about car repair, and they're dependent on their cars. Without some sort of credentialing, I predict we'd see the same with health care, and bad health care can affect people in a much more serious way than bad car repair.

tbaker 2 years, 8 months ago

Not so Jafs. The AMA produces / adopts "guidelines" but government (state licensing boards) establishes the licensing and credentialing requirements for healthcare professionals. This stipulates, for example, that ordering a prescription drug for a patient (800mg Motrin for example) has to come from a licensed “doctor.” (MD or DO) Yes you can buy Motrin over the counter – but not 800mg Motrin. Yes, you can take four 200mg Motrin you bought over the counter, but they won’t be time released like the 800’s are. See how asinine this is?

Requiring the person who writes such a prescription to have 12+ years of higher education drives up the cost of a routine, primary care protocol. The licensing board has tens of thousands of “protocols” for everything you can imagine. Most of them are created by the lobbyist organizations that represent trail lawyers, mal-practice insurance companies, and the AMA.

One cannot legislate intelligence into a person, or any degree of personal responsibility for that matter, but whatever the prevailing ignorance of the population may happen to be should never serve as a basis to impose asinine government rules upon people who are willing to look after themselves. Perhaps we could open a government office for people who cannot seem to navigate the impenetrable mysteries of daily life and assign them a handler so their ignorance doesn’t end up hurting them, but leave it up to everyone else to live their own lives and make their own decisions unhindered by stupid, costly government rules.

Your dishonest mechanic example leaves out a couple things. We live in an exploding information environment where learning about the good old “cost and value” of a service provider takes a matter of seconds. You also don’t mention due diligence. People have to be responsible for their own decisions and choices. It is not the role of government to protect people from their own laziness. The bias should be in favor of personal choice and individual responsibility, not over-regulation to the point an 8 year old needs a permit to run a lemonade stand.

I am not in favor of doing away with medical licensing and credentialing. Like a lot of things, there is a very good core function they provide society, but I am in favor of applying some common sense to a reform effort that puts the emphasis on and establishes a link between choice and individual responsibility.

jafs 2 years, 8 months ago

Yes, the state licenses doctors.

You are vastly oversimplifying the role of a doctor, when you claim they get all of that training just to write a prescription.

I suppose if you wanted to sign some paperwork that you are completely responsible for your own choices, and won't sue your health care provider if they fail to diagnose and treat you correctly, I'd be in favor of you being able to see whomever you like.

Most people wouldn't sign such a document, and they want health care providers to be of appropriate quality.

No it isn't - the Internet is a remarkable source of information, but you still have to evaluate that information - it's not really that easy to find a good mechanic - have you tried recently?

With doctors, and other health care workers, it's even harder to get enough information to make an informed decision, without any government involvement. Where exactly would you look for such information, exempting the KBHA, AMA, or other groups?

What's your "reform" suggestion?

tbaker 2 years, 8 months ago

Exactly!! Bullseye!

Let me sign some (hold harmless liability waiver) paperwork saying I am responsible for my own decisions and I can't sue my healthcare provider. Do you know what that would do to the cost of Primary Care if people could do that and healthcare professionals no longer had to carry mal-practice iinsurance?

Saying most people wouldn't sign such a document is baseless speculation. I can argue the opposite and be just as likely to be right. What if the healthcare provider was half the cost, and there were thousands of testimonials from satisfied customers (providing that cost and value feedback the market needs) on an Angie's List somewhere? Still think no one would sign it?

Say what you will Jafs. Give me 60 seconds and I can find a "good" mechanic based on customer reviews and plot them on a map relative to your current location.

If this ever came to pass, the place you would find information about healthcare providers would instantly appear becuase there would be a pronounced need for it. Someone would start or modify and existing service to fill this information need. Angie's List does this for quite a few doctors right now. There are very simular services for attorneys. There are lots of places to research a good eye doctor for laser surgery. Since that is generally not covered by health insurance (people have to pay for it out of their own pocket) that part of the healthcare market is hyper competative and getting better and cheaper all the time As I've been saying, when cost and value feedback is present, the market (for anything) always gets better.

My reform suggestion is your 3rd paragraph and the reform of licensing and credentialing of healthcare providers, and a whole bunch of other stuff I have enumerated in many past posts.

jafs 2 years, 8 months ago

It's not at all surprising you think the "market" is the best way for health care to be delivered - it's essentially the answer Libertarians seem to have for every issue.

What specifically would you retain and what would you change as far as credentialing and licensing, since other Libertarians generally argue against any of that stuff?

As I said, I have no problem if you want to sign such a thing, and take complete responsibility for your own health care. Of course, if/when less intelligent or careful people do it, and suffer negative health consequences, I'd feel bad for them.

The Internet provides access to a lot of information, but without any quality controls, so it's limited in value in this regard.

Customer reviews are limited in value - people have different values and levels of intelligence/education, so everybody's opinion isn't equal. I live near 23rd and Mass - please find that mechanic and let me know about them (just an exercise).

tbaker 2 years, 8 months ago

Don't generalize. There are no pure market solutions, but a bias in favor of market solutions as opposed to government intrusion works best, especially when it comes to healthcare. There is not a single exmple of government intrusion into the healthcare industry that can be held up as a success.

I haven't given it enough thought beyond correcting licensing rules that take choice away from individuals for the sake of government control over something (800mg Motrin example)

Lets be clear on one point: stupid people should not be shielded by government to protect them from their stupidity. That is not governments role, and it is most definately not a sound basis to otherwise limit someone else's freedom to make choices for themselves. Stupid is as stupid does. Natural consequences are great teachers.

You believe the information on the interet is of limited value becuase it has no quality controls? Come on Jafs - you're smarter than that? It has the ultimate quality controls applied to it! Example: I travel a lot so I use Yelp.com to find / assess local resturants. For how much longer would I use Yelp to make these decisions if I discovered by first-hand experience the reviews were inaccurate and not a reliable source of information? They would go out of busniness as many sites like Yelp have. If you fail to deliver the value people expect, you are done. Have you ever done a "sort by review" of a product on Amazon before you bought something and read what previous customers said? Would you keep shopping there if you discovered the information was bad? Been on Angie's List lately? Better Business Bureau? Whats wrong with letting people make up their own minds about the quality of a review? The obvious merits of millions of people making billions of cost & value judgements every day about thousands of different things simply cannot be replaced by some elite government bureaucrat somewhere.

When government fails to provide value, it simply drains more tax money and continues. When private enterprise fails, it is replaced by something/someone better. No quality control...yeah right.

Do your own exercise. If you can't do a simple Google querry you probably need help writing your posts. Since you don't, you can run your own search.

jafs 2 years, 8 months ago

Ok - I guess you can't deliver on your claim at all - "Give me 60 seconds and I can find a "good" mechanic".

See below for more.

jafs 2 years, 8 months ago

Personally, if I were in such pain that I needed a 4x strength of an over the counter pain reliever, I'd see a doctor to find out exactly what was wrong.

We can already self diagnose and treat with a wide variety of natural herbal supplements, and over the counter medications.

If you want to mimic the effects of an 800mg time release medication, take the 200mg strength at regular intervals - not that hard really.

tbaker 2 years, 8 months ago

You deliberatly ignored the point. Just becuase you can work-around an asinine government rule doesn't make the rule any less asinine.

jafs 2 years, 8 months ago

We have different ideas about the "point", that's all.

I don't get my knickers in a twist about things like the one you mentioned.

Did you miss the first part, wherein I'd be very interested in seeing a doctor if I was in that much pain, to make sure I knew what was wrong?

I don't think it's "asinine" if somebody's in that much pain, to make sure they see a doctor, as well, rather than just handing them a pill.

tbaker 2 years, 8 months ago

The "point" (again) is there is a stupid government rule driving up the cost of healthcare and costing people / business extra money. Requiring someone to be a doctor in order to write a prescription for a drug I can buy over the counter simply becuase the pill is a little larger is moronic.

jafs 2 years, 8 months ago

You seem to be deliberately missing the point.

If somebody's in so much pain that they need that strength pain reliever, it makes sense to me that they should see a doctor.

tbaker 2 years, 8 months ago

Choice Jafs. The person should have a CHOICE not to have to pay for something driven up in price by stupid government rules. Whether or not they decide to see a doctor for X amount of pain is a choice they are being denied by the stupid government rule in my example. They are being forced to by it.

jafs 2 years, 8 months ago

For God's sake, buy the over the counter stuff and take it at regular intervals, if you want. Don't go to the doctor, self diagnose, do whatever the heck you like.

There may be very good reasons that strong pain relievers aren't sold over the counter, you know.

Of all the things to get upset about in life and in this country, this just isn't one of them for me.

You're free to be as upset as you like about it, of course.

jafs 2 years, 8 months ago

Waiting on that mechanic.

It seems to have been at least several minutes by now - I think you said you could find one in 60 seconds.

12 minutes and counting - guess it's not quite as easy as you think.

tbaker 2 years, 8 months ago

3 seconds. Found 23 auto mechanics within a mile of 23rd and Mass.

jafs 2 years, 8 months ago

You said you'd find a "good" one.

Are you really not getting the point here? I can find any number of mechanics, plumbers, electricians, and handymen, but it's hard to find good ones.

I have had bad experiences with AAA recommended mechanics, BBB affiliated plumbers, tradespeople who've been recommended by friends, etc.

sleepy33 2 years, 8 months ago

You'd be risking an awful lot on someone else's positive review. Even good, conscientious doctors can make mistakes, and then what is your recourse?

tbaker 2 years, 8 months ago

Recourse? You take personal responsibility for your decision and suck it up and deal with it. You document your experience and ensure others are warned. The doctor goes out of business. If you can prove willfull negligence, then you sue him. (note the use of the word willfull)

Windemere 2 years, 8 months ago

I think the "real reasons" have to do with insufficient pressure on providers to hold costs down, along with increased consumption of costly care. The waste has to do with distorted, insufficient incentives. Perhaps this is a good analogy: we are getting from point A to point B in a Mercedes Benz S class when we could get there just as well in a base model Ford Taurus.

jafs 2 years, 8 months ago

I'd say we're not even getting from point A to point B, and in addition, it's costing us too much.

George Lippencott 2 years, 8 months ago

Where do we come up with the 10,000 to $15,000 a taxpayer per year to pay for government supplied care if we get rid of employee provided care? Love how advocates fro national health care just avoid numbers they do not like

Windemere 2 years, 8 months ago

It won't cost so much because govt plans to reduce "waste" and inefficiency, they say. Their spin emphasizes the inefficiencies in record-keeping, for instance (and there are inefficiencies, no doubt) and they claim that these inefficiencies will be reduced. But ACA advocates would rather not talk about the rules that will be put into place by decision making "panels" that says what type/level of care individuals are entitled to.That is another way that the costs will be reduced. Yikes.

tbaker 2 years, 8 months ago

Unfortunately we have no example of government ever reducing waste and increasing efficiency we can point to in order to measure the likelihood that would ever happen. The data to date suggests a near 100% probability the government will fail to do this.

George Lippencott 2 years, 8 months ago

They argue a lot of possible savings but that is all legerdemain. The simple fact is that if you move to a government owned system the $1.5 trillion now paid by business must be replaced. If I assume significant savings (maybe 25%) we might get to the lower number. That is still a very hefty cost to taxpayers. I would almost bet that most of the savings for business would go overseas and not to the employees now receiving the benefit.

The point is that advocates for a national system are very disingenuous by avoiding aggravating facts like costs.

They have been just as disingenuous with Obama Care. You can not take $600 billion out of Medicare without impacting the people currently on it. If Mr. Obama really was going to do that he would advocate a requirement that all providers must take a significant percentage of medicare patients so they can not avoid the payment cuts by dumping the patient..

jafs 2 years, 8 months ago

Libertarian philosophy seems to offer the same answer to most, if not, all issues - government bad, private sector good.

It's like the guy whose only tool is a hammer - everything looks like a nail to him.

Does the private sector work well sometimes? Sure - the best times are when demand is completely elastic (meaning that people can just choose not to buy a product, or class of products, at all), consumers are well educated and demanding/assertive, and businesses need customers.

Does it work well all of the time? Of course not, especially with less elastic demand, less educated and/or demanding customers, etc.

Lawrence is a prime example of this, in my experience - people in Lawrence aren't particularly demanding, and perhaps don't have wide enough experience in some ways. For example, I heard a group perform at the Lied Center once - they were good, but not great, and played out of tune at times. Yet friends raved about them at the intermission. From my view, they didn't offer a great price/value product. From theirs, I guess they did. Either they don't demand much, or they don't know enough about the genre to know that the group wasn't that great.

This scenario has been repeated in numerous places, from restaurants to carpet installers, for me.

When I first moved here, I tried to discuss this issue with businesses, but I eventually gave up, because it was clear that I was in the minority, and they didn't need to please me as long as they had plenty of other customers.

George Lippencott 2 years, 8 months ago

pivate sector neither good nor bad government neither good nor bad

blind faith in either = very bad

jafs 2 years, 8 months ago

Another facet of this conversation - in my experience, even trained, qualified, and licensed doctors aren't as good as I'd like for them to be.

The last thing I'd want is less stringent requirements - I might want even more stringent ones.

Trumbull 2 years, 8 months ago

What Chootspa said 2 days ago. Could not have said it better.

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