"It Is What It Is. Until It Isn't."
-Spongebob Squarepants
Tuesday, October 13, 2009
An astounding statistic
An astounding statistic from conservative David Frum. During the period 2000-2007, American employers spent 25% more on labor. How much of that went to workers? Not a dime. ALL of it went to health care spending.
We change the laws to encourage employers give workers MONEY in a Health Savings Account and you save that money up over your life to use for ANY treatments you and your doctor feel are best (gym memberships, mammograms, weight watchers, whatever...).
Everyone could carry health insurance for catastrophic events (cancer, heart attack, etc.).
It would lower costs, and you and I could rule in the world instead of Aetna.
When my money runs out, I would comtemplate going into debt (gasp) for my health. I did it for my college education. I would do it for the right house. I have done it to have a car. I would do it for my kids' educations. I value my health as highly as those things.
HSAs should obviously be governed by some rules (yes, government regulation!) keeping interest rates and other terms of the debt reasonable.
I love fair research. I use Consumer Reports regularly. The one organization I would NOT trust to give me fair information is our government. Not because I'm anti-government; because it's not its function. I want a for-profit company that will succeed or fail based on how well they provide excellent health information.
The fear of "running out of money" might be the best cure for what currently ails this country. Do I have to share the statistics on obesity, heart disease, childhood diabetes, etc.?
Do you really, honestly believe that obesity and heart disease and childhood diabetes are voluntary organizations that people sign up for? Obviously, there's a behavioral factor. But there's a genetic and environmental one too.
I don't believe in blaming sick people for becoming sick.
Poor people, generally speaking, have demonstrated a poor grasp of long term thinking. We're going to tell them, if they don't save up enough for their health care, they will go broke the first time they break a leg falling down the stairs?
I don't disagree that HSAs may be useful in bringing down health costs. I don't know enough about them yet. (And, as a society, I don't think we know enough about them.)
I also believe that outcomes based research will help people make better choices about health care. But I don't know how we're going to do that in the current free market system. I don't know who else besides the government would be able to do it impartially. (NB the National Institutes of Health does this all the time.)
In some cases, illnesses are in no way a persons' fault. Obviously these people bear no blame. Catastrophic insurance would cover them.
However, as you say, when a person chooses an unhealthy lifestyle, and that lifestyle contributes to health problems, it costs us all. There's no point in pretending otherwise.
You don't give poor people enough credit. In some instances, sure, they don't have the luxury of long-term thinking. However, they are certainly able to make the right decisions for themselves and their families.
In your example, a poor person falls down the stairs and "goes broke." Not really. They'd go into debt (again, with strict government regulations on interest rates, terms, etc.). This is far better than the current system of the uninsured using credit cards.
The example you give isn't all that different than the poor person's mother in a different country unexpectedly dying. The poor person might decide to go into debt to buy the plane ticket home for the funeral. Perhaps this is not as physically necessary as having a broken leg set, but arguably it's as psychologically necessary.
It seems EVERYONE wants to see health care costs come down. It makes sense to focus on that first, and track universality of coverage. If we do the right things with costs, coverage will become more wipespread. Without multiple government agencies running it.
I don't get how lowering costs necessarily widens coverage. Every other time we lower the costs of doing business, the business owners just keep it.
Dan Carlin had an excellent piece about this on his podcast-be very, very careful about legislating lifestyle choices. Sooner or later, they will come for yours.
On, no you didn't. You didn't just seriously write that you don't see how lowered costs leads to expanded coverage? An example from my life:
When my family got our first VCR in the early 80s, we kids weren't allowed to touch it because it was very expensive. By the mid-90s, I headed off to college with one of my own, because they were so cheap. As demand for VCRs grew, the technology got cheaper and production more efficient. More companies got in on the act, forcing competition to make the best VCRs for the lowest costs. Presto. VCRS went from an exotic luxury item to something every college kid had.
When something desirable is produced, more people WANT it. In econ terms, demand goes up. So does the price (boo, hiss). BUT, there is profit to be made, so other producers get in on the act. That means more supply, forcing downward pressure on prices (yeah!). Over time, the price of EVERY new technology goes down, if you let the market do it's thing.
I don't advocate legislating anyone's lifestyle People should be free to do whatever they want with their bodies as long as THEY suffer the consequences, not me.
But the trap in your theory ("do what you want, as long as it doesn't affect me") is that the restrictions won't stop with unhealthy behaviors. Anyone who has a child is costing me money. Anyone who elects surgery over some other form of treatment is costing me money. Only in the power of a large enough group (say, all 300 million of us) can we even out these risks.
Your VCR example is well taken, except that health care isn't like that. You can't just decide to not consume it, the way you can decide to not have a VCR. And a low quality VCR chews up your copy of "Ferris Bueller". A low quality health plan kills you.
I'm not sure I understand your point (and we're arguing healthcare on too many threads now!).
I don't advocate restricting anything and certainly not legislating lifestyle choices.
I'm not sure there is such a thing as "low quality" and "high quality" health plans. There are different health plans for different needs. What is low-quality to a young couple with two kids and one income might be more than adequate for a young, healthy single guy.
You say my VCR example isn't relevent to healthcare. But it is. The costs of several cosmetic medical procedures and Lasik eye surgery have come down substantially over the last decade, despite the fact that they are medical procedures and despite increased demand.
One theory is that THESE are medical procedures that are responsive to a market (not insurance) and the prices have come down as demand increases, profits increase, technology improves, and competition for customers drives prices down.
I find it hard to believe that a free market drives down the price of food, healthcare not covered by insurance, cars, and pretty much everything else, but that it won't work for MRIs or open-heart surgeries.
"I don't advocate restricting anything and certainly not legislating lifestyle choices."
I couldn't agree more. Except you also said:
"...when a person chooses an unhealthy lifestyle, and that lifestyle contributes to health problems, it costs us all. There's no point in pretending otherwise."
"I'm not sure there is such a thing as "low quality" and "high quality" health plans. There are different health plans for different needs. What is low-quality to a young couple with two kids and one income might be more than adequate for a young, healthy single guy."
(http://bit.ly/18enC4 (from the New York Times, September, during a Senate health care debate.)
Senator John Kyl: "I don't need maternity care in my health insurance."
Senator Debbie Stabenow: "Your Mom probably did.")
Of course not everyone's needs are the same. But your needs change over time.
"I find it hard to believe that a free market drives down the price of food, healthcare not covered by insurance, cars, and pretty much everything else, but that it won't work for MRIs or open-heart surgeries."
A lot of people have this blind faith in the power of markets. Fat lot of good that did us in the fall of 2008.
But seriously, if, as you say, we had the same unbiased, full information about costs, benefits, and risks that we do in buying a car, then yes, market forces will work in health care. But running around insisting, "the market will do it!" is not a health plan. The way things are, they won't work.
We all would love to see health reform-every thinking person wants things to change. But there are a lot of very powerful, very rich people who are doing just fine with things the way they are. So don't hold your breath waiting for it to change.
I'm all for reforms that will lower healthcare costs without sacrificing quality of care.
ReplyDeleteSome proposals will do that (electronic records).
Some will not (the public option or an individual mandate).
So without the public option or an individual mandate, we just hand the keys over to Aetna, and say, "Hey, you guys run the country for a while"?
ReplyDeleteNope.
ReplyDeleteWe change the laws to encourage employers give workers MONEY in a Health Savings Account and you save that money up over your life to use for ANY treatments you and your doctor feel are best (gym memberships, mammograms, weight watchers, whatever...).
Everyone could carry health insurance for catastrophic events (cancer, heart attack, etc.).
It would lower costs, and you and I could rule in the world instead of Aetna.
And when your money runs out?
ReplyDeleteAnd how do you compare treatments without balanced, fair government research.
I've never been brave enough to try an HSA. They seem like more trouble than anything else to me-and I'm afraid I will run out of money.
When my money runs out, I would comtemplate going into debt (gasp) for my health. I did it for my college education. I would do it for the right house. I have done it to have a car. I would do it for my kids' educations. I value my health as highly as those things.
ReplyDeleteHSAs should obviously be governed by some rules (yes, government regulation!) keeping interest rates and other terms of the debt reasonable.
I love fair research. I use Consumer Reports regularly. The one organization I would NOT trust to give me fair information is our government. Not because I'm anti-government; because it's not its function. I want a for-profit company that will succeed or fail based on how well they provide excellent health information.
The fear of "running out of money" might be the best cure for what currently ails this country. Do I have to share the statistics on obesity, heart disease, childhood diabetes, etc.?
Do you really, honestly believe that obesity and heart disease and childhood diabetes are voluntary organizations that people sign up for? Obviously, there's a behavioral factor. But there's a genetic and environmental one too.
ReplyDeleteI don't believe in blaming sick people for becoming sick.
Poor people, generally speaking, have demonstrated a poor grasp of long term thinking. We're going to tell them, if they don't save up enough for their health care, they will go broke the first time they break a leg falling down the stairs?
I don't disagree that HSAs may be useful in bringing down health costs. I don't know enough about them yet. (And, as a society, I don't think we know enough about them.)
I also believe that outcomes based research will help people make better choices about health care. But I don't know how we're going to do that in the current free market system. I don't know who else besides the government would be able to do it impartially. (NB the National Institutes of Health does this all the time.)
In some cases, illnesses are in no way a persons' fault. Obviously these people bear no blame. Catastrophic insurance would cover them.
ReplyDeleteHowever, as you say, when a person chooses an unhealthy lifestyle, and that lifestyle contributes to health problems, it costs us all. There's no point in pretending otherwise.
You don't give poor people enough credit. In some instances, sure, they don't have the luxury of long-term thinking. However, they are certainly able to make the right decisions for themselves and their families.
In your example, a poor person falls down the stairs and "goes broke." Not really. They'd go into debt (again, with strict government regulations on interest rates, terms, etc.). This is far better than the current system of the uninsured using credit cards.
The example you give isn't all that different than the poor person's mother in a different country unexpectedly dying. The poor person might decide to go into debt to buy the plane ticket home for the funeral. Perhaps this is not as physically necessary as having a broken leg set, but arguably it's as psychologically necessary.
It seems EVERYONE wants to see health care costs come down. It makes sense to focus on that first, and track universality of coverage. If we do the right things with costs, coverage will become more wipespread. Without multiple government agencies running it.
I don't get how lowering costs necessarily widens coverage. Every other time we lower the costs of doing business, the business owners just keep it.
ReplyDeleteDan Carlin had an excellent piece about this on his podcast-be very, very careful about legislating lifestyle choices. Sooner or later, they will come for yours.
On, no you didn't. You didn't just seriously write that you don't see how lowered costs leads to expanded coverage? An example from my life:
ReplyDeleteWhen my family got our first VCR in the early 80s, we kids weren't allowed to touch it because it was very expensive. By the mid-90s, I headed off to college with one of my own, because they were so cheap. As demand for VCRs grew, the technology got cheaper and production more efficient. More companies got in on the act, forcing competition to make the best VCRs for the lowest costs. Presto. VCRS went from an exotic luxury item to something every college kid had.
When something desirable is produced, more people WANT it. In econ terms, demand goes up. So does the price (boo, hiss). BUT, there is profit to be made, so other producers get in on the act. That means more supply, forcing downward pressure on prices (yeah!). Over time, the price of EVERY new technology goes down, if you let the market do it's thing.
I don't advocate legislating anyone's lifestyle People should be free to do whatever they want with their bodies as long as THEY suffer the consequences, not me.
But the trap in your theory ("do what you want, as long as it doesn't affect me") is that the restrictions won't stop with unhealthy behaviors. Anyone who has a child is costing me money. Anyone who elects surgery over some other form of treatment is costing me money. Only in the power of a large enough group (say, all 300 million of us) can we even out these risks.
ReplyDeleteYour VCR example is well taken, except that health care isn't like that. You can't just decide to not consume it, the way you can decide to not have a VCR. And a low quality VCR chews up your copy of "Ferris Bueller". A low quality health plan kills you.
I'm not sure I understand your point (and we're arguing healthcare on too many threads now!).
ReplyDeleteI don't advocate restricting anything and certainly not legislating lifestyle choices.
I'm not sure there is such a thing as "low quality" and "high quality" health plans. There are different health plans for different needs. What is low-quality to a young couple with two kids and one income might be more than adequate for a young, healthy single guy.
You say my VCR example isn't relevent to healthcare. But it is. The costs of several cosmetic medical procedures and Lasik eye surgery have come down substantially over the last decade, despite the fact that they are medical procedures and despite increased demand.
One theory is that THESE are medical procedures that are responsive to a market (not insurance) and the prices have come down as demand increases, profits increase, technology improves, and competition for customers drives prices down.
I find it hard to believe that a free market drives down the price of food, healthcare not covered by insurance, cars, and pretty much everything else, but that it won't work for MRIs or open-heart surgeries.
"I don't advocate restricting anything and certainly not legislating lifestyle choices."
ReplyDeleteI couldn't agree more. Except you also said:
"...when a person chooses an unhealthy lifestyle, and that lifestyle contributes to health problems, it costs us all. There's no point in pretending otherwise."
"I'm not sure there is such a thing as "low quality" and "high quality" health plans. There are different health plans for different needs. What is low-quality to a young couple with two kids and one income might be more than adequate for a young, healthy single guy."
(http://bit.ly/18enC4 (from the New York Times, September, during a Senate health care debate.)
Senator John Kyl: "I don't need maternity care in my health insurance."
Senator Debbie Stabenow: "Your Mom probably did.")
Of course not everyone's needs are the same. But your needs change over time.
"I find it hard to believe that a free market drives down the price of food, healthcare not covered by insurance, cars, and pretty much everything else, but that it won't work for MRIs or open-heart surgeries."
A lot of people have this blind faith in the power of markets. Fat lot of good that did us in the fall of 2008.
But seriously, if, as you say, we had the same unbiased, full information about costs, benefits, and risks that we do in buying a car, then yes, market forces will work in health care. But running around insisting, "the market will do it!" is not a health plan. The way things are, they won't work.
We all would love to see health reform-every thinking person wants things to change. But there are a lot of very powerful, very rich people who are doing just fine with things the way they are. So don't hold your breath waiting for it to change.