Sentences to ponder

I don’t understand why everyone is discussing plans that have only slightly to do with the plans being drafted by the House and Senate Democrats. Both plans have an individual mandate, with tax penalties for the young who choose to be uninsured. Sure, Candidate Obama criticized a mandate, but Candidate Obama criticized giving away cap-and-trade allowances too.

“What we should hope for–the best case, I’m afraid, that we can actually hope for–is a future in which it is possible for people to buy excess benefits outside of the public plan. And the insurance ‘reforms’ that are intended to drive people to the public plan will, if left in place, prevent that from happening.”

OMG, two tiers. Are suggesting we aren’t all equal?

/sarcasm

She appears to have the delusion that buying individual health insurance is practicable. Is it an unspoken assumption in this debate that insurers will be required to provide insurance to customers?

Many of us who are under 35 and perfectly healthy who are routinely unable to acquire even limited insurance except through our employer group plans. One friend spent months determining that in California, it is simply not possible.

It’s considerably more possible in some states than others. California has a form of modified community rating, so yes, it is not possible. The same is true of New Jersey. Other states require insurance to cover certain things, so buying a catastrophic insurance plan is difficult, though possible. However, in some states individual catastrophic health insurance can definitely be purchased.

Your complaint is analogous to living somewhere with rent control and complaining that it’s impossible to find a good apartment for cheap without knowing someone and getting into a controlled one.

Both the House and Senate Democratic health plans have a form of modified community rating as well as a mandate/tax penalty for indviduals who don’t buy and stiff requirements for what insurance may cover, so I presume that Megan’s objection will not hold.

“People are misunderstanding the point of the exercise. The entire idea is to move to a single-payer system, but to do it in such a way that it seems as if everyone voluntarily made the move.”

Is that Tyler’s plan? Megan’s plan? Ezra’s plan?

The system of health care that works is despized by large numbers of inexperienced patients and lots of god-complex doctors: true HMOs and other similarly health focused community plans.

The doctors and hospitals must not be rewarded for doing more, or harder, stuff. It seems that patients fear them because they expect that not getting heart surgery is a bad thing, which is the primary goal of everyone at a well run HMO. Some doctors, like surgeons, think every patient should get heart surgery, which all the doctors on the team of an HMO reject as a good standard of care.

Single payer produces some of the most expensive health care, especially in poor, conservative parts of the US. Like McAllen Texas, one of the highest cost according to the single payer Medicare data.

But the issue at hand isn’t what is the single best system, which I’m convinced is totally impossible, but how to eliminate all uncompensated care and do so without closing all ERs, clinics, and requiring a change in the medical ethics codes and repealing all laws requiring medically necessary care be provided and prohibiting dumping sick people on the street at midnight.

Once everyone is insured in some fashion, then the matter of maximizing health and minimizing cost can be tackled in systematic ways.

Like letting people pick the plans based on price and performance, without the providers picking them. Ideally, the doctors and hospitals in McAllen Texas are forced to find an insurer that will provide coverage for their patients and then be forced to complete with a Mayo style HMO which delivers better care for less than half the cost in McAllen.

The only requirement is each plan charges its customers/patients identical prices and covers enough so nothing will ever be uncompensated. That basically means any care required by medical ethics would be paid for, and if a team of doctors argues mothing more makes sense, there would be no public outcry.

For anyone to think that non-health science trained individuals (patients) can objectively determine the best possible health care for themselves is irrational; teams of health scientists with the means to run studies and collect and analyze data can’t do it. And to think a doctor can do what teams of doctors and actuaries and health researchers and behaviorists can do with great difficulty, as in cases like Mayo, is irrational.

But people have their own preferences, often irrational, so the economics question is how to provide choices that are equivalent, and operate like a true market. When you go buy a TV or PC, the salesman doesn’t look at you, at least in a “free market” and say, you’re black, so your price is twice the white price, or you are sick, so your price is twice that of a healthy person. Buying health insurance should be like buying a TV. All (new) TVs sold in the US have long been required to meet certain minimum requirements for more than half a century. Those minimum standards have been good for TV sales, not harmful. The minimum standards for health care are more complicated, but economists should be working on how the market for health insurance works as well as the market for TVs.

I’m not sure that “you can’t get insurance if you’re going to use it” is an improvement over “you can’t get insurance at all”, but at least the discussion can match reality.

Insurance is a hedge against uncertain future costs. If you know you’re going to use it, it’s not insurance, it’s “I want somebody else to pay for my stuff”. Most of our problems with health care stem from an inability to distinguish between the two.