universal healthcare

[Jester]

Once health care is a freely given away commodity (by the government), perhaps with some rationing even, I believe the populous will consume all that the government has to offer. The wages of care givers will be more or less fixed in that area, and so, as in other countries with socialized medicine, the number of care givers will never satisfy the demand. This is a recipe for price inflation for those that pay, and limited care and waiting lists for those who do not pay.

... do I even have to repeat the argument again? Look at the experience in other countries. Look at it on the whole, not just at anecdotes that confirm your presuppositions. Look at costs. Look at outcomes. They work. They are not drowning in a sea of Munchausen's patients, demanding MRIs and heart surgery three times a day.

We talked already about the anarchy of law, where it will cost $695 to break the law, or many thousands to follow the law. We talked about the budget gimmicks, double counting of savings, and other accounting shenanigans to create an entirely fictitious unbelievable CBO number.

Depending on how you parse the CBO numbers, and what you include as being part of the health care bill, the number is either slightly positive, or slightly negative. It is not "entirely fictitious [and] unbelievable," unless of course you've already concluded that this is going to cost a zillion dollars, and refuse to believe any number that says otherwise.

Of the 30 odd million uninsured, 9.6 million of them are in the US illegally.

Try 50 odd million, thanks to the recession. And that's just those uninsured for a whole year - the number for the transitionally uninsured at any given time is much higher. Your 9.6 million figure is for all immigrants, including legal ones. Check here.

12+ million will be added to the medicaid roles by raising the lower threshold of the % of the poverty level that qualify and the States are expected to pick up these additional costs. A $500 billion cut to medicare, which will result in fewer services, rationing and waiting lists for seniors. So the two huge deficit running government programs will get worse, both in driving up costs and offering poorer services.

They're set to reduce the growth of future spending on Medicare by $500 billion over 10 years. Is that a "$500 billion cut"? Maybe. It depends on how they go about containing costs. If the system is as terrifyingly inefficient as it seems to be, I have no trouble believing that there is $50 billion a year in excess cost growth that can be prevented. But we'll see.

Regardless, leaving aside "kill grandma" imagery, the quantity being spent to keep seniors alive cannot increase indefinitely. The question is, how much can you afford to spend, and what level of care can you get for that sum? The scary CBO projections involve the idea that you will spend almost limitless amounts, and get whatever care that buys. That's not a realistic way to look at the problem.

Some 8 or so million of the uninsured will be now covered by raising the age of what constitutes a child (for insurance purposes) to age 26, so ostensibly, children will remain on their parents insurance (while their plans remain solvent).

Great! 8 million more insured. Social costs go down, risk is dispersed more evenly.

Drug companies get richer by adding a bunch of new customers, and will be the beneficiary of the closure of the "donut hole".

Well, them and anyone paying for drugs in the "donut hole," right?

The government will implement one of the largest tax increases ever by by applying income tax rates to rent, interest, dividends. For rental income, this will be directly passed onto low income renters, and businesses that lease property.

Not onto high income renters? Landlords are fomenting a class war? Or just really hate the poor?

Regardless, the tax structure can be dealt with separately. For all useful purposes, federal government revenue is one big pot, and you can consider any dollar collected as going to any source. In practice, it's not quite so simple, but if they had any sense, it would be.

And, the mandate on employers to provide 100% coverage of face a minuscule fine ($2000 for the first 30 employees) will encourage rather than discourage employers (especially those that hire low income people) to skip providing health benefits and just pay the fines. Estimates are the up to 10 million people will lose their insurance due to employers ending their plans altogether. The non-partisan Lewin Group estimates that Obamacare will drive a total of 56 million people off their current health care insurance.

Providing insurance through employers was always a stupid idea. If this gets people off their current, employer-based insurance, that's a win for future reform. They'll still have insurance, thanks to the new system, and it will be easier to fix later.

The issue of the size of fines is a problem. I suspect fines large enough to work are also fines large enough to make the issue moot - just charge people/employers for the health care directly. I see this as one of the largest issues with the system, and a major argument for single-payer or government run health care.

New federal regulations and punitive taxes on high-ticket medical expenditures such as medical devices, prescription drugs, and high-cost insurance plans will drive up the health insurance premiums, particularly in the individual market.

We'll see about that. Insurance premiums should not respond to taxes on insurance - that makes no sense. Why would people pay more (retail) for something because they have to pay more tax on it? That should drive down prices, not up.

Regulation may have the effect of raising premiums. I haven't seen this in the predictions, but perhaps they are not considering it.

The whole risk aspect of health insurance disappears due to removing the lifetime cap on benefits, and the denial of people with pre-existing conditions. Group health plans will need to jack up their prices to cover chronically ill people now. And, yes, this does sound great when you are envisioning people with diabetes. I too thought it was pretty lame to offer insurance to those who didn't actually need it.

I'm not sure what you mean by the "risk aspect of heath insurance disappears". Risk is the entire point of insurance. Are people no longer going to get sick at different times, to different extents?

Somehow, a functional insurance system has to have the currently healthy subsidize the currently sick, in exchange for protection against future illness. You get to breathe easy, but the costs are distributed evenly across time and across people. Overwhelmingly, people who have such a system appreciate it. However, the young and stupid have a short-run, selfish incentive to defect from the system while it is less likely they need it. Another great argument for just making the whole system single payer - you don't have to bother playing this game, and you don't suffer the consequences of playing it wrong.

But then, what about the epidemic of restless leg syndrome diagnosed in California which qualifies one to get prescriptions for pot?

Easy solution to that - legalize it.

I really do want people who need health care to be able to get it, but the bulk of the cost will be consumed by this kind of general abuse by the not so sick. Yes, so we will stick it to those greedy insurance groups who make the measly 3.5% profit now, and drive them out of business. What's making us sick is an epidemic of diagnoses

The notion that the "bulk" of cost is consumed by people who do not need treatment is absolutely wrong. Show me one study that concludes anything even close to that. By my understanding, chronic conditions make up the bulk of expenditure.

The changing social nature of diagnosis has raised costs substantially, although it has also improved outcomes. That diagnosis cannot continue to increase forever and ever is one of the things that makes me skeptical of the projections for perpetually increasing medical costs. However, curbing this problem will be difficult if not impossible if doctors are selected for "customer service" in a free market system, rather than for medical competence in a system driven by professional ethics. People don't want to hear that treatment really wouldn't be worth it. They want to hear that there is a magic cure. Doctors make money off of providing that cure, whether it really works or not. The actual medical logic behind it is quite secondary, and this drives up costs.

I don't believe it will fix what is wrong with the US health insurance market, and it is not a baby step in the right direction unless you believe that perhaps destruction of the market is the correct first step.

Replacement of the market with a single-payer system absolutely strikes me as the correct first step. This goes halfway, and it is still unclear what the results will be. I predict moderate gains in outcomes, and small reductions in costs. Further reform should focus on costs much more heavily.

This all but guarantees that health care costs and spending will continue their unsustainable path. And that is a path leading to more debt, higher taxes, fewer jobs and a reduced standard of living for all Americans."[/i][/indent]

Classic Cato, ignoring any sense in which (all together now) HEALTH CARE IS NOT LIKE OTHER COMMODITIES!

I have personally been the beneficiary of two different single-payer health care systems. I use them almost never. Were I more rational, I would probably go to the doctor slightly more often than I do, for checkup and preventative things. But I don't like doctors. Very few people do. My family does not overuse health care. My friends do not overuse health care. It's just not what people do. We do not think of it in that way.

But, if Cato is to be believed, I should be consuming as much health care as I can get my hands on. This is not how people act, it's not how I act, and it's a stupid assumption that drives conclusions contradicted by the evidence from the entire OECD for the last fifty years. Taking one's ideology over empirical reality is living in a fantasyland, not that this has ever stopped the Cato Institute.

-Jester