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29 January 2011

Comments

George Rebane

This post was motivated by the comment stream from my last KVMR commentary on national healthcare here

http://rebaneruminations.typepad.com/rebanes_ruminations/2011/01/healthcare-one-more-time.html

The Informant

Me and my family are receiving free health insurance and $460 dollars in food stamps.After i applied within 3 weeks we were eligible.This is a true story.I found out that they pay for all my medical bills and my prescriptions,MRI,and x-rays.I went to healthcare-provider.info and clicked the medicaid link and applied.

George Rebane

That's very revealing Mr Informant. What did you say on your application that, in your opinion, caused you to be accepted and receive all these benefits?

Paul Emery

It's too bad that this discussion diverted into a clever but rather empty Biblical allegory. 50 million uninsured is indeed a crisis of Biblical proportions and will not go away despite the chest thumping over lower court rulings and obstructionist Republican tactics to whatever pathetic reforms have been enacted by the current administration.
Todd

I did all I could to find the example of a Democratic filibuster of Bush's healthcare reform proposals. No Luck. Can you refresh me with details. As far as I can tell there were none during the regime of either Shrub.

Todd Juvinall

Shrub? Sorry Paul, when you revert to namecalling I can no longer help you.

Paul Emery

Sorry my little attempt at humor offended you. I'm sure you'll apply you're newfound rules of civility to you're colleagues as well. Ex.. Reband "Ragheads" Rush "The Magic Negro" Glen "Whack em on the head" Beck.

George Rebane

Paul, I'm sorry that my efforts to liven an otherwise pedantic presentation of utility theory was apparently so objectionable that you dismissed the entire effort. Informationally it explicated the development and rationale behind such a utility metric for healthcare, and also presented it explicitly to serve as an unambiguous stake in the ground for discussing specifics of how a healthcare system might be devised to maximize its aggregate benefit to a nation.

Maybe I misunderstood the intent of your call for taking the discussion to such a productive level. You had me fooled.

Paul Emery

George

The situation as it exists today is a national disgrace. The fact that 50 million Americans have no healthcare provisions and rely on government assistance for any emergency means we now have national healthcare and a very poor form of it at that. Any discussion that does not take the immediate situation into account seems frivolous to me.

I'm reminded of a country music lyric
"While you're out there riding rainbows, life gets mighty lonesome on the ground."

My good friend being sent home to die happened last month and is happening every day to thousands of people right now. It that's not urgent I don't know what is.

Mikey McD

Shall I point out that NO ONE was covered by health insurance in Moses' time... more recently none of our grandparents would be caught dead begging for health care entitlements (at the working end of gun) with such extreme costs to personal liberty. The baby boomer generation has run up HUGE bills/debt, increased dependence on government, instilled an entitlement mentality in their kids... on and on we go... I suggest (again) the reading of Ayn Rand's masterpiece essay "Man's Rights"

http://www.aynrand.org/site/PageServer?pagename=arc_ayn_rand_man_rights

Todd Juvinall

Whilee we are all sympathetic with the plight of your friend Paul, I am unable to support the demise of my country for that sympathy. As a Christian I hope and pray your friend was a believer in Christ and he is now in a wonderful place. To destroy my home and country and become a slave to the Egyptians is not what I would call a smart move. Set my people free. Let us all help as we can help but not by the Pharaoh's coercion.

Paul Emery

To set the record straight my friend did not die but he had his second heart attack, as the doctors predicted after hsi first one that could have been prevented by their own admission if after his first one they would have corrected the problem they found. They did not because he didn't have health insurance. He was again rescued by 911 and emergency services and only then did they attend to his ailment and save his life. He was sent home the first time to die with a bag of pills and instructions to stay in bed and not work and that another heart attack was imminent. So instead of a through procedure the first time the costs doubled and were paid for by whoever pays for those things and untimely gets passed on to the general public. Whether you like it or not that's our national health care system as it exists today for people in serious need. We do not let people die in the streets so whenever this happens someone (taxpayers) pay for it. Socialized medicine? I think so. It's already here and there's 50 million uninsured who qualify for that treatment if they are in need.

RL Crabb

Funny how those who claim to value life so much can be so callous to the suffering of so many.

Todd Juvinall

I agree Crabb, Paul is callous and ungrateful. America is a very giving country. It appears the friend of Paul's got his affliction looked after and is now home. I apologize for thinking he had passed on. I am sure you have assisted many folks who needed help and you did not ask the government to come into the room. That is the bottom line. Any American can get help when they are in need. When they get the help then slap those givers in the face simply proves how selfish we are.

George Rebane

We can make public policy on the basis of emotionally charged anecdotal accounts such as Paul's now famous friend, or on measures that benefit the aggregate citizens of our country. The former is based on happenstance histrionics skilfully delivered, the latter on reason. If one were to assemble the similarly insane individual episodes that occur under nationalized healthcare, we would gain a totally different picture than the progressives promote. (Even the '50 million without healthcare' statistic miscommunicates the nature of this issue.)

I believe the main reason that the left does not want to approach the problem with reason (e.g. finding a policy that maximizes an HUM such as presented here) is that it might well point us toward a free market healthcare industry where participants in all sectors (providers, institutions, pharma, diagnostics, ...) can compete nationwide with minimal friction-creating oversight by the state. No collectivist regime in history has valued human life so highly as to take that risk or explore such possibilities.

There is no doubt, that we can do better than what we have. But many like me believe that with Obamacare we are headed in diametrically the opposite direction. And with a nation in hock up to its eyeballs, we will not get a second chance before there is blood in the streets.

Todd Juvinall

The left would rather all be treated poorly, you know, everyone is equal, then God forbid, someone gets a better deal. Crabb's comment is an example of that. If you don't agree with them on an emotional issue, you are a very bad and insensitive person. Sort of like the environmentalists do. If you want reasonable solutions and logic to a eco problem, they tell the world you are for dirty water and trash filled streets. This is their way to somehow feel superior to others. I dare to say we have probably helped many more with our own means than they ever have but we don't talk about it. We are too humble.

Michael Anderson

George, I found your allegory about the Israelite HUM to be quite entertaining as well as useful, but that is probably because I was following along on some earlier threads when your idea of HUM came to life. I just don't see why the HUM can't happen under the Affordable Care Act; in fact, my reading of the act is that one of the main goals is to facilitate a HUM, while still maintaining a private health insurance system.

Mikey, you wrote: "[N]one of our grandparents would be caught dead begging for health care entitlements (at the working end of gun) with such extreme costs to personal liberty." No one is begging for anything. The Affordable Care Act is attempting to regulate an industry that has spiraled out of control in a number of different ways: 1) it's the most expensive system in the first world, 2) it provides uneven care (lacking standards) across the country, 3) it is prone to various monopolistic predation, and 4) the band-aids that have been applied since WWII to fix it are all unraveling at once.

I want to take the repeal of the Affordable Care Act (ACA) off the table. There is still much work to do, but the ACA needs to be the foundation from which we move forward to create a HUM, contain costs and make health care delivery more efficient, and fix a system in this country with which no one can be truly happy.

Paul Emery

George

Yes my expression is emotionally charge as it should be. It's the situation 50 million Americans find themselves in right now. I do not discount the possibility of a free market solution to the problem but I only recognize the possibility not a likelihood since there is no evidence, by your admission that such a solution exists anywhere in the world today. Every modern country in the world except us has a form of national health care. According to your predictions they will all go broke drift into anarchy and fall into the control of totalitarian dictatorships. I don't happen to share that scenario.

Todd
It was because of the policies of the hospital that my friend was sent home not the desire of the dedicated and amazing people who provide medical care. They had no choice. By the way, isn't that health care rationing. Let's say two people are admitted with the same ailment. The one that has no insurance is sent home, the one with insurance gets the proper care so he can recover. Isn't that rationing according to the ability to pay? You're dealing with life and death here not free market consumer choices of clothes or TV sets.

George Rebane

Michael, if there is a sincere desire to establish a broadly acceptable HUM, then progress can be made even if we constrain the starting point as you suggest. Perhaps I have overlooked something in the current legislation (it's easy to do), but I see no evidence of any process toward a HUM or even one that has been forwarded by diktat.

Wouldn't the better way to proceed be to have us chickens here in NC develop a HUM (e.g. for openers fill in the constants on the one I suggested here), and then see how Obamacare calculates out on that.

A productive approach might be for various alternatives to have champions - e.g. you could champion Obamacare, Mikey might take a more free market approach, I have some specific ideas of my own I'd like to push through a HUM like this. And I bet some other readers like GregG could bring in their ideas, and then we could compare and critique how they stack up.

The 'Moses HUM' is rich enough in structure to support an a very interesting analysis of competitive systems. And we would all come out wiser in more ways than we can now predict. Thoughts anyone?

Todd Juvinall

Paul, because I have paid for insurance my policy gets dinged for more because those without insurance cause the hospital to charge me more so they can treat the uninsured. Is that fair? Is not a person somewhat responsible for themselves? If your friend (and I am not dsaying he is) a person that is way overweight from too much eating, or smoking or drugs or alcohol abuse, where is the line drawn for my responsibilty to pay his bills? Doesn't a person have the ultimate personal responsibility for themselves?

George Rebane

Yes Paul, rationing always exists for limited resources. In a free market operated by a benevolent culture (and there has been no more benevolent culture than America's) the rationing is by price. It always guarantees supply and the impetus to reduce the price and increase the availability of that supply. And to the extent that the government does not mangle that market, the system has worked beyond all imagination. History is our witness.

I can go emotional anecdote to anecdote with you any day of the week. In the fall of 1949 there was no government healthcare, and the government stayed out of that business. My mother, a dirt poor factory worker in a New England thread mill with a heart valve shriveled by an earlier bout of rheumatic fever in Estonia, had a relapse. We lived in a one and a half room apartment in Willimantic. Every pay check went to pay for food (we ate kidneys a lot), rent, and second hand clothes.

Mom collapsed, was admitted into the hospital, and was under some pretty intense care for over three months. Unbeknownst to us, a Catholic church charity stepped in and took care of the entire bill. (BTW, we are Lutherans) They later sent us a letter saying pay us back when you can if you can. That's the way the country worked in those days.

I have to beg some pardons here, but a lot of highly emotional fuzzy thinkers around here don't know jack shit about being poor, desperate, and being helped by the open-hearted goodness of their fellow men. Talk about the greatest generation. And if you want a lot more of what it was like for the Rebanes and others of that age moving west, I can tell you over a bottle of wine.

Bottom line, bureaucratic solutions ALWAYS start with emotional anecdotes, and always wind up allocating resources - i.e. rationing - in the most inhuman, cold-blooded, and inefficient ways imaginable. Why, because the corrective feedback link to cost and performance is broken.

Paul Emery


Let's look at another angle, Here's the compensation for Health Care Insurance executives in 2008.

Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

While in itself it may represent a small percentage of the costs of healthcare doesn't it indicate huge salaries for executives at the expense of the insured. What can these people possible do that is worth that salary and doesn't it point to the possibility of other bloated expenses.

http://www.healthreformwatch.com/2009/05/20/health-insurance-ceos-total-compensation-in-2008/

Mikey McD

"[N]one of our grandparents would be caught dead begging for health care entitlements (at the working end of gun) with such extreme costs to personal liberty."

The point I was trying to make is that past generations would never FORCE their neighbors, kids or future generations to pay for their health benefits (pay with liberty or $). Literally all of my grandparents died with dignity at home and not as a result of poor insurance or lack of government control. They were of a generation where you lived and died with dignity and asked nothing more of your neighbor than to do the same. They had no debt either (financial, to the collective, their conscience or spiritually).

Today's generations FEEL entitled when a hospital bill is more than their cable bill that society owes them...

I agree with Rebanes comment: "I believe the main reason that the left does not want to approach the problem with reason (e.g. finding a policy that maximizes an HUM such as presented here) is that it might well point us toward a free market healthcare industry where participants in all sectors (providers, institutions, pharma, diagnostics, ...) can compete nationwide with minimal friction-creating oversight by the state. No collectivist regime in history has valued human life so highly as to take that risk or explore such possibilities."

Michael Anderson

George wrote: "A productive approach might be for various alternatives to have champions - e.g. you could champion Obamacare, Mikey might take a more free market approach, I have some specific ideas of my own I'd like to push through a HUM like this."

Sounds pretty good to me. Can you set up a facilitation construct on this blog that is more than just a catch-all for comments? I will dig into my resources to see if there any typepad bolt-ons that can verigate comments, and then produce reports.

Michael Anderson

Mikey wrote: "The point I was trying to make is that past generations would never FORCE their neighbors, kids or future generations to pay for their health benefits (pay with liberty or $)."

But Mikey, we can no longer live in the past. Other nations dealt with the health care conundrum decades ago and they have moved on--their per capita health care costs are as much as 20% less than ours, and everyone is covered. Those are just cold hard facts.

While the US Constitution is a wonderful document in so many ways, we are still battling over some very old disagreements between state and federal rights that are really an anachronism from our provincial history.

In 1942 the United States Supreme Court ruled that a guy growing wheat in his back yard for his own use, yet exceeding his federal allotment, violated the Commerce Clause. It boggles my mind that anyone today can claim that health care, representing 16% of the United States' 14 trillion dollar per year GDP, is not a federal economic concern.

My Blue Shield rates have gone up 30% since the ACA passed, and I still support it. I wanted a single-payer solution for efficiency sake, which would have saved me a lot of money. Now I am paying for Blue Shield to cover themselves for the mandate of covering everyone, but I support that in the hopes that eventually the insurance industry will become more of a utility, and my rates will go down.

Mikey D., how many utility companies vie for your energy business by sinking power poles next to your house? And yes, that is a rhetorical question.

Todd Juvinall

Paul, when you bring up the salaries of CEO's from the free market you expose your bias. I could care less how much someone makes as long as they are not a Bernie Maddoff. The insurance industry is still almost a free enterprise business and if the government would stay out of it my guess is more people would be able to afford it. Please post your yearly earnings here along with your benefits and any other income you receive so we too can comment on your personal money.

George Rebane

Michael - I was thinking of handling that by setting up a category (on the right panel) for 'Healthcare', and invite the participants ('champions') to publish their articles there. Just email me the Word file of your byline, and I'll post it. If you can find more facile ways to do it, please let me know.

Paul Emery

So Todd, according to you we cannot include the salaries of top insurance CEO's in a discussion of health care costs. What about the nearly one billion dollars the medical industry paid for lobbying last year year? Thats a lot of money spread around to influence legislation that is paid for by somebody-I wonder who?

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George Rebane

Paul, of course you can bring up all kinds of such issues that attempt to micro-manage private enterprises. It is the natural thing to do to keep this subject on an "emotionally charged" basis. I don't think it is a productive approach, but for people without alternatives it may be the only available approach to involvement.

The point has been made numerous times that health insurance costs are a red herring in this discussion. Now you again raise them in the detail of pointing to government regulation of insurance exec salaries, etc. I think your mind was made up a long time ago on socialized medicine, and you have demonstrated on this subject that you do not want to proceed in a serious manner. Count me out of such discussion threads. Todd, he's all yours.

Paul Emery

You have added your personal values to my concerns about the costs of executive salaries and lobbying in the health insurance industry. Health insurance costs are a red herring? Who says? Not me. Never once did I imply in this discussion that the government should regulate salaries in the system as it exists today. I was only pointing out what these costs are. That's a pretty clever way to avoid discussion. It's your blog, you set the rules and make the determination when to cut off discussion when it's no longer convenient. Fair game.

George Rebane

Paul, if it's not a red herring, then you should be able to show from the public corporations' cashflow sheets that executive salaries and lobbying costs have a material effect on margins and services offered. (You could make the case for GE.) My arguments have nothing to do with personal values and all with dollars and cents. Make your case.

And BTW, I am not 'cutting off' any discussion on your "emotionall charged" approach. (Gratuitous charge?) I just expressed my own propensity to join in when more productive courses are available. In fact, I invite you to continue illustrating the left's approach to such issues of public policy. It is an existential reality of public debate in our land, and its features should be known to all.

Todd Juvinall

Paul, the reason the left always brings up salaries of a free market is to elicit class warfare. Why is it right for the government to set a salary? What if they decided to set your salary, would that be fine with you? I think not. The wage and price controls installed by Nixon were a disaster and if you recall it was deemed by Americans to be anti-capitalist. It was withdrawn fairly quickly, because, like anything the government comes up with to take our money, someone outsmarts them. Emotionally I support the position of helping your friend. I am sure you assisted him in exploring every avenue of help. Churches, government assistance, hospital forbearance, etc., maybe even loans from his friends or gifts? That would be the best way to proceed. It seems based on your communications here that your friend was successful in getting the help. That is why I love this country.

Paul Emery

Todd

There you go again. I never proposed the government set salaries in the current system. I was only pointing out executive salaries at a time premiums are rising. Also, the expenses of lobbying to effect public policy.

My friend did get help at an extremely high cost that someone picked up the tab for in a very inefficient system that couldn't address his problems when he first came in. The argument for national health care is that that the cost would be much less. Again, we now have 5o million uninsured that fall in that category if they have an emergency. Certainly a universal catastrophic programn or requirement would go a long way to solve that problem.

Todd Juvinall

Paul, so your friend did get help and is now on the road to recovery. What is your beef then? Regarding salaries, why would you list them if you weren't trying to stor up people to dislike the CEO's? It is SOP for the left to do this while never listing the salaries of their buddies in say, the Unions, eco groups, consumer advocates, ACLU types, ETC.

Paul do you support the Environmental lobbyists that pushed hard for EPA listing CO2 as a danger? This one act will cost the poor of America a gazillion bucks. Or do you only dislike "our" lobbyists?

Mikey McD

George, trying to settle on a HUM with folks who do not value personal liberty and worship government as their god is an exercise in futility.

Paul Emery

Mikey

Since you are now entering the discussion as an "emotionally charged" participant, something I have no problem with, I must chime in that my experiences with citizens of Denmark for example, that you probably categorize as "Socialists that do not value personal liberty and worship government as their god" is quite different. If everything is simplified into slogans that fit pre-conceived notions that are not sustainable with any close examination or discussion it does not serve any useful purpose. Believe me I can make that same critique of colleagues on the left as well and quite likely myself included. It's just not that simple.

Todd

Why can't you simply accept as part of the discussion on health care costs the possibility that excessive salaries and spending might be a contributing factor to spiraling health care expenses that are passed on to the consumer. That's all. Why do you keep trying to divert this into a different direction.

George Rebane

Paul, we don't have to consider the 'possible' effect of "excessive salaries", we can look at their financial statements and nail that issue. This is an objective determination that you should provide as the one making the charge. But I do suggest that if there were even a hint that executive salaries have materially cut into insurance costs OR benefits, the Democrats would have made hay on that. That all they could do was talk about the overall cost of health insurance and demogouge the rest of it should give everyone a clue that here there is neither smoke nor fire. Prove us wrong instead of considering indeterminate possibilities that take us nowhere.

Mikey McD

Paul,
Denmark is the most taxed country in the world with a tax-to-GDP ratio of 48.9%. The income tax in Denmark ranges from 42.9% to 63% progressively; I rest my case. My 11:55am comment was fact/reason based, not "emotionally charged."

Paul Emery

I doubt if the Democrats would even consider taking on the insurance companies on an issue like that. Where do you think that Billion dollars of lobby money goes? Please don't brand me as a pro Democrat on this one. Obama wrote the bill that the insurance companies wanted. It was a good return on their lobby money investment. You don't think that money is spent for no other purpose do you?

Yes indeed Denmark is a highly taxed country I don't dispute that. I don't want to go into the comparative quality of life issues again. I doubt they will be seeing the bayonet any time soon.

Mikey McD

Limit the power of government and you limit the power of lobbyists. Limit the power of government and you unleash the benefits of the free market capitalist system for all concerned (better health care, better education, more liberty).

Paul Emery

I like your rhetoric Mikey but would you like to compare our education, healthcare and quality of life with Denmark? Of course I'll expect the argument that it's not sustainable.

Mikey McD

quality of life with Denmark- "Denmark is the most taxed country in the world with a tax-to-GDP ratio of 48.9%. The income tax in Denmark ranges from 42.9% to 63% progressively; I rest my case. "

Mikey McD

Paul, what would your 'Denmark Health Care Solution' look like? And yes, is it sustainable?

Paul Emery

Mikey
Thanks for asking. I will give you a detailed response but not for a day or so. It's late and I'm swamped tomorrow with work, an annoying inconvenience.

Paul Emery

Here's something to start with. It seems that this "socialistic" health care system is leading the way in at least this technology. By the way, the Danish system leads the world with user satisfaction with over 90% happy with their health care. We are somewhere in the 40's.

http://www.nytimes.com/2010/01/12/health/12denmark.html

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