Against healthcare theater

[archerships]

Megan McArdle has a long post on her reasons to oppose nationalized health care, most of which I agree with:

I know, most of you have already figured out why I oppose national health care. In a nutshell, I hate the poor and want them to die so that all my rich friends can use their bodies as mulch for their diamond ranches. But y’all keep asking, so here goes the longer explanation.

Along similar lines, John Mackey, CEO of Whole Foods, posted the The Whole Foods Alternative to ObamaCare

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

Arnold Kling posted an eloquent defense of the superiority of exit, rather than voice:

Neither my local supermarket nor any of its suppliers has a way for me to exercise voice. They don’t hold elections. They don’t have town-hall meetings where they explain their plans for what will be in the store. By democratic standards, I am powerless in the supermarket.

And yet, I feel much freer in the supermarket than I do with respect to my county, state, or federal government. For each item in the supermarket, I can choose whether to put it into my cart and pay for it or leave it on the shelf. I can walk out of the supermarket at any time and go to a competing grocery.

The exercise of voice, including the right to vote, is not the ultimate expression of freedom. Rather, it is the last refuge of those who suffer under a monopoly.
…
In fact, if we had real competitive government, then we would be no more interested in elections and speaking out to government officials than we are in holding elections and town-hall meetings at the supermarket.

Comments

[denshi.livejournal.com]

http://baselinescenario.com/2009/08/05/you-do-not-have-health-insurance/

[vyus.livejournal.com]

this is the weirdest thing anyone who has a college degree has tried to convince me of (i assume i might be part of their target audience).

i've always paid for insurance, and it was always contingent on that insurance, so it was never "permanent."

my insurance company certainly prices premiums using time value of money and risk assessment as if they were doing insurance.

[denshi.livejournal.com]

Is, uh, English your second language?

[vyus.livejournal.com]

no, but luckily all you posted was a link. i honestly don't get it, and yes i am smarter than most mckinsey consultants. (and i have no agenda except to look for good solutions)

A+++ for you going straight for snarky, tho. you might as well live in portland.

[denshi.livejournal.com]

Oh, I just found your writing style very oblique.

[vyus.livejournal.com]

i'm actually thoroughly confused by the link.

if i don't have insurance, why do they keep calling my insurer an insurer?

it is a confusing life, but again, i'm doing ok through it.

[denshi.livejournal.com]

if i don't have insurance, why do they keep calling my insurer an insurer?

Because all the risk factors for you not having insurance are strongly correlated.

it is a confusing life, but again, i'm doing ok through it.

Well, that's excellent. And if you weren't?

[vyus.livejournal.com]

nope, don't get it.

way to explain.

[denshi.livejournal.com]

Learn some math.

You heard it here first, it's gonna be big.

apples to oranges

[daphnep.livejournal.com]

For each item in the supermarket, I can choose whether to put it into my cart and pay for it or leave it on the shelf. I can walk out of the supermarket at any time and go to a competing grocery.


Oh, right. And when I get busted up in a car accident and go to a hospital for emergency care, I can choose to leave it on the shelf, or else go to a competing hospital.

Oh, wait...

Re: apples to oranges

[crasch.livejournal.com]

I agree that the analogy breaks down when it comes to emergency care. However, most medical care spending is not on emergency care, but for chronic conditions in which the person _does_ have a choice about which medical provider to pick. (In theory--the FDA, state insurance regulations, and various medical cartels impose several limits on medical choice.)

Re: apples to oranges

[daphnep.livejournal.com]

So how does one go about choosing a good bargain in cancer care, for example? (Providing one has at least some inclination to actually try for a cure...rather than homeopathy, I mean). How would you, for example, find the best deal in discount surgeons, if you were going under the knife?

I'm genuinely curious.

Re: apples to oranges

[crasch.livejournal.com]

I'd do it the same way that I would any other service--ask my friends who they would recommend, ask people who had gone under the knife their experiences, read the stats, if available (many hospitals keep records of outcomes, nosocomial infections, etc), ask doctors who _they_ would seek treatment from. If I didn't have insurance (and maybe even if I did), I'd also look into medical tourism.

Re: apples to oranges

[daphnep.livejournal.com]

So when you do this, how have you found the doctors and hospitals come through on the price quotes? I mean, how forthcoming are the surgeons and doctors about their prices, in such a way that makes comparison shopping effective?

Re: apples to oranges

[crasch.livejournal.com]

I haven't done it yet, as I haven't had any major medical problems. As I understand it, it can often be difficult to get a straight answer on prices from hospitals. As should be clear if you read the articles I linked, I'm not happy with the status quo either. (I just think that the currently prominent proposals for reform go in exactly the wrong direction.)

I'm hopeful that the success of companies like Qwik Health will put pressure on other medical institutions to make their prices more transparent. Removing the barriers to entry in the medical market as suggested in the articles above will accelerate that process.

Re: apples to oranges

[lds.livejournal.com]

You can't? Our local ambulance contract company will take unconscious people to the nearest of a "default" hospital chain, but if you're able to communicate with them, you can ask for a different hospital if you want.

Both of the hospital chains are pretty good around here, though, so I don't really care. The competition has worked very well so far.

Re: apples to oranges

[daphnep.livejournal.com]

So how does that work? Do they give you a cost estimate for treatment on the way?

Re: apples to oranges

[lds.livejournal.com]

No, they don't advertise price much... but they sure do make sure you have plenty of other information for making your choice! Billboards around town: "Our cancer center is better!" "Our birthing centers are better!" "We have all the imaging technology you can imagine!" "Oh yeah? Well we offer gyms so we can be of service to your health even if you ain't sick at all!" That sort of thing.

Re: apples to oranges

[daphnep.livejournal.com]

(To answer your question, I don't know about the ambulance, but I certainly know if I show up in the ER, no, I certainly can't. I either pay to be seen and the total bill comes later, depending on the diagnosis and treatment, or I simply decide I'm not that sick and go home. Out of all the hospitals I've sat in in many cities and many circumstances, I've never once seen anything even remotely resembling a grocery store experience.)

[vyus.livejournal.com]

i don't even get why it's a debate.

in order to have nationalized care, we need a government that can execute it (so to speak).

we don't have that. they don't even have a solution for medicare or social securities crises - which will just be a bigger version of the auto industry implosion (i credit rampant borrowing from the future - pensions - for the downfall of GM). and health care will just be a giant version of those programs.

our government cannot do it. even if we currently could collectively afford it (or rather, our lenders up our limit on our high interest credit cards).

gravediggers can't build planes - they haven't the schooling or the skill. you wouldn't insist a gravedigger to build you one to get you to france ASAP.

sanity is just... gone...

[h-postmortemus.livejournal.com]

My dilemma here, as with many other areas of capitalism, is healthcare is a fundamental attribute to survival. If a person is to live, they need basic things like food, clothing, lodging, transportation and medical care. Unlike the others, medical care is something you only need from time to time. But when you do need it, it can be more critical than anything else.

Capitalism is great, on the surface. But too many people can't reign in their critter-level greed. So you have drug companies bombarding people with advertising to create a social consensus about an illness that may not really exist. They push doctors to push the drugs by offering them financial incentives, giving them gifts, and of course free samples.

Consumers only have some choices in the medical marketplace. The grocery store analogy only applies to what you can buy in the grocery store. But the health care debate isn't about getting a fucking cold. It's about people suffering from cancer, being greviously injured in car accidents, or discovering they have Lou Gehrig's disease.

There's a lot of medical treatments that are purely vanity-related. Skin treatments, cosmetic surgery, teeth whitening, liposuction, botox, and more. It's hard to say there's an ethical need for that sort of thing to be covered. Just as there's a lot of room to debate the ethics of outsourcing labor to a 3rd world country where $1 an hour is more money than most people make in a month.

But when a health insurance company refuses to pay for a person to receive life-saving treatments in order to cut costs, there is no room for ethical debates. If you support that, then you put yourself into a category that many people desipise.

So yeah, I want health care reform. No doubt about it. There's a lot of proposals in the Obama plan that in general I have to agree with. Because I'm not a fucking inhuman Nazi who believes in Eugenics.

However, using tax money to fund health insurance is something I'm much less interested in. There's a lot of uninsured Americans who don't really need the coverage, and so they don't bother to get it even though they can afford it. There are some folks who don't believe in medical treatments. And there are a lot of lazy people who even when given coverage, won't bother to go to a doctor.

I think I'd rather see public funding of critical medical coverage issues, with an emphasis on children who's families can't afford to get treatment. But the mechanics of that sort of plan and avoiding fraud are very difficult.