Home › Blogs › Jacob's blog ›

Debunking Some Common Health Care Myths

Submitted by Jacob on Fri, 09/18/2009 - 10:13

Many people with a cursory knowledge of America’s health care system – limited mostly to forwarded emails and CNN – have an incorrigible habit of comparing our system to Canada’s and, after presenting a few “basic” facts, proclaim victory in the ideological war on socialized medicine. I would not say I am an expert myself, but I do know the basis for many of these facts and they certainly deserve some attention. For those of you who are unfortunate enough to have to constantly read the afore-mentioned articles (or perhaps worse, have listened to these arguments being made by friends and family), here are a few responses to the more common claims I’ve come across.

Life Expectancy. These figures are often different from one report to another, but the idea is that life expectancy is 2-4 years higher in Canada than America. Ergo, they have a better health care system, right? Maybe, but not necessarily. First let’s all confess that in the course of 80 or so years of life, one’s decision to smoke, abuse substances, avoid exercise, seek unhealthy food, get hit by a bus, get shot in a homicide, fall victim to a car accident, and, worst of all, inherent genes that lend oneself to a high probability of suffering from a chronic illness have more to do with how long one lives than does the payment method at one’s local hospital.

Two points reinforce this idea. First, after eliminating victims of accidental deaths and homicide from life expectancy measures, the U.S. ranks number one in life expectancy. Second, a simple comparison of life expectancy across states, let’s take Nevada (75.9) and Utah (78.7) for example, where health care systems are nearly identical, shows that a difference of nearly three years must be attributable to something other than the health care system.

Infant Mortality Rate. Another common statistic perpetuated by bemoaners of the American health care system is the comparatively low infant mortality rate north of the border. The U.S., like most other things, is the world leader in yet another dubious category that may partially explain this apparent oddity. Teen pregnancy rates in the U.S. are far and away the highest in the world and nearly triple those of Canada’s. Moreover, teen pregnancy has also been linked with low birth weight, a common cause of infant mortality that is beyond the control of any medical system, regardless of who pays the bill.

A recent article in the Journal for American Medicine discussed the successful narrowing of the gap in infant mortality rates between blacks and whites in a particular county in Wisconsin. Their findings indicate that only when the percentage of low-birth weight children could be lowered amongst blacks did the disparity between white and black infant mortality rates diminish. Again, culture and behavior may have more to do with infant mortality rates than the quality of health care delivery systems.

Administrative Fees. The story goes that government-run medicine is more efficient than the private insurance industry because the administrative fees for, say, Medicare are only 3% while for private insurance it can be upwards of 20-30%. Let’s ignore the laughable claim here that anything run by the government could possibly be run more efficiently than by the private sector. Instead, look at the numbers. Yes, while as a percentage of operating costs, Medicare dedicates a smaller percentage of its total spending to administrative duties, the reason is actually because the cost per beneficiary is so high that its huge administrative burden appears small. In other words, because Medicare spends so much more in sum than a comparable private insurance company, the administrative costs appear lower as a percentage of total costs.

And, of course, let’s not forget the incredibly unequal comparison between a government-run program which seniors are essentially forced into (under the threat of foregoing Social Security benefits) and a private insurance company which must dedicate a share of its expenditures to marketing, borrowing, and taxes (no small burden, in case you weren’t keeping up).

America has a free-market system; Canada has socialized medicine; yet look at all these great statistics I’ve found! Let’s be perfectly clear: the U.S. is a long way from having a free-market health care system. Not only are large sectors of the system dominated by nearly pure forms of socialized medicine (Medicare, Medicaid, TRICARE, etc.), but even the “private” sector is highly regulated, taxed, subsidized, and otherwise controlled more by Washington (or your local state capital) than by the consumer.  To be clear, the CBO studies that have been released in recent months have been on the unsustainability of Medicare and Medicaid, amassing an estimated $37 trillion in unfunded liabilities over the next 75 years.  Meddling in private markets has caused the most heavily regulated states, like Massachusetts, New York, and New Jersey, to likewise have the most expensive health insurance in the country.  The opposite can be said for the least regulated states.

No individual can purchase insurance across state lines. The price a doctor or hospital charges for even basic services is often virtually unknown. One out of every ten dollars spent on health related expenditures comes out of the consumer’s pocket. The government intends to limit how much someone pays out-of-pocket, and how much the insurance company must provide. These are hardly free-market principles.

Nationwide, there are over 2000 insurance mandates at the state level. These mandates dictate what benefits your insurance must cover, who must be covered, and in some states how much you must pay in relation to your (sickly, over-weight, obese, and aged) neighbor. In several states, I, a young, healthy, non-smoking 22-year-old would have to pay the same rate as that damned neighbor I just described. And only according to the Left would a country where individuals are required to purchase insurance against… alcohol and substance abuse even if you don’t drink (47 states), diabetic supplies even if you don’t have diabetes (47 states), maternity minimum stay even if you will not or cannot be a mother (50 states), breast reconstruction even if you have no intention of reconstructing your breasts (51 states), autism even if you’ve never met anyone with autism (23 states), and hair prosthesis even if you like being bald (10 states)… a “free-market” system.

These are but a few of the arguments made, but they are probably the most likely that one will come across. To be fair, none of these counterarguments are intended to be interpreted as “America has a superior health care system.” It’s just that these statistics are often superficial, inaccurate, oversimplified, and should be left out of the debate altogether.

3
Your rating: None Average: 3 (1 vote)

Comments

Blackwater

Submitted by Mead50 on Fri, 09/18/2009 - 10:33.

Let’s ignore the laughable claim here that anything run by the government could possibly be run more efficiently than by the private sector

Hmmm... I'll take the Marines over Blackwater, my local PD over Brinks, and my local high school over the parochial school at $6,000 a year, and my state university over a "bible college".

The private sector was essentially allowed to "self regulate" on Wall Street over the past several years....how did that turn out?

Did you miss the news yesterday about the teabaggers complaining that government run DC Metro didn't put on extra services for them, so they had to turn to private sector solutions (taxis).

Administrative costs take 31 cents out of every health care dollar in the U.S., compared to 17 cents in Canada. Why? Private insurance companies spend much more on paperwork and administrative overhead, and require armies of cubicle dwellers to do it. Blue Cross Blue Shield employs 6,682 workers to cover 2.7 million subscribers in New England, which is more people than work in all of Canada’s provincial health care plans, which cover over 25 million people.

Your comparisons between the

Submitted by Jacob on Fri, 09/18/2009 - 12:56.

Your comparisons between the Marines and local PD to Blackwater and Brinks are incompatible to the health insurance industry.  The Marines and local PD provide a common good to which we all benefit equally, whereas the beneficiaries of Canadian medicine benefit individually as each patient comes into the doctor's office.  I like the Marines too, as do many others, which is exactly why our Constitution enumerates the power of a common defense to the federal government.  No mention of health insurance though, I'm pretty sure.

As for private and public schools, your tax dollars subsidize public schools and hide their true costs.  Regardless of that point, though, the difference is that you have the ability to choose and are not forced into either.  (Speaking of a public option, though, have you noticed the analogous outperforming of public schools by private ones AND spiraling costs in higher education despite the public universities "keeping private schools honest"?  Interesting..)

As for the "self regulation" of Wall Street, take a look at this article.  It makes a pretty compelling argument to the contrary.

Lastly, your concern for the higher cost of adminstrative aspects of business can largely be addressed by reminding you of the incredible complexity that government introduces when it forces regulation upon regulation on insurance companies.  The current laws dedicated to Medicare take up 110,000 pages, whereas the system is Canada is presumably more simple.  That is also not a convincing argument for Canadian health care.  Even if it only took one person to run an entire system it would not necessarily mean superiority. 

I could run a stunningly good public school

Submitted by Mead50 on Fri, 09/18/2009 - 13:10.

which is exactly why our Constitution enumerates the power of a common defense to the federal government.  No mention of health insurance though, I'm pretty sure.

No mention of police, fire, eduction, or air traffic control in the constitution as well, I'm pretty sure.

have you noticed the analogous outperforming of public schools by private ones

I could very easily produce an amazing performance from a public school by simply following the private school practice of expelling students who don't maintain at least a C average or who act up in class.

The amount of regulation that the government imposes on insurance companies is not what is driving up costs - it is the amount of regulation that the insurance companies imposes on doctors and hospitals that is the problem. And no, the two are not related. The private insurance companies have hordes of cubicle dwellers whose sole purpose is to deny and delay payments and coverage.

Why did 7 out of 10 doctors in a survey reported in the NEJM support the public option in one way or another?

You're missing the whole

Submitted by Jacob on Fri, 09/18/2009 - 13:56.

You're missing the whole point of the "common goods" argument, like protection from fire and the police department, but I'll just drop that because it's clear you won't get it.  As for education, you're right, it's not mentioned in the Constitution, and I see no reason that the federal government should usurp power from the states and deem itself the ultimate authority on education standards.

But, back to health care... How can you claim government regulation is not driving up the costs of health care?  Whenever the government mandates that your insurance must cover something that you would not normally choose to protect yourself against, that is an additional and unnecessary cost being imposed on you.  When the government forces an insurance company to charge the same for an old, sick person as it does a  young, healthy person (called community rating, a policy in 6 states I believe), that drives up the cost b/c young healthy people choose to forego insurance and leave the older and sicker people in the pool -- adverse selection.  Guess what happens to the rates for the people who are left.   And when government doesn't allow you to buy health insurance from across state lines and instead forces you to comply with the often burdensome state-level regulations, that means people cannot buy insurance that properly suits their needs and they ultimately must pay more than they need to. 

That's government driving up costs..

 

I'm sorry, but the days when you could convice people

Submitted by Mead50 on Fri, 09/18/2009 - 14:49.

that all we need is a free market solution and less government inter fence to reduce health care costs have long since past.

If that is all that is needed to fix our system, why wasn't it done from 2000 to 2006 when Republicans had control of the federal government?

Show me the government regulations that force private insurers to employ large numbers of staff to deny claims and cancel policies as soon as the customer gets sick.

 

If that is all that is needed

Submitted by Jacob on Fri, 09/18/2009 - 14:55.

If that is all that is needed to fix our system, why wasn't it done from 2000 to 2006 when Republicans had control of the federal government?

Because Republicans mostly pay lip-service to free markets.  What's your point?

Show me the government regulations that force private insurers to employ large numbers of staff to deny claims and cancel policies as soon as the customer gets sick.

Dropping customers who get sick is already against the law.  It's called a breach of contract.  If government has to establish new laws to explicitly state that, I see little hope in their ability to govern an entire health care industry.

Blackwater, under the old DOD-Bush Administration...

Submitted by MI-GOPer on Fri, 09/18/2009 - 12:10.

was helping the Marines win the wars that Obama is now losing.  If we had more NGO staff doing more work in Afghanistan, our monthly US troop death totals wouldn't be rising to the highest levels ever... and we really wouldn't have a problem if chickenshit Canadian and NATO troops actually engaged the enemy, instead of doing rear guard duties protecting bottled water supply dumps and food distribution equipment.  Heck, even the Danes are seeing more action than the sissy-fied Canadians.  When is it, exactly, that Canadian military personnel have their spines and guts removed in basic training?

Now, the reason why Canadians pay so little in administrative health care costs is because when a crisis occurs for their patients, they send them across the border to the US.  Or give them access to death panels and let them die while awaiting transit to a US emergency medical facility.

It's what medical care rationing is all about... in Canada, the patients have already surrendered in the War on Medicine.  Maybe that's why the French love Canada so much... it's the never ending capacity to surrender that endears them to the French.

$150 for a bag of laundry

Submitted by Mead50 on Fri, 09/18/2009 - 12:25.

$150 for a bag of laundry, $45 for a six pack of soda - that is Blackwater.

Nope, you got that ticket all wrong, Mr Anti-America

Submitted by MI-GOPer on Fri, 09/18/2009 - 12:39.

the truth is that former Blackwater personnel helped uncover the largest stash of drugs in Afghanistan earlier this week.  They kept the area safe until US personnel could arrive.

By the way, those former Blackwater personnel, who are mostly former US Marines and Army Special Forces, were assigned to provide security for visiting US contractors serving as consultants to Afghani judicial workers.  They learned of the Taliban stash by helping the Natl Police interrogate a prisoner who tried to blow up an Afghani judge's home.

Yeah, those pesky former Blackwater personnel.  They just don't seem to get the notion of "duty", "honor" or "service".  First up on Obama's plan to undercut the military: eliminate all NGO paramilitary contracts in both Iraq and Afghanistan.  Good bye security.

After that, cut back the troops.  After that, cut medical care service to wounded state-based troops.  After that, downsize the military and return the Coast Guard to pre-9/11 status as a law enforcement function.

It's JimmineyCricketCarter and 1977 all over again.  Oh wait, Iran has already fallen to the Islamic terrorists... Obama won't have to achieve that Leftie goal again.

Being anti-Blackwater is about as Pro-America as one can get.

Submitted by Mead50 on Fri, 09/18/2009 - 13:07.

 From KHOU TV, Houston Texas:

 Houston - Take Houston's heat on a miserable summer day and add 40 degrees, making temperatures 130 or more.

    Next, add an extra 100 pounds of life-protecting gear to your body: bulletproof vests, guns and ammunition.

    And then imagine not having enough water around to drink.

    Stories of short supplies have haunted the U.S. military throughout the war in Iraq - things like inadequate body armor or unshielded Hummers. But while many soldiers say they had good access to water and even Gatorade, the 11 News Defenders discovered that others, stationed all over the country and during all phases of this desert war, say something else was often missing.

    "We were rationed two bottles of water a day," said Army Staff Sgt. Dustin Robey, referring to 1 to 1.5 liter bottles.

    And he said that wasn't nearly enough.

    "You'll see guys throw up, you'll see them pass out," he said.

    Robey said it started early on in the war, and that he and other soldiers are paying the price to this day. In 2003, he said soldiers were given what was the equivalent of only a half gallon of water to survive on a day - all while dodging bullets in the blistering heat.

    "We were on missions, I ran out of water," Robey said.

    That's no surprise. According to an Army Fort Bragg training document on preventing heat casualties in desert climates, water losses can reach 15 liters, or four gallons, per day per soldier. Additionally, Survival, a 1957 Department of the Army field manual, states "in hot deserts, you need a minimum of one gallon (of water) per day" just to survive.

    So Robey said his company were forced to improvise.

    "We were inside a house, I'd stick my head under the faucet and drink," he said.

    But Iraqi water is often untreated and can cause intestinal sickness.

    "We had a real rash of dysentery go through my company. I'd say 50 to 60 guys got it," Robey said.

    But what about getting water from what the military calls "water buffaloes," storage trucks that are supposed to bring purified water to the troops in the field?

    A number of soldiers told 11 News that it was often difficult to locate these trucks, partly because they say there was a shortage of them. In addition, many soldiers claim that a lot of the water dispensed by these vehicles was so heavily treated with chemicals that "no one could keep it down."

    Robey said eventually they became desperate.

    "It really hit me the day I was with my commander and we're stealing water," Robey said, describing how they raided supplies at the Baghdad International Airport.

    To get there, they had to take one of the riskiest routes in Iraq at that time, riddled with road bombs and roadside insurgents.

    But they reached the airport and found plenty of water. It was in the hands of civilian contractors, who Robey claims were supposed to be distributing it to soldiers.

    "You just had pallets upon pallets upon pallets of (bottled) water," Robey said.

    Water shortages continued in other parts of Iraq at other locations too, according to other soldiers. Private Bryan Hannah recalled a troubling situation in 2007:

    Private Hannah: "My sergeant told my lieutenant we didn't have enough water and he said go find some."

    11 News: "What does 'go find some' mean?"

    Private Hannah: "It means 'if you don't want to die, then go find some water.'"

    Hannah and fellow soldiers did just that, finding it once again at a civilian contractor facility.

    "We'd just run out and start grabbing cases of water and start throwing them in the gunner's hatch," said Hannah.

    "This sounds like something that definitely needs to be looked into," said Dr. Stephen Fadem, a kidney specialist with Kidney Associates PLLC, who also teaches at the Veterans Administration.

    "If soldiers are saying that they are not getting adequate water, that needs to be taken seriously," Dr. Fadem said.

    In the short term, Fadem said, you could collapse, and in the long term, "they may end up with kidney injury."

    The same training document from Fort Bragg details those very health concerns. It states chronic dehydration is associated with kidney stones, urinary infection, rectal afflictions and skin problems.

    "This can be very challenging," said Dr. Fadem.

    But 11 News identified another problem with water in Iraq - dirty water in sinks and showers soldiers used.

    "I mean it's yellow, and it's filthy," said Sgt. Casey J. Porter.

    Porter, an aspiring filmmaker, took video footage of rust-colored water from faucets at Camp Taji in 2008. By that time in the war, Taji appeared less like a war zone and more like a mall.

    "You can eat Subway, Burger King, you can buy a $1,200 Oakley watch, but you can't have clean water to brush your teeth with; what's the real priority here?" Sgt. Porter said.

    Turns out, at many similar bases, the water was supposed to be processed by Houston-based company KBR. In an internal KBR report, the company sites "massive programmatic issues" with water for personal hygiene dating back to 2005. It outlines how there was no formalized training for anyone involved with water operations, and one camp, Ar Ramadi, had no disinfection for shower water whatsoever.

    "That water was two to three times as contaminated as the water out of the Euphrates River," said former KBR employee Ben Carter.

    Carter, a water purification specialist, was the one to blow the whistle on it all. He said he first noticed a problem when he found a live maggot in a base toilet at Camp Ar Ramadi. He subsequently discovered that instead of using chlorinated water, the soldiers' sinks and showers were pouring out untreated wastewater.

    "You're standing in what's essentially a sauna of microorganisms. Your eyes, ears, anyplace there's a cut, a person would be at risk of containing a pathogen," Carter said.

    But when he wanted to inform U.S. forces, Carter said KBR supervisors gave him a verbal lashing.

    "The military is none of your f-ing concern, uh, which was shocking to me," Carter said.

    11 News asked military officials about the water problems in Iraq. In a statement by the Multi-National Force in Iraq press office states: "We have a proven system that works. Commanders at all levels do their utmost to provide the necessary resources required to sustain the force."

    KBR in a statement, told 11 News a Department of Defense Inspector General report concluded "KBR has (since) satisfied applicable water standards," adding that "the DoD has not found any illness which it attributes to water in Iraq."

    But tell that to Staff Sgt. Dustin Robey.

    "I take 26 different types of pills a day," Robey said. "I've had kidney stones, almost on a daily basis."

    He said he's passed hundreds of them since returning from Iraq.

    "It feels like someone's stabbing you in the side just over and over and over again," Robey said.

    He blames the lack of, and quality of water for his poor health, and the hardest part of it all is the toll it's taken on his family.

    "There's days when I can't go out and play with my children outside, I'm in that much pain," Robey said.

    As for his military career? It's over. The Army forced him to retire because of his condition and slashed his pay to the point where is family is staring at foreclosure and has moved in with relatives.

    The former staff sergeant's only hope? That the next time our country does it the right way. And Afghanistan, is just around the corner.

    "If we can't provide enough water, enough materials for guys to get through the day, to where they don't have long-term effects for guys like myself, then why even fight the war," Robey said.

    Now again, many other soldiers told us a different story: That they had no problem getting enough drinkable water. However, we found that the differing experiences seemed to have a great deal to do with when the soldier was deployed there, what part of the country he was in, and what his assignment was.

    Either way, kidney stones have become such a widespread problem among the troops that the military has set up a medical treatment center in Iraq to treat them.

 

Is KBR the same outfit that

Submitted by acinphx on Fri, 09/18/2009 - 14:48.

Is KBR the same outfit that was building showers where a number of soldiers were electrocuted?  I honestly can't remember which of the Iraq horror-contractors was responsible for that one, but KBR sounds familiar. 

And then, fellow taxpayers, we paid that contractor AGAIN to repair their shoddy, fatal work. 

In the situation above, of the soldier with long-term consequences of the contaminated drinking water, we taxpayers can celebrate again!  We will all be paying for a lifetime of significant medical care for this soldier (as we should) -- while the criminal contractor suffers no financial harm. 

Yes indeedy, MI-GOPer, only an anti-American would speak poorly of Blackwater or KBR.  You have some very strange heroes.  I know you would think it anti-American of me to remind everyone of the documented instances of rape and executions of Iraqi civilians by Blackwater personnel, but what the heck -- I'll go for broke.  As an educated city-dweller, I've accepted that I'm not a "Real American" anyway.

Re: Everything Mead50 said

Submitted by Bryan Pick on Sun, 09/20/2009 - 03:03.

The private sector was essentially allowed to "self regulate" on Wall Street over the past several years....how did that turn out?

The financial sector is and has been the most regulated sector of the economy.  The regulators approved those new financial instruments that went so wrong, because they're not equipped with some special equipment that makes them smarter or more prudent than people who have their skin in the game.  The government didn't look the other way, it made the problem far worse -- see, e.g., Fannie and Freddie.  The government took on a policy of promoting home-ownership among people who weren't credit-worthy, feeding tons of junk mortgages into the financial system where those instruments they approved turned them into AAA and AA bonds.  And then, when things started getting shaky, the feds sent waves of fear and uncertainty running through the markets with proclamations of doom and inconsistent responses to problems as they arose (bail out one firm, don't bail out another).

Did private-sector actors screw up?  Sure.  They do that sometimes, which is why it's best to have a profit-and-loss system and laws to protect people from fraud.  In most markets, you sue the people who engaged in fraud, you let the bad ones fail and let the good ones buy up their assets, and you start recovery quickly.

But when government screws up, it doubles down.  They bail out the bad guys and expand their own budget authority.  They've already re-instituted the policies that caused the crash in the first place.  You think Obama and the Congressional Dems have fixed financial regulations?  Not even close.

Did you miss the news yesterday about the teabaggers complaining that government run DC Metro didn't put on extra services for them, so they had to turn to private sector solutions (taxis).

First, it makes everyone respect you less when you snigger at a pornographic word like "teabagger."  It's ridiculous name-calling, and if the Left wants to to be taken seriously, it should stop wallowing in adolescent humor.

Second, while it's ironic that anti-big-government protestors would bemoan the unresponsiveness of public services, that's a horrible argument to use in response to the claim that the public sector is less efficient than the private sector.

Administrative costs take 31 cents out of every health care dollar in the U.S., compared to 17 cents in Canada.

Didn't I just get done telling you in another thread that government health care hides its administrative costs by outsourcing them to other government agencies, like those that collect the taxes that run the whole thing? 

And didn't I and Jacob here both just say that Medicare has high administrative costs per patient, but that the admin costs are lower as a percentage of total costs simply because they spend so much more per patient? 

And have you yet responded to the fact that Medicare and Medicaid are bilked out of tens of billions of dollars a year, a claim which you unwittingly bolstered by providing a link showing that Medicaid alone loses $18.6 billion a year just on the federal end?  Wouldn't that be an argument that they should perhaps spend a little more on the kinds of administrative costs in which insurance companies invest?

which is exactly why our Constitution enumerates the power of a common defense to the federal government.  No mention of health insurance though, I'm pretty sure.

No mention of police, fire, eduction, or air traffic control in the constitution as well, I'm pretty sure.

No, but if we're going to amend the Constitution, perhaps we should do it with a vote in Congress and the states instead of just wishing new powers into existence.  And by the way, the vast majority of police, fire and education spending is done below the federal level. 

Still, despite the government competition, people still get fed up with the stuff they're forced to pay for and use private security, volunteer and private fire fighters, and private education.

[Side note to Jacob: the provision of a common defense is not a power enumerated in the Constitution.  The Congress may not do anything it pleases to provide for a common defense or the general welfare; it may only exercise the enumerated powers that follow, such as raising armies and calling forth the militia.  The Congress has the power to tax for those enumerated purposes as well.  Madison, the "Father of the Constitution", made this abundantly clear, as did Jefferson.  I can give you quotes if you want.]

I could very easily produce an amazing performance from a public school by simply following the private school practice of expelling students who don't maintain at least a C average or who act up in class.

Do you have more than an anecdote for that?

And based on your objection to private schools, would you support a voucher program that specifically targets kids who fall in the bottom half of the test-score distribution, or who have a history of disciplinary problems?

The amount of regulation that the government imposes on insurance companies is not what is driving up costs - it is the amount of regulation that the insurance companies imposes on doctors and hospitals that is the problem. And no, the two are not related. The private insurance companies have hordes of cubicle dwellers whose sole purpose is to deny and delay payments and coverage.

Yes, the regulation that government imposes on insurance does drive up costs.  Mandates force insurance companies to offer policies that cover a range of conditions that people may not even want covered, which has the effect of raising the price of limited-coverage plans. 

Government regulation also encourages employer-provided coverage instead of individual-provided coverage, which insulates the consumer from the cost of his health-care decisions and therefore eliminates price sensitivity.  As a result, nobody knows what the prices are, insurance covers even the most routine of care, and doctors answer to the insurance companies.  That means more paperwork and higher prices for everything -- paying dollars instead of cents for Q-tips and aspirin.

How about government regulation that forces insurance companies not to ask questions that would give them a better idea of how risky their customers are?  Any insurer will do the same thing in response to that regulation: raise prices to cover them against unanticipated risk.  They especially have to raise prices at the start because there are other regulations that force them not to raise their rates on a given customer too fast once it becomes clear how risky they are.

Then there's the fact that litigation forces doctors to engage in defensive medicine instead of simply informing their patients of the risks and costs.  More unnecessary tests means higher costs.

And of course, there's the FDA, which again doesn't simply inform consumers -- it bans treatments after long, expensive trials.  The FDA's insistence on punishing unapproved uses of medicine (when a drug has been found to be helpful for a purpose other than the one it was approved for), resulting in multi-billion dollar lawsuits against drug companies, must also drive up costs of drugs, wouldn't you say?  And if you drive up the cost of treatment, you drive up the cost of insurance.

Why did 7 out of 10 doctors in a survey reported in the NEJM support the public option in one way or another?

I know I just got done telling you that doctors have an obvious interest in expanding their customer base.  Why don't you mention that when you ask this question again?

I'm sorry, but the days when you could convince people that all we need is a free market solution and less government inter fence to reduce health care costs have long since past.

Try responding to some of our specific arguments sometime.  We haven't tried reducing the government's role in medicine in the last 70 years, how about we give it a try?

If that is all that is needed to fix our system, why wasn't it done from 2000 to 2006 when Republicans had control of the federal government?

Because, aside from their other problems, Republicans got shot down when they tried to spend their political capital on a big reform plan.  If they couldn't budge the needle on Social Security without being forced into a party-line vote, what hope did they have on insurance and Medicare?

Show me the government regulations that force private insurers to employ large numbers of staff to deny claims and cancel policies as soon as the customer gets sick.

First, they have to employ a lot of people just to prevent fraud.

Second, they wouldn't cancel policies if they could recuperate the cost with higher rates, but as I said, regulations prevent them from raising their rates too fast to compensate for such things.

And third, if you're worried about canceling policies when the customer gets sick, you should be on our side against employer-provided insurance, which Obama and the Congressional Dems want to expand.  People losing their employer-provided insurance just when they get really sick is a pretty bad system, so why don't you favor giving individual portable insurance the same tax break?

But regarding recission, yes, that's fraud and Republicans hate it too.

And I know

Submitted by Mead50 on Sun, 09/20/2009 - 17:38.

1) The SEC did not enforce anything for years.

2)I was not aware that "teabagger" was considered derogatory. What are you supposed to call people who have chosen a tea bag as their symbol? Teabagists?

3) BCBC needs more people to administer just its customers in New England than Canada needs to cover their whole country. And you want to say that this massive inefficiency could be eliminated with the stroke of a pen via deregulation?   Sorry, but that is fantasy.  Regarding the idea that government hides its costs. First - given that the government is still going to be there collecting other taxes, I'd say that what the Canadian government is doing is efficient use of overheads! Moreover, why do you choose to concentrate on expense added by government while you ignore the expense added by insurance companies that you can see if you visit even the smallest medical practice - there is at least one full time person there dealing with the shit that the insurance companies dish out.

4) Did we amend the Constitution to allow air traffic control?

5) Here is a link to the polices of a randomly selected catholic high school. Students with bad grades are "not allowed to return". Expelled, in other words. Wonder where they go?

6) The primary regulator of health insurance companies are the states, not the federal government. Since you've indicated above that police and fire spending are made magically OK because they are done "below the federal level", then why isn't this OK as well. If over-regulation is the key driver for spiraling insurance costs, why don't we see private insurance companies screaming bloody murder every day about these unjust shackles?

Government regulation is probably the only reason the system works at all. Private insurers, left to their own devices, work very badly: they'll take in  money and then deny as many claims as possible, and they also try to avoid covering people who are likely to need care and drop erstwhile healthy people as soon as they get sick. Because that is where profits come from - insuring the healthy. Insuring the sick, not so much.

7) Your attempt to explain away the NEJM survey showing that 7 out of 10 doctors support the public option was about as unconvincing as some saying "well...well...well....I just don't believe it!". You think it is totally driven by greed - OK, that is your opinion. I think it could just as easily be driven by a genuine desire to improve the system. If that seems to rosy, how about this - driven by a desire to see the private insurers get a much needed boot up the backside so that hopefully they will reform their ways.

Did I miss anything?

Point by point

Submitted by Bryan Pick on Mon, 09/21/2009 - 00:37.

1.) That might be more convincing if it was an argument rather than an assertion.

2.) If you didn't know "teabagger" was derogatory, you're the only one.  I'm sorry you missed out.  But now you know that "teabagger" means something else, and everyone who hears you say it is going to think you're using juvenile humor.

3.) Yes, I'm saying that removing a mountain of inefficient regulations would vastly increase the efficiency of the health insurance market.  I have given reasons for that belief, and you haven't given anyone any reason to doubt.  You just assert that it's a fantasy.

And tax collection was just an example of how their administrative costs are outsourced to other agencies.  Here in the states, we have a whole separate set of taxes to collect for Medicare et al.

4.) No, we didn't, but if it's that important that it be done at a federal level, it can be added to the enumerated powers by 2/3 of Congress and 3/4 of the states.  That's how the Constitution was supposed to work.

5.) So, anecdote.  Gotcha.  And you didn't answer my question: would you support a voucher for kids in the bottom half of the test-score distribution or who had a history of disciplinary problems?

6.)

The primary regulator of health insurance companies are the states, not the federal government. Since you've indicated above that police and fire spending are made magically OK because they are done "below the federal level", then why isn't this OK as well.

I didn't say that police and fire spending and "magically OK" because they're done by the states; I'm just saying that the states aren't limited to the powers of Congress.  Just because state firefighting spending isn't unconstitutional doesn't make it totally OK with me.  I think we'd be generally better off with more volunteer and private-sector firefighting units, and maybe call in the state to deal with the really big fires.

If over-regulation is the key driver for spiraling insurance costs, why don't we see private insurance companies screaming bloody murder every day about these unjust shackles?

Because the insurance companies are protected against competition by all that regulation. 

This is a common phenomenon: the government increases regulation in the name of protecting the consumer; the regulation comes with high compliance costs; only large incumbent firms can handle those big costs, while specialty, niche and small upstart competitors cannot.  Therefore the small competitors fold and the big company expands to gobble up more customers, and competition based on price and quality goes down the tubes.  We shouldn't be surprised if the surviving companies approve of the regulation.

Government regulation is probably the only reason the system works at all. Private insurers, left to their own devices, work very badly: they'll take in  money and then deny as many claims as possible, and they also try to avoid covering people who are likely to need care and drop erstwhile healthy people as soon as they get sick. Because that is where profits come from - insuring the healthy. Insuring the sick, not so much.

Private insurers work fine in a bunch of markets.  Insuring the sick would be profitable if they could raise rates to compensate and anticipate some of the risks before they strike, and consumers could afford those unanticipated rate hikes if we had health-status insurance.

7)

You think it is totally driven by greed - OK, that is your opinion. I think it could just as easily be driven by a genuine desire to improve the system.

Wrong.  I think it would be foolish not to assume that some of it (perhaps a significant amount) is driven by personal interest, which I made clear in our previous conversation.  Maybe many of them are convinced that what's good for them is also good for the country, but who would deny that the former often influences the latter? 

Again, you're not even trying to faithfully represent my comments.  Try.

1) Not sure if this is even

Submitted by Jacob on Sun, 09/20/2009 - 20:41.

1) Not sure if this is even worth a response.  Are you telling me an entire branch of government responsible for overseeing one of the most powerful and important sectors of the economy sat around and twiddled their thumbs for "years"?  First, obviously, that's incorrect.  If you took the time to read the article I had first recommended on deregulation, you'd have learned that the number of regulations and amount of money and personnel dedicated to regulation has actually increased over the past decade.  For confirmation, you can look at the sources in that article.  Second, if that really was the case, why would you ever want to put so much stock in a government program that would be entirely controlled and overseen by the federal government?  You realize the SAME  government that runs the SEC would run health care, right?  On a broader point, I can't understand why liberals who bemoan Bush, Republicans, the SEC, etc. constantly work for greater government control.  Who do you think would run this much-desired government?  I don't get that.

2)  How about what they actually call themselves... Tea Party Activisits, or maybe you can come up with some cute name based on "Tea Party" rather than "tea bags."

3) Why is it your business how many employees BCBC chooses to employ to fight fraud and other administrative tasks?  I know what you're going to say, "because health care costs are rising so fast."  Well, the rest of the economy that is run privately gets to choose how many people they employ... should it be up to you how many people they employ whenever you think they're charging too much?  Or making too much?  As a side note, the average profit margin for health insruance companies is between 3-4%.  Outrageous!  As a firm believer that government regulation necessarily imposes additional costs on the private sector, the way that an insurance company -- or any other for that matter -- operates should be completely out of the control of government. 

4) You really love air traffic control.  I'm not entirely familiar with the industry so I won't opine any kind of greater efficiency if it were run privately.  However, it's a pretty minor example.  Health care, education, defense, air traffic control?  Sorry.

5) Ohhhhh the Catholic High School of Baltimore has such a policy?!?! You got us.  The private school industry is and must be a failure.

6) In suggesting that the majority of the problems are at the state level, you must be forgetting about the two entirely unsustainable federal programs by the name of Medicare and Medicaid that will bankrupt our entire nation. 

Furthermore, your accusations of the health care sector are at once inaccurate and contradictory.  Inaccurate: If this was the case, why are all other forms of insurance not suffering from the same problems?  Life, auto, fire insurance... no problems there.  Insurance is not an inherently evil business of neglecting the poor and sick and accomodating only the rich and healthy.  Insurance is a beautiful thing.  Millions of absolute strangers fund the medical care of one another for no benefit of their own other than the possibility of themselves suffering a catastrophic and expensive injury.  That is how insurance is supposed to operate. 

Contradictory: you and Obama continue to repeat this claim that the insurance companies wouldn't cover the sick even if they could and were willing to pay because it is too expensive. You're telling me that the greedy insurance companies wouldn't accept money from someone even if they were able to pay the full expense of what it costs to cover them?  Hmm.. odd.  Or maybe it's that regulations don't ALLOW them to pay their share and thus prohibits them from being covered. 

7) I would make a different argument:  doctors are not economists.  As good as their intentions may be, they don't necessarily see the entire picture when it comes to costs and financial solubility of an entire system that allows for a public option.  What they see are patients who come in and cannot afford treatment.  What they don't see are the aggregate costs of an entire health care system. 

Lax oversight at the SEC

Submitted by Mead50 on Sun, 09/20/2009 - 22:43.

1)

Federal Cases of Stock Fraud Drop Sharply U.S. officials are bringing far fewer prosecutions as a result of fraudulent stock schemes than they did eight years ago, raising questions about lax oversight. Federal officials are bringing far fewer prosecutions as a result of fraudulent stock schemes than they did eight years ago, according to new data, raising further questions about whether the Bush administration has been too lax in policing Wall Street.

Legal and financial experts say that a loosening of enforcement measures, cutbacks in staffing at the Securities and Exchange Commission, and a shift in resources toward terrorism at the Federal Bureau of Investigation have combined to make the federal government something of a paper tiger in investigating securities crimes. At a time when the financial news is being dominated by the $50 billion Ponzi scheme that Bernard L. Madoff is accused of running, federal officials are on pace this year to bring the fewest prosecutions for securities fraud since at least 1991, according to the data, compiled by a Syracuse University research group using Justice Department figures.

There were 133 prosecutions for securities fraud in the first 11 months of this fiscal year. That is down from 437 cases in 2000 and from a high of 513 cases in 2002, when Wall Street scandals from Enron to WorldCom led to a crackdown on corporate crime, the data showed. At the S.E.C., agency investigations that led to Justice Department prosecutions for securities fraud dropped from 69 in 2000 to just 9 in 2007, a decline of 87 percent, the data showed.

2) You want me to call them Tea Party Activisits? What the hell is an Activisits?

The tea bag is their chosen symbol, not something I've made up for them.

3)

Why is it your business how many employees BCBC chooses to employ to fight fraud and other administrative tasks?

What kind of dumbass question is that? If you are going to hold up private insurers as models of free market solutions to pressing problems, don't be surprised if other people point out just how massively inefficient that solution is.

4) I don't think there is a magnitude exception for constitutionality.

5) Look, jackass, he asked me for a citation for a claim that I made, and I provided it.

6) Except for the fact that I never suggested that majority of problems are at state level.

There is no comparison to be made between health insurance and other forms. You want to insure your Ford? Fine - your Ford has a value of $30,000. So what is your Ford worth to you? $30,000. So we make a policy based on that figure. Now - assume you've been told you've got brain cancer. What is your life worth to you?

7) True. But something they do see every day is the way private insurance companies operate. And 7 out of 10 of them support the public option. I'd say the two are connected.