Promoted from the Ricochet Member Feed by Editors Created with Sketch. Capitalist Heath Care For Everyone

 

shutterstock_155901572For thousands of years, the question of healthcare has been basically irrelevant. If you got seriously ill, your death or survival — usually the former — had little to do with how much care you received, and it didn’t matter if you were the King of England or an American slave. People may have thought healthcare was important, but it didn’t really matter; environmental factors such as general health and diet, shelter, and workload mattered much more. To put it in perspective, most of us can count how many times we would have already died had we lived 150 years ago. For me, the score is two: I’ve had appendicitis and bacterial pneumonia so bad I was coughing blood. Neither was tremendously problematic or fearsome.

Because we’ve made such remarkable progress, healthcare matters. That progress is broadly the result of two things. The first is evidence-based medicine. In the late 1800s, somebody did a study and realized that outcomes were no better if you went to a doctor for treatment. That didn’t speak well for doctors. More recent studies have shown the same thing for Medicaid: outcomes are better for people who are totally uninsured rather than for those on Medicaid.

The second is market-based incentives. Here is an examination of health care innovation since World War II (after which, many countries nationalized care). Of 22 major advances, 17 were first applied in the U.S., four occurred in mixed public-private healthcare markets, and one occurred in a fully nationalized market (the artificial cardiac pacemaker). It’s safe to say that — absent free markets — we wouldn’t be debating health care as public policy because there’d be nothing worth arguing over.

So we find ourselves at a crossroads. On the one hand, healthcare matters because healthcare protects life (and, in my reading, it is our obligation to protect). On the other, the reason healthcare protects is because market dynamics have spurred and rewarded creativity. This problem is a very clear example of the tax, education, and life-related challenges we face in so many spheres: protection and regulation limits advancement and yet we have a duty to protect and regulate.

How do you square these demands? Most analysts see a set pie. You either ration healthcare and distribute it “evenly,” or you force people to pay for it, which guarantees that it will be distributed unevenly. People on the Left will claim that denying healthcare can be denying life. Those on the Right claim that nationalizing healthcare will freeze development and create an inefficient and politicized system that caps their right to life. Both sides are correct.

My experience with public, semi-public, and private organizations has demonstrated that directives from on-high — whether an insurance company or a government — are nowhere near as effective as market competition in driving innovation and price reduction. Bureaucracies reward the good story, the good excuse, and the effective covering of one’s rear end. In a business, those things – when your customers have choices – lead to the end of the business.

Prior to the reforms that culminated in Obamacare, the American system had incentives. Invent something with a better outcome and you can charge through the nose. For example, a new Hepatitis A drug (sofosbuvir) costs $80,000 for a course. While its target market tends to be poor, the insurance and/or government had to pay for things that are more effective. Thus, they made the payment. If you forced them to charge much less, they might not have developed the drug in the first place – and then nobody would get its benefits.

But not every private market is built this way.

In Australia, the government had a set price it would pay for any given service. It would only cover part of the cost, but you could also buy private insurance and then you would be responsible for whatever remained. In many cases, you’d pay the whole sum up front and then go to the insurance and government offices and collect the amounts they’d pay. This gave you an incentive to shop around. In one case, surgery was $1,800. The government paid $600, insurance $300, and the patient paid $900. Because there was competition, the price was lower than it would otherwise be (the same procedure in the US cost about $15,000). In another case, there was an individual who was in ER isolation for two days. The total bill was about $1,300. He was a foreigner and received no subsidies. But because there is price competition, prices are lower.

The same principle applies in laser eye surgery (where costs tumble with risks) and plastic surgery and dentistry (where outcomes and comfort have improved significantly while costs have risen at a slower pace than elsewhere in healthcare). In these markets, insurance often doesn’t pay, which ensures price and outcome competition other U.S. markets lack.

This price competition is attractive. But the fact remains that Australia also rations public healthcare, fights about services and rates, and solves things that should be solved in the market through the political process. While they are very innovative in driving down costs, none of those 22 major innovations I mentioned earlier happened there.

Another model is to have the government pay 90% of the median cost for an individual procedure (which sounds like Medicare) while allowing the doctor or hospital to charge extra (which doesn’t). The idea here is that you could charge extra, but anything extra would come out of the patient’s pocket. This would drive down costs and increase financial innovation.

The difficulty is in the details, particularly the coding. With Medicare, each procedure has a different code. This creates some problems. First, it’s a bureaucratic nightmare. Second, fraud is as simple as adding a few unnecessary or marginal services to the bill; the customer doesn’t pay, so he doesn’t really care. Third, adding new procedures or changing the compensation for existing ones becomes fodder for political wars and favoritism. Fourth, pricing isn’t so easy when you have vast differences between healthcare marketplaces. Fifth, it incentivizes cost-reduction for existing procedures more highly than creating new ones that might better serve the patient. Sixth, it undermines the profit motive, as the reward for creating a cost-saving procedure is to have the price of compensation reduced as soon as the code fees are adjusted.

Fortunately, there is a better alternative even if, like me, you think life-saving healthcare should be publicly funded. This is not like paying for food for everyone: food is a predictable need, a regular driver to life’s potential. But life-threatening health problems often hit suddenly and at tremendous cost. However, not all healthcare falls into this bucket. Routine checkups, medications for conditions normally addressable by lifestyle changes, cosmetic operations, and even disability treatments all fall into different buckets.

The public obligation, therefore, should be focused on saving lives with other needs receiving less support (if any). In some cases — such as disability — it would be appropriate to factor in one’s potential future earnings when considering what to pay for; it makes no sense, and wastes others’ earnings, to pay $1 million to repair a man’s knee if he’s only going to create $500,000 of future value.

With all this public spending, how do you incentivize the private market to both improve outcomes and cut costs?

The answer is simple. Create codes, not for procedures, but for conditions. When somebody comes in with a suspected heart attack, they get a code attached to the condition. The patient is then granted immediate access to a health account worth 90% of the median cost over the last five years of treating that condition. Compensation could be adjusted for location, degree of responsibility (i.e, it should be lower for injuries stemming from a drug overdose or reckless driving), and compound conditions (e.g. obesity and heart attack) based on national modeling of associated costs. Some diagnoses and payment periods would be short (e.g. “suspected heart attack”) and some are long (“prostate cancer.”) In order not to impose on the delivery of care, diagnoses would be able to be backdated. If the condition is not life-threatening, but productivity-threatening, then the lower of 90% of the median cost or the individuals’ expected future production would be used to determine public support for a repair.

The patient can then spend those funds as they see fit. More importantly, if they wish to spend more to receive better care, they are free to do so; and, if they spend less, they keep the difference. This sort of approach to compensation has some precedent.

With this approach, there are many fewer codes, better incentives, and more patient choice. Even the destitute can afford just-below-average care, while those who have means can purchase superb healthcare if their provider is innovative about cost (rather than just a provider of cheap services). A prime example of this would be India’s Dr. Devi Shetty who inspired this very short story.

The result: greater quality healthcare at a continually reduced price. For everyone.

There are 26 comments.

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  1. iWe Reagan
    iWeJoined in the first year of Ricochet Ricochet Charter Member

    I think the idea is very interesting, but I wonder why coding for conditions would be any simpler (or less fudge-able) than coding for procedure. After all, there are a great many flavors of illness. 500 different kinds of cancer alone, each with multiple stages, complexities, etc….

    I fear it would become a bureaucratic nightmare very quickly.

    • #1
    • December 30, 2014, at 6:50 AM PST
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  2. Instugator Thatcher
    InstugatorJoined in the first year of Ricochet Ricochet Charter Member

    I think you are referring to Medicaid in the second paragraph – the study was conducted in Oregon a couple of years ago.

    • #2
    • December 30, 2014, at 7:23 AM PST
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  3. Richard Harvester Inactive
    Richard Harvester

    iWc:I think the idea is very interesting, but I wonder why coding for conditions would be any simpler (or less fudge-able) than coding for procedure. After all, there are a great many flavors of illness. 500 different kinds of cancer alone, each with multiple stages, complexities, etc….

    I fear it would become a bureaucratic nightmare very quickly.

    It doesn’t have to be. I use the word codes, but when you consider compounding it is actually something far more involved. You could basically take the symptoms and overall condition as seen and feed it into a databank with extensive historical information like Kaiser’s health databases. Instead of diagnosing the patient, it would diagnose the funding. The system could be redefined over time with an eye to reducing outlier cases. Effectively, you’d end up with broad health descriptors associated with cost buckets and administrative courts to sort out errors made by the system.

    • #3
    • December 30, 2014, at 8:10 AM PST
    • Like
  4. Albert Arthur Lincoln

    Richard Harvester: This is not like paying for food for everyone: food is a predictable need, a regular driver to life’s potential. But life-threatening healthcare often hits suddenly and at tremendous cost. However, not all healthcare falls into this bucket. Routine checkups, medications for conditions normally addressable by lifestyle changes, cosmetic operations, and even disability repairs all fall into different buckets.

    A few years back, I had some raging Facebook arguments with liberals over Obamacare. A common argument from them about the mandate was: “Car insurance is required,” which they would invariably roll out as some kind of gotcha trump card. Well, there are a lot of holes in that argument. First, in my now-home state of New Hampshire (“Live free or die”), car insurance is not required. Second, in other states, car owners are required by the states, not the federal government, to have car insurance. Each state has different requirements. But the two biggest differences that I would always point out are: A) Sure, most states mandate that car owners have car insurance, but the states don’t require that you own a car, whereas with the health insurance mandate you don’t have the option, really, to not be alive. B) No state requires car insurance companies to cover oil changes, gas, window washing fluid, headlight replacement, or sex change operations. Why should health insurance companies have to cover annual checkups, etc?

    • #4
    • December 30, 2014, at 8:12 AM PST
    • Like
  5. Richard Harvester Inactive
    Richard Harvester

    Instugator:I think you are referring to Medicaid in the second paragraph – the study was conducted in Oregon a couple of years ago.

    You are correct.

    • #5
    • December 30, 2014, at 8:12 AM PST
    • Like
  6. Richard Harvester Inactive
    Richard Harvester

    Albert Arthur:

    A few years back, I had some raging Facebook arguments with liberals over Obamacare. A common argument from them about the mandate was: “Car insurance is required,” which they would invariably roll out as some kind of gotcha trump card. Well, there are a lot of holes in that argument. First, in my now-home state of New Hampshire (“Live free or die”), car insurance is not required. Second, in other states, car owners are required by the states, not the federal government, to have car insurance. Each state has different requirements. But the two biggest differences that I would always point out are: A) Sure, most states mandate that car owners have car insurance, but the states don’t require that you own a car, whereas with the health insurance mandate you don’t have the option, really, to not be alive. B) No state requires car insurance companies to cover oil changes, gas, window washing fluid, headlight replacement, or sex change operations. Why should health insurance companies have to cover annual checkups, etc?

    I’m not sure how to respond. I am suggesting state insurance of a form. But I’m certainly not requiring human oil changes :) So is this an argument, a supporting statement or a side point?

    • #6
    • December 30, 2014, at 8:35 AM PST
    • Like
  7. Z in MT Member

    You are just proposing socialized medicine with a twist in the payout calculation. Your twist may help to control costs somewhat, but it is still socialized medicine.

    I know this is a greatly outdated idea, but I would much prefer some sort of charity hospital system. Some of the best hospitals in this country originated, and still operate, as charity hospitals. The ones that have held on the best are the ones oriented around children (e.g. Shriners, St. Jude’s), however many of the best hospitals in the country were at one time explicitly religious hospitals that served their various congregations. The worst thing for medical costs was when the federal government came in with Medicare and its fee for service arrangement. What this did is make hospitals see the federal government not as a hindrance, but as a revenue stream.

    • #7
    • December 30, 2014, at 9:24 AM PST
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  8. Richard Harvester Inactive
    Richard Harvester

    Z in MT:You are just proposing socialized medicine with a twist in the payout calculation. Your twist may help to control costs somewhat, but it is still socialized medicine.

    I know this is a greatly outdated idea, but I would much prefer some sort of charity hospital system. Some of the best hospitals in this country originated, and still operate, as charity hospitals. The ones that have held on the best are the ones oriented around children (e.g. Shriners, St. Jude’s), however many of the best hospitals in the country were at one time explicitly religious hospitals that served their various congregations. The worst thing for medical costs was when the federal government came in with Medicare and its fee for service arrangement. What this did is make hospitals see the federal government not as a hindrance, but as a revenue stream.

    It isn’t socialized medicine. It is socialized life-saving. It would not control costs somewhat – it would control them dramatically. It would make consumers shoppers for the best deals (so they can pocket the difference) and we know that works very very well. Life-saving healthcare is growing tremendously in what it can deliver – in value. That comes with a rise in costs – but not one as severe as we’ve faced. I think this is beyond the hopes of charity funding. It is legitimately 10-15% of our economy and it would be only one target for tithing. And very few actually give 10%. The goal, imo, is to save lives without forcing rationing or collective bankruptcy through the ridiculous idea of central control.

    • #8
    • December 30, 2014, at 9:31 AM PST
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  9. Richard Harvester Inactive
    Richard Harvester

    iWc:I think the idea is very interesting, but I wonder why coding for conditions would be any simpler (or less fudge-able) than coding for procedure. After all, there are a great many flavors of illness. 500 different kinds of cancer alone, each with multiple stages, complexities, etc….

    I fear it would become a bureaucratic nightmare very quickly.

    Another quick point. You could open-source this. Put out anonymous data given existing diagnostic codes and ask people to develop systems with the smallest deviations in predicted vs. actual cost. Reward those who cut the deviations.

    • #9
    • December 30, 2014, at 9:33 AM PST
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  10. Tom Meyer, Common Citizen Contributor

    Richard Harvester:

    Instugator:I think you are referring to Medicaid in the second paragraph – the study was conducted in Oregon a couple of years ago.

    You are correct.

    Just saw this. Is it correct now?

    • #10
    • December 30, 2014, at 9:59 AM PST
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  11. Fritz Coolidge

    Nothing will improve so long as the patient is separated from the pricing and payment.

    Why does the doctor have no idea what your procedure or treatment will cost? Because it will depend on decisions made by others than the patient and doctor after the fact, after the codes have been run through the bureaucracy, and the provider gets a resulting payment from the insurer. With each provider and hospital having its own negotiated rate schedule with the various insurers, there is so much cost shifting and other moving parts that no one can give a patient any idea of cost. Therefore, no realistic market decision can be made.

    Contrast this with procedures that are not deemed “medically necessary” and therefore are not covered by health insurance: laser eye surgery and cosmetic anything (e.g., surgery, or dental caps). Those providers can not only tell you exactly what the procedures will cost, but they also promote their services by seeking to be efficient and lowering costs, while even offering financing. Gee, like a real market, and people can decide for themselves. What a concept.

    • #11
    • December 30, 2014, at 10:17 AM PST
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  12. Richard Harvester Inactive
    Richard Harvester

    Tom Meyer, Ed.:

    Richard Harvester:

    Instugator:I think you are referring to Medicaid in the second paragraph – the study was conducted in Oregon a couple of years ago.

    You are correct.

    Just saw this. Is it correct now?

    yes

    • #12
    • December 30, 2014, at 10:22 AM PST
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  13. Richard Harvester Inactive
    Richard Harvester

    Fritz:Nothing will improve so long as the patient is separated from the pricing and payment.

    Why does the doctor have no idea what your procedure or treatment will cost? Because it will depend on decisions made by others than the patient and doctor after the fact, after the codes have been run through the bureaucracy, and the provider gets a resulting payment from the insurer. With each provider and hospital having its own negotiated rate schedule with the various insurers, there is so much cost shifting and other moving parts that no one can give a patient any idea of cost. Therefore, no realistic market decision can be made.

    Contrast this with procedures that are not deemed “medically necessary” and therefore are not covered by health insurance: laser eye surgery and cosmetic anything (e.g., surgery, or dental caps). Those providers can not only tell you exactly what the procedures will cost, but they also promote their services by seeking to be efficient and lowering costs, while even offering financing. Gee, like a real market, and people can decide for themselves. What a concept.

    Agreed and that is what this system does. It brings pricing and payment together. The source of the money is public – but people can pocket what they save and the system can thus capture the laser eye benefits without leaving heart attack patients in the cold because they are cash poor. And it forgets about procedures. They aren’t what’s important – the overall treatment is.

    This also reduces the definition of what is ‘medically necessary’ to life-saving alone. If you want insurance to buy the rest go buy it in a totally free market. Or, you can simply pay for the services as you go. Either way, a market gets made.

    • #13
    • December 30, 2014, at 10:25 AM PST
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  14. Barbara Kidder Inactive

    iWc:I think the idea is very interesting, but I wonder why coding for conditions would be any simpler (or less fudge-able) than coding for procedure. After all, there are a great many flavors of illness. 500 different kinds of cancer alone, each with multiple stages, complexities, etc….

    I fear it would become a bureaucratic nightmare very quickly.

    Also, sometimes, there are several different diagnoses for the same patient who goes from physician to physician seeking an answer to what ails them. Each different diagnosis (illness) has its own protocol for treatment, usually very different from the other diagnoses and dangerous for treatment of the wrong disease!

    Examples that come to mind, in my own sphere of family and friends of people who have endured years of seeking to discover the disease (coding) that afflicts them, are: Multiple Sclerosis, Lyme disease, Chron’s disease and vasculitis…

    • #14
    • December 30, 2014, at 10:50 AM PST
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  15. Richard Harvester Inactive
    Richard Harvester

    Barbara Kidder: Also, sometimes, there are several different diagnoses for the same patient who goes from physician to physician seeking an answer to what ails them. Each different diagnosis (illness) has its own protocol for treatment, usually very different from the other diagnoses and dangerous for treatment of the wrong disease! Examples that come to mind, in my own sphere of family and friends of people who have endured years of seeking to discover the disease (coding) that afflicts them, are: Multiple Sclerosis, Lyme disease, Chron’s disease and vasculitis…

    A standard medical problem. Most of your examples aren’t both terminal and treatable. So I’m not sure they’d fall into this system.

    But there are other examples which are fatal and treatable. People get diagnosed with X when they have Y. Aside from medical issues, X might result in not enough funding. Of course, healthcare providers will tend to diagnose towards higher paying diagnoses, so where there are doubts providers will go with Y.

    This is why the system has the public audit function – it puts a check on this sort of activity. All that said, this system doesn’t mandate any particular treatment for a condition, just a public budget which can be augmented or saved.

    • #15
    • December 30, 2014, at 10:57 AM PST
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  16. iDad Inactive

    Fortunately, there is a better alternative even if, like me, you think life-saving healthcare should be publicly funded.

    What is the definition of “life-saving healthcare?”

    What makes you think that a system based on “public funding” of “life-saving healthcare” won’t soon expand to cover all manner of healthcare, “justified” on any number of grounds?

    • #16
    • December 30, 2014, at 12:22 PM PST
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  17. Richard Harvester Inactive
    Richard Harvester

    iDad:

    Fortunately, there is a better alternative even if, like me, you think life-saving healthcare should be publicly funded.

    What is the definition of “life-saving healthcare?”

    What makes you think that a system based on “public funding” of “life-saving healthcare” won’t soon expand to cover all manner of healthcare, “justified” on any number of grounds?

    It could. But the argument for this system is not charity or kindness. It is made in the context of a wider suite of policies all of which seek to maximize human potential while protecting against the risks of reality. Normal welfare programs crater human potential. They create an Eden. And in Eden, we just smoke pot and hang out. The risks of our reality drive us to be creative and productive. As individuals and educators, we have to try to find ways to be creative and productive without risk nipping at our heels. As a society, where we can find ways to limit risk without substantially impacting human potential, we can and should do so.

    In other words, it is important to leave the other healthcare off the public table because providing it would undermine the creative human spirit. For the same reason, it is important to leave the life-saving healthcare on the table because failing to provide it would kill the human body.

    • #17
    • December 30, 2014, at 12:46 PM PST
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  18. Vance Richards Member
    Vance RichardsJoined in the first year of Ricochet Ricochet Charter Member

    Albert Arthur: A few years back, I had some raging Facebook arguments with liberals over Obamacare. A common argument from them about the mandate was: “Car insurance is required,” which they would invariably roll out as some kind of gotcha trump card. Well, there are a lot of holes in that argument. First, in my now-home state of New Hampshire (“Live free or die”), car insurance is not required. Second, in other states, car owners are required by the states, not the federal government, to have car insurance. Each state has different requirements. But the two biggest differences that I would always point out are: A) Sure, most states mandate that car owners have car insurance, but the states don’t require that you own a car, whereas with the health insurance mandate you don’t have the option, really, to not be alive. B) No state requires car insurance companies to cover oil changes, gas, window washing fluid, headlight replacement, or sex change operations. Why should health insurance companies have to cover annual checkups, etc?

    The biggest difference between state mandated car insurance and health insurance is that you are not required to have insurance to protect your car. You are required by most states to have liability insurance to protect the people you hit. If you total your own car, the state doesn’t care if you have the means to replace it. If you total my car, however, you better be able to buy me a new one . . . or else. Health insurance is not at all similar to auto liability. So, the analogy between car and health insurance is really dumb (which is why you only hear Obama voters using that “logic”).

    • #18
    • December 30, 2014, at 1:35 PM PST
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  19. Owen Findy Member

    “…(and, in my reading, it is our obligation to protect).

    What do you mean “our” Kemo Sabe? It’s the government’s duty to assure that the right to life is not violated. But, not paying for someone’s medicine, doctor or hospital bills does not violate that person’s right to their life.

    • #19
    • December 30, 2014, at 3:00 PM PST
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  20. Richard Harvester Inactive
    Richard Harvester

    Owen Findy:“…(

    What do you mean “our” Kemo Sabe? It’s the government’s duty to assure that the right to life is not violated. But, not paying for someone’s medicine, doctor or hospital bills does not violate that person’s right to their life.

    As I said, my reading. We have social obligations to others which have a moral foundation. I don’t write them as huge open-ended things, but they are there. To take what you’ve written to extremes: if a man starts choking in a restaurant the rest of the customers would be perfectly in their rights to watch him die. Clearly, we have an obligation to intervene as individuals. We might even criminally prosecute those who fail to intervene when they could. Extending this to healthcare, we have an individual obligation to save life. In the context of healthcare, it is an obligation created by our technological success (as I wrote).

    My overall approach is to seek ways to maximize human potential while providing people some measure of peace.

    Is the government an appropriate mechanism for providing this? To put it in ‘libertarian’ language – is it appropriate to apply coercive power to save life?

    I suppose you could form private co-insurance groups that would provide a mechanism like the above. But without enormous market power, they wouldn’t change the fundamental dynamics of healthcare. They wouldn’t make cost-cutting a highly desirable outcome. Neither do charitable healthcare organizations. The profit motive unleashes tremendously positive powers that escape even the best charities. Finally, people simply won’t accept poor folk dying in the street because they can’t pay. The reality is as medicine became more and more able to help, the social demand for some kind of government involvement rose and rose. The US didn’t nationalize like everybody else (thank G-d), but it still provided significant incentives for large-group healthcare. We ended up going 3rd-party in an era of long-term employment and massive employers. But it was a dumb system because it dropped the profit motive except on a grand scale. It is doubly useless today when people lack such long-term connections to employers.

    I think we ought to accept the benefits and reality of government support but do it differently, by making the system more dynamic and by baking the profit motive into everything.

    • #20
    • December 30, 2014, at 3:33 PM PST
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  21. iDad Inactive

    Richard Harvester:

    iDad:

    Fortunately, there is a better alternative even if, like me, you think life-saving healthcare should be publicly funded.

    What is the definition of “life-saving healthcare?”

    What makes you think that a system based on “public funding” of “life-saving healthcare” won’t soon expand to cover all manner of healthcare, “justified” on any number of grounds?

    It could. But the argument for this system is not charity or kindness. It is made in the context of a wider suite of policies all of which seek to maximize human potential while protecting against the risks of reality. Normal welfare programs crater human potential. They create an Eden. And in Eden, we just smoke pot and hang out. The risks of our reality drive us to be creative and productive. As individuals and educators, we have to try to find ways to be creative and productive without risk nipping at our heels. As a society, where we can find ways to limit risk without substantially impacting human potential, we can and should do so.

    In other words, it is important to leave the other healthcare off the public table because providing it would undermine the creative human spirit. For the same reason, it is important to leave the life-saving healthcare on the table because failing to provide it would kill the human body.

    Well, I’m still waiting for you to tell us what you would put on the table – that is, what your starting point would be. And you concede that whatever the starting point, there is no assurance that we won’t end up with “Eden.”

    And your last sentence proves too much and too little.

    • #21
    • December 30, 2014, at 4:27 PM PST
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  22. Albert Arthur Lincoln

    Vance Richards: If you total your own car, the state doesn’t care if you have the means to replace it. If you total my car, however, you better be able to buy me a new one . . . or else. Health insurance is not at all similar to auto liability. So, the analogy between car and health insurance is really dumb (which is why you only hear Obama voters using that “logic”).

    Yup!

    • #22
    • December 30, 2014, at 6:47 PM PST
    • Like
  23. Barbara Kidder Inactive

    Z in MT:You are just proposing socialized medicine with a twist in the payout calculation. Your twist may help to control costs somewhat, but it is still socialized medicine.

    I know this is a greatly outdated idea, but I would much prefer some sort of charity hospital system. Some of the best hospitals in this country originated, and still operate, as charity hospitals. The ones that have held on the best are the ones oriented around children (e.g. Shriners, St. Jude’s), however many of the best hospitals in the country were at one time explicitly religious hospitals that served their various congregations. The worst thing for medical costs was when the federal government came in with Medicare and its fee for service arrangement. What this did is make hospitals see the federal government not as a hindrance, but as a revenue stream.

    You are right; and today, under Obamacare, the insurance companies see the federal government as a “revenue stream”.

    • #23
    • December 30, 2014, at 9:03 PM PST
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  24. Grimaud Inactive
    GrimaudJoined in the first year of Ricochet Ricochet Charter Member

    The solution is easier than a “coding bureaucracy”. Health Savings Accounts and catastrophic hospitalization insurance. For the indigent, health care providers can write off their free care against their federal income tax. Fees are set individually by physicians or groups of physicians and competition would rein in costs for otherwise non covered services.

    The down side is doctors would never pay any federal income tax and all become democrats.

    • #24
    • December 30, 2014, at 9:07 PM PST
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  25. Richard Harvester Inactive
    Richard Harvester

    iDad: Well, I’m still waiting for you to tell us what you would put on the table – that is, what your starting point would be. And you concede that whatever the starting point, there is no assurance that we won’t end up with “Eden.” And your last sentence proves too much and too little.

    Fund things that have a 20% increase in five year risk of death above median for the patient’s age. You could apply definitions of ‘catastrophic’ as they tend to overlap strongly with life-saving.

    • #25
    • December 30, 2014, at 9:28 PM PST
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  26. Richard Harvester Inactive
    Richard Harvester

    Grimaud:The solution is easier than a “coding bureaucracy”. Health Savings Accounts and catastrophic hospitalization insurance. For the indigent, health care providers can write off their free care against their federal income tax. Fees are set individually by physicians or groups of physicians and competition would rein in costs for otherwise non covered services.

    The down side is doctors would never pay any federal income tax and all become democrats.

    Wait till I post about taxes ;) I think the entire income tax system should disappear.

    This encourages high-cost care for the indigent. And catastrophic insurance doesn’t drive down costs for hospitalization. But competition does. The Dr. Shetty case is quite instructive. Google “wsj dr shetty”

    • #26
    • December 30, 2014, at 9:30 PM PST
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