Health Care Reform

[axordil]

A better phrase would be "profit-driven," which describes both the market element and the push-pull relationships between the regulators and the regulated.

[Primula Baggins]

Even if it were unregulated, C_G, the market still wouldn't be free, because most insured people have a choice of one insurance provider, through their employer—a situation the insurers like precisely because it means their customers don't have the advantages of a free market, such as the opportunity to shop for better insurance or lower rates.

People without employer-provided insurance, if they don't qualify for Medicaid, have to try to get insurance on an "open" market that refuses to insure anyone who's ever been seriously ill or who has any of a wide range of nonfatal, treatable conditions (such as being a woman of reproductive age). Removing regulation would do nothing to improve this situation for people needing insurance; it would make it considerably worse.

[Voronwë the Faithful]

Wot she sed.

[Cenedril_Gildinaur]

Even if it were unregulated, C_G, the market still wouldn't be free, because most insured people have a choice of one insurance provider, through their employer—a situation the insurers like precisely because it means their customers don't have the advantages of a free market, such as the opportunity to shop for better insurance or lower rates.

People without employer-provided insurance, if they don't qualify for Medicaid, have to try to get insurance on an "open" market that refuses to insure anyone who's ever been seriously ill or who has any of a wide range of nonfatal, treatable conditions (such as being a woman of reproductive age). Removing regulation would do nothing to improve this situation for people needing insurance; it would make it considerably worse.

That is actually the result of yet another intervention.

Before WWII, insurance was purchased by the individual. It became an employment perk when employers were forbidden to compete with wages. Then that arrangement was enshrined in the tax code as a deduction for businesses that purchase insurance for their employees.

Of course, back in the day also insurance was meant to treat the large and unpredictable things, and there was no coverage for regular office visits. Modern health insurance is like billing your auto insurance every time you have the oil changed on your car.

The employer provided insurance with little opportunity for the individual to purchase a policy is the result of regulation. Try removing the regulation that caused the problem before adding a new regulation to remedy the problem.

[Primula Baggins]

Before WWII, insurance largely was not purchased at all; people couldn't afford it. The free market didn't produce mass health and prosperity. Like our current system, it produced a lot of avoidable death and chronic illness. The cost to the economy was huge but invisible, because no one imagined that anything could change. So healthy workers died of avoidable illness or accidental injuries because they never got proper treatment, and their families were locked into poverty, often through more than one generation because the children had to leave school to work.

I'm trying to think of a free-market force that would have addressed this situation, but I'm stumped. This was a free market, free of regulation of any kind, and yet no miracle emerged: even the virtuous (employed people with plenty of money) could be ruined without notice. They were worse off than we are, and that's saying a lot.

[vison]

The situation was the same here, although I believe our hospitals (at least here in BC) were always funded by sales taxes. I should look that up. My Mum had a ruptured appendix while she was pregnant with my brother John and not only did she almost die, but the doctor's bill nearly ruined them. Took them years to pay it off.

At any rate, the socialist Tommy Douglas (an amazing man, a United Church minister and leftwing firebrand) brought government health care into Saskatchewan when he was premier there.
http://medicare.ca/main/the-facts/the-h ... f-medicare

[Cenedril_Gildinaur]

Hm, before WWII it was the great depression. A Keynesian cure for a Monetarist mess.

If you go farther back than that you run in to the temporal fallacy.

[Primula Baggins]

Or Dickensian England, also a paradise of unregulated markets.

What's "the temporal fallacy"?

[River]

Or Dickensian England, also a paradise of unregulated markets.

What's "the temporal fallacy"?

This.

ETA: x-posted with Frelga.

[Frelga]

What's "the temporal fallacy"?

Side effect of Viagra?

Oh wait, I misread it.

[Primula Baggins]

I looked it up. Post hoc ergo propter hoc. I'm not sure how it applies in this instance. If past medical miseries can't be attributed to lack of regulation because society is more complex than that, I'm not sure how present ones can be attributed to its presence.

My anecdotal mind has a lazy habit of attributing value to things in front of my eyes, such as the no-copayment mammogram I had a couple of months ago, or my insured post-college sons. (Whose insurance I pay for. It's just that I'm allowed to do so only because of regulation.)

[axordil]

To be fair, it was a lot harder to spend ten year's income on a hospital stay or treatment for a disease or such before WWII. People just died a lot earlier and a lot more often.

[River]

I'm currently enjoying my free prenatal care. At first I thought my insurance was just spiffy like that, though it did seem odd as a previous policy from the same carrier refused to cover my scopalamine prescription or the doctor's visit related to it on the grounds it was preventive. But then my employer forced me to switch carriers and I'm still getting the same kind of coverage. Spiffy twice in a row? I thought maybe so...but then I went to healthcare.gov and discovered that, actually, they have no choice. They're only being spiffy because they have to be.

Sad, isn't it, that companies only play nice with their customers when there's a law involved? Doing the right thing for the sake of doing the right thing just isn't worth it.

[Primula Baggins]

And there's an example where insurance companies that excluded prenatal care saved hundreds in order to spend thousands or tens of thousands. Putting the net at the bottom of the cliff instead of the top. An insurance business whose only value is this quarter's bottom line is not capable of making wise choices.

[axordil]

And there's an example where insurance companies that excluded prenatal care saved hundreds in order to spend thousands or tens of thousands. Putting the net at the bottom of the cliff instead of the top. An insurance business whose only value is this quarter's bottom line is not capable of making wise choices.

From their point of view they were, because the hidden assumption is that people who can't afford their own prenatal care will get the $$$$ postnatal care via Medicaid. It's the fine capitalist tradition of privatizing profit and socializing loss.

[River]

The catch is, depending on what state you live in, you might be too poor for prenatal care but too rich for Medicaid.

[Primula Baggins]

This is also a case where it serves an insurance company (or the state) to provide a service to those who can't afford it. A state, for example, spends a little upfront now to greatly decrease the number of disastrous pregnancy outcomes for which it will also have to pay. The economy benefits even if it means someone gets a service they didn't earn with their own money.

And of course there's that great intangible, reducing human suffering and wasted lives. But there aren't easily assignable dollar values for that, so it's not a factor in the health care debate, at least among very serious people.

[nerdanel]

And of course there's that great intangible, reducing human suffering and wasted lives. But there aren't easily assignable dollar values for that, so it's not a factor in the health care debate, at least among very serious people.

But come now, Prim. We're talking about people who are suffering because they didn't make the right decisions. Everyone knows that people who work hard and act responsibly (1) never get sick, suffer, or die and (2) should the conditions in #1 inexplicably befall them, can always afford their own insurance or the five, six, or seven figure amounts necessary to pay out of pocket.

Also, I will concede - if you insist - that sometimes these sufferers are the victims of circumstances outside their own control, like being the underage children of parents who cannot afford insurance. But to force responsible, insured people to pay anything to ensure these children receive needed medical care - well, that's just an outrageous infringement of the responsible people's individual freedom and liberty. Every child for themselves!

[nerdanel]

Suleika Jaouad, a leukemia patient in her early 20s who has received over $1 million in cancer-related coverage from her father's insurance company, writes of her struggle with cancer:

In two years, I’ll graduate from my parents’ insurance. What will I do about insurance then? Perhaps I’ll gain coverage through an employer — though holding a job seems like a tall task if I’m still in treatment. Isn’t it a contradiction that insurance is often tied to employment, but that the sick people who need it most are the ones who have the hardest time staying employed? If the Affordable Care Act remains in place, at least I won’t be denied coverage because of pre-existing conditions. That’s a huge victory, but what will the cost of that coverage be, and will I be able to afford it?

When I’m lying in bed at night, I often worry about how cancer may affect my future: my career, my relationships, my dreams. Sick people don’t plan on getting sick. We shouldn’t have the added worry that someday insurance coverage may not be there. Or that a medical crisis could become a financial one too.

Read more at: http://well.blogs.nytimes.com/2012/08/0 ... ainty/?hpw

I really want to know, from those who do not support either universal health care or a lesser intervention like requiring insurers to allow parents to place young adult children on their insurance, what treatment payment plan they would prescribe for Ms. Jaouad. She had the misfortune of being diagnosed with an aggressive form of cancer sufficiently early in life that she had no significant workplace savings of her own; she was seven months into her first ever post-college job (abroad, in France) when she was suddenly diagnosed at age 22. She has had such invasive treatment, including a bone marrow transplant and chemotherapy leading to emergency hospitalization, and she has at times not been allowed to go out in public due to her compromised immune system, let alone report to a job.

I don't understand a worldview that would not support cancer treatment for her, that would fault her for being unable to pay seven-figure bills out-of-pocket while under 25, that would condemn her for not being able to work while enduring excruciatingly debilitating treatment, or that would condemn her for previously having taken a salaried job abroad (i.e., without US health insurance) while she believed herself to be in the peak of youthful health at 22. And the alternative is that she must receive treatment at someone else's expense. It pains me that this is in any way controversial.

[River]

Her situation echoes my sister's, though L's cancer battles happened before Obama was even in office and, as luck would have it, all three rounds of cancer happened while she was still young enough to be on my mom's plan (23 was the cut-off age; she barely squeaked through with round three). She maintains coverage through COBRA when she she's not working a job that offered benefits, though this comes at a cost. She once spent a winter without heat because the alternative was letting her insurance lapse and thus being utterly screwed if her cancer came back. Fortunately, in the Puget Sound area such sacrifices aren't the deadly kind (to either the people or the plumbing) , but I'm not sure what planet one has to live on to see that as an acceptable trade-off.