In his defence of classical liberalism and critique of 20th Century state welfarism, F.A. Hayek argued that one of the dangers of socialised medicine (Michael Moore, please note) is that if health care is not rationed by price and expanded by the freely chosen actions of patients and doctors, then some other means of allocating scarce resources, and making them hopefully less scarce, will be needed. That “other” way is state coercion and control. Because healthcare is delivered in Britain free at the point of use – of course it is not free at all – the individual patient does not directly see the price of the health care he or she receives, such as in the form of an insurance premium. There is no price incentive, therefore, for a person to, say, cut out smoking, cut the beer and the beef burgers, get in shape by frequenting a gym, etc.
I wrote some time ago about the scarcity of human organs such as kidneys and livers, and how much of the western world suffers from a strange form or hypocrisy: we say it is great that people volunteer to donate organs (the libertarian writer Virginia Postrel has done just that by donating a kidney to a friend) but we recoil in horror at the idea that a person might ever be persuaded to sell an organ or be paid for such a donation, even though there is, in some countries, a commercial market in the business of using such organs and the related human tissue. (There is some legitimate worry that very poor people who do not realise the health implications might undergo surgery to sell their body parts, to be fair).
I thought again about such mixed attitudes when I saw the front page of the Sunday Times this morning:
THE chief medical officer wants everyone to be treated as organ donors after death unless they explicitly opt out of the scheme.
Sir Liam Donaldson believes the shortage of kidneys, livers and hearts is so acute that the country needs a donation system that will presume patients have given consent for their body parts to be transplanted.
Those who wanted to opt out would have to register in a similar way to those who now carry organ donor cards. This could be done through a central NHS database or through other documentation, such as driving licences.
But ranting away about the presumptious tendencies of a state doctor is all very well for relieving a bit of blood pressure, but there clearly is a problem with shortages of organs and how to save the lives of people in desperate need. Donation, either for no money or for a payment (with safeguards, if need be), can work only so far. We need to encourage biotechnological fixes: and a good place to see what sort of fixes might be out there is this interesting study by Ronald Bailey.
The doctors are right to highlight that there is a problem, but how less depressing would it be if they could think about ways of solving it without recourse to asuming that your body belongs to the collective, just for once.
If the state owns us, and the sum of our lives is under their direction, as our medical care standards will be dictated so will the disposal of *their* property be also dictated. One absolute test of ownership is the right to sell (dispose of) it.
Because healthcare is delivered in Britain free at the point of use – of course it is not free at all – the individual patient does not directly see the price of the health care he or she receives, such as in the form of an insurance premium. There is no price incentive, therefore, for a person to, say, cut out smoking, cut the beer and the beef burgers, get in shape by frequenting a gym, etc.
…which is precisely why America, with the most market-oriented healthcare in the industrial world, is also the slimmest and fittest.
Oh wait.
I oppose state healthcare on principle, but it’s obvious that personal health is affected more deeply by a swath of factors than whether the state picks up the tab or not.
Joshua Holmes,
You may want to do your homework a little more carefully. The US has almost completely collectivized health care at the individual level. The reason you and most other people don’t realize this is that it is concealed by group plan membership. When a higher risk person joins the group, they effect the premium that group pays, but they personally are not ‘discriminated’ against. Just last night my brother told me his company informed them that the premiums were going up because their collective risk factors had been reassessed.
While it may not be collective health care at the national level, it is certainly collectively redistributed at the group plan level.
If you doubt this, find someone in a group plan who is high risk. Have them get a quote for an individual insurance policy not in a plan. Compare the cost to what they pay in the group plan. Prepare for sticker shock.
If you are in a group plan, chances are very good that you are subsidizing high risk behavior the same as it is subsidized in the UK.
Of course State and Federal regulations tend to limit greatly how much (if at all) insurance companies can “discriminate” (to “discriminate” is another word for “choose”, remember).
The whole point of “insurance” (as classically understood) was to work out the risks that someone faces and charge premiums accordingly. But in the United States that does not really apply (not just in health – even in things like fire and flood insurance in places like California, where people at high risk pay the same as people at low risk).
And, of course, we have the F.D.A. (to increase drug prices and keep many off the market for years – thus killing lots of people) Doctor licensing (a rip off that spread from State to State in the early years of the 20th century – in the name of “protecting” people) and the vast subsidies of Medicare and Medicaid (and the other government schemes) that have the knock on effect of increasing prices. Tax law also distorts everything (with employees not getting the same tax treatment as employers).
Once most Americans were in fraternities (mutual aid societies – not student drinking clubs), but this has been undermined by the modern government.
And, only a few years ago, the H.M.O.s were spreading (to get round the regulations that had made insurance so expensive) – but the H.M.O.s got regulated as well (with predictable results). And, no, I am not just talking about tort law (although I would like negligence to be proven rather than John Edwards style “where someone suffers, someone must pay”)
I wish I could visit this “market orientated” United States that people talk about. It does not exist in the world I live in.
Ouch Midwesterner beat me to the punch – serves me right for typing too slowly.
On the other hand, the present system allows for personal choice, with a presumption that a person doesn’t want to donate their organs. The presumption can be reversed without affecting the scope for personal choice.
In my own case, I’d far prefer that anything not too ravaged by decades of drink, tobacco, drugs and red meat were reused to the benefit of someone still using oxygen, rather than it rot uselessly. But I don’t carry a donor card; I have enough problems finding my credit cards (a sentiment not echoed by the issuers).
So I don’t think this is the end of the world, unlike the Health Service itself.
On the cost of socialised medicine. On the whole, I think that if the prospect of debilitatating illness and surgery does not put people off their lifestyles, the prospect of paying for it (or not being able to pay for it) will be a minor concern. People willingly trade having a life for an earlier death, and accept the risk. Nobody carries on smoking on the basis that they think science will be able to cure whatever they get. They know it can’t. (BTW, while smoking carries a certain risk, the bit about beer and burgers are mostly propaganda from the health nazis. And I suspect the gym does not help as much as you might think. But that’s a separate rant.)
The idea of sharing risk is not collectivism. You exchange something for something by taking part – a low risk of a high impact, too high to afford, is exchanged for certainty of a much lower impact. You buy lower stakes in exchange for worse odds, and to the extent that your utility for the stakes exceeds that for the odds, you profit.
The problem with doing it through state taxes is that you do not get to choose how much risk to buy off, and you provide an incentive for everyone else to try to save money by interfering with your freedom to take risks. Nanny government assumes you should want to eliminate as much risk as possible, whatever the cost. Some people might have chosen to accept the dangers uninsured, and spend the money having fun.
The freedom to have fun, rather than saving every cent just in case, is what you are buying. To object to some people getting more fun for their money than you do is no more sensible than complaining about rich people buying the same goods you want pushing the price up in the free market. Stop moaning. Either find yourself an insurance scheme that gives you credit for a puritan lifestyle (I suspect you won’t pay much less), or go get yourself some beer and doughnuts too.
On the whole, given that we have to pay for it anyway, beer and burgers sounds a far more enjoyable lifestyle than the alternative – so I call that a good thing. Enjoy it while you can. If the health nazis have their way, it’s not going to last long.
If by “The idea of sharing risk is not collectivism”, you are referring to my remark that “While it may not be collective health care at the national level, it is certainly collectively redistributed at the group plan level”, insurance as it is generally accepted, means an actuary calculates an estimated risk and distributes the premiums accordingly.
While each group’s total collective premium is set by actuarial methods, within that group, the premiums are not adjusted by those methods. Within a group, it is collectivism.
The rest of your comment sounds like you don’t much understand the sysytem. You are not evaluated directly on your consumption of junk food. You are penalized for its consequences. You are penalized by things like age, gender, height/weight, blood pressure, medical history. You tell me how I can stop “enjoying” my medical history (a car accident) and maybe I can get something. The only way I can probably get affordable insurance now is to join a group plan by getting hired by a big company and then my risk factors will be picked up and shared by the other members of the plan.
But that is collectivism. Johnathan’s point even applies in the US. Because health care is almost entirely collectivized (by groups) in the US, there is the same problem with no force to constrain the pseudo-market prices. This means that the very few cash customers there are pay hugely inflated prices not to mention all of the other problems intrinsic in the system.
I agree with Mid that insurance is a collectivization within the group. Even so, insurance purchased from a private entity is:
a) Voluntarily entered into with full knowledge of the costs and benefits of joining, and
b) Run by a private entity which must operate efficiently (control costs) to survive (let alone profit).
Both of these points are perverted when the Government takes over:
a) Everyone must participate (not voluntary), paying through taxation (no control of the individual costs), and if Hillary has her way, everyone will be forbidden to obtain services outside of the Government system (no control of choices). As for preventative actions, the Government will have the power to impose one-size-fits-all requirements (loss of control of personal lifestyle).
b) Government is not restrained by the need for efficiency (much less profit). Government employees merely need to minimize their responsibility, and maximize their “benefits” in salary, pensions and perks. If there isn’t enough money (and there never is, since no limits to Government authority are acknowledged) the same Government just declares an increase in costs (taxes) to the consumer (taxpayer) by fiat. Result: ever decreasing volume and quality of services, ever increasing taxes.
Regulation is the current problem in the U.S. In the last 30 years, it has added huge unanalyzed and unanticipated liabilities to providers. Private providers have been required by law to provide ever more expensive treatments for ever more ailments, many purely imaginary (e.g., any number of “syndromes” and “stress” ailments). If regulations didn’t add these new liabilities/risks, then some Edwards-style lawyer did. Lawsuits also added huge penalties (judgments) for less than perfect results, as though the human body could be repaired like a refrigerator. More unanticipated costs.
Medicine is still as much an art as a science. A neurosurgeon once told me that’s why they call it practicing medicine – if doctors really knew what they were doing, they’d call it performing.
I sometimes think there has been an intentional effort to screw up medical care delivered by private companies, with the intent of selling a Government takeover. Looks like it’s working. We can all expect a call someday – “Report to the Hospital in the morning. We need your extra kidney.”
CFM, I agree with much of what you said, but I’m afraid you have bought into some popular misconceptions.
Regarding A. You left out the people who are locked out. If you are an adult and are not on s.s. disability and do not have children under 18, you might (in my state) be unable to get insurance at any price. The only way for these people is to spend themselves bankrupt (*paying triple price) and then freeload. Even among people that have insurance, very often things are ‘ridden out’ of the policy so that no coverage is possible and bankruptcy is unavoidable.
Regarding B. Insurance companies have no/zero/nada stake in keeping expenses down. If anything, it is the inverse. They set their premiums to cover expenses and put a markup on top of that. If you look at prices re inflation that insurance companies pay out, they have been going up dramatically, only exceeded by the spectacular increases in retail price put in place by hospitals. These retail increases serve both the insurance company and the hospital. They allow the hospital to over charge cash customers and attempt to overcharge the government customers. And they allow the insurance companies to wave around the big ‘discounts’ they are getting when people ask them if they try to save money. Insurance companies make more when prices go up and I suspect they are not above assisting the rest of the medical lobby to ‘raise all boats’. The result is we have a bi-directly reality detachment device. The patients don’t worry because “the insurance will pay for it”, and the insurance companies don’t worry about it because “we’ll add it to the premium”.
You probably know me well enough to predict my vomit reflex at the thought of nationalized ‘health’ care.
What I propose to start is:
Allow any qualified lab/tech/nurse/etc to perform any diagnostic on anyone who asks and pays for it. ie blood test, etc. WITH OUT REQUIRING A PRESCRIPTION to be issued by an American Medical
AssociationUnion approved member in exchange for a kick-back.Allow (and require doctors to fully release) medical records to be kept by companies that do nothing but keep records. In this way, anywhere you go, you could have your records made available to your provider and your provider could add to your records. You would have full and unharassed access to all of your records in one place. Changing record keepers would be about like changing cell phone companies. Probably easier.
Deregulate insurance so that patients could be offered plans that reward price shopping. While the patient may not be the best at judging quality of care, the patient can certainly do a better job than an insurance clerk somewhere. And I’ll trust Consumer Reports and Underwriters Laboratories type companies to better inform me about incompetent medical providers long before I trust the gov to do it.
You are right. It is all about too much regulation. As far as I’m am concerned the extent of ‘regulation’ we need is truth in advertising enforcement, and terms of contract enforcement. The rest will quickly solve it self.
“Darling, you look marvellous!”
“Yes, it’s my new regime!”
“Do tell.”
“They call it ‘slavery’. Every time I do something the government doesn’t approve of, they take my money or lock me up.”
“It suits you darling.”
“That doesn’t matter.What matters is that we respect our betters and do as they tell us – for our own good!”
“Well I think your figure is to die for.”
“Oh no!We’re not allowed to die without state permission, and then only of approved causes.”
Following an argument I had some years ago with somebody who told me it was immoral to smoke – as smokers were a greater liability to the NHS – I worked out the ratio of taxes raised by the treasury from tobacco sales versus the cost to the NHS of treating smoking-related diseases. At the time it was about 14:1.
It is outrageous that we smokers have to share wards with non-smoking ruffians. At the very least we should get private rooms, and a decent menu wouldn’t go amiss.
The obvious libertarian solution to the organ “shortage” is of course a free market in organs.
But I remember an only half-joking point made by David Friedman (no collectivist he!) that if you allow a free market in organs then every healthy person is automatically carrying around tens of thousands of pounds of organs.
Does make one pause for thought !
Julius
Mid, you said: “Allow any qualified lab/tech/nurse/etc to perform any diagnostic on anyone who asks and pays for it. i.e. blood test, etc.” But who decides who is qualified? Doesn’t it bring us back to a reign by some kind of medical guild? If anything, it should be “allow anyone to perform…” etc. Let me (the patient) check their qualifications. But that’s too radical for most people, I know.
Once you have to “ask” not to be donated, the precedent is set for your request to be suspended.
The important issue with “opt in” is ownership and control. By allowing “opt out”, the state really does own your ass.
The matter of “opt out” isn’t as bad as some make it sound.
When a person dies leaving no will, the society, by means of the law, defines who the “legal” heirs are – i.e. – whom we presume, by default, that the deceased would have wished his heirs to be.
The same goes with the deceased’s organs. Absent a will, what would the default wish be ? That his organs rot, or that they be donated ?
Legislating that the default will is that the organs be transplanted seems reasonable to me, and not too collectivistic.
Seems to me that the notmal procedure now is to ask the next of kin. That too is reasonable.
Leaving aside for now whether insurance companies are the best way to provide health care (there are other alternatives – charitable trusts, mutual aid socieities “fraternities” and “friendly societies”, direct payment and so on – my guess is that a voluntary system would be mix of many things).
However, as I tried to make clear above – Federal and State regulations do not allow insurance companies to “discriminate” (or at least make it difficult), i.e. they do not allow a rational insurance market.
It makes no sense (for example) for a person with a “healthy life style” to pay as much as someone who eats junk food, drinks a lot of booze and smokes. And yes, genetic, factors should be allowed (what a company judges relevant should be up to the companies in the market place – it should be nothing to do with local, State or Federal government).
It is as if a car insurance company had to charge the same rate to person who kept on having car crashes as to a very careful driver who never had an accident.
“It seems that only a trained economist is able to understand what is meant by the term market” (Milton Friedman).
Sadly many “economists” in the universities also do not understand what “a market” is, they seem to think that all sorts of regulations can be imposed with no negative consequences.
Just as they think that government subsidies have no negative consequences.
Medicare and Meicaid cost five billion Dollars (both together) when then came in 1965 – how many HUNDRED OF BILLIONS do they cost now?
Plus the “knock on” effect of the subsidies on private prices (just as with the knock on effect of government subsidies in higher education push up tuition prices).
History just keeps repeating itself.
For example the little scheme that President Clinton got Congress to accept (in return for Welfare Reform) to cover the health costs of some children, came in at four billion Dollars – it now costs close to eighty billions Dollars (4 to almost 80 in only a few years). And powerful forces want to greatly expand it.
Such subsidies (of course) help push up general prices (so the public pay twice – once in the taxes to pay for the program, and then again in higher priced health care).
The government has “rights” to 40+% of us while we are alive, and we do little more than complain about it on blogs and message boards, why should we care so much that they continue, one last time, take the choicest 40% of us when we’re dead? While I’m certainly not nuts about forced organ donation, I’m more insulted by the prospect of the continuation of the impounding of my mental capacities and judgements than someone taking my heart when my brain is dead. The only real concern to me is that some bumbling bureaucrat will dispatch me before my time.
Alisa,
Currently these professions are all highly tested before they can call them selves a nurse, a ___ tech, a whatever. These qualification and licensing procedures are already in place. As a transitional phase, it is entirely reasonable that a simple step like removing the requirement for an AMA kick-back would free up a lot of medical care to people who otherwise can’t afford it. It would also take a huge bite out of the pocket stuffing that happens when a member of one provider refers you to a service from their own lab. If you could freely go to a competing lab and personally save the difference in cost, … And if insurance companies were allowed to write policies that rewarded you for that, …
But the medical lobby is extremely powerful. They have many politicians (most?) bought, paid for and instructed.
The final state of medical provision that I would like to see is for qualifications to be evaluated by various consumer organizations. If one of these organizations got a little too cozy with the providers, the market would discredit them all by itself much faster than any bureaucrat could or ever would.
You can only sell your good name once.
Yes, as a transitional phase it is reasonable, only you know how these transitional measures have a tendency to become permanent. Not that I have a better solution, mind you. And I even cannot imagine most people accepting that transitional solution either. I think I am as pessimistic as Paul on all of this, unfortunately.
I think that depends on how angry liberty minded people get about the status quo. If we leave all of the outrage to the socialists, we’re SOL. We need to be leading not defending on this matter.
And how do we do do that, except for commenting on blogs?
Brad, I understand your point of view but every step of the way, I think it is right to resist these people, even the more well meaning ones. Slippery slopes, etc.
I thought people here might be interested in this.
http://junkfoodscience.blogspot.com/2007/07/information-management-news-for-fellow.html
Auto and life insurance ‘discriminate (as defined above)’ – why can’t health insurance?
Alisa,
Well, I’m doing what I can. 🙂
Jerry,
Because if it did, people would start looking closer at what they are charged. They would begin comparison shopping for health like the do for life and auto insurance. Presently, they only worry about the plan’s benefits, not its costs. Once price becomes an issue, there might be competition. (Oh, the horror!) It is far safer for the medical lobby to say that society should pay for people who are high risk than to let open competition stick its foot in the door.
Okay, so folks have given many good examples of how the American health market is unfree. Well no shit, no one said this was a libertarian paradise. What I’m wondering is why the US, with a more market-oriented healthcare policy than other industrialized country, also has the fattest people? Do you really think a regulated insurance market is less market-oriented than the NHS or France?
Or, just maybe, does health have more to do with personal factors?
Mid,
Though we seem to agree on the important points, there are a couple of . . . twists:
“Regarding A. You left out the people who are locked out.”
No, since I don’t believe it’s the Government’s job to provide everyone with the solution to all of life’s problems, I’m suggesting that by implementing your excellent suggestions and adding quite a few more along the same lines, the uninsured will be able to get in on their own. Your description of the problem is accurate, but addresses only one side of the equation. Yes, consumers are in a pickle. But providers have legitimate issues as well. We’ll need to address both.
“Regarding B. Insurance companies have no/zero/nada stake in keeping expenses down.”
I think you give too much credit to profiteering and not enough to the enormous costs of mandated services.
As just one example, over the last few years, eighty-four privately owned hospitals have gone bankrupt and closed up shop in California (This is a problem all over the Southwest – I don’t know about your neck of the woods). This is primarily because current law forces them to provide full services for free, via emergency rooms, to armies of illegal aliens (and, I’m sure, uninsured folks who don’t trust government hospitals – another subject).
Here’s the kicker: The hospitals still in business recovered enough money by . . . raising the prices they charged to folks like you. They didn’t do it for obscene profits, but to recover costs incurred by people who paid nothing. Survival.
“You probably know me well enough to predict my vomit reflex at the thought of nationalized ‘health’ care.”
Yes, I’ve read your articles before. We’re on the same side. The biggest problem we have right now are politicians who have lots of sad stories about people who don’t have (fill in the blank) but have only ONE solution: Send the bill to Mid and CFM, after adding a multiplier to provide lots of perks to useless, tyrannical bureaucrats. Grrrr.
To really solve the problem, and put the Socialized Medicine fans back in their box, we’ll have to tackle multiple tough issues: The Medical Guilds Milton Freedman was so fond of criticizing, Tort reform (no, I’m not suggesting how we shoot all the lawyers – I’m really tired of that 9mm vs .45 cal argument), De-regulation at many levels, tax code reform, and finally, teaching a particularly thick populace about how to get value for their money (not other people’s).
Oh yes, as you pointed out, transparency and enforcement of contract law. In fact, a great many problems could be solved by those.
Uhh – we seem to be seriously off topic for the original post, and I saw a picture of Perry with his SIG. I think I’m out of range here on the Left Coast, but how far are you from Pennsylvania?
“. . . why the US, with a more market-oriented healthcare policy than other industrialized country, also has the fattest people?”
We don’t need Socialized Medicine for that, either. Here’s the secret: Eat less, move more. You want to tell them or should I?
No matter. I don’t think they’re listening to us.
Try listening to commercial radio in the Yuk.
A good quarter of the adverts are government driven, and an especially irritating one is where a mercilessly upbeat bloke nags us about taking our ‘5 pieces of physical activity’ each day.
It would have to be five, wouldn’t it?
‘Pieces’? WTF is a ‘piece’ of physical activity?
They’re nothing but a bunch of illiterate communist gobshites.
No one seems to consider the option of paying for all but catastrophic conditions out of pocket. You can shop around for policies with large deductibles and no prescription coverage, which can cost considerably less. If an out of pocket doctor’s visit or a prescription seems pricey, remember that you are saving on the insurance premiums, especially in your younger years. Another thing to remember that many health providers have different price schedules for the non-insured.
The question you need to answer yourselves is: “Who owns my body?”
If they want organs so badly why not be honest and actually pay for them? That would add to a deceased’s estate.
No not content with taking 40% death tax they want to take your organs as well.
Alisa and Midwesterner:
As you both most likely know the biggest mistake made by the anti socialist forces in healt care is to defend the current situation. The current situation is clearly very bad (with health care being vastly expensive) so defenders of the status quo just discredit themselves (at least partly).
If one defends the status quo the left gradually pull things their way (just as with Medicare and Medicaid – 5 billion Dollars in 1965, many hundreds of billions of Dollars now).
Indeed some people who “defend freedom against socialism” actually sell the pass even more than by just support the status quo. Such folk as Bill O’Reilly (do not snear at my example – more people watch the “O’Reilly Factor” than read all the pro freedom blogs) oppose socialism but suggest more regulations.
More regulations on top of the vast pile of regulations that already exist – thus making health care even more expensive.
So the “enemies of socialism” aid it.
Whereas if pro freedom people suggested radical things (not in stupid sound bite “debates” where no one gets time to present their case – but in a few minutes of talking points time) such as rolling back the regulations – this would put the left on the defensive.
One was to pull hard on the pro freedom end of the rope (in the tug of war that is politics) just to stay in the same place – let alone to move in a pro freedom direction.
As for the A.M.A.
If they want to run ads saying “do not go to this person for medical treatment – he is not a member of our noble organization” I have no problem with that.
It is the “toss him in jail because he does not have a license” that I have problem with.
As for free market testing bodies.
Underwriters Labs will be familar to both of you.
Yes indeed – if something is voluntary it has to watch its reputation.
I wonder if the resistance to ‘paying for organs’ as opposed to voluntarily giving them away is based in any way on what happened to blood donations as soon as people started getting paid for blood.
– When blood donation groups started paying for blood, the people that had for years voluntarily given blood (due to their conscience) stopped giving – since they no longer felt their sacrifice meant anything – resulting in a drop in blood supplies.
About organs:
If a person dies and leaves no will his material assets go to the legal heirs (next of kin); if there are no legal heirs – the State gets the assets.
Should be the same with organs – the heirs should have the decission.
Of course, if a monetary compensation were offered, there would be more organs available for transplants.
Anything that is of value should be paid for. Simple.
Since I take a benefit allowance and buy my own health insurance, I’ve noticed something:
Quitting smoking and staying quit for a few years took about 12% off of my premiums. And that’s with me too young for any of the chronic conditions to have set in yet. I’m not positive, but either that or my life insurance also gave a discount for maintaining my LDL below a certain level.
And 30-something males are actually very cheap to insure. Less than $125/month here, if one is willing to accept a relatively high deductible. Some of us will have snowboarding accidents, and others will live off of Doritos and TV, but the latter group are again too young for the chronic cardiac or respiratory problems to show themselves. They tell me that the world changes at forty, though, when the couch potatoes will all have heart attacks and those of us who exercise will all have knee replacements instead.
It’s illegal to pay for whole blood in my state. At least, it’s illegal to pay cash to the donors, but I’ve scored some nice t-shirts over the years. Plasma, however, can be bought and sold, but the only plasma bank I know of is wedged right between the medical school and the crack cocaine epicenter of Colorado. Hmmmm…
CFM: Illegal aliens are a source of heartburn here too, but they’re not the entire failed hospital story. At least here, emergency rooms are a favorite place for uninsured people to go to receive non-emergency care. When I did my EMT clinicals, we had an ungodly number of people come in either to be treated for the common cold/flu/affliction of the week (I think it was SARS at the time) or to get their next fix for their pain pill addictions.
And if you’re wondering why you can’t get effectively treated for pain caused by a real illness or injury, it’s because physicians are terrified of losing their DEA licenses because they accidentally trusted one too many of the wrong patients.
Speaking of which, does anybody have a link to the UK NHS formulary? I’m interested in which cancer drugs they do and don’t cover and for which cancers. Google has been less than fully helpful.
CFM,
If you qualify your statement “Even so, insurance purchased from a private entity is: – a) Voluntarily entered into with full knowledge of the costs and benefits of joining, and “ by first saying that “If insurance can be purchased … “ Then we can agree. But it is possible that as a consequence of our regulatory structure, it can be completely impossible to buy solo insurance for general health. Examples of this are that once a condition occurs, insurers can adjust their premiums at the next renewal. Do the math and decide at what price it ceases to be ‘insurance’ and becomes more of a de facto health savings account.
The regulatory structure discourages (outright bans?) writing guaranteed premium insurance. Suffer a permanently expensive injury while on a group plan? Plan to never lose your job or become self-employed. Someone who’s case I know fairly well lost insurance in a divorce but had chronic health problems (Hepatitis C acquired in a third world hospital after a boating accident >20 years ago). This page gives some guidance, but when you realize that in divorces, people are often stuck with huge debts (not necessarily of their own making) and no money. And all of these provisions have very strong time limits to apply.
If you are historically without insurance (longer than 63? days), then you must work for a company providing a group plan for 18 months of eligible coverage (which often does not start immediately) before you can qualify for any of this. That is not an option for self employed people. Recent HIPAA law has capped premiums (sort of) for qualified people (great, one more form of forced collectivism) but still, if you have been uninsured more than 63 days, you’re SOL.
In a nutshell, some people are locked out. When you have zero options but a true free market would have provided you with some, the only way to describe it is “locked out”.
That paper you linked suggests “CRAG” which on reading it sounds a lot to me like Prince Prospero’s plan in Poe’s The Masque of the Red Death. I hold no hope that disease can be locked out. But I don’t think that was the particular information you were pointing out to me, just a side note. Like so often, researchers get the facts right and the solutions wrong.
The economic consequences of our system that it describes are quite real, though.
I do have a strong request of people discussing health care in the US. That is to start differentiating “uninsured” from “non-paying”. One third of uninsured DO pay their bills as well as those of the remaining non-paying uninsured (by being charged triple prices). As a paying uninsured, I’ve have rather strong thoughts about that distinction. And by virtue of debt collection laws in most of the US, if non-payers have any assets before they are billed, they don’t afterward.
(Sunfish, “emergency rooms are a favorite place for uninsured people to go to receive non-emergency care.” Speaking for myself, uninsured who pay their bills avoid emergency rooms like the plague. You are referring to people who don’t intend to pay.)
(Back to CFM) You appear to be equating the health and profitability of hospitals with that of insurance companies. At one time, hospitals and doctors shared common cause with the insurance companies. They all benefited as they rigged the system. But once the market grew hard and there was no more to be had, the insurance companies started feeding on the others. I can’t imagine the hospitals should be surprised. Honor among thieves? Riiight. I suspect most of those hospitals were not-for-profits. And while doctors, insurances companies and profit based medical service providers will defend themselves to extremes through political process, I doubt many are too vested in changing the system to save not-for-profit institutions. In our neighborhood, it is always the community that undertakes supporting non-profitable hospitals. Doctors make sympathetic noises and some donations, but ultimately move on. In short, I suspect the medical lobby is more than willing to sacrifice these ‘victim’ hospitals to show how tough it is to be them. I suspect the truth is that the loss of those hospitals doesn’t adversely financially impact many, or even any, in the medical establishment.
I don’t think we’re ever out of range of Perry. His agents circle the globe. Wait a minute … Shhh … Do you hear something?
It is a charitable act for a comercial hospital to open its E.R. to a poor person in a life-or-death situation.
And charity is one of the great virtues. Indeed that is why charible (non commercial) hospitals have been built and maintained for centuries.
But when an act is compelled by statute is not a charitable act, it is not an example of this virute (sorry Samual Pufendorf you were wrong on this one), and when such acts are compelled all sorts of abuses come in.
Mid:
Health care providers charge you over the odds because you belong to a high risk group, the uninsured, which often does not pay for healthcare provided. They have no guarantee that they’ll get paid, unlike with Medicaid, Medicare and insured patients.
Is there no one who will provide you with an insurance plan to cover your situation, say with no prescription drug coverage and a $50k deductible? With a high deductible plan you get the option to negotiate with your providers to eliminate unnecessary procedures and get decent prices for the necessary ones.
Edward King,
That was a great article. Thank you for the link. Tax law and hopefully, insurance regulations have changed favorably since last time I tried. It’s possible that the change in HSA taxing is driving changes in the market offerings. I think it’s time for me to try again. One can hope.
I’ll have to see if I can find any guides to negotiating with providers. Just knowing what insurance companies are paying for each service would be very useful. I know from analyzing my fathers bills that spectacular discounts are the norm. I also know from sorting out some of them that medical service providers do love to hand them over to collection agencies.
Sorry about that. I should have been clearer the first time around. Emergency rooms are a terrible place for non-emergency care for people who pay their bills, just because they’re a really expensive way to deliver health care. Someone who’s uninsured but not a deadbeat will get hammered especially hard in that situation. I’m just glad that, after $5000/year, I’m off the hook. When you’re brought in by the fire department, you’ve spent that five grand before you actually talk to a MD.