Mitts Pick

[Gaspar]

Interestingly, in that entire screed on why the insurance industry is not to blame for its problems, you failed to articulate why it is they cannot control costs. 

It's like talking to a brick wall. Costs are controlled through competition.  They are not established from some "farcical aquatic ceremony" nor are they efficiently established in a board room.  They are developed through competitive pressure.  Supply, demand, scarcity, and competition.  Without that the "they" have no incentive to "control costs" anywhere but up.

[erfalf]

It's like talking to a brick wall. Costs are controlled through competition.  They are not established from some "farcical aquatic ceremony" nor are they efficiently established in a board room.  They are developed through competitive pressure.  Supply, demand, scarcity, and competition.  Without that the "they" have no incentive to "control costs" anywhere but up.

He's right. The only one that should be responsible for controlling costs are the consumers, you and I. And as it stands there is little or no involvement by the consumer in the price discovery of medical care. And yes we may know the price today of care, but that is not necessarily what the cost is. There is a difference.  Econ 101.

Why do you not think that what we have proposed would not work? I can tell you that the opposite has never worked, ever. And it will never work, ever. If you want the quality of care that we are accustomed to anyways.

[erfalf]

erfalf, we know what the costs are. The insurer sends you an EOB detailing what was paid for what services. Your employer sends your insurer a check (or you do). The doctor knows what his costs are, the insurer his.

Insurers get their payout rates from government payout rates. Doctors price accordingly. This is not natural price discovery.

Many insurance companies are public, and therefore have open books. Studies clearly show that prices paid per procedure are much higher here than they are anywhere else in the world for no better care on average, and often worse care. Insurers have dismal MLRs, doctors order more procedures, care is less standardized here, there's a long list of reasons why it's expensive. Whacking Medicare doesn't change any of it, so all you're doing is pushing the cost off the government's books, not actually fixing the problem.

Forcing customers to take responsibility will decrease the bad care providers. Not instantly, but eventually. If you can show how this wouldn't work, by all means go ahead.

Just like if you gave families the money to shop for their own schooling, many schools would either close down or be forced to improve in order to keep enrollment at sustainable levels.

[heironymouspasparagus]

It's like talking to a brick wall. Costs are controlled through competition.  They are not established from some "farcical aquatic ceremony" nor are they efficiently established in a board room.  They are developed through competitive pressure.  Supply, demand, scarcity, and competition.  Without that the "they" have no incentive to "control costs" anywhere but up.

Where you completely derail is that you are talking about a capitalist system.  What we have is a capitalistic monopoly system.  Capitalistic Monopolism.

Subtle terminology difference, but huge practical difference.

[nathanm]

It's like talking to a brick wall. Costs are controlled through competition.  They are not established from some "farcical aquatic ceremony" nor are they efficiently established in a board room.  They are developed through competitive pressure.  Supply, demand, scarcity, and competition.  Without that the "they" have no incentive to "control costs" anywhere but up.

Name one state that has only one health insurer. Then perhaps you can present one or more specific action items. Not platitudes like "relax regulations," but which specific regulations? Why do the multiple insurers not compete on price?

erfalf, consumers are clearly already responsible for the cost, it drives them into bankruptcy despite being insured! And doctors are free to not accept private insurance if they don't like the rates. They have the option of doing fee for service if they like. Maybe you can clear something up for me. If doctors are getting squeezed so hard, how is it we have the highest cost system in the world even on a per procedure basis? Where is the extra money going for a hip replacement or heart surgery? The insurance companies? If not, is it simply vanishing?

The privatization push would make a lot more sense if the private market was better than the existing system by any metric at all other than ideology. It's more expensive, despite apparently always using Medicare's bargain basement rates. Beneficiaries on average are more highly satisfied with Medicare than with private insurers. Improve the private market first.

[erfalf]

erfalf, consumers are clearly already responsible for the cost, it drives them into bankruptcy despite being insured! And doctors are free to not accept private insurance if they don't like the rates. They have the option of doing fee for service if they like. Maybe you can clear something up for me. If doctors are getting squeezed so hard, how is it we have the highest cost system in the world even on a per procedure basis? Where is the extra money going for a hip replacement or heart surgery? The insurance companies? If not, is it simply vanishing?

First, we have the most expensive system because it is the best system. Second, we have the highest rates, because we medicare actuaries keep increasing the reimbursement rates every single year. It's not just one thing.

Also, there are doctors that do not accept insurance, and guess what, they charge dramatically less than those that do accept it. Coincidence?

Look, I'm not saying what I am advocating is the only way to do it. I am just saying it is better than single payer'ish type of system. It is (from the progressive dictionary) the fairest system on the planet. Sending the decision making capability out to millions of people instead of hundreds is always a good thing for the consumer.

It's funny that virtually no one on this board would trust the government to run anything yet you believe that if they implement your idea (whatever that is) they will somehow come to and get it together. Fat chance. Government is by design inefficient. It was intentionally set up that way not to keep it from being responsive, but to keep it from being ruled by a mob. That is why government and the economy are like oil and water.

The privatization push would make a lot more sense if the private market was better than the existing system by any metric at all other than ideology. It's more expensive, despite apparently always using Medicare's bargain basement rates. Beneficiaries on average are more highly satisfied with Medicare than with private insurers. Improve the private market first.

Are you saying medicare customers are more pleased with their services than those that have private insurance? If so, where do you find this, and by how much are they more pleased?

First, what we have, while not 100% private, is the best system on the planet. No other system on the planet provides the consumer with the services they desire as efficiently and as free (to choose) as this one. Second, what we (Gaspar and myself) are advocating is not some never tried system. It has been tried (in other economic situations, which is what this is) and has succeeded virtually every time it has been tried. Capitalism (or whatever you want to call it) is the system by which freedom is achieved most efficiently. What the health care industry needs is a little capitalism.

[nathanm]

First, we have the most expensive system because it is the best system. Second, we have the highest rates, because we medicare actuaries keep increasing the reimbursement rates every single year. It's not just one thing.

Weren't you just saying that Medicare squeezes doctors? You can't have it both ways. Either Medicare is too stingy or it's not.

Look, I'm not saying what I am advocating is the only way to do it. I am just saying it is better than single payer'ish type of system. It is (from the progressive dictionary) the fairest system on the planet. Sending the decision making capability out to millions of people instead of hundreds is always a good thing for the consumer.

I suppose if you define fairness as rationing access based on one's financial means, then yes, it is quite fair. (Emergency care isn't generally rationed, but that's the most expensive time to treat a problem)

It's funny that virtually no one on this board would trust the government to run anything yet you believe that if they implement your idea (whatever that is) they will somehow come to and get it together. Fat chance. Government is by design inefficient. It was intentionally set up that way not to keep it from being responsive, but to keep it from being ruled by a mob. That is why government and the economy are like oil and water.

I'm not arguing for single payer healthcare. I'm arguing against the dismantling of Medicare when the only alternative is a system we both agree is dysfunctional.

Are you saying medicare customers are more pleased with their services than those that have private insurance? If so, where do you find this, and by how much are they more pleased?

Yes. I'm saying that Medicare beneficiaries are on average happier with their package than the average beneficiary of private health insurance. Look it up. You want satisfaction surveys. Even within Medicare, traditional Medicare rates more highly than Advantage, despite Advantage costing more. Satisfaction is not complete, but it is not by any means that in the private market, either.

First, what we have, while not 100% private, is the best system on the planet. No other system on the planet provides the consumer with the services they desire as efficiently and as free (to choose) as this one.

It's mathematically impossible that our system is the most efficient. It costs more to do any procedure here than it does anywhere else in the world and our outcomes are no better than our (economic) near neighbors. The most efficient system would have the lowest prices for a given quality. Simple economics. Freedom of choice is a matter of opinion. Many insurance plans have woefully small networks and have no coverage for non-emergency out of network services. The individual gets to pick their doctor even over in NHS-land. The difference there is that they're all covered the same. Only the source of the rationing changes. But that's irrelevant, I'm not arguing for an NHS-style system here.

I wanted a public option. That is a GSE that sells health insurance. What better to liven up the market than a little competition, after all?

What the health care industry needs is a little capitalism.

The health care system is already run mainly by capitalists. You keep repeating this mantra, not realizing that is what we already have. If you have the solution, have at it. Reform the insurance industry. When it's been declared a raging success by all because it reduced costs and increased efficiency, forever (or at least for a while) banishing the drag on our economy that is the present healthcare system, I'll be right with you in turning the insurance industry loose on Medicare. I am, quite honestly, more interested in solutions that work than anything else.

[Ed W]

....And it is true that deeds done by progressives have been some of the most horrific in history. Yet they are never labeled radical.

You mean things like child labor laws, anti-trust legislation, clean foods and beverages, social security, medicare, medicaid, and the clean air act?  Those horrific bits of progressive legislation?

[erfalf]

You mean things like child labor laws, anti-trust legislation, clean foods and beverages, social security, medicare, medicaid, and the clean air act?  Those horrific bits of progressive legislation?

Eugenics, 16th Amendment, Federal Reserve...

[Hoss]

Eugenics, 16th Amendment, Federal Reserve...

You do realize that Lincoln levied the first income tax...a Republican?

[Red Arrow]

Where you completely derail is that you are talking about a capitalist system.

What Tulsa really needs is a (real) trolley system.  A trolley system that ran on a short enough headway that people would willingly leave their cars in a park-and-ride lot or maybe not need a car at all.

Subtle terminology difference, but huge practical difference.

[heironymouspasparagus]

First, we have the most expensive system because it is the best system. Second, we have the highest rates, because we medicare actuaries keep increasing the reimbursement rates every single year. It's not just one thing.

Also, there are doctors that do not accept insurance, and guess what, they charge dramatically less than those that do accept it. Coincidence?

It's funny that virtually no one on this board would trust the government to run anything yet you believe that if they implement your idea (whatever that is) they will somehow come to and get it together. Fat chance. Government is by design inefficient. It was intentionally set up that way not to keep it from being responsive, but to keep it from being ruled by a mob. That is why government and the economy are like oil and water.


First, what we have, while not 100% private, is the best system on the planet. No other system on the planet provides the consumer with the services they desire as efficiently and as free (to choose) as this one. Second, what we (Gaspar and myself) are advocating is not some never tried system. It has been tried (in other economic situations, which is what this is) and has succeeded virtually every time it has been tried. Capitalism (or whatever you want to call it) is the system by which freedom is achieved most efficiently. What the health care industry needs is a little capitalism.

What planet are you living on?  It sure ain't planet Earth.  In actual fact, we are right about #38 on THIS planet! 

As for non-insurance doctors being cheaper...well, that isn't the United States of America.  And certainly isn't Oklahoma.

You related to Gaspar??

[Hoss]

What planet are you living on?  It sure ain't planet Earth.  In actual fact, we are right about #38 on THIS planet! 

As for non-insurance doctors being cheaper...well, that isn't the United States of America.  And certainly isn't Oklahoma.

You related to Gaspar??

And maybe Shadows too?

[guido911]

Where do people find these pics?



I like the expression of the guy on the right.

[erfalf]

You do realize that Lincoln levied the first income tax...a Republican?

To pay for the civil war, yes. And now Republican's can claim Lincoln? I thought he was too non-racial for that.

But it was the socialist & Populist parties that were pushing for an income tax the most.