[turtle777]

I found this an interesting though process

Originally Posted by Karl Denninger / The Market Ticker

Social Security can be "fixed" with reasonable changes. Medicare and Medicaid cannot. The simple fact is that we cannot give every 80 year old a pair of synthetic hips. We do not have the money. Nor can we blow $30,000 per treatment (with four or more treatments required!) on people who have prostate cancer so they get an extra six months or a year to live (with a 1 in 20 chance of five years) or anything similar.

That is not about compassion, incidentally. It is about arithmetic. We have technological capabilities that far outstrip our ability to pay. This may be unfortunate, but it is nonetheless true. We can ration by price or we can ration by fiat. While price sounds cruel, it is in fact anything but. Rationing by price is what drives prices down. It always has, and it always will.

http://market-ticker.org/akcs-www?post=171626

I especially found that statement in red very thought provoking.

How many good things are we able to do in theory, due to technological advances ?
How should the government / the people decide what to pay for and what not to pay for ?
What could or should we afford ?

I have to employ the car analogy:
We are capable of building really nice luxury sports cars, why shouldn't everyone get one ?

-t

[ort888]

Are you proposing death panels for grandma?

[Uncle Skeleton]

Originally Posted by turtle777 

When The Facts Change..... in [Market-Ticker]

I love it. I love everything about it. Except for the part where I don't quite get who he's responding to.

Are his facts accurate?

I have to employ the car analogy:
We are capable of building really nice luxury sports cars, why shouldn't everyone get one ?

I agree

[turtle777]

Originally Posted by ort888 

Are you proposing death panels for grandma?

Geez, come back when you're serious about discussing this.

Until then, how about you donate all your money to the millions of people worldwide that don't have health insurance. Because clearly, you do care so much.

All you f*cking do gooders are on my nerves.

-t

[stumblinmike]

I LOVE getting on your nerves....It's quite simple, what do you value more...people or money?

[ort888]

Who said I was a do-gooder? I want on the death panel. I hate old people.

[turtle777]

Originally Posted by stumblinmike 

I LOVE getting on your nerves....It's quite simple, what do you value more...people or money?

Of course, it's an easy choice when you don't have any money.
That's why all lefties are FOR all those handouts, because they don't have to contribute.

The sad thing is, you don't see how this doesn't work.

-t

[hyteckit]

Originally Posted by turtle777 

I have to employ the car analogy:
We are capable of building really nice luxury sports cars, why shouldn't everyone get one ?

-t

Your analogy sucks.

The function of the government is to protect the lives of its citizens.

Cut national defense by half. Use that to provide national health-care.

[olePigeon]

Originally Posted by turtle777 

That's why all lefties are FOR all those handouts, because they don't have to contribute.

Yes, because only liberals are poor.

[stumblinmike]

Originally Posted by turtle777 

Of course, it's an easy choice when you don't have any money.
That's why all lefties are FOR all those handouts, because they don't have to contribute.

The sad thing is, you don't see how this doesn't work.

-t

I'm going on the record, I place more value on humans (even turtle-humans!) than money. Are you with us or against us, o shelled one?

[besson3c]

Originally Posted by turtle777 

Of course, it's an easy choice when you don't have any money.
That's why all lefties are FOR all those handouts, because they don't have to contribute.

You're kind of destroying your own thread with generalizations such as this which you know people are going to take exception to. It started out quite well. Just ignore the people that are trying to provoke you

[Uncle Skeleton]

Originally Posted by stumblinmike 

I'm going on the record, I place more value on humans (even turtle-humans!) than money. Are you with us or against us, o shelled one?

I place more value on my money than I do on strangers' lives. I think you do too, otherwise you would have no money, having already donated it all for strangers to freeload off of. Did you?

[turtle777]

Originally Posted by besson3c 

You're kind of destroying your own thread with generalizations such as this which you know people are going to take exception to. It started out quite well. Just ignore the people that are trying to provoke you

Sorry, you're right. I should have just ignored our great stumbler.

-t

[ort888]

Originally Posted by turtle777 

Of course, it's an easy choice when you don't have any money.
That's why all lefties are FOR all those handouts, because they don't have to contribute.

The sad thing is, you don't see how this doesn't work.

-t

Is that why we always see all those maps that show the majority of the taxes are paid by the Blue states and go toward the red states?

http://www.taxfoundation.org/blog/show/1397.html

[hyteckit]

turtle,

I'm sorry you can't tell the difference between a necessity and a luxury good.

LOGIC FAIL!

[stumblinmike]

Originally Posted by Uncle Skeleton 

I place more value on my money than I do on strangers' lives. I think you do too, otherwise you would have no money, having already donated it all for strangers to freeload off of. Did you?

Oh Uncle S... I've kept just enough to feed, clothe, house and entertain me and mine. I DID NOT add another layer of gold to my panic room! Enough IS enough! Don't be greedy! (It's in the bible or something....)

[turtle777]

Originally Posted by ort888 

Is that why we always see all those maps that show the majority of the taxes are paid by the Blue states and go toward the red states?

Uhm, yeah, so ALL those blue States voted 100% Democrate ?

-t

[hyteckit]

Originally Posted by turtle777 

Uhm, yeah, so ALL those blue States voted 100% Democrate ?

-t

Haha.. more logic fail on turtle's part.

[Uncle Skeleton]

I'm sorry you can't tell the difference between a necessity and a luxury good.

If it's a necessity, how did we survive until 10 years ago without it? How does the rest of the world survive without it? More to the point, how will we survive without next decade's necessities if we drain all our resources instead of inventing them?

The fact is, the bleeding edge of modern medicine is a luxury good. Living 6 months longer on life support than you otherwise would is a luxury. But the great thing is that in time it will become a cheap ubiquitous trinket, like color TV and air conditioning and cell phones did, and it won't cost more than your house like it does now. But only if it's exposed to market forces. Only if it becomes subsidized by the luxury goods of tomorrow, that will extend your life 6 months even beyond that.

[Uncle Skeleton]

Originally Posted by stumblinmike 

Oh Uncle S... I've kept just enough to feed, clothe, house and entertain me and mine.

What's more important, entertainment or life? Are you telling me people are dying so that you can sit around posting on the internet? What's more important, free time or life? You could be better using this time to work a second job to support the medication of some more strangers.

[CreepDogg]

Originally Posted by Uncle Skeleton 

I love it. I love everything about it. Except for the part where I don't quite get who he's responding to.

I concur - he gives a thought-provoking and practical analysis. For the record, he's responding to a piece by Ron Paul:

Reject the Welfare/Warfare State

On the OP's point about technological capabilities outstripping our ability to pay - I agree - it's an interesting point. Of course, it also extends to areas outside medicine, like the space program and any other R&D incentives/subsidies. Clearly there are situations where there are unseen benefits from technological advances that outweigh initial costs, but there's also the potential for a lot of waste and wheel-spinning. I guess the society that 'wins' in that regard is the one that generally chooses wisely in where they prioritize their resources.

I also really liked this in his piece:

Originally Posted by The OP's Linked Article

We import about 3.5 billion barrels of oil a year. Each has a roughly $100 imputed cost associated with it, assuming you assign half our military budget ($350 billion, give or take a bit) to protecting our energy needs. This means the true cost of our oil is not $87/bbl, it's $187, and the true cost of gasoline isn't $3.00, it's closer to $7.00.

You can make a hell of a lot of synfuel (biodiesel, Fischer-Tropf converted from coal, etc), extract a hell of a lot of oil from shale (which we have a scadload of our west) and do all sorts of other things if your comparison price for oil is $187/bbl. In fact, we could be entirely independent of foreign oil right now if we recognized the imputed cost of each barrel instead of lying about it.

It is only through government fraud that we "believe" our oil is $87.

I'm not sure where he gets his 'half the defense budget' figure, but agree that there are hidden economic costs not accounted for in the market price, and that at that 'true' economic cost, alternatives look more attractive.

[hyteckit]

Originally Posted by Uncle Skeleton 

If it's a necessity, how did we survive until 10 years ago without it? How does the rest of the world survive without it? More to the point, how will we survive without next decade's necessities if we drain all our resources instead of inventing them?

The fact is, the bleeding edge of modern medicine is a luxury good. Living 6 months longer on life support than you otherwise would is a luxury. But the great thing is that in time it will become a cheap ubiquitous trinket, like color TV and air conditioning and cell phones did, and it won't cost more than your house like it does now. But only if it's exposed to market forces. Only if it becomes subsidized by the luxury goods of tomorrow, that will extend your life 6 months even beyond that.

Medicine and medical care didn't exist 10 years ago?

Why did you do 10 years ago when you broke your leg, got sick, or injure yourself?

Come on! Basic healthcare and medical treatment is a necessity.

It's not black and white.

Stop equating basic healthcare and medical treatment with experimental drugs, and trying to confuse the argument.

[Uncle Skeleton]

Originally Posted by hyteckit 

Medicine and medical care didn't exist 10 years ago?

The most expensive ones didn't. If broken legs and other general young-people conditions were all that was covered, the costs wouldn't be prohibitive and none of this would be an issue.

[stumblinmike]

Originally Posted by Uncle Skeleton 

The most expensive ones didn't. If broken legs and other general young-people conditions were all that was covered, the costs wouldn't be prohibitive and none of this would be an issue.

What "costs"? Every human life is precious, right? If we wanted to, we could find the money....

[OAW]

This is an interesting topic that Turtle raises. One thing we need to consider is that because medical treatment ... especially of the life saving variety ... is very often an inelastic product/service, there can be a great discrepancy between the cost of treatment versus the price that is charged for said treatment.

OAW

[hyteckit]

Originally Posted by Uncle Skeleton 

The most expensive ones didn't. If broken legs and other general young-people conditions were all that was covered, the costs wouldn't be prohibitive and none of this would be an issue.

We didn't have awesome military weapons and fighter jets 10 years ago that we have today either.

Just because I think national defense spending of $680 billion/yr is excessive spending doesn't mean I think national defense is not a necessity.

Just because I think spending $2 billion on fighter jets we never use is wasteful doesn't mean I think national defense is not a necessity.


I don't make stupid arguments conservatives make about health-care not being a necessity because some medical treatments might be unnecessary, excessive, and too costly for us to afford.

There are wasteful spending, excessive spending, and spending we can't afford to pay.

But I still think both national defense and public health-care are necessities.

[CreepDogg]

Originally Posted by OAW 

This is an interesting topic that Turtle raises. One thing we need to consider is that because medical treatment ... especially of the life saving variety ... is very often an inelastic product/service, there can be a great discrepancy between the cost of treatment versus the price that is charged for said treatment.

OAW

Very true - generally, the best way to reduce that discrepancy is to expose that product/service to the market, but as you said, that can break down when demand is highly inelastic. Also - people are often not well equipped to make rational decisions when they are sick. These are inherent inefficiencies that the system has to account for.

I do think there's a lot more potential elasticity in the 'experimental' and 'improve the quality of life' vs. 'life-saving' service, and whatever changes are made need to account for that. Medicare in its current form is unsustainable, but for now, I think the best solution is to work to make it sustainable (obviously by cutting/limiting coverages and treatments). It will need to focus on necessity over optionality and clearly define that, and that means that a significant percentage of treatments that are now covered would not be.

I say this because 1) we have a health care payer system that is tied to employment, and 2) we have an employment system that assumes older workers will leave the labor market. So we need to have some mechanism, outside the employer pool, to provide health coverage for those individuals. There are inherent challenges in a market system due to the aforementioned inelasticity of demand, and the fact that this group is by definition a higher-risk group.

[SpaceMonkey]

There is also the problem that Medicare reimbursement rates (what Medicare pays the medical providers for the services the Medicare patient receives) are generally considered by the medical community to be too low, encouraging many providers to opt out of Medicare.

I'm of the opinion that health care is one of those things that's all or nothing. Don't tie it to employment. If we accept that the government has some role to play in general health care, then there ought to be some minimum standard for which the government, through taxes, covers everything. Above that would require private insurance. Of course, entrenchment of the current formula hinders that.

[hyteckit]

Originally Posted by CreepDogg 

Very true - generally, the best way to reduce that discrepancy is to expose that product/service to the market, but as you said, that can break down when demand is highly inelastic. Also - people are often not well equipped to make rational decisions when they are sick. These are inherent inefficiencies that the system has to account for.

I do think there's a lot more potential elasticity in the 'experimental' and 'improve the quality of life' vs. 'life-saving' service, and whatever changes are made need to account for that. Medicare in its current form is unsustainable, but for now, I think the best solution is to work to make it sustainable (obviously by cutting/limiting coverages and treatments). It will need to focus on necessity over optionality and clearly define that, and that means that a significant percentage of treatments that are now covered would not be.

I say this because 1) we have a health care payer system that is tied to employment, and 2) we have an employment system that assumes older workers will leave the labor market. So we need to have some mechanism, outside the employer pool, to provide health coverage for those individuals. There are inherent challenges in a market system due to the aforementioned inelasticity of demand, and the fact that this group is by definition a higher-risk group.

Thanks for making an intelligent argument. Much appreciated.

[Uncle Skeleton]

Originally Posted by hyteckit 

But I still think both national defense and public health-care are necessities.

Food and shelter are even more necessary, but they're not government services. So what?

[olePigeon]

I think the government's involvement in health care should only be to protect people from being denied coverage because of circumstances completely out of their control (physical or mental disability preventing employment, war veteran, disaster survivor, age, pre-existing conditions, etc.); the price for coverage should not exceed the national average for basic health insurance.

The rest should be up to individual states to decide how they'll govern health insurance, including what they decide should be included for "basic health insurance."

[CreepDogg]

Originally Posted by SpaceMonkey 

I'm of the opinion that health care is one of those things that's all or nothing. Don't tie it to employment.

I agree with this - if this is on the table, then I think the need for Medicare goes away. I think the most efficient solution here would be to get the risk pools as large and diverse as possible. Right now, they're cherry-picked: employers get the younger, lower-risk folks, and Medicare gets the high risk folks that no one else wants. If we were to de-couple insurance from employment and include the older generation in the same risk pools, we'd have more consistent costs for everyone.

[chabig]

Originally Posted by hyteckit 

The function of the government is to protect the lives of its citizens.

Cut national defense by half.

I'm surprised that nobody has yet commented on the disconnect in this logic.

[OAW]

Originally Posted by olePigeon 

The rest should be up to individual states to decide how they'll govern health insurance, including what they decide should be included for "basic health insurance."

Why should individual states decide these things? This is part of the fundamental problem with healthcare in America. Someone I know very well works in IT in a QA role. As we speak they are testing a new release of an insurance quotation system and do you know what they have to do? They have to test the code in all 50 states because the logic is somewhat different in each in order to comply with 50 different sets of rules and regulations. The overhead and added expense of having to deal with 50 different bureaucracies instead of 1 is phenomenal. I simply don't see the benefit of the states makings these decisions outweighing the costs.

Furthermore, because there are all of these individual sets of regulations to contend with ... we end up with a "race to the bottom" when it comes to standards. If an insurance company finds a particular state's standards to be too stringent they just pull out and offer insurance elsewhere. Leaving the original state with even less competition. Which is why the typical state has only 3 or 4 major health insurance carrier choices. States start competing with each other for lower and lower standards in order to attract insurers to do business in their state. Much like cities offer tax breaks to attract sports franchises ... which rarely pay for themselves on balance.

Why not have 1 set of regulations instead of 50? That will enable much larger risk pools and increased competition at a lower cost.

OAW

[olePigeon]

Originally Posted by OAW 

Why not have 1 set of regulations instead of 50? That will enable much larger risk pools and increased competition at a lower cost.

Health care costs are different between states, even between counties. A single set of regulations won't work across all 50 states. You'll then have the Congress writing in exemptions for individual states, lobbied by the insurance companies. Eventually all the insurance companies will operate out of whatever state will give them the least amount of control, picking the pockets of the other 49 states.

[smacintush]

Originally Posted by OAW 

Why should individual states decide these things? This is part of the fundamental problem with healthcare in America. Someone I know very well works in IT in a QA role. As we speak they are testing a new release of an insurance quotation system and do you know what they have to do? They have to test the code in all 50 states because the logic is somewhat different in each in order to comply with 50 different sets of rules and regulations. The overhead and added expense of having to deal with 50 different bureaucracies instead of 1 is phenomenal. I simply don't see the benefit of the states makings these decisions outweighing the costs.

Furthermore, because there are all of these individual sets of regulations to contend with ... we end up with a "race to the bottom" when it comes to standards. If an insurance company finds a particular state's standards to be too stringent they just pull out and offer insurance elsewhere. Leaving the original state with even less competition. Which is why the typical state has only 3 or 4 major health insurance carrier choices. States start competing with each other for lower and lower standards in order to attract insurers to do business in their state. Much like cities offer tax breaks to attract sports franchises ... which rarely pay for themselves on balance.

Why not have 1 set of regulations instead of 50? That will enable much larger risk pools and increased competition at a lower cost.

OAW

You've made a better argument against the state of massive regulation we have, than you have for more central control.