Tuesday, August 25, 2009

The Government Option or The Monopoly Peril

As all of you know, critics of the current health plans being toted by Washington have serious issues with the government option in any health plan (the "public" option is as much a misnomer as the "public" government schools). The reason we have issues is that we see the danger of the government option becoming the only option. While this has been euphemistically referred to as the "single-payer" system, it is, in essence, a government monopoly.

One thing that is clear and established is the dangers to a free market when any company achieves the level of monopoly. We saw this in the turn of the last century in the monopoly busting that occurred to pry control from companies, all the way to the recent destruction of the old Bell phone monopoly. And we have continued to see this in the de-monopolizing of cable and Internet delivery.

The reason and rationale behind this is, of course, that a monopoly, by overwhelming control of the market share, can restrict the entry of others into the market by running massive losses for the sole purpose of driving others out of business, to the point that no one has the right to free association. Then they can exercise control over the price and supply of their items in the market.

And thus, we see the government intervene to break up this stranglehold.

But what if the government is the one with the stranglehold?

To whom do you appeal when those with the power to regulate are the ones abusing the system because they control it?

And if a government monopoly doesn't work well, dismantling it requires the assent of those who wield the power of the government. And that depends on voting in the people willing to do so, especially in the face of cutting off people who were dependent (try suggesting anything to cut Social Security and see how fast the politician disappears).

This is why we oppose the government option. Because the regulator is then also a "competitor" with the power to run or regulate out any company they see as "uncompetitive." In essence, they possess the powers of a monopoly long before they are the monopoly.

So while a private monopoly is dangerous, and requires that it has to be regulated or destroyed to protect the rights of others, a government monopoly is more dangerous in that it can only choose to regulate or destroy itself, and thereby relinquish power.

And for those of you who want the government monopoly (single-payer), do you trust all the politicians who will put their hands on this power? Because while the party you may agree with is in power now, that is likely to change at some point in the future (maybe even 2010 or 2012).

Personally, I don't trust the lot.

56 comments:

Beth said...

I always say that in the capitalistic society, we "vote" with our dollars and can quickly divert our votes away from businesses we disagree with (look how quickly advertisers have pulled commercials from the Glenn Beck show), but with the government our votes must wait until their turn for re-election, and even then the change can be slow because they all aren't up for re-election at the same time.

I don't trust the lot either, Patrick, I trust my own judgment.

Jennifer said...

Thank you Patrick for one of the most sane (no pun intended) posts I've read regarding government run insurance. Without throwing all the other crap into it, that some have, you have explained exactly why I don't want single payer, there is no one to look after what they do. I tried getting that across on a couple of my comments on different blogs lately, but have not been successful and it has been beyond frustrating. Hope you don't mind if I link over here!

Satyavati devi dasi said...

Patrick,

What is it with the mass of people in this country cannot admit, not even you, that this system has been working successfully for generations (see: France) in other countries, who enjoy better healthcare and better outcomes than we do as a result?

Does something happen once it crosses the border, that it can't work here?

Why are we so hell bent on insisting that our system is better than everyone else's, when it's actually the laughingstock of the civilized world, who think we are a deluded pitiful mass of ignorant fools who pay a fortune for nothing?

Are we that egotistical?

Or do we just not give a shit about the people next door, who don't have insurance?

Jennifer said...

"Or do we just not give a shit about the people next door, who don't have insurance?"

I am so freaking tired of this lame ass comment. I don't have any insurance, so yeah, "I give a shit." Even if I did insurance I would still give a shit!!

Just because I do not like the piece of crap health care bill, DOES NOT MEAN THAT WE DON'T CARE!

Sorry, Patrick, but I am just sick and tired of being told that I don't care. It's old and totally false!

Satyavati devi dasi said...

What makes you think that it won't work here?

It's been working in France since the 1940's.

The entire civilized world, with the exception of us, have universal healthcare.

If you care, you'll care about the fact that health care costs are rising faster than inflation and faster than salaries. You'll care about the fact that thousands of people go bankrupt every year because of medical bills. You'll care that even if you can get insurance (what with preexisting conditions and exclusions), and pay your premiums faithfully, if you ever develop a serious medical condition, your insurance company may very well drop you and refuse to take care of you (because now you're actually using your insurance, instead of just giving them money).

You might care about those things.

Jennifer said...

I do care about all those things, but I have a different opinion on how to make those things better that isn't national health care.

I've been throwing ideas all over the place and have blogged tirelessly about how to improve things.

Just because something works somewhere else, doesn't mean that it would work here. This is a different country, then those places. We need to look at our country and find what would work the best here. Maybe the people actually trust their governments over there, compared to our distrust (and rightly so) of the people that are supposedly representing us!

dmarks said...

"...health care costs are rising faster than inflation and faster than salaries. You'll care about the fact that thousands of people go bankrupt every year because of medical bills...."

Then let's quickly do some simple reforms that will cut costs. Such as tort reform, which could save as much as 500 million. Or allowing competition across state boundaries. Then we won't need a public option to keep the companies honest at all (referring to Obama's quote), as the competing companies will do the job.

Let's tackle reform with the main goal of improving health care. Instead of doing it like Obama is doing it, where the main goal seems to be increasing the number of government employees who end up forced to join unions, and then end up forced to give millions to the Dems through dues and other extorted fund efforts.

That's the main thing. Support for the public option among Dems would evaporate if a provision were put in so the new government healthcare workers would each have complete choice as to whether or not to join the unions.

"Follow the money" works for their side as well.

Satyavati devi dasi said...

This reminds me of the Army Corps of Engineers' refusal of the Dutch offer of technological help following Hurricane Katrina.

Rather than accept information from people who have been battling from below sea level for centuries, we instead choose to pamper our collective ego by believing we can do it better.

Rather than accept an example that works for the entire rest of the civilized world, we choose to reinvent the wheel, all because we are too egotistical to think someone does it better than we do.

We are such a nation of fools.

Beth said...

Competition works in this country, if we actually allowed it to work the way it should, it would. Saty, can you understand Patrick's post at all? Can you comment on what dmarks said?

I do care, enough to know that the people who truly need the help should be able to get it without a massive takeover of the healthcare system.

dmarks said...

We are a nation of fools to even entertain the "public option" (or much worse, the much less popular "single payer" plan.

Just because some other countries make big mistakes like this, does not mean we don't have to.

It's not the only time we had a better idea than Europe.

Beth: Yes. We can fix things without destroying the system.

Patrick M said...

Beth:

Jenn: You may link to your heart's content. I have an ego to feed, after all.

And no need to apologize when people try to argue that we don't give a shit.

Saty: For some reason, you ignore what I wrote and go with the same line of reasoning you always do, no matter what I wrote.

Now I covered France and did give them credit for some success. However, for those who could afford it, they best health care is found here. When we take that away by turning it into a government monopoly, then the best will move somewhere else. Meanwhile, we're in the process of giving a government that has a track record of overpromising, underdelivering, and creating unsustainable programs (Mediscare, MedicAIDS, and Social Insecurity) absolute control over 1/5 of the damned economy.

And being that we are that big, spend that much money on health care (not all of it wasted), and are the reason that pharmaceutical and medical research companies make the profits that justify continued research to supply drugs and continue advances for the government-controlled systems of other countries, this is the damned tipping point where medical care ceases to become something that advnaces naturally through competition and becomes a government slug.

We've seen the effects (both good and bad) of other systems. And while we know there are problems, we're not going to fix them by repeating the mistakes of other countries.

Back to the subject, you failed to answer the question I posed to the single-payer supporters: Do you trust all the politicians who will put their hands on this power?

Because I'm pretty certain there are people you'd shudder to think they'd be able to mess with your health care.

Dmarks: Numbers are so great sometimes.

And it's not the "public" option. It's the government option.

dmarks said...

Good point. "Public" is too often a euphemism some use to mean state controlled or government-controlled. And that is what is being discussed here: something that is not controlled by the public (through the most direct method available: the free market) but is instead controlled by powerful ruling elites (the government).

Another great point on the promises of overpromising, underdelivering, etc. Obama, Pelosi, etc are lying by claiming that this scam will cost a lot less than it really will. Some like the CBO readily point out that it was cost a lot more than it is being sold as.

If Obama wants public buy-in (public as in the people, not the government) for this, he should start by being honest about the costs.

TAO said...

Dmarks,

46% of all medical expenses incurred in any given year are paid for by a 'single payer' which is the US government.

What does private insurance bring to the HEALTHCARE system that involves anything remotely resembling medical treatment? All they do is set up hoops, create bureaucracies and eventually pay as little as possible as slow as possible. Then if the consumer gets sick and really needs insurance they drop the consumer.

So, you want tort reform and you believe that $500 million dollars is big savings that will theoretically be passed to the consumer.

How will tort reform improve healthcare?

If its money you want to save then single payer is the answer because medicare allocates 4% for overhead while insurance companies allocate over 30% for overhead AND THAT DOES NOT INCLUDE THEIR PROFITS...

Maybe the reason things work in Europe and not here is because Europeans are less dysfunctional than Americans are?

We have a free market solution right now and if it was consumer driven then healthcare reform would not be an issue that we would be debating like crazy.

So, you are surprised that Politicians lie? Really? Jimmy Carter and Gerald Ford are the only two Presidents I remember in my lifetime who did not lie...

The good ones really told some big lies, that would be Reagan and Clinton then you have GWB who just didn't know any better.

At some point in the near future our healthcare system will collapse because employers cannot continue to face insurance premiums that increase every year at a greater rate than they can increase their product costs. Thus the ranks of the government insured and the unisured are going to become the majority and our healthcare system will collapse under the weight of its own inefficiencies.

TRUTH 101 said...

Continuing down the same path is silly Patrick. Single payer offers the simplest and most effective way of insuring all Americans. It is contradictory when you say you want government to regulate but not run.

Health care is just as vital to our well being as a Nation asnational security. Police and fire protection. Education and other issues. Profit needs to be removed from the equation if we are to move forward with providing health insurance for all. I've made my proposal. You've suggested(I'm not sure if it was really a proposal. More of a "supposal") private payer with strong government regulation. While I find this also agreeable in the spirit of working together, I thought it as I said earlier contradictory on your part. But if you can swallow strong government oversite, I could swallow your demands for private sector involvement.

Satyavati devi dasi said...

It is disingenuous to believe, with the amount of actual power that insurance companies and pharmaceutical giants command in Washington, with their billions of dollars, that a public option would run them out of business.

How do you propose to 'increase competition'? Set up mom&pop insurance companies on every block?

How about by providing some competition in the form of a public option, that would force some actual competition instead of the good old boys network that you see now?

People don't actually shop for health insurance in this country-thre's no REAL competition, because the vast majority of people can't qualify for private insurance, and therefore don't have any option besides the one offered through their job, if they're lucky enough to have a job that offers insurance or be married to someone whose job offers insurance. So really, any 'competition' between insurance carriers is competing for companies to take them on, not individuals. And if your employer decides they can't afford to offer you benefits anymore, well, then, you're just shit out of luck.

So what IS all this 'competition' thing about, then? Blue Cross and Cigna and United are not frantically trying to seduce me into taking one of their policies and being their customer. They have no interest in attempting to bring in individuals. If you've ever tried to get a private policy, you will know that their qualifications are unbelievable, their deductibles so high as to make the policy worthless, and the premiums can run into thousands of dollars per month. And you have to find a doctor that's willing to accept it. So please, what kind of 'competition' are we actually talking about?

Health insurance isn't a phone company or a wireless carrier, who get on TV offering you a better per-month rate with no contract and the biggest network in the business. They're not a supermarket chain offering double coupons and a discount card. Insurance companies make no effort to entice individual consumers. They deal on the company level.

So I'm not really sure what kind of choices and 'free market' you all are talking about. I don't see that there's much of a free market to begin with. I've never been able to qualify for private insurance and I've never had any choice beyond what was offered by my job. Not much competition there.

Like I pointed out earlier today, people who actually know and understand the impact of the situation in our country as per healthcare right now support a public option. The ANA supports a public option because it will give vast numbers of people access to healthcare they don't have now. It will improve our nation's health. These are people who actually know and understand what's going on, not someone who reads headlines and believes rumours without even checking on them. These are people who have a vested interest in healthcare, whose priority and goal is improving the health of all Americans, not just the wealthy and employed-with-benefits.

Are there people I'd shudder to have messing with my healthcare? Sure. The vast majority of them are seen at these town halls screaming about Nazis. These are the people I want nowhere near my healthcare, because they're deluded, ignorant fools who have no concept of what they're talking about and how it can benefit them.

Do I trust Washington on this? I believe that the system proposed is far better than the system we have now, and I believe that this is more of a historical, cultural issue for Americans than anything else at this point-we've been fighting this since the days of Roosevelt and Eisenhower-it would practically be unAmerican to think that we might be like other countries and take care of everyone. This is America, where the haves got that way by adding to the ranks of the have-nots.

dmarks said...

Tao: "All they do is set up hoops, create bureaucracies and eventually pay as little as possible as slow as possible" applies to the idea of government-controlled health care as well.

Only it can get far worse, if it is single-payer. Because there is no competition to keep the government honest, in that case.

"Profit needs to be removed from the equation if we are to move forward with providing health insurance for all."

I am open to the suggestion to make the private insurance companies into non-profits. There you go, the profit motive is taken out, without a government takeover.

I am open to strong government oversight. I am not open to a "public option" except as a last resort for the poor.

Welfare (government handouts) should be the the poor, not the middle class or rich. No taxpayer funded healthcare handouts to the non-needy.
------------------------
SDD asked:

"How do you propose to 'increase competition'? Set up mom&pop insurance companies on every block?"

Well, lift restrictions on insurance companies competing across state lines. That does a lot right there.

"How about by providing some competition in the form of a public option, that would force some actual competition instead of the good old boys network that you see now?"

No. That is a very bad idea. For one thing, the competition would not be fair, since the government-controlled option would wipe out private insurance companies by undercutting them. This is because the government agency would have no budget to meet, no accountability, and would be able to "spend" any money it wants to.

Allowing actual competition in the private sector would take care of the "good old boys" problem.

"Blue Cross and Cigna and United are not frantically trying to seduce me into taking one of their policies and being their customer."

That is because most insurers are prevented from competing for you.

"Health insurance isn't a phone company or a wireless carrier, who get on TV offering you a better per-month rate with no contract and the biggest network in the business. They're not a supermarket chain offering double coupons and a discount card. Insurance companies make no effort to entice individual consumers. They deal on the company level."

Allowing open competition would change this.

People who actually know and understand the impact of the situation in our country as per healthcare right strongly oppose what is called a "government option". These are people who actually know and understand what's going on, not someone who reads headlines and believes government proclamations without even checking on them.

The people in government proposing "single payer" or a "public optikon" have a vested interest in increasing govermment power, and don't care about improving the health of all Americans.

The system proposed is far worse than what we have now. And this is not TV or internet business: people will die if this proposal is allowed to trash healthcare.

If anything is unamerican, it is the idea that we should copy disastrous foreign ideas just because they are foreign. No matter how badly they work, and without regard to any differences between countries.

Beth said...

Damrks made some points I was going to make about competition, but I would further add that the healthcare centers and health providers are also not able to "compete" for your business right now, mostly because of insurance companies. If you and I had to pay for service out-of-pocket instead of going through the middle man (insurance company) you would see people shopping around for the best price for their needs. And the other benefit to that would be that people would only go to the doctor when they need to, now if they have insurance they go for every little sniffle because they feel they are "owed" it for paying their premiums. Having the government run healthcare will only give more people this sense of entitlement and clog the healthcare system with more unnecessary visits. So see I do care, because the people who really need help are going to be lost in the shuffle with a single payer system.

Satyavati devi dasi said...

Again, the most important parts of what I said were ignored or missed: insurance companies do not compete for individual policies. If you attempt to get a private, individual policy, chances are that either their insane qualifications, incredibly high deductibles or huge premiums will make it impossible. The only option you have, in most cases, is to take whatever insurance is offered through your employer, which effectively removes any need for 'competition' on the individual level and offers you no choice whatsoever.

Have you ever, or do you know anyone, who ever turned down insurance at their job for a private, individual policy? I don't. They go with what's offered. There is no competition and surely no choice involved. Bringing in a public option that you can choose over your current plan (if you so desire) would finally give those companies a reason to lower their premiums and lower costs. This would also give employers a break, as they pay huge amounts to provide healthcare for employees. Now, that might be some competition.

If you're not sure who the ANA is that I referred to above, whose sole interest in Washington is to support legislation that would improve healthcare: that's the American Nurses Association. They have no 'vested interest' in increasing government power-they're not government. They're an association of nurses all across the country who work in the field, see firsthand what the state of healthcare is in this country and unanimously believe that this is the best way to improve it.

As far as people going to the doctor only when they 'need' to-millions of people, myself included, don't go to the doctor at all because they cannot afford to. I have one doctor, who I'm supposed to see on a rather frequent basis (and haven't seen since March), who charges $82 for a 15 minute med management appointment. As some of my medications require written prescriptions (no refills allowed), the only way I can get my scrips is to have an appointment. No appointment-no scrip. Thus, no meds.

And as far as people shopping around for doctors based on price: this may happen with a small amount of the population for internists, but the people established with physicians more than likely won't change, and I can assure you that I for one would be choosing a doctor (especially specialists, which comprise most of my medical needs) on their resumes, not who's offering a get-one-MRI-get-one-free special this week. Would you choose an obstetrician to deliver your baby based on who's cheapest, or choose a paediatrician based on who's passing out coupons this week?

A key part of this equation has been touched on before: you cannot lump healthcare in with any other 'retail service', nor can you judge it or qualify/quantify it in the same ways, nor can you expect it to operate on an industrial level (the entire healthcare delivery system in terms of providers) the way car manufacturing or pretzel bakeries do. Handling people's lives is an entirely different thing, and that fact has to be recognized. Healthcare delivery, not so much in a hospital but on the gut level of primary care, is all about relationships, ideally. It can't be compared or treated as some kind of factory, because it doesn't operate in the same way.

Satyavati devi dasi said...

As far as a 'sense of entitlement' goes, we have to go back to basic attitudes towards our population. I believe that everyone is 'entitled' to be healthy. I believe that every child is 'entitled' to the care they need, every person is 'entitled' to their medication and the care they need. The ongoing denial of care (due to complete lack of access to the system) results in non-delivery of preventative care, and people showing up in emergent, chronic situations that cost the system far more than preventative care. The diabetic who doesn't get medications or insulin goes on for a period of time... and then develops gangrene that requires an amputation, or kidney failure that requires dialysis for the rest of his life. It's far cheaper to prevent those things from happening. Worrying about people getting a 'sense of entitlement' smacks of those who worried that slaves would get 'uppity' once they were freed, and want things like jobs, housing, the right to vote. How dare they, when we already freed them? It's a false freedom when you don't get the basic things other people (who are wealthier, or have jobs that provide insurance, thus making them more 'entitled' than you are, apparently) do.

And as far as those who go to the doctor when they're sick, and they have insurance they pay premiums for: when you pay for a service, Beth, don't you feel like if you need it you should use it? You have car insurance: if you get in a fender bender, don't you get it fixed? You have homeowners insurance: if a tree puts a hole in your roof, don't you get it fixed? You pay for a service, you're absolutely 'owed' for it. Why would you pay for a service, and not use it if you felt you needed it? If you consider that even employer-sponsored insurance premiums can run you into a couple hundred dollars a month (for my husband to put me on his insurance would cost approximately $800 a month), don't you feel that you're 'owed' something for all that money you're paying? If you go to a grocery store and pay money, don't you expect to get food in return? Or does the retail-industry analogy break down at this point for you?

Toad734 said...

If so many of you love your health insurance provider so much, and are so eager to rush to the defense of the health insurance industry, why would you fear that a government provided public plan would soon become a monopoly?? If the government can't do anything right, and they screw up everything from the delivery of your mail across the country in two days for $.49 or a vast interstate highway and National Park system, what possible threat could they be to Healthy Profits Inc. whose CEO make 14 million dollars per year denying transplants to grandma?

Oh, I get it, you are afraid you would be like those people who say they hate communism and want to support American workers but still shop at Walmart...Ya, I can see people saying one thing around their friends and then doing what best serves their own interests instead.

Patrick M said...

101 (although my response will serve for Tao and Satyavati too):
Continuing down the same path is silly [O magnicifent and illustrated one].

I actually agree here. If we were moving toward a free market, personal responsibility system, that is.

The problem with our system is that it is so fragmented and cross-regulated, and politically manipulated that it makes no sense.

In the actual delivery of service, those who are covered (either personally or through an employer) are pretty damned happy with their coverage, wait times, quality of service, etc. For those who rely on government or lack coverage it's touch and go.

In the larger hospital systems, the waste and inefficiency is causing burnout, and costing us staff, which creates a shortage in many areas. The practice of CYA medicine drives doctors out of general practice to those specialties that are worth the costs (and the doctor's ego).

But the real killer in the system is how we pay for it. A small number of people actually pay for the service when delivered. Most are under a health plan (not insurance) that covers the small stuff, but then could crap out when it's actually needed. And then there are those that rely on government, charity, or go without until they come into the emergency room (the most expensive option).

I can agree we need to streamline the whole system. What I cannon and will not agree to is that fixing the system requires doing the thing that has led us to this point: destroying the mechanisms that made the private system work. That has been mostly done, because we haven't had a truly private system for decades.

Changing directions is going back to the private system (with the coverage gap fixed somehow), not going forward into more government manipulation.

Dmarks: While I agree we are copying the mistakes other countries have made in this bill, what are your thoughts on a government system that isn't failing (yet): France?

Patrick M said...

Toad: You don't fucking listen, do you?

I don't trust the insurance providers implicitly (because if they have the monopoly power, they're just as bad). I trust them as far as it serves their own self-interest, and I expect the government to be the check where their self-interest motivates them to screw the rights of the individual.

The other option is to give the monopoly power to the individuals who also happen to be the regulators. I can think of nothing more dangerous.

The only purposes of government is to secure individual rights and those things that cannot be otherwise done, not solve every problem ever created or found.

dmarks said...

Toad said: "If so many of you love your health insurance provider so much"

Are you reading another blog and commenting on it here? You must be, because no-one who is opposing the "public option" is praising or loving the private health insurance companies.

"and want to support American workers but still shop at Walmart"

You are rather off-topic, but that actually is a very good way to support American workers. Walmart happens to be the biggest employer of American workers. I suppose you would rather see it fail, and all those workers get fired.

Patrick: There are some positive things to learn from the French system. You have made some great points on it. It is possibly to wisely copy from foreign ideas, rather than mouth the grossly civically uninformed view of "trust the government, they always do it best" that the single-payer proponents use.

What we really need to avoid is the nightmare system like in the Netherlands and the UK, where they actually do have death panels.

Toad734 said...

Patrick:

So its your individual right to drive on a free highway system?? Its your right to camp in Yellowstone? Its your right to mail a letter across country for $.49?? Those are things the government provides, aside from our "rights" that I don't hear you bitching about. The difference is that those things aren't going to bankrupt the country and they don't cause the bankruptcy of over half of all Americans. Ignoring the problem and screaming "socialism" isn't going to make any of that go away.

You know, the "government" is also in charge of making our laws, enforcing our laws and that seems like a huge conflict of interest but as it turns out, we have separate branches of the government that monitor and regulate other branches of our government. Health care would be the same way. And what is so dangerous about the people who are trying to provide health care to those who need it and want to protect your coverage?? I think I trust them more than I do an Insurance company whose only motivation is profit...not my well being and in fact, my well being stands in the way of their profits, stock prices, and private jets.

This is all coming from a guy who thought giving the Federal Government the authority of no warrant wire taps was a good idea. I think you are paranoid about the wrong things.


Dee:

SO if you agree that private insurance companies are out to screw people and are only in it for the profit...What's your plan?? Do you have a better option??

The biggest employer of low wage workers who used to make twice as much before the factory they used to work in closed due to Walmart buying from China.

dmarks said...

Its your right to mail a letter across country for $.49??"

Well, the USPS is going bankrupt now. Another badly-run government enterprise. And $.49 won't get that letter across the country. If you want to make sure it gets there, you need to do priority, registered, mail etc for a few bucks. Otherwise they might lose it.

"SO if you agree that private insurance companies are out to screw people and are only in it for the profit...What's your plan?? Do you have a better option??"

The same is true of government insurance. But if you have single payer, the only way to escape it is to die or flee the country.

If you remove the barriers to having private companies compete with each other, they will become accountable and compete for customers by offering them a better deal. Screwing them less, so to speak.

You can't get any kind of accountability with a monopoly.

And as for Walmart, the businesses most negatively affected by competition have been mom and pop stores (which pay less than Walmart does) and Kmarts (which pay about the same). Walmart buys from factories in the US AND China, but they feel no need to buy overpriced goods from factories, and get the best deal. So you do get factories closing because they are badly run and overcharge for things. I certainly feel no obligation to patronize a factory that overcharges with ripoff high prices.

dmarks said...

(Also, I am open to the idea of making the private insurance companies into nonprofits. That gets rid of even more of the "screwing").

Beth said...

Saty says:

"You have car insurance: if you get in a fender bender, don't you get it fixed? You have homeowners insurance: if a tree puts a hole in your roof, don't you get it fixed?"

You discuss preventative care, and believe me I am all for that, but in your example, think of the car insurance. You don't use car insurance to get an oil change or a tune up. Regular doctor visits are like that, where you go for a "tune up" of sorts. If your car is making a funny noise, again, maintenance, like sick visits, not an insurance item right? These are the sort of things I am saying people should pay out of pocket, and just have insurance for the major things that happen unexpectedly, the accident or the cancer that hits you. By the way, I recall Sen. Kerry mentioning this exact idea when he was campaigning for president, it was one thing I agreed with him on.

You want to talk preventative, if we had socialized medical care, would they require everyone to do whatever they can to prevent sickness & disease? Would we require new mothers to breastfeed because that is the healthiest thing they could ever do? Make everyone stop smoking? Change everyone's diet to a mediteranean diet? This is what I am thinking that if my tax dollars are paying for someone's health care that I don't even know them, they had damned well do all those things and more (exercise, get enough sleep), too. Really why shouldn't I have a say in this if I am paying for it? Or doesn't this sort of preventaitve stuff count for you?

Patrick M said...

Toad: Dmarks has covered most of the important parts, so let me clean up here.

Let me try to explain the purpose of a limited government. A limited government secures individual rights. That's it. However, I am also willing to entertain the idea of the government occasionally into forays into things that cannot be done by private industry (interstates and infrastructure, national parks, etc). Where i draw a clear line is when the government gets into the business of usurping the private sector when it's working (even only partially in the case of health insurance). I'll have to explain it in detail in another post.

Also, anything involving a war must be sunsetted and limited to that specific purpose. And I give the government a little more latitude in those specific circumstances, until I see evidence to the contrary. Care to produce that?

Beth said...

Another thing about all this talk that other countries have better systems than we do and are healthier, well they have a healthier lifestyle than we do, better diets, breastfeed more than we do. If we're the laughing stock of the world, it's because we put ourselves there. And know what, it's a free country, so if we want to be fat and lazy, so be it, we also must deal with the consequences of our choices and take responsibility for them, not expect the government to "bail us out", and everyone foot the bill.

That is not how our country was established. We can be charitable and care for others without giving our freedoms over to the government to do so. We can get to the same place, I guarantee you that, please stop thinking the government is the only answer, you only diminish the greatness of all the individuals in our country, including yourself. I don't know how else to say it, just really think through what those of you who want socialism want, what you are giving up, please!

Satyavati devi dasi said...

Your car insurance, just like your health insurance, stipulates exactly what it is you're paying for. If you pay for insurance to cover routine, preventative, and non-emergent care then certainly you have every right to use it as such. You get those services that you pay for.

Lately you might have seen the commercials on tv for 'warranty' coverage on cars-basically an insurance plan for standard repairs, not simply accidents like regular insurance policies do.

Again, if you pay for it, you are entitled to use it.

And I think we talked about this earlier with the preventative care. This was when Patrick had said that people could be denied or something because they did unhealthy stuff, and it launched right into denying Uncle Cletus his diabetic care because he eats Krispy Kreme and Gramma MayBelle her high blood pressure medicine because she puts salt on her Spam.

And your tax dollars are currently hard at work paying for Medicare, just like mine, so I'm not sure what you're basing this all on.

What we can do is reward health-promoting behaviours and offer incentives for it. This is done, I believe, by some insurance companies now.

Beth said...

What we can do is reward health-promoting behaviours and offer incentives for it. This is done, I believe, by some insurance companies now.

I am glad you pointed this out, because this is a step in the right direction, and it is private businesses doing it. My son's gym teacher also does an excellent job teaching his students the importance of eating right and exercise, and we reinforce it of course at home. This sort of thing I like. Negative incentive by denying coverage I don't like, I prefer positive incentives to do the right thing.

I know that doesn't work when some people get diseases despite a healthy lifestyle, those are the people who truly need that help in an emergency.

As for the idea of incentives, what I also worry about in a single-payer system is the lack of incentive on the side of the doctor or nurse to do their best, if they have no incentive to try to get repeat customers or referrals. It's human nature to feel like doing an exceptional job deserves recognition, and rewards for the work you do. To even the playing field for costs does the same thing on the other side of the coin. There needs to be positive motivation to attract the best to do their best.

Satyavati devi dasi said...

What makes you think there's a lack of incentive for providers in a public option?

I'm not sure where you got this idea.

Beth said...

You think the government will pay out to doctors different amounts based on their abilities?

dmarks said...

Here is an interesting article that shows another view of the French system. Of especial interest are the references to how rather costly the French system is.

Contained therein is another reference about how the French rely on the products of the American drug industry. The same American drug industry that ObamaCo has identified as an ememy to be broken.

Such a trouncing of the companies that make these drugs might satisfy those "trust the government for everything" folks who are ignorant and fearful of private enterprise, but it would be damaging for the health of Americans, the French, and the world. "Nationalizing" the goose that lays the golden egg often makes the goose stop laying at all.

dmarks said...

Beth asked: "You think the government will pay out to doctors different amounts based on their abilities?"

The government has a bad reputation at determining the value of real-world jobs.

Satyavati devi dasi said...

Do you think the 'incentives' there are now for providers are money based?

I don't know about doctors but I do know about nurses. The 'incentives' you get for compliments on your stellar care are things like a little sticky star you can put on your badge. I had 17 of these on my badge at one point. And then I got in trouble cause my name was covered up.

Once a quarter, of all the people who received little sticky stars, a name was drawn to receive a $10 gift certificate for the local movie house.

For nurses' week, we got a balloon, a smiley sticker, and a $3 lunch coupon.

This is typical and representative of every single place I worked, except when I was in charge of the nurses' week (at a nursing home) celebration and got in a HUGE amount of trouble for spending $2600 on personalized scrub tops for every nurse in the house, company t-shirts for every CNA, an enormous catered lunch that rivaled a wedding and really stunning gifts for the admin team. (I did some creative math on my $250 budget, which would have worked out to slightly over $1/employee, which will tell you what the company's original plan was.)

I'm not sure what kind of incentives you think there are out there. I would venture to say that it's not quite what you imagine.

If a for-profit company will give you a sticky star in appreciation for busting your ass enough to make someone put a compliment in writing, and once a quarter give out a $10 gift certificate... or spend $1/person to celebrate the hard work they do all year...what kinds of 'incentives' do you think we'll be missing out on?

Beth said...

All your story tells me is that you like spending other people's money, which doesn't surprise me in the least.

How would you feel if a fellow nurse who worked as hard, or not as hard, made a lot more money than you? Would those sticky stars really make you happy?

Beth said...

Anyway, the super rich are going to be able to get better health care no matter what they do in Washington, so if you think your plans are going to make a difference, but all it's going to do is make it a little better for those who really need help, make the rest of us suffer, and the super rich will still be better off. I seriously believe there are ways to make it better for those who really need it without dragging everyone down.

Satyavati devi dasi said...

Um... there are plenty of nurses who make more than me. I work with two of them now. We all have the same title and do the same job. I have more years of experience than one of them does, and only one year less than the other.

The point I'm making (why do I always have to repeat these?) is that you were intimating that there would be no 'incentives' under a single payer system.

I'm telling you that there's no incentive now, with for-profit companies who have the money to spend.

My story, which to you just said I like to spend people's money, was the point that the for-profit nursing home I worked had put aside less than $1/employee for 'incentives'. I made an attempt to actually do something that would make people feel valued and recognized for their backbreaking, asschewing, shortstaffed hard work, by putting together a celebration worthy of the name, since the company, which was a private, for-profit corporation, was not particularly concerned about. I don't get how you missed that, but there it is in smaller words.

You're so worried about incentives under a single payer, but there's no 'incentive' now.

Unless you really like sticky stars.

Therefore, this more or less ought to nullify your fear of 'no incentives' in a single payer system.

People spend a lot of time fantasizing about fears and worries under a single payer system, when they really don't quite know how it is under the system we have now.

Patrick M said...

Saty and Beth: Let me try to crystallize a point or two in your argument so you can stop not understanding each other:

First of all, a government monopoly (single-payer) is not motivated by anything but maintaining its own power, and by keeping the politicians that can dick with it off their back. To that end, and to meet certain budgetary criteria, they will decide on such things as pay with no input from the market. It will likely benefit the lower ranks of doctors, but impact their ability to earn. And unless they are specifically mentioned in the bill (as in the nurse practitioners), the nursing profession will be subject to working for people who's profits are "managed" and will likely get less than they do now (no gold stars for you!). And while many dedicated nurses will stay, some will leave, as will many doctors, when they see there are financially better options out there.

However, the companies have resorted to stars now because they are becoming failing companies, partially because of spiking costs, partially because of government intervention, and partially because there is no moral or legal obligation to do the right thing anymore.

While I'm certain that a government monopoly of anything is a bad idea, the sickly state of the quasi-capitalist system we have now is also not going to cut it.

So you're both wrong!

Beth said...

I'd have to look back Patrick to see if it was you are dmarks who pointed out that regulations would be what prevents that no incentive for the profit-makers to do the right thing, but that would be the way to proceed that makes more sense to me. And in your posting today that said making the help come from local sources also a great one, the Constitution was not designed to give the federal government this kind of power.

Satyavati devi dasi said...

Hospitals and other facilities give you stars and other worthless nonsense as 'incentives' for one reason, and that's because every dime they don't spend on staff increases their profits.

It has nothing to do with regulation. It has to do with increasing their bottom line by spending as little as possible on the people without whom the place could not function.

We don't get incentives. We don't get 'retention bonuses' to keep us in our jobs. Plenty of years we don't get cost of living increases. If you live in a medical-dense area, you have more options and you might find companies competing a bit more for you, but the treats they dangle aren't tangible: they use words like 'respect', 'empowerment', and 'dignity'. This is all so much candy coated bullshit designed to get you in the door. Trust me on that.

If you ask a nurse who's leaving her job why she quit, she'll tell you it was management. It's never the patients, and usually it's not about money. It's not even about the fact that all you get for nurses week is a balloon and a $3 lunch coupon. It's about the things that matter most, which are indeed intangible, and which are nothing more than buzzwords for recruitment in the average workplace.

They're not worried about patient care. They're not worried about their nurses, on whom the quality of patient care depends. They're worried about making money. Period.

Beth said...

I think there are always two or more sides to stories and you may not believe me but I do appreciate hearing your side of the story, Satyavati. I definitely think that when debating the issue of health care improvements, that those working in the field should be heard moreso than a bunch of politicians. By the same token, those who manage the health care systems we have should also give input as well as consumers.

Satyavati devi dasi said...

Beth,

Those working in the field, in the form of the American Nurses Association, unanimously and wholeheartedly support a public option.

Because those who work in the field know the reality of the system we have now, and know it would vastly improve healthcare in this country.

Unfortunately, no one seems to care about the reality, just a lot of scary words and phrases they like to throw around to frighten each other into opposing it. And none of them would ever think to ask anyone who actually works within the system and has a grip on the actual, factual, for-true situation as it is (instead of incendiary nonsense designed to cause panic).

So now you know what those who work in the field, and understand the reality of the situation, believe and support.

There you go.

Beth said...

Yes, you have made your myopic views known, Saty, but as I mentioned there are others groups whose imput is important, such as the AMA which opposed a public insurance option, and 70% or maybe I heard 80% of Americans who are fine with their health insurance.

Satyavati devi dasi said...

Really? Have you checked with the AMA about that?

The AMA is not opposed to a public option. They are opposed to a single payer system. Now, if you can't differentiate between the two, they can.

You might also want to know that the AMA does not support nurse practicioners or physician assistants working in any way independently, because that would cut into their bottom line-a physician gets paid for every patient seen by a NP or PA. So the idea of using advanced practioners for 'routine care', which so many people here support, is vehemently opposed by the AMA.

The 80% of people who are happy with their insurance (I don't know any of these people, but we can assume they're all there and living in small enclaves without electricity) don't have to make any changes. They get to keep their insurance. Has that part not sunk in yet, or is it filed in the 'facts to be ignored' pile?

My 'myopic' views, Beth, happen to be shared by millions and millions of the very people who will be wiping your ass and attempting to take care of you, which I hope will include orders for generous amounts of versed and ativan, should you find yourself in the hospital. I would hope that you would take those views with a bit more respect for the knowledge we have of this industry, that you don't.

Patrick M said...

Saty: The AMA is not opposed to a [government] option. They are opposed to a single payer system. Now, if you can't differentiate between the two, they can.

Let me clarify the difference. Single-payer government health care is just as advertised. The government option is the same thing, except that it takes more time to regulate the private sector out. Which is the whole damned point of the post. The only difference is honesty in intentions.

Beth: Government option, not "public." Just like the government schools. I can understand supporters using the euphemism, but facts alone work here.

Beth said...

http://www.examiner.com/examiner/x-7715-Portland-Civil-Rights-Examiner~y2009m6d10-AMA-to-oppose-Obamas-health-care-reform

Satyavati devi dasi said...

Beth,

Your information is dated June 10. In the modern world it pays to keep up to date, and to go to the actual source.

http://www.ama-assn.org/ama/pub/health-system-reform/upload/hsr-hr3200-faqs.pdf

Updated 8.04.09

Beth said...

I stand corrected.

I did come across this interesting exchange between several doctors on CNN, sounds like a lot of what we've discussed here. Especially where the Dr. from the Cleveland Clinic notes that our unhealthy behaviors are part of our problem and that no amount of government money thrown at health care can change that.

http://transcripts.cnn.com/TRANSCRIPTS/0908/12/lkl.01.html

Beth said...

In the end, as the original point of Patrick's posting here, when there is a monopoly, people have only one choice. Right now as a nurse, Saty, you have options as to where you work and who your boss is. If the government takes over the health care industry, your only boss will ever be whomever is in power in Washington (which someday could be Sarah Palin). I think that sums up why monopolies by the government never makes everyone happy, but the free market can.

Satyavati devi dasi said...

Beth,

I am not really sure where you conjure up these fantasies, but I assure you that the government is not going to ever own every medical facility in this country, nor will it ever become the sole pay source for medical care in this country.

And if Sarah Palin ever gets into any position more powerful in Washington than a McDonalds drive thru chick, so help me God we're leaving the country.

What version of this health care bill are you reading, Beth? I mean, we're moving into the realm of bad science fiction. Why not spend all that energy on something productive, like going to donate blood or visiting people at the local nursing home?

Once again and for the last time, unless you are one of the few people who can both qualify for and afford a private insurance carrier, you probably carry either no insurance or whichever insurance is offered at your or your spouse's employment, about which you had no choice, no say, and certainly no 'competition'. The idea of 'competition' is an imagination. People don't choose their insurance carriers-their employers do. Their employers also choose what coverage is offered. So all this crap about 'competition' is just delusion. I'm sorry I have to be the one to explain it to you. Insurance carriers don't compete for you, Beth. They compete for companies. They don't care about you.

If you honestly believe all this stuff you go on about, maybe you ought to be checking whatever coverage it is you have to see if they cover psychiatrics, and if so, make an appointment posthaste.

Satyavati devi dasi said...
This comment has been removed by the author.
Beth said...

Or maybe you should re-read what I have written to know I am fully aware of what you say, so if you only half listen then I have no time for you, I do indeed have more important things. But thanks for this enlightening conversation, and thanks for some motivation for voting for Palin for president if ever I get the chance.

Toad734 said...

Patrick:

It isn't working. Thats the point. Its the most expensive system in the world yet we have the lowest life expectancy and highest infant mortality rate and highest obesity, cancer, heart disease, diabetes, rates in the western world. We spend twice as much as the "socialist" countries for health care and they provide health care for everyone.

Stop pretending that it is working.

And they do have private highways, its called I90. Most people still drive on public highways, send their kids to public schools, use the public libraries, send their mail through public mail, etc.

Dee:

Who said anything about a monopoly? 1st off, in a single payer system, which no one has proposed, there is no incentive to screw anyone because they are not profit motivated. And you can still pay out of your pocket if you so desire. As it is now, I have to take shitty expensive insurance or flee. I think I would rather have the option of cheap, better insurance or flee than shitty and expensive.

Anyway, there will be competition, no one is closing the doors of the insurance companies. All you freaks carrying nazi signs at town hall meetings will keep your expensive insurance that will drop you when you get sick and you will be happy.

Wait, were you one of those people who were afraid of the airplane? You would have been the one out picketing for the rail road barons who were about to loose billions when the tax payers started building airports wouldn't you?

Patrick M said...

Toad: PARTS are not working, because the system is not yet a monolith. I oppose the continued intrusion of government into the system because the places where there are problems have their roots in government intervention.

Now while there are things that the government has done right, the list is getting smaller, and things that once worked don't like they used to (government post, government schools, and the maintenance of government roads). And the reason they don't is because the government keeps getting bigger and sticks its fingers into more and more (and we abdicate related responsibilities to them).

The solutions to every problem lie in getting the government out of the things it does not have to do so it can concentrate on doing the things it is responsible for. That was the point you keep conveniently ignoring.