A Bit Late But Welcome to 1984

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9 responses to “A Bit Late But Welcome to 1984”

1. 

   Ronald D. Hunt

   2009-12-29

   The coming health care bill has made it pointedly clear that a few states are going to have to step up to the bat on this one. California One Care will pass either next year, as the California legislature has enough democrats to override Arnolds Veto ability and pass the related tax increase. Pennsylvania also has a bill gaining a lot of traction HB 1660/SB 400 which and this is a shocker has Bipartisan support their bill has 5 republican Co-signers and the Governor has said he will sign the bill’s if/when they get to him.

   Tho their isn’t a bill yet New York is likely to be trying to get single payer bill going sometime next year as well.

   I think the progressives have given up on Federal level single payer legislation for now, And I believe the strategy they are using to get around ERISA will work. It will only take a few states implementing single payer for the benefits and savings to become obvious, with any luck it will spread across the country and eventually lead to a federal single payer program.

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   1. 

      David

      2009-12-29

      I have no problem with the idea of individual states implementing single payer health care but even if they prove t be successful I have no doubt that a federal level single payer would be less efficient and more prone to fraud and exploitation than state level single payer. Truthfully I expect that even if smaller states see success with such a model larger states like California are likely to see uncontrolled cost overruns.

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2. 

   Ronald D. Hunt

   2009-12-29

   The Japanese single payer system serves over 127 Million people at 1/4 the cost of the American system, The French system serves over 62 Million people at 1/2 the cost of the American system, In fact single payer systems all over the world run with grand efficiency well beyond the American system. I just don’t see anyone can reasonably believe that single payer would increase costs.

   Both France and Japan have better health out comes then we do, longer life spans, lower birth mortality, etc. They don’t have the huge cost shifts from Medical bankruptcy, late diagnosed diseases, excessive administrative related activity’s, improper compensation models encouraging abuse, etc.

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   1. 

      David

      2009-12-30

      I just don’t see anyone can reasonably believe that single payer would increase costs.

      I’ve never seen a government program, including our current government health care programs, that did not overrun their costs – that’s why I’m skeptical of a government program of this scope. I don’t know about France and Japan but we have developed a culture here in America of irresponsibility – especially among the political culture. Until that culture is eliminated there is no way I would expect such a massive federal program to not be rampantly abused. We’ve never shown the political backbone to go after those who abuse the programs on a large scale and we don’t seem to be able to distinguish between good private partners and bad ones. (How long does our government continue to do business with Halliburton and Blackwater?)

      Even with a single payer system you must see that the government health care program would be partnering with private enterprise to deliver all this “free” care.

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3. 

   Ronald D. Hunt

   2009-12-30

   “I’ve never seen a government program, including our current government health care programs, that did not overrun their costs – that’s why I’m skeptical of a government program of this scope.”

   I can give yea that argument, however private industry is doing no better. The major difference being that premiums, co-pays, deductibles, and co-insurance increase instead of tax rates. One way or the other the effect is the same. However the government programs have shown that they can keep their cost inflation lower then private programs though decreases in administrative costs simplified billing practices etc.

   “Even with a single payer system you must see that the government health care program would be partnering with private enterprise to deliver all this “free” care.”

   Theirs no perfect solution, without leaving the doctors and hospitals as private entity’s you would effectively create a service ceiling(example: British NHS). Other single payer systems have shown that this is not a difficult to police interaction between private industry and government.

   “I don’t know about France and Japan but we have developed a culture here in America of irresponsibility – especially among the political culture.”

   France has a populace that loves any excuse to go and protest, and the people their have won all kinds of things that make it easy for them to make time for it as well. In France its mandated by the government that all business provide at least 5 weeks of paid vacation per year. Housing, Jobs, Health care, Broadband internet, living wage, etc are all considered human rights their. You would likely find it to be a funny place from how you see the world.

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   1. 

      David

      2009-12-30

      There’s no doubt that the structure of our health care system needs to be reformed – that’s true whether the system is administered publicly or privately. I don’t see that kind of reform in any of the current efforts. We’re busy arguing public vs private rather than arguing what is actually causing the problems in the system.

      One of the major differences between public and private is that we can play various private providers off of each other to ensure some degree of efficiency (not individuals in our messed up market, but it’s still theoretically true) but in a government system that potential of customers choosing another option disappears – that’s one less level of accountability. You can argue (rightly) that it’s not working right now, but removing the possibility does not seem like a step forward – it seems more like locking ourselves into whatever we legislate for better or worse.

      Backers of the current legislation claim that it will save a little bit of money over the current system but those estimates all assume no cost overruns. As bad a “private” industry is doing now the new legislation does not come close to guaranteeing to do better – in fact it does not appear to even have a realistic chance of doing better.

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4. 

   Ronald D. Hunt

   2009-12-31

   “Backers of the current legislation claim that it will save a little bit of money over the current system but those estimates all assume no cost overruns. As bad a “private” industry is doing now the new legislation does not come close to guaranteeing to do better – in fact it does not appear to even have a realistic chance of doing better.”

   Your right the current legislation is terrible. The win is that it has opened the national dialog on health care, and it’s passage will kept health care in the national dialog until a better solution can be found. Part of the reason for several state reform solutions to start getting off the ground is due to backlash against the proposed national reform. Progressive and Liberal Democrats in California, New York, and Pennsylvania will turn their anger into a powerful force that will bring real reform to those states. After those states have put in place their reform it will spread like wildfire until a national system can be established. And I can support the crap bill in congress on that basis.

   “One of the major differences between public and private is that we can play various private providers off of each other to ensure some degree of efficiency”

   Health care costs to much to get away from the third party payment systems that make the above idea non-function as price pressure tool.

   “We’re busy arguing public vs private rather than arguing what is actually causing the problems in the system.”

   That’s because their really isn’t a lot of disagreement on what the causes are. Explosive administrative cost growth, unaffordable access to preventative care, misplaced compensation, the whole fee for service model, increased technology costs, increased drug costs, etc.

   Whats in argument is the model in which health care can be financed, and delivered. The question is can these problems be solved within the confines of a lightly to moderately regulated private multi-payer system. I don’t believe they can be, I haven’t seen any proposed regulatory model that would fit into the lightly to moderately regulated requirement and actually solve the problems.

   Switzerland is the closest I can think of but their system is very heavily regulated and would likely not fit into the conservative vision.(their insurance is non-profit by law, regulated as utility and the government negotiates rates with hospitals and doctors not the insurers, claims denial is illegal so claims disputes have to be handled directly with the insurance customer and not pass though the hospital/doctor system, co-insurance and deductibles are illegal, and premiums are subsidized though income tax, their is no public option, they have several of the regulations proposed in the current health bill here).

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   1. 

      David

      2009-12-31

      The win is that it has opened the national dialog on health care, and it’s passage will kept health care in the national dialog until a better solution can be found.

      The national dialog was opened by the debate – passage was not necessary for that. Passage of such a lousy, mangled bill hardly guarantees that the health care debate will continue in Congress – there is plenty of chance that they will set it aside out of fatigue. The thing that will keep it in active debate (if anything) will be soundbite campaigning as Republican incumbents are accused of ruining the legislation through obstructionism and Democrat incumbents are accused of selling the country into deeper debt without any real reform to show for it.

      It’s funny that your list of what the causes are all look like symptoms to me rather than causes. I would have listed causes such as distorted incentives, a bias toward treatment, hidden costs, a lack of transparency, curbed competition, and service to the wrong customer. Sounds like that debate is hardly settled. Until we agree on what the problems are we can’t hope to arrive at compatible conclusions about what the solutions ought to be.

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5. 

   Ronald D. Hunt

   2009-12-31

   perhaps we are seeing the same problems but from different angles,

   misplaced compensation = a bias toward treatment, distorted incentives

   third party payment(I forget to list this above) = hidden costs, a lack of transparency

   “The national dialog was opened by the debate – passage was not necessary for that. Passage of such a lousy, mangled bill hardly guarantees that the health care debate will continue in Congress”

   I believe that all dialog in congress will die for 4-5 years at least, its not that the dialog will have stopped it will simply have moved as people observe State implementations of reform that pop up. People in all states will have their eyes on the reforms and in a way that will keep health care in the national dialog.

   The longest congress will stay out is around 7-10 years, even with subsides after insurance goes above the $20,000 per year mark it will start pricing people out of it. >6% growth is a scary thing.

   Actually given the taxation model of going after “Cadillac” insurance plans. After California, New York, and Pennsylvania pass single payer a good half of the tax’s they planned on will dry up and they may have to consider changes sooner.

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