Re: 08/07 Doonesbury/Rush Limbaugh synchronicity

On 10 Sep 2009, George W Harris said the following in
news:p6vga55qld5dh1hc30qvvsqjpjmk704qh5@xxxxxxxx

On Wed, 9 Sep 2009 16:00:18 -0700 (PDT), Dann <detox665@xxxxxxxxxxx>
wrote:
<snip>


Health care savings accounts
perform a pre-payment function that permits people to save for future
expenses. They have the added benefits of diverting some employer
funds used to purchase insurance into the HSA for the benefit of the
individual rather than an insurance company as well as introducing a
direct cost based link between consumer and provider. When a third
party is paying the bill, the consumer tends to think less about cost.

Okay, there are a few problems with HSAs. First,
for many people they're unaffordable. For the large
fraction of people who don't make enough to make itemizing
deductions worthwhile, they aren't any advantage
whatesoever.

But you don't need to itemize to get the deduction. All we have to do is
make contributions to an HSA 100% deductable from one's gross income.

That is another problem with the current set up. Individuals purchasing
coverage have to meet some arbitrary limit before they can deduct their
expenses. Companies and their employees can deduct the same expenses
right off their gross income.

Fixing that will make buying today's insurance more affordable today
without some overarching national policy.

Second, there's the problem with variance
of lifetime costs. Some people are going to spend
$250,000 in medical expenses and others are going to
spend $5,000,000. It's impossible to predict with any
certainty what your lifetime medical expenses are going to
be, and when they are going to be incurred. Even if
everyone were able to put their expected lifetime medical
expenses into an HSA, those people (less than half, but a
significant fraction) whose actual expenses exceed
expectations are going to be left high and dry.

Which is why HSAs are almost always tied to a catastrophic health care
policy.

In short, we should act to make the health care market more like other
markets instead of completely severing any connection with market
based feedback. We may not be able to sell health care like bread,
but we should be able to sell it like high end computer systems or any
other high tech product.

No, we can't. People can predict when they're going
to need a high-end computer system, and can know they
won't need to buy five hundred of them in a year. The same
can't be said of the need for medical care. It is this extreme
variance in need which makes some form of insurance system
mandatory for health care.

I don't disagree with the need for insurance. I disagree with having the
government providing that insurance. Governments weird markets.

Free markets do very cool things. Perhaps the most important thing
they do is to signal relative demand and supply to every consumer and
producer without requiring that every participant possess encyclopedic
knowledge of the complete market.

But free markets can't solve every problem, and this
is one of them. Since, as I believe I have adequately
demonstrated above, insurance is necessary for a workable
healthcare system, we need to make sure costs are
controllable and insurance is accessible. There are three
basic restrictions that need to be in place for this.

You didn't adequately demonstrate anything above. You demonstrated that
you are unwilling to consider anything less than a complete government
health care system.

1) Universal coverage. No insurance company can
deny coverage to anyone, and they have to offer the same
price to everyone within limited demographic categories (I'd
restrict it to age, myself; maybe smoking).

I understand the concept. They'll probably add weight or body mass as a
qualifier. Perhaps cholesterol levels as that has an effect on future
heart attacks.


2) An individual mandate.

I understand the concept. My initial reaction isn't favorable, but not
unrealistically so.

3) Competition must be guaranteed. We don't have
free market competition now, as in many markets there are
virtual monopolies (in Maine, for example, one company
accounts for 2/3 of the state's health insurance coverage).
The option most discussed now is having the government
offer a public health insurance option, which is actually
probably the most effective means. Other options include
federalizing insurance regulation, so that regulations are
uniform across the country, and insurance can be purchased
across state lines.

I don't have a problem will allowing interstate competition. I believe
in free markets. I would include such regulation as a part of a package
of reasonable reforms that are worth pursuing.

The only "public option" that I would consider would be if Congress and
every federal employee, including the union, were only allowed to have
that "public option" as their only health insurance option. Otherwise we
end up with a tiered system where taxpayers are taxed to provide superior
benefits for their public employees and as a result are left without
enough money to buy similar coverage for themselves.

Now I'd like a turn.

One of the most disconcerting aspects of nationalizing our health care
system is that it will

Yeah, about that. No one is proposing nationalizing our
health care system. It's not on the table. Arguing against it is
like arguing against going to war with Belgium.

(argument against going to war with Belgium snipped)

But it is on the table. Mr. Obama favors a single payer system. I've
watched him say it on video. Several leading members of Congress favor a
single payer system and regard the current legislation as a stepping
stone towards that objective.

Incrementalism is the friend of every socialist.

The fact is that the government's "public option" will become the defacto
base insurance policy. Insurers will adjust their other policies to
match. Or employers will dump their coverage to buy the cheaper (and
presumably less coverage) government approved "public option".

That is what happens when the government starts setting standards. They
quickly become not a minimum, but the maximum that providers are willing
to provide.

Add to that the fact that part of the current proposal is the creation*
of a government panel of doctors that will be possess the power to decide
exactly which treatments will be available for which conditions. Mr.
Obama his-own-self has discussed this panel as being key to reducing
wasteful spending on non-effective treatments.

This adds yet another hurdle to bringing new procedures, drugs, and
equipment into the medical market. So yes, the proposed legislation will
slow the advancement of medical technologies.

Please respond to my original question.

*AIUI, this advisory panel has existed for years. The current
legislation would give them authority that they currently lack.

I'm certainly open to any number of options. Why aren't you?

I'm open to options that work.

Freedom works; each and every time it is tried.

--
Regards,
Dann

blogging at http://web.newsguy.com/dainbramage/blog.htm
Freedom works; each and every time it is tried.
Now also on Facebook in case you just can't get enough of me!
.

Relevant Pages

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