Wed 21 Oct 2009
Imagine going to the supermarket, taking your groceries to the checkout and instead of paying, you are handed a complex form.
It lists all your purchases, with arcane technical descriptions of the compositions and recommended usage of each product.
You then submit copies to your grocery insurer, who scrutinizes it to determine if each item is covered by your policy.
Sound absurd?
But how are the items in your grocery cart any less uniquely personal than your health care requirements?
According to HealthPAConline, an advocate of universal health care, in 2005, 36% of personal health care expenditures were paid by private health insurance. Another 46% by various government agencies. That’s 82% of payments by a third party.
Under it’s “History of insurance” heading. Wikipedia states:“In some sense we can say that insurance appears simultaneously with the appearance of human society…we can see insurance in the form of people helping each other. For example, if a house burns down, the members of the community help build a new one.”
So we see from the beginning, the purpose of insurance is to protect the individual from unpredictable and severe losses, by spreading the cost amoungst the entire aggregate of the insured.
David Goldhill, a media and technology executive who has studied the health care industry extensively points out that “Insurance is probably the most complex, costly and distortional method of financing any activity. That’s why it is otherwise used to fund only rare, unexpected and large costs.”
Writing on the website of the Economic Policy Institute, another advocate of universal health care, Ross Eisenbrey describes their study of health insurance industry employment.
“From August 1997 to August 2007, employment in the health insurance industry grew an astounding, 52%…during the same period, employment among physicians, nurses and others who provide health services or work to support them grew half as fast, 26%.”
What puzzles me is, why is Mr. Eisenbrey astounded?
He cites economist Paul Krugman’s description of the health insurance industry: “…an important part of it’s business model is collecting premiums while denying deserving claims and seeking out reasons to exclude patients from coverage they need. It takes a lot of extra employees to do this socially questionable work…”
But as we know, this is not merely a “business model” adopted by evil profiteers.
It is rather the nature of insurance.
Of course, welfare statists such as Eisenbrey and Krugman, pragmatists to the bone, take the status quo as the given, immutable starting point, ignoring both the fundamental nature of insurance and the history of it’s application to the paying of everyday, run-of-the-mill expenses.
Goldhill asks, “An expensive and wasteful absurdity, no?”
Not rhetorically, he answers:
“Is this really a big problem for our health-care system? Well, for every two doctors in the U.S. there is now one health insurance employee- more than 470,000 in total. In 2006 it cost about $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we payed routine and predictable health-care expenditures the way pay for everything else- by ourselves.”
Of course, welfare statists don’t want to go there; that may be a workable solution, but it entails reducing the centralized power of the insurance industry, and thus, the governmental authorities that regulate them.
Instead, they prefer to demonize the insurance companies and replace them with benevolent, all-powerful government.
Thomas Jefferson said: “If the people let government decide what foods they eat and what medicines they take their bodies will soon be in as sorry a state as are the souls of those who will live under tyranny.”
AND
William L.Anderson, a teacher of economics at Frostberg State University in Maryland notes that Montreal, with a population of three million people has only three MRI devices, while Allegheny County, Maryland, with approximately 80,000 residents also has three MRIs.
Why? In Maryland, an MRI machine is a capital asset, providing an it’s owners and operators an income.
In Montreal, as anything else the medical industry provides the consumer, the MRI examination is “free”. The MRI machine is an expensive liability.
Montreal’s medical industry would be better off if MRIs had never been developed.
Stop for a moment to ponder the implications for the future.
So we see that rather than correct the misapplication of insurance to mundane medical needs, what we are being offered is effectively the consolidation and expansion of the insurance dilemma under a single authoritarian agency.
An agency that of necessity, suffers a liability every time it performs it’s avowed function.
Ah, but with proper oversight, this tendency can be superseded, statists may argue.
But what about the cost of oversight?
Well, we’ve seen that by examining the health insurance industry. Note that the inherent inefficiencies pertain to the insurer’s position as a third party payer.
Christopher J. Conover, an assistant research professor at Duke University says the annual burden of health care services regulation amounts to $169.1 billion.
And as we are keenly aware here in Miami, that oversight, as expensive as it is, doesn’t seem to quite fulfill it’s purpose.
It’s easy enough to stand here and cite anecdotes about our personal experiences, positive or negative as to any country’s health care.
As a teenager, I was in Canada with my mother. She became ill and was treated, free of charge, at a Canadian Hospital.
A strong supporter of expansion of government power, as she observed in her homeland, she was quite pleased.
We may forgive my mother for allowing her personal experience to reinforce her extreme socialist bias.
But my mother was an anonymous private citizen.
Miami Herald writer Myriam Marquez presents a maudlin account of the death of her cousin in Cuba, offering this up as a blanket condemnation of Cuban health care.
But no health care system is perfect. There will always be unfortunate deaths that could have been prevented, if all else being the same, the deceased had lived elsewhere.
The simple citings of single incidents or examples are hardly comprehensive, meaningful endorsements.
An anecdote is useless unless it illustrates a broadly applicable principle.
“Woman, 108, must wait 18 months for hearing aid”
read a headline in the U.K. Guardian in July, 2007.
A spokesman for the Royal National Institute for the Deaf is quoted: “I am afraid this is a common problem. In some parts of the country there are over two year waiting lists, which is shocking.”
Again, a statist is unpleasantly surprised by the inevitable consequences of their policies, remember the astounding of Ross Eisenbrey?
A Reuters story from last May indicates Europeans had better get used to it…
“…the European drug industry’s heavy reliance on government funding for reimbursement of medicines means the worst is yet to come…
Industry leaders…warned…health care…(is)…an all-too-easy target for budgetary cost-containment measures.”
And while the heavy regulation along with the severing of the organic link between the causing of a cost and the bearing of a cost prevents competition from holding prices down, it also serves to export that competitive effect.
Thus the phenomena known as “medical tourism”
The on-line travel industry journal, Hotelmarketing.com reported in 2006 that…
“…Medical tourism in Asia is growing rapidly, far outstripping the 4 to 6 per cent growth in general travel bookings predicted for 2006, with the number of medical tourist visits to many countries swelling by 20 to 30 per cent a year.”
Abacus International President and CEO Don Birch says, “The lure of low-cost, high quality healthcare in Asia is estimated to be attracting more than 1.3 million tourists a year to the key locations…
What we’re seeing now is an increase in the number of service providers in the industry specialising to meet the needs of this market…
The current estimated 1.32 million medical tourists come to Asia from all corners of the world – including US and Europe…
Singapore…makes world headlines for performing complex neurosurgical procedures and delivering cutting-edge medical treatment by the region’s leading health specialists…
The cost of treatments in Singapore, such as a hip replacement, can be less than a third of the price in the United States. In some cases, the cost is less than a tenth of what people would pay in America or Europe.”
There we go, conflating “cost” with “price”.
While the prices may range from one third to one tenth the price in the U.S., is the cost really much different?
Of course, this line of reasoning forces up the question; Compared to what?
A question, we now see, can only be answered rationally and pertinently within the parameters of a level competitive playing field.
Only a truly free market, devoid of regulation and licensure, can provide that.
This is an issue of national significance, however contrived and forced that status may be.
I’ll close with a quote that puts the health care debate in a broader perspective, this from congressman Ron Paul:
and
use some of those savings to take care of Americans at home
instead of killing foreigners abroad.”
CNN headline from October 16, 2009:
U.S. deficit biggest since 1945
Obama administration closes the books on fiscal 2009: Falling revenue plus soaring spending leads to a $1.42 trillion deficit.
—The Bikemessenger
2 Responses to “Health Care: The Principles Underlying The Facts”
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October 21st, 2009 at 3:15 pm
Here is my problem with your solution. It still leaves us in the hands of the corporations. Even if health insurance were to be changed to cover only catastrophic care, a corporations first responsibility is in providing the largest profit it can muster for it’s shareholders so the incentive remains to collect premiums and deny claims.
The long forms you fear are one of the most valued and effective tools of the corporate insurance bureaucrat in this strategy. One omission or inaccuracy is enough to invalidate a claim while at the same time not revoking the validity of the policy therefore denying the “insured” a refund of all the money they have paid for insurance they apparently don’t really have.
Without dealing with the legal responsibilities of corporations, the regulations governing them and the inequities created by corporate personhood, it seems to me we are all left to the wolves.
Thomas Jefferson once warned, “If the American people ever allow private banks, to control the issue of their money, first by inflation and then by deflation, the banks and corporations that will grow up around them (around the banks), will deprive the people of their property until their children will wake up homeless on the continent their fathers conquered.”
Jefferson also said, “I hope we shall crush in its birth the aristocracy of our moneyed corporations, which dare already to challenge our government to a trial of strength and bid defiance to the laws of our country.”
Well I think Jefferson was right and would be very disappointed in what we have today as we are already there and have seen where it has brought us. These corporations are the “people” to whom you would trust our welfare in our most disastrous scenarios of catastrophic need.
With this as the alternative, I would much rather have a government flunky who sole purpose is to process claims through the system without any other agenda than making it through another day. While the insurance company bureaucrats are nitpicking in search of creative denials and deferrals (i.e. delay them till they’re dead), which are encouraged and indeed rewarded with bonuses to the highest performing employees, the government worker on the other hand is only encouraged to process as many through the system as possible while insuring against fraud and paying for medical quackeries such as psychic surgery or crystal healing. (Apologies to my new age friends out there but until I see an objective scientific basis for such treatments, I shall remain skeptical of them)
Another issue I have with your proposal is that insurance should be for the catastrophic. I would argue that would be a privatized version of what we already have and would do nothing to stem the skyrocketing costs. Indeed it is in insuring the small thing where I believe we can find our biggest cost savings.
The reality of life in this country is that we have created a society that has been pushed into living paycheck to paycheck. (Admittedly, we are partially responsible for this fact with our overconsumption and reckless embracing of the consumer credit mentality, but that is a separate discussion that goes back into corporate and banking reform) People who are worrying about paying rent, food, electric, etc., will invariably delay a routine check up or even a visit to the doctor because they are feeling vague symptoms such as lethargy or headaches. It is a matter of priorities, if I am worried about my house payment being late and paying to go to the doctor would upset the delicate balance of my household economy, I am certainly going to make that house payment rather than pay the doctor to have him tell me I am overworked.
Here is the predicament though early detection is key to containing costs and better healthcare outcomes. Using the example of lethargy, one of the first signs of leukemia is a lack of energy and testing for it is relatively simple and inexpensive. In the early stages of leukemia there is a good chance of surviving, this becomes increasingly more difficult in the latter stages though because of the toll the treatment takes on the body.
Right now, if you have no insurance you probably have delayed any medical assessment until your condition has progressed to an advanced stage which you are unable to ignore, at which point you resort to the “insurance provider” of all the uninsured, the only place you cannot be denied and healthcare costs are at there highest - the hospital emergency room. This has the result of driving up costs for everybody, reducing desirable healthcare outcomes and reducing the quality of care given to those whom the emergency room was designed for.
Indeed, I not only believe that that healthcare coverage should not just include paying for the little things such as routine check ups but it should even be more proactive than that and pay for things such as wellness programs as well.
I would also argue that under a system of solely catastrophic insurance in the corporate environment, that the insurance companies would use the fact that the insured did not take the proper steps in preventing the condition and would therefore be denied for not doing their due diligence.
I am a very results oriented kind of person and honestly am not concerned with big government versus small government, rather I want effective results and what I see when I compare our current system with those abroad is that our costs are much higher than those of other countries that provide universal coverage to their citizens while at the same time providing no better health outcomes than those systems. It is my opinion that part of that cost savings comes from the fact that all healthcare is provided for rather than just the catastrophic.
According to the World Health Organization, our healthcare system is ranked 37th in the world behind Costa Rica at 36th and in front of Slovenia at 38th. The much maligned Canadian system of single payer through the provinces sits at 30th, the United Kingdom which is the ONLY truly national socialized system is at 18th, the Netherlands who provide universal coverage through a HIGHLY regulated private system is at 17th, Japan whose system has produced on of the healthiest citizenry in the world is 10th and France is up there at number 1.
The only thing in common these countries have in terms of healthcare, is that they provide universal coverage and they do it cheaper than we do. For all the clamoring about some of those systems going bankrupt, they all provide healthcare at a smaller % of GDP than we do. We are actually ranked at number 2 in cost. They also have a healthier citizenry based on life expectancy as well.
Do these systems have their problems? Sure they do, no system is perfect but in lieu of some unknown alternative there is much we could learn from them about improving our own system.
The biggest problem we face in implementing a universal coverage system is not cost but rationing based on available healthcare professionals and facilities. The fact is we do not have the infrastructure to provide everybody with everything without wait times but the reality is that we already have a system of rationing and wait times. The uninsured wait until the situation forces them to go to the emergency room and the insured are rationed on the basis of maximizing corporate profits.
The shift to universal coverage has to be done in conjunction with encouraging more people to be doctors by lowering the costs of education, low interest student loans and scholarships. Until then, with universal coverage we can at least be assured of the attempt of fairness in the apportionment of resources while we all wait for the availability of those resources to catch up to the need.
In my mind there are few justifications for government, one of which is to provide for the welfare of it’s citizenry and if through the pooling of resources the government can not only increase life expectancy but also the quality of that longer life, then that becomes a legitimate role for it to undertake. I certainly find it preferable to leaving people to die, even if they are partially responsible for their condition (i.e. smoking).
I believe life is of immeasurable value and to deny people based on economic status rather than availability of resources is unconscionable. It is on this basis that I consider healthcare not to be a commodity but a right, and if the government is not there to protect our rights, then it is we who serve the government and will all find ourselves in the position of being nothing more than fodder for a system that serves itself and the profits it generates.
Links you might find interesting
healthcare rankings - http://www.photius.com/rankings/healthranks.html
life expectancy rankings - http://www.photius.com/rankings/healthy_life_table2.html
healthcare expenditures as a % of GDP - http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html
October 28th, 2009 at 1:02 am
Alonso, why are you arguing against a defense of the status quo?
Is it so hard to conceive such a fundamentally different scenario that, as I disagree with you, you\’re forced to assume I must be on the side of the evil, profit seeking CEO’s?
Well, I guess it must be.
So let me re-emphasize…
What we are proposing it a pure free market.
So no, your problem is not “It still leaves us in the hands of the corporations.”
To the contrary, if a free market system were instituted, large corporations would collapse rather abruptly and rapidly.
As Sheldon Richman pointed out…”There is no thin layer of intervention. Government has intruded deeply into economic activity from the beginning, most particularly in banking and finance, which is by nature at the center of any economy. The web of privilege and control is pervasive, touching all parts of the economy. Moreover, this intervention was never imposed on bankers, financiers, and the rest of the business elite. It was welcomed — to be more precise, it was invited and sponsored by them. Free enterprise, risk, and loss were for the little guy. Partnership with the state was for the elite. That partnership meant favoritism and protection from competition. It meant exemption from market discipline and exploitation of taxpayers, consumers, and workers.”
http://www.fff.org/comment/com0810b.asp
The corporations you rightly rail against exist only through the insulation provided by the myriad tangle of regulations, mandates, taxation, franchisings and edicts of government.
Restrictions they at least help design, if not dictate (depending on their degree of influence). Restrictions they easily manage and profit from, as the insulation from real competition of these artificial costs makes entering the field financially unfeasible, if not outright illegal.
Of course, as with any problem, the free market doesn’t really provide a solution. It would still be permitted to maintain the existence of the large corporations.
But it would become extremely unprofitable. Now, the only avenue to profitability is through the providence of products and services the consumers of same purchase of their own free will.
You either produce a value which people purchase from you freely, or you go out of business. These two are the only possibilities.
No one is “too big to fail”. On the contrary, the bigger and more successful you get, the more vulnerable you become, as your success draws competitors.
And the government is EXPRESSLY PROHIBITED from helping you.
As to corporate personhood, Keith Preston writes:
“Some advocates of free enterprise will respond to such charges by indignantly proclaiming their opposition to state efforts to “bail out” bankrupt corporations or subsidies to corporate entities for the ostensible purpose of research and development. Yet such defenses will often underestimate the degree to which the state serves to create market distortions for the sake of upholding a corporation-dominated economic order. Such distortions result from a plethora of interventions including not only bailouts and subsidies but also the fictitious legal infrastructure of corporate “personhood”…”
http://www.alliancejournal.net/109/free-enterprise-the-antidote-to-corporate-plutocracy/
Granted, not all free market advocates call for the elimination of corporate personhood.
I’m not an economist, or a pragmatist. My argument against corporate personhood is moral and metaphysical.
In the context of human society, the individual is the seat of rights, as it is it’s nature that necessitates the concept of a “right” in the first place. You cannot, therefore, create an abstraction and assign it status which possession pertains, of necessity, only to a material existant.
In short, corporate [an abstraction], is oxymoronic to personhood [pertinent only to material entities].
And metaphysically impossible.
Thus, the corporation in practice, allows those who control it the power of a person while evading the concomitant responsibilities.
Such evasion morally wrong.
“These corporations are the “people” to whom you would trust our welfare in our most disastrous scenarios of catastrophic need.
With this as the alternative, I would much rather have a government flunky who sole purpose is to process claims through the system without any other agenda than making it through another day.”
But why settle for the lesser of two evils?
I recall a conversation you and I had with another person about political third parties, which we both favor.
Now, apply that same principle to economic matters.
In a free market, you get to fire your “government flunky”.
“…the government worker on the other hand is only encouraged to process as many through the system as possible while insuring against fraud…”
But what about the cost of preventing fraud in the complex, centralized system? We\’ve already covered the ramifications of that in the current system, not mention the fact that said oversight fails.
And the basic, inescapable fact that it is the artificially large scale of the system that facilitates fraud in the first place…
Decentralization wouldn’t eliminate fraud. But it would make it’s broad reach impossible, as there is no broad reach.
“Indeed it is in insuring the small thing where I believe we can find our biggest cost savings.”
But how do you determine if the “small thing” is indeed a “small thing”, however you may define it?
You seem determined, my friend, to evade the acknowledging the inevitable costs of what you propose.
Again, the “evils” of the insurers conniving to deny legitimate claims are not due to their profit motive, but rather are intrinsic to insurance per se.
Insurance claims, by nature should be the exception and not the rule. The extraordinary scrutiny applied to an insurance claim is a valid norm, inherent to the application of insurance as a means of payment.
It is insurance, and not payment that should be removed from the system.
This savings, along with the elimination of other previously enumerated restrictions, would render most health care costs manageable.
So you can stop attacking the status quo to me. You are much more it’s defender than I.
“I am a very results oriented kind of person and honestly am not concerned with big government versus small government, rather I want effective results and what I see when I compare our current system with those abroad…”
Stop comparing the two as though there were no other alternatives.
I have no trouble conceding that your single payer system is superior to what we currently experience. Not as I believe it to be the case, but as I consider it a moot point.
If you really want “results” then work towards a system that allows the consumer to apply economic pressure. Any coercively enforced monopoly, such as what you advocate, eliminates competition. And therefore eliminates the possibility of formulating any objective criteria.
You leave yourself without the means to judge results, as what ever happens is the only possibility.
And as pointed out earlier, the system is harmed every time it provides it’s intended purpose.
“Japan whose system has produced on of the healthiest citizenry in the world is 10th…”
Physical health is only one essential aspect of comprehensive well-being.
Human nature dictates that personal liberty is at least as vital.
But in the name of physical health, the Japanese have thrown it to the wind.
http://www.nytimes.com/2008/06/13/world/asia/13fat.html?_r=2
So we see that by making the state responsible for the individual’s health, we must OF NECESSITY yield it dictatorial power over all matters directly associated with it.
“…no system is perfect but in lieu of some unknown alternative there is much we could learn from them about improving our own system.”
Well, I just finished proposing an “unknown alternative”. And since it’s unknown, you will have employ some vision to concive it.
“Until then, with universal coverage we can at least be assured of the attempt of fairness…”
Results orientation sure takes a beating when we have authoritarianism to apologize for, doesn’t it?
More to come…