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Mar 22 2010, 05:15 AM (Post #1)
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So the health care bill passed the House. I kind of wish the Dems didn't have to appease the "centrists" in the Senate.

I think mandatory insurance is stupid. What do you all think about the bill?
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Mar 22 2010, 05:32 AM (Post #2)
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QUOTE (Jinghao @ Mar 22 2010, 12:15 AM)
So the health care bill passed the House. I kind of wish the Dems didn't have to appease the "centrists" in the Senate.

I think mandatory insurance is stupid. What do you all think about the bill?
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Watched the voting on CsPAN.

The mandatory insurance was the only thing I really opposed (strongly, that is, I had an opinion on most I kept up with, but that was the only thing I really cared about). I'm sort of hoping the supreme court overturns that at least, it probably won't take too long to get there. The best arguments I've heard for it were "The only way this will work is if everybody is in the system" and "Car insurance is mandatory in most states", which says a whole lot in that I've never heard anything remotely resembling support for the former, and the latter, car insurance is only mandatory if you own a car, which you don't HAVE to have. In another sense, why can't someone pay directly for their health care instead of through insurance? Or what if someone still can't afford it?

I think it'll be a few years before anything actually happens, at least from what I've gathered (just in time for a new president to be blamed for it). I expected it to pass eventually, I'm just disappointed in what the end result actually was.
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Mar 22 2010, 08:40 AM (Post #3)
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I have a hard time figuring out what the supposed 'supporters' of this bill actually support? It's not a "single payer system" or a "public insurance option" so you can't make that argument; and it's not simply reforming fraudulent practices of health insurance companies, trial litigation, or health care providers.

It's a boost to the large private insurance conglomerates, whose stocks have gone up and up since the debate started—watch them go up even more this week.

It's corporatism, pure and simple. It's giving a few large insurance corporations tens of millions of new 'customers' and paying them hundreds of billions of taxpayer dollars. Meanwhile, behind curtain number two, is an 'in' to yet unquantifiable facets of citizens' personal lives; while the bill contained little in the way of personal medical decisions or such, it's quite feasible to consider such a future, especially when *gasp* the costs double, triple, quadruple from the "estimates" they have put forward so far, and expenses have to be controlled by rationing care, cutting fees to hospitals or research (lowering quality), etc., etc.

If this was about providing insurance to the poor/uninsured—well, Richard Nixon had a plan for this way back when. BUY insurance plans for the 35 million uninsured. It would cost way less in the short and long runs, and provide basic care for the 'most needy' while keeping the bureaucracy out of the intricacies; yes, imperfect. But the plan that passed tonight 1. has nothing to do with health insurance (it's not insurance when you eliminate risk and provide coverage irrespective of risk) and 2. necessarily must progressively cost more and consume more of the health care industry, including basic medical care, hospitals, HMOs (which are ridiculous anyway), medical unions, and of course, patient rights/responsibilities.

This is about much, much more than "reform", and is a questionable, if not borderline evil collusion of very misguided—or, malicious—individuals.
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Mar 22 2010, 04:07 PM (Post #4)
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First of all, I think that a lot of people are unhappy about the details of the package, but voted for it anyway so they can claim to have voted for "Health Care for Everyone". The package is imperfect—it's not even close to perfect—and does nothing to address the underlying causes of health care inflation—not underinsurance, but overinsurance. I believe I've discussed that in detail before and I'll forgo that part today.

Secondly, the fact that the bill appeals to the worst of the Democratic party—the fringe Senators—is the lack of Republican support. I would much rather have dumped 20 Democrat votes to get 20 Republican votes, but the tactic of filibustering everything simply made that option impossible.

Thirdly, I was hoping for a "public option" in the bill—so that it doesn't end up being a freebie for insurance companies. What the hell? What if I don't care if I die from a cancer or something? Why do I need insurance?

Lastly, I'm not sure how well this addressed the changing demographic landscape of the US. Americans are getting older, but unions are refusing to raise retirement age. Public pension liabilities are going to balloon while workers retire with over a third of their lives yet to be lived. When Social Security was enacted, the age boundary was set above the average life span. Even if we don't do something as extreme as that, we still need to raise the coverage ages for some of the social services lest we bankrupt the country. There's not much discretionary spending to cut—soon, in a couple years, if China does pull out of US bond auctions as the Treasury wants them to, interest expenses will be double the discretionary spending in the country. We need to start adjusting entitlement benefits to the changing demographics.

Health care is the first.
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Mar 22 2010, 04:49 PM (Post #5)
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As much as I like the idea of health care reform, got to admit, they screwed the pooch on this one. This is quickly going to become a hated bill. I don't see what the hell they were trying to do.

On the positive side, I found that Glen Beck, talking about health care reform, is normally boring, an incredibly insane, but, when I am high off my ass, he's incredibly funny, wich is something I've gotten used to doing. I recomend watching Glen Beck after sparking up, every day. It's really fun.
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Mar 22 2010, 09:44 PM (Post #6)
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QUOTE (Jinghao @ Mar 22 2010, 11:07 AM)
Thirdly, I was hoping for a "public option" in the bill—so that it doesn't end up being a freebie for insurance companies. What the hell? What if I don't care if I die from a cancer or something? Why do I need insurance?
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That's the bote i'm in :\
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Mar 23 2010, 04:59 AM (Post #7)
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QUOTE (Jinghao @ Mar 22 2010, 11:07 AM)
First of all, I think that a lot of people are unhappy about the details of the package, but voted for it anyway so they can claim to have voted for "Health Care for Everyone". The package is imperfect—it's not even close to perfect—and does nothing to address the underlying causes of health care inflation—not underinsurance, but overinsurance. I believe I've discussed that in detail before and I'll forgo that part today.

Secondly, the fact that the bill appeals to the worst of the Democratic party—the fringe Senators—is the lack of Republican support. I would much rather have dumped 20 Democrat votes to get 20 Republican votes, but the tactic of filibustering everything simply made that option impossible.

Thirdly, I was hoping for a "public option" in the bill—so that it doesn't end up being a freebie for insurance companies. What the hell? What if I don't care if I die from a cancer or something? Why do I need insurance?

Lastly, I'm not sure how well this addressed the changing demographic landscape of the US. Americans are getting older, but unions are refusing to raise retirement age. Public pension liabilities are going to balloon while workers retire with over a third of their lives yet to be lived. When Social Security was enacted, the age boundary was set above the average life span. Even if we don't do something as extreme as that, we still need to raise the coverage ages for some of the social services lest we bankrupt the country. There's not much discretionary spending to cut—soon, in a couple years, if China does pull out of US bond auctions as the Treasury wants them to, interest expenses will be double the discretionary spending in the country. We need to start adjusting entitlement benefits to the changing demographics.

Health care is the first.
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Your arguments are starting to sound more "Republican."

Overinsurance is a problem, and some argue that the free market best takes care of that—without government subsidies, people would insure against catastrophes which is precisely what insurance is for in the first place. In the absence of overinsurance, prices would drop significantly, making regular (preventative, check-up) care more affordable "out of pocket" or through co-ops.

The intention to expand Medicare and Medicaid is absolutely misguided. It's just insanity, with absolutely no thought or consideration given to debt. They have simply given up caring about the debt, in spite of the underlying currency crisis which has been created directly by the debt. It has to be reined in, or it's going to rein itself in very, very harshly.
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Mar 23 2010, 05:25 AM (Post #8)
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QUOTE (Jumpin' Jodi Gajadar @ Mar 22 2010, 08:59 PM)
Your arguments are starting to sound more "Republican."

Overinsurance is a problem, and some argue that the free market best takes care of that—without government subsidies, people would insure against catastrophes which is precisely what insurance is for in the first place. In the absence of overinsurance, prices would drop significantly, making regular (preventative, check-up) care more affordable "out of pocket" or through co-ops.

The intention to expand Medicare and Medicaid is absolutely misguided. It's just insanity, with absolutely no thought or consideration given to debt. They have simply given up caring about the debt, in spite of the underlying currency crisis which has been created directly by the debt. It has to be reined in, or it's going to rein itself in very, very harshly.
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I don't consider myself republican. Most of the time, I lean more democratic in the two-party system here. Of course, there are some elements of economic liberalism that I adhere to, but there are also elements of centralism/federalism that I believe in. That comes from the cold, hard rational discipline of economics.

That's it on the "republican" part. Otherwise, I find it to be an extremely antagonistic and anti-progressive group—I think every legislator should vote for himself, not group together to vote as a cluster. That in the real world would be collusion and thus illegal by FTC regulation, for good reason. I think their prevention tactic against health care was very immature. So in execution, I'm highly opposed to the republican party.

Yes, overinsurance is a problem but the solution is not free market. I do believe that there's a huge role for the free market to play in this, but there needs to be a central actor to facilitate transactions. Regulation needs to be favorable to efficient transactions. Doctors should be rewarded by results, not how many tests they do or how long he works. Insurance policies should be extremely explicit in exactly what they cover, and that should be very clear and easy for customers to decipher.

Everyone should have their basic health needs covered by public insurance—I mentioned this before, like vaccination, physicals, etc—and they should be free to look for additional services if they so choose, but that will be taxed at the going rate for services.

The government should focus on preventive measures, including the discouragement of the consumption of unhealthy foods—fat tax on fries (et al), elimination of sugar subsidies, among many other things. That will reduce long run health care costs and prevent them from spiraling out of control.

As for extraordinary circumstances, everyone who opts in to the "Extraordinary Insurance" package will have their relevant health information in an anonymous database—managed by the government that also packages together those claims and rates them by collective exercise rate (say, using a bayesian predictor from historical data and client information), which is basically the distribution of expected payouts to holders of the package. Then those are chopped up into individual chunks similar to bonds and sold to investors. Basically, when one of the members in that package encounters an extraordinary circumstance, he gets money from the package worth 50% (or some other percent—50% isn't set in stone) of the cost of the care.

In this way, there will be no "insurance companies" that make excessive profits; all profits will be fair and efficient; medical information is anonymized and kept confidential—there are secure encryption and MAC schemes to provide that feature; everyone who opts-in will be insured against random things, at cost basically equal to the expected future cost of caring for all that (given family history, other physical characteristics, etc); and they will be encouraged to stay healthy because otherwise their costs will rise.
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Mar 23 2010, 08:46 AM (Post #9)
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I fundamentally disagree, but I see some of your points.

I don't see why the free market, without regulation, can't 'reward' doctors for beneficial service, provide effective, clear, and cheap insurance, and allow people to be responsible for their personal health/well-being.

And, sure, government *could* tax soda, sugar, fats, or whatnot, but when politicians are responsible for such things there is always cronyism and behind-the-scenes work that would, perhaps, favor one company's sugar over another...there are endless examples of this (practically every government subsidy and regulation in existence today in the U.S.). Unfortunately we have to accept that the U.S. system is inherently corrupt and the intention to actually just do good applies to a measly few percent of elected officials at the federal (and most state) levels.

Your packaging of extraordinary insurance sounds interesting—that's basically the "public option" in a nutshell that *cough* somehow *cough* never made it into the final bill that passed.

I don't know what insurance companies you mean that have made "excessive" profits and, who's to judge what is excessive? If health insurance could be purchased across state lines and didn't have anti-trust exemptions, competition would spurn an obvious fall in prices, regardless of profits. Why single out the medical insurance industry for profits? I have a feeling you wouldn't stop there (though I'm not sure your stance on this) as most who attack insurance company profits attack the profits of just about every corporate entity.

Again, I agree with what you're saying "they will be encouraged to stay healthy because otherwise their costs will rise." But this is accomplished in a free market—efficiently. People are "encouraged" by the simple desire for either longevity or spending less money. Sure you might say that it's a collective burden if they get sick, but it's not a collective burden if we don't all have to pay for it. People will be discouraged from being loaded with cholesterol if there is nobody at the other end to pay for their twinkies and liposuction. As long as someone (government) is there to pay for anything and everything, there is no reason to curtail one's destructive behavior, and in fact the burden will increase as more and more people become careless. Even Obama zombies aren't going to make themselves healthy because it's their patriotic duty to take less of the pie. We shouldn't even let the feds put the pie in the oven to begin with.
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Mar 23 2010, 05:33 PM (Post #10)
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Maybe it wasn't clear the intent of the collateralization of the health cost obligations. It is to basically eliminate independent risk. In a "free market" with no central system, how much money do I have to save to ensure my health against cancer (Say, 5% chance, with 2m cost) and heart disease (say, 1% chance with 500k cost)? Suppose they were the only two unexpected health burdens possible in this world.

Without risk-spreading, I need to stock up 2.5m$ in case I get both cancer and heart disease. With collateralization, I only need to stock up 0.05*2m + 0.01*0.5m = 0.1m+0.005m=105k. That, annualized at Treasury rates would be around $3.5k a year.

Do you see why free market doesn't work when a collective organization can be much more efficient at allocating/eliminating risk?
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Mar 23 2010, 07:55 PM (Post #11)
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No, I don't.

You're basically making the argument for the very concept of insurance. I don't see why it needs to be morphed into a collateralized product via a collective organization.

I can't defend the 'status quo' and that's not what I'm doing—because it's hardly a free market and hasn't been so since FDR. But the whole concept of insurance is to spread risk. Why can't that be done in a free market? What is wrong with insurance? And, why do you think that a free market is void of insurance, and everybody has to save millions of dollars to pay out of pocket for medical care?
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Mar 23 2010, 09:53 PM (Post #12)
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QUOTE (Jumpin' Jodi Gajadar @ Mar 23 2010, 11:55 AM)
No, I don't.

You're basically making the argument for the very concept of insurance. I don't see why it needs to be morphed into a collateralized product via a collective organization.

I can't defend the 'status quo' and that's not what I'm doing—because it's hardly a free market and hasn't been so since FDR. But the whole concept of insurance is to spread risk. Why can't that be done in a free market? What is wrong with insurance? And, why do you think that a free market is void of insurance, and everybody has to save millions of dollars to pay out of pocket for medical care?
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Because entry-exit barriers, among many other industry forces prevent the insurance industry from being truly "free market" in the sense that it's a competitive, efficient market where marginal cost is marginal revenue.

This way, individual investors—you, me, your grandma, etc—can invest in these assets and thus get returns commensurate with assets of equal risk.

I think you're arguing for corporatism. My prescription is much closer to a "free-market" system than your "every insurance company for itself" idea. The only purpose for the central authority is not to dictate price or terms, but to aggregate and anonymize data, so that people's medical data is kept private.

(Just to reiterate, free market in the financial markets means equal risk = equal payoff)
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Mar 24 2010, 12:48 AM (Post #13)
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QUOTE (Jinghao @ Mar 23 2010, 04:53 PM)
Because entry-exit barriers, among many other industry forces prevent the insurance industry from being truly "free market" in the sense that it's a competitive, efficient market where marginal cost is marginal revenue.

This way, individual investors—you, me, your grandma, etc—can invest in these assets and thus get returns commensurate with assets of equal risk.

I think you're arguing for corporatism. My prescription is much closer to a "free-market" system than your "every insurance company for itself" idea. The only purpose for the central authority is not to dictate price or terms, but to aggregate and anonymize data, so that people's medical data is kept private.

(Just to reiterate, free market in the financial markets means equal risk = equal payoff)
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I'm not arguing for corporatism—I'm simply advocating a free market, as in, yes every insurance company for itself, if that's how they want to be.

Aggregating and anonymization of data already occurs, quite readily and quite efficiently throughout most industries, especially insurance. Private rating or data companies are all over the place and are essential to the market forces.

I would argue that the primary and major factor preventing insurance from being competitive and open to new entries into the market, is government. Actually, I won't argue that, I will contend that. The federal government has been involved in heavy insurance regulation (including banning interstate commerce in health insurance, mandating compliance with Medicare regulations, and offering anti-trust exemptions, etc., etc.).

It almost sounds ironic when you say that a central authority would be responsible for anonymizing data to keep medical data private. Quite clearly, that will never be the case in a realistic system. Whether for political purposes, incompetence, or whatever else, if government has your data, it's not private. Why can't privacy simply mean you keep to yourself what you want to keep to yourself, and the maintenance of the doctor-patient relationship? Obviously if somebody decided to give away your records that would be criminal fraud.

I don't see how a bureaucracy managing privacy is more 'efficient' than an individual maintaining his privacy.
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Mar 24 2010, 01:21 AM (Post #14)
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I didn't want to go into the mechanics of how privacy is ensured because that's out of the scope of the discussion. The idea is that there is a central, non-personal system (i.e. completely electronic) that makes sure investors (whether that be insurance companies or not) get all the relevant information they need without that being connected to an individual. The individual will have proof that a package is for him, without anyone knowing anything about the owner of the package. This sort of stuff is done for web authentication all the time. This isn't the issue, so stop debating this.

If you're not arguing for corporatism, you would want every "investor" to face the same costs and returns as insurance companies, i.e. I can "invest" in the health CDOs I described above and earn the same returns as any insurance company. Eliminate administration costs, and bring the investment opportunity to everyone. It's basically a Treasury bond.

You're making the generalization that "government"/"central authority" => "bad/bureaucracy." This need not be the case. If it helps, think of a private company—verisign—that does a lot of the digital certificate signing on the web. Government in this case is not a bureaucracy, just a mechanism.

I think you're not understanding the idea.
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Mar 24 2010, 07:13 AM (Post #15)
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Unfortunately, I don't think either of our ideas will ever make it into law swink.gif

I think you're making my point for me by mentioning Verisign. Why ought the federal government decide where to allocate resources, what's right, and what's efficient, when the market does that on its own? If we were a nation of supermen, government could do what Verisign does, but we aren't and never, ever will be. Not even close.

I understand what you are saying though, about simply providing an insurance mechanism. But the recently signed legislation is anything but that. It mandates citizens to buy insurance plans from private institutions, provides entitlements to the poor, with the obvious predictable consequence of lower and lower quality, such as is already the case (this is common knowledge) in the U.K.

The government-run medical system in this country, the VA, is the worst care you can find. You could walk into an abortion clinic and get your baby sucked out with a rusty hose and it would be better, cleaner, and more efficient care than government-run VA hospitals, which, by the way, overrun their cost estimates every period since inception (same with Medicare and Medicaid).

The engines of medical innovation in this country have always, always, always been the free market (pharmaceuticals, insurers, universities*), individual responsibility. I think we probably agree that medicine and health shouldn't be about financials...but more government is going to either increase costs in a vain attempt to prop up decent medical care, or lower costs and yield reduced and bureaucratically-rationed care. Call me crazy.

*I know, government subsidies, esp. the last couple of decades. But taxpayer subsidies are certainly not the engine of innovation at universities. That's for another day, though.
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