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The Power of the SCOTUS II: "Release the Kagan!"

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Re: The Power of the SCOTUS II: "Release the Kagan!"

leswp1 said:
The uninsured here don't get surgery/service at all unless on an urgent basis. There is no mechanism to take care of them at all. At least the other countries address the problem in some way
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We all agree that we need to address this issue, which can be done more practically in an incremental fashion. PPACA doesn't have a mechanism to take care of them either; it merely says they have to pay a fine if they don't buy insurance themselves; except that the dollar figures are all way out of balance: the fine is lower than the premium. What is worse, there is no way to buy catastrophe-only coverage, even though that is what makes the most sense in this context. A policy with a $5,000 deductible and coinsurance above that to a higher limit would be very affordable compared to what is mandated in the current law.

It seems to me the single biggest problem is a grave error in thinking: trying to invent a comprehensive solution on the fly rather than allow for a variety of local solutions that fit the unique circumstances of such a widely-varying nation.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
The evidence from Canada and the UK seem very clearly to indicate that their are two payors; the people receiving the service pay by waiting in line for months for I'm not willing to have my children and grand-children do without scientific advancement so a few people can pat themselves on the back by appreciating how clever and progressive they are.
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And many are not willing to have millions of children and grand-children go uncovered so a few people can pat themselves on the back by appreciating how clever and regressive they are.

The strongest arguments against universal coverage are about "what ifs" like corporate profitability and scientific innovation. The strongest arguments in favor of universal coverage are about real life, present day problems, like people being uncovered or only being covered for emergencies, which drives up everybody's costs.

Absent a compelling ideological bias that willingly blinds one to certain outcomes, the rational thing is to address the problems we already know exist and then accommodate down the line if we see theoretical issues actually coming to fruition. My guess is that profit motive and scientific advancement are strong enough forces that they can withstand a local reconfiguration of one business model.

I'm sure there were plenty of merchants who wanted to declare war on the Arabs when they started charging more for overland routes to Asia in the 15th century. Extrapolation of existing economics by their contemporary knowledge would compel them to that conclusion. But Columbus found a better way.
 
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Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
It may seem like a technicality, however "single" payor will never work.
a) the person receiving the service is the "single" payor. No way.
b) the government is the "single" payor. Economically impossible.

You need at least two "payors" for it to be economical. The person receiving the service MUST have some "skin in the game" or there is no reason to be judicious. You can't seriously propose that every aspirin, every band-aid, every tube of Neosporin, be covered 100% with no coinsurance and no deductible, can you? Elective plastic surgery okay too?

Whenever unlimited wants and limited resources get into a wrestling match, guess who always wins in the end?

It seems to me that we have to include some kind of incentive to people to use resources responsibly. I'm all for surcharges for smokers and overweight people, for example; they cost more to treat and if they change their ways we are all better off, why not give them some financial reason not to burden the rest of us with their lack of self-discipline?
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Who is suggesting that the single payor would pay for any imaginable health related expense?
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

Kepler said:
And many are not willing to have millions of children and grand-children go uncovered so a few people can pat themselves on the back by appreciating how clever and regressive they are.

The strongest arguments against universal coverage are about "what ifs" like corporate profitability and scientific innovation. The strongest arguments in favor of universal coverage are about real life, present day problems, like people being uncovered or only being covered for emergencies, which drives up everybody's costs.

Absent a compelling ideological bias that willingly blinds one to certain outcomes, the rational thing is to address the problems we already know exist and then accommodate down the line if we see theoretical issues actually coming to fruition. My guess is that profit motive and scientific advancement are strong enough forces that they can withstand a local reconfiguration of one business model.

I'm sure there were plenty of merchants who wanted to declare war on the Arabs when they started charging more for overland routes to Asia in the 15th century. Extrapolation of existing economics by their contemporary knowledge would compel them to that conclusion. But Columbus found a better way.
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I'm not opposed to "universal coverage" I am merely saying please don't try to achieve it by imposing a one-size fits all, centralized control, unilateral no-choices design, single payor, single insurer plan. Assemble different pieces together in different parts of the country for different people in different ways. Everyone needs transportation; we don't force everyone to buy only one particular make and model of car; we don't even force bicyclists to buy cars at all!

Have insurance premiums reflect the actual morbidity of the group being insured (don't charge those in their 20s five times what their risk profile indicates they'd cost). Allow high-deductible catastrophe only plans, and a tax-deferred health savings account that you can roll over from year to year from which to pay deductibles and co-insurance. Allow differential pricing for those whose lifestyle choices create higher medical costs (e.g., smokers, heroin and meth addicts, sedentary over-eaters). Have special subsidized risk pools to help people with chronic conditions. There is no reason that the government couldn't provide premium-support plans to those who really need the help.

You are confounding two very distinct situations into one.



I thought you presented yourself as an engineer? Isn't the law of unintended consequences important? Do you roll out a radical new design that's never been tested first? do you routinely ignore data whenever it is inconvenient for your ideology?
 
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Re: The Power of the SCOTUS II: "Release the Kagan!"

Kepler said:
Good God, man! I can ignore most insults in the heat of battle, but some things are over the line.
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At least it is personalized and not generic! ;)


(The PC police can be happy that no other person, not even any other engineer, was insulted! :) )
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

Kepler said:
Good God, man! I can ignore most insults in the heat of battle, but some things are over the line.
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LOL. I think he must've thought he wandered into the insults thread.

See you at the service entrance...
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
We all agree that we need to address this issue, which can be done more practically in an incremental fashion. PPACA doesn't have a mechanism to take care of them either; it merely says they have to pay a fine if they don't buy insurance themselves; except that the dollar figures are all way out of balance: the fine is lower than the premium. What is worse, there is no way to buy catastrophe-only coverage, even though that is what makes the most sense in this context. A policy with a $5,000 deductible and coinsurance above that to a higher limit would be very affordable compared to what is mandated in the current law.

It seems to me the single biggest problem is a grave error in thinking: trying to invent a comprehensive solution on the fly rather than allow for a variety of local solutions that fit the unique circumstances of such a widely-varying nation.
Click to expand...

Although this is a terrific idea, it would have to be implemented by states (and in some cases even counties, because Kings County NY is VERY different from, say, St. Lawrence County NY). That would require even more bureaucracy, and would make the idea even MORE expensive.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
The evidence from Canada and the UK seem very clearly to indicate that their are two payors; the people receiving the service pay by waiting in line for months for procedures that in the US are performed in weeks.
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And yet, in the aggregate, aren't they healthier than we are?

The UK also has explicit rationing which also is a form of "payment" by the service recipients.
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Whoever is the payor is going to ration. In the UK, it's the government; in the U.S., it's committees at the insurance companies.


For what it's worth, I'd prefer the Swiss system.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
We all agree that we need to address this issue, which can be done more practically in an incremental fashion. PPACA doesn't have a mechanism to take care of them either; it merely says they have to pay a fine if they don't buy insurance themselves; except that the dollar figures are all way out of balance: the fine is lower than the premium. What is worse, there is no way to buy catastrophe-only coverage, even though that is what makes the most sense in this context. A policy with a $5,000 deductible and coinsurance above that to a higher limit would be very affordable compared to what is mandated in the current law.

It seems to me the single biggest problem is a grave error in thinking: trying to invent a comprehensive solution on the fly rather than allow for a variety of local solutions that fit the unique circumstances of such a widely-varying nation.
Click to expand...
The problem with localized solutions is that people and their insurance companies are NOT local all the time. We end up with the same morasse we are currently in with multiple crazy laws, loopholes and confusion. The lack of a comprehensive plan is what makes providing care and then trying to bill for it a massive nightmare. The current system is so screwed up and convoluted we can't even figure out what is covered and what will be reimbursed until it is submitted. The avg Joe has no idea what their insurance does because there are so many possibilities and so many different regulations depending on the state.

As to the high deductible thing. Mass has that currently. It is a massive failure. The cheapest I think you can get is about 350 a month if you are buying as an individual. So the $ that would have been spent to take care of things like the visit and the meds goes to the insurance co for providing catastrophic coverage. Ergo the patient then does not afford the regular visits and is in the ED with the heart attack he could have prevented with more consistant care of his BP, diabetes and high cholesterol. We get the one health maint visit a yr for free but if we discuss a problem we have to charge it as an office visit.

THe whole thing is so *** up it should embarrass us all.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FlagDUDE08 said:
Not really. Also remember they don't have as high a population.



OK, I'll bite... what's the Swiss system?
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Very cool. THey found out that there were like 2% of the population being rejected d/t pre-exsisting conditions and this was not acceptable. They made healthcare for profit illegal. They can attach healthcare as a rider for things like life, car, fire insurance. The companies have sig more motivation to keep you healthy because it decreases their other pay outs.

Germans have a hybrid system. Everyone is covered. You can pay for supplemental insurance that gives you a deluxe version where you are seen faster, go to the head of the line. This is understood by all. Everyone gets care. If you can afford more you may get it faster.

I don't have much patience with the c/o of having to wait. Many of the things we rush to do here could be addressed in less aggressive ways but would necessitate people changing lifestyle while they wait. A perfect example- If you have a gallbladder attack and it is not infected in most instances a careful diet will prevent further attacks for awhile. People do not want to wait or change their diet. Just get it out. (and before anyone asks, yes I have experienced it, it was bad and I did have infection or I would have waited.) This isn't true for all conditions but it is true for many.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

leswp1 said:
Very cool. THey found out that there were like 2% of the population being rejected d/t pre-exsisting conditions and this was not acceptable. They made healthcare for profit illegal. They can attach healthcare as a rider for things like life, car, fire insurance. The companies have sig more motivation to keep you healthy because it decreases their other pay outs.
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????
Having just lived in Switzerland for 2+ years, I can assure you that there are lots of people there making a profit in the healthcare business, so I'm not sure what this is supposed to mean. Switzerland basically has a mandate system with minimum specified coverages, but there are loads of private companies who will sell you boutique plans that offer far more benefits at the numerous private hospitals, clinics, and "medical spas" in Switzerland.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

Well, Scalia seems to think there will at least be parts of the law that will be struck down:

"There's no way that this court's decision is not going to distort the Congressional process," Scalia said. "One way or another, Congress is going to have to reconsider this."

Time to break out the scalpels or chainsaws, depending where they draw the line between what stays and what goes.

(oops - forgot link)
 
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Re: The Power of the SCOTUS II: "Release the Kagan!"

LynahFan said:
????
Having just lived in Switzerland for 2+ years, I can assure you that there are lots of people there making a profit in the healthcare business, so I'm not sure what this is supposed to mean. Switzerland basically has a mandate system with minimum specified coverages, but there are loads of private companies who will sell you boutique plans that offer far more benefits at the numerous private hospitals, clinics, and "medical spas" in Switzerland.
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It was my understanding that they could not be stand alone plans. I may be misinformed.
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

FreshFish said:
Also, if the US does transition to a single-payor system, where will innovation come from? That would be a huge social cost. I'm not willing to have my children and grand-children do without scientific advancement so a few people can pat themselves on the back by appreciating how clever and progressive they are.
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How much did the pharmaceutical industry spend on "innovation" last year?

How much did the pharmaceutical industry spend on advertising last year?
 
Re: The Power of the SCOTUS II: "Release the Kagan!"

LynahFan said:
Switzerland basically has a mandate system with minimum specified coverages, but there are loads of private companies who will sell you boutique plans that offer far more benefits at the numerous private hospitals, clinics, and "medical spas" in Switzerland.
Click to expand...

This is the way that I understand it, and what I was advocating.

I'm not sure it's <em>that</em> different from what ends up being imposed by the current form of PPACA. One thing that I think would tend to help us all is for health insurance to become decoupled from employment.
 
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