naked capitalism

Francois says:

“tell me why I should believe the reverse is true, that a single payer system would be bad for competitiveness?”

No one should believe that. On the contrary, if small entrepreneurs in highly specialized fields would not have to deal with the health care morass, their costs of operation would be much lower.

I was under contract in a small pharma company in 2003. While chatting with the CEO, he told me that one of his headaches was that, in order to attract very qualified people, he had to offer the same benefits that a Merck or Wyeth had. Needless to say this wasn’t exactly cheap, even excluding the non-negligible administrative overhead.

As for Wal-Mart CEO’s comment, let’s say that society should be more involved, and business should be kept out. In return, business should not have to bear the brunt of offering health care.

The more I read L. Kotlikoff’s book “The Health Care Fix” the more I think is on to something that deserve much more discussion than the ideological bromide and spin we get served all the time in the media.

But asking for an adult discussion on health care reform in the US is like asking the ayatollahs in Iran to discuss secularization of their society. Not happening anytime soon.

Anonymous says:

anon at 3:06 are you serious? The problem with co-ops and every other private means is adverse selection. Unless you have complete mandatory portability (a gov’t regulation if you will), co-ops are a non starter. I’m also fairly skeptical of an economist designed health care system seeing as how well the economists have done right now.

I think single payer is time. Let’s just take insurance out of the mix completely.

weinerdog43

Anonymous says:

Market failure? I don’t think so! The market has not been allowed to operate for over forty years. Already there is a huge amount of government regulation in the health care industry and you think the solution is more regulation and less choice?
The primary reason that healthcare costs are less in other countries is that they have not accounted for the huge amounts of human suffering and the loss of economic production from citizens who need care. Lineups for healthcare are the norm. Treatable conditions too frequently become untreatable after a few months of waiting for service with death often the result. (I have seen this happen to two close friends in the past 5 years in Canada; death the result in both cases).
Anyone who thinks that government will be their saviour is completely out of touch with reality.

minka says:

This reminds of a story in the most recent Economist, on political and social attitudes of the UK and USA (compared). There were funny bits. The Americans by a large margin felt govt should not help out when a worker was laid off or fired, whereas the UK interviewees felt the opposite, that govt should help out.

So, who did the ‘individualistic’ Americans think should help out? The employer. Of course. We expect our employers to supply health care, pensions, and what, unemployment insurance?

What a crock. The business who likes you so much they fired you, or who is doing so well they laid you off, is supposed to ‘help’.

What this shows is how our refusal to rely on our govt has resulted in this inane system of relying on private employers, who are not accountable to their workers. The business world is not a democracy, for heaven’s sake.

Americans are worker-serfs. How many millions are stuck in jobs because they have health insurance? How many businesses don’t get started because the founder can’t risk no health insurance?

Rant On: Americans are best in the industrialized west at one thing: kissing rich and corporate butt. You may end up on the street in your fifties with no pension or health insurance, but comfort yourselves with this: you’ve got a mouthful of rich ass. Leave in your will for your kids before you jump off that bridge. Rant Off.

Thai says:

“The most expensive thing of all is the loss of trust”…

As an administrative physician for a large group of physicians, my gut tells me a single payor system ‘might’ help, but then again it also might not. The devil is in the details.

But notice I only say ‘help’ and not ’solve’, for I do think single payor systems are a kind of ’smoke screen’ of both the left and right. My gut tells me neither approving not rejecting a single payor system will really deliver America to the promised land of lower healthcare costs.

As I see it, there are really four main reasons healthcare costs are escalating in this country and they are pretty easy to understand (I just hope I am up to the task of explaining them

1. The various players in the system no longer trust each other (in prisoner’s dilemma language– the players are beginning to ‘defect’) and they are increasing barriers within the entire system with the intent of improving things, but in totality making things far more expensive than they otherwise would be (at least from a cost standpoint). In this fashion, what we are witnessing is analogous to the credit crunch. Imagine a marriage with all kinds of regulations, would it really ever work? Yet the marriage must operate according to husband and wife ‘playing by the rules’ or it would fall apart for lack of trust.

It is a circular problem without answer, except that it works when the participants trust one another.

2. There are many well intentioned regulations which dramatically increase barriers to competition (this is really again the same thing as problem #1). The biggest of all of these ’sacred cows’ were really past over 100 years ago and have to do with what a physician or healthcare practitioner is-should be and what skills they need before they can even practice medicine (think bariers to entry).

As medicine become more and more proceedure oriented, this issue is becomming bigger and bigger. Since all of these laws are passed at the state level, they are often ignored in national discussions. This is the biggest ‘low hanging fruit’ of all.

3. Most people do not understand the fractal nature of illness and healthcare spending (most people don’t even understand fractals!). This leads many people to MANY wrong impressions regarding who is ill, what is ‘bad medicine’, and where our healthcare money is spent.

Further, since people don’t understand fractals, they don’t understand how to reconcile issues of scalability and ‘power laws’ with issues like trust.

3. America continues to avoid a values discussion on when it is ‘OK’ for our healthcare system to ration care and who should be empowered to ration. Indeed the very notion of rationing or tiage (so fundamental to medicine once apon a time), are completely anathema to most Americans.

Yet whomever empower as a society to ration healthcare (just as we empower judges to administer justice), still we must decide this issue. For rationing SOMETIMES requires override the wishes of individual patients and families (like judges must sometimes override plantifs or defendants), in order to protect ‘our collective finances’.

AND, if you have the power to ration, you must also have the power to be wrong (just as judges are allowed this privledge), or rationing will never work.

You may not have ever thought of how physicians in America were once the guardians of your healthcare resources (and they still are in countries like England and France) but in America today, with its diminishing trust, SOME of the physicians who once guarded your resources are loosing faith in their patients, and prescribing care as if it were a blank check (this is on top of an besides the point of any financial motive they may have)– physicians fear character assaults or errors in their judgement leading to malpractice.

…While this point can be overstated, there is a strong kernel of truth to it.

If any of you want further elaboratino on 1, 2, or 3 (or all), let me know, I can easily provide further details.

Anonymous says:

Is our priority in reforming healthcare going to be global competiveness, or providing the best quality care to our citizens? If left to politicians and business leaders, as it seems it will be, I think we can count on a decrease in access to and quality of care, all the while cloaked in metrics “documenting” CQI, gamed by a whole layer of healthcare system bureaucrats.