Obamacare in the supreme ct

[modhatter]

SamClem. I watched the video last night, but it was only one part of a 6 part series.

I had difficulty finding the whole series, but will continue to hunt them down until I can see the whole lecture on socialized medicine. I did wind up seeing a couple of other though in my search. One I found interesting which you should watch if you haven't. It was with a group of economists from other counties discussing his theories. They disagreed with him on his premise that big government and higher taxes was bad for a countries growth. When he (Freedman) asked them to name them, they mentioned Norway and Sweden but mentioned that there were others as well. When they argued his theories, Freedman last statement in the video was that he didn't think Norway will continue to do well down the road.

Well here it is about 30 years later, and Norway has continued to grow and prosper, and has remained #1 to this date. Jobs have increased expeditiously, and so has population. Even with the financial crises throughout the world and especially Europe, they have been little effected. There unemployment rate even today is around 3%, and wages still high.

I'll give you the link to the video I'm referring to, and you can do your own study on these countries they refer to yourself.

I don't want to wonder from the original subject of health care, but don't want to comment on Mr. Freedman's view until I see all the video's on the subject and feel I fully understand the logic behind his words. As I mentioned before, I have always enjoyed listening to Milton Freedman and read a couple of his books some years ago. I think he has some sound theories, but I am of the opinion too that many of them were not all inclusive and not applicable in individual cases and circumstances and that such a broad brush can never be applied to all people at all times. If we were on a different forum, I could give you concrete examples of what I mean, but that is for another time and place.

We will stick to the health care issue and what is to become of us moving forward. Many future retirees have a lot of concern in this area, and rightly so. How we make sense of it and go forward from here is important. I am of the opinion that assimilation of good and accurate information on the subject is badly needed, as well as keeping an open mind as to all possibilities and solutions.

I still remain somewhat unclear as to your actual proposed "fix" from where we are now, as opposed to where we should have been now. I personally would like to hear your plan as to what and how you would go about making health care right. Suppose the Supreme Court for argument sake strikes down the mandate provision, where would you go from there? What do you think would work for us?

Suppose we did what you say, separated health insurance from business. Now we are on our own. We still still have a handful of companies to chose from. You no longer have the protection of a large group plan that keeps companies (for the most part) from dropping you when you get sick or discriminating against you if you are. You can try and start your own large group that would mimic having one with a large company.

That would be helpful in the protection area and and the mobility of people, as well as give you some leverage. But what happens when the insurance companies get to only two. What do you suppose is going to happen to your leverage. It's not the kind of commodity we can walk away from and say "oh forget it, I don't want it". We have to have it. So who's got the better leverage? How are you going to deal with that without a level of protection from your government?

Remember, their objective is to make money and increase profits, yours it to provide good service for a reasonable cost. Somehow, having a middle man taking out profit makes little sense and acerbates the problem of affordability in this situation. These are my views anyway.

 

[Midpack]

If you're interested in a video on how other countries have dealt with health care, this one had a lot of influence on my thinking FWIW. It examines health care in the UK, Japan, Germany, Taiwan & Switzerland. From 2008, but still applicable and well worth the time IMO: Sick Around The World | FRONTLINE | PBS Not political in nature either (honestly)!

 

[explanade]

If people think The Muppets are political, then there's little hope for any PBS doc.

 

[samclem]

SamClem. I watched the video last night, but it was only one part of a 6 part series.

I didn't want to bog things down with 6 links, thumbnails for other videos showed up on the right side of my YouTube page when I clicked on the first video. Anyway, here are the rest:

Part 2:

Part 3:

Part 4:

Part 5:

Part 6:

(Part 6 is almost all an answer as to why he opposes licensure for physicians. You can bet that went over great with this audience of doctors!)

I'm looking for a good clip of him addressing the problem of private insurance. He mentions that major medical coverage is a good approach (i.e. true insurance for medical needs) and he talks about the problem of health care for the indigent, but I want to know what he'd propose for people with preexisting conditions.

When they argued his theories, Freedman last statement in the video was that he didn't think Norway will continue to do well down the road.

Well here it is about 30 years later, and Norway has continued to grow and prosper, and has remained #1 to this date. Jobs have increased expeditiously, and so has population. Even with the financial crises throughout the world and especially Europe, they have been little effected.

There unemployment rate even today is around 3%, and wages still high.

If we want to see the impact of high taxes and high social welfare spending, we need look no farther than Europe as a whole. US GDP per capita (probably the best measure of relative economic prosperity) is about 30% higher in the US. Our growth rate is historically higher. And that's before we address the mess that has become of the Eurozone, due in no small part to government spending policies there.

You've probably got a bit of cherry-picking with the Norway example. They discovered large oil reserves off their coast and production from those fields began in 1971. That's gonna skew numbers on their economic growth, unemployment, etc a lot.

I still remain somewhat unclear as to your actual proposed "fix" from where we are now, as opposed to where we should have been now. I personally would like to hear your plan as to what and how you would go about making health care right. Suppose the Supreme Court for argument sake strikes down the mandate provision, where would you go from there? What do you think would work for us?

What I think would be "perfect" is a lot different from what I think is the best situation that is also politically realistic. There's going to be government support of insurance health care, there's going to be forced taking of assets from some people for the individual benefit of others -- that's a given. Here's what I think is the best we can do realistically :
1) Private insurers (profit and nonprofit can both play) who sell health insurance in a market must take all applicants who apply. We can either decide that all will pay the same rate (thus provide a subsidy for the old) or allow rates to vary by age. But everyone who applies (regardless of health, previous conditions) pays the same rates.
3) Policies: There are a rather limited number (2?4?) of standardized policies (like we have today with Medicare supplements). This makes comparisons between insurers and their policy offerings far easier and drives down prices. All "flavors" would cover things that have been shown to drive down costs overall (vaccinations, well baby care, screenings, etc). All insurers would not have to offer all the types of policies. Policies might differ with regard to deductibles, copays, ammenities (private room?) etc. All would feature catastrophic coverage (why? Because we know that when people are wiped out financially they wind up on the taxpayer's doorstep anyway.) To minimize the likelihood people would upgrade to a "Cadillac" policy when they get a chronic/expensive illness, we would need to set limits on switching of policy types (maybe an open season every 5 years?), but allow switching of insurers any time. Supplemental insurance for added things would remain available on the private market.
Alternative: Just one standard policy type is mandated and eligible for use of tax subsidy vouchers (see below). Supplemental policies are available for individual purchase. This is how Swizerland does it, and has the advantage of simplicity.

4) Government's role:
- Collect information on health outcomes, satisfaction, wait times, costs, etc to allow people to make a more informed choice between health insurers.
- Provide vouchers for the purchase of health insurance. Amount is based on need (income/wealth/whatever we decide as a nation is best). The goal is to assure that nearly everyone still has some of their own money in play when they make health care choices. Switzerland caps individual expenses for health care at about 9% of income IIRC, that sounds about right to me.
- Provide an effective mechanism for enforcement of contracts. That means eye-opening penalties for insurers who don't follow through with their end of the bargain.

My opinion is that the individual mandate is unconstitutional. If it is found to be constitutional, then the everyone must participate and we go with the plan above, with 100% participation mandated and penalties for those who don't. If found unconstitutional, then we go with the plan above and stop provision of government health care outside of this plan. This plan makes affordable care available to all--that (in my opinion) is the very outer limit of our responsibility through the use of government.

There it is. Health care insurers compete for customers on price and quality. Government provides vouchers sufficient for even the indigent to get a bare-bones plan (no private rooms, expect waiting lists, maybe no heart transplants when you are 85 YO, but the "big stuff" is covered). No employer involvement in health care.

Well, you asked!

 

[modhatter]

I appreciate it SamClem. Sometimes it is hard to argue against something when you are unclear of what the opposing side actually advocates.

I will finish watching the videos tonight and re-read your post until I can totally say I understand all of it, and then comment. OK. Fair?

 

[modhatter]

SamClem, Sorry for taking so long to respond to your last post. I did finish listening to the video's by Milton Freedman. So let me first preface by saying that I found Mr. Freedman's comments on "socialized medicine" as he liked to call it, full of half truths, inaccurate numbers, falsehoods, and some good points (but admittedly few) Just quoting a few comments by Mr. Freedman that I found false.

1. Medical insurance is not an unreasonable cost, and is manageable by most people. (Don't need to elaborate on this one)

2. The FDA should be eliminated. He cited that the involvement of the FDA,results in good medications being delayed from hitting the market resulting in more people dying from having to wait , compared to the few that might get on the market that could be harmful.

Here is an example of both distorted percentages and half truths. Any doctors out there feel free to join in. Though it is true that the FDA's lengthy process in approving a drug or treatment CAN IN FACT delay a good drug or treatment being made available and creates a greater cost to the developers. Anyone experienced with the pharmaceutical R&D, and the clinical trials conducted as well as those completing level 3, will also tell you that by far the greatest number of attempted new drugs (95%) or so FAIL, and are either ineffective and in some cases prove harmful. So if the percentages of finding good drugs and ultimate cures is skewed so heavily towards a treatment or drugs failing, how in good conscience can Mr. Freedman say we should eliminate government trials and let the pharmaceutical companies police themselves, and people will decide if they are a good company or not. (the free market)

Now, I am not saying that the process of getting a new drug or treatment to market is not a long and expensive one. It is difficult to speed up good science, and I think improvements can be made there, but to say that we need to eliminate the FDA and take all government involvement out of the equation is not a very healthy environment for the public. For the companies, yes, but definitely not the end consumers.

3. He talks about the adaption of "socialized medicine" as lowering quality and choice. I don't need to elaborate on this one too much either, as look at the statistics of outcome in the countries who have adapted it, and then compare not only their costs, but their outcomes to that of the US.

4. He talks about the elimination of licensure. No license required for Doctors, pilots, etc., etc. Now here surprisingly, I see some half truths, and some things he omitted as a positive side of such practice, but because it would require a lot of time to explain my position, I will just say that this is a half truth.

5. His answer to how to handle the 20% of people who just can't afford insurance was a bit brutal when you think about it realistically. How many people perhaps even in your family was unfortunate enough to be touched by alcoholism or drugs (including prescription drugs) for a period of time. According to Mr. Freedman, if they fall in that 20%, they should be given a monetary stipend, and if they spend it on alcohol or drugs instead of health insurance, well too bad for them. While I understand the reasoning to a certain degree, how many recovering alcoholics and drug users get sober and get their life together eventually. Can you really say, oh well, they should have known better, too bad, good bye.

And last concerning the free market creating choice and therefore competition. As you know, most industry has been allowed by government (NOT INTERFERING) to become too big, and they have not followed the founding fathers caution in this department, and have allowed big corporations to purchase or take over competitors' until there is very little choice there to vey for quality and price by the consumer.

Mr. Freedman, is a very confident and engaging public speaker (has a good gift of gab) and tends to make good arguments some times. Some of these arguments are good. Some of them are very flawed. This is one of them that I find very flawed.

Of course, we could always go back to the good old fashioned way of dealing with unaffordable medical costs, and bring a chicken to the doctor instead, or offer to paint his/her offices in luau of payment. (Need to know your Nevada election stuff for this one)

I'm just injecting some humor here.

As for your proposal. I am shocked. It is workable to me with some caveats. First, the voucher would have to increase close to the rise in cost of basic policy. Second, if the mandate were to be ruled unconstitutional, then the penalty would have to be as substantial as the basic cost of a policy. Reason being, I believe there is a greater number of people who "chose" to go bare, and think of the emergency room as their doctor's office. Then you have the young who feel they are invincible, but their contribution is needed to even out the cost factor for everyone else including themselves as they get older, as well as go in the pot for the subsidies.

So, in the end, it makes a lot more sense to have it be mandatory for everyone to have to contribute, for both financial reason as well as health coverage reasons. Cause what are you going to do with the people who opt out and wind up at the emergency room. Are we going to throw them out?

The only point we still disagree on is the elimination of for profit insurance companies. Insurance companies could continue to operate, in a service capacity only, and create some choice. You could even set up a bonus plan to reward the most successful companies and it's executives.

But sucking 20% profits out, is just wasteful to me given the rising cost of health care and the needs for reforms and improvement.

Prescription drugs. Every other government controls costs of prescription drugs but the US. Now it is no longer true that it is because that the US is the number one drug maker. Not true any more. To me, the savings derived from eliminating shareholder profits, and lowering drug costs ( or at least insisting that the pharmaceuticals can no longer offer such savings to other well off industrial countries, while excluding the US from these cost savings) could well go into areas that need fixing as well as lowering our eventual costs.

I don't want to cripple the drug companies for further R&D, ( and we all know how they are hurting) but I do not see why Canada, and England, and France etc, etc. get cost reductions and we don't. A little more Even Stephen is called for here don't you think?

What could we do with the savings as mentioned above. Some examples: We desperately need more doctors, so some help with education might go a long way in producing more doctors and especially family physicians as well as perhaps a look at greater compensation levels for them.

Setting up more local clinics open extended hours, staffed with perhaps PA's and nurses to handle the day to day colds, cuts, non-real emergency stuff etc. We don't just get hurt during 9 to 5, and besides, most of us work during those times

And why can't they (these clinics) handle stitching up a bad cut or setting a broken bone,
Nope it's off to the hospital where it costs sixty million skillion dollars to take care of this. That's real cost effective. And while were at it, let's ad drug over dose patients to that list.

One last point. Retirees: I agree with the concept of having to have some skin in the game, and I propose a co-pay for people on medicare. But you have to be careful here. This is a ever so difficult area.

We still have a very large percentage of people on medicare who live on medicare alone or close to it, so we don't want to prevent them from going to the doctor when they may need to - because they don't have the money to pay for a doctor.

So here you have to have an exemption for the poor elderly, which will include a percentage of people on medicare. So there you are again, being robbed of your hard earned dollars to pay for these guys who should have known better than to end up like that.

Now, that remark, was a little sarcastic.

Anyway, got to stop here.
By the way. Two excellent books to read.
One called "The healing of America" by John T. Reed, and also "Deadly Spin" by Wendell Potter
Both, VERY good reads.
Cheers friend.

 

[ERD50]

2. The FDA should be eliminated. He cited that the involvement of the FDA,results in good medications being delayed from hitting the market resulting in more people dying from having to wait , compared to the few that might get on the market that could be harmful.

Here is an example of both distorted percentages and half truths. Any doctors out there feel free to join in. Though it is true that the FDA's lengthy process in approving a drug or treatment CAN IN FACT delay a good drug or treatment being made available and creates a greater cost to the developers. Anyone experienced with the pharmaceutical R&D, and the clinical trials conducted as well as those completing level 3, will also tell you that by far the greatest number of attempted new drugs (95%) or so FAIL, and are either ineffective and in some cases prove harmful. So if the percentages of finding good drugs and ultimate cures is skewed so heavily towards a treatment or drugs failing, how in good conscience can Mr. Freedman say we should eliminate government trials and let the pharmaceutical companies police themselves, and people will decide if they are a good company or not. (the free market)

Now, I am not saying that the process of getting a new drug or treatment to market is not a long and expensive one. It is difficult to speed up good science, and I think improvements can be made there, but to say that we need to eliminate the FDA and take all government involvement out of the equation is not a very healthy environment for the public. For the companies, yes, but definitely not the end consumers. ...

There was a lot to your post, but let me just comment on this one piece -

First, cut to the chase, I think I agree that we still need an FDA type org, but that it might be better if run quite differently, rather than eliminated. But, without numbers to back up your claims, I don't think you can say that a lack of an FDA would be worse than what we have.

You say 95% fail due to being ineffective or dangerous. Well, like any other product on the market, I'd expect the ineffective ones to never make many sales. In the free market, bad products fall out all the time.

Where the numbers come in is, how many lives are hurt by the delay in new, effective drugs? Unless we actually know that number, how can we 'know' that introduction of drugs w/o FDA approval would be worse?

In addition, you can't look at this as a static model. I'd assume that if the FDA was gone, doctors, hospitals, patients and insurance companies would be looking for some sort of third party validation before they spend their money. Just maybe, these alternatives could be more cost effective (and maybe just plain more effective period) than the current FDA?

I always like to point out the the UL label you see on electrical products is NOT a govt agency. It is a private third party testing organization. Private companies submit their products for testing, because the free market wanted safety assurances. UL got its start at the dawn of the electrical age when people (and their insurance companies) didn't know what was safe or not. So UL testing gave them some assurance. UL is still around, so it seems to be relevant and reasonably effective.

Why couldn't we have pharmaceutical version of UL?

-ERD50

 

[modhatter]

ERD50. I am not opposed to considering a third party safety regulator, as long as we can keep them out of the pockets of the organization they are overseeing. You see how well that went for Standard & Poors, and the rest of the rating agencies regulating Wall Street. There would definitely have to be only one, not a choice to compete. But then the question becomes, who's going to pay them. Where are they going to get their revenue from? It can't be from the Big Pharma, cause you know where that will lead.

But to your comment that "Well, like any other product on the market, I'd expect the ineffective ones to never make many sales. In the free market, bad products fall out all the time." That's an awful high price to ask people to make to find out. Especially, considering the number of new drugs entering the market weekly.


Watch these two clips, to further illustrate some of the things I have been saying:

 

[Midpack]

1. Medical insurance is not an unreasonable cost, and is manageable by most people. (Don't need to elaborate on this one)

3. He talks about the adaption of "socialized medicine" as lowering quality and choice. I don't need to elaborate on this one too much either, as look at the statistics of outcome in the countries who have adapted it, and then compare not only their costs, but their outcomes to that of the US.

#1 was almost certainly true in 1978. And #3 was probably true in 1978 as well. we probalbly had better quality and choice then. The US probably fared well as measured by the must common outcome stats (life expectancy, infant mortality) at the time, and socialized medicine in other countries has evolved for the better from what I read.

Where I (still) believe in the free market, I wish Milton Friedman (not Freedman BTW) was alive today to comment on health care in the USA, where the free market has resulted in very high costs without good outcomes. The free market would probably provide the best outcomes if not for unethical or outright criminal distortions, an unfortunate given more than ever. It would also be interesting to hear him comment on the real estate bubble, another huge free market failure.

Free to Choose is one of my favorite books of all time, and I learned a lot about economics since reading it.

 

[ERD50]

But to your comment that "Well, like any other product on the market, I'd expect the ineffective ones to never make many sales. In the free market, bad products fall out all the time." That's an awful high price to ask people to make to find out.

I'll watch your links later, thanks for them, but you missed my point.

You don't know that it is a high price to pay, because you don't know how many lives are being affected by the delay in the 'good' pharmaceuticals. Perhaps the delays are coming at a higher price than the problems. And I don't know either - but you can't make these statements and expect us to accept them at face value.

Plus, we should not equate 'slow' with 'safe', and 'fast' with 'reckless'. We need a faster, more effective process.

I recall reading a book about the Thalidomide tragedy. The drug was not approved in the US, but, according to the book (and my memory), the delay was not because of the FDA's superior screening process, it just plain bureaucratic molasses slowdowns. The same kind of slowdowns that would have kept needed medicines out of the hands of people who needed them for years. And even at that, look what happened (from wiki):

Although thalidomide was never approved for sale in the United States, millions of tablets had been distributed to physicians during a clinical testing program. It was impossible to know how many pregnant women had been given the drug to help alleviate morning sickness or as a sedative.

And in a parallel to this, how many lives has been lost to Malaria, because overzealous regulators lobbied to ban the use of DDT (rather than assure it was used in specific, targeted ways)? You can't just point to any positives from banning DDT, w/o also acknowledging the harm done from NOT having it available to people who needed it.

RE: third party testing org:

But then the question becomes, who's going to pay them. Where are they going to get their revenue from? It can't be from the Big Pharma, cause you know where that will lead.

Again, look at the UL model. Yes, companies PAY UL to certify their products. But UL gets paid whether they pass or fail, the company gets a report. In fact, UL makes more money if they fail, as they will resubmit after making the changes, and pay for a second test.

UL can only keep doing their thing if their reputation is clean. Plus,[-] I'll bet[/-] I KNOW that other companies do tear-downs of their competitors products, and if they found UL guideline violations, it would come to light.

-ERD50

 

[MichaelB]

Thanks to all for an engaging discussion.