dagblog - Comments for "Home Economics With Destor"

What's funny about that is

Michael Maiello — Thu, 20 Jan 2011 18:51:30 +0000

In reply to I agree with you. But it was

What's funny about that is that the premiums you pay for your insurance don't just go to your household's health care needs. In a good year where the actuaries did their jobs right, your health care costs come in way below your premiums and the rest is either profit for the insurance company (up to regulated limits) or it's used to cover your neighbor who ran up costs in excess of premiums. If people want a system where their money goes to their health care and that's that... well... that's not the current system! It's also an entirely inadviable system.

I agree with you. But it was

Elusive Trope — Thu, 20 Jan 2011 18:27:10 +0000

In reply to Ultimately, I'm concerned

I agree with you.

But it was the fact that most people already have some kind of health care insurance that in part made it so difficult to sell significant reform. Among the features that was part of the national debate was that for these folks that health care tax pay for their own household's health care. Reform measures had to be sold on paying a "tax" that also provided to health care for other households. Since we weren't getting rid of the private sector, we would still have the executive bonues, plus increased subsidies for the lower-income households. Most people wouldn't go to the lengths you would to calculate whether you going to come out better at the end of the day, which wouldn't have begun to show up until after some time. People in general don't like their health care plans, nor do they like the executive bonuses, but they are more afraid of losing what little they do have in the hopes of something better. Few people, left right and center, don't trust the government to do a good job that they were in effect willing to trust them to go down a national healthcare path, at least not enough so that they didn't put any pressure on their Senators.

I agree with you that about

Elusive Trope — Thu, 20 Jan 2011 18:02:51 +0000

In reply to Show me the math Another

I agree with you that about us able to get more with less, the need for competition, etc. But the positive outcomes would occur over time. Prices wouldn't immediately come down in any noticeable way. In order to put the government into the game and make it possible for low-income people to participate would require money up front. It would require an entire new health care structure to be implemented nationwide which from a bureaucratic point of view is mindboggling in its scope. If the goal was just to get pricing down so that more could find it affordable then that would be a little less expensive. But that would still leave people uninsured in the short run. Basically it would be the same system we have now except the government was one of the competitors.

And I agree that what people should be is focused on their total expenditures. But one would have to first get people to agree to a tax hike with the promise that down the road, because of increased government involvement, they would be seeing more money at the end of the day stay in their pockets. A tough sell. Plus the short-term increase for many in the middle class would not increase the quality of their health care, but help provide health care to the lower-income households. So it would have to been basically in part a subsidy as built within the system as opposed to a feature of premiums which has the potential to decrease over time.

And one has to keep in mind that this was occurring right after the stimulus and during bad economic times. Going into even greater debt or raising taxes to pay for a new national healthcare infrastructure was about as politically impossible as they come. And that was without the huge special interests spending a dime basically on fighting it out in the media. Even with them standing on the sidelines for the most part we still had death panels, etc.

It's true that Obama sees those special interests as some of his "stakeholders," as it is also true that Obama had no interest in removing the private for-profit sector from the health care system. But the nature of the health care system that emerged had to do with a lot of factors, one of the most important being the Senate. Had there been the political will in the Senate to push forth a public option, it would have happened. But one can argue that there was not enough grassroot support nationally for going down that path - i.e. people were not willing to sacrifice a little in the short run for the potential payoff in the long run. Had Obama been more bold and pushed for something more along the lines of what you are calling for (which I think is a great idea), it is very likely that nothing would have been accomplished and Obamacare would have gone the way of the Clintoncare. Of course that is one view of it, others can make the argument about rallying the people to make it happen via the bully pulpit, etc. This particular debate has been going around and around here and eleswhere for the blogosphere. None of the sides can really prove how things would have gone down had Obama did this or that differently along the way.

My view is that the reason

Atheist — Thu, 20 Jan 2011 13:51:45 +0000

In reply to Show me the math Another

My view is that the reason for that is that the private US health system faces inadequate cost-cutting pressure from either competition or public regulation.

That very well might be one reason, but I think another reason might be that "an ounce of prevention is worth a pound of cure." Most of our poor do not get that ounce of prevention, so we end up paying for the pound of cure in the ERs.

Ultimately, I'm concerned

Michael Maiello — Thu, 20 Jan 2011 13:17:55 +0000

In reply to The reality is that if we

Ultimately, I'm concerned about what I get to keep at the end of the day. Taxes would have to go up to fund national health insurance, sure. But the insurance premium taken from my check every two weeks isn't fundamentally different than a tax. So the question becomes: would taxes go up more than what I already pay in premiums or less? The whole objection that taxes would have to go up in order to fund government health care would only make sense if the current system was free. But in essence most of us already pay a health care tax. It pays C-level bonuses at health care companies.

I agree. If the Republicans

Dan Kervick — Thu, 20 Jan 2011 12:54:08 +0000

In reply to Your comments on HCR are a

I agree. If the Republicans controlled both houses of Congress, they would have changed their agenda to one of modifying the health care law, not repealing it.

Show me the math Another

Dan Kervick — Thu, 20 Jan 2011 12:52:44 +0000

In reply to The reality is that if we

Show me the math Another Trope. But please note that I also called for using government options to reduce costs, not just expand access. The United States spends a huge amount per capita on health care in comparison to its peer developed nations:

http://www.infoplease.com/ipa/A0934556.html

and gets worse outcomes in some cases than countries that spend much less per capita. My view is that the reason for that is that the private US health system faces inadequate cost-cutting pressure from either competition or public regulation. Far too many resources are devoted to enriching the participants in the system. I'm convinced we could all be getting much better health care for much less money spent overall. But we need to drain a lot of waste, exploitation and mindlessly uneconomical profiteering from our racketeering system.

As for whether taxes go up or not, the thing people should be focussed on are their total expenditures on health care. If my taxes go up but my health insurance payroll deductions go down, and my out-of pocket deductibles go down or are eliminated, then I might easily be a net economic gainer. But my guess is that, done right, taxes wouldn't have to go up.

The reason Obama did not go further with health care reform and take bolder steps to cut costs is simply the political pandering to nfluential lobbies. He views all of the people who are making money off the system in its current form as "stakeholders", and wanted to reform the health care system while making sure all of those people get to make as much money as they were making before.

Your comments on HCR are a

William K. Wolfrum — Thu, 20 Jan 2011 11:51:16 +0000

In reply to Home Economics With Destor

Your comments on HCR are a reason I believe the Republicans truly have no interest in repealing the Affordable Care Act. Yesterday was political theater, period. They knew it would never get past the Senate or Obama, so they got to stand up and yell and scream loudly so their base could hear.

In the end, the Health Insuance companes will make a fortune on this. The GOP would never stand in the way of that.

The reality is that if we

Elusive Trope — Thu, 20 Jan 2011 07:12:48 +0000

In reply to This isn't Obama's fault in

The reality is that if we were going to implement a national health care system as you describe, taxes for just about everyone would have to go up. The notion that just the wealthiest of this country could foot the bill is unrealistic, to put it nicely. The rich and the middle class would have assist the needy. And that was not going to happen. As Destor's blog points out, people are concerned about what they taking home at the end of the day.

I'm all for a national health care system and would be willing to accept higher taxes to achieve it. But I am in the minority. Obama's challenge was to get some HCR implemented that was budget neutral (in large part because of the stimulus bill that had recently passed).

So one passes higher insurance costs onto the consumers or higher taxes onto the workers. People are still complaining about helping the "needy."

Then again maybe you think it is only the top 1% in European countries that pay income taxes.

Perhaps. On the other

artappraiser — Thu, 20 Jan 2011 05:38:45 +0000

In reply to It should have been about

Perhaps. On the other hand.....

As I was just reading his latest piece, and it seems to me that "getting everyone more care for less money" (though destor actually should have said "better care for less money" because iatrogenic complications are a major part of the cost problem these days) has been Dr. Atul Gawande's main interest for a least a couple years now, and then I saw your comment. I decided to look his bio up and turns out he is M.D. from Harvard Medical School, and M.P.H. from the Harvard School of Public Health. I know what you mean, just razzin' ya; just had to share that it turns he is another Hahvahd guy.