Althouse: "People think just because you have insurance that you're going to have access to care

April 24, 2012

"People think just because you have insurance that you're going to have access to care — which is not the whole story."

"They're very few pediatric dentists that accept Medicaid in this area, so these children have nowhere to go even if they do have insurance.... It's a big problem."

An important problem for the specific children who are suffering, described in the article, but also a problem more generally. You can extend insurance coverage, but it doesn't cause the caregivers to come into existence. What will happen when everyone is forced to buy health insurance — it's not some government munificence, but something you paid for — and then the coverage is for something unavailable? I can't imagine the anger that will arise if/when that happens.

181 comments:

Hoosier Daddy said...: That's an easy fix. Just nationalize the entire industry and make doctors public servants.; 4/24/12, 10:34 AM
JMS said...: " I can't imagine the anger that will arise if/when that happens."

The government will blame the providers, not themselves.

See, e.g., Chavez, Hugo.; 4/24/12, 10:35 AM
SteveR said...: Going the next step forward (backwards?), even having access to care doesn't mean it will be very good care. Add it that ObamaCare was designed to phase out private insurance and it will really be good.; 4/24/12, 10:36 AM
Christopher in MA said...: I can't imagine the anger that will arise /ifwhen that happens.

Oh, I can. But all you'll hear from our betters like Nancy, Harry and Barry will be a Nelson Muntz haw, haw! at we proles.; 4/24/12, 10:39 AM
Dust Bunny Queen said...: Big news!!

ABC discovers the principles of supply and demand.

Next....the sun makes the earth hot.; 4/24/12, 10:39 AM
rhhardin said...: It's automatic that it happens.

Third party payers increase demand and reduce supply.

The result is always rationing by lines.

Low prices and empty shelves, like a Russian department store.

It comes from misallocation of resources when market prices no longer are allowed to function, causing voluntary exchanges to disappear.

None of this is a mystery. Politicians are con men - the cost will always be after the time of their personal concern.

Women voters buy it. Nobody else does, but women voters regulate the media, whose audience they are.

Try having a serious public debate and see where it goes.; 4/24/12, 10:40 AM
Original Mike said...: No. Fucking. Kidding.

They'll try what Hoosier (sarcastically) suggests, but it won't work. It's going to be a God awful mess. And JMS is right. It will be everybodies fault but the politicians.; 4/24/12, 10:42 AM
KCFleming said...: Since Massachusetts passed its own health care reform in 2006, the state has developed "severe or critical shortages" of doctors in eight specialties: family medicine, dermatology, general surgery, internal medicine, orthopedics, neurosurgery, psychiatry, and urology.

There has also been a shortage of primary care physicians for the sixth year in a row, as of October 2011.; 4/24/12, 10:44 AM
Original Mike said...: Where was ABC (and the rest of them) BEFORE this shit sandwich was passed? Because this isn't news.; 4/24/12, 10:45 AM
Anonymous said...: One size will be mandated to fit all.

One size, and one level of service.

Nobody will be allowed to want more butter in exchange for a gun.

Nobody will be allowed to want to less butter and two guns.

You'll get your butter in the government mandated amount, and you'll get your gun (if you're lucky) and you'll like it!

So sit down and shut up, you ungrateful miserable excuse for an American citizen!; 4/24/12, 10:47 AM
DADvocate said...: My last visit to the dentist was about 6 months ago. While the dentist was working on my teeth the oral surgeon next door came in and asked my dentist if he took Medicare. My dentist respoded, no they took too long to pay. The oral surgeon said he was having the same problem.
I've used both of them and they seem to love my private dental insurance that pays rather promptly. The DMV is the government model for service delivery. Some people have bills to pay and payroll to make and can't wait that long.; 4/24/12, 10:48 AM
Shanna said...: And that isn't at all the result of pricing being taken out of the private sector.; 4/24/12, 10:48 AM
bagoh20 said...: Government will just fix that problem too. That's what they do, and it's why I love the government - my big cuddly government. Thank God they care so much.; 4/24/12, 10:49 AM
acm said...: Medicaid dentistry has an even worse scandal. The lowball reimbursements that Medicaid pays have inspired several dental clinics to "make it up in volume" by pulling or capping (with ugly metal caps) perfectly healthy teeth. Google "Kool Smiles unnecessary procedures" for some real fun. The dentists who will deal with Medicaid are often (not always) the horrible ones who can't make their practice run any other way. They can't make any money shining up healthy teeth at $15 a mouth...so they bring Mom in and tell her how horrible the teeth are and how much work needs to be done. If she hesitates, they threaten to call CPS, make her think that they "know" she's a bad mom, that CPS will determine neglect based on the dentist's say-so, that the kid's teeth with break and fall out if they wait even a week. And of course they know she has no other dentist to see for a second opinion. And Medicaid pays a little more for using restraints and papoose boards (which good dentists/doctors only use as a last resort, for very combative kids) so it becomes a first resort.; 4/24/12, 10:51 AM
Anonymous said...: the state has developed "severe or critical shortages" of doctors in eight specialties: family medicine, dermatology, general surgery, internal medicine, orthopedics, neurosurgery, psychiatry, and urology.

Wow. So these specialists can now raise their prices, which will attract more of them to set up practice in MA, and the shortage will be alleviated, right?

Right?

Right?; 4/24/12, 10:51 AM
Hoosier Daddy said...: My daughter needed braces to correct her horribly crooked teeth. I have dental insurance but it didn't cover braces. So we sucked it up and paid oop. $4800.

Last year I broke a tooth and had to have it extracted. Extraction was covered but the implant wasn't. $1800 for that oop.; 4/24/12, 10:52 AM
garage mahal said...: Where was ABC (and the rest of them) BEFORE this shit sandwich was passed? Because this isn't news.

So what is your solution for these low income kids that need dental care? How do they get it? It sounds like you agree it's a problem and they do need it. A real life Death Panel, if you will.; 4/24/12, 10:55 AM
Synova said...: Rand Paul was trying to explain to someone that doctors were not slaves.

It didn't go over well.

But this is what a "right" to medical care (or dentistry) gets you and Rand Paul was 100% right.

People think of health care as a "right" and they stop wondering where the service is going to come from. Just dictate that the prices will be lower and presto-chango, ta-da! Lower prices.

If you can find a doctor.

Doctors chose what health insurance they're going to deal with. My husband lost his doctor when his company changed insurance providers. They've changed back, so he can go back to the guy, so we're happy about that. But I don't blame the doctor one bit. He has as many patients as he has time to see. He doesn't need more patients. If he doesn't want to deal with a particular insurance provider (or Medicare or whatever) why should he have to do that?

Dentists are no different.; 4/24/12, 10:56 AM
Eric the Fruit Bat said...: I thought affirmative action was supposed to take care of this problem.; 4/24/12, 10:58 AM
PogoПОССУМ said...: дефицит Shortage will be divided equally among the peasants!; 4/24/12, 10:58 AM
Dust Bunny Queen said...: @ Hoosier.

No dental insurance and I need a root canal. Fortunately there is no pain, but the procedure with a cap is going to cost me at least $2000 to $2800. Cash. Yikes.

So what is your solution for these low income kids that need dental care? How do they get it?

Charity? Private foundations? Dentist without Borders?

Perhaps Warren Buffet and Bill Gates could kick down some money. Maybe if Obama and Michelle took one less trip a year that would free up several million dollars. Take away the party hats and fun money from the GSA and other agencies and divert those funds to this?; 4/24/12, 11:00 AM
Tank said...: Fairness dictates that doctors and dentists start to pay patients for the privilege of practicing on them.

I mean, those docs already have big houses in the nice [insert politically incorrect color here] part of town.

It's only fair, and my Zero says that fairness counts the most.; 4/24/12, 11:00 AM
Original Mike said...: "So what is your solution for these low income kids that need dental care?"

Medicaid needs to pay at a rate doctors and dentists will accept. And to pay for that, the government has to drastically scale back it's ambitions of running (and "paying for") everybody else's health care.

I've got no problem subsiding care for the truely poor, garage.; 4/24/12, 11:01 AM
edutcher said...: A lot of Medicare patients (and check out the latest Social Security Trustees Report) are having a similar problem with their old doctors.; 4/24/12, 11:02 AM
Tank said...: I need an dental implant now (like today) and I have plenty of paint [thank you Mr. Codeine].

Who wants to pay?

Garage?

Andy R?

Alpha?

Wahhhhh; 4/24/12, 11:02 AM
PogoПОССУМ said...: "So what is your solution for these low income kids that need dental care?"

Only solution is принудительный труд.

Forced is labor!

дантист Dentist is slave of state!
Problem is solve!; 4/24/12, 11:02 AM
Original Mike said...: "Rand Paul was trying to explain to someone that doctors were not slaves.

It didn't go over well.

But this is what a "right" to medical care (or dentistry) gets you and Rand Paul was 100% right."

That is exactly right.; 4/24/12, 11:03 AM
Hoosier Daddy said...: Maybe we need more doctors. Then again going a couple hundred grand in school debt to get paid Medicaid wages may not be much of an incentive.; 4/24/12, 11:03 AM
garage mahal said...: I've got no problem subsiding care for the truely poor, garage.

Particularly children, yes.; 4/24/12, 11:04 AM
Tank said...: At some point you run out of other peoples' money.

Well, I think we're here.; 4/24/12, 11:05 AM
Bob Ellison said...: Let's start by not calling it "insurance". Insurance is a business model in which customers pool risk and pay for extraordinary costs. "You can extend insurance coverage, but it doesn't cause the caregivers to come into existence." Extreme insurance might do just that: fund medical schools and study incentives and pay in order to incentivize bringing those caregivers into existence.

What people call "health insurance" is really just a payment system, much like a mortgage, but often based on a pyramid scheme. Dental coverage is an extreme example of this.; 4/24/12, 11:07 AM
SGT Ted said...: Oh no, not something else I am expected to pay for myself out of pocket! Especially if a child is involved! For teh CHILLLRENN, of course.

Surely we have money falling from the sky we can use to pay for other peoples doctors and dentists, don't we? Government ALWAYS makes those things cost less.; 4/24/12, 11:08 AM
PogoПОССУМ said...: "Maybe we need more doctors. Then again going a couple hundred grand in school debt to get paid Medicaid wages may not be much of an incentive."

Bah! Is простой simple!

Make all medical school for бесплатно free!

Problem is solve!; 4/24/12, 11:09 AM
rhhardin said...: The way it worked for the poor before the government took over the industry was that doctors had no fixed prices.

They charged according to what the patient could afford, and in return were considered professionals.

Meaning that they worked for the patient's interest even when it conflicted with their own.

If you make that involuntary, they quit, which they have.

The check on doctor greed was picking another doctor. Nobody stays in business charging more than people are willing to pay.

Charging what they are willing to pay, in other words, solved everything.

That's called a voluntary transaction.; 4/24/12, 11:09 AM
Original Mike said...: "At some point you run out of other peoples' money.

Well, I think we're here."

I think we passed that point a long time ago. We're borrowing 40 cents of every dollar we spend.; 4/24/12, 11:11 AM
Bruce Hayden said...: Since Massachusetts passed its own health care reform in 2006, the state has developed "severe or critical shortages" of doctors in eight specialties: family medicine, dermatology, general surgery, internal medicine, orthopedics, neurosurgery, psychiatry, and urology.

There has also been a shortage of primary care physicians for the sixth year in a row, as of October 2011.

Hate to be picky there Pogo, but aren't some of those specialties considered "primary care"?

I would suggest that these physicians are the worst hit by the level of reimbursement they receive there in MA, as well as by Medicare, etc. Their practices are more commoditized, or at least the GPs' practices are. Not so sure why orthopedics and neurosurgery are getting hit so hard.

Part of what I mean there is that the insurance companies and state agencies see huge numbers of, say, flu shots, but very few complex operations, like, say, heart-lung replacements. Worse, stuff like flu shots can often be administered by nurses under PA supervision. So, the reimbursement rates for flu shots are cranked down, and down, and down, while they have a much harder time with the more specialized and complicated procedures, etc.

Just my theory, and you are a lot closer to this than I am, or ever will be.; 4/24/12, 11:11 AM
Hoosier Daddy said...: "... I've got no problem subsiding care for the truely poor, garage..."

This is really the crux of the matter. You are not going to find very many folks who are truly the Scrooge types who favor decreasing the surplus population. The problem is that liberals simply want the government to fund everything, from health care to day care to free birth control for 30 year old Gerorgetown law students.; 4/24/12, 11:12 AM
Hoosier Daddy said...: "... I think we passed that point a long time ago. We're borrowing 40 cents of every dollar we spend."

Yeah but we haven't run out of Chinas money. ;-); 4/24/12, 11:14 AM
Original Mike said...: "Let's start by not calling it "insurance"."

Hoosier and I have been singing that song until we're blue in the face. The system we currently have is economically unviable.; 4/24/12, 11:14 AM
acm said...: The solution is to make Medicaid more like food stamps. Grocers have little reason to decline foodstamps, now that they're an easy-to-deal-with card. The grocers get the same $2.99 or $3.10 for a box of Cheerios, whether the consumer pays with cash, foodstamps or Visa and the consumer can make his or her own choices based on his/her family's own needs and wants, and more importantly, the dentists would have to compete. Wal-Mart, CVS, Kroger, and HEB all are happy to make sure you know that they accept foodstamps and they compete like mad to get those foodstamp customers, just like they compete for the cash customers. Both the cash customers and the foodstamp customers get lower prices and better stores out of the bargain.

If a grocery store is nasty and mean it only survives if it's the only one around. Nasty, mean dentists have been the only ones around for Medicaid patients and the results are terrible.

Yes, Medicaid should be only for the truly poor, if it should even exist at all. But it's here to stay, so it needs to be efficient.; 4/24/12, 11:15 AM
bagoh20 said...: There is plenty of money in government and charity to subsidize care for the poor. We just spend it on other silly shit that is not a true human need at all, but rather vote and donation seeking.

How many poor could have been helped with the money Solyndra blew on nice new buildings and offices and salaries that helped no one.

The solution is simple: Priorities. The truly needy come first, the productive second, and the rest need to get off their ass and the dole.; 4/24/12, 11:16 AM
Anonymous said...: rhhardin,

None of this is a mystery.

You would think this is true. We have centuries of economic experience and empircal evidence, but seemingly people are able to convince themselves that this time it really is different.; 4/24/12, 11:17 AM
KCFleming said...: They are primary care indeed. I separated the fact that primary care was in shortage status for the 6th year in a row, unlike the others.

Docs also hate practicing in Mass. due to the lawsuits, which explains the neurosurgeon deficit.

Worse, the number of training programs for neurosurgery has not increased in the last 15 years, so the shortage is national, but more marked in states with harsh medicolegal climates.; 4/24/12, 11:18 AM
Anonymous said...: garage mahal,

So what is your solution for these low income kids that need dental care? How do they get it?

The answer is easy and always the same, but something that leftise find abhorent: reduce regulations and let markets work.; 4/24/12, 11:18 AM
SteveR said...: free birth control for 30 year old Gerorgetown law students.

so? What's wrong with that?; 4/24/12, 11:22 AM
Original Mike said...: "so? What's wrong with that?"

No money for poor children's teeth.; 4/24/12, 11:25 AM
garage mahal said...: Make all medical school for бесплатно free!

Maybe open the medical profession to professionals willing to do services cheaper than the next guy. The magic hand of free markets, if you will. Open the floodgates of doctors from beyond our borders that are willing to perform services cheaper than their American counterparts. You wouldn't have a problem with that, would you PogoПОССУМ ?; 4/24/12, 11:25 AM
KCFleming said...: I favor it. But only if you also reduce the regulatory burden, get rid of Medicare price caps, etc. etc.

But you never will.

It ain't a 'free market' unless people are allowed to trade freely.

The State loves its power too much for that.; 4/24/12, 11:29 AM
bgates said...: So what is your solution for these low income kids that need dental care?

You are right to say we’re not coming before you today to say ‘we have a definitive solution to that long term problem.’ What we do know is, we don’t like yours.

-Nah, just kidding. What kind of irresponsible idiot would say such a thing? Anyway, I know you're not buying any of this hocus-pocus and jibber-jabber about the voluntary exchange of goods and services leading to better outcomes for all concerned, or the fairy tales about people giving time and money without governmental coercion, so let's have a tax.

A federal tax on anybody who gets rich off of a smile - Julia Roberts, Barack Obama, lightweight celebrity types like that - say 15% of income past $1M/year, proceeds to go directly to dental care for poor children (and/or conferences in Aruba for members of the Federal Dental Care Advisory Board - open bar, but they have to pay for hookers themselves).; 4/24/12, 11:32 AM
Bruce Hayden said...: Make all medical school for бесплатно free!

Problem is solve!

Except that even with high tuition, medical schools tend to cost more than they bring in, excluding government assistance. You are suggesting then (I assume tongue in cheek) that the government spend even more per student/physician. Which we don't have and can't afford.

But, one other thing to keep in mind is that part of the scarcity of U.S. born and trained physician has long been the AMA. The number of medical schools, medical students, and different residency slots, have long been strictly controlled by the very same people who benefit from the lessened competition that results from their actions. Things may have changed since some beer lubricated discussions a couple of years ago with adjunct faculty at what appears to be your local medical school. One of those involved went to some depth at how disastrously the AMA had predicted practice requirements awhile back, and how long it took to compensate for their failures. Well over a decade, given staffing, then medical school, then residencies.

And that just goes to show how central planning inevitably leads to market failures.

Which is to say that as long as the number of medical school and residency slots are strictly limited, the cost of going to medical school is not going to be the only factor determining the number of native born doctors we have.; 4/24/12, 11:32 AM
traditionalguy said...: The Government's credit card is what backs Medicare/Medicaid. The price will be kept low with the aim to drive out all competition from real Insurance Companies. The Rockefellers know how that is done.

The next move is to cut Doctor's pay to a small salaries paid by a Government backed entity.

Citizen's angry reaction is already factored in. The Drone launch sites, the highway checkpoints, the Concentration camps and the military ammunition stocks have to be created first. The internet kill switch is also in place.

The guys in DC are planning a war against us, and they plan to have everything ready to defeat the Tea Partiers this time.; 4/24/12, 11:32 AM
Wally Kalbacken said...: acm said...

The solution is to make Medicaid more like food stamps.

Yeah, except that the point is Congress dials down reimbursement rates to save money. If you simply distributed the same amount as vouchers, recipients would still be short of a competitively set fee for a given service. From the perspective of Congress, and the administration, they are "bending the cost curve down" by dialing down the reimbursement rates. They assume that practices have a blend of private pay and medicaid/medicare patients and can mix them in some proportion and still come up with a net profit. Which is why somewhere earlier in this discussion there were comments about $4,800 orthodontia, etc., etc., etc. Cost-shifting from government-covered patients to private-pay patients has been going on for a long time and it leads to completely absurd nominal prices for services.

I've has 3 primary care physicians leave practice here in FL in the past 5 years. They will not come out and say it, but you can tell their practices are not flying, in P & L terms.

This is going to be one of the huge unintended consequences of government tinkering (Obamacare or some other variant), and yes - folks will be angry.; 4/24/12, 11:33 AM
KCFleming said...: Garage, seriously, I actually favor the market approach here.

Doctors formed a guild to keep others out. Rent seeking.

I oppose it.; 4/24/12, 11:33 AM
Hoosier Daddy said...: "... free birth control for 30 year old Gerorgetown law students.

so? What's wrong with that?.."

I think it should be obvious. I was buying my own birth control at sixteen back when all that stuff was behind the pharmacists counter.

And as Original Mike said, less money to pay for dental work for poor kids so 30 year Ike Georgetown students can have consequence free recreational sex; 4/24/12, 11:38 AM
Bruce Hayden said...: The answer to physician shortages is to hire foreign born and trained doctors. Not optimal, I know. But, we seem to be seeing it more and more.

I have a client who is a Canadian born and trained physician. He is highly specialized, and has equipment in his office that some of the provinces probably don't have even one of. He still makes a bit of money, and is banking much of it, for when he retires back to Canada. At least his English is (almost) understandable, and would esp. be to those of you who share a border with Canada.

Unfortunately, after we hire all the smart doctors from Canada, and maybe the rest of the countries where English (of some sort or another) is the first language, then what is left to fill all those physician slots, esp. in primary care specialties? And, hence, why a growing number of ERs and hospitals seem to be filling up with doctors (and nurses, etc.) who are not native English speakers.; 4/24/12, 11:41 AM
Wince said...: How much is a check up? And the parents involved will watch their kids teeth rot instead of fork-over the money to pay it?

Parents, whether on public assistance or not, should be subject to what the IRS calls a "lifestyle" or "financial status" audit, and if the parent spent money on something less important than care, that parent should be charged with neglect.

Dependence breeds the expectation that nothing needed should have to come out of pocket.; 4/24/12, 11:43 AM
Revenant said...: Silly question, Ann. Everybody knows your can abolish the law of supply and demand if you just CARE enough.; 4/24/12, 11:44 AM
Matt Sablan said...: "ABC discovers the principles of supply and demand."

-- I thought the same thing.; 4/24/12, 11:46 AM
Anonymous said...: Original Mike said;

"Let's start by not calling it "insurance"."

Hoosier and I have been singing that song until we're blue in the face. The system we currently have is economically unviable."

Exactly.

Aetna CEO says Health Insurers Face Extinction

And it's not all because of Obamacare. "The system doesnt work, it's broke today".; 4/24/12, 11:47 AM
acm said...: My whole point was that the government *shouldn't* dial down reimbursement, that they should pay the same amount as everyone else as they do with food stamps. The cost savings will come from the falling prices (due to increased competition) and the fact that there won't be so many unnecessary procedures, and people's overall health will improve. Right now the we pay half of an inflated bill. If we pay real prices for normal cleanings, sealants, sometimes fillings and the *very* occasional pediatric root canal it has got to be cheaper and better than paying for constant caps (the kids I see have their front baby teeth, six of them, capped as a matter of course, it seems) and root canals and papoose boards.

If the issue is how to get poor kids to the dentist, I really think that vouchers to either purchase insurance on the private market or pay dentists directly (maybe even purchase toothpaste and floss) are the answer. I don't know if that will make the government's expenditures on dental care higher or lower, but I do know that I'll sleep better at night knowing that my money helps kids get the preventative care they actually need...not unneeded caps, or only the painful restorative care.; 4/24/12, 11:47 AM
Geoff Matthews said...: We need to make the provision of care more efficient.
Are there aspects that dental assistants can w/o a dentist? If so, why not allow dental assistants to open their own offices? Same with nurses or physician assistants. If you kid (~1 yr old) is crying and clutching their ear, when you take said child to the doctor, chances are a nurse will look in the kid's ear. If they see redness, they'll diagnose an ear infection and proscribe antibiotics and send you on your way.
And you won't see the doctor, but the doctor will still get paid.; 4/24/12, 11:48 AM
Robert Cook said...: "Add it that ObamaCare was designed to phase out private insurance and it will really be good."

No, it wasn't. Stop lying.; 4/24/12, 11:54 AM
KCFleming said...: The proble with poaching doctors from other countries is that you cause a brain drain for 'emerging nations', which often paid for their education.

That's been the case when the UK went after the same supply.; 4/24/12, 12:11 PM
Original Mike said...: SteveR: "Add it that ObamaCare was designed to phase out private insurance and it will really be good."

Robert Cook: "No, it wasn't. Stop lying."

I think it clearly is, but maybe they are that clueless.; 4/24/12, 12:14 PM
Hoosier Daddy said...: ".. And it's not all because of Obamacare. "The system doesnt work, it's broke today"..."

It doesn't work because its not insurance. Insurance is about protecting yourself from unexpected risk. If you want health insurance you get a cat care plan and you foot your own payment for non crtitcal care.

When I was a kid, I had to get allergy shots and none where covered by my parents insurance because they were 'major medical' policies. Mom cut a $25 check every month at the docs office.Now, health pans are comprehensive that cover everything from organ transplants to drug rehab and bariatric surgery.

Yeah no shit the system doesn't work.; 4/24/12, 12:16 PM
damikesc said...: The DMV is the government model for service delivery.

Not always. Mark Sanford, before he flamed out here, got our DMV to be efficient. I've had to change addresses, replace licenses, and get copies of titles to vehicles and never spent more than 10 minutes in a DMV at a time.

For his faults, Sanford cut the wait times in the DMV here dramatically.

So what is your solution for these low income kids that need dental care? How do they get it? It sounds like you agree it's a problem and they do need it. A real life Death Panel, if you will.

Government involvement CAUSED the problem. Only a fool would say further involvement will fix it.; 4/24/12, 12:17 PM
Original Mike said...: Douglas Holtz-Eakin and Michael Ramlet from the American Action Forum provide some useful detail. They write: “In 2011, Medicare spent $549.1 billion on medical services for America’s seniors but only collected $260.8 billion in payroll taxes and monthly premiums. Trustees have now issued a funding warning for 7 straight years.” The bottom line: “ The cash shortfall is responsible for over one-fourth of the federal debt accumulated since 2001.”; 4/24/12, 12:21 PM
Anonymous said...: The end of health insurance as we know it?

The system is unviable, it was going to crash, just like the Housing Bubble burst, the Health Insurance Industry will crash. CEO of Aetna Mark Bertolini knows it and says it and he says it's not entirely the fault of Obabamacare.; 4/24/12, 12:21 PM
SteveR said...: No, it wasn't. Stop lying.

OK I'm sorry, they crafted that bill in the dark and it just so happens to be having that effect. Stop acting like you don't know what's going on.; 4/24/12, 12:21 PM
Hoosier Daddy said...: "... Add it that ObamaCare was designed to phase out private insurance and it will really be good."

No, it wasn't. Stop lying...."

Actually Robert, its not a lie. Now that the Federal government will be able to dictate coverage, premium rates and also what profit margin the insurers can make, private insurers will essentially become quasi government entities.

Of course Obama would have preferred to go the full Cuban model but that just wasn't a selling point to non-socialist wings of both parties. So this is just the next best thing. It will just take a but longer.; 4/24/12, 12:25 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 12:25 PM
Anonymous said...: "filling cavities and teaching children and parents about the importance of oral hygiene"

This indicates to me that perhaps lack of insurance is not the whole story. Parents, now stripped of maturity by a life of dependency, don't even teach their kids to brush their teeth! Or go to the hospital before your kid dies of an infection.

This article is PR for govt control of all health care, courtesy of ABC.; 4/24/12, 12:25 PM
Matt Sablan said...: "The system is unviable, it was going to crash, just like the Housing Bubble burst, the Health Insurance Industry will crash."

-- Just like the housing bubble, some politicians -- like Bush and McCain -- will fighting to keep other well-meaning, but stupid, politicians -- like Dodd and Frank -- from making things worse. The insurance industry will crash because the government meddled, but if you like your health care, you can keep it.; 4/24/12, 12:34 PM
Seeing Red said...: --People think just because you have insurance that you're going to have access to care -- which is not the whole story---
DUH!

See Canada. The city of Windsor was supposed to get to heart surgeons to perform angioplasties in 2008.

That's why the Obamacare argument was so stupid in the 1st place.; 4/24/12, 12:44 PM
jimbino said...: Funny, but there is or will be NO medical or dental care, through Medicare, Medicaid or Obamacare, available to Amerikans temporarily living or traveling overseas, in spite of the fact that they are still liable to pay taxes to support Medicare and Medicaid and "penalties" for Obamacare.; 4/24/12, 12:44 PM
Seeing Red said...: It's facing extinction because the states & fed it to face extinction, they write the laws. They know what they're doing.; 4/24/12, 12:48 PM
Seeing Red said...: Since Massachusetts passed its own health care reform in 2006, the state has developed "severe or critical shortages" of doctors in eight specialties: family medicine, dermatology, general surgery, internal medicine, orthopedics, neurosurgery, psychiatry, and urology.

There has also been a shortage of primary care physicians for the sixth year in a row, as of October 2011.---

Try reading the Brit, Irish & Scot papers. They're the roadmap.

Brits had bad teeth for a reason. They had national care.

Only in the last 20 years have their teeth appearance improved.; 4/24/12, 12:50 PM
chickelit said...: jimbino said...
Funny, but there is or will be NO medical or dental care, through Medicare, Medicaid or Obamacare, available to Amerikans temporarily living or traveling overseas, in spite of the fact that they are still liable to pay taxes to support Medicare and Medicaid and "penalties" for Obamacare.

Stanley Ann Dunham must be roiling in her grave.; 4/24/12, 12:50 PM
Seeing Red said...: All I know is that my grade school sends home a flyer that kids can get basic medical coverage w/a
$25K death benefit for about $60 for the school year.; 4/24/12, 12:52 PM
KCFleming said...: @ Bruce Hayden "one other thing to keep in mind is that part of the scarcity of U.S. born and trained physician has long been the AMA. ...strictly controlled by the very same people who benefit from the lessened competition"

There's more to it:

"Some critics have argued that organized medicine has conspired to constrain residency positions to improve physician income by limiting competition; obviously, they have not considered the consequences of their actions. This is not an American Medical Association (AMA) or AAMC conspiracy; this is a monetary problem –where will the funding come from for more residency slots?

Most residency slots in this country are funded by the Center of Medicare & Medicaid Services (CMS). This CMS funding covers the salary of most residents as well as the cost of the administrative infrastructure necessary for excellent training. For the past 15 years, CMS has stopped funding new residency slots. This freeze has discouraged hospitals from adding new residency positions and/or expanding their current resident programs. Residents receive their pay from hospitals and if CMS does not provide more money, hospitals simply cannot continue to fund more residency slots. We could ameliorate this problem if all private insurers and outside payers were also required to contribute to residency training.

Residency positions are much less prevalent in hospitals that are not financially attached to a medical school. Many partnered hospitals fund extra residency slots, but we cannot solve the physician shortage by these efforts alone. We must expand residency programs into all hospitals across the county, especially in the areas of family medicine, internal medicine, general surgery and emergency medicine.

Residents cost around $80,000 per year, this number includes; salary, fringe benefits, malpractice insurance, secretaries and program directors."; 4/24/12, 12:54 PM
chickelit said...: Allie said: The system is unviable, it was going to crash, just like the Housing Bubble burst, the Health Insurance Industry will crash. CEO of Aetna Mark Bertolini knows it and says it and he says it's not entirely the fault of Obabamacare.

You should add that the state sponsored/supported model which I've heard you champion is also unsustainable. The demographics are to blame.

How now brown cow?; 4/24/12, 12:56 PM
Sigivald said...: Isn't the problem not that "insurance" isn't providing access t care, but the two following things?

A) Medicaid is not "insurance" and

B) Medicaid payments are so limited that nobody wants to lose money taking the work.

A real insurance company wouldn't do that both because they'd lose all their customers, and because they'd get sued for falsely advertising that they provided useful coverage (or some equivalent tort).

The State can, naturally, do all the stupid pretend-care it wants - and then use its failure as a "crisis" that it must fix with further intervention.

(Bastards.); 4/24/12, 12:58 PM
Hoosier Daddy said...: If the expectation is to have healthcare coverage that pays for everything from root canals to heart transplants to birth control then perhaps some facts as to how much this coverage will cost and whether the taxpayer is willing to pay for it.

Medicare and Social Security combined account for nearly half of Federal spending right now.; 4/24/12, 12:58 PM
prairie wind said...: The answer is easy and always the same, but something that leftise find abhorent: reduce regulations and let markets work.

Yes. Lefties find it abhorrent but I'll add that conservatives are also reluctant to try this. They say they agree with it, then they add that they would let the government take care of the really poor folks. No, no, no. REALLY let the market forces work.

Poor people nearly all have air conditioned homes with color TVs, and cell phones. Why? Because the market has forced the cost of AC, phones and TVs down. Why not think the market would do the same for healthcare? It already works for procedures that insurance doesn't pay for. LASIK eye surgery, for example.

Have faith in the free economy!; 4/24/12, 12:59 PM
Anonymous said...: Oh Chickenlittle, the sky isn't falling, I champion a Singapore style healthcare system, that uses both private and public healthcare. It's rated number one in the world.

Why not aspire to greater things?; 4/24/12, 1:00 PM
Scott M said...: @chickenlittle

How now brown cow

Your anti-bos primigenius agenda has been apparent for quite a while, now, chickenlittle. I never pegged you for a spiciest, though.; 4/24/12, 1:00 PM
chickelit said...: @Pogo and Bruce Hayden: Aren't lawyers a protected guild too?; 4/24/12, 1:03 PM
KCFleming said...: But lawyers are special.; 4/24/12, 1:04 PM
Scott M said...: Aren't lawyers a protected guild too?

Not really, but you need to hire an attorney to do anything to them.; 4/24/12, 1:05 PM
chickelit said...: Scott M: You're an ursine flasher!; 4/24/12, 1:06 PM
chickelit said...: AllieOop said...
...I champion a Singapore style healthcare system, that uses both private and public healthcare. It's rated number one in the world.

What are Singapore's demographics like? Lots of older people reaching the end of the pipeline?; 4/24/12, 1:08 PM
Hoosier Daddy said...: "... I champion a Singapore style healthcare system, that uses both private and public healthcare.."

Funny so do we.; 4/24/12, 1:12 PM
Anonymous said...: This, from the smart guys at Forbes; 4/24/12, 1:14 PM
KCFleming said...: Singapore reports a declining age dependency ratio (see page v, page 3.)

In 2011, Chinese formed the majority at 74% of the population,
followed by Malays with 13%, Indians with 9.2%, and 'others' less than 5%.; 4/24/12, 1:17 PM
Anonymous said...: I bet the Swiss have similar demographics to the US; 4/24/12, 1:18 PM
garage mahal said...: "... I champion a Singapore style healthcare system, that uses both private and public healthcare.."

I champion a Make the Poor Sing style healthcare system. Like jesters entertaining the aristocrats. A two-fer!; 4/24/12, 1:21 PM
chickelit said...: @Pogo: Your link is taking forever to load for me. What does it say?; 4/24/12, 1:23 PM
KCFleming said...: Nope:

Switzerland:
Ethnic groups
German 65%, French 18%, Italian 10%, Romansch 1%, other 6%.

Closer to some neighborhoods in Madison, though.; 4/24/12, 1:23 PM
Hoosier Daddy said...: Allie do you know what demographics are?; 4/24/12, 1:23 PM
Hoosier Daddy said...: Singapore has a helluva justice system too.

Just sayin.; 4/24/12, 1:25 PM
Anonymous said...: AllieOop,

he says it's not entirely the fault of Obabamacare

Who is saying it is entirely the fault of Obamacare? It is the fault of government intervention, though. Government held down wages during WWII, so to attract workers, employers started offering health insurance as a way to increase compensation and still be in compliance with wage caps.

Well once government started to see what was happening, they wanted to tax it because it is a form of income. You can imagine how that went over. Now employer provided health insurance is non-taxable, but personally purchased isn't. Since government officials see this non-taxation as a subsidy they feel it is their right to regulate it into the monstrosity it is today.

Things like reducing competition by not allowing companies to sell across state lines. Thers are nearly 2000 health insurance companies in the US. I have a choice of six from my employer. Seriously? How does this help?

Then you throw in things that absolutely should not be covered by insurance, like doctor visits, routing medication (lipitor, insulin, birth control), and the insurance company killer: coverage of pre-existing conditions. Imagine someone buying car insurance after a car wreck and actually being outraged that that coverage does not cover that wreck.

Insurance is characterized by low frequency, high dollar claims. If your making claims every years or multiple claims every year, you are not using insurance. You are foregoing savings and giving to your "insurance" company to have them pocket part of it, then fight with you about spending the rest. You are far better off saving money and paying out of pocket for almost all medical expenses. It will personally save you money and you will get far better care.; 4/24/12, 1:28 PM
chickelit said...: @Allie: The Swiss have an enormous foreign-born workforce. They also have a two-tiered political system with indigenous voters and non-voters. I think we are evolving towards their model.

When I lived there in 1990-1992, I used their healthcare once (I paid a small nominal fee via the University in Zurich). I never saw a doctor. They delegated a lot of care downwards away from specialist. Plus I think in general, physicians make much less.; 4/24/12, 1:28 PM
Anonymous said...: Yes, Hoosier I do. Minorities are still minorities.

Demographics of the US; 4/24/12, 1:29 PM
KCFleming said...: Old age dependency ratio is the ratio of older dependents--people older than 64--to the working-age population--those ages 15-64.

Singapore = 12.25

USA = 19.53

That is, the US has many more elderly, and that dependency ratio will be greater than for Singapore.; 4/24/12, 1:31 PM
KCFleming said...: Allie, that means Switzerland is 94% white.; 4/24/12, 1:33 PM
chickelit said...: @Ken Imagine someone buying car insurance after a car wreck and actually being outraged that that coverage does not cover that wreck.

Didn't Obama make essentially that same point on the campaign trail in 2008? He was outraged to find out what his car insurance didn't cover?; 4/24/12, 1:34 PM
chickelit said...: Well, having lived there, I came to believe that the Swiss government undercounted illegals and also fudged their unemployment numbers. When the economy went sour, many poeple just self-deported. Also, their police get to walk around carrying machine guns which is cool and tends to keep order.

But Allies' right that there many many older Swiss--mainly female.; 4/24/12, 1:38 PM
Hoosier Daddy said...: "... Yes, Hoosier I do. Minorities are still minorities."

Allie you claimed the Swiss have similar demographics as the US. Did you actually, you know, look at Swiss demographics? Cause its about 98% white European.; 4/24/12, 1:38 PM
chickelit said...: At least there were in the 90's...I haven't kept up with their domographics.; 4/24/12, 1:39 PM
Anonymous said...: The US is 72% white. Still a majority.

At any rate if you all think our health care system was just great then just keep on keeping on. I'm going to tell you "I told you so" when it crashes. Plus I'm going to try my hardest to stay healthy.; 4/24/12, 1:40 PM
chickelit said...: Switerland's ethnic profile is complex. They're a polyglot nation (a reason I went there). Rural Switzerland is probably 99.9% white. The color is in the "big" cities like Zurich...northeast of the Limmat.; 4/24/12, 1:42 PM
Anonymous said...: Hoosier, I was mostly referring to its age demographics, which you conveniently ignored.; 4/24/12, 1:53 PM
chickelit said...: At any rate if you all think our health care system was just great then just keep on keeping on. I'm going to tell you "I told you so" when it crashes. Plus I'm going to try my hardest to stay healthy.

I'm quite happy with high deductable plan coupled with an HSA. I really don't see why more people can't/don't use that system.; 4/24/12, 1:53 PM
Hoosier Daddy said...: "... The US is 72% white. Still a majority..."

Um...did you look and see what you posted? Our demogragphics are nothing like Switzerland.

"... At any rate if you all think our health care system was just great then just keep on keeping on. I'm going to tell you "I told you so" when it crashes.."

You know, I'm concluding that you aren't very bright because I don't see anyone here heaping laurels on our current system. In fact, the comments are quite critical but since they aren't advocating for a Cuban style health care system then it must be praise.; 4/24/12, 1:57 PM
Nathan Alexander said...: At any rate if you all think our health care system was just great then just keep on keeping on. I'm going to tell you "I told you so" when it crashes. Plus I'm going to try my hardest to stay healthy.

Our health care system is not very good at all, agree.

But govt involvement is most of the problem.

More govt involvement will only make things worse.

The biggest problem with our health care system is that price and cost are separated.

The 2nd biggest problem is people who try to use the value of life (priceless) to justify the amount of money the US govt must pay for each person to preserve life.

The problem is, a human life's value is only priceless to the individual and to those who love/cherish them. It isn't priceless to the anyone else, or the nation...and it is slavery to make *you* pay the amount I think is necessary to keep *my* loved one alive when I am unable or unwilling to pay that cost myself.

I favor:
- only catastrophic insurance coverage
- changing laws/regulations/codes to encourage retail clinics (including triage by nurses to determine what a doctor needs to see) over emergency room clinics
- encourage medical savings accounts
- encourage rich people to purchase longer lives/better health instead of blocking, discouraging, and demonizing it...rich people make great guinea pigs to figure out what is scalable and cost effective for the rest of us (like LASIK)
- direct payments to doctors/hospitals only

We'd save billions in reduced admin costs...; 4/24/12, 1:59 PM
Original Mike said...: @chickenlittle:

This was Obama at his health care summit:

"When I was young, just got out of college, I had to buy auto insurance. I had a beat-up old car. And I won’t name the name of the insurance company, but there was a company — let’s call it Acme Insurance in Illinois. And I was paying my premiums every month. After about six months, I got rear-ended and I called up Acme and said, I’d like to see if I can get my car repaired, and they laughed at me over the phone because really this was set up not to actually provide insurance; what it was set up was to meet the legal requirements. But it really wasn’t serious insurance."

So Obama, at the time, didn't understand that he hadn't bought collision insurance on his car and, more distressingly, doesn't understand to this day the stupidity of buying collision insurance on an old beater. He has no clue what that what cost.

Striking parallels with the nonviable economics of his health "insurance" scheme.; 4/24/12, 2:00 PM
KCFleming said...: I think what Allie doesn't get is that what makes Singapore and Switzerland (and Japan) healthy is being almost entirely one race and one culture (European, Asian).

This has a marked effect on health.

White US looks a lot like Switzerland, health-wise. But you're not supposed to notice that.; 4/24/12, 2:01 PM
Hoosier Daddy said...: "... Hoosier, I was mostly referring to its age demographics, which you conveniently ignored..."

Funny cause I didn't see the word age in your comment which you conveniently left out.; 4/24/12, 2:02 PM
KCFleming said...: It was implied.; 4/24/12, 2:10 PM
Hoosier Daddy said...: "... So Obama, at the time, didn't understand that he hadn't bought collision insurance on his car and, more distressingly, doesn't understand to this day the stupidity of buying collision insurance on an old beater..."

And the fact the media didn't hoist this on the news as to how dumb this guy really is just proves how much in the tank they are.

My first car was a 73 Chevy Nova and all I carried was liability coverage. Full coverage on an $800 car was rather stupid and I fucking knew that at 17 years old.; 4/24/12, 2:10 PM
TMink said...: Nathan wrote: "Our health care system is not very good at all, agree. But govt involvement is most of the problem."

True. But I think a LARGE part of the problem is psychological. People with insurance do not see how much their procedures cost, they see a copay. If they have Medi they do not even see that. So the cost of healthcare has been divorced from the consumer in conditions that are covered by insurance.

Now the costs of elective procedures, which are NOT cost invisible, are much cheaper and driven by the market forces of competition. Those are the most reasonable medical prices today, because they are consumer transparent.

So want to lower healthcare costs, increase the visibility of the charges.

Trey; 4/24/12, 2:13 PM
Hoosier Daddy said...: "... It was implied..."

I'm immune to Jedi mind tricks.; 4/24/12, 2:15 PM
chickelit said...: But getting everyone to pony-up for catastrophic healthcare isn't going to solve the demographic problem. We Americans are going to have to invent cheaper ways of dying and still feel dignified.

The poor, even if forced to buy catastrophic insurance, still won't pay into their own HSA's.

There used to be nurses at schools who could notice and or treat routine things. I was shocked the other day to learn that my kids' school wasn't even allowed to dispense aspirin (note to Foster Friess: they can lecture all they want on birth control). I blame the lawyers.; 4/24/12, 2:24 PM
Anonymous said...: AllieOop,

The US is 72% white. Still a majority.

This is disengenuous to say the least. This statistic include the two subcategories "Hispanic white" and "non-Hispanic white". When people talk about "whites", they almost always mean "non-Hispanic white", as I'm sure you do in this thread. Maybe you're not being disengenuous. Maybe you're just ignorant. Neither would surprise me.

Either way, you (as can anyone else) can go here to get the break downs. Another place is here.; 4/24/12, 2:35 PM
Scott M said...: I'm immune to Jedi mind tricks.

You're practically begging for it...; 4/24/12, 2:37 PM
Anonymous said...: AllieOop,

Plus I'm going to try my hardest to stay healthy.

Healthy people who live longer cost more in terms of health care consumption than anyone else. Smokers and fat people cost less than healthy people. They die before they really put any pressure on the system.

The basic rule of thumb is that the longer you live, the more healthcare you consume. For a retired nurse, you don't seem to be too knowledgeable about this stuff. Maybe you should stick to nursing (administering medicine), rather than sound so ignorant when discussing the business side of health care.; 4/24/12, 2:40 PM
Alex said...: That's an easy fix. Just nationalize the entire industry and make doctors public servants.

That is the leftist solution.; 4/24/12, 2:46 PM
Alex said...: garage... Particularly children, yes.

Oh wow, you're scum.; 4/24/12, 2:47 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 2:48 PM
Anonymous said...: Good grief Ken, fat people and smokers will cost insurance companies FAR more money than a healthy 80 year old. Fat people and smokers just don't up and die, they have numerous costly health issues before they eventually die.

Who are you trying to kid?! Maybe YOU should keep your nose out of the clinical side of healthcare.; 4/24/12, 2:49 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 2:52 PM
Anonymous said...: Mayo Clinic Study on Obese and Smokers Health Care Costs

The study you cited Ken, is crap. Common sense would tell you straightaway it's crap, why do you think Health Insurers want thin non smokers?; 4/24/12, 3:14 PM
Anonymous said...: AllieOop,

Good grief Ken, fat people and smokers will cost insurance companies FAR more money than a healthy 80 year old.

As I said, spoken like someone truly ignorant of the costs of health care. Simply asserting a statement doesn't make it true. The lifetime consumption of health care has shown repeatedly that health people who live long lives consume more than unhealthy people who die young, like smokers and obese people.

You want to take a snap shot of a smoker at age, say, 55, and compare them to someone relatively healthy at the age of 80. You simply want to ignore the total lifetime costs of these these people, so you can ignore the comparison. And you ignore the reality that that smoker will probably be dead by 65 and ignore all the health care consumption of the 80 year from 65-80 that the smoke will not consume (on account of being dead). Not to mention the health care that the 80 year old is about to begin cosuming.

These comparisons are important because the primary comparison is this: two people age the same age (say 60), one a smoker with health problems X and Y, and the other a non-smoker with no known health problems. Both are insured by company A and will continue to be insured by them till they die. Which one will cost A more money? The answer is the healthy person. The smoker with health problems will die much younger, cosuming less health care.

Denying this truth by sticking you fingers in your ears because you don't like that answer is irrelevant.

As I said, you may have been a good nurse, but you know jack about the business and economics of health care.; 4/24/12, 3:14 PM
Hoosier Daddy said...: "... You're practically begging for it..."

I wondered when you'd show up.

;-); 4/24/12, 3:20 PM
Anonymous said...: AllieOop,

Your own link even verifies this with the statement "Average yearly health costs were $1,275 more for smokers than nonsmokers and $1,850 more for obese people than those with normal weight."

"Average yearly" costs. Get it? That's like saying I spend more on my care than I do food since I paid $13000 for my car (back in 2006) and I spend only around $20on food per day. Guess what? $20times 365 days times 6 years is $43800, nearly three times what I spent on my car. Even adding in insurance (~$750/yr) and gas (~1500/yr) and maintenance (~500/yr) it's still less than I spend on food. The fact that my yearly spending on cars in the years that I buy cars is always greater than my yearly spending on food does not mean I spend more on cars than food.

The numbers given in the article you link to is meaningless in the grand scheme of things because it completely ignore total cost. It's easy to be confused when talking about statistics. A ton of information is lost when talking about yearly averages, then ignoring that the average number of years lived.; 4/24/12, 3:26 PM
Calypso Facto said...: This comment has been removed by the author.; 4/24/12, 3:31 PM
Anonymous said...: Well, Ken, so what are you advocating, euthanasia? I dont think so but I'm throwing it out there just in case this is a way that you think it can save health insurers all that money taking care of all those old folks.

Or should we encourage everybody to just go ahead and eat drink and smoke and be merry while it lasts, because I won't last long? Makes the health insurances happy to have smokers and fat people, maybe they should give discounts for being obese and a smoker!; 4/24/12, 3:33 PM
Calypso Facto said...: Although smokers have a higher health care cost at any given age, Allie, Ken's right about lifetime costs:

"The risk of the diseases not related to smoking is considered equal for smokers and nonsmokers, but the nonsmoking population lives longer and therefore incurs more costs due to those diseases, particularly in old age, when the costs are highest. On balance, the total costs for male and female nonsmokers are 7 percent and 4 percent higher, respectively, than for a mixed population, whereas for smokers the total costs are 7 percent and 11 percent lower."

New England Journal of Medicine

*reposted to fix link since I can't preview anymore without having to go through the pain-in-the-a** word verification 2-4 times.; 4/24/12, 3:33 PM
KCFleming said...: The Mayo study only referenced employed adults, not the total costs over a lifetime.

From the NYTimes, February 5, 2008:

Smokers and the obese cheaper to care for, study shows
"It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.

"It was a small surprise," said Pieter van Baal, an economist at the National Institute for Public Health and the Environment in the Netherlands, who led the study. "But it also makes sense. If you live longer, then you cost the health system more.""; 4/24/12, 3:34 PM
KCFleming said...: "Or should we encourage everybody to just go ahead and eat drink and smoke and be merry "

No, the point is that preventive care saves no money in the long run, so that's not a reason to defend it.

There are better reasons, not cost savings however.; 4/24/12, 3:38 PM
chickelit said...: AllieOop said...
Well, Ken, so what are you advocating, euthanasia?

The Dutch have considered that...so long as it's voluntary.; 4/24/12, 3:40 PM
Original Mike said...: "Or should we encourage everybody to just go ahead and eat drink and smoke and be merry "

We could just leave everybody alone.

Just a thought.; 4/24/12, 3:40 PM
Anonymous said...: True enough Pogo, there ARE better reasons to encourage people to be healthy. Too bad everything seems to be measured in dollars and cents first.; 4/24/12, 3:41 PM
chickelit said...: There are better reasons, not cost savings however.

Healthier people tend to be more productive at work, and work longer, so there's that.; 4/24/12, 3:42 PM
Anonymous said...: AND, I plan on living a long healthy life just to spite my health insurance company.; 4/24/12, 3:44 PM
Original Mike said...: "Too bad everything seems to be measured in dollars and cents first."

And why is that?; 4/24/12, 3:46 PM
Anonymous said...: AllieOop,

Well, Ken, so what are you advocating, euthanasia?

Is this what you consider a good talking point? Have I made this suggestion anywhere? Of course not, but you've been shown to be completely wrong, so resort to ad hominem, amounting to shouting "Oh yeah, I may not understand business, but you're a poopy head!!!"

Of course I don't advocate euthanasia. This has always been a lefty/progressive notion (along with forced sterilization, racism, segregation, and the power of central planning), not someone who recognizes the dignity of every life.

What I propose is the best solution that has ever been discovered in human history: free market health insurance. This will provide an incentive to the consumers (patients) to find the best quality health care for their dollar. Those who live unhealthy lifestyles will end up paying higher health care premiums, putting the costs of their lifestyles on them (for the time that they are alive) rather than everyone else. And then I would incentivize health care savings plans for anyone, not just those who have special types of health insurance plans.

Or should we encourage everybody to just go ahead and eat drink and smoke and be merry while it lasts, because I won't last long? Makes the health insurances happy to have smokers and fat people, maybe they should give discounts for being obese and a smoker!

This is what's so wonderful about free markets: individuals bear the costs of their bad decisions. If I drink and smoke and eat heavily (which I do), then I and I alone should bear the health and health care costs. If others want to be charitable and chip in great, but to expect others to chip in and pass laws forcing others to chip in is morally wrong and plain evil.

Government shouldn't be "encouraging" any behavior, except to stop violence and stopping violations of property rights. Individuals can make the best decisions in their life and determine what the best trade offs are. If I want to live a short smoky life and pay the higher and have higher average yearly health care costs for the time that I am alive, I can make that decision. I am an adult after all. Just because you want to live a long, non-smoky, thin, non-alcohol life is no reason to impose your preferences on me.; 4/24/12, 3:47 PM
Anonymous said...: AllieOop,

AND, I plan on living a long healthy life just to spite my health insurance company.

And that's a perfectly valid reason. I hope you're wish comes true.

I plan on living the life I have because I enjoy living that life. Sometimes that means being spiteful, too, particularly those who want to impose their will on my through the force of law (which is at the barrel of a gun).; 4/24/12, 3:50 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 3:53 PM
Anonymous said...: AllieOop,

Too bad everything seems to be measured in dollars and cents first.

The mantra of those who wish to the core of their being to take dollars and cents from others and give to themselves.

What's that you say? I didn't save or earn enough to live the lavish lifestyle I want? Well, no problem I'll vote in my favorite asshole politician who will do his level best to take from those who didn't vote for him and give to you, who did vote for him. You and people like you are the ones who have deeply corrupted politics in this country. Congratulations.

But I'm sure you did it all for the children. Of course.; 4/24/12, 3:53 PM
Anonymous said...: Ken, did you miss the part in which I said I didn't think so?

You don't like ad hominems, don't use them yourself as you have done repeatedly over the last two days in your comments directed toward myself.

How many times did you use them yesterday? I stopped counting and didn't even address it with you at the time because I didn't think it was worth it.

You can dish it out but you can't take it?; 4/24/12, 3:54 PM
Anonymous said...: AllieOop,

don't use them yourself as you have done repeatedly over the last two days in your comments directed toward myself.

Wrong. I've called you names, but I always backed up my arguments with facts and logic.

Ad hominems arguments substitute name calling for arguments. It helps to know what words mean before you use them.; 4/24/12, 3:55 PM
Anonymous said...: Allie said; "Too bad everything seems to be measured in dollars and cents first."

Ken said;
"The mantra of those who wish to the core of their being to take dollars and cents from others and give to themselves.

What's that you say? I didn't save or earn enough to live the lavish lifestyle I want? Well, no problem I'll vote in my favorite asshole politician who will do his level best to take from those who didn't vote for him and give to you, who did vote for him. You and people like you are the ones who have deeply corrupted politics in this country. Congratulations.

But I'm sure you did it all for the children. Of course."

Ken, bullshit. I didn't get to retire at age 60 because I want your money or the money of others. I worked hard for over 30 years and my husband who was a Pediatrician worked his ass off too to provide for us.; 4/24/12, 4:00 PM
Anonymous said...: Ken are you stalking me? It feels like it.; 4/24/12, 4:02 PM
Anonymous said...: AllieOop,

I didn't get to retire at age 60 because I want your money or the money of others. I worked hard for over 30 years and my husband who was a Pediatrician worked his ass off too to provide for us.

Are you getting a social security check? Are you using medicare and or medicaid? Then you are sponging off workers because you failed to save enough for your own retirement and expect others to pay for it.

Am I stalking you? For now. I get tired of stupid people pretty quickly. You are showing some signs of understanding, though. You can admit when you are wrong, which many people cannot. You just seem to be ignorant of the facts (like the fact people are corrupt and should be trusted with as little power as possible and it's odd that there are so many clamoring for politicians to have even more power, as well as the fact that healthy people consume more health care over the course of their lives than smokers and the obese). Ignorance can be correct. Stupid cannot.; 4/24/12, 5:15 PM
Seeing Red said...: --AND, I plan on living a long healthy life just to spite my health insurance company.--

Unless your insurance company is the US gov't.; 4/24/12, 5:27 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 5:29 PM
cubanbob said...: garage mahal said...
Make all medical school for бесплатно free!

Maybe open the medical profession to professionals willing to do services cheaper than the next guy. The magic hand of free markets, if you will. Open the floodgates of doctors from beyond our borders that are willing to perform services cheaper than their American counterparts. You wouldn't have a problem with that, would you PogoПОССУМ ?

4/24/12 11:25 AM

Good idea there garage, how about we apply the same idea to government employees, university professors and administrators and any unionized outfit?; 4/24/12, 5:31 PM
Anonymous said...: NO, Ken, I don't. Not that it's your business.

As I said, my husband and I worked hard, I continue to live in a county with the highest income and home prices in the state of Wisconsin.

The problem with you dear Ken is that your idea of what makes a liberal a liberal is very narrow, unimaginative. You can't wrap your mind around the fact that liberals work hard and save money, are responsible and yet can be compassionate.

You come across as very angry and borderline abusive with all the name calling. Maybe you would actually make some liberals want to understand your point of view if you toned down the vitriol.; 4/24/12, 5:31 PM
Anonymous said...: AllieOop,

It is my business who draws a social security check. If you're going to make me pay you, I get to know that I paid you.

The problem with you dear Ken is that your idea of what makes a liberal a liberal is very narrow, unimaginative. You can't wrap your mind around the fact that liberals work hard and save money, are responsible and yet can be compassionate.

Liberals are very narrow minded and unimaginative. This is why they call for big government all the time. The economy is doing good? Raise taxes and spend more. The economy is doign poorly Raise taxes and spend more. And regulate every industry because liberals know the one true way that everything should be done and everything should be done according to their rules.

Liberals lack the imagination to understand that the work and knowledge of 310,000,000 dwarfs the work and knowledge of the few million who work for government.

And it's not compassionate to take from one group by force and give to your politically favored.

Liberals lack the imagination to think through their idiotic policies. Liberals live in a fantasy world where private sector workers are greedy and selfish, but government officials are altruistic and selfless. The facts are that government officials are people too and are just as greedy and selfish as everyone else.

You come across as very angry and borderline abusive with all the name calling. Maybe you would actually make some liberals want to understand your point of view if you toned down the vitriol.

I am angry. I am angry that liberals like you would take from me, by force, and give to others, then have the audacity to call it "compassion". All government actions begin with force; it's what's required to enforce the rendering unto Caesar.

I am angry that the liberals claim to live in the real world and say how awful Bush was, then elect a man who kept every policy Bush had and expanded many (assassinating US citizens without due process, starting two MORE wars, doubling the debt in 3 years), and increased the debt faster than anyone in history, except FDR.

I am angry that liberals expect others to pay for the things that they want, rather than pay for it themselves and call it "hope". I'm angry with fools like you who understand human nature (or claim to), then insist that these same flawed humans should spend more, regulate more, and control more of everyone's life, then act all upset when someone points out the simple fact that you were stupid to begin with for trusting these people.

And if you don't like my language, tough. I'm sure that as a good liberal woman you insisted your whole life that men treat women as they do men. Well this is it. It's tough world. If you're not man enough to live in it, don't go around telling others that you should be treated as a man is treated.; 4/24/12, 5:52 PM
Anonymous said...: This comment has been removed by the author.; 4/24/12, 5:53 PM
Anonymous said...: Ken, Ken, Ken, deep breaths, in, out, in out. Such anger makes you release all sorts of stress hormones, not good for you. You probably just increased your blood pressure by at least 50 points with that last outburst, I hope you have good blood vessels.

Shhh, calm down now, it will be alright, here have some hot tea and brandy. If you are going to be my pet stalker, you will have to remain calm. I don't want to have to worry about you.; 4/24/12, 6:03 PM
chickelit said...: Take heart, Ken. Walker is winning Wisconsin, and that chafes Allie. Personally (and having grown up there), I wish Wisconsin Democrats were more Bill Proxmire and less Russ Feingold.; 4/24/12, 6:04 PM
Anonymous said...: Chickie, the only thing that chafes me is when my underwear is too tight.; 4/24/12, 6:06 PM
chickelit said...: I'll remember that in case Walker gets 'em in a wad.

_______________
wv = awaskin rButtede

That reminds me that I miss madawaskin. Anybody know where she went?; 4/24/12, 6:14 PM
Anonymous said...: AllieOop,

Thanks for the concern about my blood pressure. I am able to control my anger. I don't let my emotions rule me the way liberals do. I understand the importance of emotions and use them rather than be dominated by them. I filter them through my head and think, rather than emote. That's why I was able to articulate the reasons for my anger, unlike you who just assumes what you believe is "compassion", when it's in fact violence.; 4/24/12, 6:29 PM
Anonymous said...: Ken, well I am beginning to feel a bit chafed it could be my panties or it could be you, I might get violent, but then I'll show you some compassion, being the good liberal nurse I am.

Do you have a funny bone Ken, or has that been repressed in your conservative fervor?; 4/24/12, 6:36 PM
chickelit said...: Allie said: Do you have a funny bone Ken,...

Allie, never ever talk about a man's manhood like that.; 4/24/12, 6:39 PM
ken in tx said...: When I taught 6th grade, I had a black kid in my Home Room, who had terrible breath. I thought he might have a tooth or gum problem. I was right. I sent him to the school nurse and she made arrangements for him to get free oral care. His parents did not take him to the appointments. He hated me for pointing him out for this. He made a dance about how he hoped I was fired.

BTW, he was in my home-room two years in a row.; 4/24/12, 6:42 PM
chickelit said...: @Ken in sc: indignant indigent. His parents should have thanked you.; 4/24/12, 6:51 PM
Elliott A said...: Sorry I'm late! Someone must speak for the dentists!

The 2700 page health care bill does not contain the word dentist or dentistry. There is no dental care under medicare and although it is available with Medicare Advantage, the health care plan deep sixes Medicare advantage.

As is the main problem with many subsidized services, there is no reciprocal responsibility on the recipients to be responsible. So, not only will the dentist be reimbursed at a fee which is 1/2 his or her overhead, but the Medicaid kids have an enormous no-show rate making it impossible to see these patients at the same time as the regular patients. At least if you had only medicaid patients, you could triple book and not have down time when everyone in the office is still getting paid. A better solution would be to have various state governments or federal government have clinics where salaried people treat the kids. You remove the entire administrative cost on both ends for the treatment, and take any cheating out of the equation. Any time someone is forced to take inadequate payment, it is only natural for many to learn how to game the system.

It is a tragedy that old people who do not have access to dental insurance through retirement benefits have no coverage, even for life threatening dental infections.; 4/24/12, 7:14 PM
wildswan said...: Under the old system poor people had treatment but not coverage and did not pay; under the new system they will have coverage but not treatment and they will have paid.; 4/24/12, 7:29 PM
Ken said...: Ken, well I am beginning to feel a bit chafed it could be my panties or it could be you

It's not me. I'm not interested in your panties, bunching them or otherwise.

I might get violent

Not surprising.

but then I'll show you some compassion, being the good liberal nurse I am.

Because it's totally fine to be violent as long as you feel compassionate afterwards, right?

Do you have a funny bone Ken, or has that been repressed in your conservative fervor?

Violence isn't funny. But I'm not surprised violence is funny to a liberal. Especially violence fantasies done against non-liberals.; 4/24/12, 7:48 PM
Anonymous said...: Ken, for pity sake, you are the one who said I was violent , when I said liberals are compassionate. A sense of humor is something you have been deprived of, I blame Bush. At least if you're going to stalk me be amusing, or go stalk some other liberal.

What a dull, serious man you are. As Althouse has been known to say B.O.R.I.N.G.; 4/24/12, 7:56 PM
Tyrone Slothrop said...: My health-care coverage through work is Kaiser Permanente, an HMO. When the company dropped its 80-20 coverage due to cost I was not happy. I had to give up a number of doctors with whom I had developed satisfactory relationships. I pictured Soviet-style waiting lines, incompetent doctors and poor coverage. None of these things happened. I have come to see Kaiser as the model of the future. They keep costs down by centralizing treatment. Expensive equipment like CAT machines are in use almost constantly, unlike the private practice doctor who must amortize equipment he only uses infrequently. Call it Costco-style medicine. I think these are some of the benefits liberals see in government run health care. Unfortunately they ignore the most important aspect at work here. Kaiser must compete with other providers for my, and my company's, health care dollars. If they get too expensive, or if the quality of their service falters, we can always bolter. With Obamacare, we will get only the care that the government in its vast wisdom allows us to have.; 4/24/12, 8:06 PM
Phil 314 said...: For whatever reason this discussion, Pogo's humorous Soviet commentary and Garage's responses remind of the birth scene in the Chinese movie To live (1994).

Barefoot doctors not so good.; 4/24/12, 8:49 PM
Synova said...: "So Obama, at the time, didn't understand that he hadn't bought collision insurance on his car and, more distressingly, doesn't understand to this day the stupidity of buying collision insurance on an old beater. He has no clue what that what cost.

Striking parallels with the nonviable economics of his health "insurance" scheme."

Oh, dear.

Am I entirely delusional to expect that the average under-educated Joe, who knows how to pay his rent and buy his groceries, understands liability and collision insurance and what "totaled" means?

I do know people who buy collision insurance for older (paid for) cars. It makes more sense, I suppose, to pay yourself into a savings account so if have to replace your beater with another beater, you've got the cash on hand.; 4/24/12, 9:14 PM
Nomadic100 said...: Dentists had the good sense to avoid getting embroiled in the Medicare quicksand back in 1965. Dentists have no incentive to treat Medicaid patients when they lose money on every patient they treat.; 4/24/12, 10:21 PM
rcocean said...: "Are you getting a social security check? Are you using medicare and or medicaid? Then you are sponging off workers because you failed to save enough for your own retirement and expect others to pay for it."

WTF? I've paid plenty of SS taxes over the last 25 years and expect to get a SS check however small when I retire. Same with Medicare and Medicade. Yeah, that's right Ken, all of of who have paid for Medicare and Medicade all are lives are just "Spongers" and "spendthrifts".; 4/24/12, 10:59 PM
Unknown said...: The good news: we have an Affordable Care Act now in force.

The bad news: "affordable" will be defined by a few unaccountable bureaucrats.; 4/24/12, 11:35 PM
Firehand said...: This is connected to something I asked before: do the bureaucrats who'll enforce Obamacare understand that when they tell someone "Yes, your mother would live longer, but at her age the treatment isn't cost-effective so she can't have it" it won't be Obama telling them "We're going to let your mother die", it'll be the clown behind the desk; and THEY'LL be the first ones the pissed-off relatives will want to deal with?

And if the IRS thinks people hate them now, wait till they start acting as Obamacare enforcers...; 4/25/12, 8:47 AM