ADDED: I don't know — and don't believe anyone could know — if the numbers will work out that neatly. Even if you pick an option and let the 10 years pass, you couldn't know, because you don't run the real-world experiment on the other option. Of course, everyone knows this. You still have to pick.
But let's assume for the sake of analysis that the 2 options cost roughly the same. Another way of putting this, is let's imagine the thought processes of an American voter who completely accepts the premise that the 2 options consume the same amount of money. Why would this person pick Option 1?
I think it would go something like this: I and my loved ones are on track to get a pretty decent share of the $52 trillion in health care services that will be provided in the next 10 years. I know everyone deserves access to health care, but I think there might some big groups of needy people — including people who are migrating to our country — who will be taking a lot more if we switch to Option 2, and my hopes and expectations, which I've built up over a lifetime, will not be met.
That is, even if the same amount of money is spent either way, there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off.
I'm not an economist or an expert on health care, and I haven't read the entire Elizabeth Warren document, and I probably never will. I loathe the subject of finance, and I respect it enough to refrain from offering half-assed opinions on the subject. All I am attempting to discuss is the instinctive emotional reaction to "socialized" medicine. And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money.
ADDED: My thought experiment, above, includes wondering about health care for all the migrants who are continually arriving in the country and who would, presumably, arrive in greater numbers in a Warren administration. Warren's plan does say something about immigration.
I support immigration reform that’s consistent with our values, including a pathway to citizenship for undocumented immigrants and expanded legal immigration consistent with my principles. That’s not only the right thing to do – it also increases federal revenue we can dedicate to Medicare for All as new people come into the system and pay taxes. Based on CBO’s analysis of the 2013 comprehensive immigration reform bill, experts project that immigration reform would generate an additional $400 billion in direct federal revenue.That is, the immigrants won't cost more. They'll provide more revenue.
पोस्ट्स
२४२ टिप्पण्या:
242 पैकी 1 – 200 नवीन› नवीनतम»The entire US Budget for 2017,was $4.2 Trillion.
I know how stupid Warren is. No big shakes. But for her to believe I'm that stupid is about as offensive as it gets.
she's lying.
SFOSICOHE...
I don't want the government in charge of my health care.
I want the opposite.
“I would cure all of the diseases! Then replace them with worse ones!” - Some character in Disenchanted.
But since it’s all going to be essentially free... Sure! What could go wrong!
I'm sure her "plan" is as accurate as her bogus "study" on rampant bankruptcies due to medical bills.
https://www.washingtontimes.com/news/2018/jul/9/elizabeth-warren-claim-medical-bankruptcy-wrong-st/
She lies with the practiced ease of Hillary.
Purest idiocy.
Changing who pays for it is not going to change the cost structure.
Your problem is that you have set up your medical industry to be incredibly expensive.
Nobody wants to mention that.
The reasons for that silence should be examined, no?
Btw, we have just had out first checkups here in THIS First World country, under our vastly cheaper private medical plan. We walked away from @200K in retirement medical benefits (which would be used to partially pay for Medigap coverage, etc.) in favor of what we have here.
Option 3.
Switch to a competitive system.
I'm doing a new health care thing in 2020. I'll be saving lots of money. I pay the doctor direct rather than an insurance company.
The market works Liz. That's why you made $300-400k per year at Harvard Law teaching one class. Er, correction. You gamed the merit system with your fake Indian status. You weren't first in your law school class and then clerked for a federal judge but somehow you ended up at Harvard, you fake.
Does she take into account all of the for profit hospitals that would close with Medicare for All? Think of any non-government hospitals in your area. Now imagine they are gone. It would be hell in Nashville, and I imagine your city.
Looks suspiciously like not math. And a tax plan.
Do not believe any Fake Indian statistics. Liz is a known liar.
Again, what do the doctors and nurses, especially the potential ones, think about all this?
As evidenced by what they actually do?
Besides, any projections prophesying developments more than 6 months ahead are pure speculation.
someone who has always assumed that a single-payer system would be better
Better in what ways?
If both options cost $52m what is the argument for changing the way it is financed? As our host teases out: to provide health insurance or plans to those that don't already have it. If that is true then candidate Warren needs to credibly explain how benefits will not be reduced for those that have insurance today. I wager that this argument will be a repeat of "If you like your doctor and plan then you can keep them"; and just as false as that one was.
Because turning a function over to the government always increases efficiency, convenience, and level of service, right?
I think it's valid to include what we currently pay out of our own pockets when calculating how much more expensive national healthcare will be for the government. I also wonder what people are thinking when they take the "it can't be done" approach to argument considering that much of the developed world does do it.
That said, Warren is making a typically Warrenesque mistake when she assumes that since Medicare hasn't destroyed the system, making medicare the system won't destroy it either.
I'm not sure where she's getting her figures from. Perhaps she's counting private expenditure and just throwing it in one big bucket as "Total Healthcare Costs"? Then the argument is that single payer is no worse because it ultimately costs the same? That's an enormously debatable assumption at best. History has shown that the second the government gets involved, total expenditures go up. You need not look any further than the saleries of typical Federal Employees compared to the analogous private sector employees.
The $11 trillion in household insurance and out-of-pocket expenses projected under our current system goes right back into the pockets of America’s working people. And we make up the difference with targeted spending cuts, new taxes on giant corporations and the richest 1% of Americans, and by cracking down on tax evasion and fraud. Not one penny in middle-class tax increases. [Emphasis in the original]
So basically she is just going to go back the the corporate tax rates that were the highest in Western industrialized countries, she is going to institution a wealth tax that is going to completely change the way our economy currently works, and wait for it...
Every person in America – all 331 million people – will have full health coverage, and coverage for long-term care.
Anybody who magages to cross the border gets complete coverage!
I have been “in. hospital” in Australia and Canada, both have coverage *for their citizens*, I got a bill both times.
Socialism sucks. Socialist healthcare sucks. Elizabeth Warren is dumb. These are excellent principles to live by.
Senator Fauxcahontas
Can you cite any examples of government programs that came in on time and under budget? I can cite one that didn't - Obamacare. Now what does Obamacare have in common with Medicare for All? That's right, both attempt to hijack 15% of the economy.
"And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money."
Medicare advantage plans versus Medicare alone offer a convenient test of that hypothesis.
You can get medicine men to treat the population much cheaper. Also boys playing doctor.
I don't know — and don't believe anyone could know — if the numbers will work out that neatly.
We do know if the numbers will work out that neatly. We know they will not. We know this because we have watched thousands of large scale government program implementations and see (1) people react to the programs by altering their behavior to maximize their own benefit which increases program cost and (2) these changes are not included in Warren's analysis.
The most recent and relevant example was Obama's claim Obamacare would save the "typical" family 2,500 / year and would reduce total healthcare spend while covering everyone. Everyone knew these were lies the minute he asserted them. We all know Warren's comments are lies as well.
And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money.
They save money by denying care, lowering quality, and reducing development of new procedures. In what sense would such a system be "better"?
The reason that seniors like the Professor (and myself) get the quality of medical care we do is because private insurance pays multiple times the rates that Medicare does. The studies are out there but I don’t have time to search and link.
Take away that “subsidy” and be prepared for a vastly different healthcare system. Of course the elite will find a way around that.
I'm to lazy, and must likely not smart enough, but infusing competition into the system seems like the solution.
Elective surgeries are getting cheaper, not more expensive. Lasixs surgery? Much better and cheaper than 20 years ago.
How?
Start by giving each baby born a govt funded HSA, add to it till they leave the educational system, or age 25. Shop for medical care. Dr orders an Xray? Go shop it.
Govt provides catostophic insurance for stuff over ? $50k ?
The details can be worked out. Turn routine medical visit into cash transaction. Whats that, 95% of all contacts?
We can work out safety nets for the exceptions.
DR's will again open small practices if they are free from all the govt regulation, and insurance operational overhead.
"there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off."
$52 tril centrally amassed will require a HELLACIOUSLY large bureaucracy to administer it 'properly'. That bureaucracy will require the most up to date buildings, built to the best 'green' standards, with lots of room for expansion, in a very expensive part of the country. After all, you want to draw the BEST possible people to work there, don't you? You aren't going to be the 'BEST' willing to live in Billings, MT, or Tonopah, NV. Shoot, all you'll get there are folks who'll work for less than you'd have to pay in DC.
So for administrative costs, you're likely looking at 25% OFF THE TOP for facilities and personnel costs.
And another 15% for 'ongoing management expenses'.
Then there's Fraud, Waste, and Abuse that SHOULD be caught by your 'top-notch' administrators, but they've been so busy putting out reams and reams and reams of directives and regulations and guidance that they haven't been able to stand up a committee to possibly address the need for a group to look at what the functions of such an office might consist of, or what they'd have to be doing.
So... lose another 25% over ten years because folks have figured how to game the system.
Let's see... figure 65% will never even see a patient that needs it.
Pessimistic? Oh, of course. Because Obamacare made some pretty grand promises that it couldn't deliver on. Why in the hell would ANYONE think that enlarging it will make it work BETTER?
And why would anyone think that a politician who has NO record of ever doing anything in the real world with any sort of success would be able to do something this complex?
Electing someone who has no management experience at all just because they've managed to stay in office long enough and slit enough of their opponents metaphorical throats to climb to the top of the proverbial food chain is lunacy.
As would be letting Warren play with $52 tril. Because you won't be getting back anywhere near what you paid for.
Both of those numbers (what the current system will cost over 10 years, and what her "plan" will cost) are meaningless abstractions. Also, if she'd really "done the math" she'd know it is unaffordable, regardless who gets taxed for it.
'better the devil you know than the devil you don't'
Hospitals complain that Medicare does not reimburse them for their costs. Would any close? How many? To be replaced by?
There are many doctors who do not accept Medicare patients - or they do not accept many - reimbursement is too low. Will drs spend the years and the money to attend medical school?
Where would the wealthy Canadians go to avoid the 6 month wait for surgery?
It's not just the cost - it's also about the future of medicine in the US. Will there be private care too?
How much more would it be if we include the Indian subcontinent?
Asking for a friend...
Google cancer survival rates in Britain and compare them with survival rates in the US.
Capitalism added 128000 jobs last month. 128000 jobs that didn’t exist before. Capitalism lets you pay bills. Socialism didn’t build that...
As a person recently on Medicare, my main complaint is that many doctors are less attentive to your medical needs because they avoid procedures that Medicare will not cover. They are not going to spend a lot of time with you because they get terrible reimbursement. They also spend 70% of their time on paperwork, according to one of my surgeons.
The analysis that no one is making should focus on how Medicare for all will affect the medical profession and those bright minds changing thinking about going to med school. How will that affect patient treatment?
Another analysis should focus on ecological diversity. When all your trees are Dutch Elm and a disease comes.... You know the rest. Diversity of insurance plans is a good thing in that sense.
Their whole "Medicare for All" depends on lowering reimbursements to doctors/hospitals to Medicare rates.
There are already numerous providers that will no longer accept Medicare/Medicaid insured patients because the Federal reimbursements are lower than their COSTS.
So sure, Elizabeth, if you can just convince the entire healthcare industry to amble down the path to insolvency, you plan is just dandy.
False dichotomy. I think I found the book Priceless by John C. Goodman and read it earlier this year thanks to a comment here. It's old (2012) but still relevant and bolstered by the author's accuracy in predicting what the ACA would accomplish.
People want prices to go away because healthcare is expensive. But prices don't go away just because you hide them. They tend to increase when you do that.
"And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money."
No, a single payer system would not be "better" in the sense of delivering better outcomes. It would vastly reduce the incentive to innovate. How many great new treatments and procedures are coming out of Canada and the UK right now? The rest of the world free-rides on U.S. medical innovation. The Warren plan and every other socialized medicine plan is going to end the free ride for the world (not that I mind) and in the process kill the golden innovation goose. As socialism always does.
I think one of the primary problems with socialists and leftist in general is that they either didn't have Aesop's fables read to them as children, or they did, and drew the exactly wrong conclusions. "Yeah, we SHOULD kill the golden goose!" "Yeah, that dog in the manger was doing the right thing by keeping all the other animals from eating!"
the Overwhelming majority of americans are happy with THEIR health insurance
a small minority of americans HAVE NO health insurance
For the Low Low, Low Low, Price, of EXACTLY what we're paying NOW
We can make the ENTIRETY of amercians have the sort of crappy health care you get at the VA
Sounds like a WIN, WIN!
So under her plan the government will pick up the 52 trill in insurance premiums, while currently most of that is by paid by citizens and the private sector. So, yeah, where is the 52 trill coming from ?
Liz claims she won't tax the middle class. So what's her tax rate for Harvard law profs that make $300k?
The calculator is ridiculous. I did it it said my health care would be free. But I'm frankly I'm not poor. and I assume my taxes would go up at least as much as the new health care costs. Probably more, because ultimately this will be a redistributive program. I'm actually fine with SIngle payer health care, but we should be clear about the benefits and costs.
Regarding projections and expectation, I attended a mid-80s conference where a speaker laid out the changes effected by the just enacted revision of the federal income tax code. His presentation was split between the short term and long term effects. After presenting the former, he cited the frequency with which the tax codes changed. He then said, "So as for the long term, there is no long term." After the laughter died down, nobody challenged him on the point.
Let me just add that Warren is a singularly obnoxious person. Watching her crash and burn would be almost as much fun as watching Hillary's world come tumbling down.
I can't even work up as much personal dislike for Sanders -- nasty, irredeemable communist that he is. He's just a cartoon of a 60s commie radical preserved in formaldehyde. Repulsive, but you can put him on a back shelf and ignore him.
Warren is just awful at every level.
She forgot to mention that she will siphon off about 20trillion of that for government regulations.
Take any decade of the past and compare ten year prognostications of the future at the beginning with the actual situations at the end of the decade.
And AA is still talking about HMO's and their advocates' projections without considering the impact on the actual health care providers; the doctors and nurses.
"and I haven't read the entire Elizabeth Warren document"
Lemme summarize it for ya,
"Everything within the state, nothing outside the state, nothing against the state"
Let's assume, and it's a big assumption, that her numbers are correct. There is something inherently valuable about maintaining control over my own options.
Let's change this a little bit. Last year US citizens spent $1.2 trillion on purchasing vehicles. Why don't we centralize the payment for cars? Why don't we do this for everything we purchase?
Because it is a loss of freedom. Even if I would save money on cars this way I wouldn't do it. No one would. Why is healthcare different?
So for me it comes down to:
1) What does the federal government do more efficiently than the market?
2) When was the last time proposed government savings actually came to fruition? And assuming you can come up with an example of this actually happening, the difficulty in doing so should indicate that a health skepticism on this is warranted.
3) When has centralizing anything led to less political acrimony?
4) What problems are so bad in healthcare that we have to blow it up and start over? Why couldn't we just address whatever those problems are?
5) Why would I want to trust the government with my health and healthcare information?
Compare doctors' and nurses' pay in the US to the pay in any single-payer country. Then describe, in detail, your plan to reduce those salaries. Show your math.
a single-payer system would be better and would save money
There's no way it could do both, and more likely it would do neither as the remaining market discipline is removed.
Option 1: Buy whatever car you can afford on the free market from the current suppliers.
Option 2: Get a car from the government. One size (small), one color (beige), one level of quality (sucks). A 5 year wait, but hey, it's "free"! You're not, but the car is.
Once college is free, we will have lots more doctors. You guys worry too much!
Higher costs and less actual health care: that's what single payer means. However you do it, this is always what it means.
The evidence is world-wide. The one exception is pre-natal health care. There are some single payer systems that do a better job than the system we currently have.
Single-payer systems always end up deciding that they have to save money by refusing to treat certain conditions. The usual criteria is age so that as you get older you become ineligible for medical treatment. Alternatively, or in addition to this, single-payer systems save money by creating wait lists for treatment which can stretch to many years in length. And of course if you're old that means you may never survive to get the treatment.
Our mixed market system, I say mixed because a large portion is already basically single-payer, also rations health care. But it's a rationing based on wealth. However unfair that may seem, the bottom line is more people getting actual health care.
The US health care system is probably the most expensive in the world. But the comparison is unfair, since we are the only population in the world paying for the development of new treatments. Other than medical research, which is a surprising small of the cost of developing new treatments, the rest of the world, or at least all of it that is single-payer, free loads on the United States.
What about Obamacare? A fail? Oh. Gosh darn it. And you were so certain too. But this time is different?
Okie Dokie then, by all means, please proceed to your next grand scheme, oh wise ones. Thank you so much for all you do.
That is, even if the same amount of money is spent either way, there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off.
Congratulations on defining Conservatism so well, so succinctly. You have also proved that one need not be “finance educated” to understand basic macroeconomic distrust of redistributive schemes. And IMO you identified their inherent weakness, such schemes require a lot of trust in the person proposing to do something and we have a really poor crop of alleged experts who do not inspire trust at all.
I don't know — and don't believe anyone could know — if the numbers will work out that neatly.
I think it's safe to assume they won't, because such predictions never do. When you make sweeping changes in policy that affect hundreds of millions of people and trillions of dollars of economic activity, it's impossible to account for all the consequences. At worst, the predictions assume there will be no such effects; at best, they try to account for some, but the prediction is still unrealistically optimistic (because, after all, you want an argument why the sweeping policy change is clearly a good idea).
From a purely rhetorical point of view, this is a massive political error. I know it is common to promise unbelievable things in political campaigns, but this one, coming after Obama's demonstrated "errors" in selling the ACA, is just fucking stupid. Basically, in that political manifesto, Warren promises to give everyone, including illegal immigrants, more coverage and benefits than they have today, but at a lower overall cost. However, not only at an overall lower cost to the country as a whole, but promises to give back the average household with private coverage today their $11 trillion dollars over the next ten years.
Could this be done? Sure, but the methods of raising the revenue combined with the promises of benefits will surely result in the program costing at least 50% more than promised (people with "free" coverage will overconsume it at every opportunity- I literally have witnessed this first hand with my parents on Medicare combined with my father's UMW retirement benefits), while the attempts to tax corporations and the wealthy will end up, as they always do, resulting in far less revenue than the initial projections expected (accountants and lawyers are more clever than government apparatchiks). So, in the end, the people paying for their coverage today will still be paying for their coverage under Warren, but then also paying for all the new beneficiaries and all the new benefits.
Doctors and nurses are all over the place. But it's always Awful Now, and couldn't get any worse, blah blah. We should have single payer, even when UK medicos tell them about that awful system. And they aren't finance people either.
Don't look to them for much leadership.
"Better the devil you know than the one you don't."
So, option 1 wins, hands down.
Besides, everyone knows fake Indian speaks with forked tongue.
Robert
Socialized medicine always ends with waiting for months for critical care like chemo if one becomes very sick. The rich end up going to private clinics/hospitals/doctors but the poor and middle class suffer in those lines.
Is it too selfish to ask "What's in it for me?"
I've lived with and used socialized medicine in the first world and the second world.
There is a lot of good in both. By far the best was in Germany with their multi-payer system. There everyone has access to basic healthcare. But employers pay for private health insurance which gets private clinics and private hospitals with the most advanced technology. No way that would be allowed in this country.
The, all intents and purposes, single-payer in post Soviet Ukraine was ok but lots of problems too. My favorite cabbie was an ER doctor working a part-time gig to make ends meet. I had access to doctors and clinics but I had to get there early in the morning and sit and wait until my name was called. it could take all day if you were there for something a little bit complicated, like an ultrasound. My Mother-in-law had breast cancer mastectomy and chemotherapy without any delays or complications. She still goes twice a year for blood work and still cancer free.
I originally thought the Dems and Trump would team up and pass some type of universal healthcare. But there psychological breakdown prevents them from thinking logically.
Don't worry folks! Uncle Joe is going to cure cancer.
He will do that without the drug companies and the medical research system built up over many years in the US. He'll put Hunter in charge!
Li'l Tomahawk:
Open Borders!! Unlimited 3rd world immigration!! Free health care for all illegals!!
How much will it cost to provide "free" healthcare for another 50 to 100 million people?
I do think that the net cost of health care is the wrong issue to argue. I think the conservatives are wrong to say that the Warren plan will cost more or raise taxes as a logical argument. It is helpful as an emotional argument because it is true that the funding will come in the form of direct taxes, but this is only cost shifting. Instead of your employer paying the fee which eventually does come out of your paycheck (the same argument that corporate taxes just get shifted to the price of a product) You pay it directly. So it is true it raises taxes, but them employers cam make it up by increasing salaries.
The first problem with the plan is that you have fewer rights and protections for your health care. One entity, the government not only gets to decide what coverage you have, they also act as arbiter when you have a dispute. If you have insurance companies deciding, you then have a third party who can act as arbiter in the government.
The second problem is that the government has no competition, and therefore no incentive but political to improve things. But since people can never directly vote for heath care issues, they cannot easily remedy any problems. Look at EVERY issue that the government manages. People complain all the time about the inefficiencies of government, but then they vote those same politicians in because of some hot button issue such as guns or abortion. We lose control of our health care this way.
Third. Rent seeking. There are people attracted to money and power. They will attract others with like mindsets and they will make sweetheart deals to help each other out. The weak, the less unscrupulous, and the politically under-represented will receive the short end of the deal every time. Because health care consumes such a large portion of the economy it will have significantly higher attraction by the rent-seeking crowd. Big money draws big flies. People will find ways to milk the system to get easy money and there is a lot of money to be had.
Fourth. Limited innovation and interest in improvement. If the money comes in the same whether you perform well or poorly then the default is to perform at a lower level. You won't work to solve problems. The customer will have no ability to motivate you. You get paid whether they are satisfied or not because they can't choose an alternative.
The best system is when the consumer has all the control. The worst system is when the government has all the control.
And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money.
A system of indentured servitude might be even better and save even more money. If we're really clever we can structure it such that our healthcare providers remain indentured the entirety of their careers, saving us even more. And why stop there? Let's just create an entire single-payer economy.
Do her estimated costs include vision and dental? 🤓
All government cost estimates are underestimates, usually way under. As to Warren, the lady isn't honest to begin with.
There are never just two options.
Didn’t she vote for Obamacare?
Here is the argument against in a nutshell. Markets are the best social technology we have. We should strive to make healthcare a better functioning market. There are many ways to try this, but “single payer” is not among them.
I think it's valid to include what we currently pay out of our own pockets when calculating how much more expensive national healthcare will be for the government. I also wonder what people are thinking when they take the "it can't be done" approach to argument considering that much of the developed world does do it.
I used to follow Megan McCardle before she went round the bend with TDS. She had an interesting column once on the theme: "Just because other countries can do it, doesn't mean the US can do it". The US is different in all sorts of ways, from size to different levels of government all fighting with each other to people's level of trust in the government (at any level) to lack of social cohesion to constitutional barriers and what have you.
Under a single payer plan more people will suffer for longer,and more will die sooner. Health care workers will be paid less, and far fewer breakthrough drugs and treatments will emerge. That's the record of socialist systems in healthcare and everything else.
Can people not look at the numerous past and present experiments with socialism and deduce the most obvious conclusions? On top of that, I think full-blown socialism in America would be the most disasterous of them all and the most contentious. It's un-American at its core, and it's at odds with what made us so successful throughout our history, avoiding the mass killing and slavery of other nations. The socialism we do endure here is only made possibly by the power of the rest of the free-market economy. An economy that is the envy of the world right now. So yea, lets just throw that out for a famously failed idea.
Unfortunately, due to a lack of creativity and education, the Democrats in order to offer an alternative to vote for, need to offer one that is different than the incredibly successful situation we are currently enjoying. They need to lie about that, and tear our success down. Of course we have things that need adjusted and fixed, but fundamentally transforming the nation is an incredibly stupid alternative, especially coming from the very same people who screwed up our former health care system, lied about it's potential, and passed it in the dead of night without a single Republican vote. Those are the people you are going to trust with this...AGAIN?
On a more serious note: that quoted $52T is better off in the hands of those who earn it and not the fucking government’s.
Think of the nudging your betters can do when they can gatekeep your access to healthcare.
You'll be a good person finally. How do you put a price on that?
Does anybody expect the government to supply better health care? What else does the government provide better than the free market?
Math is hard.
100% of all the wealth of all the millionaires won't run the Federal Government for 7 months.
Isn't this how Hugo Chavez got elected.
"Better in what ways?"
My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much), and that it's a horrible burden on people to figure out insurance matters and to feel anxiety about what to pick and how to pay for it, and that it's screwy to have it connected to employment (given that children and sick people are especially in need of health care and are not in the best position to be employees). I understand the concept of a free market, but it's already not a free market, and it can't be a free market for a number reasons because the product relates to health, and relates inversely to the ability to get money to pay for it.
They told us to turn up our AC so that it is 80 degrees in our homes in the summer, and to turn down our heat so that it is 60 degrees in our homes in the winter.
Then I got my utility bill and found that by doing so, I saved about $5-10 per month.
Screw that. I'll pay the extra so that I'm not sweltering or freezing.
The progressive cost-benefit analysis did not work.
Does her calculations include health care for everyone from the Third World that can drag themselves across our open borders?
Imagine the money to be made by connected individuals (see Hunter Biden) when politicians and their friends and family get their hand in there. It will be scandal after scandal that will never be really be punished or slowed down, (see the VA system). People will still get rich as they do now, but it will be different people - not people who succeeded via merit, but by knowing or marrying the right people. I think that's a poor incentive system that rewards relationships over ability and merit. See Venezuela for examples.
The federal government has neither efficiently nor cost-effectively managed any program. Ever. Can anyone seriously affirm that our educational system is better or more affordable for the federal takeover? Giving them any additional power and control is not only economic disaster but a Great Leap Forward toward a totalitarian state.
It is true that much of the health care system here sucks because it is too bureaucratic, too complex, too expensive, and nobody can understand a bill.
But within this complexity there are many good doctors and nurses. I've had to go to the Emergency Room twice in my life, and both times the care was excellent.
Warren -- a quack politician -- won't address any of this. She'll just make it much worse and take away your private health insurance, even if you think, on the whole, it works pretty well.
"My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs “
Yes. I am all but certain that replacing non unionized employees with 401Ks with Federal employees with gold plated retirement plans and which would likely end up one of the largest voting blocks in the country, will cut costs. because we all know how easily one can insert efficiencies into the Federal workforce as they are discovered!
This is bullshit because anywhere in the world where single-payer, and this goes way beyond “single-payer” has bee introduced, it comes from regressive taxes, because that’s the only way to get the money you need. Warren’s ideas about destroying the wealthy classes to pay for this are a fantasy.
Plus, once government is in control, the medical research goes towards the women. There will be millions for breast cancer research, but prostate cancer research will be limited to studies that prove we are spending too much already.
The big research that has come out of Canada in recent years is the HPV vaccine, a good thing! But it is not just random chance that it was largely about cervical cancer.
It'd be preferable for poor people like me to die in dignity or whatever, rather than force other people, essentially at gunpoint, to pay for their medical care, but "A new analysis has found spending more on health care has little impact on improving key health outcomes. It found that a 10% increase in health-care spending reduces the number of deaths by only 1.3%, and increases life expectancy by only 0.4%."
including people who are migrating to our country
This here is the rub, isn't it?
Warren has no plan to stop illegal immigration. It's the opposite of that. She wants more and more immigration. Legal and illegal, it doesn't matter. In the view of Democrats, we have to take care of the world.
So, we aren't talking about taking care of ourselves with her Medicare for all plan. We are talking about taking care of the entire world. Or at least, anyone who can make their way here.
Liz Warren loathes finance and economics. She thinks GE doesn’t pay taxes because she doesn’t know what a tax loss carryforward is. She’s dumb. She wants to be President.
On the other hand, I have had a friend die of lung cancer who couldn’t afford a doctor until it was too late. I might support single payer if the funding were based on the models that have “worked” elsewhere. This is a difficult problem and if there were not trade offs, it would have been solved by now, you know, like electricity generation and building highways.
Speaking to the point of voter trust in government intervention, most of the voting population was around when Obamacare was going to fix all the problems that Warren's plan is really going to fix this time. A lot of people who believed the first will double down, but a lot won't. And nobody who wasn't buying Obamacare is going to have their minds changed by Warren.
Hunter at 9:36 AM
People want prices to go away because healthcare is expensive.
Pricing is capitalism's huge advantage over socialism.
A price is full of information that drives efficiency and innovation.
Instead of pricing, socialism uses political pressure.
In socialism, decisions about allocating medical resources are political decisions. If the top socialist suffers from gout, then he will allocate the country's medical resources toward the research and treatment of gout.
In socialism, the squeaky wheel -- the political activist -- gets the grease.
In capitalism, the profitable innovations get the investments.
There is a lot of waste in our current system. The way to fix that is competition, transparency of costs and pricing. If patients could see what things cost and control their own cost by choosing what they want or need, enormous savings and superior experiences would be immediate and profound. Doing that would be a fraction of the cost, without any of the risks. There will be money to be made, but only if you give people what they want, and it has to be real to pay off. You can't just keep promising things and never delivering as they do now with our politicized system. What are the risks of transitioning to that?
Althouse wrote:
"My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs"
I think that last part is incredibly naive. The intuitive theory you are drawing from is that if the government controlled everthing it could effectively control costs, but the actual experience (see public choice theory) is that the government does a far worse job in controlling costs. The incentives for controlling costs in the private sector are different than in the public one. We are watching a real life example of this in the Chicago teacher strike- the city is fundamentally bankrupt because it couldn't control the costs of public education, and is prepared to go even deeper in the hole because the the fundamental control of financial solvency doesn't even matter to the people in charge.
OK..how do you square : I loathe the subject of finance, and I respect it enough to refrain from offering half-assed opinions on the subject.
with:
And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money.?
You tell us you refrain from offering half-assed opinions, and then immediately give us your half-assed opinion!
It's simple. Everyone assumes they end up paying less. Thyat somehow evil profits would be removed, and typical government corruption not substituted at a high multiple to the total profit. (even those who's brains are switched off assuming it would be cost neutral).
As Gene Wilder put it in Blazing Saddles, "They're morons."
Higher costs and less actual health care: that's what single payer means.
The sky-high cost of the healthcare system (like education and increasingly housing) is due partly to the involvement of government -- and private group plans -- disrupting a truly free marketplace. Medical providers will charge as much as they can -- with costs disclosed AFTER the provision of services -- because they know that someone will pay. Additional government intrusion will only make things much worse.
The other factor is the medical culture here, which has become elitist and feels entitled to be the highest paid people in the economy. Same with "educators" and also with many lawyers, by the way.
Ann Althouse said...
My intuitive non-expert feeling is that ...if the government ran everything, it would control costs
Like it does in education and military contracting? It's amazing that no matter how often real-life shows us government involvement increases costs people insist on concluding the opposite.
it's screwy to have it connected to employment
Which is why we should decouple insurance from employment, after all you don't buy your car insurance through your employer. But in fact insurance through your employer is another example of government interference. In WWII government price controls meant certain companies could not offer more pay. Because government needed these businesses for the war effort it allowed them to offer other benefits so they didn't have to completely rescind the price controls.
Now we claim employer involvement justifies single payer. As each step of government control proves insufficient to deliver the desired outcome the natural response of those who believe the economy can be controlled is an additional level of government authority. This is why government "regulation" is on the path to socialism and beyond. Hayek referred to this as the Road to Serfdom. Similar to other roads this one may be paved with good intentions but that does not change the destination.
Althouse says: I know everyone deserves access to health care[.]
Every person on the planet? Every American citizen on the planet? Every taxpaying American citizen on the planet? Every person within US controlled areas of the planet? Every taxpaying person within US controlled areas? Every citizen within US controlled areas? Every taxpaying citizen within US controlled areas? ??
Access to health care? Door-to-door transport from residence to facility of persons' choice to receive any and all desired medical treatment? ... ... ... If you can get here, take a number and have a seat; we will take your vital signs, also give you an NSAID if we have one.
Ann says it cannot be a free market. Ask the Swiss.
Perhaps it cannot be a “free market” if you mean complete liaisez faire. There are serious arguments for that. But that isn’t really relevant, since we are looking at forms of intervention to ameliorate the known market failures. The biggest market failure is non participation. That can be ameliorated by subsidies. Again, as the Swiss or the French. A better, more honest, Obamacare is such a system, but you have to admit you are taxing people to do it.
I was taken to hospital in Sydny in an “ambulance” that was basically a pickup truck with a guerney and a couple EMTs with a black bag. In the US, an ambulance has more life saving equipment in it than the emergency room did in that hospital. There was a cute Tai nurse there who flirted with me a lot though. She even offered to help me wash off in the shower. I still wonder why I said no.
What about the lawyers? Are they still going to be able to sue over every little mistake? Or are their objections going to be mowed down along with the doctors? Even Obama wouldn’t take them on, as he said “for political reasons."
Your problem is that you have set up your medical industry to be incredibly expensive.
It didn't use to be. What we have now is a system in which insurance companies pay all claims, even for $50 office visits. The processing costs are about 60% of that amount, maybe more. As a surgeon, my overhead was about 30%. For primary care like internal medicine or pediatrics, it would be close to 70%.
I know a number of older docs, mostly GPs and internists with no student loans and kids educated, who dropped all insurance and practice for cash,. the way it was done in the 1950s before everything got so expensive. They tell me their overhead drops 75%. No back office staff billing insurance. I even met a young woman who was practicing Geriatrics in Iowa. She was getting harassed by Medicare for seeing her homebound patients too frequently. Geriatrics is a university specialty, almost impossible to make it on private practice. Medicare pays too little. She now practices on Visa and Mastercard and is making a living.
""A new analysis has found spending more on health care has little impact on improving key health outcomes."
Likely because we are now at the level of health where we die of one thing or another after living far past our ancestors, regardless of what we do. At a certain point, it is inevitable due to genetics and a lifetime of choices long past. Once there, you can spend all you want with no effect.
If you believe that incentives matter in making economic decisions about life, you will come to the conclusion that countries with non-socialist policies will attract opportunity-seekers, risk-takers, entrepeneurs, inventors, non-breeders and the self-reliant, while socialist countries will attract the comfort and security seekers, the risk-averse, bureaucrats, breeders and those who prefer fulfilling their needs and pleasures, whether education, health care, or family leave, at the expense of others.
US Medicare already spends as much as Canada does for universal coverage.
Add to that all the extra US spending through other government programs, State and Fed, an extra 25% or more.
You already have the means to do complete socialized medical service delivery, if you really wanted it.
But Medicare, and others, are at least as bound as the private insurance carriers.
The hitch is costs.
I must be insane. The whole problem is obvious, 1+1 is 2 obvious.
But there in America it is all blind people. Or you are under some sort of spell.
American Education is the same.
It’s already kinda socialist so let’s go full socialist is stinkin thinkin. Move it more capitalist and the 90 plus percent of people who used to be happy will be happy again. Government can subsidize premiums for the rest and they will be happy. No loss of quality or innovation. Quality and innovation might improve
There was a urologist who commented about the guidance that said that doing tests for prostate cancer every year had proven to be wasteful that “maybe. so, but I don’t miss the wards full of men dying of it."
Ken B: "Here is the argument against in a nutshell. Markets are the best social technology we have. We should strive to make healthcare a better functioning market. There are many ways to try this, but “single payer” is not among them."
Wrong wrong wrong!!!
Everything you said was absolutely correct.....
But here's the political argument: The dems will take away your healthcare to enslave you in their "post office of medical care" and give your tax dollars to illegal alien MS13 machete murderers and to fund unlimited abortions where they will sell the little baby body parts along with providing gender transition surgeries for 8 years olds.
How much will it cost to provide "free" healthcare for another 50 to 100 million people?
Don't worry, Drago.
According to my calculations, the 2 options, being roughly equal, will cancel each other out...like...mathematically. So basically, after 2020, no matter what happens, health care will free.
So be happy. This is a good thing.
Althouse,
My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much)
I understand the sentiment here, but I disagree with the conclusion. I think political pressure does not work the way you would like it to. I explained above my thoughts on that. Government will respond to what pressures it has; direct control over health would be diffused by all the other political issues. People vote package deals (R or D), so there is less control for the people. Also, Government has no history of controlling costs. I am not sure how you can justify your faith in that.
and that it's a horrible burden on people to figure out insurance matters and to feel anxiety about what to pick and how to pay for it,
True. Picking a car, buying a house finding a job, choosing a college all are complex and scary things. One choice for all of them would make everything easier, but it is not a good option. There are other potential remedies for this than just removing choice.
and that it's screwy to have it connected to employment (given that children and sick people are especially in need of health care and are not in the best position to be employees).
Remember HOW this got to this point? Government messing with the system. I agree that employer paid plans are the wrong way to do this. My wife and I have experienced periods of unemployment where insurance was lost. This is a really bad system. But there are also other solutions. Give the tax break back to the employee and let the company pay the employee the money they pay for insurance. We do not need government to take over to solve this problem.
I understand the concept of a free market, but it's already not a free market, and it can't be a free market for a number reasons because the product relates to health, and relates inversely to the ability to get money to pay for it.
I also think there are other solutions. One better solution I can think of would be a lot like school vouchers. Have a true Insurance voucher. Not a health care voucher. Insurance in that it covers the catastrophic only. Individuals can then pony up for their own level of personal care after that. I am not a full "no government involvement" libertarian. I think we can give protection for the poor by providing the funds for catastrophic coverage, let the charity system pick up the routine care for the poor, and then everyone else can choose their own level of service. It's more complex than that, but I don't want to write a 20 page paper on it right now.
Since I was married to a doctor, I can tell you that it is an extremely tough job and very hard to become one. Hunter Biden and Hillary's daughter couldn't do it. Docs should get paid the most. They save lives.
Hospital and insurance company executives, on the other hand, are paid way too much. But I can't complain as that is more or less the free market.
Children's Hospital here in Omaha was wildly mismanaged. The head pharmacist stole millions and it went on for years undetected. And then the CEO yanked the privileges of two surgeons who ratted out an incompetent employee doctor. The CEO is now fired. Children's Hospital is top heavy in management and the Board is asleep. There is just so, so much cash washing around the system.
"it can't be a free market for a number reasons because the product relates to health, and relates inversely to the ability to get money to pay for it."
Of course it can be a free market. Food is a free market. Shelter is a free market. Transportation is a free market. Entertainment is a free market. About the only heavily un-free markets in the U.S. are healthcare and education, both of which are consequently perpetually screwed up. There is no inherent reason that we can't purchase healthcare in a free market just like any other good or service. None.
Option 1: spend your $$ and time as you decide best will satisfy you.
Option 2: send your $$ a thousand miles away, to be spent as determined by layers of bureaucrats over whom you have insignificant influence, whose decisions may also constrain how you spend your time.
The gov't runs the DoD. Private co's vie for contracts to provide the DoD with products and innovations. Since these private sector suppliers have never charged any cost overruns to the gov't in defense contracts, I expect we should expect the same low-cost medical innovations with the gov't in charge of health care contracts.
Government controls costs by rationing. Capping salaries. Punishing ‘corporations’. Government worries about not having the right amount of minority and gay doctors at your hospital. Your hospital uses too much fossil fuels? You pay one way or another...
Blogger BleachBit-and-Hammers said...
Google cancer survival rates in Britain and compare them with survival rates in the US.
When I looked and shared with a lobbyist friend about 2 years ago, they were consistently about 10% lower that the U.S. The Demogogue party wouldn't think of sharing these facts with our citizens.
"And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money."
Perhaps you could name another instance where allowing the government to run something has saved money?
More than 10 years ago my primary care physician told me it would be financially better for him to put a basket of $20s on the reception counter, and give one to each Medicare/Medicaid patient that would just leave without seeing him. I don't imagine that's changed.
Now, imagine the entire medical industry lacking a financial incentive to provide care while everyone expecting care has zero price sensitivity or no financial disincentive in the amount of care they demand.
The law of supply and demand is probably more immutable than the law against traveling at greater than the speed of light.
One other comment i would like to make about cost of care.
I have several special needs children that I have adopted, and I use a higher portion of care than average for some of them (For myself my insurance company has made a mint off me so far.)
When I take my child into the local Children's hospital I am amazed at the level of service and amenities. Sometimes I feel I am given 5 start hotel service there. When I am there, sometimes we see 5-6 providers when I think all we really needed was a nurse for vitals and a Dr. for the care. There is a cost for all this and I pay nothing for it. I am divorced from the payment system. Because there is so much money spent to make us feel like a king, there is less money available for other things. Government taking over would remove this elite service, I am sure. However, I would prefer to have the option to stay at a 3 star accommodation hospital if I wanted to save money. But I don't have a choice. So my insurance company pays premium when I don't really need it. That drives some of the impetus to "fix" healthcare because it costs so much. Again, I think there are better choices then government take-over to fix this.
Capitalism added 128000 jobs last month. 128000 jobs that didn’t exist before. Capitalism lets you pay bills. Socialism didn’t build that...
I saw that factoid this morning. A panel was 'analyzing" the number. One guest also noted that the previous two months job number were adjusted. Higher. 90,000 jobs MORE than those previous months releases announced. I thought back to the previous years and remembered that, after the fact numbers were also often (always?) adjusted...down. So over the last 10 years job numbers were announced higher then corrected to lower numbers, but now, numbers are released, and then adjusted up. I saw it once said, that perception is reality. It seems the govt worker bees are invested in managing the perception, then quietly make an adjustment to square with reality.
The British NHS is peculiarly bad and peculiarly cheap, as socialized medicine goes.
They spend about half what Canada does, PPP adjusted.
’My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs...
Indeed.
"She even offered to help me wash off in the shower. I still wonder why I said no."
Perhaps you should buy the "How Gay Are You" app.
About the only heavily un-free markets in the U.S. are healthcare and education,
It's revealing to consider the Dems approaches to these industries. They both have out of control cost increases where funding is largely controlled by government. But that's where the similarities end.
What we mean by "healthcare" changes every year with new treatments available. So the product we're paying for is different (better) over time.
On the other hand to the extent education is different it's largely worse. The costs are not related to improvement but rather to non-educations costs supported by political activists who control the system.
Since we have two industries with out of control costs why do the Dems plans for them differ so greatly? They want to control healthcare and claim this is to control costs. they cite high costs as a negative justifying their change to the structure. In education however their plan is to throw more money at the problem but hide it by charging taxpayers rather than the receivers of the education?
I'll suggest the difference in treatment is not despite the different causes of the massive cost increases in these industries but rather because of the different causes.
The last time government fixed healthcare my costs quadrupled.
I can't afford any more fixing.
My self employed family members had their costs go up even more.
I can't imagine that running everything through a government bureaucracy could possibly make it either cheaper or more accessible.
When has that EVER happened?
and lets not forget we have 7 times their population, we have 5 times the germans, and 10 times the Canadians,
I am not aware of ANY mechanism in government that incentivizes it to "control costs". Ever. In fact, the opppsite happens - the only reward a government agency gets for coming in under budget is to have its budget slashed the following year, so when they do come under budget, they will create enough make-work and waste to ensure it won't appear so on paper.
This is the precise reason that socialized medicine fails every time. It lacks the incentives to control costs that private industry does. That cost control is seen as a factor in *favor* of socialized medicine is frankly terrifying.
Elizabeth Warren has shown numerous times, her lack of fundamental understanding of free market economics. Who does she think is going to pay for the large tax increases laid on corporations? Does she think corporations just say, 'Hell, it's just our bottom line. Our stockholders won't care if that shrinks and our value deceases."
They pass those tax increases onto the paying public-in the form of price increases. Their customers pay that tax. To suggest the middle class will not see a tax increase is incredibly naive. Even for a Harvard professor.
In 1965 the predicted cost of Medicaid by 1990 was to be 12 Billion. In 1990 it was costing us 90 Billion. That was then. Imagine how far off Elizabeth's numbers are in today's numbers. This is preposterous. She's preposterous. Surely the Democrats can put someone better up front than Elizabeth or Bernie???
as someone (iowan2?) said,
Things like Lasik eye care are Much better, and Much cheaper than they used to be
Things like Breast enhancement surgery are EVEN cheaper
Why is it, that medial procedures NOT covered by health insurance (or the Government) are DECREASING in costs, while procedures that ARE covered continue to skyrocket?
Hmmm.. kinda makes you wonder
All medical procedures should have price tags attached. Yes our current system needs some tweaks but in the direction of free markets, not a government run system.
US Medicare already spends as much as Canada does for universal coverage.
Sounds like a bargain unless you are comparing per capita. Also, of course a significant share of Canadian care is outside the system.
Private clinics in Canada and outside Canada take a share of those who can afford them. I was at a Toyota CQI conference a few years ago. The guy sitting next to me was the architect building the first new hospital in Canada in 25 years. There was a tremendous exodus of doctors in the late 80s when they went to the "Saskatchewan Plan." I used to go to a laparoscopy meeting in Saskatoon every year. Then one year it was no more. All the faculty had emigrated and were replaced by foreign grads from Pakistan. In England, 10,000 young doctors have emigrated in the last few years. Canada closed nursing schools.
even if the same amount of money is spent either way, there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off.
Take it one more step: . . . unless you either are a member of a politically favored class or have personally cultivated the political connections necessary to evade the rules that apply to others.
Leftie programs are designed by politicians that loathe finance but are disguised as economists. They ignore adverse selection, unintended consequences, negative externalities because they don’t know what those things are. They guess that people never change their behavior or that they never respond to incentives.
If the problem was progressive cost, then a single/central/monopoly solution would be the choice. However, there is evidence that the problem is progressive prices, schemes backed by government, that sabotage market forces to produce a product and service that is affordable and available. Yes, immigration reform (e.g. illegal immigration, excessive immigration, cover-ups of collateral damage from social justice adventures) is a clear and progressive problem, too.
My spouse works for the local government hospital. It's pretty good at what it does - mostly last resort care for the indigent and low income population. It is a thoroughly socialist institution, paid for by the taxpayers. The director got a pay and bonus package this year of around $25 million. The doctors are paid fairly. The nurses are paid fairly. The plugged-in administrators get rich. The system takes care of its own. This is doubly, triply, fourply true of socialist systems.
My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do,
Also known as protecting against fraud and unnecessary care.
If this "complicated work" isn't picked up somewhere in a single-payer system, it's going to cost a lot more than $52T.
talk to people who have needed life saving treatments in Canada or Britain or Germany. It's a nightmare.
So called 'free" heath care isn't free anyway. Get in line. We have such an amazing system and the left want to throw it all away. Look at the tax hikes needed to pay for it. It's shuffling deck chairs on the titanic.
People confuse market and barter economies, where the former can accommodate but is not the latter. They misunderstand how free markets (e.g. democratic systems) dynamically optimize supply and distribution. Also, market economies (e.g. capitalism) are not defined by profit, but it exists as a factor in a distribute system, an incentive to human productivity, and feedback to direct its evolution.
American arguments over all of this aren’t realistic or rational, not proper considerations of public policy. It is rather a sort of perverted theater. Fake emotional narratives with facts treated as macguffins.
Veterans Administration health care is what he offers. The costs of that is three times what she proclaims and first does any harm the bureaucrats can do. Warren’s plan actually proposes enslavement of medical personnel and enthronement of Medical Administrators.., just like EDU that spawned her has done at warp speed.
When the government shows it can run something simple like the DMV efficiently, I might consider letting them run something complex like Health Care.
But to believe that "My intuitive non-expert feeling is that ...if the government ran everything, it would control costs" is to believe that no incentives are required to make things better. Coyote blog has a maxim "government agencies are run for the benefit of government employees, not for the benefit of the service users". A simple example of that is the fact that many government agencies that serve the public are closed on Saturday and Sunday when the public has the most free time and the most opportunity to access them.
I wish Warren wasn't so far left. She's far better than Hillary in so many ways.
How about more of this?
https://www.forbes.com/sites/brucejapsen/2019/09/13/walmarts-first-healthcare-services-super-center-opens/#5590e7cf79d2
John Henry
"On the other hand, I have had a friend die of lung cancer who couldn’t afford a doctor until it was too late. I might support single payer if the funding were based on the models that have 'worked' elsewhere. This is a difficult problem and if there were not trade offs, it would have been solved by now, you know, like electricity generation and building highways."
What makes you think it wouldn't be? (And why the quote marks around "'worked' elsewhere"? Various types of government-funded medical care have worked and do work elsewhere.) There is no one way of designing such plans, and there are various working models to emulate.
She's lying.
I think it would go something like this: I and my loved ones are on track to get a pretty decent share of the $52 trillion in health care services that will be provided in the next 10 years. I know everyone deserves access to health care, but I think there might some big groups of needy people — including people who are migrating to our country — who will be taking a lot more if we switch to Option 2, and my hopes and expectations, which I've built up over a lifetime, will not be met.
That is, even if the same amount of money is spent either way, there's an instinctive fear that if the money is amassed centrally and redistributed, you'll be worse off.
That's not "an instinctive fear", that's "a correct assessment of reality".
The Democrats are trying to pull "upper middle class, college [indoctrinated] 'white' people" from Republicans.
Those are the people who will be utterly screwed by Warren's plan. They've got theirs. They will lose theirs so that other people can be taken care of.
Very few of those people will vote for Warren, and a Democrat in the House and a Democrat in the Senate.
Many will vote against all 3, just to protect themselves and their kids.
Warren as Dem nominee would lead to an utter wipeout of Democrats in 2020
The abortion industry would thrive, though...
Docs should get paid the most. They save lives.
But it doesn't take much to see that as a form of extortion.
There was a time when virtue was largely its own reward.
tim maguire said...
I think it's valid to include what we currently pay out of our own pockets when calculating how much more expensive national healthcare will be for the government.
Sure. No problem!
"Hey voters: take every $$$ you are currently 'paying out of pocket' for your health care. Every co-pay. Every prescription payment. And those all up.
You personal Federal taxes will go up by that amount in order to fund M4A"
That's a totally winning message
"Pay the same, get less! Vote Democrat in 2020!"
Because all those new "immigrants", who currently aren't getting anything from the US healthcare system, are going to be added. And their costs come out of your pocket.
This plan is terrible. She plans to fund it by freezing all private insurance premiums employers pay out and having that money go to the government to pay for healthcare. This means that employers that have been generous will in fact be forced to subsidize all others. Their employees will have no incentive to work for them anymore since their healthcare will be the same as everyone elses - crap. It's even worse for small companies <50 employees. Small companies with no current plan will not be asked to contribute. Small companies with a current plan will be forced to hand over that amount to Lizziecare. All of a sudden the more generous small company is less competitive than their rival across town, with no incentive to offer prospective employees to encourage them to join. This plan is utter communist crap.
I'm quite confident healthcare quality will go deeply down - I'm Canadian and have experienced the rationing, wait times, lack of doctors all my life. I live in a tri city region of about 500,000 population. They are currently 20,000 people without even a family doctor, don't get me started on specialists.
Personally, I'm tired of the health care subject and it's not in my zone at all, so don't expect much participation from me. I answered someone who asked me a question and now people are responding to that. I have to say that I'm not going to keep responding. Please take that to mean nothing other than that I am not interested in this subject. It's important but it's not for me.
"On the other hand, I have had a friend die of lung cancer who couldn’t afford a doctor until it was too late."
In the US hospitals must provide medically necessary treatment regardless of ability to pay (if they take Medicare, and virtually all do.). So this is bullshit.
"It's important but it's not for me."
You have kids. They must feel so loved.
Ann stated the following: "I loathe the subject of finance, and I respect it enough to refrain from offering half-assed opinions on the subject." Everyone here is arguing cost (finance). That is not driving Ann and millions more like her. It's about "justice" - social justice. You ever see those commercials put on by animal protection orgs? Or third world sick/malnourished/uneducated children sob stories put on by "health" (wealth transfer) orgs? Those images pull at your heartstrings. And for only 19 cents a day you can save a life, etc. Liz Warren doesn't give a hoot about cost anymore than Obama did. It's all about the narrative of feeelllzzz. But if implemented someone will have to pay and it won't be our political caste. People like Ann will be able to pay and so will I, probably. But millions of "hard-working Americans" (boy, do I hate that term) will be screwed and they won't know it until it's too late.
Low cost
Comprehensive high quality coverage
Available to everyone
Pick any two of the above......
Ann Althouse said...
"Better in what ways?"
My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much),
"Costs" are voters (doctors, nurses, every other hospital employee).
"Costs" are gov't contractors who spend 10% of what they make in "campaign donations", then go visit their Congress member or Senator whenever the bureaucrats try to put the squeeze on them.
So, no, it is litterly not sane to think that "the gov't will control costs better than private businesses will".
Skylark said...
On the other hand, I have had a friend die of lung cancer who couldn’t afford a doctor until it was too late.
And I've got multiple family members dead of cancer, who had perfectly fine health insurance.
In one case it was because the (possibly overworked) doctor didn't keep an eye on that "suspicious nodule" until it was too late.
So, by all means, let's make every doctor more overworked. i'm sure that won't kill anyone
American arguments over all of this aren’t realistic or rational, not proper considerations of public policy.
I don't disagree. What we see is a variation of politicians offering free stuff.
The NHS was enacted at the end of a war that nearly bankrupted Britain which did not have much of a safety net before the war. Read AJ Cronin's novels, which I have, to see what the health acre situation was before the war.
Sometimes the sadistic side of me hopes single payer comes to pass. Imagine the look on the faces of all those progressive public sector union employees when they realize they have to trade in their gold plated insurance plans for the same government managed generic healthcare forced on Joe Sixpack. Now that would be epic.
Of course reality hits when I realize the liberal elite will just create exemptions for themselves, leaving the leftover scraps for the rubes.
No disrespect. I understand what you mean, but still, this is an issue that will greatly impact all Americans for decades or more. And people will vote ideology without understanding. That is a scary proposition. I would suggest that health care is one of the top issues facing our time and I would like people to vote with understanding. It's rather important that votes are informed. In fact, it becomes almost a point of ultimate irresponsibility to both advocate for the government to take over functions of our life and not be totally informed about what it is doing. If you want government control and you believe that the government is accountable to the people, then you would need to have even MORE engagement in the processes the government engages itself in, not less. To vote to turn it over to the government with the assurances that it is accountable to the people and then abdicate your full oversight of that process seems irresponsible.
it's one sixth of the economy, so what happens there is significant, this is the same cbo that was 160% in their calculation of Obamacare's coverage,
"Set the US Government in charge of the Sahara, and within five years there will be a shortage of sand."
There are reasonable alternatives for reform. I studied this ten plus years ago and concluded the French system would probably be best for us. It is a large country, so a better comparison, and it has the highest satisfaction ratings in Europe. It's easy to get high satisfaction for people who have not used the system. The NHS rates very low with people who have used it. One of France's biggest problems is with Brits who have retired to France and will NOT go back to UK for the free care. They have not contributed to the payroll funded French system and apply for the program for the poor and indigent, which they are not.
I did a series of posts about it here.
"My intuitive non-expert feeling is that ...if the government ran everything, it would control costs"
Are there any examples of this actually happening? Like the bureaucratic budgets that must get spent to allow those agencies to get even more next year. Cutting costs is specifically incentivized against by government control. It always has been and always will be.
They would try to control costs by rationing care, becuase that's what every similar system does in an attempt to protect those in control from sacrificing, and they would succeed at rationing care, but it would not control costs. Organizations are only rewarded for saving money in free-markets where they get more customers and more profits. They have to make you happy to get rewarded with your money.
I can't believe that intelligent educated Americans still don't get that, even while living in such a system, and enjoying the choices and control, while seeing socialist systems deny their citizens around the world, then revert back to free-markets, live off them, or collapse. That desire for free stuff paid for by others is really a powerful soma.
Warren has already stated that she doesn't want to enforce the immigration laws or secure the border OR punish "sanctuary cities and states". She's also in favor massive expansion of the refugee program AND Amnesty for all those who are here illegally. On top of letting 1.5 million in EVERY YEAR legally.
Her plan will not only cover all the illegals here, it will add all the illegals who come here in the future AND all the newly Amnestied brothers, cousins, sisters, fathers, mothers, and Grand-parents who come here through Chain Migration.
She is AGAINST any control on immigration. So if 40 million Zulus move here to get Free Health care, that's OK With her.
It is precisely the socialist aspects of our current system that makes it so costly and unsatisfying. We need an open pricing mechanism based in transparency. It's my goddamn body and likely the most expensive thing in my life, and I don't know what it costs for any of it. You got to ask yourself: why is that, and who does it benefit?
That is, the immigrants won't cost more. They'll provide more revenue.
Yeaaah...how's that working out for California?
I love how the "Free Market" morons advocate for Open Borders and More immigrants from wherever. You import enough socialists or poor people who can be bribed with Free Stuff and you'll lose your free market.
Hilariously, the California "Libertarians" are outraged at rent control in California. Hello? Its a Democrat dominated state and going further to the Left every years. All due to immigration. Hugh Hewitt has been pushing open borders for years, and called anyone who supported Prop 187 a racist. now, he's wanking on about "socialism" - haha.
Ann Althouse said...My intuitive non-expert feeling is that a lot of money is consumed by the complicated work insurance companies do, that if the government ran everything, it would control costs (but would still be subject to political pressure and couldn't really hurt us too much)
That hurts my heart, Professor; it genuinely does.
That's the default position of nice centrist people, and such people decide elections. Oh well.
What's the intuition that limits this understanding just to the medical care realm? Food, childcare, education, housing--shouldn't they all be socialized and "run" by "the government" for the same reasons?
The best reason why this will not be a good campaign issue for Warren is Obamacare.
The disastrous rollout, then the horrendous premiums have poisoned that well.
Althouse says: I know everyone deserves access to health care
Well, at least she didn't say they have a "right" to health care.
But I'm wondering who is denied access to health care in the United States today? Not being able to buy as much as something you want is not the same thing as being denied it.
Althouse,
"And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money."
Why do you assume that?
And a follow up question, if I were to take you as Jane Q. Public, what would you be willing to give up/alter/significantly change in order to have single-payer healthcare?
It's well known that illegal mexican immigrants cost us on net, as do legal 'refugee' types. So I'm going to have to assume that her policy promises are just more Obamacare style lies.
To be fair, we already pay for the health care of people who are or claim to be undocumented.
Ask anyone who works at an ER/hospital/clinic.
Medicare is broke. Social Security is almost broke.
No way would the USG control costs.
How much money went down the crapper setting up the failed exchanges?
They can’t even cut down on Medicare fraud.
Pigs trough noses.
We peons will suffer.
Why aren’t people covered now? Obamacare was supposed to fix this.
Althouse seems disinterested in anything regarding finance or the economy. Like most liberals, she just assumes 'it will get paid for'. This is especially true of people who have always worked in the public sector. They probably have no clue--and even less interest--in where 'capital' comes from.
“That is, the immigrants won't cost more. They'll provide more revenue.”
Yes! Because they will all be in the 1% who are going to pay for this! Genius!
Younger readers here might like to know that Medicare isn't free. Part A (the hospital)is, but you pay a monthly premium in excess of $100 for Part B (the doctor). They take it out of your Social Security. Additionally, as with most private plans, Medicare only reimburses 80% or so, so most seniors buy a supplement from a private insurance company or from AARP for at least another $150 per month premium. Seniors below a certain income level may have their Part B premium waived, and may qualify for Medicaid as their supplement...
IMHO Medicare For All would in short order mean Medicare For None. Any senior voting Democratic in the 2020 election is cutting his own throat...
They'll provide more revenue.
Sure. Day laborers working off the books pay taxes.
What planet are we supposed to be on?
If you check her links, it’s all based on untestable economic models that are heavily laden with assumptions. In other words, you can take it to the bank!
All of those billions from new immigrants lost to us now even though they live here, presumably, is going to go purely to health care because there won’t be any other costs associated with them. This is so. easy.
It’s almost as if she read the stuff rhhardin writes about women shortcutting rational thought to emotion and says “Hold my beer!”
Assuming single payer will reduce health care prices is a real bad assumption based on not knowing anything about economics.
Two of my children have had lasik eye surgery, paid for by them, affordably. There are no government subsidies for laser eye surgery. Competition has driven down the price so that anyone who really wants it could get it. Me? I'm 64, been wearing glassed for the last 56 years. If I get through the next 56 years, maybe I'll consider it....
There's competition for imaging services in the U.S. My orthopedist has his own machine. My small rural hospital has theirs. Was at an Camporee this last weekend with Canadian troops in attendance. Waiting time in single payer Canada for an MRI is measured in months. And if you miss your 3 AM appointment spot you'll have to wait another few weeks for another slot.
Cross over the border from Canada to the U.S. and there are billboards up advertising walk in imaging services to Canadians. If single payer was the solution they wouldn't be there.
The entire health care industry needs to be rethought. There's not just one thing wrong with it. In NY, I can't walk into a pharmacy or lav and order up basic lab tests; I have to go through a gatekeeper, that is, pay a doctor to order the tests and then tell me about them. I'm not trusted to make decisions on my own health, nor to get information on my own health, because the legislators - Democrat legislators - of NY have deemed the public is too stupid to monitor their own health. That drives health care costs UP. And availability down. My son in CO can walk into a lab and order up any available blood test he wants and pay for it out of pocket.
It's worth noting that some uninsured could afford private insurance but elect to spend their money on other things. A critical care physician in a town that hosts an annual pilgrimage of motorcyclists,
some of whom plow into each other and wind up in his ICU, once told me that some of them were medically indigent. "But how can a guy who can afford a $20,000 motorcycle be medically indigent?" I objected. "They make poor decisions," he replied.
Warren's plan is good news / bad news.
Have any of her experts quantified the financial turmoil her plan would cause? I'd estimate it would decrease our GDP by at least 20% in years 1-3 alone and our economy would never recover. We'd be Venezuela on a grand scale. That is the bad news.
The good news is the brainwashed young turds and old commie Dems in America would get what they have been voting for ....absolute social justice leading to "Misery and Zero Economic Opportunity for All [except for those in power of course]".
I had a minor surgery a couple of years ago. I read a lot of history and it occurred to me that if I had the problem that required that surgery 100 years ago I would have died. I would 100% have died, likely after several days of agonizing pain, fever, etc.
If it'd been 50 years ago I would probably have lived but would have been hospitalized for more than a week, would need to recuperate for a month at least, and would have a huge scar across my body. If it'd been 25 years ago I'd have been hospitalized for 2-3 days with a 8 inc scar.
I had the surgery in the morning and was home walking around by 4pm. I was back at work (in an office) two days later.
People take the amazing--literally amazing--advances "we" have made in the medical field for granted. That's part of what allows millions of nice centrist people like the Professor to say they're "not interested in" the topic. I appreciate her honesty and I understand what she means, but it's just a fact that our collective advancements in the medical field are inextricable from questions of healthcare financing and related subjects.
The US spends a ton more on medical care than the rest of the world. In large part that cost we pay subsidizes the care of the rest of the world (pharmaceutical companies make their profit here and sell at cost elsewhere, etc) and in part our "overspending" in the field generally subsidizes scientific medical advancements that benefit the world.
People don't understand that the status quo level of prosperity (and technological advancement) we enjoy today doesn't just happen automatically and isn't the default of humankind. We're at the very far extreme in terms of all of human history and that position isn't something we can take for granted.
In the year I was born close to 90% of people in China lived in extreme poverty; today less than 4% (of the many hundreds of millions of additional people there) do.
You may not be interested in the things that propel and undergird human advancement and that allow the near-miraculous medical and healthcare interventions that are available to us today, but we all have in interest in not taking them for granted. "It doesn't matter what changes we make, I assume things will work out fine" is an attitude that invites disaster.
Cost isn't the issue. It never is.
It's about control.
Call for Mr. Goldberg...Mr. Rube Goldberg...
Medicare for All means Doctors for None.
"Younger readers here might like to know that Medicare isn't free. Part A (the hospital)is, but you pay a monthly premium in excess of $100 for Part B (the doctor). They take it out of your Social Security. Additionally, as with most private plans, Medicare only reimburses 80% or so, so most seniors buy a supplement from a private insurance company or from AARP for at least another $150 per month premium. Seniors below a certain income level may have their Part B premium waived, and may qualify for Medicaid as their supplement...."
"Medicare for all" is just a term coined to make the more inscrutable "single payer medical care" more comprehensible to the masses. It doesn't necessarily mean the government would simply expand the existing Medicare to cover everyone. (It doesn't mean they wouldn't, either). If the so-called "Medicare for all" was ever passed, it could be (and hopefully would be) redesigned from the ground up, using existing models in other countries as guidance to build in known strengths and exclude known weaknesses, insofar as possible.
And I'm saying that as someone who has always assumed that a single-payer system would be better and would save money."
Why do you assume that?
It's her creamy hippy-chick center talking
"The best reason why this will not be a good campaign issue for Warren is Obamacare.
"The disastrous rollout, then the horrendous premiums have poisoned that well."
That was because Obama was compromised from the start by catering to the health insurance providers: ACA is basically a delivery system of a captive audience to the insurance providers. He never invited or allowed any advocates of single payer to participate in any so-called "town meetings" held to discuss how to improve our healthcare system.
That said, for many who could not afford or could no be approved for insurance previously, Obamacare proved a boon. Which just hows how wretched our extant system was (and is).
"that if the government ran everything, it would control costs"
Head ---> Desk.
Jesus lady. Do you not pay attention to anything?
If you think it’s expensive now, just wait until it’s free!
Or;
What are you willing to pay for free healthcare?
Talking Bull (D-Mass) suggests that "Medicare for All" is self-evidently better (certainly cheaper) than our existing healthcare system. Most of us (myself included) feel otherwise.
Let me propose a simple experiment. Convert all Federal workers (including the House, Senate, SCOTUS, and the Executive Branch) over to "Medicare for All" for say, 10 years, and then assess the outcomes.
What could possibly go wrong?
You may not be interested in the things that propel and undergird human advancement and that allow the near-miraculous medical and healthcare interventions that are available to us today, but we all have in interest in not taking them for granted
I teach US History and Government at a suburban high school. Several times a year I give my students the "You've already won the lottery" speech. I tell them they were lucky enough to be born in the 21st century in the US (or be able to move here). I tell them they have a higher standard of living than 99% of all humans who have ever lived. (Our socio-economics are so bad that every student can get a free breakfast, lunch and dinner) Then I start with all of the things they take for granted. I start with the fact that 100 years ago, most of them would already be working, in dangerous unpleasant conditions, rather than sitting in an air conditioned classroom. Then I move on to access to plentiful, relatively cheap, food the whole year round, regardless of season. I talk about advances in hygiene, including being free of fleas and lice. Then I talk about the miracle they are all carrying around in their pocket. (I talk about what you had to go through to make an international call 30 years ago, and how much it cost. Now they can stream a movie from a site in China for free while they walk down the street) The one I end on is toilet paper. Such a simple thing we all take for granted. But it did not become widely available until the late 1800's.
I think I reach some of them...you can see the wheels turning in their heads.
"We should be more like the rest of the world--they spend so much less than we do!"
Ok, sure.
They pay doctors and most other healthcare workers much less than we do. Let's see the AMA vote for large pay cuts, sure.
They ration care via long waits and restricting access to procedures. Let's see how the AARP likes it when wait lists for hip replacements are 14 months long.
They are much slower to adopt new and cutting-edge procedures and medicines. Let's see Joe Patient cheer receiving "free" healthcare that's equivalent to the state of the art in 1980--that'll definitely save some bucks.
They free ride off of U.S. medical spending and innovation. That one's tough...if we aren't spending the billions to develop new drugs (because there's no more money to be made doing it) I'm not sure who we're going to free ride off of. Maybe the medicines and devices we have today will just have to be good enough. Think of the money we'll save!
"I don't know — and don't believe anyone could know — if the numbers will work out that neatly." I would hazard a guess that neither does she. It's generally wise to disbelieve "liberals" on general principle. A gang that came out of the "no truth but socialist truth" mental set, and whose basic socioeconomic agenda is based on legalized plunder--AND wants to disarm you--is not a bunch with much credibility--especially in the case of Liawatha.
The notion of "cost the country" is absurd. What does it mean?
I can't look at the current Impeachment charade going on in the House of Representatives and have any faith that these people would be able to control costs AND produce a decent healthcare system. Imagine all the lobbying that will go on. Imagine all the polling and special interest group pressure. If we look at the VA, we know they cut costs by delaying care and then sweeping it under the rug. Why would we expect anything different if our government took over the whole shebang?
Name the Federal program that cost what was projected and worked as projected.
Here's an article from a sober Reasoner (McSuderman) on Warren's plan:
Reason on Warren Plan
Highlights include:
"But there is a commonly accepted term for a plan that requires companies to send payments to the federal government in order to finance government programs. That word is tax."
Joe Biden: "For months, Elizabeth Warren has refused to say if her health care plan would raise taxes on the middle class, and now we know why: because it does.
"an Urban Institute analysis [projects] that single-payer plans would raise national health care spending by $7 trillion over a decade."
"[Warren] also proposes raising trillions in tax revenue through increased enforcement—far exceeding what mainstream experts have suggested is possible. For comparison, CBO says that increasing IRS enforcement by 35% would generate.... $55 billion in revenue over a decade. Warren is counting on getting 40 times that."
"The Washington Examiner's Philip Klein has published a useful roundup of Warren's less plausible ideas; the takeaway is that even if Warren somehow managed to raise the enormous amounts of tax she proposes, it probably would still not be anywhere close to enough to finance her plan. (More on this in a future post.)"
"In some ways, Warren's plan amounts to a list of technically sophisticated magic asterisks. It is as much an attempt to obscure the economic and political feasibility of passing and implementing a single-payer health care plan as a good-faith attempt to describe what it would practically require."
Remember that scene in Animal House where Otter & Boone tell Founder "You fucked up. You trusted us".
This is your chance to not be Flounder.
Wait, isn’t Warren a senator? That is, in a position to actually make changes to the way healthcare is run? Why does she have to be a president to make these changes?
I’m sure if it’s such a solid plan that saves everyone money, that it’d be veto proof, surely?
HoodlumDoodlum,
Well said.
That is, the immigrants won't cost more. They'll provide more revenue.
Si te gusta tu médico puedes quedarte con él.
Scientific Socialist:
Thanks for that.
— Providers accept lower unit prices (but more volume) . - Vox
Sure, let’s just enslave the doctors!
mockturtle said: "This is especially true of people who have always worked in the public sector. They probably have no clue--and even less interest--in where 'capital' comes from."
Bingo.
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