Sunday, July 26, 2009

US Healthcare

I’ve been in Europe for a couple of weeks now and I keep getting asked about US Healthcare. It’s in the news every day and everyone seems to have an opinion. Here’s a fact that I think many of us need to accept.

If you are gainfully employed and enjoying the benefits of a solid PPO insurance plan, it is unlikely that you can maintain your current quality of care and level of access to care as the nation moves to a better solution for everyone. If you are unwilling to budge on this, then you are part of a problem that cannot be solved. (Yes, my family enjoys PPO coverage and yes, I am willing to downgrade our care to meet the uninsured in the middle.)

Please note that I am very similar to some of you imaginary readers in many regards. I support free markets, I favor small government, and I do not wish to create public support programs that encourage a lazy life of free loading. However, we need to get the overall costs of healthcare under control and when about a third of our citizens cannot seek care for emerging problems, we have no choice but to treat them when they arrive at an expensive, emergency state of poor health. If we can get everyone access to earlier, routine care, then we can control costs and work toward improving standards going forward.

If that is Socialism then I guess I am a socialist when it comes to healthcare.

Just to finish that point. I am a capitalist in general and I agree with the old adage “capitalism is the worst form of economic structure except for all the others that have been tried”. Nonetheless, I don’t think that a pure free market yields good care for all. In fact, a free market is only designed to yield spoils to the winners; only the successful get BMW’s, the adequate get Honda’s, and the losers join the lazy and the unlucky on foot.

For automobile’s, this works fine and everyone gets where they are going eventually. For healthcare, the consequences of “poor performance” in the market can be both dire and immutable; a bit of structure is required to keep the population at its healthiest and most productive. That is best for all of us.


  1. Boo Hoo7/27/2009

    Ahhh Finally a complex issue with many opinions, sure to draw in the thousands of silent readers that paruse this blog on a daily basis.

    Boo Hoo to you - a now confirmed socialist - I have always had my suspicions !!!!!!

    A few points:

    1. This practice of having an employer provide healthcare coverage is absurd. You change jobs and you have to go thru the entire enrollment process again, and maybe even have to switch doctors. Individual coverage across state lines would be much better.

    2. Health Savings Accounts (HSA) for everybody would be a solid move in the right direction. An incentive to ask what things cost and if you were able to live healthy you could actually acquire a significant amount of $ that is yours to use when you are 65+ as you see fit (pun intended) TAX FREE !

    However, all of this requires that the individual take responsibility for their own health. This I think is not plausible. People know what is bad for them, but they continue to do so. Smoking, drugs, half the US population is overweight (we just hit a new high on obesity), childhood diabetes is at epidemic propertions - all things that can be virtually eliminated, but people choose not to.

    To think the people can handle healthcare when they can't handle their own 401k or their current health NOW, I just don't see it.
    So now we need the government with all of their beuracrats, with no incentives (I am sure they all mean well) to handle it for us. I see how they have done such a great job with roads bridges, soc. security, etc. etc. etc.

    Government has a tendency to expand, they have little incentive to shrink and provide effective services.

    You think healthcare is expensive now, wait until it is free ! I think the problems of obesity etc. are only going to get worse, there will be even less incentive. We fine people now to take care of themselves - helmet law, seat belt law, restaurants fined for using transfat - but where are the fines for parents who let their children eat twinkies and get 30 pounds overweight. No individual responsibility, and this experiment is going to end badly.

  2. Anonymous7/27/2009

    I agree with Boo Hoo - personal responsibility should be the starting point in any system, healthcare or otherwise.

    Side bar: Good comment Boo Hoo, but please use spell check. : )

  3. So I guess Anonymous thinks we should not have mandatory auto insurance? Just leave it up to everyone to be personally responsible? That way, you can be sure that the kid who rear-ends you leaving the Thin Lizzy concert will be fully covered and you'll have no problems getting your ride fixed.

    Personal responsibility works if you withhold the benefit until responsibility has been established but not if you grant the benefit up front to all. Boo Hoo already made the case that too many people are not personally responsible for their heath - it's just not a viable starting point.

  4. Against my better judgement, I'm not going to use an 'anonymous' name here. I should, because quite frankly I don't think I'm old enough to know what I'm talking about, which I'm sure will be readily pointed out. But the soluation seems simple. There is one thing that guides our every move and decision: money.

    There has to be a give and take. It certainly can be done - forcing responsibility is not a new concept in this country. Make auto insurance optional, but have the excise tax for those who do not carry it abnoxiously high. For food, charge by the calorie. Big Macs should cost $13 and a soda (the leading cause of over-weightness in America) should be $5 for a 20oz drink. Offer tax breaks for people who carry health insurance (MA does this now). MA requires everyone to carry health insurance. If you don't, you pay a higher tax. And guess where that extra money goes...

    Sadly, people need incentive to take responsibility. Our country has such ADD that we tend to not focus on the consequences of our actions, we need a reason NOW. We don't think our house will ever flood, we'll ever get in an accident, or ever break a bone. We don't feel the need to carry (*ahem*) rental insurance. We make decisions to save money based on the present. Money makes the world go around, so the incentive to become responsible needs to start there. If it is, you'll find a lot of people are going to fall in line. That's why people opt out of a lot of these things to begin with, to save money.

  5. Anonymous7/28/2009

    I think we already have socialized health care, and its on the backs of corporations. This fact reduces their global competitiveness and reduces their incentive to hire more workers. I hope any solution considers this burden.

    One topic I would like to see discussed more is the cost reduction aspect (I obviously don't have a grand solution). As long as there is a third party payer (i.e. insurance), there is no incentive for the patient or the provider to reduce costs. Since health providers are for-profit organizations there is no planning among them. If a medical center orders a new MRI machine, even though there are 3 others in a 10 mile radius already underutilized, they have to pay for it. How do they do that? By "selling" more tests to their customers. The patient doesn't mind because they are not paying and the doctor knows the patient doesn't mind. Eventually the insurance premiums go up to cover these type of costs. All of these extra services are paid by the corporations and people who have insurance, in addition to indirectly covering the costs of people without insurance.

    Now I'm rambling worse than Boo Hoo. Bye. RF

  6. Great posts. I got some comments on the comments:

    1) Not to make anyone feel old, but you'd have a tough time finding a "kid" coming out of a Thin Lizzy concert.

    2) Michael Phelps has a 6,000+ calorie diet. If we tax calories, he would have to pay more. Why should he? The man is in great shape. Calories are not the enemy (not should they be the target for tax). Its things like trans fat, high fructose corn syrup, and other junk that is just filler in our "food." Remember when everyone thought BREAD was the enemy? BREAD! The first food invented! Literally thousands of years old. Which brings me to point #3...

    3) As a man planning on entering the education field, I think I got a solution: education. If we can better articulate the fact that the money you save on junk and fast food is really an investment in poor health and thus not cost effective... we'd have a lot less problems. People need to educate themselves and start participating in their healthcare and their government. When that happens, both will start serving the people and not the ones currently particpating: corporations.

    If people started making thier "food run" actually involve running, we'd be in a better place now. In the meantime, I am for a national plan that can help America get out of its hospital gown.

    This solution is not prurely proactive, as I am confident when we have less people clogging the arteries of the healthcare system, we'll be able to pay teachers more.

    Knowlege is the true power of the world, as it is the difference between true wealth and just a large bank account.

  7. Anonymous7/29/2009

    thanks for stepping out on this one. I am so sick and tired of our politicians taking polarizing views. As a republican, I can't agree with a stance that we can sit by and just try more "prevention" etc.
    People get sick, even if in good normal health, and often they are those (like young adults) that don't have insurance, and suddenly have debt up to their eyeballs. My company pays about 60% of the bills, but that still leaves me with a 1k individual/ 3k family deductible and hundreds of dollars per month in costs.

    There is also no incentive on the health care side either to control costs. My normal bill is "adjusted" by my insurance company by nearly 50%. So if I didn't have insurance, my bill would be 50% higher.
    And there are philosophical issues. where do we draw the line? Someone who's in their 80's will rack up $0000 in bills just to prolong their life a few short months. And what about "experimental" drugs-- that are very expensive-- are they mandatory when it looks like they "may" help?

    I don't know-- a lot of random thoughts here-- we need to do something much better now than we are doing it. I may be leaning "socialist" on this as well. JD.

  8. Jeff Ryer7/29/2009

    "You cannot legislate the poor into freedom by legislating the wealthy out of freedom. What one person receives without working for, another person must work for without receiving. The government cannot give to anybody anything that the government does not first take from somebody else. When half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend, is about the end of any nation. You cannot multiply wealth by dividing it."

    Thomas Jefferson

  9. Boo Hoo7/29/2009


  10. As Jeff Ryer points out, Thomas Jefferson had brilliant insights into the accumulation of wealth. Not sure why his thoughts on the matter were posted in this health discussion as the two topics are quite distinct. Unless we are willing to let a significant percentage of the sick and injured just fester and die, Jefferson's comments don't apply to healthcare.

  11. Jeff Ryer7/30/2009

    As a Socialist I can see where you might have a hard time understanding the connection. Personal responsibility was an underlying theme to the whole discussion, icluding teachers salaries right to a fat tax. And if the conclusion is that - because the people are not going to take responsibility for themselves, thru their own healthy lifestyle, paying the bills (thru HSA, investing for retirement, etc., - then why don't we just give up now on this whole experiment of "Liberty for all", embrace socialism and save us all a lot of time and aggravation.

    I for one am tired of trying to start a business and build wealth for my 20 employees and help revitalize an ailing downtown. Give me a job with the Federal government, taxpayer funded healthcare and I will take my first vacation in 2 years. Lets just get rid of the charitable deduction and let the government do it all. I am tired and I am giving up. No more posts for me of any relevance, lets just talk Red Sox and Michael Vick (he's coming back).

  12. Boo Hoo7/31/2009

    I think what Jefferson was trying to say is that if people are not going to take care of themselves, the government can't do it, beacuse the government has no money, unless they first take from someone else. And it is relevant here because whether it is healthcare, diet & exercise, credit card debt, 401ks, or education - it all comes down to personal responsibility. I am all for paying taxes so we can have relevant healthcare for those that need it, without them having to file bankruptcy. But for the low income person who spends $120 month on smokes, or who is 70 pounds overweight, and others have to pay for their health conditions brought on by their own behavior, I just don't see how this ever works unless they are paying too. We are at 50% population overweight now, what's next 60%, 70%, I ask you, when does it end ?