Thank You, America. - by Nicker
Vasquez on 8/11/2012 at 05:18
Is popcorn good for breakfast?
Quote Posted by blaydes99
but at least I was able to vent some of my rage. :D
Wow, getting ahead in life really made you a happy person.
Anyways, I've slept through most of the storm, so I just totally agree with this:
Quote Posted by DDL
There will always be more people in shitty baseline jobs than there will be people managing, and those shitty baseline jobs are fucking
vital to keeping the world running, so anything we can do to reduce the inequality between the tiers, or hell, just make the bottom tiers less fucking awful, will help vastly more people than tax cuts for the rich or encouraging free enterprise or whatever.
DDL on 8/11/2012 at 07:41
Quote Posted by heywood
But for health care, insurance is the most logical approach for managing the risks, regardless of whether it's a private or government entity doing it.
See, with something like car insurance, you're able to make statistical assessments over the likelihood of an accident requiring "X amount of funds to fix" occurring in unit time, and base your prices on that. The point is that the likelihood of that accident is relatively low: many people who buy car insurance never claim anything close to the amount they pay...and that is why insurance works, after all. You're taking everyone's money, distributing some of it to the few, and the rest is profit.
Now imagine that everyone was only allowed one car. For life. And no matter what happened to that car, that was the only car they were allowed. Every bump, scrape, flat tire, all that cumulative damage: that all had to be treated, because that was the only car they could have.
This changes the dynamic enormously. It's no longer statistical risk, it's essentially
certainty. Almost all of those cars
will need expensive repairs, and the only ones that won't are those that are destroyed totally in one shot. And that's hardly an optimal scenario.
I'm assuming you can see where this analogy is going.
So now you're taking everyone's money, distributing it back to everyone, and the profits are looking vastly less bountiful. And it's profits that companies are interested in, after all. Something has to give, and it's...distributing it back to everyone. That's insurance-based healthcare. You have a system where the prime motivation is to deny people healthcare wherever possible. You pay into these companies so they can then use a lot of that money t
o hire lawyers to contest giving you the rest back. It's...insane.
Remove the insurance companies, establish a governmental not-for-profit organisation funded by the fees that would've gone to insurance companies, and suddenly
all that lawyer money is freed up to actually treat sick people.
Will the not-for-profit organisation be able to treat everyone to the
peak of medical care? Probably not, funds are limited after all, and medical need is a certainty...but would it be better than an insurance-based model where a hefty chunk of the funds are spent on lawyers
contesting healthcare provisions? Yes. Oh jesus fuck yes.
(or, you know: just check out the statistics faetal posted. That is not symptomatic of a healthcare system that works)
Peanuckle on 8/11/2012 at 08:22
Quote Posted by DDL
Remove the insurance companies, establish a governmental not-for-profit organisation funded by the fees that would've gone to insurance companies, and suddenly
all that lawyer money is freed up to actually treat sick people.
The money saved by the switch would be immediately lost to bureaucracy, ineptitude, and corruption. And then the government would realize it's sitting on this huge lump of cash that isn't really going anywhere, and they'd use it on other things, just like they did with the Social Security funds. And now we're out of them.
Fact is, you can't trust government with money, period. They'll always abuse it. Insurance companies could be regulated so that they MUST pay out when criteria are met, and can't contest the payment.
DDL on 8/11/2012 at 08:54
"We can't trust the government with our money!
...but we can trust the government to regulate profit-focussed third parties with our money!"
WHAT
(also, why does the cash just sit there? You don't save up all the cash from the current generation to pay for the subsequent healthcare of that generation, that's fucking stupid. You use the cash from the current generation to pay for the healthcare of those who need it RIGHT NOW. The cash is in constant flow from taxpayers to "people who need healthcare", not building up in a bunker somewhere)
Chimpy Chompy on 8/11/2012 at 08:55
That's just... ideology. The vague but ominous demon of bureaucracy and inefficiency spiriting away all the money in the night. "You can't trust government with money", as a blanket statement, is more a declaration of religious belief than a fact.
demagogue on 8/11/2012 at 09:33
But for reals, anybody that's actually worked for the gov't knows how inefficient it is. The computer networks are practically a decade behind the curve. It's painfully obvious there is not a bottom-line driving motivation behind every-freaking-decision-no-matter-how-minor except for ideology. You can hardly do anything without circulating to get the approval of every sub-department involved, and just one of them can hold up the whole thing for as long as they whine about it. What's incorrect is to say there's nothing people can do to find some methods that work more efficiently than others.
On the other hand, anybody that's worked for private business knows how much the bottom-line drives every little thing, and even when they "have a heart" you have to second-guess what's the real motivation...
The thing about insurance markets is that certainty plays a big role... The whole world of these people in actuarial science is that they know how to play the risks. I don't think there's actually the biggest incentive to make policies that get them sued a lot. The whole science is, well, down to a science... You can calculate the risks of anything you can get the data for and package the most efficient plan for it, and companies like when they have that kind of certainty and economy of scale, as opposed to throwing a bunch of wildcards in. I don't think the problem is corruption as much as just market failures you can predict, like there are going to be certain risks they can't profitably insure, like pre-existing illness, because the risk is too high... And there's competition, so they can't get as big pools of people, even if they and the consumers want it to push premiums lower, but the transaction costs & information costs are way too high to have it actually happen in the real world. So there are basic market failure built-in to the whole system, and that's why you need some gov't regulation, to deal with the expected market failures.
Not everything in politics has to be some grand conspiracy between the plutocrats and the socialists. Sometimes it's just understanding how markets work and how regulation works, and trying to tinker with the right mechanisms for the job, given all the expected crap you know can go wrong.
scumble on 8/11/2012 at 10:21
Quote Posted by Chimpy Chompy
That's just... ideology. The vague but ominous demon of bureaucracy and inefficiency spiriting away all the money in the night. "You can't trust government with money", as a blanket statement, is more a declaration of religious belief than a fact.
The opposite view that the government should take care of everything is equally daft (accepting that you haven't said that either). There is merit in pointing out what a financial mess most governments are in with excessive deficit spending. Personally I see the same organisational inefficiencies in large government entities and huge corporations.
However this seems to be the usual back and forth thread with stereotyped arguments so I won't spend too much time writing...
Chimpy Chompy on 8/11/2012 at 10:54
Okay, I agree gub'mint should strive to do more with less when possible. Everyone likes efficiency. I don't think anyone's running on a pro- bureaucracy*, platform. But I dunno how big a part of current financial problems it really is - something like healthcare is going to cost shitloads however you run it. Or rather maybe its something we have to accept, as the alternative, ie throwing public services to the wolves of the private sector, could go wrong in other ways. An efficient process is not necessarily one producing a desirable outcome.
*I will never, ever be able to spell that word without looking it up
heywood on 8/11/2012 at 11:07
DDL -
Insurance based health care is not a specific type of for-profit operation. Insurance based health care describes pretty much every decent health care system in the world.
Pardon the repetition: insurance is a collective risk management process in which risk is transferred from the individual to the collective by pooling funds and risk exposures for a large number of people, and using actuarial science for risk assessment and planning. Health insurance is a type of insurance where the risks arise from adverse health conditions or contingencies, and the means of indemnification is medical treatment for these conditions.
The risk pool
can be managed by a for-profit entity, but it need not be. It can also be run by a non-profit entity, or a government entity. Similarly, indemnification can be provided by a for-profit entity, non-profit, or government. And the funding can come from individuals, governments, employers, whatever. If you look at the health care systems around the world, you can find all kinds of permutations on the above.
It's actually crazy to think about a health care system that didn't incorporate pooling and statistical risk assessment, which are the two most fundamental elements of an insurance system. Without pooling, you're talking about people paying fees for services rendered which is OK for routine stuff but gets crazy with emergencies and major illnesses. And without statistical risk assessment, you'll have poor planning, resource shortages and gluts, price instability, worse treatment, and poor outcomes.
Quote Posted by DDL
See, with something like car insurance, you're able to make statistical assessments over the likelihood of an accident requiring "X amount of funds to fix" occurring in unit time, and base your prices on that.
You do the same in health care. It doesn't matter whether it's a for-profit insurer setting premiums, a non-profit insurer setting premiums, a regulator setting premiums, or a government determining funding levels and tax rates. Statistical analysis underlies nearly all areas of modern medicine no matter where it's practiced. And the statistical assessments aren't just for setting rates, they determine how many ambulances a community needs, how much flu vaccine to buy that year, how frequently certain tests are required, what the most effective treatment is for a particular condition, how much smoking contributes to lung cancer risk, whether it's better to perform a procedure inpatient or outpatient, and so on.
Quote:
The point is that the likelihood of that accident is relatively low: many people who buy car insurance never claim anything close to the amount they pay...and that is why insurance works, after all. You're taking everyone's money, distributing some of it to the few, and the rest is profit.
It doesn't matter whether the probability is low (like getting HIV) or high (like getting the flu).
It doesn't matter whether a profit is being taken; it's still insurance with or without that.
Quote:
Now imagine that everyone was only allowed one car. For life. And no matter what happened to that car, that was the only car they were allowed. Every bump, scrape, flat tire, all that cumulative damage: that all had to be treated, because that was the only car they could have.
It doesn't matter.
Quote:
This changes the dynamic enormously. It's no longer statistical risk, it's essentially
certainty. Almost all of those cars
will need expensive repairs, and the only ones that won't are those that are destroyed totally in one shot. And that's hardly an optimal scenario.
It doesn't change the dynamic one bit. The likelihood of having a particular type of accident in a particular time period in a particular area is still a quantifiable statistical risk, and the most likely cost to fix it and the statistical distribution of that cost is quantifiable based on the type and age of car. But anyway, never mind the car analogy.
The fact that everyone is highly likely to need significant non-routine health care sometime in their life is obvious but not really relevant. The chance of me getting a certain type of cancer over my lifetime is a quantified statistical risk, and the distribution of the potential costs of treating that cancer is also quantified. The chance of me catching the flu this year is a statistical risk that gets quantified annually. The cost of giving me flu vaccine has been traded off against the reduction in the factored cost risk of me getting sick enough to require treatment. The chance of my unborn baby having Down's syndrome is quantified. And the relative influence of demographics, lifestyle, genetics, etc. on my risk factors has been quantified.
Quote:
So now you're taking everyone's money, distributing it back to everyone, and the profits are looking vastly less bountiful. And it's profits that companies are interested in, after all. Something has to give, and it's...distributing it back to everyone. That's insurance-based healthcare. You have a system where the prime motivation is to deny people healthcare wherever possible. You pay into these companies so they can then use a lot of that money t
o hire lawyers to contest giving you the rest back. It's...insane.
Remove the insurance companies, establish a governmental not-for-profit organisation funded by the fees that would've gone to insurance companies, and suddenly
all that lawyer money is freed up to actually treat sick people.
Will the not-for-profit organisation be able to treat everyone to the
peak of medical care? Probably not, funds are limited after all, and medical need is a certainty...but would it be better than an insurance-based model where a hefty chunk of the funds are spent on lawyers
contesting healthcare provisions? Yes. Oh jesus fuck yes.
I'll repeat it one last time: Regardless of whether the risk pool is managed by a for-profit company, or a non-profit, or a government entity, it's still an insurance model. You don't want it any other way.
