Thank You, America. - by Nicker
DDL on 8/11/2012 at 11:40
Ah, semantics.
Ok, I think we're experiencing a cognitive disconnect between "insurance modelling as a concept" and "insurance modelling as something done by insurance companies". My fault for not being clear enough. Sorry.
If you simply call it something like "risk management" instead, then that's fine. Everyone uses risk management for everything they do, all the time. I don't refer to my crossing the road as an "insurance model", but it's definitely a risk management strategy (especially in London).
It's the connotations of insurance that I'm objecting to, most specifically: that implied by insurance companies. These are entities that are pretty much obligated (as has been discussed before) to maximise shareholder profits, and thus if it's economically better to spend money on lawyers to deny healthcare than it is to spend money on providing healthcare, then that is what they will do.
And that is what they do. It is financially favourable for them to spend your healthcare money on denying you healthcare.
And this is incredibly, incredibly fucked up, I hope we can agree?
Insurance modelling as done by companies, where you estimate risks over time, work out likely average costs of those risks, then charge everyone slightly more than their statistical share of that risk (the rest being profit) is fine for things where risks are not certainties. You might have a year in which nobody has a car accident: bam, profitable year. You might have a year in which everyone has a car accident. That could fuck you over totally as a company, but hey: risk.
With healthcare, everyone, without exception, will need it. You are not working out risks of "will we need to pay out or not", you ARE going to pay out. You are instead working out "what are we going to pay out most on, and what are we going to pay out least on". It's less insurance modelling and more budget management. And it turns out that the best way to manage that budget is "don't pay out for shit, spend money on lawyers instead". Plus the issue of pre-existing conditions muddies the waters yet further: should you really be forced to pay a ton more just because you get a shitty hand in the genetic poker game? Or should the system allow for the fact that there will be people with preexisting conditions, and treat them just the same as people without them? Which sounds more humane to you?
So yes, fine: a totally not-for-profit insurance company would be a marked improvement, but you're still dealing with unnecessary middlemen. Instead of simply spending healthcare money on hospitals, you're spending healthcare money on a system that then reimburses hospitals for treatments they provide...and anyway: the hospitals themselves are trying to make a profit.
Sure you can argue about faceless bureaucracy (jesus, it IS a hard word, isn't it?) wasting money, but hopefully we can agree that a system where money put toward healthcare was spent on actually delivering healthcare rather than maximising profits would vastly improve healthcare in the US.
It would admittedly be a bit socialist, though. Think of all those poor people getting healthcare when they could be out getting jobs. :mad::mad:
jay pettitt on 8/11/2012 at 11:43
Quote Posted by demagogue
But for reals, anybody that's actually worked for the gov't knows how inefficient it is.
Anybody who's ever worked anywhere doing anything for anybody knows how inefficient it is. Unless you work for Foxconn, but they treat people like robots and, frankly, that ain't on ~ see Adam Smith.
Comparisons between private and public sector are tricky but when you can make them - such as public vs privately run utilities between US states - the public sector comes out pretty well.
The myth of the efficient private sector doesn't come from any measurement of efficiency, rather a presumption that the private sector naturally strives for efficiency because that's a good way to stay competitive. There's a process there. The problem is that this ignores other motivations to be efficient - accountability, empathy, pride etc etc etc and also that it ignores the fact that, even in the private sector, more often than not people make decisions based on what other people are doing, not on what would be most efficient.
Mostly it's just rhetoric I reckon. When speaking of government you always hear words like waste. In the private sector you get the word efficiency. Without numbers both are meaningless. 25% waste and 75% efficiency are much the same.
And as Adam Smith eloquently argues in the second half of Wealth of Nations, and it's a shame most people don't make it that far, the strive for efficiency isn't without some whopping social issues that demand government intervention at every turn.
Also, (
http://www.youtube.com/watch?v=u6XAPnuFjJc) this is fun. Not sure what it says about the necessity for bankers' bonuses.
Briareos H on 8/11/2012 at 11:57
Quote Posted by DDL
It's the connotations of insurance that I'm objecting to, most specifically: that implied by insurance companies.
In France, the healthcare system is called health insurance and is, by all means, a government-run insurance organisation.
The only difference with the private sector is that it doesn't go to any length to deny your coverage: it just does what it says on the tin, if you fraud they will cancel your coverage and pursue you, if you are ill you deserve to be treated in accordance to their reimbursement grid.
And really, the private sector here is also pretty mild and honest by american standards I guess. I would seem to think that your opinion is biased slightly by the fact that there is an asshole-ish general trend in american private ventures to screw the people over. With all due respect.
DDL on 8/11/2012 at 12:03
My opinion is biased by the fact that the US system
does not fucking work.
(
http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm) random easily found google linky
Quote:
Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.
Those are
horrifying statistics.
demagogue on 8/11/2012 at 12:10
I wouldn't disagree with anything you said jay. I'd probably word a lot of it like that myself.
The thing I'd add is that efficiency itself isn't even the only factor. Issues like public or quasi-public goods (utilities, the environment), tragedy of the commons & prisoners' dilemmas, lack of information by a party, transaction costs, cognitive biases, distribution and justice concerns, or the big one, externalities, etc, etc, are just inherit problems markets have a hard time dealing with, sometimes completely aside from efficiency of connecting supply with demand.
jay pettitt on 8/11/2012 at 12:11
Briareos, It's called that in the UK too. We all pay National Insurance. It don't get close to paying for our health care though. That comes out of general taxation.
Clearly it is a kind of insurance - to pay collectively to cover the costs when occasional bad things happen. The question is what part a profit motive might play in improving health outcomes. Do market forces do a good job there.
By the by, anyone who might have had a breast implant in France in the last decade or so might have some other ideas about how mild mannered French private health care is.
To my mind the thing about private companies is that they are just that - private. It's the lack of public accountability that makes them problematic when spending public money.
DDL on 8/11/2012 at 12:44
It's the hilarious combination of a government too gutless to legalise euthanasia, but also superkeen to bump off crumblies.:(
Jason Moyer on 8/11/2012 at 12:47
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faetal on 8/11/2012 at 12:57
One thing which has bugged me for a while is how the overall US mood has no problem mobilizing against "darkie foreigns who want to kill our freedoms" and mandating hugely divisive war, restrictions on domestic freedoms to fight terrorism etc... while being really dismissive of the fact that people die every year equivalent to 6 9/11 attacks, so that's roughly 66 9/11s since 9/11, from preventable causes due to a shortfall in healthcare provision based on ability to pay. SO easy to get whipped into a froth over fuckers who talk funny and worship different gods, but its ok for poor people to die in droves so that rich folk can keep getting richer. The biggest turn-off for me of the republican mind set is this almost teenage sneering at anyone whose situation is below a certain "winner" threshold. The trade center was full of hard working winners, the poor who die for the sake of profit are losers, who should have done better for themselves etc...
That's a bit of a straw man, I'll admit, but watching all of this happen in a country which can pay to take care of its people is just aggravating. How can you be patriotic if you can't look after your own people?
