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Ezra Klein: National Health and magic - no rationing
Posted by: McQ on Monday, July 16, 2007

The usual suspects are all atwitter because Paul Krugman, behind the Times Select shield, has decided that those who oppose national health care "have run out of honest arguments", because, apparently, he's decided they're lying about rationing health care.

Ezra Klein swallows it whole:
I've grown convinced that many conservatives actually don't understand what rationing is. They appear to consider it some sort of intrinsic quality of state-run health systems — national health care has rationing in much the way a car has doors. It's just there.

Of course, that's not the case. A state-run system could decide, as Medicare does, that they'll pay for any and all necessary procedures, and do so quickly. Then there would be no rationing. There would be, as there is in Medicare, enormous spending and astonishingly fast cost growth. Instead, other systems, and their attendant societies, makes a judgment to devote relatively fewer resources to health care and relatively more to other things (like leisure!). That's a fair allocation of resources.
With all due respect to Klein, what in the world is he smoking? It is Klein who doesn't understand rationing.

Some form of rationing always kicks in when demand outstrips supply. It is nothing more than a physical method of allocating a product in short supply. It has nothing to do with how quickly you pay for something, because unless you have the physical assets available in which to accomplish the task in demand, payment is irrelevant.

Example: if there are 10 hip replacement surgeons and 10 patients demanding the surgery, the allocation model is simple. Each patient is served as demanded at a particular price and in a particular time-frame. But if there are 10 hip replacement surgeons and 1,000 patients, suddenly some different method of allocation must be found.

In a free market that equilibrium would be determined by price and rationed in that manner. In an National Health Care scheme, however, which fixes price, a different method of allocation is necessary. And what most have hit upon is a form a rationing known as "first come, first serve". Thus the waiting lists. Price, of course, is irrelevant, because that's been fixed by the system. But what the system can't "fix" is the supply of qualified hip surgeons.

So it wouldn't matter in the least how quickly a NHS scheme could pay for such services, or even how much it was willing to pay. If the supply is less than demand, some form of rationing will be present.

Just like a car has doors.

Klein goes on:
What we do in this society is devote relatively unlimited resources to health care for wealthy and insured people and relatively fewer to health care for poor people. It isn't clear whether we think that's a useful way to spend trillions of dollars, or whether we'd prefer some alternate ordering of expenditures, with more going to preventive medicine and paid maternal leave.
"We" as a society do this? "We" think its a useful way to spend trillions of dollars? "We'd" prefer some alternate ordering of expenditures?

Who is this collective "we" and by what right does Klein think he can speak for them? More importantly, who is he to presume he has a right to decide how health care is to be rationed?

Society has not "devoted unlimited resources to health care for the wealthy and insured". Instead, those who are wealthy and those who pay for insurance have devoted their earned resources, by choice, to health care. That's quite a different story, isn't it?

Additionally, has anyone noticed that the basic an unchanged argument for a national health care scheme is always based on "the poor and uninsured" and how they should have access to health care too? But have you also noticed that instead of putting forward a scheme to address the needs of the 'poor and uninsured' they always want to mess with the entire system and move it under government? This isn't about the "poor and uninsured". This is a naked attempt to put a huge slice of our economy under government control because these people think it would be more fair.

And then they come out with bogus arguments like "gee, if we just spend the money necessary as quickly as possible, there'll never be rationing."

Klein concludes:
This is largely because the political party that has tasked itself with protecting the unlimited privileges of the rich has skillfully made it taboo to discuss such things as limiting or redirecting health care expenditures through collective action, but it is, theoretically, something we could explore.
No, it's not because a political party is protecting the privileges of the rich. 85% of America is insured, but 85% of America isn't rich. And for the most part, that 85% is satisfied with their health care. What most don't want is government messing with what works for them. But the collectivist never rests and Klein represents those who would remove the individual from the equation and arbitrarily decide what is best for them.

In this case they're doing it with misinformation about the lack of rationing under government care. It's like freakin' magic if you turn it over to the government. No one waits, no one hurts, no one goes without. All you have to do is pay more and pay it faster and all is right with the world.
 
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Queuing = Rationing. Pricing?... also a form of rationing. You will have rationing in any situation because resources are not unlimited.
 
Written By: CJ
URL: http://
Correct, CJ, but rationing by price is much more efficient. First, it has the ability to increase supply in the long term, lessening the need for rationing. Second, in the short term, those who really need the resource can indicate that by being willing to pay more.

Example: Suppose you have one person whose sleep apnea is just marginally bad enough for surgery (according to government rules about such things). That person may *not* be willing to pay for it themselves, but they’ll take it if someone else pays. Another person may have sleep apnea just under the limit for what the government thinks should warrant surgery, but they work in a mentally demanding field and the clearing up sleep apnea so they can think more clearly has a higher value for them, so they’re willing to pay for it themselves, even perhaps to the extent of paying a premium so they don’t have to wait long to do it.

In a private system, that option is available. Under universal, single-payer healthcare such as HillaryCare, he doesn’t get that choice - he simply suffers. That’s an inefficient allocation of resources.

You can repeat for thousands of medical procedures. And saying that you’ll just come up with better rules for the allocation is not the answer. The inefficiencies and resulting rationing cannot be taken out of the system without distributed decision making, and anyone who asserts otherwise simply doesn’t understand economics.
 
Written By: Billy Hollis
URL: http://
What we do in this society is devote relatively unlimited resources to health care for wealthy and insured people and relatively fewer to health care for poor people. It isn’t clear whether we think that’s a useful way to spend trillions of dollars, or whether we’d prefer some alternate ordering of expenditures, with more going to preventive medicine and paid maternal leave.
What’s this ’we’, white man?
 
Written By: Scott Jacobs
URL: http://


Some form of rationing always kicks in when demand outstrips supply. It is nothing more than a physical method of allocating a product in short supply.

You and Ezra aren’t talking about the same sorts of things. "Rationing" is a term used to describe government bureaucrats imposing artificial delays on medical services for budgetary reasons. That’s what Ezra’s claiming is in no way guaranteed or expected under current health care plans.

Supply and demand do indeed force people to wait for health-care procedures. Under the current more private system, any proposed public system, and any other system on the planet.
 
Written By: glasnost
URL: http://
In a private system, that option is available. Under universal, single-payer healthcare such as HillaryCare, he doesn’t get that choice - he simply suffers. That’s an inefficient allocation of resources.

Neither HilaryCare nor any of the current health-care proposals seek to abolish private health insurance. So under any realistic past or present proposal that relates to the United States, that option remains. Therefore, your entire argument about losing the price allocation mechanism of the private market can be discarded. None of the public insurance expansions being discussed are prohibiting private insurance.
 
Written By: glasnost
URL: http://
That’s what Ezra’s claiming is in no way guaranteed or expected under current health care plans.
No, that’s not what Ezra’s claiming.
 
Written By: McQ
URL: http://www.qando.net/blog
This is a naked attempt to put a huge slice of our economy under government control because these people think it would be more fair.
You DO know that nearly 50% of all healthcare spending goes through government at some level TODAY right?

You are aware that healthcare is very highly regulated by government?

I think pretty much everyone, including the rich, are getting a bad deal on healthcare, though getting a lot and paying a lot is not such a big deal when you can afford it.

But to say that 85% are happy with their healtcare requires you to walk a very fine line between truth and fiction. You must completely ignore the opinions of Americans on the cost, and whether they believe their healtcare is WORTH the price they pay to make that statement, and in my opinion, it is disingenuos to do so.

From polling earlier this year...
Although most Americans say they are generally satisfied with the quality of their own health care, including 41 percent who say they are very satisfied, it’s a different story when it comes to the cost of care.

Just one in five are very satisfied with what they pay for health care, while a majority (52 percent) are dissatisfied, including a third who are very dissatisfied.

Americans are even more critical of health care costs in the nation as whole: 59 percent are very dissatisfied with the overall cost of health care in the U.S. and another 22 percent are somewhat dissatisfied.

Most Americans believe government can play a role in fixing the health care system. Two-thirds say the federal government should guarantee that all Americans have health insurance — and a similar number says providing health insurance for all is a more serious problem than keeping health care costs down.
How many people that have been bankrupted by the cost of lifesaving medical care would say that they were happy with the CARE that saved their lives, and if you never asked another question, you might find yourself under the false impression that they were happy with the STATE of healthcare in this country.

The number of people who go without insurance is going up, and as long as the costs keep going up, far outpacing inflation, that number will continue to rise. You claim that 85% of Americans are insured, and that’s close, but nearly 20% of the rest are underinsured, putting them one serious medical condition away from potential bankruptcy.

My opinion is that since half the money in healthcare is going through the government already, in incredibly wasteful and inefficient ways, why not use that money to fund a single payor plan that is as comprehensive as that budget allows, and then people can pay out their pockets (as they do now) for more or better care than the plan would allow. This would alleviate the economic rationing that occurs now, whereby a growing portion of the population cannot get healthcare because of the cost.

Oh, and by the way, the amount of our healthcare costs that go through government is about 8% of our GDP, about the same as Canada or France pay for their ENTIRE healthcare system.

Cap





 
Written By: Captin Sarcastic
URL: http://
Who is this collective "we" and by what right does Klein think he can speak for them? More importantly, who is he to presume he has a right to decide how health care is to be rationed?

um, the "we" is the american voting public that elected the politicians who approved medicare, medicaid, chip, mandatory emergency room care, and dozens more major bills that affect the manner in which health care is delivered in this country.

as to who he is, he is (a) a voter and (b) someone who has chosen to get educated on comparative health care systems.

and as to the first quote, this country is sufficiently wealthy that we could, if we chose, pay for lots more doctors of all specialties so that waiting times would be minimal for every possible procedure.

yes, taxes would go up and military expenditures down. so? it’s a societal choice.
 
Written By: Francis
URL: http://
Even better, while price is still a form of rationing, it has one giant and obvious advantage over a queueing system:

It provides demand feedback in an immediate and effective manner; more money means more incentive to provide the service. In other words, if demand for specialist surgeons stays strong, surgeons in other areas (or new graduates of medical school) are more likely to get trained in that specialty to reap the benefits (which of course lowers prices as demand is fulfilled - who knew?). We already see this in areas like heart surgery, which have had strong demand for a long time; without that demand and the commensurate reward, I don’t imagine we’d have nearly as many heart surgeons. Except for those who feel a natural proclivity for one specialty or another, I imagine most specialisation decisions are made with at least some awareness of compensation.

—-

Francis: That’s only true ("it’s a societal choice") if one assumes that "society" has the right to confiscate and reallocate individual wealth in any way it sees fit (or if not in any way, then specifically in that way). But that’s not by any means a universal assumption - even among people who voted for politicians who happened to later support all of those policies.

And for that matter, it requires one assume that whatever politicians vote for is the same as "society’s choice". It’s only close to being that if it was a major issue in their campaign.

(Thought experiment: If the Senate voted to ban orange dogs tomorrow, would that be "society" choosing to do that, because they elected those Senators?)

Remember, politics is not a game where we get to pick and choose our ideal policy; only a few politicians are seriously available for any given position, and it’s quite likely that all of them will support at least one option a vote dislikes. This does not mean that the voter "chose" that policy, however. It means only that someone the voter elected for whatever reason decided to vote for it. Those who used that policy preference as a reason to vote "chose" that policy; others didn’t.

(As an addendum, I didn’t voted for anyone who approved Medicare, since it was signed into law 8 years before I was born. So I guess the "we" is some historical we from 1962 or so, in order to have elected Senators and Representatives who’d have passed the amendment that created it, so President Johnson could sign it?

I suspect (though I have no way to verify) not a single one of them ran on the platform of creating Medicare. This "choice" that "we" made looks extremely thin, no?)
 
Written By: Sigivald
URL: http://
Neither HilaryCare nor any of the current health-care proposals seek to abolish private health insurance. So under any realistic past or present proposal that relates to the United States, that option remains.
Sorry, glas. You are simply wrong. Very wrong.

President Clinton’s proposed health care legislation of 1993, Section 1406, paragraph d, paragraph 2, contains a provision that prohibits private contracting for seniors and everyone else.

That same article discusses the fact that, to be a part of Medicare, a 1997 law effectively made it impossible to treat outside of Medicare without leaving all Medicare involvement for two years:
Under Section 4507 of the Balanced Budget Act, any doctor is free to contract privately with a patient enrolled in the Medicare program, treat that patient on an independent basis outside of the rules and regulations of the Medicare program, and refrain from submitting any claims to the taxpayer for Medicare reimbursement.

However, Section 4507 contains a catch. A doctor who wishes to contract privately with a patient enrolled in Medicare Part B must first sign an affidavit to that effect, submit that affidavit to the Secretary of Health and Human Services within ten days, and agree to remove himself from the Medicare program and refrain from submitting any claims to Medicare for reimbursement for a period two full years.
Now, I guess you could say that there’s still some theoretic opening for people to go outside the system. But if it’s realistically impossible for the providers to do so, what good does that do?

Then, of course, we’ve heard a lot about modeling our system after Canada:
Ms. Allen figures the lawsuit has a fighting chance: In 2005, the Supreme Court of Canada ruled that "access to wait lists is not access to health care," striking down key Quebec laws that prohibited private medicine and private health insurance.
So Ontario did indeed take away that option, by law, until a court said otherwise in their famous "access to a waiting list is not access to healthcare" decision. (And as a side note: the problems brought out about Canada are despite the fact that Canadians have an "out" - they can come to the US and pay, no matter what the Canadian system requires. So it’s pretty easy to believe their wait lists would be longer if they couldn’t do that any more.

There there’s this:
A single-payer system would prohibit private insurance for services covered by the national plan...

Your assertion that no seriously discussed plan does away with private insurance is flatly wrong. The 1993 effort, headed up by Hillary herself, clearly did exactly that. I would remind you that Hillary Clinton is a major party frontrunner for the presidential nomination.

Now you might have been thinking that you could make such an assertion by transforming it to mean that none of the candidates right now are discussing a plan that would do away with such options. But the plans touted by the candidates are so fuzzy that they could be interpreted in many different ways. Since Hillary herself already proposed a plan in 1993 that contradicts your assertion (and it came close to being adopted during Bill Clinton’s first term), any such reassurances about the parsing of current proposals is meaningless.
 
Written By: Billy Hollis
URL: http://
So when did the government become known for doing things efficiency and without developing massive, slow, and wasteful bureaucracies?
 
Written By: jpm100
URL: http://
Sigivald:

The various federal and state statues regulating health care continue to exist so long as they are not repealed; there is no vested right whatsoever to a continued entitlement. (A vested right is one that the government cannot deprive you without paying compensation.) So, "we" includes current voters because our elected officials fail to repeal those laws.

if one assumes that "society" has the right to confiscate and reallocate individual wealth in any way it sees fit .

Even though I’m a liberal, I think the Commerce Clause should have some teeth. However, since not even Justice Scalia believes that any more (Raich), it’s kind of hopeless at this point.

More broadly, libertarians should develop some consistency on their views of the judiciary. Do you want a strongly interventionist judiciary, willing to strike down federal laws and budgets as being in excess of federal power, or a judiciary more deferential to the will of the majority?
 
Written By: Francis
URL: http://
Do you want a strongly interventionist judiciary, willing to strike down federal laws and budgets as being in excess of federal power, or a judiciary more deferential to the will of the majority?
The former.

The whole purpose of American constitutionalism was to limit the will of the majority, in order to, in part, prevent the citizenry from enlarging themselves at the expense of a minority.
 
Written By: Dale Franks
URL: http://www.qando.net
You know,
There is something I just don’t get.

Plan 1) Under a single payer plan, gov. provides X services for Y tax cost. The individual has no choice in the matter.
Plan 2) If we give people the choice in enrolling in a gov. plan, they enroll and pay for it knowing they will get X services for Y cost and the rest of us will self insure out of pocket or buy ins. (Hopefully without having to pay into plan one as well.)
But when we offer plan two as an option, everyone says this will create a two tiered system and only the rich will get good health care.
Well Duh! Doesn’t that prove the point that plan one has serious flaws.
The only advantage I can see with plan one is everyone has lousy health care. Equal misery for all.
I thought that this country was about equal opportunity, not equal outcome.
 
Written By: Brian Kilburn
URL: http://
It is perhaps noteworthy that my state of Texas has apparently solved the doctor shortage: So many doctors are moving there they can’t license them fast enough.

And how did they achieve this? By limiting the non-economic (pain and suffering) damage awards for malpractice to 250k. This caused malpractice insurance rates to drop like a rock.

Of course, since the Democrats are owned in fee simple by slimy bottom feeding trial lawyers like John Edwards, the odds that they would go along with this solution are 0.
 
Written By: SDN
URL: http://
You DO know that nearly 50% of all healthcare spending goes through government at some level TODAY right?
Which might explain why healthcare spending in this country is out of control.

Seriously, is it a good thing that the US government pays nearly half the cost of any commodity?
 
Written By: Steverino
URL: http://steverino.journalspace.com/
Keep the government our of it and the free market will produce the most eficient system.
I’m not saying go Dr. Mengal on everyone, But keep gov out and let ecconomic darwinism run its courc.
 
Written By: Brian Kilburn
URL: http://
I’d guess most of the Americans would like some form of national healthcare actually are more worried about losing their healthcare if they are fired and see it as a way to "guarantee" them having healthcare.

They don’t actually want nationalized healthcare, per se. The solution would be to make everyone be in charge of their own healthcare and take this away from the employer - but most people would assume they would not get a pay raise to cover this and would "lose money."

I won’t event talk about the people who like the idea of "free healthcare."

Therefore, the best solution right now is to educate the consumer by allowing every state to experiment and not impose a federal solution. Personally, I think making health insurance mandatory serves one useful purpose: taking away some of the "but what about the poor people" argument when its actually many not-so poor young people who prefer not to buy their own insurance. If we can find the percentage of people that actually cannot afford their own insurance, then its just a simple problem of cash to pay for it. (societal choice of course.)
 
Written By: Harun
URL: http://
Stalin, Mao and Castro would love this guy. He bemoans the 10 % poor in America but welcomes the 85% poor in socialist countries. Never mind, socialists don’t devote resources to health care, they just let their people eat cake.
 
Written By: RA
URL: http://
Seriously, is it a good thing that the US government pays nearly half the cost of any commodity?
No it’s not a good thing, but it’s a true thing. Another true thing is that it’s not going away, government is not getting out of healthcare.

So, I, who for most of my life would argue that getting government out of healthcare was the best option, realized that since this is not an option, we should go with plan B, take the money that already goes through the government, put it all neatly into one package, and use it to provide significant healthcare coverage for every man, woman, and child in America. Then let Americans who want more, have more, and can afford more, go ahead and get more.

The most important element to this whole equation for me is this... And I am sorry if I am being repetitive, but national healthcare is coming, and if the people who actually believe in equal outcomes are the only one’s at the drawing board, with everyone else just saying NO!, then we will end up with equally bad outcomes. So I want to be at the drawing board.

Think about elements of national healthcare you can live with, and think about elements of a national health care program that you cannot live with, and participate in making it happen in the best way it can.

Or swing at this windmill, and hope some people with your sensibilities, but perhaps not your blind adherence to philosophical principals make their way to drawing board to do the work that you refuse to do on principal.


Cap

 
Written By: Captin Sarcastic
URL: http://
Correct, CJ, but rationing by price is much more efficient.
And I never stated otherwise. ;)
I’d guess most of the Americans would like some form of national healthcare actually are more worried about losing their healthcare if they are fired and see it as a way to "guarantee" them having healthcare.
I tend to agree with this sentiment. People like security. They would love to take comfort in knowing that, if the worst should happen, they still are protected from danger. Unfortunately, I think they also sometimes fall into the fantasy that the state possesses magical powers that allows it to make happen whatever the people desire.

The leftists will continue to delude themselves of the "superior quality" of socialized health care and preach its virtues, but the only angle that seems remotely capable of swaying the rest of America is the one mentioned above.
 
Written By: CJ
URL: http://
No it’s not a good thing, but it’s a true thing
True or not, if it’s a bad thing, then work against it.
So, I, who for most of my life would argue that getting government out of healthcare was the best option, realized that since this is not an option, we should go with plan B, take the money that already goes through the government, put it all neatly into one package, and use it to provide significant healthcare coverage for every man, woman, and child in America.
A little like saying since you’re going to be raped, you might as well relax and enjoy it. I don’t share your optimism that the government will be able to provide significant health care coverage for everyone in America. It hasn’t been able to with either Medicare or Medicaid, and I don’t see how it will do any better with your mysterious Plan B.
Or swing at this windmill, and hope some people with your sensibilities, but perhaps not your blind adherence to philosophical principals make their way to drawing board to do the work that you refuse to do on principal.
You don’t know me well enough to say anything about my adherence to principals. From what I’ve seen of your posts, you’re far more of an idealogue than I.


Government getting into health care is what broke the system. Before Medicare, doctors charged pretty much what the market would bear. Once Medicare was enacted, it set rates for "reasonable and customary" charges for various procedures. Lo and behold, all of a sudden the Medicare rate became the minimum charged. How nice of Uncle Sammy to do that for us, huh? Do you really think that it’s going to get better with universal coverage from the government? Because I know some beach-front property in Yuma, AZ, for sale. (It’s the perfect beach, just add your own water!)


Look, if the government is going to be able to provide health insurance for everyone in the country, why not have it provide car insurance, too? After all, there are millions driving around without insurance. And uninsured motorists cause financial damage to other people (all insured motorists, as increased premiums, and also to anyone whom they injure in accidents), so this is a big problem that needs fixing. And since you’re so sure the government can cure health insurance, then you should be equally sure it can fix car insurance.

Hey, maybe Uncle Sam can start providing homeowners’ insurance. We can make the government one big multi-plan insurance provider.


There is no plan, government-paid or otherwise, that can work if the primary consumer of health care services isn’t picking up the majority of the tab.
 
Written By: Steverino
URL: http://steverino.journalspace.com/
You don’t know me well enough to say anything about my adherence to principals.
True or not, if it’s a bad thing, then work against it.
I think you answered that one yourself.

It’s like Social Security, I would prefer that the system immediately ceased to exist, but it’s not going to happen, so I fight for private accounts. Make a bad system better within the constraints of what is possible.
Do you really think that it’s going to get better with universal coverage from the government?
I know we spend 16% of of the GDP on healthcare NOW, I know that in the next 10 years it is estimated that we will spend 20% of the GDP on healthcare. And this tells me that we can’t go on doing what we are doing (and we won’t). And I know the government never gets out of anything. You do the math.
Look, if the government is going to be able...
Slippery Slope argument is a logical fallacy.
 
Written By: Captin Sarcastic
URL: http://
Slippery Slope argument is a logical fallacy.
Not arguing slippery slope here. (It’s not a slippery slope argument, anyway, because I’m not claiming anything is inevitable, so you’re wrong on this count.) Just wondering why you don’t apply your logic regarding health insurance to other kinds of insurance.
I know we spend 16% of of the GDP on healthcare NOW, I know that in the next 10 years it is estimated that we will spend 20% of the GDP on healthcare. And this tells me that we can’t go on doing what we are doing (and we won’t). And I know the government never gets out of anything. You do the math.
You didn’t answer my question: do you think more government involvement will make it better? I’m betting it’s because you really don’t have an answer for it. Let me show you what you’ve argued:

1. Government involvement in health care is a bad thing.
2. We should let government get more involved in it, even though that won’t make it better.

If you can’t see the fundamental flaw in your position, there’s no point in arguing with you.
I think you answered that one yourself.
So, working against something I think is wrong equates to "blind adherence to principals" in your estimation? You really are a lightweight.

 
Written By: Steverino
URL: http://steverino.journalspace.com/
Example: if there are 10 hip replacement surgeons and 10 patients demanding the surgery, the allocation model is simple. Each patient is served as demanded at a particular price and in a particular time-frame. But if there are 10 hip replacement surgeons and 1,000 patients, suddenly some different method of allocation must be found.

In a free market that equilibrium would be determined by price and rationed in that manner. In an National Health Care scheme, however, which fixes price, a different method of allocation is necessary. And what most have hit upon is a form a rationing known as "first come, first serve". Thus the waiting lists. Price, of course, is irrelevant, because that’s been fixed by the system. But what the system can’t "fix" is the supply of qualified hip surgeons.
McQ, did you actually read Krugman’s column? Did you choose hip replacements as your example just to make yourself look foolish? As Krugman points out in his column, the VAST majority of hip replacements in this country are paid for Medicare, which sets the price, just like Canada’s Medicare does. The difference is that the U.S. sets no limit on the amount of hip replacements it will fund. In other words, Ezra is right and your are wrong. Rationing in the sense of setting quotas is not a necessary feature of nationalized insurance systems. We have a nationalized insurance system for the elderly in this country. It’s call Medicare, and it doesn’t set quotas, and therefore there is no rationing in the sense Ezra was refering to. Of course there is normal, market-based supply and demand rationing. You have to actually find a doctor with the availability to do the surgery. But that’s a totally different thing, and would be the same in any system which relies on private entities to provide care (such as the U.S., Canada, France, etc.). Have you ever tried to get an immediate dermatologist appointment in this country? It’s really hard, even if you have lavish private insurance or are willing to pay out of pocket. That’s because there are not enough dermatologists to keep up with demand. So you have to wait months. It has nothing to do with national health care.
 
Written By: Anonymous Liberal
URL: http://www.anonymousliberal.com
1. Government involvement in health care is a bad thing.
2. We should let government get more involved in it, even though that won’t make it better.

If you can’t see the fundamental flaw in your position, there’s no point in arguing with you.
I don’t believe that I am arguing for MORE government involvement, I am arguing for a change in the nature of the current government involvement. Rather than having hundreds of different ways to pay for healthcare for some people, have one one way.

The fundamental flaw in your argument is that you are falsely defining my position, and then arguing against that falsely defined position.
So, working against something I think is wrong equates to "blind adherence to principals" in your estimation?
No, and this again is a false representation of my assertion. I stated that I believe that government involvement cannot be UNDONE, therefore the best course of action is to try and improve the nature of the current government involvement.
You really are a lightweight
Ad hominem, unless of course you can prove it. Might I suggest, "You sound like a liberal, therefore you must be a lightweight".

Your response does not address my arguments at all, if it had, you might be a heavyweight, as it is, you are just going for the sucker punch and missing.

Cap
 
Written By: Captin Sarcastic
URL: http://
"It has nothing to do with national health care."
In a way so profound that it goes right over your head, that is exactly the whole point.
 
Written By: Billy Beck
URL: http://www.two—four.net/weblog.php
"McQ, did you actually read Krugman’s column? Did you choose hip replacements as your example just to make yourself look foolish? As Krugman points out in his column, the VAST majority of hip replacements in this country are paid for Medicare, which sets the price, just like Canada’s Medicare does. The difference is that the U.S. sets no limit on the amount of hip replacements it will fund." —Anonymous Liberal

There is a limit to how much it can fund. These limits do not cease to exist, even if you or your cohorts run the printing presses that pump out the money.

"That’s because there are not enough dermatologists to keep up with demand. So you have to wait months. It has nothing to do with national health care." — Anonymous Liberal

I don’t mean to be a jerk, but I’ll say this flatly; of the economic and political effects of general price maxima/minima, cartelization, the creation of monopoly privileges in the form of licensure, how these things will be pushed to apotheosis under a system of nationalization one must be completely ignorant in order to say something like that, and imply what you do thereby. If I should say nothing else on the subject, let me say that.
 
Written By: Brian
URL: http://
In a way so profound that it goes right over your head, that is exactly the whole point.
Thank you, Obi-Wan. We mere mortals have no hope of understanding your profound wisdom. I guess that’s why you don’t even bother to share it with us.
I don’t mean to be a jerk, but I’ll say this flatly; of the economic and political effects of general price maxima/minima, cartelization, the creation of monopoly privileges in the form of licensure, how these things will be pushed to apotheosis under a system of nationalization one must be completely ignorant in order to say something like that, and imply what you do thereby. If I should say nothing else on the subject, let me say that.
There’s a tendency among the commenters here to cryptically dismiss anything written by someone who doesn’t buy into libertarian orthodoxies as the product of basic ignorance about economics and/or the complexities of policy, etc. It’s incredibly obnoxious. Look, you may not agree with me, but I’m not some know-nothing idiot. I’m a lawyer who deals with health-care related laws and regulations all the time. I also studied economics and health care policy extensively in college. That doesn’t mean you should just defer to my opinion, of course, but at least do me the favor of offering some sort of substantive response instead of just dismissing me personally as some sort of ignoramus.

Believe it or not Brian, I actually know something about economics, cartelization, monopoly privileges, etc. You’re not blowing my mind by throwing big words around. In my previous post I wasn’t even attempting to address the question of why we have long waiting times in some areas (like Dermatology). The answer to that is complex. But my point is that this sort of "rationing" can happen even in a completely free market system (which I’m not suggesting ours is). There was recently an article in BusinessWeek that compared wait times in the U.S. to other countries and found ours to be longer than most (such as France and Germany). McQ’s attack on Klein’s post is misguided. He simply ignores Klein’s point and redefines "rationing" in a counterintuitive way that obscures the point that both Krugman and Klein were trying to make.
 
Written By: Anonymous Liberal
URL: http://www.anonymousliberal.com
Sorry, glas. You are simply wrong. Very wrong.

Billy:

Nope. I admit that I never heard of what you’re quoting here, but upon further research, I’m still right, and you’re wrong again.

First of all, your link is from 1998.

I’m not familiar with this at some point proposed provision in the 1997 Balanced Budget Act, but the fact that the proposed law in question is, in fact, from 1997 should clue you in that it was not part of the proposed national health care plan of 1993.

This law is clearly in the context of Medicaid, which is definitely not a national system in any way. Furthermore, this article on the subject, which is not at all friendly to the law, claims only that

In an unprecedented invasion of physician/patient privilege and privacy, "Doctors are supposed to submit bills for all their elderly patients to Medicare once they care for a single Medicare patient,

So there guys claim not, what you claim, that such doctors treating Medicare patients are unable to contract separately with these patients, but only that they can’t submit for reimbursement from Medicare unless they bill through Medicare.

Horror! Doctors can’t get money from a government-run healthcare program unless they also agree to submit their bills to that same program! Shock!

This is nothing whatsoever, in any way, like any form of attempted national prohibition on private health insurance. Even if it was a proposed national plan, which it wasn’t, of Hilary’s in 1993, which it also wasn’t, its most extreme possible consequence is only that doctors would have to choose between seeing private patients or government-health patients, but not see both.

That’s not "practically impossible". The free market, combined with the glaringly obvious deficiences of the government system, should make that happen in a heartbeat. Right?

And that’s only in the hypothetical scenario that this was proposed as part of a national healthcare plan. Which it wasn’t.

I await your retraction.

 
Written By: glasnost
URL: http://
Second Anonymous Liberal.
 
Written By: glasnost
URL: http://
Second Anonymous Liberal.
LOL!

Gee, there’s a surprise.
 
Written By: McQ
URL: http://www.qando.net/blog
"Thank you, Obi-Wan. We mere mortals have no hope of understanding your profound wisdom. I guess that’s why you don’t even bother to share it with us."
{laff,laff,laff} As if you would be remotely interested. Go try to con someone else.

You’re going to get what you want. It’s going to happen, and the damage that it will do to this country is going to out-strip your lifetime by orders of magnitude. It will take many generations to get over it, if that ever even happens. You’re going to go down in history just like the bloody fools who cheered for social security and didn’t live to see what that is coming to.

It’s almost enough to make a man wish that religion were true: if there were a god, and prayers were something more than fantastic, they would be the only thing really useful in dealing with you. That’s because you’re going to have your way in this, and millions of others who dimly sense something wrong with it are going to have nothing but their American equivalent of a blue finger when it’s all said and done. They’re going to vote against it and then take the ride.

"If your children ever discover how lame you really are, they’ll murder you in your sleep."

(Frank Zappa, 1966)

 
Written By: Billy Beck
URL: http://www.two—four.net/weblog.php
I await your retraction.
I suspect you’ll be waiting a long time.

You seem to be conflating the 1997 law and the 1993 proposal. I listed both (which just happened to be referenced in the same article) because I believe they both refute your claim.

I believe you are misreading the 1997 law, but it’s pointless to debate that. Hillary’s 1993 proposal is all I need. Since you didn’t get it before, let me make it even more clear:
Q. The President emphasizes "choice" as one of the six principles of his reform plan. Do families have the freedom to choose a health care benefits package outside of the regional health alliance?

A. No. The choice available to families is limited by the government, with very few exceptions. As the Manhattan Institute’s Elizabeth McCaughey remarks, "Unless you now receive health care through Medicare, military or veterans benefits, or unless your spouse works for a large company, the law will require you to buy basic health coverage from the limited choices offered by your alliance. It will be illegal to buy it elsewhere." {emphasis mine}
 
Written By: Billy Hollis
URL: http://
In an unprecedented invasion of physician/patient privilege and privacy, "Doctors are supposed to submit bills for all their elderly patients to Medicare once they care for a single Medicare patient,

So there guys claim not, what you claim, that such doctors treating Medicare patients are unable to contract separately with these patients, but only that they can’t submit for reimbursement from Medicare unless they bill through Medicare.
Please reread the quote you provided. It says exactly what you claim it does not. It explicitly says that if they accept any Medicare payments, they may not accept private payment from any patient who is enrolled in Medicare. It says nothing about them still getting reimbursement from Medicare whatsoever. This is consistent with the section Billy Hollis refers to above. Moreover, the article he linked explicitly states that the law only allows you to contract privately with patients enrolled in Medicare if you give up any right to reimbursement via Medicare and have not accepted such reimbursement for at least 2 years.
 
Written By: Phlinn
URL: http://
Hmm, I just reread the article. It doesn’t require that you haven’t recieved medicare for 2 years, but you will be unable to accept medicare for 2 years. It looks as though you could drop out of the program at any time, but would have to wait at least 2 years to start accepting it again. I’m assuming it’s worded different in the actual law, but as presented you would have to present a signed affidavit that you would forgo reimbursement for 2 years each and every time you billed someone privately. You would have to go a 2 year period after the last time you treated a patient on Medicare but billed privately before you could start getting reimbursed by Medicare again.
 
Written By: Phlinn
URL: http://
Hillary’s 1993 proposal is all I need. Since you didn’t get it before, let me make it even more clear:

You’re still wrong. We’ve established that the 1997 law doesn’t do what you claimed it did. Now, to deal with the 1993 law and your cite, well, I’ll quote you:
Under universal, single-payer healthcare such as HillaryCare, he doesn’t get that choice - he simply suffers. That’s an inefficient allocation of resources.
The misunderstanding here is fundamental. To quote from your linked document:
Q. Can a regional alliance prevent a plan being offered to consumers?

A. Yes. The regional health alliance must normally offer contracts to health plans meeting the federal conditions, but it still has reserve powers to exclude a plan. For example, a regional alliance may exclude a plan if its proposed premium exceeds the average premium within the alliance by more than 20 percent; if the plan fails to offer coverage for "all services" as outlined in the federal government’s comprehensive benefits package; if the alliance finds that the plan discriminates against any group of the basis of race, ethnicity, gender, income, or health status.
So, per reading and per what I thought was common knowledge for anyone who lived through 1993, HilaryCare was not a single-payer system. Per the above cite, the government established a new set of minimum requirements for private plans, administered with a limited set of federally specified criteria for denying said plans, and any private insurance carrier who wanted could compete for business under the plans.

So when the Manhattan institute troll says :
the law will require you to buy basic health coverage from the limited choices offered by your alliance.
, the key word here is limited, or to be more realistic, "limited", quotation marks definitely intended, the selection is "limited" to.. any private plan that wants to sell to the given state and meets the criteria. Which is rather similar to how our current system works in principle - just with a different set of criteria. What’s being described is a regulated private market. So, to return to your quote:
Example: Suppose you have one person whose sleep apnea is just marginally bad enough for surgery (according to government rules about such things). That person may *not* be willing to pay for it themselves, but they’ll take it if someone else pays. Another person may have sleep apnea just under the limit for what the government thinks should warrant surgery, but they work in a mentally demanding field and the clearing up sleep apnea so they can think more clearly has a higher value for them, so they’re willing to pay for it themselves, even perhaps to the extent of paying a premium so they don’t have to wait long to do it.

In a private system, that option is available. Under universal, single-payer healthcare such as HillaryCare, he doesn’t get that choice - he simply suffers.
The scenario described here is completely inappropriate and non-applicable. HilaryCare was not a single-payer system. There were no government personnel involved in telling private citizens what medical procedures they could or could not get. There were oversight boards that required private healthplans to provide a full range of services and may not have allowed them to deny coverages or procedures. There’s nothing described anywhere about a government role in citizen care decisions, and there’s nothing at all limiting private citizens for making direct arrangements with medical care providers and paying out of pocket.

Your scenario doesn’t match the system. Your quoted recent cite doesn’t describe citizens not being allowed to pick their own health insurance, and it definitely doesn’t exclude them paying for health services out of pocket, as the "illegal" quote refers only to failing-grade insurance plans. Your 1997 cite , again, at worst, would require doctors to choose between treating Medicare patients or private-payment patients.

I know this is an internet forum and all so no one ever retreats and all, regardless of what the facts say or how they shift, but it’s clear that HilaryCare was not a proposed single-payer system. That’s the absolute minimum you ought to be able to admit from reading your own links. You also ought to be able to admit that even a plan that made it illegal to purchase non-government approved private health **insurance** does not make it illegal to pay for health care yourself, unless specifically written to do so, which you have not provided an example of, because Hilary didn’t propose it. Except your Canada example (which was a regional law, not a national one). And this isn’t Canada.






 
Written By: glasnost
URL: http://
Phlinn, like I said:
its most extreme possible consequence is only that doctors would have to choose between seeing private patients or government-health patients, but not see both.
Even accepting your interpretation of the law, requiting doctors to treat either Medicare patients or private patients, but not both (at the same time), is nothing whatsoever akin to making it illegal to pay for private treatments.
 
Written By: glasnost
URL: http://
No, and this again is a false representation of my assertion. I stated that I believe that government involvement cannot be UNDONE, therefore the best course of action is to try and improve the nature of the current government involvement.
No, it’s an accurate representation of your assertion. You originally said I was blindly adhering to principal, without any supporting argument. Then came this exchange:
True or not, if it’s a bad thing, then work against it.
I think you answered that one yourself.
If you aren’t saying that my desire to work against a bad thing is blind adherence to principal, then what are you saying?

And, yes, if you think working against a bad outcome is blindly adhering to principal, then you are a lightweight. Not because you are liberal, but because you used an extreme label for a non-extreme position, simply because it’s a position with which you disagree. Working against a bad idea is NOT blind adherence to principal.

You are the one who started the ad hominem and mischaracterization. Don’t complain because you got your bad argument stuffed down your throat.
I don’t believe that I am arguing for MORE government involvement, I am arguing for a change in the nature of the current government involvement. Rather than having hundreds of different ways to pay for healthcare for some people, have one one way.
How is this NOT more government involvement? You want the government to pay more, and to assume the role of insurance provider for everyone. If that isn’t more government involvement, then what is? These were your own words:
we should go with plan B, take the money that already goes through the government, put it all neatly into one package, and use it to provide significant healthcare coverage for every man, woman, and child in America
Since you advocate using the government to provide insurance to more people than it already does, you are advocating more government involvement. Don’t run from your own words.


You have yet to address the fact that government insurance (Medicare and Medicaid) has failed miserably, and only served to increase the cost of health care in this country. But for some reason you think that having the government provide insurance for more people is going to be better, and you haven’t explained how.
 
Written By: Steverino
URL: http://steverino.journalspace.com/
You have yet to address the fact that government insurance (Medicare and Medicaid) has failed miserably, and only served to increase the cost of health care in this country. But for some reason you think that having the government provide insurance for more people is going to be better, and you haven’t explained how.
There are reasons for Medicare’s failure, and they do not need to be repeated in a national healthcare plan.

You make the overly simplistic claim that government involvement is the final answer, and that’s simply not true. It can, indeed has, been done better, in other countries, and in our own with the federal employees health plan.

Compare the two, both are government plans, one is failing, one is very successful... (very briefly)

Medicare
Today, the Medicare program is overwhelmingly statist. Medicare uses political fiat, price controls, and centralized bureaucratic processes to try to regulate an infinitely complicated health care program. Many Medicare rules—such as record keeping, ownership rules, and quality standards—directly regulate almost all health care providers.

Most regulatory decisions made by Medicare are compromises that are wrong—often deeply wrong—for many enrollees and providers. Medicare is like a government-designed automobile: designed by committee, changed too late, with final details set by legislative or bureaucratic fiat, and based on the principle that "one size fits all" and the corollary ethical proposition that everyone should get an identical benefit because anything else is "unfair." Like the government-designed automobile, Medicare fits very few as well as the plan they would choose for themselves if given a choice.
Federal Employees Health Benefits Program
In contrast, the Federal Employees Health Benefits Program (FEHBP) uses the mildest forms of government direction and oversight to allow the forces of choice and competition to determine health plan costs, benefits, provider choice, administrative convenience, and a host of details.
You are correct that Medicare is broken, but it cannot be eliminated, and a well run (like FEHBP) plan, could fix what’s wrong with Medicare, as well as dealing with the decision of the American people that healthcare should be a right.

Cap
 
Written By: Captin Sarcastic
URL: http://

 
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