[quote]orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
DrSkeptix wrote:
LIFTICVSMAXIMVS wrote:
chiro1 wrote:
If you want the best treatment money can buy you must actually buy it…with your own money.
Problem solved.
You cannot afford me.
I can afford 10 of you and all of your moms.
And you are too irredeemably stupid to know why you are wrong.
But just as an exercise, why not look into the total charges for operative care of, say, colon cancer and 6 months of adjuvant chemotherapy, especially if you can not work.
Oh, that’s right… I forgot. You do not need verifiable facts, because all you need know is between your ears already.
While LM struggles with his homework assignment, I will expand on a fallacy of “health care.”
There is a line of reasoning in these threads that all pricing problems would go away if insurance disappeared, and “health consumers” were left to negotiate with “providers” in something called a “free market.”
(For purposes of discussion, I make a distinction between “medical care”–for a crisis or a chronic illness–and “health care,” variably defined.)
Let’s agree that an ideal free market depends on the open and transparent availability of information. If information is held disproportionately by sellers, buyers are at a disadvantage which cannot be bargained away.
There is NO free market in medical care for precisely this reason. Technical information is held by a few, the consumer cannot know if one doctor (or provider) is truly offering the same commodity as another, and most strongly, the consumer of services is the provider, not the patient.
(A patient cannot educate himself, in a timely fashion, in the technical merits of one diagnostic procedure or treatment over another. He is very often–not always–at the mercy of others.) The medical care market is not comparable to airflights on Priceline.com.
The parallel fallacy entertained by some, here, in “macho” style, is that they do not want to be compelled to buy insurance, or they do not need insurance because they can save and pay for it when needed. I do not intend a run through of the general theory of risk. But anyone with life experience knows that rare things nevertheless happen: meteor showers, bus crashes, colon cancer.
These are expensive events, and we are all doomed to get something, sometime, when we are least prepared. The 26 year old man I saw tonight in the ER, whom I predict will have Stage II Hodgkin’s Disease, wasn’t planning on $100,000 bill to save his life this year.
For those of you who still think you can avoid insurance premiums and save up, guess what? You will compete with the indigent for attention, and you may get the care you need, and the rest of us will foot the bill.
Medical insurance–to mitigate the risk of the unpredictable catastrophe–is absolutely necessary. “Health care plans,” not so much.
I would agree that insurance makes sense at some point, depending on how rich and risk averse you are but I did not really see anyone arguing against private insurance.
The idea that a market was not able to deal with information asymmetries is strange though. There is no reason whatsoever why consumer watchdogs should not find a ready market for their services.
Also, such asymetries usually hurt both buyer and seller so it would be in the best economic interest of at least those doctors who provide quality to make it known that they indeed provide better service that is worth the extra price they demand.
Fair points. Rebuttal:
- “Consumer watchdogs?”
Surely you, orion, do not mean government agencies?
If consumer watchdogs would be a consequence of market inefficiencies, we would have seen them already. We don’t.
“Asymetries hurt both buyer and seller.” Perhaps, but my premise is that the provider of medical care, and not the patient, is the consumer. So the asymetric market for medical care has no remedy in the competition, or in “watchdogs” you propose.
If you are correct, that watchodogs would “find the market,” consumer watchdogs would serve the provider and the insurance company, but not always to the economic benefit of the patient. That is the case: it is the professional societies that establish norms, and insurance companies have placed restraints on consumption which are often irrational and do not necessarily benefit their customers, the patient.
What does the provider consume?
I understand that the decision whether he gets paid ultimately lies with a third party but why does the provider “consume” anything
- “Quality”
In medical care, quality is like pornography; you can’t define it but you know it when you see it.
Contrary to popular belief, outcome or dollar efficiency does not define the quality of the product; you cannot compare one doctor to another based on the outcome of medical events. (Surgical success rates may serve as a benchmark for hospital quality in certain cases.)
Insurance companies and the Federal Government (chiefly CMS) will tell us they have quality standards, but they remain the most primitive lists; more geared to “health maintenance” on the one hand and a repetitive “checklist” on the other.
The patient-consumer has only highly unreliable methods of comparing the quality of the product he seeks.
These “quality guidelines” are in reality just “documentation guidelines;” they are for the benefit of lawyers, billers and payers. The value of the event recorded is low, but the value placed on the medical record is high. So we will see “pay for performance” laws, which are just “pay for documentation,” with the goal of decreasing payments to providers.
Hence, the real pollitical push for electronic medical records is not coming from doctors or patients, but from hospitals and insurance companies, in order to document events for payment, and to track “consumer” usage.
Yup.
Government is either a player OR a watchdog, but when it gets to be both everybody is fucked.
I�´d prefer them to be neither.
- “Insurance makes sense at some point…”
Yes, that is the purpose of the free market in insurance services. (Health care insurance and medical insurance are slightly different animals.)
That market should be transparent, comparative and rational.
For every individual at risk, there would be a risk pool that describes his situation, and then there would be a product which would be priced to sell; it would be such a bargain that everyone would want one.
Unfortunately, many people and their families fall into adverse risk pools for which any actuarially determined premium is simply out of reach. There is no insurance market for this population, and this is precisely where the social welfare aspect of medical insurance is defined. Everyone must be served, and everyone must pay, one way or another.
Well that I obviously do not agree with.
I understand that health care is an emotional topic and maybe I am a heartless bastard, but that helps me realize that the market forces do not care whether you buy shoe polish or health services.
Actually, a lot of voices you hear in America now are distinctly Marxist. The argument is literally the same, they believe by abolishing the “profit” in health care and “cutting the cost of competition”.
Excuse me but when I hear people discussing health care who do not even understand the importance as profit as a market signal I just know that the only option is private charity.
[/quote]
- "What does the provider consume?
I understand that the decision whether he gets paid ultimately lies with a third party but why does the provider “consume” anything"
The medical care provider orders tests, procedures, and resources on behalf of the patient. To this degree, the patient is an object, and the provider is the consumer. A patient cannot walk in and order an MRI mammogram and directed biopsy, but a doctor can; that doctor has consumed a few kilobucks of resources, putatively for the benefit of the patient.
- I: "There is no insurance market for this population, and this is precisely where the social welfare aspect of medical insurance is defined. Everyone must be served, and everyone must pay, one way or another. "
Thee: “Well that I obviously do not agree with.”
I was being descriptive, rather than normative here.
I attempted to define the “set point” which rationalizes the intervention of public policy in private matters health and medical care.
For example, imagine that there has been an “explosive” development in medical technology and its expenses, with unfettered demand, since 1965. Society demands that no one should be deprived.
Well, as the expensive new technologies come on line, insurance risk calculations become more tenuous, fewer people can afford either the costs–ordered by others–or the premiums on insurance. Thus, the “set point” of public intervention descends, capturing first the destitute, then the lower classes, then the working classes, then the middle class. Then everyone.
This line of reasoning does not involve Marxism, or a negation of profit motive. It simply describes where the USA stands now, and why it is not like Europe, or Britain.
I said I was being descriptive, but truth be known, I am also being normative.
But that is where you, orion, might be better at describing Pareto’s ophelimity and optimality.
- “…the importance as profit as a market signal I just know that the only option is private charity.”
Ah, charity. What is missing from any such calculation is “invisible charity.”
A lot of the service I render goes uncompensated; a lot of the care for the uninsured by doctors, in EDs, goes uncollected. The same is true of a lot of the care rendered to those with “insurance,” in HMOs.
This is all private charity, and it goes unnoticed.
Of course, there is a lot of cost-transfer. If someone doesn’t pay, someone else is paying through their insurance premiums, their taxes, their co-pays. But no one knows how much of the real burden is born by others.
- On profit, the profit motive, a historical note.
There are no histories written in this, but I may change that.
Before Hillarycare debacles in 1994, insurance companies made their profit on investing the “float” (i.e., the premiums collected from members) and anticipated paying out in indemnity claims all the premium collection.
After the onslaught of HMOs, doctors and medical groups became decapitalized; all the loose change was sucked out of the sofa cushions. But what people lose sight of is the change that occurred in the Health Insurance Industry; the business plan now was collect premiums, invest, and also to deny and discount payments.
Profits soared, and now Insurance Industry was clearly aligned against doctors and hospitals and patients: the profits grew as employees were enrolled and payments were subsequently denied.
Now, can someone tell me why this arrangement should be preserved in Obamacare? Why will private and public money be funneled through these same companies, whose chief motive is the denial of service?
Under National Health Care, why are Insurance companies not turned into utilities, with a nice secure profit on collection of 6% or so?