Putting aside Judicial nominations and steroids
 

If America's large corporations decide that we need government provided healthcare that is going to turn the whole debate upside down. The insurance companys and drug companys may have a lot of clout, but it is pretty much nil when you match it up against the combined clout of the rest of the fortune 500 company's.

Putting aside Judicial nominations and steroids
 

I have two thoughts, which I will express briefly. First, you say that the health care market is not an example of market failure, but of non-market/regulatory failure, because a true market doesn't exist. We agree on the state of the market -- there isn't one. Isn't that the most extreme kind of market failure?

Second, you suggest that the moral issue is whether health care should be allocated in a way other than the market? I would be inclined to respond that yes, it should. Basic health care should be available to all people, at a price consistent with the true cost of the service provided.

What this means is that the hospital can't charge $3000/night for a stay in a semi-private room to the patient in for pneumonia, because the room price has to subsidize the cost of the MRI machine. No $3.50 aspirin to help defray the cost of a clinical trial for a drug which the pharmaceutical company is charging $10,000/month per patient.

The cost of basic health care should be within everybody's means. And the government should provide ransfer payments for those who can't afford it.

I would start there, and then I would try to tackle an ethical way to deal with high-cost treatments.

Putting aside Judicial nominations and steroids
 

A true market doesn't exist because there have been various regulatory and legislative efforts to keep medical care out of the free market. That's a legitimate social choice, but the justification for it is not that a free market wouldn't function well, it's that a free market would result in an allocation that we as a society don't think is fair.

Putting aside Judicial nominations and steroids
 

For the fourth consecutive year, health insurance costs have increased at double-digit rates and at five times the overall rate of inflation. Employers and employees are increasingly unable or unwilling to purchase health insurance coverage as it is currently offered. Part of this problem results from government’s disruption of the marketplace through over-regulation, over-mandating and limiting customer choice of health insurance plans. The Maryland Chamber believes that restoring market competition to Maryland’s health insurance system will improve customer choice, help to control costs and provide greater access to those who want coverage. The Maryland Chamber supports the following steps to help make health care more affordable and available to Marylanders:

Improving our market-based health insurance system, which successfully provides coverage to most Maryland families - - not replacing it with a government-mandated universal health care system;
Supporting efforts of the Maryland Insurance Commissioner to review and modify current laws and regulations to increase competition by encouraging additional insurance carriers to enter the Maryland market;
Reviewing mandates and underwriting requirements that add to the cost of health insurance and limit customer choice; and
Implementing the Limited Health Benefit Plan in July of 2005 as a means of improving customer choice.

Putting aside Judicial nominations and steroids
 

heh.

Putting aside Judicial nominations and steroids
 

Exactly. Why was this google quote selected as better than all others?

Putting aside Judicial nominations and steroids
 

Dunno. I'm the dumbest poster, remember?

Putting aside Judicial nominations and steroids
 

Except for the last item, the Limited Choice - I mean, Limited Benefit Plan approval - this is a whole lotta words that mean nothing, other than they see there's a problem.

But it's a great post, Hank. Really, it is. I learned a lot.

Did anyone here actually have six forms of ID when they first got their drivers licenses?

This is ridiculous.

So is the claim. From the bill:

• To meet the requirements of this section, a State shall require, at a minimum, presentation and verification of the following information beforei ssuing a driver's license or identification card to a person:
  
  (A) A photo identity document, except that a non-photo identity document is acceptable if it includes both the person's full legal name and date of birth.
  
  (B) Documentation showing the person's date of birth.
  
  (C) Proof of the person's social security account number or verification that the person is not eligible for a social security account number.
  
  (D) Documentation showing the person's name and address of principal residence.

H.R. 418, § 202(c)(1).

I can't see how that gets you to six. I see three or four. I'd go with a birth certificate, ss card, and (if a student) a report card or if not some government letter, like a tax doc, voting record, etc.

Can (A) and (B) be the same thing? A birth certificate works for (A), but then that's my (B), too. A Social Security card gets you (C), and I suspect I have one of those somewhere. (D) could be easy, depending on what kind of documentation they have in mind.

When would this take effect? If I'm going to move to another state, maybe I need to do it soon.

Putting aside Judicial nominations and steroids
 

I don't agree with your assessment. I believe the insurance effect is what has led to the market's collapse. Although I do note that the free market failed abysmally before unionization made health insurance widely available.

It's passed in the House. That's all.

Calling RT...
 

Texas legislature takes swift action to end the scourge of...bawdy high-school cheerleading.

"Edwards [the bill's sponsor] argued bawdy performances are a distraction for students resulting in pregnancies, dropouts and the spread of sexually transmitted diseases."

Oh, the humanity!

local rules change
 

Here this passed...
http://www.chron.com/cs/CDA/ssistory...olitan/3166954

• House to cheerleaders: hooray, but no hip-hips
  Bill that bans dirty dancing, but doesn't define it, nears passage
  By KRISTEN MACK and ALLAN TURNER
  Copyright 2005 Houston Chronicle
  SPIRIT OF THE LAW
  Highlights of the cheerleader legislation:
  • What it does: Prohibits school dance teams, drill teams and cheerleaders from performing "in a manner that is overtly sexually suggestive" at public school events.
  • What it doesn't do: Specifically define the prohibited behavior or set any penalty for violations.
  • What supporters say: Pep routines have pushed the boundaries of decency and exploit performers.
  • What foes say: The bill is a toothless and meaningless effort to legislate morality.
  • What's next: If it survives one more House vote, the bill goes to the state Senate.
  
  AUSTIN - House members got into the spirit of toning down suggestive cheerleading Tuesday, rallying behind a bill that could leave Texas cheerleaders shakin' a little less booty next year.
  
  By a 65-56 vote, the House gave preliminary approval to a bill sponsored by Rep. Al Edwards, D-Houston, curbing "sexually suggestive" routines by cheerleaders, drill teams or other public school performance groups.
  
  The bill doesn't define the behavior it is trying to prevent or specify punishment.
  
  Edwards, who in past sessions has battled raunchy pop lyrics and advocated cutting off drug dealers' fingers, pledged that Tuesday's vote was just the opening volley in his effort to curb gyrating teenage booty-shakers.
  
  "I've seen it with my own eyes," Edwards said. "I've had people talk to me about it at football games. There was just a feeling that people were waiting for something to be done about it."

RT- WTTW- next he's going after nips showing in depos- gotta wear a bra he says. Of course, that would be for state court cases only.

Putting aside Judicial nominations and steroids
 

Well, I'm glad that we're down to a debate on terminology.

I will henceforth blame the ailments of the airlines on "market failure", rather than their own unsensible pricing policies.

I will likewise fault market failure for the absence of a Mercedes-Benz in my driveway. Those are nice cars, which I believe should be more widely available. Union anyone?

Calling RT...
 

I know, I know.

The good news is that the Daily Show was on the floor of the legislature yesterday, so at least we can all laugh about it.

My favorite quote over the whole thing was back in March when the bill was introduced: "How do you define that? When I was in high school, I considered the very existence of cheerleaders sexually suggestive." Grits for Breakfast

Another Texas blogger has suggestions for new uniforms.

No one thinks it will get through the Senate.

Calling RT...
 

I always considered cheerleaders sexually unapproachable :( :(

Putting aside Judicial nominations and steroids
 

I wasn't disagreeing with your terminology. I was disagreeing with you on substance. But it's nice to be able to file away for future reference that you have difficulty discerning between the two.

Putting aside Judicial nominations and steroids
 

Health care involves buyers and sellers who have radically different levels of information, in circumstances approaching if not defining duress. It should be no surprise that markets don't work well in these sorts of situations. You can try to ameliorate these problems by negotiating insurance contracts, but it only helps somewhat, and creates massive incentives for gamesmanship as the insurer and provider fight over the application of coverage. We have compounded these problems by incenting (I hate that word) employers to purchase group coverage, further removing the customer from the decision about what to purchase.

Putting aside Judicial nominations and steroids
 

It's what got me a reputation for wanting to euthanize grandma. (I was, perhaps, making a leap from "allocate based on cost/benefit" to "fuck the rich oldsters, terminate Medicare and replace it with universal coverage for minors" without much explanation. But it's not much of a jump.)

I'm not necessarily opposed to RT's framework, actually, Libertarianism notwithstanding (because I am willing to consider the population's basic health to be a reasonable national concern), though I would want this kind of c/b analysis seriously in force in the area of catastrophic coverage. Then again, I interpret RT's "outcomes analysis" talk as polite code for "C/B based rationing."

Putting aside Judicial nominations and steroids
 

1) Buyers and sellers always have different levels of information, but that doesn't mean we should price-regulate in all circumstances. There is certainly an argument for it in some instances, e.g., emergency room care, and perhaps an argument for quality regulation (i.e., licensing requirements), but not wholesale. Even with a PPO plan, I shop around both for credentials and for price (i.e., are they in the plan). Why can't other consumers do that--it's 20% of the frickin' economy; people drive 5 miles to save a nickel a gallon.

2) Insurance contracts and employer tax incentives create the problem, and are not themselves market failure, but regulatory failure. I agree, however that they contribute to the problem. Take away the tax incentives then.

Putting aside Judicial nominations and steroids
 

Without insurance, any medical need that arose would bankrupt most families. Of course, I use the term bankrupt metaphorically, because that avenue is now closed off for most people. The fact remains, however, that insurance is an absolute necessity.

Deductibility of premiums is not a tax break. The deduction is allowed because payment of health insurance premiums as part of the employee's compensation is a necessary and ordinary expense, just like payroll.

Do you really think these things through, or is your reaction automatic any time someone suggests that governmental oversight may be a necessary component of rational distribution of scarce resources?

Putting aside Judicial nominations and steroids
 

The information imbalance seems particularly extreme here. I shop around for credentials and price with a PPO, too, but I was thinking about the problems with insurance plans that specify what sorts of treatments are covered. As it stands, it's next to useless for the ultimate purchaser -- the patient -- to try to consider this ex ante. And even when you look at credentials, the kind of information you get is pretty lousy.

The whole industry is the result of measures designed to solve one problem that create another. If you're just going to say, undo all of it, you'll have fun talking to that crowd of liberatarians over by the bar, but don't expect other people to come join the conversation.

medical insurance
 

Do you actually read what I say before responding? You constantly conflate questions and solutions in response to my challenges. To wit, you say insurance is necessary to prevent families from bankrupting themselves. Well, maybe. Maybe catastrophic insurance is necessary. And maybe people have access to it, or should be given it. But that doesn't call for a single-payer system. And none of that has anything to do with employer-supplied insurance. If I have an automatic reaction, it's to say "give me something more than a knee-jerk 'government solves all the problems and gives my daughters pink ponies, too'"

There are several layers of problems here, which you simplify to one: all people should have health insurance. Well, great, but you haven't made any effort to analyze whether they should have it by paying for it themselves, by getting it through their employers, by getting it through the government. Your simplistic response is "there's market failure, so of course the government should do it." Well, no. There's not market failure, there's a wealth-distribution problem (in your mind) that you think shouldn't impact whether people have accees to health insurance. Fine, we can disagree on that last point, but rather than throwing out barbs, why not make a little effort to analyze problems beyond calling everything market failure.

Putting aside Judicial nominations and steroids
 

Hey, hey, hey now. He could do far worse for cocktail party/bar chatter. Why go to bars if not to get drunk and solve all the world's problems, if only you were king of the universe?

And not ALL libertarians look like Penn & Teller or chicago school economists, you know.

Putting aside Judicial nominations and steroids
 

I don't mind talking to libertarians while drinking, particularly if it's a Peter Franus zinfandel or something of that sort, but it seems to me that the "let's revert to the free market" impulse is particularly unhelpful when you're talking about health care, for the reasons I suggested above.

Putting aside Judicial nominations and steroids
 

All fair points. How does government solve it?

1) Gov't plan. Well, it makes shopping around unnecessary, at least.

2) Gov't control of plans. Okay, so the gov't says what should be covered. A bit better, but then you see what we do in states--whoever has the most powerful lobby gets their disease covered. And it's still one-size fits all.

3) Information forcing. Well, what's government's role then? To rate plans? Maybe that works, but you still end up with some of hte problems of 2 (e.g., some lobby insists that a "high" plan has to have coverage for a particular disease). Nonetheless, this is the least objectionable.

All in all, though, while government can solve part of the problem, I'm not sure any broad solution doesn't create more problems than it solves.

Putting aside Judicial nominations and steroids
 

Because health care is considered too important to leave to the unregulated free market, it is rigorously supervised by politicians. They have brought us Medicare, Medicaid, billions of government research dollars and new legislation every year to regulate health-insurance companies and HMOs. Federal regulation runs to hundreds of thousands of pages.

Has this reduced the price of health care?

No. Every year it becomes more expensive, less user-friendly, more inaccessible – causing well-meaning politicians (and those of the other kind) to impose even more regulations.

If the health-care industry had gone through what the computer industry has experienced, today you might have health-care-at-home, prescriptions that cost a dollar or two, and surgery for only $100 – making health insurance unnecessary except for catastrophic events.

Does that seem far-fetched? It shouldn’t. That’s what health care was like before the federal government started to intervene in the 1960s.

Putting aside health care for the moment, and moving on to Social Security
 

I have only just started reading this, but thought it presented an interesting perspective. Pity this guy didn't go on to talk about the projected Medicare funding shortfalls and how to address that . . .

http://www.tcf.org/Publications/Reti...y/ballplan.pdf

The author was the Commissioner of Social Security under Kennedy, Johnson and Nixon.

Putting aside Judicial nominations and steroids
 

Where'd you c&p this from?

Putting aside Judicial nominations and steroids
 

the cut & pastes I've been posting the last few days are lifted directly from Ty's blog. i thought everyone knew that.



Please link, too. It helps me on Technorati.

Oops -- I meant to quote, not edit -- Sorry! -- t.s.

Putting aside Judicial nominations and steroids
 

You keep on talking about plans. The problem with healthcare is that it's not exactly an exact science and the demand curve is artificial. A patient isn't able to weigh the costs and benefits in order to determine a fair price because he relies on his physician to tell him what he needs. The physician also happens to be the seller of the service. Physicians also happent o be in a very closed supply market (the result of licensing and the years of training), physicians have access to treatment that is otherwise inaccessible (drugs and surgery), and that physicians are trusted to provide treatment that is appropriate for the patient. Stark and anti-kickback (government regulations), under these circumstnaces, are not unreasonable methods to realign incentives.

Then healthcare is removed further from the actual consumers and sellers, by having employers purchasing and insurance companies selling a contracted bundles of healthcare services.

Putting aside Judicial nominations and steroids
 

I'm not sure either, which is why I like to give RT my proxy.

Putting aside Judicial nominations and steroids
 

Health care continues to get more expensive -- in part -- because we keep inventing new ways to treat medical problems. If we were paying more now for the same treatments we had in the 1960s, that would be a problem. We aren't.

Putting aside Judicial nominations and steroids
 

The other thing is there are many ways to approach any given healthcare problem, and no way is the "best" way. Some are more cost effective in the short run, whereas some are more cost effective in the long run. Some aren't cost effective at all and may offer no benefit at all, but we don't know until after a shitload of money has been spent. Insurance companies have no interest in the long run. Patients aren't really thinking about the long run for most healthcare issues.

For example, for a heart issue, one physician may prescribe asprin and blood pressure monitoring and exercise. Another may put the patient on beta blockers and put the patient through a variety of high tech, non-invasive tests. Another (especially one that's getting compensated for it in some way) may go for the cardiac catherization. A fourth could go for bypass surgery. Each could probably argue very well as to the rationale for his or her choice in treatment, and though the utilization review process does have an impact on those decisions, interference by the third-party payor in making those decisions is generally not permitted (though most payors will not pay for services without proper documentation of dignosis). The patient (generally) relies on the physician to make the best choice for him.

Putting aside Judicial nominations and steroids
 

Shhhh! Goddamnit, some of us rely on those hundreds of thousands of pages for our livelihood.

Putting aside Judicial nominations and steroids
 

You're advocating smaller fonts?

I don't get all the sarcasm surrounding the introduction of this bill. You may scoff at this bill, but do you think nothing should be done. Do either of you really think it is not too easy to get a drivers license right now? What is wrong with making it difficult to get a drivers license? I think if you were hit by an illegal alien without car insurance you might have a different opinion.

Sure, but all the bill means is that now I'll be hit by an illegal alien without car insurance and a driver's license.


That said, I don't think that's entirely true. From the limited press coverage I've seen, I understand states can provide an unofficial license, marked as such, that allows illegals to drive but does no purport to provide a confirmed identification. In other words, people know it's worth teh paper it's printed on and nothing more, from the face of hte license.

But personally, I'd rather just create national identity cards for these purposes, and be done with it. Why bootstrap off of an entirely different process to achieve this goal?