Re: David Cross on Health Care

On Wed, Oct 27, 2010 at 4:29 PM, Karl <[email protected]> wrote:
>> > And our *current* health care system is not one that I'd like
>> > to defend.
>>
>> **sure.  But it is much more effective than the detractors will admit.
>
> Effective?  Effective at what?  If you mean in the same sense that the
> Pentagon is effective, then I agree.  ;-)
>
> **nope, I meant effective in that most people do not want or need a change.  The
> system should have been modified to fix the problem of uninsured, not mess with
> the happily insured.

Well, that's kind of the entire point of *insurance*.  Most people
don't need insurance most of the time.  Except sometimes they
eventually do.  Someone once tried to convince me that he didn't have
and didn't see the need for car insurance, because he was a better
driver than almost everyone else and had never been in an accident.

As I understand it, America is one of the few (the only?) wealthy
nations in which people can be (and frequently are) bankrupted due to
medical emergencies entirely outside of their control.  It doesn't
need to be that way.

> ***and the VA, Military and Indian healthcare systems, not to mention medicare are
> all worse then we have now overall.

As much as I'll argue against our current system being good, I don't
think you'll get much argument from me that Medicare, Obamacare, etc
are all that great either.

> We are complaining about the established
> precedent of our own systems existing failures, not a comparison to someone
> elses..

Well, you said that the current system is "more effective than the
detractors will admit", and most detractors compare our systems to
someone else's system.  But I think I see your point.

> Also, there are a few actuarial difficulties which distinguish health
> care and insurance from property insurance; the math and ethics don't
> work quite the same.  E.g. with house insurance, you can ethically say
> "just don't live there" or "pay gargantuan premiums to live there"
> (unless you live on the Florida coastline, where the politicians price
> insurance without needing any actuary's approval).
>
> **the disconnect is calling this health insurance and not allowing it to act like
> actual insurance.

Well there is a distinction between: the standard health care, ongoing
care for the chronically ill, and health insurance.  Usually we just
say "health care" to wrap them all up together (and more besides).
For standard care, insurance companies are either simply putting you
on a payment plan or justifying the costs as being less than the
insurance savings (in aggregate).  For ongoing care for the
chronically ill, the insurance companies in an unregulated market will
kick you off the plan as soon as their contract allows (and they wrote
the contract to begin with) or never accept you because it isn't
insurance: it's a payment plan, guaranteed to be expensive,
unprofitable, and make them uncompetitive in wooing profitable
customers.  So a big chunk of it can't be treated like normal
insurance because it simply *is* *not* insurance.

And the other part shouldn't be treated like normal insurance because
many consider it unethical to say "just don't live" or "pay gargantuan
premiums" because of health conditions that are completely outside of
the patient's control.  A car insurance company can tell you that they
are going to junk your car and count it as a total loss.  A car
insurance company can price you off the road because you are an
expensive hazard to everyone else.  A home insurance company can
charge you an arm and a leg to live in an area that sees frequent
hurricanes.  Again, these are not good terms for health insurance, but
they are not ethical dilemmas for property insurance.

If you can figure out how to make the math work for completely free
market universal health care, and convince a few actuaries and
financiers that you are right, please do so.  http://xkcd.com/808/

> Universal health care (for most values of "universal health care")
> just won't work with any actuarial model in a purely free market with
> short-sighted selfish participants.  It needs an enforced buy-in of
> some sort (or market participants who are considerably more selfless
> and charitable in aggregate than humans).
>
>
> **Enforced?  How draconian.

It's the only way to make the math work.  Either you enforce buy-in
via taxation or mandatory purchase, or you can't get universal health
care.  Again, if you can prove otherwise, you should be talking to
some venture capitalists about it, not us.

If health care for everyone isn't important to you, then... well...
I'll not belabor the point any more.

>  That could be taxation,
>
> **could?   Really?  Would they really?  {/sarcasm}

Of all the things our tax dollars go towards, this is one of the
worthier causes.  If you are completely against taxation of any sort,
then please start working with the anarchists to dismantle and replace
our state-provided roads, schools, military, judicial system, police
enforcement, etc in a just and equitable manner.  (I'm not being
entirely facetious here.  I really am interested in stateless
solutions to these problems and how to migrate from where we are to a
more decentralized future.  And some of the problems and potential
solutions are very interesting.)

> or (to get back to
> Paul's original post) it could be an enlightened self-interest
> movement of Christians and other ethically-minded individuals to
> voluntarily fill charitable health care funds (and keep them filled)
> to previously unprecedented levels.
>
> ** no, that would no longer be universal health care.

If it provided health care to absolutely everyone so that no one ever
needed to go bankrupt for health reasons and very few injured their
health for financial reasons then it would qualify as universal health
care by my standards.  And something approaching this already existed
today outside of fiction, then the political climate around this whole
debate would be *very* different.

Oh wait, something eerily similar to this *does* already exist in most
wealthy nations.  They haven't been able to do it entirely voluntarily
(yet?), but most of them prefer it to what we have.

> **health care is only one aspect.  A huge amount f waste is done by people with no
> care wasting resources at emergency rooms getting non emergent care.  They often
> cannot be turned away.  Also, we insured likely waste a lot of money and drive up
> costs with some of our insistence at non essential convenience care.

Agreed.  The Incidental Economist link from my previous email analyzes
many areas where we currently pay far more than other countries.  And
there are a great many hospitals and individuals fervently trying to
figure out how to cut costs while still improving quality of care.

> Even for the
> moochers, the money would at least be going towards creating societal
> value (e.g. healthier individuals who might one day be productive,
> funding research towards making non-mooching individuals healthier),
> which is better than half of our military budget can justify.
>
> ***I just cannot share your altruism.

Is it altruism to say that half of the defense budget (half of a
trillion dollars per year) would be put to better use providing health
care via a grotesque overgrown health care regulatory bureaucracy full
of moochers than providing for our grotesque overgrown
military-industrial-congressional complex full of moochers?  Or is
that naivety?  Both?

This would put us back at roughly the same military budget as at
during most of the Cold War (after inflation adjustment).  I don't
even think I can fathom what $500 billion per year means.  How about
$200 billion towards health care, and we send $300 billion back to the
taxpayers (per year)?  $200 billion is also an unknowably large
number.  The estimates I saw for ObamaCare (again, I'm very unhappy
about many of the particulars and also how it was passed, but just as
an example) were in the realm of $1 trillion dollars per *decade*.  So
after slashing the defense budget in half, and overfunding ObamaCare
by 2x, we'd return $300 billion to American tax payers per year.
That's about $1000 per person (if it were distributed evenly, which
would be silly, but is simpler for this conversation).

What would you spend your returned ($1000 + potential savings on
insurance premiums and deductibles)/year on?  I'm thinking I'd get a
new MacBook Air (and run Ubuntu on it as I do with my current MacBook
Pro).  ;-)

-- 
Nick

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