Asymmetrical Information

It's sensible to give business a leading role, since more than 60 percent of us are covered through work, and more than 80 percent of the uninsured live in households headed by someone working.

I don't see why we should involve business any more than we have to. One of the biggest problems with our current system is that insurance is tied to your job. You can get car insurance and life insurance for the same price whether you're employed or unemployed; why should health insurance be any different?

It seems like we ought to trying as hard as we can to get away from employment-based health care. In fact, that's what I hate the most about the plans being offered by Dean and Gephardt: they get employers even more involved in the process.

The AMA has some interesting ideas on the subject as well.

I've never heard of any barriers to buying health insurance outside of employment. The barrier is cost--have you ever actually priced health insurance?

Sam - It is far more expensive, as a rule, to buy medical insurance as an individual instead of as part of a group. An individual is underwritten based on his or her health. Not only is that expensive, it's difficult for an insurance company to get a large enough pool of individual policy holders for the insurance to work like, well, insurance. (Healthy people tend to opt out of buying insurance, so the insurance company is likely to end up with a lot people with higher than average needs for health care.) Many of these problems are avoided by having a group of employees puchase insurance for themselves and their dependants. The resulting pool of individuals is much more likely to fairly reflect the health of the overall population, making it easier for the insurance company to properly price the coverage.

Wow, I've got to disagree that it's a good piece. That's a HORRIBLE article.

"generally produces no better health results"? Try produces vastly better results. The US is certainly the only country in the world I'd ever want to have cancer in, and a much better place to need any number of expensive and complex healthcare treatments.

"three ways of achieving universal coverage"? My god, he completely misses treating health insurance like car insurance: make people buy it for themselves, with subsidies if needed. That's a 4th option that's vastly better in every way. He seems oblivious to the idea that anyone is self-employed.

The later article is a bit better, but it sure starts out weak.

Jane,

He raises some interesting points. A useful article; thanks for the link.

Cheers,

Brent is right.
Nothing interesting in that article, it just repeats old platitudes.
The US spends more on health beacuse it is richer, and rich people, like all people, want more health care, but they can also afford it.
There is no direct relation between the amount of spending and health - because that's the nature of medical treatment. You try a lot of treatements when you are sick (or too rich), not all of them help in any way, but all of them cost money.

I'd be a lot more interested in buying my own health insurance if my company would pay me the true cost of my health insurance. Right now, they charge me a small part of the total cost as a deduction from my paycheck. The rest is a hidden subsidy that I don't see and can't recover. This puts me in the positiion of effectively paying for some of my health insurance whether or not I get it.

My wife's last job was worse. She got a "free" HMO. I would really like to see companies required to report your true total compensation with everything they provide shown as a deduction. The full cost of the various insurance packages, the "employer-paid" portions of taxes, any fringe benefits like health clubs and parking, etc... I think most people would be surprised.

Bolie IV

Bolie -- that's a very interesting idea.

The US is the best place to have cancer care if you have the insurance to cover your treatment and the necessary new or heroic measures to really knock it on the head.

Otherwise, frankly, I'd prefer Germany or France.

Beating cancer has a lot to do with catching it early and if you don't bother with the Doctor because you don't have the right cover its probably too late.

My sister-in-law had cancer and received heroic care through the Huntsman Center in Salt Lake City, Utah. Did she have health insurance? Yes, but her treatments quickly blew through the policy limits AND they, from the start, provided her with therapy that was not covered under any insurance plan (because it was considered experimental).

I was concerned about the bills she was running up, so I asked one of her doctors about it. He seemed embarrassed and just said, "Look, unless you've got a spare million or so laying around, you can't pay her bills. Neither can she. That's okay. None of you have to." (Or words to that effect.) Then he told me to worry about more important things and went to check on other patients.

I keep hearing how people in the US cannot receive quality care if they lack insurance. That just does not jive with my experience. I have seen members of my family (and others I have just known is some manner) receive quality care despite their inability to pay for it. Sometimes, as my sister-in-law's case proves, that care is provided by the very best the community has to offer.

This whole cost problem is so easy to solve, it's ridiculous. Who wouldn't expect costs to keep rising when the patient doesn't care about the cost? The current set up is contrary to (almost) every other market we have in the States. Sure it may be an intractable problem if you're trapped in a socialist mind set, but not once you move to the market.

This whole cost problem is so easy to solve, it's ridiculous. Who wouldn't expect costs to keep rising when the patient doesn't care about the cost? The current set up is contrary to (almost) every other market we have in the States. Sure it may be an intractable problem if you're trapped in a socialist mind set, but not once you move to the market.

So for those (including me) who think the market is the answer, say we wave our magic wand and health insurance is now priced and sold like car insurance. The self-employed will be dancing in the streets, but most people will have to pay more out of pocket for their insurance; it'll seem more expensive, and some people just won't choose to pay, even if we offer tax credits etc. What do we do about them? Absorb the cost of their health care in the ER the way we do now? Or does Big Brother somehow force/strongly encourage everyone to be insured?

If you want to cover most of the uninsured, then repeal state insurance laws which make it illegal for small employers and individuals from forming associations to purchase group health insurance.

Most of the uninsured work for a small business, are self-employed, or are a family member of such a person. (60% are small business related, I couldn't find a statistic that included the self-employed).

I believe the next largest group of unisured are people who have access to employer-provided health insurance but choose not to purchase it.

It seems to me like the solution he offers to our supply demand discrepancy is a self-solving one (that of increasing the supply).

How much would you be willing to bet that guidance counselors are telling students right now: "Go into medicine. Now!" I had an opportunity to talk at some length with the head of a medical staffing service, and the breadth of the jobs available even in a poor economy is staggering. Everybody knows the boomers are aging.

It's just taking a while for the supply to get educated and out there, is all. That's my theory.

Auto insurance is nearly universal as it is required for vehicle registration. This would argue for some sort of mandate for health insurance. (There are some who do not carry it and costs are passed on to insured in the form of uninsured motorist premium.)

Alternatively, the law mandating care of patients at hospitals(ER)could be repealed and the costs of uninsured will not be passed on to the insured. I am not sure most people will be in favor of above in the face of stories of many deaths due to lack of health insurance.

I agree with an earlier comment, I was very disappointed in the article, especially given the usual quality of the posts at this site.

Again in agreement with an earlier comment, the author of the article first states:
At nearly 14 percent of gross domestic product, health care claims almost twice as large a share of the economy in the United States as in Britain or Japan and generally produces no better health results.
(Is this due to lifestyle choices, or access to health care or other factors addressed in this article?)

Regardless, he concludes by stating:

A single-payer public system could ration care as such systems do in many other countries; that would put all of us in the position of the uninsured today, with waiting periods for everything but emergencies and limited access to expensive technologies.

There is so much that is wrong with this article, I don't believe the space constraints of the comment section could contain it.

Concerning that statistic about the high level of spending for health care in the US - it would be interesting to follow the methodology of obtaining it.
For exmaple - is the health care that foreigners receive in the USA and pay for in full - part of that statistic? There is a sizeable portion of the health care expense that can be regarded as an export industry, benefiting the US economy.
On the other hand - the health care that Canadians, or Brittons receive outside their countries, becuse it is unavailabe there in best quality, does not appear in the amount of spending on health care in those countries.
So beware of statistics.

> I don't see why we should involve business any
> more than we have to.

No kidding--it's a historical accident that we do, and we're supposed to perpetuate that model why? It reminds me of the Social Security debate: everyone can see the train wreck coming, but no one is willing to make a move.

One question about the article and comments: how come nobody mentioned community rating? Is that a dead idea now? It's always seemed to me that, if have to have any government intervention at all, that's the least intrusive way to go; very much like the liability-insurance requirement for autos really helps that market, without any inherent necessity for micro-managing the market.

"(Healthy people tend to opt out of buying insurance, so the insurance company is likely to end up with a lot people with higher than average needs for health care.) "

Healthy people will only tend to opt out of buying insurance if they're required to share a risk pool with unhealthy people. In which case they are getting screwed in the transaction, and it is perfectly reasonable for them to avoid such coverage. But if insurance companies are allowed to price according to risk covered, they can acquire a large risk pool that includes relatively healthy people.

"The self-employed will be dancing in the streets, but most people will have to pay more out of pocket for their insurance; it'll seem more expensive, and some people just won't choose to pay, even if we offer tax credits etc. "

At least until their employers take the money they'd been spending on "fringe benefits" and put it in the paycheck instead.

"What do we do about them? Absorb the cost of their health care in the ER the way we do now? Or does Big Brother somehow force/strongly encourage everyone to be insured?"

People who can't afford insurance or treatment are already getting treated at ER's. This change will not make them consume more such treatment.

People who actually have money and get treatment can pay up. Those who won't can be dealt with by collection agents, wage garnishments, and so on.

"We could try federal and state deregulation and subsidies to sharply increase the numbers of doctors, nurses, and clinics over the next decade;"

But that would lead to lower costs and higher availability of care without crusading government bureaucrats getting any credit. I don't see any way to overcome that fatal flaw in an otherwise sensible plan.

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