Health insurance bill passes the house

[merithyn]

I don't think that fairly characterizes my point - it is not at all exclusive to frequency, it includes exactly what you are talking about. They are not at all exclusive.

And it manifests itself in other ways, even beyond people consuming too much health care. It manifests itself in costs as well - why does an MRI, a technology that has been around for decades, still cost $1500? Because there is no incentive for it to cost less, since nobody can get a competitive advantage by ruthlessly driving down the cost, since the basic cost/benefit market mechanism is non-existant.

Nobody care what their MRI costs, and nobody shops around for a cheaper MRI, since they are not paying for it anyway.

How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?

I don't know what the answer is - what I do think though is that we are looking at the health care debate from the wrong side. We talk about how much the public option would cost, but it is all bullshit, since we have no real idea what the fair market value of health care actually is, since the market is so grossly distorted right now.

I suspect that we could all afford a lot more health care if the market actually priced the costs in some kind of sane manner. Right now the costs of routine coverage is grossly out of whack though,  because the market has so many influences that create fucked up pricing mechanisms, and the net effect is that we keep paying more and more and more and more for the same amount of service, with the increases going to a growing health care market that isn't growing in services or quality, but simply growing in bureaucracy.

This is the most sane post I've ever seen you make, Berkut. It is 100% true, and the absolute issue that needs to be addressed before all else.

[Berkut]

I think my employer pays about $12,000/year for my familys medical coverage. I kick in a like amount between the portion of my health "insurance" that I pay for and co-pays and such.

I wonder how much routine health care I could afford if I just paid out of pocket for my health care, the costs were based on everyone paying for their own (and hence health care providers being driven to provide the best care for the lowerst price) and they let me keep that $24,000/year, after I use some amount of it to pay for true medical insurance to cover catastrophic costs?

I bet we could save enough to cover the out of pocket expenses AND catastrophic coverage for the poor (on some sliding scale based on income) if we had a system where the costs were understood and reacted to market realities.

[DGuller]

I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy.  It has to be about half that.

[Tonitrus]

The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death.  And even short of death, one may not be in a condition to "shop around".

Of course, one could say the same about food...but I doubt that would make a good analogy.

[DGuller]

The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death.  And even short of death, one may not be in a condition to "shop around".

Of course, one could say the same about food...but I doubt that would make a good analogy.

Yes.  And even if you're not near death, a lay person just doesn't have the knowledge or experience to make the right decision.  If we could, then we're wasting a whole bunch of money educating future doctors for a decade.

[Iormlund]

How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?

Reason has nothing to do with pricing. The state will pay as much as it has to and no more.

[Iormlund]

The problem with the market in health care, is that often the highest medical costs come from situations where the alternative to "doing without", as one can in many cases involving a normal purchase(a car, appliances, etc), is death.  And even short of death, one may not be in a condition to "shop around".

Of course, one could say the same about food...but I doubt that would make a good analogy.

That is precisely the argument behind agricultural subsidies in both the EU and the US. True as well, at least back in the day.

[Berkut]

How do you solve this problem with socialized medicine? The obvious answer is that the state must demand it to be cheaper, but how is the state competent to decide what *ought to be* cheaper, and what is actually reasonably worth its high price?

Reason has nothing to do with pricing.

When the state pays for it, this is often the case.

[Fate]

I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy.  It has to be about half that.

If one of your kids has something like cerebral palsy, I guess it could be possible.

[garbon]

If we could, then we're wasting a whole bunch of money educating future doctors for a decade.

I read an article in some British newspaper the other day that said a sizable amount of the recent graduating medical students in Britain were unable to perform even basic tasks like injections.

Also, contrary to the feeling of some, I don't think that many doctors are even qualified to make the right decision.

[DGuller]

I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy.  It has to be about half that.

If one of your kids has something like cerebral palsy, I guess it could be possible.

I don't think so, employer's policies have no underwriting by law.  Maybe everyone at Berkut's workplace is just very sick, so his company gets charged a hefty premium.

[Berkut]

I don't think that $24k sounds right for a family of 4, even in New York that sounds way too much for an employer's policy.  It has to be about half that.

Yep, you are right - I had the numbers mixed in my head - it is actually about $13,000/year. Same principle applies though.

[DontSayBanana]

Yep, you are right - I had the numbers mixed in my head - it is actually about $13,000/year. Same principle applies though.

Really?  An uninsured office visit is approximately $100.  If you have one office visit per month per person, then for a family of four, you're shelling out $4,800 before you get any testing or procedures done- $13,000/year sounds like a bargain in comparison.

[Admiral Yi]

Really?  An uninsured office visit is approximately $100.  If you have one office visit per month per person, then for a family of four, you're shelling out $4,800 before you get any testing or procedures done- $13,000/year sounds like a bargain in comparison.

Who goes to the doctor once a month?

[DGuller]

I think someone without insurance would spend a lot of time haggling with medical providers to first get a price out of them, and then to negotiate that utterly absurd price down.