Patting the wrists, rolling the eyes.

[Mmmm, Burger (C.J.)]

Originally posted by taxwonk
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.

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?

[Replaced_Texan]

Originally posted by Sexual Harassment Panda
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!

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.

[Hank Chinaski]

Originally posted by Replaced_Texan
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.

I always considered cheerleaders sexually unapproachable

[taxwonk]

Originally posted by Mmmm, Burger (C.J.)
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?

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.

[Tyrone Slothrop]

Originally posted by Mmmm, Burger (C.J.)
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.

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.

[Bad_Rich_Chic]

Originally posted by taxwonk
I argued exactly the same thing a couple of months ago. It was not well-received. YMMV.

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."

[Mmmm, Burger (C.J.)]

Originally posted by Tyrone Slothrop
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.

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.

[taxwonk]

Originally posted by Mmmm, Burger (C.J.)
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.

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?

[Tyrone Slothrop]

Originally posted by Mmmm, Burger (C.J.)
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.

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.

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.

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.

[Mmmm, Burger (C.J.)]

Originally posted by taxwonk

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?

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.

[Bad_Rich_Chic]

Originally posted by Tyrone Slothrop
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.

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.

[Tyrone Slothrop]

Originally posted by Bad_Rich_Chic
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.

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.

[Mmmm, Burger (C.J.)]

Originally posted by Tyrone Slothrop
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.

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.

[Hank Chinaski]

Originally posted by Tyrone Slothrop
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.

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.

[ltl/fb]

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.