Friday, March 9, 2012

Abbott & CostOverRuns

It's a good thing that Vaudeville is dead...because otherwise it would need to get it's medical treatment from Obamacare and be really screwed - just like the rest of us.

As a case in point, Health and Human Services Secretary (and editor-in-chief of the new King Barry Catholic Bible) Kathleen Sebelius just appeared before Congress to answer questions about the all-encompassing healthcare program, and showed a lack of understanding (or unwillingness to share honest answers) which should terrify every American.

When asked about new figures which show that, rather than saving $143 billion dollars in 10 years, Obamacare will actually add $54 billion to the deficit, Sebelius just stammered that she didn't have those numbers available.

When it was pointed out that Obama promised insurance premiums would drop $2500 per family, but those premium have actually gone up by $2200 per family, Sebelius said that it's because the "affordable" markets Obama envisioned (or more likely imagined) haven't occurred yet. Oh!

Well, how about Obama's sacred promise that "if you like your doctor or healthcare plan, you can keep it. Period. Case closed." The only way this can currently happen is if the Obama administration gives you a waiver - and those waivers are only going to political cronies. Sebelius was quick with her answer: "I have no idea what waivers you're talking about."

Okay, then how about the CBO's estimate that at least a million Americans will lose their employer insurance plans because of Obamacare? While other experts estimate the number to be far higher, saying 30-50% of all Americans will lose their employer insurance. Sebelius basically blew off the CBO's figures and refused to her alleged area of expertise.

Since Obamacare is the biggest government program ever, and one which will forever change the health and freedoms of every American, you'd think that the stumbling, fumbling, disingenuous performance by Ms. Sebelius - coupled with the increasingly disastrous cost projections - would be pretty big news.

Until you realize that Vaudeville isn't really dead after all; it's just moved to MSM News Shows, taking its seltzer bottles, pies in the face, over-the-top performances, and carefully scripted comedy bits with it.

"Who's a slut?" is our new "Who's on first" routine. But this time, it's the people performing onstage who are laughing at us.



BS Footprint said...

We are living in an Ayn Rand novel. Truly. Sebelius is a minor bureaucrat, doomed like the rest of us.

Sadly, I don't see any Howard Roarks or John Galts anywhere. Do you?

Stilton Jarlsberg said...

@BS Footprint- No, I don't. But I'd love to be surprised when one appears and gets traction.

Colby said...

BS Footprint,
Seems for the past year or so, I am constantly reminded of Atlas Shrugged. Scary....

We are surrounded by politicians and media that are either malicious hacks or incompetent morons. Sometimes they are a combination of both like Joe Bite-me. When was it that Queen Nan proclaimed that we had to "pass it to see what's in it?" It was a loooong time ago, and STILL idiots like Sibelius don't have a damn clue what they did to us, nor do they care, it would seem.

Here's hoping that there is rampant unemployment on Capitol Hill in January.

Emmentaler Limburger said...

@Colby: And that The Wicked Bitch Of The West got away with that inane statement galls me to no end even to this day. It truly showcases our MSM's new purpose, and the ruling class is alive and well. "We have to pass it to see what's in it" smacks of "Let them eat cake"...

Stilton Jarlsberg said...

@Colby- "Malicious hacks and incompetent morons" will eventually be listed as the cause of death in America's obituary.

@Emmantaler- The phrase "pass it to see what's in it" still makes my head explode. I think I'm starting to lean toward an alternate method of writing bills which is inspired by the piñata: we smack the legislation with sticks until the contents are spilled BEFORE it becomes law. And if a few legislators get smacked with a stick by accident...well...they're the ones who put the blindfolds on us.

FlyBoy said...

Hey-who cares how much all this will cost as long as we get free contraseptives!!!!!!

FlyBoy said...

Oops-should be "contraceptives". (hopefully still free)

Stilton Jarlsberg said...

@Flyboy- Isn't it funny that Sebelius knows how much contraceptives should cost, but has no idea (or interest) about what the rest of Obamacare will cost?

Suzy said...

Its so sad. My friend's husband now has to pay for his own employer-provided insurance, which means they took a fairly drastic pay cut, thanks to Obamacare.

Our employer is still paying for our insurance, but they aren't happy about the 30% increase we were forced into this year, and if that happens again, they will no longer be able to afford it, either, and we will be scrambling to find some sort of coverage for our relatively large family. (Probably government insurance of some sort for the kids, just as originally intended. They might just have us beat if this nonsense goes on.)

This was all predicted accurately before Obamacare was passed.

Its so stinkin sad, today, in America.


Stilton Jarlsberg said...

@Suzy- Sebelius said that the "affordable market" hasn't occurred yet. Allow me to translate that: once Obamacare puts ALL private insurance out of business (which it was designed to do, and will inevitably do), then the government will be able to exercise 100% price control to bring down the cost of premiums. Except to bring down those costs, they'll have to reduce expenditures - meaning a host of medical services will simply become unavailable. Keep in mind that it was Obama himself who said the path to more affordable medical care was "painkillers instead of pacemakers."

That's a pretty unambiguous statement: they'll drug us until we die early (after which they won't have to pay our social security either - convenient, since they stole all those funds eons ago).

Obamacare is not in the least about healthcare and never has been. It's about control of our money and our lives.

John the Econ said...

Only billions? ObamaCare will eventually cost trillions when you count the collateral damage to the economy.

Only $2,200 per family? The Econ family's insurance has gone up $3,340 since Obama has taken office! And that is a absolutely no-frills plan. I can't imagine how much we'd be paying now with one of those "golden" plans like Ms. Fluke thinks we should all have.

(But then again, Ms. Fluke doesn't expect to pay for most of what she consumes, now does she)

So as far as I am concerned, Obama now owes me $23,358 for the savings I didn't get.

Now, as to the unfortunate reality that half of Americans are going to eventually lose their insurance under ObamaCare, that is now flaw; It's the central feature of ObamaCare. ObamaCare was specifically designed to destroy what is left of private health insurance in America; to forcibly drive the remaining 50% of America who does not depend on the government for their health care to join those that do so that they can implement the ultimate goal: A Canadian/NHS-type single payer system.

Yes @BS Footprint, we've been living "Atlas Shrugged" for quite some time now. We're well into the 2nd section. (I have little doubt that roughly 2/3rds into Obama's 2nd term, we'll get his version of direction 10-289) It's fun equating our current government officials, media pundits, and academic scoundrels to their fictional counterparts.

(Finally got around to seeing the movie a few months ago; what a disappointment. But then again, I really didn't think it possible to turn that book into a real movie anyway)

CenTexTim said...

Stilton - you touched on a big part of the problem that is often overlooked in discussions of obamacare ("... a host of medical services will simply become unavailable"). The supply side of the equation is often neglected

As the pressure to reduce expenses intensifies, there will be fewer and fewer people choosing medicine as a career path. We've seen a foreshadowing of this with the increased number of doctors who no longer accept new medicare patients because the reimbursements are too low (not to mention the cost of complying with the onerous regulations) and declining enrollment in medical schools. Once the government dictates how much doctors will get reimbursed for patient care there'll be a flood of people heading to plumber school instead of Johns Hopkins.

At that point doctors here in America will be brought in from India or China on H1-B visas, just like IT workers are now.

John the Econ said...

To hear the pundits tell it, Obama is going to win in November because the Rush & the GOP have flushed the female vote over the free birth control thing.

Seriously women? You are going to sell out your country for free birth control? Perhaps Rush was right after all.

@CenTexTim, you only have to look at what has happened in Britain to see what will happen, where now more than half of their doctors are foreign-born. Relatively few Brits now see it worthwhile to go into the profession. Much better to go into law or banking.

Mike Porter said...

I believe the term is one of scatology: "we have to pass it to see what's in it". But even the thickest practitioner of this dark art would immediately recognize this steaming pile for what it is - a worthless load of crap that if not disposed of immediately will bring disease and illness to the entire village. When I heard this phrase oozing out of that despicable sack of swill I just about screamed, for it was one more piece of evidence that we're institutionalizing the insane without realizing that these particular institutions are making all of the rules. And here I thought that only small children might consider fecal finger painting to be art... they at least have an excuse.

Anonymous said...

When I was in England, a trip to the doctor was the fulfillment of me worst nightmare. LOOOONG lines waiting for their "free" medical care (which as an American I got to pay for), then a short visit with someone who spoke such broken and rudimentary english, that I couldn't even get through to him what my problem was. Eventually, got back stateside for a diagnosis.

@John the Econ ... my experience with the British system was that the vast majority of those who no longer attend medical school, they don't go into law or banking .. they have mostly figured out it's easier to sit at home, drink beer, and wait for the dole check to clear.

Now, I find that I am being treated to the same thrilling prospect here. My wife went on Medicare this year (mandatory if you want to keep your military medical "benefits"). We also discovered that the cost of her prescription has suddenly jumped by 25%, just by virtue of gaining the benefit of Medicare.

Discussed the Obamacare Independent Payment Advisory Board, I think that's what they call the Death Panel, with some friends. Seems we have discovered that our "life-years" place us in the "take a pain pill" category of medical treatment. It seems the ultimate goal is to have people like my wife and I, wander off into the wilderness, or float away on an ice floe, in order to allow Obamacare to treat those whose life-years are of more value.

Funny how modern technology, and modern medicine, has suddenly turned us into Eskimo tribes.
( )
Then again ... if Oblowhard keeps rattling on about cutting off fossil fuels, we'll all be living in the Stone Age again soon enough.

John the Econ said...

@elcedar, what you describe is what has happened to the British middle class. There is now little difference in the physical standard of living you can have if you decide to be productive, or to be on the dole.

On the other hand, there will always be those who strive to be something more than a couch potato. The question is, will society encourage those people to do something that truly contributes to the betterment of the society as a whole, or to just become high-priced rent-seekers? Today here, as in Britain, we send more of our native-born to law school and academia than to medical school, engineering school, or other professions that lead to actual production of things.

Ms Fluke is a fine example.

Pete(Detroit) said...

Emmentaller - I'm not sure that "cake" is precisely the substance she wants us to be eating...

John - Yes, surely she's a fine example, but of what, exactly? As she's taken all that money from various gifts and grants, just to get into a position to screw us all, perhaps "Prostitute" is not a totally inaccurate description after all...

Bobo said...

Know what I don't undeerstand? Why do the Republicans not do something, say something or any other act of something to bring the bad actions of Obama and his cronies to the attention of Americans. We can't blame the MSM for everything not being reported. I'm sure if the republicans in Congress started spouting off, the MSM would have to pay attention and report.

Many current congressmen and senators were elected on the promise of repealing obamacare as soon as they got to D.C. I haven't seen or heard of one bill being put forth to do this.

Arizona congressman, Ben Quayle, promised he was "gonna kick some butt" when he got there. I still am waiting for a response from him detailing just exactly whose butt he has kicked so far.

If the republicans are just going to sit on their asses and not actively go after what the democrats are doing to this country, then they might as well be democrats, too.

Now, for the recent hearing on the topic of today's cartoon, what will be the next step of the committee? Do nothing?

Just say'n...

Colby said...

In retrospect, after thining about malicious hacks and incompetent morons, I think Sibelius falls into a third and perhaps more common category. She is a lemming; mindlessly following in the wake of SS Obama. Obama's strategy of surrounding himself with willing lackeys has netted him an unforeseen result. Willing lackeys are often not the brightest lights on the tree. Hence Sibelius, Biden, Chris Matthews, Sandra Fluke and the like are all playing Igor to Barry's Frankenstein.

Colby said...

Grrr... thinKing, not thinning....

Stilton Jarlsberg said...

@John the Econ- You're right that the negative impact of Obamacare hasn't even begun to be felt yet. And there's a genuinely frightening piece in the Wall Street Journal today about the IPAB 15-member SuperDuper Health Board which will decide what medical treatment we can and can't get. They will be unaccountable to patients, physicians, and even politicians. Their decisions will be final and uncontestable. And, if history is any judge, those decisions will also be disastrously wrong.

And for those unfamiliar with Directive 10-289, here's a link. It's not even barely hard to imagine this coming out of the Obama Whitehouse.

@CenTexTim- The situation you're describing has already been happening for years in Hawaii. The more of Obamacare is enacted, the fewer doctors there will be to do anything for patients. As surely as the sun rises in the East, we will soon be getting bored, barely literate union employees tapping our symptom codes into a computer terminal for an "auto-diagnosis" without ever seeing a doctor.

@John the Econ- I don't believe that women are that stupid. God knows the ones who post here aren't!

Regarding foreign-born doctors, I think it will be more economical for them to stay in their home countries and simply see patients by Skype. And I am so not kidding about that.

@Mike Porter- When I created "Obama Sutra," I made it about as tasteful as a satiric sex manual possibly could be: with one significant exception. There was no way I could address "pass it to see what's in it" without going for the scatalogical. Because that's the exact truth: Pelosi took a big steaming crap and then told us to pick through it for whatever bits of corn or peanuts that we might try to live off of.

@elcedar- I'm reminded of an example in which my brother was in the UK, got sick, and got the "free" treatment. It was extremely rudimentary, used no modern diagnostic equipment, and he was basically told "if you don't die in 24 hours then you'll probably be okay." But hey - it was free.

And yes, yes, YES you've got it right that one of the few "health" related goals of Obamacare is to kill off (or, ahem, "allow to die") the older folks who have paid taxes their whole lives but are now owed benefits which can't be paid.

@John the Econ- When there's little economic incentive to be productive, people will certainly find other wonderful things to do. I remember not long ago when Nancy Pelosi described the good side of all this unemployment (and extended unemployment payments) as freeing up people to write books, write songs, and create great works of art. And I wish I was making that up, but I'm not.

@Pete(Detroit)- As far as I'm concerned, the only real difference between lawyers and prostitutes is the dress code.

@Bobo- Actually, the Republicans do complain and have floated some good bills to kill or defund Obamacare. But with a wave of his withered little pinky, Harry Reid can (and does) kill the legislation and the MSM never mentions it - unless they want to slant it: "Senate Democrats today beat back a Republican bill to throw blind orphans into the snow."

Regarding the current committee, there's not much they CAN do other than try to get these facts out into the open. If you follow the link in my commentary, you can see Sebelius with your own can every member of the MSM. So if this isn't being reported, it's not because the Republicans aren't bringing it to light- it's because the MSM is covering it up.

Stilton Jarlsberg said...

@Colby- "Useful Idiot" is actually on Ms. Sebelius's business card. Embossed in gold letters.

JustaJeepGuy said...

I'll do the thinnin' around here, Babalouie!

Anonymous said...

Yes, I like to think of Ms Sebelius, Ms Pelousy, and Ms Fluke as all prostitutes. I choose to think of it in terms of the second definition found in Merriam-Webster: to devote to corrupt or unworthy purposes : DEBASE .
I can think of nothing more corrupt or unworthy than Obamacare.

Unfortunately, I think the Republicans are unable to speak on their own behalf. When they do get a few moments of time in front of the cameras, they squander it with foolishness.

BTW, to my deep regret I have recently discovered that the Ron Paul wing of the Libertarian Army, is no more tolerant of free speech than the Democrats. Ayn Rand's minions talk a good game, but when questioned on their tolerance ... it turns out they'd rather delete your comment than respond.

It seems there are now three branches of totalitarianism. Speech police of every ilk.

pryorguy said...

God help us!

John the Econ said...

Yes @Stilton, I just read the WSJ ed over a late lunch. Sheer insanity. Sure looks like the makings of a "death panel" to me.

Stilton Jarlsberg said...

@JustaJeepGuy- Wow! That was a real trip down memory lane! (And a good one! Where is El-Kabong now that we need him?)

@elcedar- It seems like there are very few places anymore where people can exchange opposing opinions without either being censored or threatened. Meaningful dialogue has become a lost art. And from time to time, I try to draw out liberals pleasantly to just talk, and get my hand bitten every time. It's genuinely sad.

@Pryorguy- Yes, please.

@John the Econ- The WSJ piece literally made me queasy. The words "DEATH PANEL" should be in flashing neon letters, 100 feet high. But instead, this will be spun as a "Life & Health Panel" which simply determines how much of each you'll get...

badlarry said...

Just keep repeating the mantra I do, "Just eight more months."

Heck you can even countdown the closer you get to November. It's like an advent calendar for Christmas a month early and for something way better than presents under the tree.

Coon Tasty said...

From an outsider's perspective, it seems like one of the key factors giving Obamacare the upper hand is this: the cost of privatised medical care/insurance in the US is outrageously high. - If it were the banking industry, it would be called usury.
I have no issue with doctors being able to make a decent living but letting them charge whatever the market will bear means that prices spiral beyond affordability for some people. After all, most people will pay whatever they can for healthcare.
Then we end up with a situation where "specialists" work three hours per day and make $1000,000 year.
Having lived in *two* countries with socialised medicine, my experience of it hasn't been negative at all. However, private healthcare should also be available for those who wish to have it.

I am completely against the way socialised medicine is being implemented in the US but I reiterate: I think one of the biggest problems with privatised healthcare there is that the big insurers/HMO's are charging far, far more than they have any moral right to do.

John the Econ said...

@Coon Tasty, 1st, why shouldn't doctors be able to charge what the market will bear for their services? It literally takes decades and hundreds-of-thousands of dollars to become a doctor. Just how many would there be if they were not allowed to charge market rates?

I know several "specialists". I don't know any who work a mere "3 hours a day". Most work far more than 40, and frequently at hours that the rest of us would find unpleasant.

2nd, the reason health care is so expensive is because it is not a truly "free" marketplace. It is practically impossible to get a price quoted for anything before you actually consume it.

3rd, most people are not the real customers for health care. Their employers or the government is, since they pay most of bills. The system responds to their needs before yours.

4th, the government mandates what insurers and providers must provide, regardless of cost. If the the government is now mandating "free" birth control and gender re-assignment surgeries, then it shouldn't be a surprise that the cost of insurance is going to rise.

5th, in America, theoretically people have "the right" to charge whatever the market will bear. The most simple of economic laws states that if the government forces a below-market rate, there will be shortages, as there is building now with doctors willing to take Medicare assignments.

You can be unhappy with the laws of economics, but your ignore them at your own peril.

Coon Tasty said...

@John the Econ - "why shouldn't doctors be able to charge what the market will bear for their services? It literally takes decades and hundreds-of-thousands of dollars to become a doctor."

This is why I usually don't argue with Americans about the pros and cons of socialised vs. private medicine: you guys never seem to understand where I'm coming from. (I think it's a cultural divide that cannot be crossed.)

Anyway, to rebut:

1) The enormous cost of becoming a doctor is a peculiarly American phenomenon. There is no other country on Earth in which it costs hundreds of thousands of dollar to obtain a medical degree, and it is much more than simply a reflection of the standard of training. (I rather suspect that it is so expensive in the US mainly because the organisations providing the training know that they can charge that they do.)
In my own case, I am a commercial helicopter pilot, a profession vital to life-saving/emergency rescue/ferrying workers to oil rigs, etc. I personally paid $64,000 to receive my professional training, yet I make nowhere near the sort of money that my own GP (who is a personal friend) makes. - His trip through medical school cost $35,000. Now, I'm not at all worried about the difference between our incomes, I'm just making the point that if income were relative to cost and hours of training, I should be getting paid more than he is.

So where does that leave us? Well, it is obvious that healthcare comes down to the value that the users (a.k.a. customers) place upon it. The downside of this is that in a completely unregulated marketplace, the price of a highly valued commodity will be driven up to a point where it is beyond the reach of a significant percentage of the population. I don't believe that this is morally justifiable.
Again, I think people who have medical degrees are most certainly entitled to be paid well for their efforts. After all, a surgeon has spent more time and money on his training than has a burger flipper at the local diner. However, there is a point where just reward becomes pure greed. But, as you point out, the greed may be more on the part of the insurers than the actual practitioners.

"most people are not the real customers for health care. Their employers or the government is, since they pay most of bills."

If your employer is footing the bill for your non-work-related healthcare, then I submit that you in fact *are* paying for it...because the cost of that healthcare premium is money that your employer could otherwise be paying *you*.

"the government mandates what insurers and providers must provide, regardless of cost. If the the government is now mandating "free" birth control and gender re-assignment surgeries, then it shouldn't be a surprise that the cost of insurance is going to rise."

Oh, I completely agree. And I also agree with you that the government has no right to mandate that things like gender reassignment surgery should be covered by insurers.
I just think that even if it were a completely free market, healthcare costs would still be insanely high. In fact, having been a student of human nature for some time now, I think that healthcare in a completely free market would become even more expensive than it is now.

Ultimately, I don't see any simple resolution. I don't believe that a completely free market would solve anything, nor do I think that Obamacare will make things better. I am of the opinion that the current system you have seems to be the lesser of the two evils.

From a personal perspective, I have no problem with my tax money being used to pay for socialised medicine. Accidents happen and I feel that I have a duty to help my fellow man, in the same way that I'm happy for my taxes to be used to pay for firefighting/the military.

Please understand, I'm not saying the US system is wrong, I'm just telling you how things look from an outsider's POV.

BS Footprint said...

"We'll have to pass it to see what's in it" conjures up images of a temple priest examining the Emperor's latest bowel movement.

Apt, no?

BS Footprint said...

It all started swirling down the toilet bowl when, for some gawdforsakenreason, a visit to the doctor became something other than a simple business transaction between buyer and seller.

Trying to get someone else to pay for health care has wrecked everything.

Now, some people think that inserting a bunch of bureaucrats with guns into the transaction is going to improve service and lower costs?

And people say I'm nuts?

BS Footprint said...

A significant factor in the rising cost of health care in the U.S. of A. is something called "cost shifting". Google for it.

Basically, people (and employers) who are unfortunate enough to be able to afford insurance are paying for those who aren't.

Now we're trying to spread the disease by cost-shifting even more.


P.S. If you really want to reduce costs and improve service, eliminate the government-enforced monopolies on health care practice (licensing, AMA, etc.) and get rid of the FDA. Things surely haven't improved since that bureaucracy came into being.

John the Econ said...

@ Coon Tasty. even if becoming a Dr. was free, it still requires over a decade of dedication and training. It’s a commitment that appeals to a very select class of people. True, I’d like a doctor who is motivated by more than good money. But even then, relatively few people would go through that level of commitment to become mere civil servants.

But I do agree with you that much of the reason that it is so expensive is because of the subsidized “education bubble” (exact same phenomenon as the “housing bubble” and well discussed here before) sees to it that it is.

As for your helicopter training: Your example is a non-sequitur. Although like doctors, pilots tend to be “another breed”, the reason that you do not get paid like your doctor friend is because for decades now pilots as a class of people have proven themselves more than willing to pay 6-figures to get trained to perform 5-figure jobs. Also, as a helicopter pilot, you well know that you have been competing in the marketplace with thousands of former military pilots. (But don’t worry; they’re starting to retire en-masse, and the marketplace for your services will likely find better balance)

It would be a fair debate to discuss the social value, or “morally justifiable” aspects of access where “health care” is “beyond the reach of a significant percentage of the population”. But that isn’t what we’re talking about here. What you are suggesting are “price controls”. In the history of mankind, “price controls” have never, ever worked to a desirable end. The only thing price controls ever achieve is an imbalance between supply and demand; either surplus (usually of things we don’t want) or shortage (usually of the things we do want).

And again, I’ll use Britain as an example. The majority of the doctors in Britain are imported from the 2nd & 3rd worlds. Why is that? Britain has millions of intelligent people and many excellent universities, and has more than enough potential to produce their own talent. And yet, the best and brightest in Britain choose to go into law, or banking. Why?


John the Econ said...


I applaud on your perception that in reality, the employee is paying for their health care. (Just as they’re paying for all the employment taxes as well) The problem is transparency. The employee has very little say on how his money is deployed for purchasing what is supposedly his own health care. Since the employer chooses the insurance companies/providers, he/she does it based upon what they see their needs are, mainly affordability and ease-of-management. What the employee’s needs are is a secondary consideration, if that.

I, on the other hand have complete control over my health care. I choose the insurance company. I choose the providers. I choose how much I want to pay up-front and on the back end. I choose the level of risk I am willing to take, and I carefully manage the money to do so. And since I do all these things, I actually know what health care costs. To the penny. Very few Americans know that. Most blithely go to their doctor and hospital, pull out a benefits card and maybe make a $20 co-pay as they then proceed to consume hundreds or thousands of dollars in goods and services. (And then they bitch about the co-pay!) And that is the big problem. At best, they know it’s expensive. And most know it’s expensive enough that they want someone else to pay for it. How that happens, they don’t care so much. They hope that “the rich” may pay. Or they hope their kids may pay. Or they hope that it might be made more affordable by forcing doctors to make less money. Either way, it’s lazy and greedy; hardly a healthy way for society to approach a complex problem.

So I highly disagree with you that a “free market” in health care would make it more expensive. When people have to pull money out of their own pocket, they pay far more attention to how it’s spent. Even the 3-hour-a-day doctors you bemoan would have to react to that.

So let me buy an insurance plan that does not cover birth control, in-vitro fertilization, gender re-assignment, or thousands of other things that I will never want or need. If Ms. Fluke wants all that, let her buy a plan that supplies it. Under ObamaCare, we will not get these choices.

And finally, if you are going to rely upon the government (nee Obama, Sebilius, Geithner, Frank, Pelosi, Ried, etc, etc) for everyone health and well-being, you are going to get what you deserve. Unfortunately, those of us who know better are going to get taken for a very bad ride.

Chuck said...

IMHO: The problem is the third-party payer system. Health "insurance" ought to be for the catastrophic events, not the routine. My car insurance does not put gas in my car or pay for oil changes, tune ups, tire rotations ...

Saying that health care costs would go through the roof in a true free-market is getting it backwards, but it is what the bureaucrats have drummed into the masses for years! If that were the case, everything that exists in a “true” free market would be through the roof, too, like the price of bread and eggs. But because grocery stores compete for my business, I can still buy bread and eggs at a fair price determined by supply/demand and costs of production/transportation. In a true “free” market for health care, doctors would compete for my business. They would post price lists. I’d contract directly with the doctor (or his staff) for my services. A good doctor with a fair pricing model would thrive. A poor doctor (or one with an inflated pricing model) would not. That’s free market.

I don't shop at some stores because I can't afford them, but I'm no less satisfied with the merchandise I get, and someone shops at those stores I don't, or they would be out of business.

I don't drive a Rolls Royce, either, but I'm quite happy with what I do drive, and I got it at a price that was "fair" to me at the time. Free market. It would have been even cheaper without all the government regulations, too.

Insurance companies and Government regulations are what have forced health care cost to rise by taking the consumer out of the mix. How many people even know what that trip to the doctor costs? What, exactly, does an insurance company add to the quality of your health care, by the way? Ø, that’s what.

John the Econ said...

Good points @Chuck. For example, look at areas of medicine that truly are “free market”. I’m speaking of products and services that the government or insurance companies do not highly regulate or pay for. The best example off the top of my head is the various eye-correction surgeries that are now available. Since being introduced in the late ‘80s & ‘90s, the costs of these procedures have gone drastically down. How many things in the health field can you say that about?

Why is that? Mainly, because eye-correction is an elective procedure that people pay for with their own money. They shop for it. And if it was too expensive, people would not purchase it. This gives those providing the service incentive to make the procedure as efficient and inexpensive as possible. This single element is what is missing from the rest of “health care”.

Just how much would your auto insurance cost if the auto insurers were required by government to provide fuel, oil & tires? And if the cost of fuel, oil & tires were included in your insurance, would you care how much fuel, oil & tires you consumed? Of course not. You’d drive with abandon, buy “premium” instead of “regular”, and you’d get the most expensive tires you could.

Now, expand that paradigm to a “socialized” system where you didn’t even have to buy the insurance; the state simply provided the fuel, oil & tires and you needed them. What would happen then? Would your taxes go through the roof, or would the government have to start rationing fuel, oil & tires. And exactly how would the government “ration” those item “fairly”?

Stilton Jarlsberg said...

@Readers- Wow! So much has been said so well in the comments above that I'm not going to remark on them individually other than to say "great stuff!"

The medical payment system we have in this country is clearly broken and needs fixing. Obamacare is not that fix. And as discussed many times previously, the only effects it will have will be bad ones - a huge metastasis of the current combination of insurance companies and government regulations which have all but destroyed the free market aspects of American medicine.

Several years ago, I needed a colonoscopy and wanted to find out the price before getting it. I asked my insurance company and they refused to tell me what they considered fair for the area I live in (even though they have those figures readily available). I asked the doctor's office what I would be charged, and I was asked "how much is your deductible?" I said $5000. "How much of that deductible have you met?" None of it. "Then the price of your colonoscopy will be $5000," I was told. Because that was every last cent they could conceivably charge me without the insurance company giving a rat's ass.

In other words, the price of the procedure was based entirely on how much they thought they could extort from me. There was no other consideration.

I'd love to see a real insurance overhaul: I'm self-employed and always have been, meaning I pay for 100% of my family's health insurance. Because of some special circumstances, I pay sky-high rates for a crappy policy.

But as long as the government is ordering doctors and hospitals to treat huge groups of people at a loss, everyone else has to be gouged to make up for it.

The hypocritically-named "Affordable Care Act" will only make medicine more expensive, harder to find, and of worse quality than we currently enjoy. All unnecessarily, and all in the name of the biggest power grab in U.S. history.

Stilton Jarlsberg said...

@Chuck & John the Econ- The car insurance/maintenance model is really perfect for helping people visualize what's going on here.

And isn't it interesting to see what happens in medicine when the free market is actually allowed to work (as in the case of eye surgery)? Look what's happened to the cost of generic prescriptions: Walmart drastically lowered prices and other pharmacies did price matching (or price beating) - which is why it's easy to buy a month's worth of many generics for $4 or so. A tremendous boon to consumers, but no government agency was responsible for this gift, and no billions of tax dollars were spent to make it happen. Rather, it happened because the government didn't (for once) prevent the free market from working.

Pete(Detroit) said...

Coon - Very Well Said! Points made in an articulate, concise and polite manner. EXCELLENT demo of how to disagree w/o being disagreeable. Should be required reading on all blog FAQs, IMAO.

Agreed, loving the auto insurance / maintenance illustration. I'm going to have to remember it!

The sad thing (or one of them) is that a fairly simple solution exists - the concept of a 'Medical IRA.' As a consumer, I can choose to buy a catastrophic policy w/ a fairly high deductible (say, $10k) for a reasonable price, then be allowed to put up to the deductible amount into an IRA w/ 'pre-tax' money. At the end of the year, any of the 'deductible' that was NOT spent would roll over into an investment portfolio, llike any other IRA and we begin again. The big advantage is that people, being able to keep what they don't spend, become responsible for their own health and invested in taking care of it - regular exercise, proper diet, limited drinking, quit smoking, etc. The obvious down sides are the 'entry level' workers who will not be able to set aside $10K (or even $5k) in a year - it would take some time for them to build an account. Fortunately, most of them are young, and should not NEED much. Another issue would be the unemployed, of course, as they are always an issue. Perhaps basic clinics, either publicly or privately funded could provide some care for those unable to take care of themselves.

Those who are merely 'unwilling' can go hang, I think...
But hey, that's just me shooting my mouth off - I had a good childhood, well nourished and decently exercised and have been stupid healthy my whole life - went to a GP last fall for the first time in 30+ years (last time had been a high school physical - fig'd it was time for another). So I'm sure my perception's all skewed up.

Pete(Detroit) said...

And, to be clear, the Medical IRA concept is just that, as yet, a concept, a fantasy. It does not exist. Unfortunately. (That I'm aware of, at any rate)

Coon Tasty said...

@John the Econ - My example was *not* a non-sequitur, in the context given. - You implied that doctors deserve their high incomes due to the cost and length of their training; I showed that my training cost twice as much as my own doctor's training (and is an ongoing process). All I was doing was making the point that it is not necessarily cost of training that is the main factor in what a person's remuneration might be.

I still disagree that a completely free market would result in lower healthcare costs. I strongly suspect that it would result in collusion and price-fixing beyond any Marxist's wildest imaginings, as healthcare is more than just a commodity - it is a necessity.
I could be wrong, of course, but I have lived in two countries where I saw State-owned assets become privatised and deregulated (accompanied by enormous amounts of propaganda about how it would make things far, far cheaper for the end users), only to see prices quadruple and service actually deteriorate, while profits soared. Admittedly, that may have been partly due to a lack of competition but I doubt that it was the sole factor.
Out of curiosity (and I am not being facetious), can you give me some examples of how a completely free market has resulted in lower prices *for a highly valued/rare commodity*? (I can't think of any but neither do I have a degree in economics.)

"if you are going to rely upon the government (nee Obama, Sebilius, Geithner, Frank, Pelosi, Ried, etc, etc) for everyone health and well-being, you are going to get what you deserve."

I couldn't agree more. - I don't have a problem with socialised medicine *per se* but I DO have a problem with the way it is being implemented in the US, where it can easily be used against dissidents, as a control measure. - It will no longer be a case of having the IRS ream you out for publicly disagreeing with a Democrat President, it will become a case of "Oh, you're sick? Yeah, you're number 5000 on the list. We'll call you..."
From my own experience, a *combination* of socialised and privatised medicine can work quite well.

FYI, for all of those Democrats who think "free Obamacare for all" is such a great thing, I'd ask them why it is that the Australian Government is doing its best to encourage people to get private health insurance, rather than solely rely on the public system? (Answer: the Treasury can't afford the drain of having an ageing population costing the remaining taxpayers that much money for medical care.)

Coon Tasty said...

@Pete(Detroit) - Thanks!

@SJ - $5000 for a colonoscopy?! - That is the sort of thing I mean when I say that medical care in the US is outrageously expensive. There is no way anyone can persuade me that the *real* cost of such a routine procedure is anything like $5000. I would think that even $1000 would be really "pushing it" to speak.

Stilton Jarlsberg said...

@Pete(Detroit)- Actually, the Medical HSA (Health Savings Account) is pretty much what you're talking about when you describe a medical IRA. I've got one, in fact. But rather than encouraging such self-reliance, Obamacare discourages it with provisions designed specifically to take the savings our of HSAs so that people will abandon them. For instance, a person could use their own HSA funds to buy over the counter medicines, and as long as you had your proof of purchase to show the government, it was acceptable. But Obamacare changed the rules so that even if you're buying a bottle of aspirin, it's not an acceptable medical expense unless you have a doctor write a prescription for it. So that $3 bottle of aspirin suddenly is going to cost $53 or $103...and people are going to ask what the hell they're locking their money in an HSA for.

@Coon Tasty- It's really interesting and helpful getting your perspective. I think that some combination of free market and government regulation would probably be the best (albeit imperfect) system...but Obamacare is the worst of all possible worlds.

Per the example of my colonoscopy, I'd love to see changes made which would allow consumers to price shop before having a procedure done. For instance, after being quoted that $5000 price for a colonoscopy, I found out that insurance companies will generally reimburse physicians only about $700 for the procedure in my area. So what I was experiencing was economic anal rape, pure and simple - with no one to turn to help me.

For another procedure I had done recently, the charge was going to be $1500 if I told the facility that I had insurance - but they'd do it for $300 cash if I was uninsured. And so I paid the $300 cash while lying about the coverage that I pay through the nose for. (Let me emphasize that this was simply their cash price - not a charity price nor a subsidized price of any kind. NOBODY was going to have to pay an additional dime; it was simply what they were willing to take when there wasn't an insurance company to haggle with, and they were getting immediate cash flow rather than a "billable" which might remain on the books for a year or more).

Obviously, this is all messed up enough that I'd eagerly embrace substantive changes to our medical/insurance systems...but only if done intelligently and transparently (ie, no "pass it to see what's in it" 2000-page bills).

Stilton Jarlsberg said...

@Pete(Detroit)- Here's how (great folks, great site!) summarizes what Obama is doing to HSAs: Starting in 2012, Obamacare restricts the products that consumers may purchase with a Health Savings Account (HSA) or Flexible Savings Account (FSA)—such as over-the-counter medications—and increases the penalty for such non-qualified uses of HSAs. It also limits the amount taxpayers may deposit into an FSA to $2,500 a year in 2013.

Got that? They're greatly restricting what consumers can use their own money for, increasing penalties for trying to save money, and reducing the amount of money you can even put away for your own future use. It is, in other words, legislation to kill HSA and FSA plans, because Obamacare must eliminate anything which will reduce dependency on the government.

Madness. Madness and evil.

Coon Tasty said...

@SJ - Thanks. I think it has been a very informative thread for all!

And, yes, $5000 for a colonoscopy is both literal and figurative rape.

Segue: Have you seen *this* bullcrap?

"Obama's only negative is that there are too many accomplishments."

If I didn't know better, I'd think this guy was being paid by Ann Coulter, to make liberals look stupid(er).

Stilton Jarlsberg said...

@Coon Tasty- Oddly enough, I agree with the guy: Barry's only real negative is his record of accomplishments... which has gone a long way to destroying our country.

Emmentaler Limburger said...

The high cost of medical services can be traced back to pretty much the same source as the high cost of automobile insurance and products in general: Liability, lawyers, and an out of control torte law system in the US. If you want to have a dramatic effect on the costs of such things, you need to address the outrageous payouts received on some clearly egregiousness stretches of the concept of "liability". But, of course, most who could address the issue are lawyers themselves who have used the system to generate enough wealth to reach their positions of political power, so don't expect THAT to change until the latter changes as well. (And don't start me up on how our political system has changed from that which our founders envisioned - "Joe Everyman" serving for a short period and then returning to civilian life vs. the millionaire's club it is today...)

Stilton Jarlsberg said...

@Emmentaler- You raise a great point. Tort reform would immediately bring down medical expenses without costing taxpayers a penny. So why hasn't it been done? Because the trial attorneys (who benefit from frivolous lawsuits and absurd payouts) have the Democrats in their pockets.

During the nearly nonexistent debate on Obamacare, Republicans said they wanted tort reform included and Obama said he'd "think about it." And he did - which is why a short time later, language was added to Obamacare which said that any state which had tort reform would be penalized.

Sad and disgusting, but not in the least surprising.

Pete(Detroit) said...

Yes, a HSA (or FSA, like I had when I had a job) is "similar" to a Medical IRA - the big difference being with the former there is a 'use it or lose it' feature that kicks in annually, as opposed to a 'save it and keep it' attitude w/ the latter.

But that would just lead people to take responsibility for their own expenses, and (shudder) health in general. And the more personally responsible people are, the less they need / want the dadgum gummint messing in their lives...

Stilton Jarlsberg said...

@Pete(Detroit)- Exactly. The simple rule of thumb is that if something is cost effective, empowering to the individual, and logical then Obama is against it and Obamacare is designed to kill it.

Emmentaler Limburger said...

Bit confused but your post, Pete. To clarify...

FSA - flexible spending account. Available for both medical and dependent care (separate accounts). "Use it or lose it," tax-free accounts. "Use it or lose it" because the democrats thoroughly believed that, since predominantly employed (read: rich) folks have them, "they must come with some risk".

HSA - health savings account. Available only for medical, and only to those having "high deductible" health insurance. "High deductible" defined as follows:

Min deductible (single): 1200
Min deductible (family): 2400
Max out-of-pocket (single): 5950
Max out-of-pocket (family): 11900

The deductibles must be met before the insurance pays dime-one.

The automaker I work for has been slowly dropping plans and herding us all into these. My beloved non-BCBS PPOM fell to them a few years back, and the BCBC Blue Care Network PPOM I replaced it with fell to them this year. THe only options are two HDHI plans or a HMO. Since most HMOs can be characterized as the next best thing to the quality of care you'd receive with socialized medicine, I now have a HDHI/HSA account so that I can still use my doctor - though not nearly as often as they'd like.

Emmentaler Limburger said...

Oops - I missed making one point on the HSA: they endure beyond the year's end. Once you have it, assuming there's money left in it, it's yours until there is no. Of course, that comes shortly after you stop paying into it as the bank/management firms are pretty quick to start slurping the principle out via management fees once the incoming stream is stopped up...

Stilton Jarlsberg said...

@Emmentaler- Good summary. And as I mentioned, Obama has made it much more difficult and expensive to use your HSA funds. So expensive, in fact, that you'd be a fool to use them on anything but major expenses - but while you're (hopefully) waiting for such a crisis, your medical savings get frittered away in maintenance fees.

BS Footprint said...

Seems obvious to me that he who pays the piper calls the tune. Even if the piper-payer is the U.S. taxpayer.