Sennin wrote on November 14, 2008 01:35 AM: One thing no-one has considered in this discussion is this:

Why do we NEED medical insurance?

For the first 30 years of my life, there was NO medical insurance. That stuff was for CEO's and Big Wigs.

If I needed to see a doctor, I went to his office, got diagnosed, prescribed-for/repaired, and paid him MONEY (CASH, CHECK, MONEY ORDER).

Still do it that way and it costs less than an insurance policy; plus, I get a discount for paying cash.

Just sayin' ...

Bill Smith wrote on November 03, 2008 05:24 AM: As usual Vin, the fascists who read your articles always resort to ad hominem attacks and only offer the same tired government schemes that have been proven not to work. One thing that people always seem to forget about is all the wonderful charity hospitals and doctors who help those in real need who cannot afford health care. There would be many more charities to help those truly in need if the Average American did not pay 50 – 60 percent of his income into some form of tax.

Paolo wrote on October 27, 2008 06:53 PM: John F--

Thank you for your cogent comments.

Now, if your argument is that SOME people cannot afford medical care, then we have some room for discussion as to how to best address this issue.

That is not the proposal, however. Because SOME poor people cannot afford medical insurance (it is argued), then ALL OF US must be brought under the thumb of government medical care.

Addressing charity cases is one issue; bringing the entire population under a government bureaucracy is quite another.

Incidentally, regarding old people: the market can and does address this issue in the area of life insurance, in which one hundred percent of those insured will in fact eventually die. The insurance customer has a number of choices. One is to buy a "whole life" policy, in which a portion of the premium goes to term insurance, while another portion goes to investments that will provide income in retirement, and a legacy to pass on to one's children.

Or, one can buy term insurance at a very low price when one is young and has beneficiaries (children) who would need the money if the buyer died at a tragically young age. Then, when the children are old enough to fend for themselves, the customer can drop the term insurance entirely.

In like manner, in a free society, one could purchase "whole life" health insurance, when young, at a higher premium, and be covered for life.

Paolo wrote on October 27, 2008 06:43 PM: Hi Patrick--

Regarding "tort reform." I agree with you one hundred percent that doctors who are guilty of malpractice should be made to pay. "Tort Reform" is not a phenomenon of the free market, but of guild socialism; that is, the medical guild (aka AMA) looking for legislative help to guard its exclusive "territory" of medical care.

On the flip side, there are many cases where doctors are sued, not because of malpractice, but because they are not Gods. This is why malpractice premiums for Ob/Gyn specialists exceed a hundred grand per year in some parts of the country. But this is a problem with the legal system, and not with capitalism as such (though a well-functioning legal system is essential to a healthy free market).

Ted Sell wrote on October 27, 2008 07:47 AM: Thank God for Vin.

I wished more people would learn to think before they voted. But that would mean they'd have to get an education; something that will never happen in public schools.

Nate Ogden wrote on October 27, 2008 06:30 AM: "That's unthinkable! Snake oil and charlatans! We want regulation! It makes us feel safe!"

Anyone that feels this way needs to google Ted Kennedy and the HMO Act of 1973. Ted decided that he knew best and despite their strong desire not to be everyone should be in an HMO. So they passed the law and forced all employers with more then 25 employees to offer them. Then to make sure the HMOs got members they heavily subsidized them so they could peel off all the healthy young risk with low rates. For the next 10+ years Kennedy bragged about how successful HMOs where and how proud he was to pass the bill. Then HMOs started killing people an became very unpopular. So Kennedy started passing bills and protecting people from what he created. Now before he dies he wants to do it all over again. He wants America to go on another ride of wild Kennedy reform....how many people will it kill this time?

Whatever wrote on October 26, 2008 08:54 PM: The amusing part is that none of this matters. The only thing that will lower costs is focusing on preventative care so we can minimize expensive, radical treatments that happen during the later stages of a disease. We, as a country and a society will continue to abuse our bodies and then wait and expect for someone to magically make us better. With the system where everyone is covered, the wait in the ED or even for a routine visit will just be significantly longer. Do you really think that people, poor or otherwise, will all of a sudden decide to go get a physical or a colonoscopy or a pap smear or a mammogram just because it's the right thing to do and the government is paying? There is always some excuse preventing people from taking responsibility for themselves and their health. Currently, that excuse is money. When that problem is "solved," there will be another reason health care wasn't made a priority. The pendulum is swinging to the other extreme. Now, millions of people are uninsured and are waiting for the government to make it all better, and there will be more issues when universal health care comes too. Instead of trying to stop this pendulum and "muddling around in the middle" (which is probably where the cost to benefit ratio will be optimized), we are propelling it to the other extreme. We will be having this same conversation about "fixing" our health care system in 5-10 years.

John F wrote on October 26, 2008 06:38 PM: Paolo,

I see your point. However, that still leaves us with the fact that many people would not be able to afford health insurance. Medicare, for instance, exists because private insurers won't provide insurance to the elderly at anything approaching an affordable rate.

So we have a choice. We can either have a market system for health care where (even assuming the lower costs you predict) a significantly large portion of the population can't afford insurance, or we come up with a system that helps us cover everyone. I, for one, believe that we should opt for the latter. But whatever we decide, we should go one way or another and quit muddling around in the middle the way we are. The current system is dysfunctional.

patrick wrote on October 26, 2008 06:18 PM: Paolo:

Perhaps you can explain to me, using "free market principles" how bush and his minions could use "tort reform" to protect doctors from paying for their mistakes like the rest of the world does; in accordance with how much damage a plaintiff has incurred.

Perhaps you could also explain why, since this was as much an action to protect physicians as it was to PREVENT a plaintiff from obtaining legal representation by EXPRESSLY LIMITED the amount that an attorney can receive for representing such a claim, WHY they didn't EXPRESSLY LIMIT THE AMOUNT THAT AN INSURANCE COMPANY CAN PAY ITS LAWYERS TO FIGHT SUCH ACTIONS?

Seems unfair to me; while the insurance company can spend all it wants to DEFEND the claim, a PLAINTIFF is limited to chosing attorneys that thinks the amount provided for by statute is sufficient to pursue the action on behalf of the Plaintiff.

All this "free market bushsit" is just that, nothing but a smoke screen to prevent the "little" guy from being able to compete on an equal basis with the rich.

Paolo wrote on October 26, 2008 04:57 PM: John F--

More on the comparison of gasoline to medical care.

There are many products in a free market that are relatively undifferentiated: regular gasoline, pork bellies, bushels of wheat, and so forth.

There are also many products that differ enormously, depending on what the consumer wants or needs: automobiles, televisions, clothing.

Insurance companies, in a free society, are fully capable of dealing with complex products. A bent fender on a Ford may cost much less to repair than a bent fender on a Lexus; the insurance company negotiates the best fee possible in both cases, employing insurance adjusters and others to negotiate the best price possible, and varying insurance rates by type of vehicle, where you drive, how old you are, etc.

In medical insurance, the government often FORBIDS insurance companies to vary rates according to the health or age of the insured. In group plans, a healthy, vibrant twenty year old pays the same price as the obese seventy year old who has already had a bypass operation.

In a free and open market for medical insurance, people who paid attention to their health would demand and get lower rates, as they should.

Because, in a free market, people would be powerfully motivated to discuss treatment options with their doctors, extreme procedures like coronary bypasses would only be used as a last resort, unlike now, when they are done far more often than necessary. More conservative (and I would argue, better) procedures would be used first, prior to the more extreme measures.

Incidentally, I am not one to side with doctors. I generally see them as about on the level of attorneys for despicable behavior and turf-guarding. Vin has discussed this at length, also.

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