Sunday, July 15, 2007

Health Care, Part the Second

Sweetie little Bobert! Pretty Lady just loves hearing from Bobert. He reminds her of her Granddaddy, the crotchety one--not so much for Content, as Attitude. All bluff cynicism! So adorable.

I have heard many glib comments about going into business for yourself. Try to imagine the resulitng total collapse of everything if the majority of underpaid Americans did exactly that.

That's why 40 million Americans are uninsured, and a sure-fire recipe for future disaster, when a poorly educated and penniless mob of retirees hit Social Security and Medicare age, along with those twenty million illegals Bush has refused to contront.

This system IS going to collapse.

But... you know what? Those scumbags that are making vast fortures in the here and now - actively engineering the upcoming collapse - will be gone... skipped out of the country with their ill-gotten gains... laughing all the way.
Now, Bobert, dear. Try to stop thinking of scumbags. Thinking of scumbags, Pretty Lady has it on good authority, is terrible for a person's health. Daily meditation upon the Scumbags that have Done One Wrong directly contributes to headaches, backaches, stomach ulcers, sore ankles, respiratory infecctions, cancer, liver disease, kidney failure and bags under the eyes.

Plus, this is exactly the sort of rhetoric that Hillary Clinton uses to instigate the masses into doing things Her Way.

No, as attractive as it may seem to blame all our current woes on scumbags, Pretty Lady tells you sternly to stop. Pretty Lady does not believe in Blame. Blame may exist, and may be appropriately apportioned, but Blame never fixed anybody's tooth. So out with it.

Now, Bobert. As you so astutely point out, astronomical health-care costs plus millions of uncared-for persons present a Problem. The nature of this Problem, as you imply, is Systemic. It affects, not merely the Scumbags and the Irresponsible, but the vast majority of all of us, insured or not.

Thus, it seems to Pretty Lady that the vast majority of us have a vested interest in pondering this problem.

Pretty Lady points out the obvious, merely in order to make the point that the interests of the individual and those of the the Whole are not necessarily and permanently at odds. Individuals may work with the Whole, on behalf of the Whole, with the Whole in mind, and not necessarily be Totalitarian Control Freaks, like Hillary Clinton. There is a danger of such, of course, but it is not a given.

Pretty Lady grounds herself in the obvious, then, in order to move on to Bobert's initial point.
Medicaly speaking, the problem always has been that large groups get a good price break for medical insurance, while the individual gets hammered...It used to be a trade-off, until the medical community and the insurance companies raised the cost of having good health through the stratosphere.
In economic terms, as Bobert demonstrates, it is frequently in the interests of individuals to Pool their Resources. This lessens the shock to the system of catastrophe, and allows for the potential efficiency of Bulk Processing to enter the picture. Pretty Lady would elaborate, except that she knows that none of her readers are stupid, and are perfectly able to fill in the blanks.

HOWEVER, and AT THE SAME TIME, economic and health care interests are also served by the individual having maximum control over how those resources are spent. See: Free Market Capitalism.

Moreover, the notion of 'health insurance' is patently stupid and unworkable, for the same reasons that Car Repair Service Plans are a scam. When the head gasket blows, it is no earthly good to have a car-repair plan that provides two oil changes and a tune-up. Tune-ups and oil changes are relatively cheap; head gaskets, as Pretty Lady knows from vile experience, are basically prohibitive.

So, to recap the Obvious Points:

1) It is in the best interests of Society At Large to have healthy citizens, and as few destitute diseased persons dying in the streets as possible, spreading germs and and despair far and wide.

2) It is in the best interests of Individual Health and Economic Well-Being to seek out the best care at the lowest prices, and laugh in the faces of incompetent dentists who present them with deadpan $13,000 estimates.

So then, what is wrong with individually managed medical savings accounts, coupled with catastrophic coverage in a pool?

Chiefly, Pretty Lady supposes, the problem with individual control and responsibility for preventive healthcare, paired with group risk management, is that the elaborate systems in place for milking people without their consent would have to go. Unless, say, an existing HMO were sufficiently efficient, pleasant and effective to induce the individual to voluntarily pay for a Plan. The vast numbers of persons drawing a paycheck for shuffling paper and vetoing treatments would, unfortunately, have to learn an actual Useful Skill.

This might be good for their health, however.


Anonymous said...

Well thank you for your comments! Most rewarding.

I am known -- in family circles -- as Mr. grouchy pants, because I am usually the one that throws the cold water on neat sounding but stupid ideas.

Should you manage to survive as long as I have, remember me, because you will have become me, just a lot more flowery.

You are far more focused now than I am, but wait...just wait... broadsides in a general direction will become most satisfying.

Thats of course assuming you'll still be able to post on the internet without a government censor.

Desert Cat said...

Our medical plan at my employ is switching to exactly the plan you describe, starting January. I couldn't be happier. Not because I get more "free" care than now, but because I think it is the only way to go on principle.

Anonymous said...

Daily meditation upon the Scumbags that have Done One Wrong directly contributes to headaches, backaches, stomach ulcers, sore ankles, respiratory infecctions, cancer, liver disease, kidney failure and bags under the eyes.

But since daily scumbag meditation has not been linked in clinical studies that have been documented in refereed-journals to ED, I guess it does not pose a genuinely serious health risk

Bob said...

My not-so-daily mediataion on various scumbags scattered around like pidgeon droppings results in laughter over the stupidity of man, not headaches, etc,. etc.

The inablility of the United States Congress to deal with the vast assortments of scumbags out there is what gives me headaches, but not often.

What mostly gives me headaches is hitting my head on stuff in the dark, but that happpened only once... when I was widdle bitty boy.

Now that I am a cranky old man I studuiously avoid getting headaches of any kind, since I have absolutey NO masochistic tendencies, other than occasionally posting over at Vox's place, allowing myself to become a dart board for the "regulars".

But stirring them up is so much fun!

Roci said...

Nice comments on Health care.

I would like to add, if I may a few additional points.

1. The problem of the uninsurable. Some people are so "high maintenence" that insurance is not really an option for them. They seek instead to pass their costs onto someone else under the guise of insurance. Such people mahe insurance plans more expensive for everyone else in their pools.

2. Federal law mandates that emergency rooms must accept and treat anyone who presents at their door without regard to ability to pay or citizenship. Most do not pay. Those cost get passed along to people who do... insurance companies, making premiums higher for everyone.

3. America does not have a health care system. We have a collection of private, public and charitable institutions that operate under a myriad of government regulation, corporate oversight and philanthropic principles. To claim we have a "system" is to empower those who wish to take over control of that system.

thimscool said...

So then, what is wrong with individually managed medical savings accounts, coupled with catastrophic coverage in a pool?

Nothing is uniquely wrong with that plan.

But the rubber must meet the road. You would need to specify what is, and what is not, a catastrophe.

Moreover, you have to recognize that many people have a very limited capacity to save money, and as such would be forced to skip treatment for illnesses not categorized as catastrophic. Not only does this circumstance likely affect their ability to earn and save more money, but it also increases the likelihood of arriving at a catastrophe, which raises rates for everyone.

Presumably you are suggesting that very healthy individuals could use their unspent health savings for other purposes, subject to some regulations? If not, then what is the point of calling it savings?

I assume that the incentive to save would be that the money could be deposited tax free, like a cafe plan. But some people (the very poor and the very rich) don't pay taxes anyway. So either you make the savings mandatory, or you deal with poor people (of which there are many) having no savings, and therefore no health care except for catastrophic situations.

That is no different than the situation we have now, where, as Roci points out, federal law ensures that any poor person can get open heart surgery free of charge, assuming that they can make it to the hospital (and that the procedure is deemed necessary).

I'm not sure what the best fix is, but I can say that we already have socialized health care in this country, and it is horribly mismanaged.

Anonymous said...

Ah, yes. Health insurance provided bu employers. Health insurance, as if the medical establishment knows anything about health as opposed to disease.

There was a time when employers did not provide health insurance. As recently as the 1960's I think.

Seeing a doctor was a bit more reasonable then as people actually paid for it out of their own pocket.

Then there came a shortage of good help in the corporate world. I don't remember the reason or if the reason was known, but anyway, the corporations decided that offering health insurance would be a good way to attract and keep good help.

This idea spread until it was nearly universal.

The problem is that once the cost is being paid by deep pockets corporations, the price charged went up. And the idea of providing cost effective service declined.

Now, large numbers of people can not afford health care, or even insurance for that matter.

The problem is health insurance provided by employers. It is not the solution.

The system is bloated and inefficient for a reason.

The system also cures few ills and charges a fortune for managing symptoms.

The cure for cancer is a definition, not a reality.
Definition: if you live for 5 years after being diognosed you are cured. It will likely return and kill you, but that will be a reocurance. The initial cancer was 'cured'.

I prescribe free market.

Anonymous said...

"But the rubber must meet the road. You would need to specify what is, and what is not, a catastrophe."

This is not a problem.

It used to be called major medical and is what insurance is supposed to be.

You pay for the small stuff and the insurance pays for the big, banckruptcy inducing stuff.

Your auto liability does not pay for tuneups. You pay for that.

What we have now and what everyone has been trained to want is not insurance at all, but rather pre-paid all inclusive health care.

Pre-paid care. Not insurance.

It will bankrupt us.

We need insurance that will be affordable.