Government run health care... if you're going to do it, a "better" way to do it...

Economics Economics Questions
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1

I think I will be hard pressed to find anyone on these forums supporting government-run health care. But, if you have to do it, this is how I think it should be done:

  1. Pass a law requiring everyone have some form of health coverage that meets some minimal standard - I would favor a formula that takes a several baskets of common diseases and say that the total cost of treating each of these baskets cannot exceed some dollar amount ($15K with ongoing CPI adjusters), but what the standard is a “less important” issue that can be debated forever.
  2. Eliminate all of the government incentives (tax or otherwise) that encourages employers to provide health insurance for employees as a “benefit” - if employers still provide insurance for employees, than it is because of a market judgment, not a political one. Regulation that needs to be eliminated includes employer discrimination (with regards to health insurance) for health-related issues - if you choose to smoke or be overweight, the employer should be able to charge you more (or pay you less) for your health insurance.
  3. Set up a government-run health insurance scheme as an insurer of last resort, that has a premium of 10% of a participant’s adjusted income (plus an extra 5% per dependent).
    • People that have private insurance don’t pay the premium.
    • This insurer has all of the things you expect from a government health insurance scheme: long lines, bureaucratic gate-keepers, group of gray-beards deciding what to cover, etc.
    • Subsidize the government-run health-care system explicitly from general revenues.
    • Allow the government to regulate the personal lives of people on the system as it wants to (make them pay extra for smoking, or coerce them to stop; forbid them from eating a fast food, stop them from using recreational drugs, etc.), but only allow these regulations on people in the federal system.
  4. Fold Medicaid into the new federal program, consolidating state and federal bureaucracy into the new system.
  5. Fold Medicare into the new federal program.
    • Eliminate the Medicare payroll tax.
    • Allow those that are 65 or older to still purchase private insurance if that is less expensive than the 10% tax.
    • Allow those that are 65 or older, with no dependents, to opt-out of insurance altogether (by signing some form at the court house), and let them spend their money (or pass it on) as they wish instead of spending it on health care. The kicker is, they make an explicit choice, and we don’t care if they die early because of no access to health care.
  6. Fold the VA hospital system into the new program, giving veterans without war injuries a defined monthly monetary health benefit (say $100 for retirees) that they can spend on private insurance, or deduct from their public plan premiums.
    • For veterans with war injuries, you can leave the VA hospitals open, give them some additional defined benefit, give them a reduced-cost or no-cost public plan, pay for private or army treatment, or have some other scheme to have them treated at public expense.
  7. Force the states to pay for any of their regulatory tomfoolery that affects the cost of the public program.
    • For example, if the State of California passes a regulation forbidding insurance companies from treating HIV as a pre-existing condition, raising the cost of private insurance, causing people to choose the public program over private insurance, the additional cost will be paid by the state to the Federal Government.
    • Alternatively, if California chooses instead to subsidize people with HIV that purchase private insurance, and that reduces the burden of the Federal program, then the Federal Government would make a transfer payment to the State of California.

I think this type of system might be better than the one we have now, since we have now take all of these hidden health-care costs and made them explicit. The system is far from perfect, but if you are going to have a system that must cover everyone, I think this system is better than most, because it has less “market information” distortion than any other system proposed so far.

Given the parameters of the exercise (that you must have some government system), what do you think? Any ideas?

2

No, I still favour a market system.

A major problem with the system in the U.S. is that it has no price system. A person can not bid between comparitive services. The consumer is not the boss under the current over regulated system as it is. “Any highly regulated industry inevetably produces shoddy goods, and service.”

At the risk of sounding cruel I have to ask. Why must everyone be entitled to health care? Why is health care a human right, that must be monopolized?

“If you want a job to be done poorly ask the government to do it , if you seek impovrishment in that service make it the states monopoly.”

3

I personally think the system will collapse no matter what because it’s leeching off of productive sectors of the economy and they will eventually give out too.

4

That was why most people are still in private health care (even though they are being coerced into it) under this system. The consumer chooses a health care plan for herself, and pays for it with her own money. That person can choose a plan like the one I have - I pay out of pocket for all medical expenses up to the $10,000 deductible, and after that, everything is covered. I (hopefully) will never meet the deductible, and I shop value for health care. (I take two prescription drugs, and I told my doctor to put me on the moderately less effective, not under patent ADHD drug, rather than the more expensive one. Likewise, I choose to take a less effective but much less expensive hair-loss pill.) But, if I get really sick (knock on wood), then I know I will be treated with the latest and greatest health-care, which I choose, after I fork over the ten grand deductible.

My plan is insurance, not pre-paid health-care, and that is what I am talking about everyone being required to have (in some way). That preserves most of the price information (and incentives for cost-reducing innovation), while still giving me state-of-the-art care if I really need it.

People could also buy “pre-paid health care”, in which case they would have to deal with some type of private beurocrate gate-keeper, but the customer would likely be the one choosing the plan, not the employer. If the employer is choosing the plan, then there must be some free-market reason for doing so (such as lower-cost of underwriting or an employer that wants to ensure employees are choosing to get flu shots and other preventative care, and wants to change the incentives for recieving it). This system is now very consumer driven, instead of the way it is now.

I agree with you on both points. I don’t think health care should be monopolized by the government, and that is why I am proposing this system, which doesn’t monopolize health care. As for health care as a human right - I agree that it is not. You could make an argument using the Public Choice model of “public insurance” (I don’t remember the model’s name, but it goes “if you were deciding the policy before you were born, with no idea about where you were going to fall in society, you would want redistribution to insure you don’t wind up too far down” or some such nonsense). I think the argument’s horrible, but it is an argument.

The point is, if we are going to do it (because the teeming masses have been hoodwinked into buying into it, and they have guns), then this is the lowest cliff with the deepest water we can jump off of. What’s more, I think this system is less bad then what we currently have.

5

But, the question is, “what is the least harmful parasite we can let suck on us?” I think the patient can live with this type of parasite sucking on it, because this parasite has reduced growth mechanisms.

  1. By eleminating Medicare and folding it into the system, we disunite the “old people” lobby, because healthy old people and wealthy old people are now out of the public system, and they don’t want to pay for unhealthy old people that want to live forever. This reduces the political demand for “state of the art” health care for middle-class seniors that pull up the costs for everyone.
  2. By folding in the Veteran administration, we have eliminated that unified (and powerful) interest group that supports the expansion of their publicly-run health care system.
  3. By making the states pay for their own economic stupidity (and be rewarded for their genius, if that happens), we mitigate people falling on the public system because of state regulation of private insurance (like California).
  4. My proposed system takes all of these hidden costs, and makes them explicit, so now voters really know how much something is going to cost, instead of paying through higher good prices and undiscovered economic activity.

I think this system would be a sustanable system that accomplishes the key policy goal (eveyone covered) with the least amount of damage.

I also think that taxes, while bad, are less bad than regulation, because with taxes, you at least have some idea of the scope of the money you are throwing in the ocean…

6

Only number two really addresses any of the current problems in the health care system of the US today.

People always go for the flashy stuff - oh boy, we can simply mandate everyone has health insurance, and voia la, we’ve fixed teh problem.

The actual problem is delivery systems. Fix that and you’ve eliminated almost all of the mess involved.

Now, one thing I think could significantly cut costs and increase competition immediately - allow health insurers to provide plans across state borders. Right now, the constitutional clause on interstate trade regulation has been used to prevent insurers from covering nationally. Stop that. Institute a complete free-trade mandate among all the states and get rid of every interstate regulation by amending that clause - this would mean getting rid of FFL licensing too, which I would personally love!

7

So what do you do about people who are, fundamentally, uninsurable? Given that you have a policy goal of providing health insurance for everyone, how do you assure them that they will receive health care? I’m not saying the mob is right, but they are at the gates with the fire and the pitchforks. Do you think solving #2 will make the market “solution” able to placate them?

I think that would help, especially in states with nutty regulations (California again). However, I think you would get more demand for federal regulation, because the current fashon is to make healthy people pay a hidden tax for unhealthy people by limiting what you can discriminate for when you buy insurance.

8

You’re missing the point. All mainstream media discussions of the health care crisis miss the true issue, which is the damaging effect of State licensing requirements for doctors.

The AMA and the government collude to artificially restrict the number of slots in medical schools. This artificially reduces the supply of doctors. This artificially increases the price of health care.

Expensive health care is 100% caused by the artificial shortage of doctors, caused by the AMA licensing cartel.

9

Wouldn’t that just be giving free reign to states to subsidize whatever gets votes with everyone else’s money? Why should I pick up the tab when California decides to subsidize breast implants and sex change operations?

10

I know you are at least 100% correct on this. Not really interested in the rest of what is said.

11

What do you mean by, “uninsurable”? I think any company is willing to insure you, even at the current rate, it’s just people don’t like how much the premiums are going to cost. I do think eliminating costs is really the problem here as far as health “insurance” goes - as the “uninsurable” are a very small segment of society. By eliminating a lot of the weight on insurance companies in terms of primary care costs - implementing a no-third party payer system there, I think you’ll see a situation where the “uninsurable” shrink to the point that only the true bleeding-hearts are going to care.

That said, I personally would think it’d be better for the human race to see the “uninsurable” die off, but that’s politically unfeasible and so you might want to implement an argument for a voucher system - or if you’re really just against the state no matter what, charities and the like of mutual aid societies.

Also, I don’t think you’ll possibly have anymore regulation than their currently is now among the states with their health care, so even if there were a call for federal regulation, which I don’t see why there necessarily must be, it certainly couldn’t be as bad as the regulation on state levels today - this coming from the son of a nurse, I have an idea about statewide regulations and how nefarious they can be. In anycase, the point is about increasing competition, so I think throwing worries over federal regulation into the mix is just distracting.

12

Someone who is currently sick is “uninsurable”, because the only thing you can “buy” at that point is pre-paid health care. If you are sick, there is no more “risk” to spread around a pool of people that “might get sick” - you can’t insure a house that’s burning.

Someone with HIV might be insurable against getting full-blown AIDS within ten years, but the cost of anti-virals that everyone with HIV must take to keep from getting worse is not insurable - it is a known cost.

I agree, the regulation in some states is horrible. While I was living in California, I didn’t have health insurance because the premiums were so high, but when I came back to Florida, it was one of the first things I purchased.

At least with state regulation, there are 50 states to choose from.

13

No, the point is to eleminate federal expenditures for state nuttiness. If California subsidizes people with HIV to buy private insurance, then some of those people are no longer a burden on the federal system. Because they have been moved off the federal dole, California should recieve a balance payment for the program - the payment being the marginal reduction in federal heath insurance expenditures that the state program causes.

If, however, California does things that increases the cost to the Federal health system, then California should be forced to cough up the cash to the Federal insurance scheme.

14

First, on uninsurable, you’re simply wrong. I interned with a hospital a year ago and I have experience with people who were insured despite still being treated for serious illnesses (mostly diabetes). Again, the problem is not about whether the company will take you or not, it’s about cost, the company will merely shift you into the high risk category and charge you very high premiums and co-payments - though not all companies will do this, I know enough that will.

Second, you’re wrong. There are not 50 states to choose from. There is one state to choose from and one state only. Yours. That’s the problem. If you’re talking about moving across the country for health care, it’s really unrealistic - no one does that, and for good reason.

15

Scott, do you really think anyone is going to go against the old people lobby? Seriously, they’re the most active voter block. That’s like saying one is happy to slit their wrists and drink battery acid. In simpler terms: it’s political suicide, which is the biggest reason why it will never happen.

16

Not just that, nurses and other medical specialists are also affected by extensive regulation. There’s a lot of interference into the actual work, too. My uncle is a physician and he swears he’s spending more and more time on meeting various government demands than on his patients. Yet he voted for Obama [:^)]

17

How could any company make a profit insuring higher-risk patients at the same rate as low-risk patients when a competitor is willing to offer low-risk patients a lower rate? They can’t, without artificial entry barriers and regulations

Oh, so the fact that the high cost of health insurance in California was not a major factor in why I left…

Wait, no it was. In California, there are so many regulations that you can’t get individual private health insurance for a decent price if you are… healthy. In Florida, I have a great policy for $60 a month… in California, that same policy would cost me $300+. I tried to buy health insurance in CA, and could not afford it.

18

No… I think as the lobby stands today, you can’t go against them. That’s why I want to break up the block, by offering some of them a much better alternative: if you are healthy as you get older, you can buy private insurance cheeper than the government plan. If you are wealthier, you can buy better health care than the government plan allows, and pay the marginal cost for better care, instead of the full cost of private care which you do now when you opt-out of Medicare.