Let’s get that insurance death spiral really working, eh?

This week, after long resisting Mr. Sanders’s call for a single-payer health care system, Mrs. Clinton embraced allowing people as young as 50 to buy into Medicare.

Who will buy in? Those for whom private insurance is too expensive…..

13 thoughts on “Let’s get that insurance death spiral really working, eh?”

  1. So Much For Subtlety

    It amazes me that the Democrats could have screwed up Obamacare as badly as they did. Free medical care is a no brainer. It is a situation where it is impossible to lose. Even if someone is young and healthy, they *may* get sick and so will tend to support some sort of safety net.

    Sure, the costs are serious, especially where innovation and new drugs are concerned. But they are spread out over all of society. While free stuff is free.

    You have got to give it to them. They managed to make a bad system worse. Maybe even less attractive. And what’s their solution? The NHS? Great.

  2. When Clinton says “allow” she means “force”. As in “Bill graciously allowed Juanita to have sex with him.”

  3. The US health care “system” needs root and branch reform even more sweeping than the NHS. The vested interests are likely to obstruct it though, rather like the NHS. Though the NHS has the added impediment of being the Established Church of the UK (a sally that goes back to Nigel Lawson, I believe.)

  4. So many people seem trapped in an “insurance” mentality. They think the cost of insurance is the problem, and that the people who suffer are suffering because they don’t have insurance.


    The problem is that people cannot get the medical care they need. The principal obstacle to solving that problem is the cost of medical care. Politicians avoid that issue because it pits them against a constituency of physicians and other medical professionals they do not want to challenge. So instead they go after the high cost of insurance. Evil corporations. That plays with the public but it does not solve the problem.

    Thats because the cost of insurance is a symptom, but is not the problem. No one would knowingly see a physician who only treated symptoms and ignored the problem. But the US public has preferred to follow their health policy makers down that same path health for more than 50 years.

    Insurance is expensive because medical care is expensive, not the other way around. The Obama administration gave that fact lip service, then ignored it. Instead Obama created a vast insurance mechanism which does virtually nothing to reduce medical costs, or restrain their growth. Worse, by providing a fount of federal money, ACA actually stimulates higher costs.

    The discussion in the US has been going on since the early 1960s but precious few of the thought leaders or political voices have acted on that simple fact.

    It seems to me that “insurance” just gets in the way if the objective is simply to provide medical care to people. Let people see their physicians and get the care they need. Separately let the government pay for all medical care – professional and institutional – subject to standards which physicians should broadly take part in establishing and administering. That will require physicians take a much larger role in the management of medical care cost than they ever have. They will object. And I think that right there is the issue that won’t go away until it is effectively solved.

  5. Single-payer legal care.

    Put all attorneys (or solicitors/barristers on your side of the pond) under the same regulations the politicians wish to impose on doctors.

  6. What Mr. Fembup said captures the problem; spot on.

    The future is cloudier than he suggests, because altho’ the problem is indeed cost of health care, I reckon that a pretty penny of the care is spent on GP visits. And most of those are or soon will be diagnosable by some el-cheap app running on your smartphone given some relatively cheap sensors. To make that useful, we’ll need it to be possible for an appropriately-credentialed piece o software to write prescriptions.

    My, what a shitstorm that will produce!

  7. So Much For Subtlety

    Ted S. – “Single-payer legal care. Put all attorneys (or solicitors/barristers on your side of the pond) under the same regulations the politicians wish to impose on doctors.”

    That is actually not a bad idea. It couldn’t be worse.

    Single-payer girlfriends? The way affirmative action laws are going, everyone should get a girlfriend the way they get medical treatment from the government.

  8. There is a solution to the cost of healthcare in the USA.
    Reduce the cost of malpractice insurance (which is about double the cost of malpractice claims in order to cover commission, admin costs and a return on the capital mandated by the insurance commissioner).
    Shakespeare said “kill all the lawyers”.

  9. Some clues, Insurance is a perfectly reasonable way to fund medical treatment as long as there is a reasonable free enough market in policies; and in the US that market is extensively regulated and restricted. Second, as John 77 notes, solve the legal problem of malpractice suits and the enormous costs associated with that. That’s a start.

  10. @ John Fembup
    What you’re describing there as your ideal solution is essentially the UK’s NHS. And isn’t that the envy of the world?

    Forget the notion of nationalised healthcare & look what actually goes on.
    On one side we have private individuals. Surgeons, nurses, GPs, administrators … All the people working in the NHS. But they combine in various professional bodies, unions etc have muscle, influence & clout in forwarding their members’ interests.
    On the other side you have another lot of private individuals. The users of the health care system. There is no “single payer”. There are individual payers, who are net tax payers. They have no professional body or union & little influence apart fro the occasional electoral vote..
    In the middle is government, which is balancing the demands of the strong groupings on the provider side against vote buying in elections from private individuals, both net taxpayers & non-net taxpayers. But the latter, unlike the former, also have bodies rooting for their cause. The socialist, bleeding heart, think of the children movement.
    You can see who’s going to get shafted here, can’t you?

  11. If you read Karl Denninger he reckons you could collapse the cost of healthcare in the US by 80% if you enforced the anti-trust and racketeering laws that the healthcare industry are exempt from. Merely forcing them to print a list of prices that they would have to adhere to would be a start. Allowing drugs to be imported from outside the US (where they are sold far cheaper) would be another.

  12. @bloke in Spain “What you’re describing there as your ideal solution is essentially the UK’s NHS”

    Well, I wouldn’t claim I’ve described anything “ideal”, I’ve just written down a few a few ideas. Any system in America would have to take into account American requirements & preferences, also the flaws and failings encountered in other countries’ systems, and most of all a lot more personal and general public understanding of what’s driving medical costs in the first place.

    Besides, I doubt even the best of existing systems could simply be grafted on to America. The objective is not to copy some system or other, but to remove obstacles that prevent Americans from getting the medical care they need. And don’t forget that Americans’ health behaviors are not ideal, driving up costs from the demand side. That’s a looming problem, too – and frustrating as well, because health care is free. It’s medical care that’s so daggone expensive.

    @ Jim “Karl Denninger reckons you could collapse the cost of healthcare in the US by 80% if you enforced the anti-trust and racketeering laws that the healthcare industry are exempt from.”

    If that’s what Denninger really said, he’s mistaken. American medical professionals, institutions, and insurance companies are most assuredly NOT exempt from anti trust and racketeering laws.

    Besides, costs drive prices. It’s true that many medications are Priced much higher inside the US than outside. why is that, really? Here’s my view: reducing the prices Americans pay by importing medications only reduces the pharmas’ income, it does not reduce their costs. If it does not reduce costs, prices cannot fall very much. What’s the real margin earned by the pharmas today? How much do they really need to support their operations, R & D and the cost of bringing a new medication to market? Would the pharmas try to offset income losses in US by raising prices outside the US, perhaps bumping up against some countries price controls? Higher prices abroad would reduce Americans’ savings from imported medications. It’s all very complicated and I think not well enough sorted out to decide on policy.

    @ Ed Snack I think you are correct that the so-called medical care markets in the US do not function as true markets – mostly because of overregulation, lack of price transparency, and overreliance on third-party reimbursements. Fixing those is simple in concept but very difficult in practice. That’s an important reason I think we need more physicians more directly involved in health policy.

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