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April 05, 2011

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Ryan's plan doesn't miss the point. It's just aimed at a different point.

It has nothing to do with "saving" Medicare. It has nothing to do with reducing the deficit or getting the budget under control. It has nothing to do with improving access to health care or reducing its costs.

It is one thing and one thing only: an attempt to destroy Medicare as we know it because of dogmatic opposition to government services per se, indifferent to how many people it will kill or impoverish.

Everything else is bulshytt: distortions, distractions, and outright lies intended to obfuscate the fact that Republicans want to eradicate one of the most popular government services in the nation.

They just want to replace Medicare with a private system. Because, you know, private health insurance works so well for everyone under 65.

Someone pinch me.

I think you got a "Medicaid" in there instead of Medicare, russell.

D'oh.

Yes, all of the above refers to Medicare, not Medicaid.

Thanks HSH!

You know, if everybody had the body and health they had as a 21 year old and then just died suddenly "when their time came", why this would be a very workable plan.

Russell,

Will our combined subsidies, adjusted downward somewhat due to our relatively high household income, be a reasonable replacement for our current plan, ten years from now?

No.

I went on Medicare about two months ago. Before that I had a high-deductible plan with an HSA. There was no prescription coverage and the "in-network" deductible was $3000/yr.

I paid a little more than $6K a year just for myself. There were no special issues since community rating is used.

Does that answer the question?

As I said about the TransOcean bonuses, so I say about Ryan's proposal:
there MUST be another side to the story. It must seem like a good idea to SOMEBODY.

While we wait for anybody to speak in favor or Ryan's cockamamie scheme, let's try to guess who might surprise us by opposing it. It's no surprise that Russell opposes it, but I wonder how long it will take for any doctors Russell might know to oppose it as well.

Doctors may bitch and moan about how little Medicare pays them, but there's no way they would get paid more under Ryan's plan. Oh, sure, SOME of them might -- the ones who specialize in diseases of the rich. But most doctors can probably figure out that Ryan's scheme is no better for themselves than it is for their older patients.

--TP

It must seem like a good idea to SOMEBODY.

Why, if I were the CEO of an insurance company I'd think it was a fabulous idea!

Tony,
Not sure about that- wo Medicare, doctors & hospitals will be charging their regular rates rather than the rates set by Medicare. There may be some downside for them as well (eg medical bankruptcies among the elderly), but it's not all downside.
otoh, Im trying to figure out what this would mean in terms of existing laws compelling medical providers to treat the critically ill- currently those treatments are covered for the elderly by Medicare, but Im imagining that hospitals would suffer much more under the legal requirement to treat elderly patients who cannot hope to pay for the services. Patients who might not be able to afford the preventative care or medications which could prevent them from becoming critically ill in the first place (and often at a lower cost).
So Im guessing that you're right, this would probably be a bad deal for medical providers, but maybe more for hospitals than for doctors. Off of the top of my head.

I'd say that, if you can't see the connection between shifting the cost of health care onto the consumers of health care, and reining in health care inflation, somebody's missing the point. But it ain't who you think it is...

Oh, of course, Brett think that consumers can shop for the best deal on health care, thereby bringing the price down. "Mr. Ambulance driver, please take me to three different hospital ERs--I want to do comparison shopping"

Brett,

I'd say that, if you can't see the connection between shifting the cost of health care onto the consumers of health care, and reining in health care inflation, somebody's missing the point. But it ain't who you think it is...

You'll never shift it onto consumers unless you outlaw insurance.

Look, to the individual health care costs are unpredictable and potentially financially devastating, or completely unmanageable. Therefore, guess what, people tend to buy insurance if they can.

And what we've had for many decades is a cobbled together system of private insurance that leaves a large percentage of the population uninsured, and oddly enough has not held down health care inflation.

Sometimes, reality does not conform to the wonders of libertarian theory.

I'd say that, if you can't see the connection between shifting the cost of health care onto the consumers of health care, and reining in health care inflation, somebody's missing the point

Wouldn't it make more sense to hold this position if Medicare was more expensive than buying insurance on the private market? This seems dogmatic to me- rather than working from evidence to conclusion, you've gone from conclusion to (hypothetical) evidence.

I'd say that, if you can't see the connection between shifting the cost of health care onto the consumers of health care, and reining in health care inflation, somebody's missing the point.

That's great. Perhaps now you'd like to explain what that pointlessly vague drive-by has to do with Ryan's roadmap for abolishing Medicare?

It will not reduce the cost of health care, it will not reduce the deficit, it will leave many more people uninsured, and it will kill people who will under this plan have no way to afford life-sustaining treatment for which they now depend on Medicare.

if you can't see the connection between shifting the cost of health care onto the consumers of health care, and reining in health care inflation, somebody's missing the point.

If the only, or even the primary, reason that health care costs go up is because people are getting a free ride via insurance, you might have a good point here.

Can you demonstrate that that is so?

If the only, or even the primary, reason that health care costs go up is because people are getting a free ride via insurance, you might have a good point here.

I don't even think that's true, insofar as the Ryan plan pushes seniors back into the existing insurance market. It doesn't push them into some hypothetical libertarian paradise market where prices are kept low, it pushes them into the market of today. So I think any justification for the plan saving money needs to account for that savings in today's market.

As I said about the TransOcean bonuses, so I say about Ryan's proposal:there MUST be another side to the story. It must seem like a good idea to SOMEBODY.

I watched Ryan on Charlie Rose for the entire hour a couple of months ago, and he was going on and on about how great it would be if the corporate tax rate was cut to 0%. I'm betting that's what sounded like a good idea to someone.

As for Ryan not addressing the rising cost of health care, wasn't that one of the Republicans' major criticisms of HCR (after Soci@lism, of course)?

Another major Republican criticism of the ACA was that it would "cut your Medicare by $500 billion!" They got a lot of mileage out of that, because everybody knows you can't cut Medicare unless you call it an entitlement first.

--TP

Tony P.: Another major Republican criticism of the ACA was that it would "cut your Medicare by $500 billion!" They got a lot of mileage out of that, because everybody knows you can't cut Medicare unless you call it an entitlement first.

I think a lot of the bewilderment and confusion that sensible people experience when trying to make sense of contemporary Republican arguments and policy proposals comes from assuming, as a starting point, that said arguments and policies are advanced by their elected representatives in good faith or are logically consistent.

I think there's far more evidence to the contrary at this point. Which doesn't help when you're dealing with individuals whom you're trying to persuade, but does help avoid a great deal of unnecessary mental gymnastics when analyzing the arguments of public figures whose careers revolve around deliberately lying about what they want to do and who it's likely to benefit or hurt.

I watched Ryan on Charlie Rose for the entire hour a couple of months ago, and he was going on and on about how great it would be if the corporate tax rate was cut to 0%. I'm betting that's what sounded like a good idea to someone.

That is a pretty good idea, actually. It would allow for tax increases on individuals, which would be harder to avoid, as few individuals have large tax law departments.

Corporations are, after all, just groups of individuals. And when you talk about going after the income of corporations, I'm pretty sure you don't mean going after the income of the secretaries, accountants, managers, engineers and line workers that compose 99.99% of the corporations work force - you're just talking about the handful of richie rich high level management. So just go after them directly.

It would allow for tax increases on individuals, which would be harder to avoid, as few individuals have large tax law departments.

It is odd that hedge fund managers as a group have no tax law department and yet somehow have managed to get most of their income taxed at an absurdly low rate. Somehow, these brave individuals have managed to avoid individual income taxes on a vast scale.

That suggests to me that removing the corporate income tax won't reduce the aggregate level of tax avoidance and evasion.

But it does so by shifting that risk to the consumer of health care.

Any plan to reduce cost will reduce the amount of health care available to the consumer. You can bicker over details, like who decides what's worth spending on and what's not, but ultimately controlling costs will mean receiving less healthcare. No one on earth has ever managed to do otherwise; hell, the rest of the developed world can't control costs, either. They're just growing from a lower baseline.

In general, health care dollars are spent on several classes of maladies which have a variable degree of overlap:
1) Accidental - acts of God that can happen to anyone, anytime. Automobile accidents. Lupus. Brain tumors.
2) Inevitable - care that we need as part of our daily modern lives like vaccines, cholesterol drugs, nursing homes. As we age, these get increasingly expensive
3) Symptomatic - chronic poor health as a manifestation of an underlying inability to thrive, or even get by, in the modern world. This is the chronic alcoholic in the ER every week or the 400 lb disabled woman with uncontrolled diabetes who lives alone in a trailer. Atul Gawande had an interesting article touching on this class of patient in the New Yorker recently. When people talk about health care spending not producing a commensurate improvement in health, it's this kind of patient that's often hiding in the data.

Most people like to talk about the first class of sufferer, because that universalizes the debate and gets the attention of the yuppies, but the problem is in the second and third catagories. And we tend to avoid dealing with these catagories, because the options are so ugly. When we pay money out through medicare, for example, we're functionally subsidizing old age, which is to say, we're paying money now, so that we have the option of paying yet more money later when the person is sick again. And in between, they'll do little to no productive work. But what's the alternative to that? Death panels?

And for catagory three; people in this situation don't need a doctor, they need surrogate parents, someone to essentially take control of their lives for them, make sure they have good food, exercise, take their insulin, etc. What are the options there? Institutionalization?

I don't know the answers; I just have questions. I'm just sick of the debates where the two sides accuse one another of bloody murder while ignoring any substantial discussion. Lets stop pretending that we can give everyone what they want by spending more, or less, or shuffling some money around. The health care debate isn't about healthcare, it's about serious underlying social issues that go beyond who pays taxes and who gets benefits.

I'm not entirely clear why comparison shopping for private (but subsidized) health insurance is dramatically less workable than doing so for home-owners or auto insurance. And everybody who drives is (at least in California, required to buy auto insurance -- which means that there is at least as much of a captive audience as there would be for mandatory health insurance (driving being pretty much a requirement if you live in most of California).

Anybody help me out here?

As far as who will think Ryan's plan is a good idea: let the knees jerk and the rationalizing begin!

It's a good plan because:
It is based on the rightwing ideology which is more important than either real poeple or real life
A few years after the voucher plan starts Republicans can start demonizing the low income recepients of the vouchers and start reducing the amount of the voucher or even try to eliminate them altogether
Big governemt is bad. That's all one has to know.
The "crisis" which supposedly makes this "reform" imperative was created by which party? Oh, no, we are all supposed to forget about that!
Grover Norquist who?
This plan and its twin, the attack on Medicaid, has no relationship to the attacks on collective bargaining (and the attacks in Ohio, Indiana, Wisconsin, and New Hampshire are not realted to each other) and are not related to the attempts to roll back child labor laws and it has nothing to do with the tax cuts for the rich and nothing to do the Supreme Court's ruling on corporate citizen ship. The dots must absoltuely not be connected.

In other words this plan will be supported by people who don't see themsleves as being hurt by it, don't give a shit about anyone but themselves, and are willing to hide their selfishness from themsleves with the same bullshit they have used to rationalize the other attacks made by the Republican party on the citizens of this country.

I'm not entirely clear why comparison shopping for private (but subsidized) health insurance is dramatically less workable than doing so for home-owners or auto insurance.
...
Anybody help me out here?

Just in case you're not actually asking a rhetorical question, which you almost certainly are, the health insurance market is heavily regulated to the effect that instead of having a wide spectrum of health plans at a wide level of coverages and prices, you have a much narrower spectrum of plans that all include a palate of sometimes unnecessary offerings. This functions to subsidize the plans with better coverage at the expense of those needing less coverage, i.e., 55 year old women still pay for obstetrics coverage.

Any plan to reduce cost will reduce the amount of health care available to the consumer. You can bicker over details, like who decides what's worth spending on and what's not, but ultimately controlling costs will mean receiving less healthcare.

I don't agree at all; you're assuming that there is a fixed supply of 'heathcare' available for a given amount of resources put it- so if we put in fewer resources, we get less healthcare.
But there is also the possibility of systems being inefficiently organized. For example, we might find that allowing PAs and RNs to do more reduces costs. Or that cost-effective preventative care is underutilized.
Not trying to argue those specific points, just against the idea that we've got some sort of ideal system where the only way to save money is to cut services.

That is a pretty good idea, actually. It would allow for tax increases on individuals, which would be harder to avoid...

If we were having a discussion about changing the tax cut while keeping receipts at the same level, I might agree (depending on the specifics). But Ryan is, I believe, talking about cutting taxes and reducing receipts.

Corporations are, after all, just groups of individuals. And when you talk about going after the income of corporations, I'm pretty sure you don't mean going after the income of the secretaries, accountants, managers, engineers and line workers that compose 99.99% of the corporations work force...

It doesn't mean going after any employee's wages- corporate profits are distinct from wages (which are a cost and therefore not taxed as corporate income). Corporate taxes are on profits, not gross income.

This seems dogmatic to me- rather than working from evidence to conclusion, you've gone from conclusion to (hypothetical) evidence.

A libertarian? Gee, you don't say.

The non comparable points are
1) the government can easily penalize people who don't have car insurance by suspending licenses and imposing fines. Hard to imagine them doing that for mandatory health
2) the problems of uninsured drivers are alleviated a bit by a)no-fault insurance and b)civil suits of people who don't have insurance.

This article talks about why you have mandatory car insurance. To pull a quote

You're less compelled to buy auto insurance because it's meant to protect people (almost always strangers) who may be involved in an accident with you.

Second, the potential damage you can cause with an automobile is much greater – and more burdensome to society – than the loss of income to your family arising from your death.

"Without mandatory insurance, the victims of automobile accidents would be very unlikely to see much compensation from the individuals at fault," say the authors.

Because we don't see the damage to society caused by the uninsured (though if you want a glimpse, hit an emergency room in a low income area on a Saturday, where the uninsured often deal with conditions that could probably have been dealt with more cheaply and more easily if they felt that they could go to a doctor earlier), mandatory auto is an easier sell. (and anyone who can afford a decent car probably has the money to pay for at least basic insurance, but a person there is no similar correlation for medical insurance) At least that's a first pass at reasons, but there are few more.

But there is also the possibility of systems being inefficiently organized. For example, we might find that allowing PAs and RNs to do more reduces costs. Or that cost-effective preventative care is underutilized.

Oh, there's almost certainly waste, but I stand by my statement. You can reduce costs in some areas with improvements in efficiency - or possibly even other measures, like malpractice reform for that matter - but ultimately controlling costs- and that's the key point - will mean giving out less. You can't fix health care with improvements in provision efficiency any more than you can fix global warming with the energy efficiency. It's a lovely falsehood to think otherwise, and it may even help get a few people elected, but it's a falsehood nonetheless. The real savings are going to come from hard choices.

Corporate taxes are on profits, not gross income.

Which is where the money comes from that allows for future expansion, i.e., more jobs, and the savings to survive downturns without liquidating more personnel. But this is getting OT. My fault.

I'm not entirely clear why comparison shopping for private (but subsidized) health insurance is dramatically less workable than doing so for home-owners or auto insurance.

Well, there's the cost of the uninsured, which gets passed on to the insured.
There's the problem of providing insurance through employers, which makes it unportable and causes problems for both pre-existing conditions and for valuing preventative care properly.
There are diagnostic issues- so much of medicine is trying to figure out what's wrong (eg when a given diagnostic test is justified). And issues with treatment eg when a much more expensive treatment with a slightly better outcome is justified.
There is the fact that house and auto incidents are typically a moment in time: a house burns down, a pedestrian is hit. Health issues are frequently long-term- so a health insurer has the option of reacting to those costs. Which makes it not-like-insurance anymore; it's insurance while you're healthy, but it goes away (or becomes exorbitantly expensive) if you get chronically ill.
[If we had to buy life insurance year to year and the rates could be increased at any time, it'd be very hard to deal with death due to chronic disease- the policy would become incredibly expensive].

Sick people are in no position to comparison shop for doctors or hospitals or specialists. They were notably bad at making those decisions in areas where the health insurance programs used to allow almost unlimited choice.

Shopping for health care and shopping for health insurance are two completely different undertakings. The problem for those who have a fetish for choice is that the best medical programs are those that have the insurance program integrated with a reasonably large medical practice. In Wisconsin, the clinic/hospital groups are mostly integrated with an insurer of some sort in the Madison area and the Fox Valley and the insurers and clinic/hospital groups are at each others' throats in the Milwaukee area. Milwaukee health care costs 28% more than that of Madison and the Fox Valley is even cheaper. No prize if you guessed that the least effective health care was provided in the Milwaukee area.

Integrated systems where the medical practices are a critical part of cost controls work. Trying to throw up your hands and just make someone else responsible, either insurers in Ryan's terrible Medicare plan or states in Ryan's even worse medicaid plan -- block grants are not a plan, is totally irresponsible.

DBN -

The governments of each developed nation spend roughly the same amount per capita on health care. The United States is the only one that required private expenditures of the same amount to provide health care of random quality. Our doctors are overpaid compared with other countries. Our hospitals are far more grandiose. We spend much more on testing of minimal or nonexistent utility. Cutting some medical care may actually improve American health. More is not necessarily better and more expensive doesn't provide better quality.

Corporate profits are more than adequate to hire more people, yet the hiring is not being done. Still, I'm quite willing to get rid of corporate taxes as long as we get rid of payroll taxes (the most regressive taxes collected in this country) and replace them with VAT that will pay for Medicare for All. Despite the fraud that exists in Medicare, private insurers are still far more expensive than Medicare is for paying health care costs.

Your claims about mandates are semi-meaningless. I would agree that it is totally irresponsible to require insurance companies to pay for chiropractic and other imaginary medical treatments, but having a requirement that they actually pay to treat real diseases is perfectly sensible. I don't want to have people buying useless insurance policies and only finding out that the policy is useless when they need it.

The Ryan budget is the craziest thing I've seen proposed as a major-party initiative. It literally kills Medicare dead, just about kills Medicaid, and throws in tax cuts for the rich and tax increases for the poor just to make sure we take the point.

It is completely insane. Even if you're over 55 now there is no way you can look at this and say "Well, they excluded me from killing Medicare so I'll be fine."

You think 34 year olds like me are going to stand for paying Medicare taxes for the next 33 years even though all we'll get is a voucher whose value will have eroded over the decades? I don't think so. If you're over 55, you think you can trust that as you become an ever-smaller slice of the population your "gold-plated" benefits will be retained by all the people not eligible for them? Are you kidding?

If you're over 55 the best thing you can do is make sure Medicare is set to be around for people my age. Because otherwise your continued access to the program rests on very insecure ground.

The fact that it slashes social programs by trillions of dollars while also cutting taxes for the wealthy and corporations is just icing. I cannot imagine a less popular platform for Republicans to run on in 2012.

DBN: "Corporate taxes are on profits, not gross income." Which is where the money comes from that allows for future expansion.

Or for dividend payments or giant executive salaries. Companies don't reinvest all their profits.

Corporate taxes diminish the available returns to pay investors and therefore result in less investment than would be possible otherwise. But so what? So do payroll taxes and income taxes and property taxes and any number of other taxes. That's the price of an environment where businesses can operate.

Say you are paying $500 or $1000 a year for Medicare and $5000 to $7000 a year for some kind of private insurance. After 45 years, you have paid $45000 into Medicare, and want to have access to procedures that can cost, for a relatively modest procedure like a broken limb, around $15000 to $20000. Complicated procedures (especially for elderly patients) might cost a quite a bit more bit more.

(Your Medicare tax probably has grown, and you were not paying $500 a year way back when.)

Now if a portion of those Medicare payments had been invested into the pharma and medical device companies back when, wouldn't there be a lot more dough now to pay for the expensive treatment? I would guess that if private insurance had only taken in and paid out equivalent amounts, then those premiums would now be huge, but even as high as the premiums are now, they cover more for less because it's insurance and can be invested, so the companies invest money to cover future claims that almost certainly will be impossible on a pay as you go basis. My understanding is that Medicare doesn't invest diddly-squat, and the $45000 paid in over the years is supposed to cover possibly $millions in old age, when the population is not increasing. Eventually that appears not to work, and eventually is now, or very darned soon.

The real question is this: Why does Ryan not propose to just eliminate Medicare and Medicade alltogether and give the "poor" vouchers or increase the earned income tax credit?

Because that's what his so-called 'budget' is actually about.

but ultimately controlling costs- and that's the key point - will mean giving out less.

Absolute lie. Many countries with 'national health care' or 'single payer' deliver just as much "health care" as we do for about half the price.

Yo, conservatives. When will we get our "Defense Vouchers"? Hmmmmm?

Don't fall for it, DaveC. Grover Norquist didn't sit in a office in Washigton DC having Monday morning chats with the Republican leadership because he wanted to address the nation's problems in a constructive way. He wanted to create debt in order to force an end to progams he disapproved of on ideological grounds.

In my state the Republican party has successfully destroyed the state's revenue base with one tax reduction after another, all aimed at reducing taxes on the wealthy one way or another. I know all the rationalizations and its all crap. There isn't enough "waste " in the budget to balance it that way. Well not what I call waste anyway. Clearly services for the medically impaired, for mental health, for animal control, for infratsture, for schools, for everything that makes the state a decent place to live is waste to Republicans.

I'm losing my health insurance because of the Republicans.

I'm sick of the excuses and the rationalizig and the lies.

Either people care about their fellow Americans or they don't.

Which is where the money comes from that allows for future expansion

So. Retained earnings are just so much pixie dust?

Couple of things...

Corporations are, after all, just groups of individuals

Actually, they are not. But that's a topic for another thread.

Any plan to reduce cost will reduce the amount of health care available to the consumer.

As long as there are inefficiencies in the process of delivery, this statement is not true.

And even assuming that reasonable plans to reduce costs will reduce the amount of health care actually delivered to individuals, that doesn't necessarily result in worse outcomes.

The only way in which Ryan's plan addresses health care costs is by making some amount of health care unaffordable to some (or most) people. To me, that is a stupid plan, because it does not address the goal we ought to be addressing.

Any knucklehead can figure out that if you put a cap on spending, you can limit spending. Why Ryan gets points for being a "big idea man" based on this kind of proposal escapes me.

The difficult question is how to make effective use of the money spent. I don't see the Republican plan addressing that at all, they simply punt and make it the individual's problem.

And no, the market is not going to make that happen. The market is going to create the greatest financial return on the money spent, which has no particular likelihood of correlating with most effective use in terms of health outcomes.

Unless your understanding of what public health programs are about is maximizing private revenue, as opposed to maximizing public health.

And for catagory three; people in this situation don't need a doctor, they need surrogate parents

This is a very good point. A huge amount of health care expenditure goes to caring for folks who are chronically ill with issues that are, to a greater or lesser degree, lifestyle related.

Surrogate parents is a not-too-bad way to characterize the type of care they need.

There are organizations -- both for- and not-for-profit -- that focus on these populations. There are significant opportunities there either for straight-up cost saving, or for improved results for the same cost.

DBN, actually, it wasn't a rhetorical question. I'm not really convinced by that "free-riders" are necessarily a problem. In the example of California I mentioned, purchasing insurance coverage is mandatory. The same could, presumably, be a feature of a health insurance law as well. (And you put teeth in it by making the fine for failing to get it equal to the cost of all years' premiums skipped, plus a substantial dis-incentive.)

I do appreciate Carleton reminding me of the issue of chronic conditions. That is much more problematic than free-riders, I think. I'm not sure that it is insoluable, but it does require a bit more than home or auto insurance. (Although I do think of homes built in flooding or earthquake-prone areas. If the hazard is chronic, might that be analogous to chornic conditions...?) I'll have to think about that one some more.

Following bobbyp's point, I believe the next proposal will be the William F. Nolan/George Clayton Johnson Health Care Plan.

Which can also double as a tv channel, with profits going to pay for the health care of the young! Win-win!

The Ryan budget is the craziest thing I've seen proposed as a major-party initiative. It literally kills Medicare dead, just about kills Medicaid, and throws in tax cuts for the rich and tax increases for the poor just to make sure we take the point.

Fret not, Jacob -- remember that Obama and the Democrats have our backs. And I have absolute confidence in their ability to whittle the worst parts of the Ryan plan down by...oh, at least 10 or 15 percent before grudgingly acquiescing to it.

I agree with Russell, "Essentially, Ryan's plan defines a cap, tied to income, on what the feds will contribute toward any individual's health insurance costs in a year. That will certainly insulate the federal government from the risk of runaway health care costs.

But it does so by shifting that risk to the consumer of health care."

I work in this insurance industry. In any just about plan about 50% to 60% of the cost - the medical loss - is incurred by about 4% to 5% of the members. While some of these (the 4% to 5%) members are othwerwise healthy, but experienced an unexpected acure onset catastrophic and expensive illness or injury, the majority are chronically and seriously ill.

Today, the annual cost that puts a member into that 4% to 5% category is right around $12,000. So the subsidy appears designed perfectly to have impacts on the typical consumer and the sickest consumers. The typical consumer, it would seem, will financially benefit from the subsidy, but the sickest will be harmed.

This cost shifting to the sickest could have some marginal savings impact. This would, I expect, be in the area of the more or less "elective" procedures. For example, consumers with chronic conditions like degnerative osteo arthritis might defer a total knee or hip replacement (cost = appox. $12,000 per knee/hip) because that procedure alone would push them over the subsidy limit. I suppose someone is thinking that the knowledge of future cost will promote healthy life style decisions in consumers while they are still young. I am skeptical.

However, the majority of the 4% to 5% have chronic conditions and associated costs where decisions would be less around "elective" procedures and more around life sustaining. One very expensive condition that always shows up in that member bucket is renal failure through end stage renal disease. These people require dyalisis to maintain life. Dialysis must occur two or three times a week and it is incredibly expensive; meaning up to or more than $10,000 a month. There are other associated health problems that also tend to be expensive to treat and add to the members' totall monthly cost. The only thing elective about this situation is the choice of whether to live or to die. Ditto the chronic cardiac and diabetes cases in the bucket and some forms of cancer.

In fact, this proposal seems to me, to rather ingeniusely target consumers who's choice is life sustaining (though not curative) treatment versus hospice and death. If the decision is forced through lack of money - to elect death over treatment then there would be substantial savings. I wonder if that is not what the designers have in mind, but of course, cannot say.

I should add that another cost savings potential is on the provider side. Despite Michael Morre type screeds of HI cost being high due to insurance company greed, the fact is that in most Blue Cross plans 85% to 90% of what you pay in premium goes back the door to providers. The cost of insurance is driven by the cost of providing health care. If providers know that consumers (aka patients) cannot pay, they will be forced to chose more cost effective approaches to treatment. There will be less waste.

That being said, there will be some patients who just don't get the actually necessary care they need.

Maybe they are just channeling Platon and http://de.wikipedia.org/wiki/Sozialvertr%C3%A4gliches_Fr%C3%BChableben>Karsten Vilmar.

For those of you not speaking German:
Mr.Vilmar was the head of the German Medical Association. He reacted to plans of the German governement to limit doctors' fees with the claim that this would lead to reduced care and that it would be necessary to endorse 'socially responsible early departure from life'. It was heavily debated, whether this was genuine sentiment or a case of out of place irony. In any case it was too close for comfort to Nazi terminology and the term sozialverträgliches Frühableben became the unword of the year.

This is Ryan's opening offer.

The key here is for the Democrats to respond with a liberal counterproposal, advocate strongly for it, and (in the end) meet in the middle with a proposal that we can all live with.

[waits for the laughter to die down]

The endgame should, IMO, be a mixture of some of Ryan's cuts, cuts to the military, fairly minor social security cuts, and tax increases (back to Clinton-era levels).

We don't get there if the Dems either: a) spend their time shouting about how evil the GOP is; or b) pre-emptively capitulate (again).

I'm with DNB and many others on the corporate tax rate thing: I'm fine with reducing it to zero, in exchange for higher (and more progressive, at the very top) personal income taxes. But in a vacuum, no.

Which is where the money comes from that allows for future expansion, i.e., more jobs

recent history proves that companies do not spend profits on new jobs.

...at least not on jobs in the US.

The key here is for the Democrats to respond with a liberal counterproposal, advocate strongly for it, and (in the end) meet in the middle with a proposal that we can all live with.

they already have, kindof. the Cat Food Commission's not-really-official-but-good-enough-for-the-press proposals are the counter. everybody on NPR agrees. Ryan has now given pols a choice: his plan or the Bowles-Simpson plan.

today's menu: crap or crap with cheese.

As you no doubt know, the Simpson-Bowles commission unofficial plan isn't a liberal counterproposal. It's a centrist proposal.

So we have a right-wing plan and a centrist plan. What's the liberal plan? Who will prospose it, and who will fight for it?

It's not that I necessarily want the liberal plan to the the ultimate winner. But if it's not in the mix, the result will be, well, as you say: crap w/cheese, at best.

mmmmm, cheese...

What's the liberal plan? Who will prospose it, and who will fight for it?

All of the liberals in Congress and the Executive, of course.

The liberal counter should look something like this:

Tax reform that includes taxing capital gains as income, removes most deductions, increases progressivity, and targets revenue of 22% of GDP. (Current: ~14%, typical ~19%).

Major cuts to military spending - shoot for $400 billion or so. This includes bringing our current military adventures to a close.

Means-testing Medicare and SS.

Slashes subsidies, particularly oil/gas (I, personally, wouldn't target this, I'd slash & burn, baby, but this is supposed to be the liberal opening offer).

I'm sure I'm forgetting something, but that's the gist of it. Then you bargain.

this proposal seems to me, to rather ingeniusely target consumers who's choice is life sustaining (though not curative) treatment versus hospice and death.

avedis, these are essentially the same folks (OK, not entirely, but a huge overlap) who supported going to court to prevent pulling the plug on Terri Shiavo, right? I'm getting congative dissonance here.

How about noting that we are paying very low interest rates on our debt, meaning that the "crisis" only exists in certain people's minds and not in the mind of the almighty market? (Or that there's no actual need for an issuer of fiat currency to issue debt instruments in the first place...)

Well played, Russell.

This health-care thing is symptomatic of the larger issue of our spending in too many areas that do not sufficiently promote the general welfare. Our spending isn't too much, it's insufficiently productive. And by "productive," I don't mean simply GDP-expanding. I mean making people's lives better. There's some overlap there, by they aren't one and the same.

Why don't we subsidize preventive and primary health care (the whole delivery system, top to bottom, starting with sending people to medical school to become primary care physicians) more and oil companies and big ag less? How about blowing fewer things up and fixing our damned roads, water delivery systems and electrical grid? How about educating people in a way that nurtures a broader range of talents, abilities and proclivities rather than getting everyone ready for college to varying degrees (including not at all), so that people have a better chance of contributing to society and living fulfilling lives? (Should I throw in legalizing weed and taxing it?)

I know that's all a bit far afield for the subject of the post, but I have to rant once in while, if only briefly (I could go on...), to release the pressure in my head caused by what seems to me to be our national mass insanity.

How about noting that we are paying very low interest rates on our debt, meaning that the "crisis" only exists in certain people's minds and not in the mind of the almighty market?

Even at low interest rates, there's a limit to the amount of debt that e.g. you as a household should incur. OTOH if you're loaning yourself the money, you can charge yourself zero interest, and borrow all you want!

I think that last resembled an actual, serious suggestion we had here in comments, once upon a time. I'd have to look around for it.

OTOH if you're loaning yourself the money, you can charge yourself zero interest, and borrow all you want!

You don't want to borrow to purchase goods and services beyond your national productive capacity, or what's left of it after the private sector has purchased all the goods and services it has deemed necessary. Since we've still got lots of unemployed people and under-producing facilities, we're well short of that.

But sovereign, monopoly currency issuers do have a bit more leeway than households, not to mention more responsibility for the general welfare.

HSH: Why not....

Because that would be fascist commie socialism (and shariahconform too). One could as well install a Kenyan born Indonesian Hinduist Muslim n-word in the White House.

Hsh:

Have you seen I AM?

Have you seen I AM?

No, but I want to. It sounds interesting.

In fact, this proposal seems to me, to rather ingeniusely target consumers who's choice is life sustaining (though not curative) treatment versus hospice and death. If the decision is forced through lack of money - to elect death over treatment then there would be substantial savings.

Replacing government "death panels" with private sector initiatives!

"Even at low interest rates, there's a limit to the amount of debt that e.g. you as a household should incur."

Exactly apt.

This is why in my household we followed Grover Norquist's prescriptions for never permitting a rise in the amount of revenue flowing in and in many cases members of my family agreed to place their reduced salaries on their employers' credit line, rather than following the usual corporate practice (Kellogg, Aetna Health, etc) of raising prices to cover expenses.

We also cut two aircraft carriers from the family Navy, shut down a good part of our nuclear arsenal, and withdrew from some of our commitments abroad, though we still burn a Koran in the fireplace every Tuesday to keep ourselves warm and the world angry.

Other cuts included my sister. Yes, my entire sister was cut by refusing to take her in for her thrice-weekly dialysis treatments unless she drove herself, which she couldn't, having gone blind from the diabetes as well.

We also made her comparison shop via the internet for a health insurance policy which would cover her pre-existing conditions at a more reasonable cost than her Medicare arrangement.

It was fun standing behind her as she made her choices, which we made it out to look like were her own so she too could experience and indulge that old time, American frontier spirit and the true, literal meaning of the Constitution.

When she chose cremation over full burial, we rejoiced at her independence and the budget savings.

In fact, those savings alone permitted out family to stay in Iraq for an additional three seconds, thus securing our future oil fro roughly another four seconds.

I remember when the Republican Party filmed Terri Schiavo as her eyes wandered over the small print of several dozen health insurance policies and she finally chose one that covered HER pre-existing conditions at reasonable cost and then she got two jobs to pay the additional Rick Scott corruption premium.

Then, when they turned off the cameras and the bright lights, the insurance company rescinded her coverage but they explained that corporations are people, too, and, after all , what would Dagny Taggert have done in a similar situation?

I mean besides spreading her legs for Rick Scott.

Although I do think of homes built in flooding or earthquake-prone areas. If the hazard is chronic, might that be analogous to chronic conditions...?

That gets at part of it- but being in an earthquake zone etc is known to all of the parties beforehand. Whereas someone can sign up for insurance and then get chronically sick, changing the equation for both sides.
Looking at just individually-purchased insurance: you may think you are buying insurance that will cover you if you get sick, but what you are actually buying is insurance that will cover you until you get sick. Once you're chronically ill, your rates will skyrocket (and, times past, you wouldnt be able to change insurers or even get insurance through employment wo the pre-existing condition catch).

Insurance is still good for acute conditions, one-timers: a broken leg, an appendectomy, even expensive surgeries from a car accident. But once you get chronically ill, your house has moved from the Ozarks to a termite-infested flood zone under a mudslide-prone hill on top of the San Andreas fault.

I keep thinking- what if life insurance worked this way? If you die in a car accident, fine. But if you get sick to where your death becomes much more likely, then the $1M policy starts costing $50k a month.
People just wouldn't bother with that. What they want is what we have now- a long term (like your working life) where you're covered regardless of the changes in your circumstances. Health insurance ought to work that way too (and that would have the added benefit of making preventative care and incentives for healthy behavior worthwhile for insurance companies).

That's what people want from health insurance too, I think. Also, I think that this problem is only somewhat related to the rise in healthcare costs themselves.

Ryan's plan draws widespread ridicule:

"The idea he'd go to Heritage for that kind of support indicates he didn't like what the CBO was going to tell him," Stan Collender, a former budget aide for both the House and Senate, told TPM. "This is the same guy who said his budget has no gimmicks in it turning to the rosiest scenario he could get."

Dean Baker, co-director of the Center for Economic and Policy Research, pointed to the projections in the Ryan plan that unemployment would decline by 2% in 2012 as fishy even on their own terms.

"I think they just misprogrammed it," he told TPM. "Note that the unemployment rate falls by 2.1 percentage points relative to the baseline in 2012 even though they only created an extra 900,000 jobs. That doesn't make any sense."

By 2021, unemployment would hit 2.8% under their projection, well below the 5% - 6% range that the Federal Reserve considers the maximum desirable rate achievable without dangerous inflation.

The Heritage analysis bases its numbers on a "dynamic" model that it says takes into account the explosive growth unleashed by tax cuts. As a number of commentators have noted, it's the same approach that led them to conclude the Bush tax cuts would reduce the deficit and create millions of new jobs -- instead they exploded the deficit and unemployment worsened, eventually skyrocketing.

Emphasis mine.

This is not a serious, credible policy proposal. It is a road map for dismantling one of our key social safety nets dressed up in fraudulent numbers and magical thinking.

There is an inverse relationship between a given person's support for this plan and how seriously anyone should ever again take their opinion on budgetary matters.

The Heritage analysis bases its numbers on a "dynamic" model that it says takes into account the explosive growth unleashed by tax cuts.

I would be more inclined to buy into a tax-cut-induced-explosive-growth argument if our tax rates weren't already historically low and if many, many firms weren't already sitting on piles of cash that have yet to be invested.

As it is, feh.

The Heritage analysis bases its numbers on a "dynamic" model that it says takes into account the explosive growth unleashed by tax cuts.

This is not a serious, credible policy proposal

Correct. It is an assertion of an article of faith, and one that benefits the folks who pay to keep the lights on at Heritage.

I love that line. It is beautifully written.

Our model took into account the massive earthquakes unleashed by marmosets.

No, I can't top it.

This is Ryan's opening offer.

The key here is for the Democrats to respond with a liberal counterproposal, advocate strongly for it, and (in the end) meet in the middle with a proposal that we can all live with.

[waits for the laughter to die down]


Ryan's proposal: No more Medicare.

Counterproposal: Medicare for all.

The basic fact I keep coming back to on this stuff is this:

US pays public money for health care - insurance, direct care, what have you - in amounts comparable to other OECD nations. Not exactly the same, but comparable. More than some, less than some.

Then, we pay about that same amount again in private money.

It's hard for me to believe that health care in every other OECD nation sucks so much that a difference in care delivered and/or outcomes explains the difference. In fact, some of those countries have outcomes and a general level of health that is better than ours. Not in every particular, but generally.

We're doing something wrong. And some of the things we do wrong have really got to be discoverable, and discoverable fairly readily. Not everything, it's a complicated problem. But a lot of things. Because other people do a better job.

We can just look at what they do, adapt what fits, and move on. How hard would that be?

Ryan's proposal doesn't seem to be a step in the right direction, because it doesn't address the cost aspect. It just punts.

Ryan gets credit for making "hard decisions". There's nothing hard about his thought process, it's dead simple. Everybody gets X dollars, full stop.

The hard decisions will be made by all of the rest of us.

Part of me wonders if this is even a serious proposal in the sense of wanting to implement it- I suspect that even the advocates for it recognize that it'd leave a lot of (voting) seniors fairly well screwed. Even if one hates the socialized medicine that is Medicare, dismantling it seems to me like playing 'Who Wants To Be The Permanent Minority Party?'
That is, maybe this is just an extreme position taken for bargaining purposes, so that it can be given up in return for eg not sunsetting the Bush tax cuts.

I want to offer my condolences to Countme-In, because I have the awful suspicion that some of his last comment was autobiographical.

And I want to add that I admire his ability to keep ridiculing the GOP/conservative mentality with homely parables.

--TP

Part of me wonders if this is even a serious proposal

There is not the slightest doubt in my mind that it's a serious proposal.

"There is not the slightest doubt in my mind that it's a serious proposal."

Thus we have the tragedy of farce.

Counterproposal: Medicare for all.Expropriate the expropriators.

Okay, I have a question.

Basically Obama care is subsidies on a sliding scale for people who can't afford insurance.

Ryan's idea for Medicare is to give people vouchers pegged to income to use to buy insurance.

Aren't those a lot alike?

Aren't those a lot alike?

Absolutely not.

Carlton Wu, "Insurance is still good for acute conditions, one-timers: a broken leg, an appendectomy, even expensive surgeries from a car accident. But once you get chronically ill, your house has moved from the Ozarks to a termite-infested flood zone under a mudslide-prone hill on top of the San Andreas fault."

That is a patently false statement as a sweeping generality. In fact, it is 180 degrees opposite of the truth in many cases.


1. Most people - especially those under 55 years old are financially better of without HC insurance. 95% of us cost less in medical loss - usually far less - than we pay in premiums. Paying out of pocket for services and putting something like 50% of what you would have paid in premiums in a savings account for a period of ten years or more would more than cover the cost of an acute episode of care.

2. Insurance companies will not raise your premiums if you are chronically ill if the contract is though an employer group. If you are unemployed, Medicaid or one of the other safety net plans will cover you regardless of costs. The only people that would be effected as you state are self employed small group or privare pay purchasers. It is true that they might face increased premiums. This problem cam be ameliorated to a large extent by purchasing insurance through a co-op.
3. Even in the case of private pay or small group experienced rated purchasers, most states have rules about how much premiums can be increased that minimize the fear that you present.

"Ryan's proposal doesn't seem to be a step in the right direction, because it doesn't address the cost aspect. It just punts."

The cost problem won't be addressed until we decide to put controls on the providers. Physicians are supposed to be healers; not golf playing business men/women making $200K a year and up. They are also supposed to adhere to clinically proven standards of practice. Instead they waste both money and patients' health with wildly varying patterns of practice that include ineffective and often costly procedures and services and persciptions. Having spent many years studying practice patterns, costs and outcomes I am almost afraid to go to a doctor.

Most people - especially those under 55 years old are financially better of without HC insurance.

When I said "insurance is still good for acute conditions" I didnt mean "insurance is a good bargain for people because they might get acute conditions". I meant "insurance is still a worthwhile thing to have to handle acute conditions- because it cannot be canceled or have the rates raised astronomically in the interval between the condition being known and the full course of treatment being administered (and paid for)". I thought the context made that clear.
I wasnt trying to debate the point you made- of course, that's true afaict for just about every form of insurance: one mitigates risk and pays a premium above the average cost of that risk, so on average one loses money by having insurance.

Although Id still dispute that "financially better off" bit- there is a real cost to risk that cannot be dismissed via averaging. There is a difference between the loss of a thousand dollars and a 1% chance of a loss of 100k dollars, even though the average value is the same.

Insurance companies will not raise your premiums if you are chronically ill if the contract is though an employer group.

Thus my caveat - "Looking at just individually-purchased insurance"
I made that caveat bc I expect that most of the seniors who would be kicked out of Medicare under the Ryan plan would be hitting the individual market rather than the employment-based one. And because while I think employment-based insurance has problems, this is obviously not one of them (at least directly- there is still a significant problem insofar as chronically ill people may find that their illness costs them both their job and their healthcare plan).
And yes, these people may end up on Medicaid. I think that's an indictment of the current system (dumping the chronically ill onto government plans is effectively cherry-picking) rather than a feature.

Even in the case of private pay or small group experienced rated purchasers, most states have rules about how much premiums can be increased that minimize the fear that you present.

This I hadnt heard- can you give us an example of such a law for individual plans?

There is not the slightest doubt in my mind that it's a serious proposal.

Well, I don't doubt that some in the GOP would leap at the chance to implement this. But it strikes me as such an electoral albatross that it might also be a nominal position for others.
Similar to how the GOP has treated Roe v Wade- they constantly claim to want to get rid of it, but in actuality they satisfy themselves chipping away at it. Actually overturning Roe v Wade by whatever method would (again IMHO) do serious damage to the GOP.

Again, Im sure there are Congresscritters who would go all-out for this. But my guess is that they'll be restrained and will accept giving up this chip for some other position- a position that not only favors the GOP's backers, but also isn't electoral poison.

But I doubt it can be proved either way- eg if the GOP does compromise on this point that doesn't mean that they wanted to get rid of it.

[I suppose the case against this position could start with SS privatization, or the GOP's Walker fiasco in Wisconsin where the TP seems intent on galvanizing the opposition via extravagant actions]

Pelosi has said that her response to Ryan's plan is that it needs to die and that, as with the Republican's failed attack on Social Security, she has no intention of putting forward a counter proposal to negotiate from. Her counter proposal is medicare and medicaid stay as they are, and she doesn't intend to negotiate the difference.

"This I hadnt heard- can you give us an example of such a law for individual plans?"

Carleton Wu, these reg.s vary from state to state and the level of regulation can range from just about none to rather stringent. If one is unfortunate enough to live in a state with poor regulation in this regard, your point would definitely have some substance.

".....there is a real cost to risk that cannot be dismissed via averaging.There is a difference between the loss of a thousand dollars and a 1% chance of a loss of 100k dollars, even though the average value is the same."

This is absolutely true and it is the way costs/benefits should be assessed and calculated. And this brings us to what is meaningfully different about HC insurance compared to other forms of insurance. If you insure your house, you can only purchase coverage up to the appraised value of the home. You cannot obtain $1,000,000 worth of coverage on a $150,000 home; let aone an open ended sky is the limit on coverage. One reason is, of course, moral hazard and another is that the cost of insurance would sky rocket - pricing most consumers out of the market - in the case of coverage above and beyond home value and, in the case of open ended coverage, because the actuaries could not accurately calculate financial risk faced by the plan. Yet this is the situation we find ourselves in with HC insurance. Often the best I can offer when someone wants to discuss the "healthcare insurance industry" is a grimace. It isn't insurance pure and simple and the only people saying it is are the ignorant and those profitting from the current state.

For that reason alone (but there are others) I do not consider HC insurance to really be insurance. It is more of a ponzi scheme.

And for that reason, I think it is only reasonable to remove HC coverage from the private sector and make it, instead, an egalitarian good provided by society (at the federal level) much in the same way it is handled in Canada and other civilized nations.

Even the not for profit blues exist for two reasons; 1. to provide a few executives a nice salary and 2. most importantly, to make sure that providers get paid and paid well. In fact, this latter is the founding raison d'etre of BCBS despite all the bs about doing good for the whole community.

Thus, there are no private sector "cures" for the HC insurance issues that plague the consumer of that good and such talk is just so much foolishness and time and energy wasted.

That being said, I do think a socialized single payer plan (which I would prefer) would have to make hard choices about coverage lest cost continue to sky rocket and, despite Russel's protest about hard choices falling on patients, they would continue to do so. A lot of this would perceptual only; meaning that the patient would actually be receiving appropriate and effective care, but providers would bitch that there is something else that could be tried that isn't covered and the patient would feel cheated as a result.

Well, I don't doubt that some in the GOP would leap at the chance to implement this.

I guess I was thinking mostly about Ryan himself. IMO he's completely serious.

I agree that there are likely other folks in the GOP who are not so happy.

Pelosi has said that her response to Ryan's plan is that it needs to die

Go Nancy!

If you insure your house, you can only purchase coverage up to the appraised value of the home. You cannot obtain $1,000,000 worth of coverage on a $150,000 home

Is this correct? I believe some insurers and mortgage issuers require insurance sufficient to rebuild the home in the event of a complete loss, and materials/specifications costs can often exceed the appraised value. This guy had exactly that happen to him, which led to some hilarious shenanigans between him and Wells Fargo:

A single, white, goth and industrial music event promoter who declines to give his age, he wanted someone to explain why they were doubling his premiums and requiring him to insure his century-old house for its full replacement value instead of the market value. His broker told him full replacement value would cost about $1 million to insure in the event his house, a 6-bedroom, 3 bath Tudor he paid $180,000 for in 2002, was reduced to rubble and needed to be rebuilt stone by stone to standards from over a hundred years ago.


OT:

Jeff Spicoli: Hey, I know that dude.

Not the goth promoter dude, but the photographer who took his picture, Kyle Cassidy. Small world (or metro area, anyway).


Carleton Wu, these reg.s vary from state to state and the level of regulation can range from just about none to rather stringent. If one is unfortunate enough to live in a state with poor regulation in this regard, your point would definitely have some substance.

I didnt want that to sound like 'prove it'- I just dont know that much about this, so I was looking for an example of a stringent one out of curiosity. I understand if you dont want to bother digging something up if you dont have it at hand.

And this brings us to what is meaningfully different about HC insurance compared to other forms of insurance. If you insure your house, you can only purchase coverage up to the appraised value of the home. You cannot obtain $1,000,000 worth of coverage on a $150,000 home....

Well, auto insurance does involve insuring against events rather than assets, and often have high potential payouts. Of course this has a cap, but (most? some?) health insurance policies used to have lifetime coverage caps too. I think the big difference is that 'chronic auto insurance users' 1)are often morally responsible for their behavior and 2)lose their insurance and their drivers licenses. Whereas 'chronic health insurance users' 1)are often not morally responsible and 2)get handed over to the public treasury. As well as 3)likely to cost much more than a repeat-DWI offender.

As a general principle, when corporations do the wrong thing I put a significant chunk of the blame on government- corporations are very useful beasties in some ways, but asking them to go above and beyond in protecting consumers etc is asking your pet to be a babysitter.
Asking health insurance companies to maintain a years- or even decades-long relationship with people after they become money sinks (ie chonically ill) is a bad idea. They will try to find some way out of it, and if they don't they'll go bankrupt as their competitors do and then offer lower rates to healthy customers.
My answer is the same as yours- when the profit motive can be successfully utilized to improve society, use it. When the profit motive causes harm to society, structure that part of the economy using a different method.

I guess I was thinking mostly about Ryan himself. IMO he's completely serious.

Good point- it's so easy to speak of something like the GOP as monolithic when it is in fact composed of a myriad of individual viewpoints.

"Is this correct? I believe some insurers and mortgage issuers require insurance sufficient to rebuild the home in the event of a complete loss, and materials/specifications costs can often exceed the appraised value."

Well, yes. That's what I meant as well. The risk is capped at the value of the home, even if it's the rebuild value. So a home that would cost $150k to rebuild cannot be insured for a $million. Same thing.

"...health insurance policies used to have lifetime coverage caps too." Not the major plan I work for (a blues plan). Some plans do have caps and this tends to lower premiums. Other plans have internal "caps" like reinsurance which should, in theory, also lower premiums. Many products - like indemnity or some PPO - use deductibles. The plan doesn't kick in until the member has incurred costs up to a certain threshold. This makes for more of a catostrphic type coverage depending on where that threshold is set. This arrangement is more common than spending caps. Some indemnity prodocts - like the plan I worked for previously - did have caps and these could be moved upwards in exchange for higher premiums, but still, most caps are set so high as to impact only the smallest minority of members. Most chronically ill or catastrophically ill never reach the cap.

We have a member who is a hemophiliac with complications. This member's annual expenses are in the several $millions per year and (s)he has been surviving for a few years now. (S)He is still insured and still receiving the expensive treatments and surgical procedures. And we are paying out on all of this.

...when the profit motive can be successfully utilized to improve society, use it. When the profit motive causes harm to society, structure that part of the economy using a different method.

Amen

...when the profit motive can be successfully utilized to improve society, use it. When the profit motive causes harm to society, structure that part of the economy using a different method.

Amen

Seconded.

the motion carries.

^ Spam alert.

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