Obama will to try to save his med reform effort by getting more involved; he won’t leave it all to Congress anymore. Some encourage him to stand tough for a public option (i.e., a cheap widely available government run insurance plan), while others
In the UK we deal with the issue of special interest campaigning (and health care triage) by a quango called NICE. NICE calculates quality of life year gains from all available treatments and only funds those that exceed a set threshold. That threshold can go up or down but applies to all treatments (there may be some exceptions but I think they are rare).
Despite all the negative press in the US (and to some extent in the UK) the NHS offers, in my opinion, much greater value for money for the most important medicine (that which has a greater impact on life expectancy and quality of life) than the US health care system. The US spends a lot more money than the UK (both on a per capita and a GDP basis) but does worse in some areas. Like any state institution the NHS gets a lot of flack from the press but this is not really representative of the actual quality of the system.
There is a problem with the a ban on preexisting claims disqualification. And the solution is less than ideal, but leaving 1 in 6 Americans with essentially no health care coverage is clearly much worse.
And another point: Patients aren't necessarily knowledgable or rational in their choice of health care coverage. And furthermore their decisions in the US create a health care system that maximises treatments that rich people desire rather than treatments that benefit the population as a whole.
Maybe the BMJ ratings aren't right, but it seems dishonest to: a) cite the source, b) say you don't trust the source, and c) not say why you don't trust the source, all in the same post.
1) Because of the existing tax distortion, the easiest way to become part of a group insurance plan is to work for an employer that offers the opportunity to do so.
2) If you take away the tax advantage, many people fear that their employer will no longer let them buy into a group plan.
3) The individual health insurance market in the U.S. is completely fucked up. If you can't buy into a group plan, your chances of getting the insurance you need at a price you can pay is extremely poor. People don't trust the insurance companies, with good reason, and insurance companies face adverse selection issues.
4) Therefore, people - quite reasonably - fear that losing the tax advantage will result in them losing their insurance.
I personally really, really wish I could chose not to pay for the various foreign wars that our government likes to get into. But since I'm not given the choice, I pay my taxes, and the military contractors take my money.
Personally I can't see why it is so hard to turn Medicare or even Medicaid into a public option system. I'd be delighted to pay some $100 a month for the right to see a doctor or go to a hospital which otherwise saw only Medicaid patients, precisely because I do believe -- as Robin does -- that the vast majority of our most expensive treatments are of dubious utility. Let us divide medicine into bare-bones treatments for those of us who are sceptics and expensive, high-premium service for people who like to visit doctors. Right now I'm signed up for the highest-deductible plan I can find, but my gynecologist - whom I need to see simply to get birth control - sent me a certified letter saying she won't see me any longer because she believes that I must get a mammogram every year while I believe that I do not want my breasts irradiated every year for the rest of my life. (BTW I also agree with Cass Sunstein's proposal that adult individuals should be able to opt out of the medical mal tort law system.)
But we need a public option to create this kind of bare-bones approach. The only reason I purchase health insurance at all is so that I don't lose my apartment and all my savings because I get cancer.
Are you just in from Marginal Revolution or something? Robin is neither stupid nor that kind of selfish.
Robin believes that in general, health care is less effective than people think - whether you yourself are healthy or sick. Robin wants, in general, to pay for less health care (in both "healthy" and "sick" conditions) than other people would, because of extensive evidence that marginal medicine is ineffective.
Robin wants to be able to make a commitment to get less health care later in exchange for lower premiums now. His ideal system would let him buy "Rational Health Insurance", which would - among other things - be purely catastrophic, and either have a standard list of excluded procedures and drugs based on Evidence-Based Medicine showing that they are not relatively cost-effective, or let Robin go down a list and check off particular procedures and medications that he doesn't want to have covered, in exchange for a discount.
"Surely it can’t be that hard to separate the two?"
Yes, it can be that hard - if you're crazy, and other people are crazy.
Sorry for all these comments here, I just want to show the sheer ubiquity of "Can people really be that crazy?" and how often the correct answer is just "Yes, they really are that crazy."
Okay, that's fair enough. Except that the citation you're using today seems to directly contradict your claim that half of medicine is worthless, and you haven't responded to that contradiction anywhere I've seen.
Because, as others have noted, your words rather than your subjective interpretation of them say that you would purchase a limited package of insurance benefits - or none - because you don't want to pay for additional benefits that you believe aren't worth the money. Others believe those benefits are worth the money and want them - or they wouldn't be included - and still others aren't aware of them or don't care or don't think about them. So you've set up two possibilities: that you don't want to pay for whole areas of coverage (because of waste / inefficiency) or you somehow want an unworkable discount because you might like orthopedic care but you don't want to pay for the part of orthopedic care that you think is worthless. That means you'd have to choose a lesser coverage policy; it's simply impossible to say "I want to pay less for orthopedic care because when I need the services I only want the ones that work and baked into the total cost is a lot of crap." Then when you or your child gets sick, you want to expand your coverage because now you need more insurance and who the bleep would then care about the waste built into the coverages you then need.
In other words, you take your skepticism about medical procedures and take it unwittingly to a selfish place.
As someone has already implied, your stance is completely disengenuous. The minute you have a serious medical condition, you'll seek treatment--and if not insured, pass along the costs to the public budget or to those who do pay for insurance.
Are people really that stupid? Don't they have see the total Cost of employment"? It's not "free". The "Medical Aid/Fund" (any type of "insurance" is banned in my country) is clearly visible, I get less money at the end of the month...
If religion cost hundreds of thousands of dollars at the end of life, and almost everyone demanded it for themselves or even for others (because it was viewed as reprehensible to withhold it), then yes, I think it would make sense to treat religion like health care.
In the UK we deal with the issue of special interest campaigning (and health care triage) by a quango called NICE. NICE calculates quality of life year gains from all available treatments and only funds those that exceed a set threshold. That threshold can go up or down but applies to all treatments (there may be some exceptions but I think they are rare).
Despite all the negative press in the US (and to some extent in the UK) the NHS offers, in my opinion, much greater value for money for the most important medicine (that which has a greater impact on life expectancy and quality of life) than the US health care system. The US spends a lot more money than the UK (both on a per capita and a GDP basis) but does worse in some areas. Like any state institution the NHS gets a lot of flack from the press but this is not really representative of the actual quality of the system.
There is a problem with the a ban on preexisting claims disqualification. And the solution is less than ideal, but leaving 1 in 6 Americans with essentially no health care coverage is clearly much worse.
And another point: Patients aren't necessarily knowledgable or rational in their choice of health care coverage. And furthermore their decisions in the US create a health care system that maximises treatments that rich people desire rather than treatments that benefit the population as a whole.
Maybe the BMJ ratings aren't right, but it seems dishonest to: a) cite the source, b) say you don't trust the source, and c) not say why you don't trust the source, all in the same post.
Let me elaborate:
1) Because of the existing tax distortion, the easiest way to become part of a group insurance plan is to work for an employer that offers the opportunity to do so.
2) If you take away the tax advantage, many people fear that their employer will no longer let them buy into a group plan.
3) The individual health insurance market in the U.S. is completely fucked up. If you can't buy into a group plan, your chances of getting the insurance you need at a price you can pay is extremely poor. People don't trust the insurance companies, with good reason, and insurance companies face adverse selection issues.
4) Therefore, people - quite reasonably - fear that losing the tax advantage will result in them losing their insurance.
No mistakes.
I don't have to literally and exaclty believe the results of the BMJ ratings.
I personally really, really wish I could chose not to pay for the various foreign wars that our government likes to get into. But since I'm not given the choice, I pay my taxes, and the military contractors take my money.
Personally I can't see why it is so hard to turn Medicare or even Medicaid into a public option system. I'd be delighted to pay some $100 a month for the right to see a doctor or go to a hospital which otherwise saw only Medicaid patients, precisely because I do believe -- as Robin does -- that the vast majority of our most expensive treatments are of dubious utility. Let us divide medicine into bare-bones treatments for those of us who are sceptics and expensive, high-premium service for people who like to visit doctors. Right now I'm signed up for the highest-deductible plan I can find, but my gynecologist - whom I need to see simply to get birth control - sent me a certified letter saying she won't see me any longer because she believes that I must get a mammogram every year while I believe that I do not want my breasts irradiated every year for the rest of my life. (BTW I also agree with Cass Sunstein's proposal that adult individuals should be able to opt out of the medical mal tort law system.)
But we need a public option to create this kind of bare-bones approach. The only reason I purchase health insurance at all is so that I don't lose my apartment and all my savings because I get cancer.
Are you just in from Marginal Revolution or something? Robin is neither stupid nor that kind of selfish.
Robin believes that in general, health care is less effective than people think - whether you yourself are healthy or sick. Robin wants, in general, to pay for less health care (in both "healthy" and "sick" conditions) than other people would, because of extensive evidence that marginal medicine is ineffective.
Robin wants to be able to make a commitment to get less health care later in exchange for lower premiums now. His ideal system would let him buy "Rational Health Insurance", which would - among other things - be purely catastrophic, and either have a standard list of excluded procedures and drugs based on Evidence-Based Medicine showing that they are not relatively cost-effective, or let Robin go down a list and check off particular procedures and medications that he doesn't want to have covered, in exchange for a discount.
Robin, correct me if any of this is mistaken.
"Surely it can’t be that hard to separate the two?"
Yes, it can be that hard - if you're crazy, and other people are crazy.
Sorry for all these comments here, I just want to show the sheer ubiquity of "Can people really be that crazy?" and how often the correct answer is just "Yes, they really are that crazy."
Why, yes, progressives really are that stupid.
Yes, people really are that stupid.
Okay, that's fair enough. Except that the citation you're using today seems to directly contradict your claim that half of medicine is worthless, and you haven't responded to that contradiction anywhere I've seen.
Because, as others have noted, your words rather than your subjective interpretation of them say that you would purchase a limited package of insurance benefits - or none - because you don't want to pay for additional benefits that you believe aren't worth the money. Others believe those benefits are worth the money and want them - or they wouldn't be included - and still others aren't aware of them or don't care or don't think about them. So you've set up two possibilities: that you don't want to pay for whole areas of coverage (because of waste / inefficiency) or you somehow want an unworkable discount because you might like orthopedic care but you don't want to pay for the part of orthopedic care that you think is worthless. That means you'd have to choose a lesser coverage policy; it's simply impossible to say "I want to pay less for orthopedic care because when I need the services I only want the ones that work and baked into the total cost is a lot of crap." Then when you or your child gets sick, you want to expand your coverage because now you need more insurance and who the bleep would then care about the waste built into the coverages you then need.
In other words, you take your skepticism about medical procedures and take it unwittingly to a selfish place.
As someone has already implied, your stance is completely disengenuous. The minute you have a serious medical condition, you'll seek treatment--and if not insured, pass along the costs to the public budget or to those who do pay for insurance.
Are people really that stupid? Don't they have see the total Cost of employment"? It's not "free". The "Medical Aid/Fund" (any type of "insurance" is banned in my country) is clearly visible, I get less money at the end of the month...
If religion cost hundreds of thousands of dollars at the end of life, and almost everyone demanded it for themselves or even for others (because it was viewed as reprehensible to withhold it), then yes, I think it would make sense to treat religion like health care.
Sounds like you will still be able to opt out. A penalty of $750 would make that the cheapest "insurance" of all. Probably have a lot of those.