The Obama Presidency - 2008 & 2012

[JPhillips]

I don't think there's any doubt that the Dems are looking at a rough election cycle. For a number of reasons, the off-year history, shitty economy/employment, dissatisfaction with the inability of Congress to do much of anything, and an enthusiasm gap between right and left among them, the landscape is very bleak for congressional Dems.

However, what I haven't seen in polling is a turn away from the policy ideas of the Democrats in favor of the policy ideas of the GOP. That's why I still think the best chance the Dems have is getting their agenda passed through reconciliation consequences be damned. If they are too timid to do anything with the largest majorities in decades they deserve to be thrown out on their asses.

[Ronnie Dobbs2]

Originally Posted by Dr. Sak

What was Bush's approval rating in year 2? Shouldn't we compare Obama's to that at this point?

That's an obvious question. More obvious, though, is why would you compare Obama to someone who is pretty much regarded as a colossal failure?

[JPhillips]

Originally Posted by Dr. Sak

What was Bush's approval rating in year 2? Shouldn't we compare Obama's to that at this point?

Not with 9/11. Here's a graph of his approval ratings. It's hard to speculate where he might have been in year two without 9/11, but he was on a general downward trend.

[flere-imsaho]

Originally Posted by Dr. Sak

What was Bush's approval rating in year 2? Shouldn't we compare Obama's to that at this point?

The unity bump from 9/11 skews Bush's rating in year 2, so it's probably not a meaningful point of comparison.

[Dr. Sak]

Originally Posted by flere-imsaho

The unity bump from 9/11 skews Bush's rating in year 2, so it's probably not a meaningful point of comparison.

I agree but comparing it to all 8 years is a bit much also.

Side rant: I didn't vote for Obama, I think the guy is a good speaker who told people what they wanted to hear. But I want him to succeed because if he does, that means that our lives as Americans get better. I want him to prove me wrong, I want him to do what he campaigned he would do, and have it work. I understand it is hard to do given the back-handedness of politics, but it's just one opinion of one voter.

[Arles]

He was at 54% in August of 2001, so I'm guessing around 46% is a fair ballpark for where Bush would have been 6 months later without 9/11.

At some point, people will realize policies don't mean crap for most of the voting block. Outside of some hot-button issues for a small % (major tax change, social issues), voting is based on how happy people are with their own situation (and to a lesser degree, the country). If they're happy, they tend to keep the current guys/party in. If they are not, they tend to vote them out.

Thinking that an average voter is going to say "Hmm, I like the democrats stance on education funding, but I am a little worried about republicans not cutting spending enough - so, I think I'll vote democrat" is a little silly. It's almost as silly as trying to draw voter preferences on issues from election results (for both sides).

[Mizzou B-ball fan]

Originally Posted by Dr. Sak

I didn't vote for Obama, I think the guy is a good speaker who told people what they wanted to hear. But I want him to succeed because if he does, that means that our lives as Americans get better. I want him to prove me wrong, I want him to do what he campaigned he would do, and have it work. I understand it is hard to do given the back-handedness of politics, but it's just one opinion of one voter.

Sure. I don't think there's any question that everyone hopes that whatever is done by the administration and Congress works out better than the status quo. Most of the debate is about the opinions on what will work. There's very little debate on whether people want improvement.

[flere-imsaho]

I honestly don't think there's going to be much relevance to be found in comparing Obama's approval ratings to Bush's over the course of his term or terms.

Bush came in with a booming economy that did a correction and then roared back only to collapse at the end, while Obama inherited what I guess we're now calling the Great Recession.

Bush also had 9/11 and started two wars while Obama (hopefully) won't be President during another 9/11 (hopefully we never have another 9/11) and he's inherited two wars, not started them.

A better comparison might be Clinton or Reagan, but even then....

[JPhillips]

Originally Posted by flere-imsaho

I honestly don't think there's going to be much relevance to be found in comparing Obama's approval ratings to Bush's over the course of his term or terms.

Bush came in with a booming economy that did a correction and then roared back only to collapse at the end, while Obama inherited what I guess we're now calling the Great Recession.

Bush also had 9/11 and started two wars while Obama (hopefully) won't be President during another 9/11 (hopefully we never have another 9/11) and he's inherited two wars, not started them.

A better comparison might be Clinton or Reagan, but even then....

Reagan isn't a bad comparison economy wise, and right now they are tracking pretty closely.

[sterlingice]

Originally Posted by JPhillips

Reagan isn't a bad comparison economy wise, and right now they are tracking pretty closely.

So what you're saying is that Dulles is on track to be renamed Obama in about 30 years

SI

[RainMaker]

Thought this was a good piece of investigative journalism. Shows it's still business as usual in Washington.

Paul Blumenthal: The Legacy of Billy Tauzin: The White House-PhRMA Deal

[sterlingice]

Originally Posted by RainMaker

Thought this was a good piece of investigative journalism. Shows it's still business as usual in Washington.

Paul Blumenthal: The Legacy of Billy Tauzin: The White House-PhRMA Deal

SI

[sterlingice]

More insurance fun.

Individual insurance rates soar in 4 states - Yahoo! News

Screw any previous agreements. Everyone remember this happened before there was any sort of health care bill or agreement because I'm sure there will be a lot of revisionist history coming our way from that industry. To borrow from South Park, "Fuck them, fuck them right in the ear"

SI

[Dutch]

Originally Posted by sterlingice

More insurance fun.

Individual insurance rates soar in 4 states - Yahoo! News

Screw any previous agreements. Everyone remember this happened before there was any sort of health care bill or agreement because I'm sure there will be a lot of revisionist history coming our way from that industry. To borrow from South Park, "Fuck them, fuck them right in the ear"

SI

I guess this affects you then...that sucks.

[sterlingice]

No, I don't live in any of those four states at the moment. However, I suspect that if they can get away with this there this year it's going across the board next year.

SI

[Dutch]

Since I'm in the military and receive (mostly) free medical care, it's hard for me to understand how much a 20% hike or a 35% hike is. I'd imagine it's a pretty good kick in the shorts though.

Now the article states individual vs company rates. I have no idea what that means. Also, it says "some" individual rates could climb by as much as 35% (or 20% depending on which of the 4 states it mentions).

Honestly, I have no way to quantify what any of that article means. How many people are afffected, how much more are they paying.

[sterlingice]

The simple version is that it's for individual rates. That's basically if you don't get your health care from the company you work for (i.e. small businesses, unemployed, etc- anyone who doesn't get group insurance). I remember when I was unemployed in Kansas, that was looking like about $400-$500 just for myself for a healthy 20-something year old non-smoker. I'm sure it's gone up since that as we're talking about at least 5 years ago now. But just taking that, you're talking about jacking up rates from $500 to $700 per month for no better coverage or service, just because they need to maintain profit margins (and without getting into anything about high administrative and overhead costs of insurance companies). And that's for a healthy 20-something year old. So, yeah, $6000 to $8400 for someone who, well, has no job or is a small business owner or worker.

But, somehow, working for the large company I work for, it's like $250 a month for myself and my wife. However, if I lose my job, as I'm in danger of- we're looking at around $1000 per month and they're going to jack that up 20-40%.

The article did mention the following:

Originally Posted by article

*Steep rate hikes in this sliver of the insurance market — about 13 million Americans, as of 2008 — have popped up sporadically for years. Experts see them becoming increasingly common.

*Anthem Blue Cross, a subsidiary of WellPoint Inc., has been under fire for a week from regulators and politicians for notifying some of its 800,000 individual policyholders in California that it plans to raise rates by up to 39 percent March 1.

*The Anthem Blue Cross plan in Maine is asking for increases of about 23 percent this year for some individual policyholders. Last year, they raised rates up to 32 percent.

*Kansas had one recent case where one insurer wanting to raise most individual rates 20 percent to 30 percent was persuaded by state insurance officials to reduce the increases to 10 percent to 20 percent. The insurance department would not identify the company but said it was not Anthem.

*And in Oregon, multiple insurers were granted rate hikes of 15 percent or more this year after increases of around 25 percent last year for customers who purchase individual health insurance, rather than getting it through their employer.

*Under Anthem's proposal, a family of four could be charged up to $1,876 per month if the proposed rates are allowed to take effect in July.

*Last year, Maine's Superintendent of Insurance Mila Kofman rejected Anthem's initial requests, which would have increased individual rates an average of 18.5 percent. She allowed an average increase of 10.9 percent, with the highest increase at 32.4 percent.

I don't think this is too hard to do the math on. How specific of numbers do you need? It's not like they're going to have a table of every single person and every single rate ready today since Anthem and others are just now doing it in the past week.

SI

[JonInMiddleGA]

Originally Posted by sterlingice

just because they need to maintain profit margins

And they somehow have less right to do that than Microsoft or Jack & Jill's Corner Florist?

[sterlingice]

Originally Posted by JonInMiddleGA

And they somehow have less right to do that than Microsoft or Jack & Jill's Corner Florist?

Yes- and there's a pretty strong two-pronged argument to this that I've been arguing all along through this debate. There is both an ethical and legal capitalistic component.

1) They have a stronger ethical responsibility because of what their business is. If they screw people, people die. If Jack and Jill give you a wilty orchid, you don't die. Legally, we don't hold florists to the same ethical responsibilities as doctors. Same is true, here.

2) Ethics aside, there's legality. They have an anti-trust exemption for reasons I really have yet to fathom. So, yes, that means there is a limit to the amount of price fixing they can do. Because there is restricted competition in their field, they can name whatever profit level they want. Thus they have different rules with rate hikes.

SI

[sterlingice]

Originally Posted by JonInMiddleGA

And they somehow have less right to do that than Microsoft or Jack & Jill's Corner Florist?

As an aside, Microsoft should have been busted up for illegally leveraging their monopoly in the mid 90s (and late 90s and early 00s and mid 00s and...). But I guess that's another story for another day.

I believe that a lot of small competitors with low entry barriers are the closest to perfect capitalism we can get. As we are now, where we have a couple of large companies exercising oligopolistic controls over practically every industry is not capitalism. It's the equivalent of capitalist authoritarianism (or fascism) where you have a very centralized power base that controls everything with practices that are unfair to consumers for the benefit of very few.

SI

[JonInMiddleGA]

Originally Posted by sterlingice

Yes- and there's a pretty strong two-pronged argument to this that I've been arguing all along through this debate. There is both an ethical and legal capitalistic component.

1) They have a stronger ethical responsibility because of what their business is. If they screw people, people die. If Jack and Jill give you a wilty orchid, you don't die. Legally, we don't hold florists to the same ethical responsibilities as doctors. Same is true, here.

I don't buy that argument at all, in fact I'm probably as adamantly opposed to it as anyone you'll find. There's no such thing as an "ethical responsibility" that limits the ability to make a profit. No one should be banished to making less than the market will bear because of some imaginary burden invented by people too damned cheap to pay the going rate.

Because there is restricted competition in their field

Must be a state-by-state thing because, having just changed health insurers to get a better price, I sure as hell didn't find anything resembling a shortage of options. If anything, too damn many possibilities (from a practical standpoint) even insuring as individuals with no company participation and with a lung cancer survivor in the family.

It was significantly harder to find homeowners insurance that would take our still unsold albatross than it's ever been to find health insurance, even with our pre-existing condition complications.

[RainMaker]

Looks like our tax dollars bought some filipino hookers. Odd how the ACORN crusaders have not posted this yet.

http://www.guardian.co.uk/world/2010...ud-accusations

[DaddyTorgo]

Originally Posted by sterlingice

More insurance fun.

Individual insurance rates soar in 4 states - Yahoo! News

Screw any previous agreements. Everyone remember this happened before there was any sort of health care bill or agreement because I'm sure there will be a lot of revisionist history coming our way from that industry. To borrow from South Park, "Fuck them, fuck them right in the ear"

SI

this (and Jon's reaction to it) is one of the key reasons why health insurance should be handled by a nonproifit entity

[molson]

Originally Posted by DaddyTorgo

this (and Jon's reaction to it) is one of the key reasons why health insurance should be handled by a nonproifit entity

As I'm learning more and more in my own profession - the government is not a nonprofit entity.

[JonInMiddleGA]

Originally Posted by molson

As I'm learning more and more in my own profession - the government is not a nonprofit entity.

Testify

[gstelmack]

And Blue Cross / Blue Shield here in North Carolina IS a nonprofit entity, and still raises rates regularly. One of the big fiascoes was a few years back they had a tent at Pinehurst for the US Open and dumped like $850K for "marketing" to help reduce the massive cash on hand. One good thing they did was use some of that cash to make generic drugs zero copay for a long time. But heaven forbid they'd DROP their rates with that much cash.

So don't believe the whole nonprofit thingy is good.

[Dutch]

Originally Posted by sterlingice

But, somehow, working for the large company I work for, it's like $250 a month for myself and my wife. However, if I lose my job, as I'm in danger of- we're looking at around $1000 per month and they're going to jack that up 20-40%.SI

Health Insurance - Affordable Health Insurance Quotes, Individual Health Insurance

Looking at this web-site, individual health insurance rates for a 2-person family in Richmond, VA puts $1000 a month at the very high end of the 100 options listed. I'm going to guess this is for self-employed folks, not for unemployed folks (not to be insensitive to your situation, mind you). A vast majority seem to be in the range you are talking about ($250) or less per month.

Assuming that the government is going to give you the top rate plan while unemployed is not really thinking this through. You're gonna have to pay for it, but you won't get a choice. I am certain that any nationalized unemployment health benefit will be a "one size fits all" and I see no way that we could afford top notch coverage for everybody when there is no way we could do it privately.

Again, I'm not the expert on this...so I'm left to fend for myself, so I can't argue with RL details. I'm just always going to be concerned when we start throwing around the idea that if "only the government were in charge, everything would be great".

[DaddyTorgo]

self-employed/small businesspeople get fucked. that's where i fall.

[cartman]

Originally Posted by Dutch

I'm just always going to be concerned when we start throwing around the idea that if "only the government were in charge, everything would be great".

Interesting quote, coming from someone who is in the military, which is run by the government.

[RainMaker]

Originally Posted by gstelmack

And Blue Cross / Blue Shield here in North Carolina IS a nonprofit entity, and still raises rates regularly.

Is it really a non-profit if your top executives are making millions of dollars a year? BC/BS of NC is as non-profit as Microsoft.

[RainMaker]

If this helps, it's the rates United Health Care has for group health insurance for my business. As you can see, our rates went up a good amount this year.

You can also tell that the problem isn't dealing with people who are young, it's when you hit 45+ that it starts to become a problem. Lets say you and your wife are in your late 40's with two kids. You are looking at $1300 a month plus co-pays, deductible, etc. That can get up to around $16,000+ a year for a family of 4. A couple in their 50's without any kids is still paying a fortune. I'm not against the system we have for younger people (I do think we need some reform in some areas), but the problem is when you get older and priced out before you hit Medicare age.

[Dutch]

Originally Posted by cartman

Interesting quote, coming from someone who is in the military, which is run by the government.

The military is the biggest socialistic program in America. It's wildly expensive to the taxpayer (as I'm sure you are aware) and we still call it "getting out" when we leave it.

[sterlingice]

Originally Posted by RainMaker

If this helps, it's the rates United Health Care has for group health insurance for my business. As you can see, our rates went up a good amount this year.

You can also tell that the problem isn't dealing with people who are young, it's when you hit 45+ that it starts to become a problem. Lets say you and your wife are in your late 40's with two kids. You are looking at $1300 a month plus co-pays, deductible, etc. That can get up to around $16,000+ a year for a family of 4. A couple in their 50's without any kids is still paying a fortune. I'm not against the system we have for younger people (I do think we need some reform in some areas), but the problem is when you get older and priced out before you hit Medicare age.

Problem is that also is the group rate for a company. I can guarantee you that the individual rate is at least double that.

SI

[gstelmack]

Originally Posted by RainMaker

Is it really a non-profit if your top executives are making millions of dollars a year? BC/BS of NC is as non-profit as Microsoft.

And given that my local school superintendent makes over $300K, you think this will change if healthcare goes government and non-profit? You've made my point, thank-you.

[RainMaker]

Originally Posted by sterlingice

Problem is that also is the group rate for a company. I can guarantee you that the individual rate is at least double that.

SI

I can't speak for other states, but I found the opposite. Individual rates are cheaper because they can drop you at the end of the year. They can also pre-screen you in a way that group health insurance plans are not allowed to.

It appears cheaper because the company is "picking up a portion", although that's still technically part of your hidden salary. I used to have individual health insurance when I started my company and it became more expensive when we got a group plan. But the group plan gives you that benefit of not being dropped at renewal time if you come down with cancer or something serious.

[flere-imsaho]

I still don't understand why people continue to defend a health coverage system where those who pay for your coverage have clear and unambiguous incentives to not cover, drop coverage on, or minimize the coverage of the people who need that coverage the most.

[DaddyTorgo]

Originally Posted by flere-imsaho

I still don't understand why people continue to defend a health coverage system where those who pay for your coverage have clear and unambiguous incentives to not cover, drop coverage on, or minimize the coverage of the people who need that coverage the most.

+40,000,000

[JonInMiddleGA]

Originally Posted by flere-imsaho

I still don't understand why people continue to defend a health coverage system where those who pay for your coverage have clear and unambiguous incentives to not cover, drop coverage on, or minimize the coverage of the people who need that coverage the most.

Because they aren't in the business of providing medical treatment, they're offering a risk management opportunity. They're a business that exists solely for the purpose of making money for the owners/investors just like real estate or advertising and it boggles my mind that so many people seem not to understand that or to be in some state of denial about it.

[DaddyTorgo]

Originally Posted by JonInMiddleGA

Because they aren't in the business of providing medical treatment, they're offering a risk management opportunity. They're a business that exists solely for the purpose of making money for the owners/investors just like real estate or advertising and it boggles my mind that so many people seem not to understand that or to be in some state of denial about it.

No - we get that. You misunderstand. People are saying that it shouldn't be an opportunity to make money...it should be an opportunity to provide proper medical care.

(Speaking for that group of people if I may?) We fundamentally do not believe that an explicit, competitive profit-motive has any business being a part of the healthcare system.

[flere-imsaho]

Originally Posted by JonInMiddleGA

Because they aren't in the business of providing medical treatment, they're offering a risk management opportunity. They're a business that exists solely for the purpose of making money for the owners/investors just like real estate or advertising and it boggles my mind that so many people seem not to understand that or to be in some state of denial about it.

I get that Jon, I really do. What I don't understand is how some people continue to think that a system based on this setup will somehow provide affordable healthcare to the entire population.

It's like saying there's no need for mass transit because the car companies can provide affordably priced cars for everyone.

[flere-imsaho]

Originally Posted by DaddyTorgo

(Speaking for that group of people if I may?) We fundamentally do not believe that an explicit, competitive profit-motive has any business being a part of the healthcare system.

I view that as a separate argument.

If you view, as I do, the public health being a public good, then it's really difficult to see a private health care system as something that will work. Private companies will always have a fiscal responsibility to their owners/shareholders first, and providing for the public good will only be a secondary goal, at the very best.

So why do we think that a system that rests on private healthcare providers will somehow provide for the public good. Out of the goodness of their heart? LOL

[JonInMiddleGA]

Originally Posted by DaddyTorgo

No - we get that. You misunderstand.

Fair enough, I'll accept that about the group here as long as you'll allow that there's a loud portion of the argument outside of FOFC that doesn't appear to have as firm a handle on it.

People are saying that it shouldn't be an opportunity to make money...it should be an opportunity to provide proper medical care.

I'd strongly argue that's a different system entirely, insurance companies are about risk management while doctors/hospitals/et al are about providing medical care. It's two completely different subjects afaic, or more accurately I suppose, it should be two completely different subjects.

(Speaking for that group of people if I may?) We fundamentally do not believe that an explicit, competitive profit-motive has any business being a part of the healthcare system.

That's probably a reasonable representation of it, at least as far as I can tell, God knows I have problems really grasping it but that seems to be a big chunk of the take. That said, I disagree entirely, as the profit motive is the primary motivation for virtually every successful enterprise & I see no rational reason to believe that healthcare has even the potential to be any different.

[JonInMiddleGA]

Originally Posted by flere-imsaho

I get that Jon, I really do. What I don't understand is how some people continue to think that a system based on this setup will somehow provide affordable healthcare to the entire population.

Okay, some of that I've kind of addressed in my reply to DT, but this phrasing leaves me with a question.

What does the phrase "a system based on this setup" mean in your usage? Only insurance as it relates to the payment to providers? Or are you cutting a much broader swath with it?

In the interest of clarity, that's meant to be a legit question, I'm really not clear on how broadly or narrowly you're speaking. It's a twisty windy topic through the thread & it ain't hard to get lost, especially on a Snowfizzle Monday / erstwhile holiday.

[flere-imsaho]

Originally Posted by JonInMiddleGA

What does the phrase "a system based on this setup" mean in your usage? Only insurance as it relates to the payment to providers? Or are you cutting a much broader swath with it?

I simply meant the system where private insurance companies provide the money to cover medical care.

Their motivation is profit first, other things second. Since companies primarily generate profits through a combination of charging as much as the market will bear and cutting as much cost as they can, I question how people can think such a system would result in good coverage for all (or even most) Americans.

[flere-imsaho]

Originally Posted by JonInMiddleGA

I'd strongly argue that's a different system entirely, insurance companies are about risk management while doctors/hospitals/et al are about providing medical care. It's two completely different subjects afaic, or more accurately I suppose, it should be two completely different subjects.

I agree, but this is where it gets murky. Your insurance company gets involved in providing medical care from the moment it says it'll pay for one type of procedure and not another, despite what medical advice says (and we have several recent examples from people on this board on this).

This, to me, is where even the "insurance companies are about risk management" argument falls down. I'll let Nate Silver explain:

I'm a big believer in the profit motive in 99 percent of all cases. If the government decided to open a non-profit hamburger stand, I doubt that it would compete successfully against Five Guys. If it tried to open a non-profit airline, I doubt that it could offer the same value as JetBlue. Insert joke about General Motors and/or the Post Office here. The point is, I think the profit motive is generally well worth it in terms of the incentives it creates to cut costs, develop new products, improve customer service, and so forth.

But health insurance is not like those things.

Insurance exists because of the decreasing marginal utility of income: most people would rather have a 100% chance of paying $300 a month than a 1% chance of paying $30,000 a month. In fact, our hypothetical customer -- let's call him Frederick, after George F. Will's middle name -- might very well accept a 100% chance of paying $400 a month rather than take 1% chance of having to pay $30,000, which he might not be able to afford. This is true even though Frederick will lose $100 on this deal in an average month.

There's nothing wrong with this arrangement -- the customer has improved his marginal utility and the insurance company has made $100. It's a win-win.

The thing is, though, that the insurer hasn't had to work particularly hard for his $100. He hasn't had to figure out how to cook up tastier fries or save you a few bucks off the cost of your next flight to Orlando. All he has to do is to have a bunch of money pooled together, such that he has a different marginal utility curve than you do. He has the luxury to accept the risk of unlikely outcomes, particularly if he can hedge his position by making the same deal with other customers, most of whom won't wind up requiring an angioplasty or cataract surgery, even if Frederick does.

Now, what's supposed to happen in the free market is that another company will come in and offer Frederick a better deal: they'll offer him the same coverage for $350 a month, accepting a smaller profit, and Frederick will happily take the deal. There are at least a couple of reasons, however, why this may not be happening in the insurance industry. The first is that Frederick might not realize he's paying $400 every month for insurance. That's because if he's like the majority of Americans, he's getting his insurance through his work, and except when the HR lady gave him a shiny brochure on his first day at the office, he's probably never thought very much about what this insurance is costing him in terms of foregone salary. This is particularly so because health insurance benefits, unlike other types of income, aren't taxed, and so Fredrick is less cognizant of them if show up on his paycheck at all. Not only, then, is the free market maxim of perfect information violated, but it's violated in such a way that creates artificial profits for the insurance industry: the government is effectively subsidizing every dollar that Frederick's company is willing to spend on his insurance benefit.

The profits the insurance industry is making, of course -- profits artificially boosted by an enormous backdoor tax subsidy -- don't seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service. If JetBlue were raising the cost of its fares by 10 percent per year, they'd be out of business.

Silver was making the point in this article (a response to a column by George Will) that one shouldn't fear the existence of a public option, but I quote him here to make the point that health insurance isn't really like other forms of insurance because in the United States health insurance also means the provision of health care itself.

Unlike home insurance or car insurance, without which an average person can still be a productive member of society (i.e. don't own a home if you can't afford the insurance, don't own a car or an expensive car if you can't afford the insurance - amongst all the other costs, of course), the ramifications of not having health insurance tend to be pretty catastrophic. So people are pretty much forced to have insurance of some type, which creates an artificial market.

But instead of insurance companies simply pooling and thus mitigating risk, they operate on the same model all other insurance companies do - to make a profit (or, for non-profits, to make money to cover their expenses - all their expenses). This, to me, is the disconnect.

When you buy health insurance you are effectively putting your life in the hands of a private company. But that private company doesn't care about you, or at least not more than it cares about making a profit. Shouldn't that concern you?

[JonInMiddleGA]

Let me take a crack at Nate Silver's argument because there are some pretty obvious holes in it that showed up on even my first pass through.

The thing is, though, that the insurer hasn't had to work particularly hard for his $100.

Clearly Mr. Silver underestimates the difficulty in having "a bunch of money pooled together". It's definitely not as easy as he seems to suggest believing otherwise we'd all be doing it.

The first is that Frederick might not realize he's paying $400 every month for insurance. ...

So it's the insurance companies fault, and even the fault of the free market, that Frederick is either too stupid or too lazy to pay attention? Well damn.
The rest of that paragraph is nothing more than blaming anyone but Frederick for his own shortcomings.

... don't seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service.

This makes an assumption that doesn't hold water either, that cost increases are directly related to "improved service" or even that consumers always directly benefit from competition in the form of reduced costs. That fails even the most cursory sniff test by the most simpleminded of analysts & it's so lazy he ought to be ashamed. Is that loaf of bread dramatically better than the one last year or five years before? Mine isn't but it sure as hell costs more than it used to. And reduced costs aren't the only form of consumer benefit from competition, there's less tangible aspects such as improved customer relations (i.e. something is less annoying to deal with). And I can definitely attest to a difference in the caliber of experiences with insurers same as I can with something as unrelated as, say, restaurants.

When it comes to the attacks on the insurance industry, I honestly don't see much beyond class envy & a fundamental misunderstanding of the role of insurers and/or the market. And Silver definitely does nothing to change that perception. The reality is that the cost of healthcare -- and you'll get no argument from me that it is indeed painfully high -- rests primarily on the shoulders on the providers but there certainly seems to be a reluctance to call them out on it & start addressing the subject at the root of it (if indeed there's a belief it needs to be addressed) because ultimately, we all know deep down that they could simply say "fuck it, we quit" or even something much more sinister and there seems to be little will to deal with those possibilities.

[flere-imsaho]

I don't feel you understand the point of my argument, Jon, but I certainly won't get in the way of a good rant.

[SportsDino]

Well, the business of insurance is basically a form of legalized gambling. We, the massive pool of insurance money, are going to bet on average that you and your family are not going to have any significant loss anytime soon, so adding your premium to our pool will have a net positive effect.

This is all fair and well, plenty of economics and math can be used to show that after all of the probabilities play out the businesses net a profit, and the poor father whose kid gets a treatable but expensive disease gets medical care. Everyone is happy!

Then contract law enters the picture, the supposed 'tort reform' and 'malpractice reform' movements trying to increase the gap (sponsored by Big Money). Not to mention a solid dose of government intervention, and a little bit of collusion among the limited competition in the field.

You get things like contracts being paid on the individual side all the way up to a catastrophic event, with the insurance company being able to void their end of the contract with a variety of tricks at the crisis point.

You end up being unable to find a contract that lets you pay for insurance from the age of 20 to 70... all the contracts are worded with numerous options for the insurer to drop so they know with high probability at least one of those will trigger before you reach old age. Note, a lot of this math only makes sense for the individual if they are considered as a stream of payments from a low risk period for a significant duration of time, into a relatively shorter high risk period.

You see costs inflate across the board due to bureaucratic costs rather than the real cost of materials or skilled labor. The number of office workers related to health care grows faster than the number of doctors... with or without doctor pay raises we end up paying more.

Since the overhead margin keeps increasing, the prices of the actual services then inflate since the hospitals need to cover their other costs but they can't charge people for 'filling out form 27-B in triplicate', so the cost of a 'broken leg' ends up doubling. Before too long, people forget where the money is going to, its 'always been that way' and the assumption becomes that fixing people up is just incredibly expensive.

Combine this with individuals falling for marketed drugs, playing along with unnecessary tests, and falling into the whole frame of thought of 'someone else is paying for this I might as well load up on the free goodies' and you end up with a market primed to keep exagerating itself until it collapses when fairy tale thinking has bankrupted everyone.

Should insurance companies be allowed to exist and make a profit, sure, but we need a lot more intelligent consumers and vicious competition in the product that is out there to make it work. Public health works because it breaks off all the little feedback loops that the fully private market is encouraging. We are not seeing efficiencies in the market, so the whole argument that capitalism will work... doesn't. Its actually spawning a massive inefficiency at the moment.

Then we are going to pass a bill mandating everyone get some of this coverage, most typically an individual plan which is easy for a company to ditch at the drop of a hat? It would explode! You will pay 10-15K when you are 25, 26, 27, 28... then go on public care when you are 29 because you got in a car accident and your insurance company found that you didn't properly report something that happened when you were 28 and your plan is no longer in effect. You turn 30 and you now have a potential condition because of the accident... say increased likelyhood of heart failure due to a steel bar being shoved through their chest. Every individual plan you can find is now 20-25K and will likely be cutoff around your 40th birthday, you have to pray you have employer insurance as an option and stay employed (which will die out as a benefit within the next couple of decades I am sure, if this market continues anyway).

Markets don't just magically work, particularly in the presence of government interference or simple collusion among providers. If all the companies agree to only provide certain types of contracts, that is all that will be available. Sure a company could form that offers a fair contract (say insurance from 25 to 75 at a flat, perhaps moderately high, but unchanging rate)... but it would be competing against the massive companies fed by consumer sheep who just get what has the lowest price tag this year, never mind if it will leave them high and dry ten, five, or even just two years down the road.

Even if a company did decide to enter the market, it needs to get past the government boogeyman, which is highly lobbied by the established players. Pass that, it needs to deal with the government trying to force it to sell at a certain price, or accept customers it doesn't want.

So profit as a motive for health-care is complicated to me. I honestly believe in the power of incentive mechanisms to push efficiency, cost reduction, and quality improvements (in quality of service, technology, and quality of goods used in those services). My complaint is that those mechanisms are too broken at the moment to achieve the intended effect anyway, and they need to be fixed for the profit motive to result in a successful enterprise that performs the goal everyone wants (profitable health care industry where the vast majority of people are treated).

In my opinion, it might be nice now for the people that are covered, but everything about the market design is such that even people in the middle/upper class who are capable of paying this insurance monster will get decreasingly low quality service until it all breaks down under its own weight. It turns out that the same math applies to rich as to poor in this case, if the nature of the contracts do not change such that it creates pools where people enter young and never leave... if the companies can continue to use legal tactics and contract design to create opt out points for themselves at strategic points... then inevitably we will end up with high premiums and an inability to find coverage as you age. Then the rich folk will just pay out of pocket for extremely overpriced health care that needs to keep inflating prices to stay afloat.

More likely, one of the big companies will see a massive untapped pool of customers and figure out the simple math to make it profitable, but I've found where there is an option to use government bully tactics to get easy money, most of the energy will be spent on that instead of creative thinking to make a useful product. Would you rather sweat to earn a margin or take it easy and punch people in the gut to steal their lunch money? Most big money folk choose the latter (the corporate culture these days seems to encourage it, a sort of aura of 'our customers are stupid they deserve to be screwed').

[JonInMiddleGA]

Originally Posted by flere-imsaho

I don't feel you understand the point of my argument, Jon, but I certainly won't get in the way of a good rant.

Well you did position Silver to make your argument there, and I didn't see much beyond class envy & fundamentally flawed assumptions in his piece, so maybe he didn't say what you were hoping for.

[flere-imsaho]

It's like you didn't read what I wrote after I quoted him.

In your defense, I did edit the post to add that in later, so you might have missed that.