Editore"s Note
Tilting at Windmills

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February 16, 2006
By: Kevin Drum

SELLING HEALTHCARE....Steve Benen highlights this passage from a speech on healthcare that George Bush gave on Wednesday. He was trying to explain why Health Savings Accounts are supposedly better than traditional healthcare plans:

You show up, you got a traditional plan, you got your down payment, you pay a little co-pay, but you have no idea what the cost is. Somebody else pays it for you. And so there's no reason at all to kind of worry about price. If somebody else is paying the bill, you just kind of hey, it seems like a pretty good deal.

....For many routine medical needs, HSAs mean you can shop around until you get the best treatment for the best price. In other words, it's your money; you're responsible for routine medical expenses....And so you you talk to your doctor, you say, can't we find this drug at a little cheaper cost? Or you go to a specialist, maybe we can do this a little better old Joe does it for X, I'm going why don't you try it for Y?

I met up with the New Republic's Jon Cohn a couple of weeks ago while he was in town doing research for his forthcoming book on the American healthcare system, and both of us were baffled by the same thing that baffles Steve: what makes Bush think that this approach to healthcare is a political winner? Forget the substantive arguments against Health Savings Accounts and "consumer directed" healthcare. Instead, just look at how this sells.

Current system (for those with insurance): When you get sick you go to the doctor. When your kids get sick, they go to the doctor. You don't have to quibble over costs or spend time second guessing your doctor over whether a test he recommends is really necessary. As Bush himself says, it seems like a pretty good deal.

Now here's what Bush is trying to sell: When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not.

For now, forget about the substantive arguments in this debate. Pay no attention to Bush's obvious lies that national healthcare plans in other countries routinely create long waiting times and low quality of care. Instead just ask yourself: Does Bush's healthcare vision shopping around, haggling over costs, second guessing your doctor, worrying over your decisions sound like a winner? Who does he think is going to be excited by this?

Kevin Drum 2:12 PM Permalink | Trackbacks | Comments (146)

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Comments

"Who does he think is going to be excited by this?"

That's easy, his campaign contributors!

Next question?

Posted by: Dan F. on February 16, 2006 at 2:23 PM | PERMALINK

Twiggie knows that Rocket Man in the Bay Area will absolutely love the plan. He'll be here any moment to rave about it.

Posted by: thiethirdPaul on February 16, 2006 at 2:25 PM | PERMALINK

I'm sure those trained seals that show up to hear him speak all think it's great. He could feed them a shit sandwich and they'd call it caviar.

Posted by: Ringo on February 16, 2006 at 2:25 PM | PERMALINK

"You're on your own" isn't a policy, it's an excuse for not having a policy.

But what do you expect from people who think government isn't the solution? A solution? Conservatives in government see their ideology as an excuse to not do their jobs.

Must be nice. "I'm sorry, boss, but I'm afraid that's just the discredited rhetoric of management warfare. If I actually do my job, people will become dependent on me, and that's not good for them."
.

Posted by: Grand Moff Texan on February 16, 2006 at 2:27 PM | PERMALINK

Instead just ask yourself: Does Bush's healthcare vision shopping around, haggling over costs, second guessing your doctor, worrying over your decisions sound like a winner? Who does he think is going to be excited by this?

Well, no one who has to shop, haggle, second guess and worry. But Bush wasn't speaking to them. He was speaking to the folks who can afford better healthcare for themselves and will be excited by the prospect of making it harder and harder for the great unwashed to obtain healthcare, thus maximizing profits for the industry.

Posted by: shortstop on February 16, 2006 at 2:29 PM | PERMALINK

Who does he think is going to be excited by this?

Blind worshipers at the Free Market Altar.

It solves everything, doncha know. Once the "docs" are free to practice their love, you won't need no stinkin' insurance.

Posted by: Krowe on February 16, 2006 at 2:31 PM | PERMALINK

Kevin,

This an interesting line of attack. You can almost see the bewildered couple in the attack add. "Consumer driven healthcare" sounds quite benign. The reality for the vast majority though is more likely to be "economically limitted health care"


Ralph

Posted by: Ralphnf on February 16, 2006 at 2:32 PM | PERMALINK

"Who does he think is going to be excited by this?"

The republican sycophants who treat every time Bush farts as a pronouncement from God.

Posted by: JRI on February 16, 2006 at 2:33 PM | PERMALINK

Yeah, this is the great disconnect between people who were born with everything handed to them, and everyone else.

Bush simply can't conceive of what it's like to not have enough money, or to worry about the cost of healthcare. To him, it's just another consumer good. And if it works for toasters, it ought to work for cancer treatment, right?

The "Man of the People" strikes out again...

Posted by: craigie on February 16, 2006 at 2:34 PM | PERMALINK

I would love to see some reporter ask Bush if he has EVER haggled with his doctors this way and to give an example of the great savings he achieved.

Posted by: karog on February 16, 2006 at 2:35 PM | PERMALINK

What I don't get is how it will appeal at all to people who work at Wendy's. That was a bizarre photo-op. If you work at Wendy's you can't afford to put aside money for any purpose. Is there some sort of low income entitlement in Bush's HSA plan or is he trying to sell palm seedlings to the Inuit?

Posted by: ranaaurora on February 16, 2006 at 2:35 PM | PERMALINK

Their instinct is telling them that the current system is hobbling business, and they are correct. It's just that they can't envision an alternative that replaces it. They are merely providing a way to tear down employer-provided health care with no good alternative to take its place.

Posted by: JRI on February 16, 2006 at 2:36 PM | PERMALINK

Well, Wall Street is happy with this proposal. Then Wall Street funds Republican campaigns that scoff at Democrats as weak on defense and gay-agenda liberals. Who needs good policy in this system?

Posted by: jb on February 16, 2006 at 2:36 PM | PERMALINK

This shows how out-of-touch Bush is:

>>And so you you talk to your doctor, you say, can't we find this drug at a little cheaper cost?

The answer is: No, for a patented drug that has no generic competition, you can't find a cheaper cost, unless you want to buy it from another country.

In the U.S., a patented drug is a monopoly.

Posted by: Vicki Meagher on February 16, 2006 at 2:37 PM | PERMALINK


"Who does he think is going to be excited by this?"

That's easy, his campaign contributors!

Next question?
Posted by: Dan F. on February 16, 2006 at 2:23 PM | PERMALINK

And morons. You forgot morons.

Posted by: phleabo on February 16, 2006 at 2:38 PM | PERMALINK

As a brand new father of pre-mee twins that are in Intensive Care right now - I guess I really screwed up by not "shopping around" - I made the awful decision to use the best Child hospital in my city - I must be a bad daddy.

Posted by: Robert on February 16, 2006 at 2:38 PM | PERMALINK

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

Posted by: kidkostar on February 16, 2006 at 2:39 PM | PERMALINK

This is partly just meat for the free market fundamentalists that Bush courts. You know, those people that believe with a religious fervor that there's no problem a "free market" can't solve. This argument is meant to dupe those folks (although the plan is not aimed at them, unless they also happen to be rich).

And I bet there is something of a disconnect. The "have mores," which by Bush's own admission make up his base, are often rich enough that they don't strictly have to buy insurance. A plan like this is great for them -- they a get a little tax break for some money they set aside for health care spending.

That's the most important thing to remember about Bush policy: almost everything is aimed at the betterment of the top 1%.

Bush is the reverse Robin Hood: he robs from the poor, to give to the rich.

Posted by: teece on February 16, 2006 at 2:40 PM | PERMALINK

He's appealing to people who beilieve they have high premiums because other people are wasteful. Young Republicans are frustrated that they have premums higher than their percieved annual health budget, and older Republicans likely have enough money not to care too much if they end up spending the limit on their account. It's not designed to appeal to anyone who visits a doctor, rather to people who are concerned that collective insurance helps out the sick too much at their expense.

Posted by: Miguel on February 16, 2006 at 2:41 PM | PERMALINK

Jon Cohn's book not yet listed on amazon with
a pubication date....sure it is soon forthcoming?

Posted by: Genghis on February 16, 2006 at 2:41 PM | PERMALINK

This already happens, to an extent.

The last 2 times that I went to the emergency room I subsequently received bills from various departments in the hospital. Then I got to call up various departments within the hospital and haggle over whether I actually owed the money, and what the process was if I didn't.

As far as the sell, haggling pisses me off more than any other aspect of health care. I don't get it.

Posted by: Saam Barrager on February 16, 2006 at 2:47 PM | PERMALINK

If their claim of Royal powers goes undisputed, why does anyone think that anyone would attempt to contradict their assertion that HSAs will cure our Healthcare ill?

Republican monarchy for our life time. Get used to it.

Posted by: lib on February 16, 2006 at 2:48 PM | PERMALINK

The answer is: No, for a patented drug that has no generic competition, you can't find a cheaper cost, unless you want to buy it from another country.
Not true. Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance.

That said, I still think HSAs are an absolutely stupid idea.


Posted by: Rufus on February 16, 2006 at 2:49 PM | PERMALINK

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

Outstanding!

Posted by: craigie on February 16, 2006 at 2:50 PM | PERMALINK

Does the congress have a medical savings account plan? How about the executive branch?

Posted by: Ron Byers on February 16, 2006 at 2:50 PM | PERMALINK

Bushco will never pass a significant piece of "meat and potatoes" legislation before he's done. He failed miserably with SS reform. This, too, will die a slow, annoying death as well.

As long as there are sufficient first term birds coming home to roost (or sitting on the the shoulders of the VP's close friends) nothing significant will change. This is typical of second terms in general, even those without lots of baggage from the first. Bushco, however, looks like an overburdened skycap cum shopping cart pushing street person.

Posted by: Jeff II on February 16, 2006 at 2:51 PM | PERMALINK

It's wonderful, wonderful.

I can see the ads now.

"It's Discount Days at Bob's Mammary Shop. You get BOTH TITS enhanced for the price of one. And if you agree to use our DISCOUNT TIT FILLER, you can get 3 FOR THE PRICE OF ONE - you provice the third tit !!!"

Yes, medicine will soon be the same as car sales.

Isn't this what we had in the 19th century?

Posted by: POed Liberal on February 16, 2006 at 2:51 PM | PERMALINK

Specialists will love this plan. Nobody will spend money on regular checkups and preventive medicines, so people will get sicker and specialists will have more patients.

Posted by: reino on February 16, 2006 at 2:52 PM | PERMALINK

Kevin, Bush's statement is exactly the sort of thing you'd expect a "regularly guy" that you'd "like to have a beer with" would say!

But, yeah, echoing the observations of the other posters, this is Bush's awkward attempt at trying to tell voters that the blame for high premiums lies with other patients who are asking for too much health care. After a few more refinements of the message, Bush will explain, more clearly, that other people are the ones who need to pay more attention to how much things cost, not those to whom he is speaking.

Posted by: Constantine on February 16, 2006 at 2:52 PM | PERMALINK

This is Kabuki. Bush knows HSAs are going nowhere, but he must provide the public with "the illusion of due diligence" (my favorite quotation from "Syriana") in attempting to improve health care. Having so provided, he will then blame the Dems for blocking his "solution".

Only problem is, while his brain dead legislation waits for congress to pull its plug, he has to have some sort of sales pitch, however lame. And this is the best he can manage.

Posted by: penalcolony on February 16, 2006 at 2:53 PM | PERMALINK

As a brand new father of pre-mee twins that are in Intensive Care right now - I guess I really screwed up by not "shopping around" - I made the awful decision to use the best Child hospital in my city - I must be a bad daddy.

Good luck. My twins just yesterday turned 16. Both learning to drive, or not as the case may be, at one time.

Posted by: POed Liberal on February 16, 2006 at 2:54 PM | PERMALINK

Amazing -- I didn't think it could happen, but Bush's arguments in favor of HSAs quoted here are so blatantly idiotic and self-defeating that not even the trolls are out on this board defending them.

I'm sure they'll be revising Bush's script on this *very* quickly. But to what?

Posted by: Steve on February 16, 2006 at 2:56 PM | PERMALINK

There are 2 ways to sell it:
1) Use language like "shop around for the best price" and "more control over your health care dollars" and people will think it will save them money and that it's a good idea. I've already heard my local TV news refer to the plan as "giving consumers more control".

2) Explain that by reducing unnecessary demand for healthcare, healthcare costs will drop. This could even be true, although it's obviuosly an idealized model.

Here's a better question: why do lieral's oppose epanded HSA's? They would be a financial benefit to a large number of people. Just because it's not national health care doesn't mean it's a bad idea

Posted by: Tom on February 16, 2006 at 3:00 PM | PERMALINK

It is expected, I suppose, that the professional Bush haters will jump on yet one more opportunity to argue like headless chickens over a well-thought out plan to save our healthcare system from utter ruin just because the plan is being proposed by George W. bush.

Posted by: tbrosz on February 16, 2006 at 3:00 PM | PERMALINK

"Who does he think is going to be excited by this?"

Dan F has it right in the first post. Bush's base is excited, and his base is the "have-mores," as teece pointed out.

Executives with a tax-free account they can pump money into will be excited about it.

And unlike current retirement accounts, which are tax-postponed, these news HSA's will not be taxed going in OR coming out. AND at some point it can come out for any old thing, not just health care spending.

And incredible drain on the fisc--just what Bush and his have-more base love.

And a shoutout to kidkostar for the vision of Cheney shopping around for the best price for Whittington's health care!

Posted by: Cal Gal on February 16, 2006 at 3:01 PM | PERMALINK

Not true. Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance.

Costco has really good prices on prescription drugs (usually at least $20-$30 less) and, in California, you don't have to be a member to use their pharmacy.

That is one of the secret things drugstores don't tell you: if you're uninsured, they don't all have the same price for prescription drugs.

But it gets real old real fast having to call around to every pharmacy in town to price-compare and decide if it's worth driving 10 extra miles to save an extra $5. I was doing it for non-urgent stuff, like rosacea medication. I can only imagine trying to price-compare your asthma medication when you're in the middle of an attack.

Posted by: Mnemosyne on February 16, 2006 at 3:01 PM | PERMALINK

Anybody else notice Kevin Drum has no alternative to offer?

As long as Drum and the rest of the Pelosi/Reid/Kennedy/Dean Democrats sit on the sidelines and whine about Bush's proposals, the Dems will continue losing elections.

Posted by: BigRiver on February 16, 2006 at 3:02 PM | PERMALINK

We should call it the "shopping while vomiting" plan.

Posted by: Josh Yelon on February 16, 2006 at 3:02 PM | PERMALINK

Rufus said:

"Drugstore.com almost always has cheaper prices than your neighborhood drugstore. Canada has yet cheaper prices if you're willing to take a little risk. I know--I've been shopping around for cheaper drugs for a few years now, sans health insurance."

I too was shopping around for cheaper drugs for my mother. And I didn't much difference at all for patented drugs in the U.S. Generic drugs, yes. Patented drugs, no.

I ended up buying them from Canada. Patented drugs were quite a bit cheaper from Canada.

Posted by: Vicki Meagher on February 16, 2006 at 3:03 PM | PERMALINK

The reason W would be pursuaded by his handlers that this is a good idea is because he has no life experience. None. His handlers take advantage of the fact that George has never seriously considered retirement income, catatrophic health coverage, access to education (vouchers! there's a solution ins earch of its problem!), mass transit, military service, or even belonging to the PTA or attending church. He simply doesn't do any of these things, and never has.

John K. Galbreath has written that the children of the leisure class are by definition more stupid than their parents because they don't have as much life experience, and George W. is 4th generation stupid! On top of that, being raised by Barbara in a family with an absent father, he also has no empathy. He can't imagine anyone else being concerned about these things either! The only things he knows about real life is what people tell him. He's surrounded by people who lie, so he repeats the lies not knowing--not having any way to know--if they're true.

Posted by: W Action on February 16, 2006 at 3:11 PM | PERMALINK

Little Creek:

"Anybody else notice Kevin Drum has no alternative to offer?"

Basic public choice theory: the alternative to any policy proposal is the status quo.

In this case, allowing employers to deduct (most of?) the cost of providing health care to employees from the employer's taxes.

Thanks for playing. It's not like the president has this WHOLE NEW BIG IDEA - people should see doctors!

Posted by: Arr-squared on February 16, 2006 at 3:11 PM | PERMALINK

I know how to get my drugs cheaper....order from Canada.

Oh wait, they are not taking my shipments before they come across the border.

What an ass he is.
There is no way to lower your drug prices, except to get them somewhere else. Unless you have medicare partD. I hear they are charging more than Drugstore.com for some drugs. And that prices went WAY up when these private plans started.

Bush is hazardous to Americans' health.

Posted by: lilybart on February 16, 2006 at 3:12 PM | PERMALINK

I have to admit I don't even know how much many of the tests and drugs I am ordering for patients cost. You'd think that information would be easy to get, but it's not. In a busy urban ER, my job is to exclude life-threatening problems, and to discharge everybody else (95%) as quickly as possible. I do not have time to listen to social concerns, personal problems, or any complaints that can be managed by a primary doctor. To counsel a patient about his or her financial decisions would simply break the system.

Posted by: Bad Shift on February 16, 2006 at 3:12 PM | PERMALINK

"Here's a better question: why do lieral's oppose epanded HSA's? They would be a financial benefit to a large number of people."

Because "HSAs for some and normal insurance for others" will drive the young and healthy into HSAs, which means the "normal insurance" group will consist of the sick and the elderly. Which kind of defeats the risk-sharing purpose of health insurance.

Also, because HSAs encourage people to cut health care costs whenever possible, and people are notoriously bad at figuring out what preventative care is cost-effective, one likely outcome of HSAs is that massive numbers of people will skip physicals, blood tests, etc. Meaning a lot more of them will get sick than currently do.

Posted by: Joe on February 16, 2006 at 3:12 PM | PERMALINK

The current plan: we all pay through a system of distributed risk-management, and I get health care whenever I'm sick.

Bush's plan: whenever I feel sick, I have to make several phone calls, get put on hold by doctors, pharmacies and insurers for hours on end, and pay for it myself. "It's your money, you're responsible for routine medical expenses" -- meaning that if I don't have enough money, those routine medical expenses will go unmet.

You're right, it does sound tempting when you put it that way....

Posted by: Stefan on February 16, 2006 at 3:13 PM | PERMALINK

HSA's could be a useful means of acquiring healthcare,just not here. Try calling around to various hospitals in your area (assuming there's more than one) and ask for a price quote for,say, a liver screening. After you've been told that the hospitals don't know what that test costs because it depends on which insurance you have,you'll have some idea of the problems with HSAs.
To implement them,the currently hidden process of bulk negotiation with a limited # of insurance plans,will have to devolve to a process of individualized negotiating which hospitals,labs and doctors will view as necessitating a quote sheet. The trouble is hospital cost accounting really can't handle that level of detail.
What sort of intermediary will such a market require?
HSAs will be a great idea for fund managers,a potential nightmare for providers and users.

Posted by: TJM on February 16, 2006 at 3:13 PM | PERMALINK

I understand this is a simplistic statment. The average saving rate in 4th quarter 2005 was negative -0.07 per cent, where will the monies come from to fund this.

Posted by: Neo on February 16, 2006 at 3:15 PM | PERMALINK

BigRiver: No Alternative?

Choice #1 is the clear winner -- Bush's Alternative #2 sucks toilet water compared to the do-nothing alternative.

The alternatives offered by the other industrialized contries are better, as Kevin has pointed out.

People like medicaid, medicare, and social security -- they need fixing and expansion to cover the people that have been paying for them and relying on their continued exisitence since their inception.

What's wrong with single-payer? Is it just that it doesn't appeal to those who Bush is targeting?

Posted by: Fnord on February 16, 2006 at 3:17 PM | PERMALINK

Health care is one area where the "heavy hand of government" makes so much more sense than "free market solutions" (although Bush and his cronies don't really believe in truly free markets).

This idiotic HSA idea, pisses me off, because it is based on several flawed assumptions, including:

(1) That all human behavior is predicated on what the tax consequences of that behavior are. In other words, people will change their behavior because it helps them save a little on taxes [FOOLISH].
(2) That people working at Wendys and the like have one single dime to put away for their health care [FOOLISH]. As craigie and others have pointed out, the poor don't save money, because they don't have any left to save after they pay their bills!
(3) That the health care crisis in this country is caused by people seeking routine medical treatment (e.g. check-ups, flu, minor injuries, etc.) [FOOLISH] Health care costs are astronomical due to the heroic and extremely expensive costs related to children in the first six months of their life and old people in the last six months of their life. Take out those costs, and we do not have a crisis.

A lot of this gets down to moral and ethical questions that Bush and his ilk refuse to address: Do we spend millions to keep very premature babies alive? Do we spend millions to give an 80 yr. old man a heart transplant? Do we spend millions to keep brain dead people like Terri Schiavo alive indefinitely?

Until we honestly confront these difficult decisions, the costs of health care in this country are going to be a big, big problem. It's very, very easy for the far-right to take the simple-minded position of saying "all life is sacred" (unless you happen to be a Muslim, of course) and walk away and let society figure out how to pay for keeping human beings alive that 100 years ago would have died a natural death. Any damn fool can do that. We need to be asking ourselves - "Who do we allow to die, when the costs of keeping them alive are prohibitive?" This is the sort of thing we need to be talking about - not about whether I can get a tax break on the $1,000 that I squirrel away to pay for my Lasik surgery.

Posted by: Stephen Kriz on February 16, 2006 at 3:18 PM | PERMALINK

Now here's what Bush is trying to sell: When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not.

I'm not sure that I understand this the same way as Kevin suggests.

If there was some financial incentive involved, I could choose to use a medical clinic (or whatever the correct term is for those "chain" medical offices surrounded by a parking lot) instead of a private doctor for selected types of medical problems.

I could choose to buy prescriptions from a Costco or Walmart if I knew that I was saving money (today I pay the same copay regardless of where I buy scrips).

Similarly, I might choose to defer certain types of tests if it meant I could pocket the money saved.

So, bottom line, if there were a financial incentive for me personally to make choices, I MIGHT make those choices. But, under my current insurance system, there is no financial incentive for me to consider doing so.

These types of choices seem much less complex than the scenario that Kevin suggests.

Posted by: pencarrow on February 16, 2006 at 3:21 PM | PERMALINK

this is the exact same pitch my employer gave us when they announced the 2006 health plan.

we get an HSA that we get to spend away before a standard insurance plan kicks in. the insurance is actually a high-deductible plan, but the HSA (which is funded by the company) counts against that deductible - so we don't actually pay the deductible out-of-pocket. oh, and it costs more than last year's plan. and given the trend, i expect that next year the HSA will be smaller and we'll be stuck picking up more of the deductible.

anyway, they used the exact same terms: this HSA gives us control over our own spending, choice about our healthcare, the ability to make decisions. i was awe-struck, listening to the presentation; i kept thinking: why the fuck do i want to have to shop around for the cheapest surgery i can find? why do i want to have to worry about pricing doctor's visits? why do i want to tell the doctor which lab he has to use to process my bloodwork? why is any of that better for me than paying my co-pay and walking away ? hell, if i'm going to have to do all that, what's the point of having insurance anyway?

i might as well opt-out completely and just buy my own HSA and high-deductible policy, just like what W is pushing. funny how that works...

Posted by: cleek on February 16, 2006 at 3:21 PM | PERMALINK

It sounds exactly like the Medicare drug benefit plan, which I am wading through, trying to find the best policy for my mother with Altzheimer's. And let me tell you, it's a hum dinger.

He can't see that this isn't attractive because
1) he knows nothing of personal responsibilty having been handed everything since his upper-class birth
2) he is incapable of empathy

Posted by: mrs thompson on February 16, 2006 at 3:24 PM | PERMALINK

Ignore the 'cheaper doctor' aspect. The rest sounds good to Bush and his cohort because shopping around is how they do health care. If they need angioplasty or a bypass, they call their friend the doctor or someone who's been through it and ask "Who's the best?", and "What new treatments should I ask for?".

If their kid is born with a serious problem, they call on their network of acquiantances to find the best doctor in the country and take their kid to her.

And when they think about health care, they can't believe that most people just go to the first doctor and follow the doc's recommendations. Ordinary people don't have the initiative and market sense to find the best health care. Not everyone can have the best doc, of course, but ordinary people could use the same approach to find the *cheapest* treatment...

Posted by: Jim Lund on February 16, 2006 at 3:27 PM | PERMALINK

Who does he think is going to be excited by this?

Insurance companies -- you know, the ones that torpedoes Clinton's health care proposals (to which, let's not forget, the Republicans felt no obligation to offer an alternative).

Posted by: Gregory on February 16, 2006 at 3:31 PM | PERMALINK

Similarly, I might choose to defer certain types of tests if it meant I could pocket the money saved.

You might, but, humans being the notoriously poor risk-assessors that we know they are, especially when it comes to their own health ("who, me? I'll never get lung cancer!") the most likely outcome of this will be that you will indeed get sick, but you'll catch it much later than if you'd gotten the early tests and therefore you'll be much sicker and your treatment will cost much more in the long run. So yeah, you'll save the hundred bucks for the test, but you'll pay $100,000 for the operation and hospital stay. It's the ultimate save a penny, lose a pound scenario.

Posted by: Stefan on February 16, 2006 at 3:34 PM | PERMALINK

Stefan: So yeah, you'll save the hundred bucks for the test, but you'll pay $100,000...

No, everyone in whatever insurance group will pay the $100,000. That is why what seems like a good idea to save money from an individual's point of view actually ends up costing all of us money. The inability to look at the effects of individual decisions on group is the common failure of thinkers(?) like GWB.

Posted by: patrick on February 16, 2006 at 3:39 PM | PERMALINK

"Who does he think is going to be excited by this?"
Answer: Republican MBA students without families who believe they will never get sick.

Posted by: BigRed on February 16, 2006 at 3:39 PM | PERMALINK

No, everyone in whatever insurance group will pay the $100,000.

Yeah, assuming your insurance will even cover that procedure. If not the hospital will bill you directly and, when you can't pay, eventually the cost will be passed along to all taxpayers.

Posted by: Stefan on February 16, 2006 at 3:47 PM | PERMALINK

Republican MBA students without families who believe they will never get sick.

Uh, I think phleabo already mentioned them.

Good thing our troll showed up to remind us that there is at present no system of any kind to deal with this problem and that Bush is the first to deal with it.

Man, what a leader!
.

Posted by: Grand Moff Texan on February 16, 2006 at 3:47 PM | PERMALINK

I think HSAs will replace employer provided health insurance just like 401ks replaced pension plans. For many of the same reasons. And businessmen were a driving force behind the changes.

I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense.

Posted by: Chad on February 16, 2006 at 3:47 PM | PERMALINK

Who does he think is going to be excited by this?

People who want to keep a little of their own money and retain a little more control over their own lives.

Middle class swing voters, perhaps.

Posted by: republicrat on February 16, 2006 at 3:48 PM | PERMALINK

Somebody asked why liberals are opposed to improving HSAs. I am a liberal, and I am not opposed to improving them. I am opposed to thinking they are the solution to the healthcare crisis.

If we do nothing, more and more of you are going to find yourselves with HSAs. You will want the improvments.

Posted by: Ron Byers on February 16, 2006 at 3:51 PM | PERMALINK

So he wants to make shopping for a proctologist just the same kind of fun, rewarding experience we all enjoy when it's time to buy a new car? And he thinks we're going to see that as a good thing?

Posted by: DaveL on February 16, 2006 at 3:52 PM | PERMALINK

This argument doesn't even make sense on its face. Individual consumers are not going to drive down health care prices negotiating individually. The only chance of driving down costs would be through collective bargaining strategies and I am quite sure that is something to which Republicans will be manifestly opposed.

Posted by: brent on February 16, 2006 at 3:53 PM | PERMALINK

Chad, I wouldn't want a bypass surgery operation even if I knew it were free. Poor health can incapacitate someone, force them to miss work while they undergo an operation and cut their lives short. The Bush-supporters are saying, "but what they really need to face is the prospect of bankruptcy. That will convince them to exercise more and watch their cholesterol."

Posted by: Constantine on February 16, 2006 at 3:54 PM | PERMALINK

Chad, I wouldn't want a bypass surgery operation even if I knew it were free. Poor health can incapacitate someone, force them to miss work while they undergo an operation and cut their lives short. The Bush-supporters are saying, "but what they really need to face is the prospect of bankruptcy. That will convince them to exercise more and watch their cholesterol."

Posted by: Constantine on February 16, 2006 at 3:56 PM | PERMALINK

Of course employers will love to have all of their employees "take personal responsibility" and buy into their own HSAs.

Stefan,

Actually I believe that Mary M, Cheney's aide, did check for cheaper hospitals. However, they were limited. Outside of Christus Spohn Memorial, there is a Children's Hospital. But the one they wanted and which was the cheapest, Banfield, was closed on weekends. However, their PetSmart store was open.

Posted by: thethirdPaul on February 16, 2006 at 3:56 PM | PERMALINK

So he wants to make shopping for a proctologist just the same kind of fun, rewarding experience we all enjoy when it's time to buy a new car?

yeah, we'll all drop by the Dr's office to look around, inspect their glove and swap supply, talk to the staff, hang around "just looking" for an hour or two, maybe give the 'scopes a test drive. we'll do this at three or four doctors' offices before deciding we'll just skip it until next year.

Posted by: cleek on February 16, 2006 at 3:56 PM | PERMALINK

"This is Kabuki. Bush knows HSAs are going nowhere, but he must provide the public with "the illusion of due diligence" (my favorite quotation from "Syriana") in attempting to improve health care. Having so provided, he will then blame the Dems for blocking his "solution".

Only problem is, while his brain dead legislation waits for congress to pull its plug, he has to have some sort of sales pitch, however lame. And this is the best he can manage. "

HSAs are already law. An HSA is coming to your company soon. You guys missed the debate on this one.

Posted by: Chad on February 16, 2006 at 3:57 PM | PERMALINK

Cleek and others are correct. While this is an idiotic plan, it appeals exactly to those who are convinced that a great swarm of the vast unwashed are driving up their costs of everything. It appeals to all the young people who say that social security is immoral because you have an obligation to save for your own retirement and that no one owes you money.

It's use of choice and empowerment language is the same sort of appeal used by adverts that do the 'you make the call' or 'take control' riff. And it appeals to the idea that you are smart and you can find a deal that other's can't so you will get a leg up on others cause you found the best deal.

I've seen this thinking at work. My son-in-law is absoluely convinced that if he spends money on discount CD's he is better off financially than if he doesn't buy any at all. He counts up savings as profit to himself. And ignores the cost.

Posted by: JohnN on February 16, 2006 at 3:57 PM | PERMALINK

s/swap/swab/g

Posted by: cleek on February 16, 2006 at 3:58 PM | PERMALINK

As usual--

us libruls say "this plan will fuck us."

Chad says, "No it won't."

us libruls say "Chad, you are full of it" and proceed to show him why.

Chad says "Too bad, you're fucked anyway" and imagines this means he won the argument.

Why am I not surprised???

Posted by: Dr. Uncle Cap'n Mr. Goto-san on February 16, 2006 at 4:00 PM | PERMALINK
It is expected, I suppose, that the professional Bush haters will jump on yet one more opportunity to argue like headless chickens over a well-thought out plan to save our healthcare system from utter ruin just because the plan is being proposed by George W. bush.

Nope, that's just icing on the cake.

If I'm seriously ill, I want the quality of my healthcare and treatment to be the most important considerations -- not bargain-hunting!

OTOH, if YOU'RE seriously ill... knock yourself out shopping at Eazy Bob's Cheapo Health Mart.

(headless chickens argue? must be a side effect of the bird flu. makes 'em cranky.)

Posted by: webmacher on February 16, 2006 at 4:03 PM | PERMALINK

Stephen Kriz at 3:18 p.m.

I usuallly don't find much on which to agree with you, but your comment, about where a lot of the costs/inflation arise, is dead on; and it isn't just the right that refuses to deal with this reality honestly. Almost no one wants to face up to the fact that any public/private healthcare system will have to ration healthcare to actually reign in the costs. Indeed, many commenters here, with a straight face I assume, promise that universal healthcare will provide most everyone with at least the level of healthcare they receive today, while providing that same level of coverage to all of those who did not have health coverage before, while at the same time reducing the % GDP consumed down to the level of that of Canada.

No one really wants to face reality- to control the cost escalation, someone will have to have healthcare withheld from them.

Posted by: Yancey Ward on February 16, 2006 at 4:04 PM | PERMALINK

Someone somewhere pointed out that the campaign ad writes itself: "Bush thinks the problem is that you have too much insurance and it's too easy for you and your children to see a doctor. If you agree, vote Republican."

Many of the reasons people are correctly giving as to why this is a bad idea also apply to school voucher programs.

Ted

Posted by: Ted on February 16, 2006 at 4:06 PM | PERMALINK

I have no problem with bargain hunting or getting the best deal on medicines. I simply acknowledge the reality that insurance companies are best-suited to make these negotiations. That is, after all, what I pay them for-- so that they, not I, do the legwork necessary to agree who will get paid how much and when. They have more buying power than I do.

Yancey, having "healthcare withheld" is sort of a loaded term. When I need an operation or I'll die and I don't get it, that's a matter of health care being "withheld." When my insurance company says that they'll pay for a procedure that is known to work but will only partially cover a procedure that has no overall benefit for patients who go through it, that's not having health care "withheld" from anyone.

Posted by: Constantine on February 16, 2006 at 4:11 PM | PERMALINK

I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense.

Except, of course, that all statistics show that other comparable modern societies that have universal care (basically everyone besides us) live healthier lives and enjoy greater health than we do (when measured by such factors such as infant mortality, life span, incidence of obesity and heart disease, etc.), and for much less than we spend, to boot. But why drag facts into it....

Posted by: Stefan on February 16, 2006 at 4:12 PM | PERMALINK

This is such a stupid idea.

Normal people are going to haggle with their doctor? Rich sons of bitches might do that, but normal people will not. Doctors are respected--you think people who trust a man with their life and their kids' lives are going to be comfortable saying to him, "oh, by the way, I think you're ripping me off."

Americans don't like to haggle to begin with. You think we're going to treat doctors like we treat car salesmen? You think people are going to want to? You think doctors are going to let them?

Man, these ads are going to ROCK!

Posted by: theorajones on February 16, 2006 at 4:21 PM | PERMALINK

"When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not."

Where does he live? That's what most people have to do now. It's called "managed care." Only people with the more expensive PPOs get sick and "just go to the doctor." Everyone else has to get a referral and a permission slip.

The Bill/Hill. plan of the 90s was criticized because, God forbid, the GOVERNMENT was going to be making clinical decisions. Well, guess what, instead we've got INSURANCE EXECUTIVES making clinical decisions.

Bush should just stay home and keep making those speeches about terrorists. It's the only thing he's had any success with. (The speeches, that is, not the terrorists).


Posted by: allie on February 16, 2006 at 4:27 PM | PERMALINK

Here's MountainDan on the Iran thread:

Anybody surprized Kevin Drum doesn't take a stand on Iran's nuclear program??

Kevin Drum is the mirror image of the Pelosi/Reid/Kennedy/Dean wing of the Democratic party. Never lay out an agenda. Never take a stand that requires courage. Use any and all events to point out Bush's failures.

And here's BigRiver, on this thread:

Anybody else notice Kevin Drum has no alternative to offer?

As long as Drum and the rest of the Pelosi/Reid/Kennedy/Dean Democrats sit on the sidelines and whine about Bush's proposals, the Dems will continue losing elections.

I report, you decide.

Posted by: Alek Hidell on February 16, 2006 at 4:30 PM | PERMALINK

Stefan,

No one has really shown that the healthcare system is the cause of Americans' poor diets. I still don't see how universal healthcare is going to stop people from stuffing themselves every Friday night at the steakhouse, or eating lunch every day at McDonalds.

Posted by: Yancey Ward on February 16, 2006 at 4:31 PM | PERMALINK

Yancy, I don't pretend that a single payer health care system is going to solve all the problems, but I do think it has a better chance of managing the problem of rationing in the future. Sure: care will be rationed. There are limited healthcare workers and an aging population, not everybody is going to get a million dollars worth of quadruple bypasses and replacement joints. I do want everybody to get casts for broken bones, and HSAs do absolutely nothing to help that, and in fact hinder it by separating the risk pools.

The people who will always be able to choose and afford the insurance that will cover a bypass or hip replacement want out of the risk pools of people that will need to go to the ER to for basic care, and HSAs are a mechanism to do just that.

Posted by: Fnord on February 16, 2006 at 4:32 PM | PERMALINK
Almost no one wants to face up to the fact that any public/private healthcare system will have to ration healthcare to actually reign in the costs. Indeed, many commenters here, with a straight face I assume, promise that universal healthcare will provide most everyone with at least the level of healthcare they receive today, while providing that same level of coverage to all of those who did not have health coverage before, while at the same time reducing the % GDP consumed down to the level of that of Canada.

Well, since most evidence suggests that's true, unless Americans are just nationally incompetent at delivering healthcare (a possibility that I suppose can't be ruled out), that's a perfectly reasonable thing to suggest.

The particular hybrid system the US has is, by every evidence, incredibly cost inefficient compared to almost every other system in the developed. So there is no reason to believe that a system could be designed which would both improve service availability and decrease total costs.

You seem to assume that all systems must be equally efficient so that any reform is zero-sum. This assumption is contradicted by all evidence available.

Posted by: cmdicely on February 16, 2006 at 4:33 PM | PERMALINK

"old Joe does it for X"

Wall, uh gyiss I'd go with ol' Joe, he does it fer me. Cuz X were a great band, as I recall. An he has jus the purtiest way a puttin' things.

Posted by: cld on February 16, 2006 at 4:34 PM | PERMALINK

Yancey:The argument made by most proponents of a single payer system, is that you can easily lower the % of GDP spent on health care through the elimination of duplicate beauracracy. From speaking to people who have actually worked with the current framework, I have no doubt that this argument is correct to some degree. Will it be enough? I don't know. Although I think a combination of eliminating the paperwork combined with a national malpractice insurance program should keep costs under much better control than they are currently.

Posted by: Karmakin on February 16, 2006 at 4:36 PM | PERMALINK

"I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account. If we don't get people living healthier health care will be a huge expense."

Funny how countries with universal health care have healthier populations than countries without it though. It's as if you assumptions aren't valid.

Posted by: jefff on February 16, 2006 at 4:41 PM | PERMALINK

You nailed it, Kevin.

Posted by: TuiMel on February 16, 2006 at 4:42 PM | PERMALINK

Lately I have been very careful about being sure that doctors write my prescriptions carefully to maximize reimburements under my coverage. It can make a big difference in your cost- the amount you order at a time, for what period of coverage, right to substitute generics, etc.

Generally, I've found that doctors don't really want to be bothered with this and I have to make myself a bit of a pain-in-the-ass to get them to do it. And its the busy doctors themselves who you have to deal with. Nurses, assistants, etc. usually can't write prescriptions or make any significant medical decisions.

How many people are really going to be confortable negotiating the little financial details of their medical treatment with their doctors. Not many, I'll wager.

Posted by: wvmcl on February 16, 2006 at 4:43 PM | PERMALINK

watch the angles.

we already know bush is in the pocket of the health insurance industry and the pharma industry. he's not going to seriously back anything that risks reducing revenues for either of those backers.

so what's he really doing? is he replacing serious health care reform with a straw dog? or is there a wrinkle to this we haven't seen yet?

Posted by: jm on February 16, 2006 at 4:44 PM | PERMALINK

I do like the idea of the commercials...

After all the haggling, I sure hope I don't get a lemon.

Or maybe I can talk the doctor into taking $10 for writing me a scrip without an office visit.

Or maybe if I hold him to his $50 quote for fixing my sore shoulder, he will do a good job of setting the unforseen broken collarbone.

And how is it going to work from the doctor's side?

A prix fixe menu of potions and services?

Are they going to spend time on the other side of the haggling? Or $20 bucks gets you 5 minutes and an aspirin, $50 gets you other, think of what a hundred would do?

Posted by: Fnord on February 16, 2006 at 4:52 PM | PERMALINK

Bringing the market back into the public/private dog's breakfast that's our current system was something that should have been dealt with years ago.

IMO, health savings accounts in their current form aren't really going to do it. Too little, too late. The key would have been making it easier at the beginning to find insurance outside your employer.

Personal health insurance should have been made completely tax deductible thirty years ago. Even now, this would help. I'm self-employed, and health insurance costs became fully deductible in the past few years. Give an employee a reasonable option to buy his own insurance compared to what the company offers and then you'll have something. Not an easy thing to do, since companies get all kinds of price breaks not open to individuals.

In any case, you should be "shopping" for insurance, providers, and health plans before the fact, not after. You look for family doctors, treatment centers, and drug plans before you get sick, not after. If health savings accounts work for this, fine, but I don't know if they do as currently envisioned.

Government health care, where the market is completely removed from the system as far as the consumer is concerned, sounds great. But Yancey has it right. The inevitable result of unfettered demand and limited supply will be rationing and price controls.

If putting everyone on the same mediocre level of "good enough" care is better than excellent care for some and no care for others, fine. Maybe you can make a good case for that. But let's not pretend that we're all going to be getting all the high-tech and cutting edge health care goodies we want for nothing while costing the providers less than they charge now.

Posted by: tbrosz on February 16, 2006 at 4:52 PM | PERMALINK

"Except, of course, that all statistics show that other comparable modern societies that have universal care (basically everyone besides us) live healthier lives and enjoy greater health than we do (when measured by such factors such as infant mortality, life span, incidence of obesity and heart disease, etc.), and for much less than we spend, to boot. But why drag facts into it...."

"Funny how countries with universal health care have healthier populations than countries without it though. It's as if you assumptions aren't valid."

But did they get healthy after the universal health care or are they the type of people who will complain about genetically modified foods and pay more to eat well. If you know everyone is healthy for the most part, then you are less resistant to instituting healthcare for all.

Posted by: Chad on February 16, 2006 at 4:54 PM | PERMALINK

Nobody's excited about Bush's plan, but we'll be seeing them written into the budget shortly, if it hasn't already been done. It's Bush's way to futher save the insurance companies.

Posted by: pol on February 16, 2006 at 4:55 PM | PERMALINK

"I still maintain that the biggest benefit is in giving people an incentive to live healthier lives. That's what universal care doesn't seem in my view to take in account"

That make no sense. The poorest people in American society, those with the least access to health care, are more likely to be obese and to be smokers. Wealthy people with the most access to good, comprehensive health care are also the most likely to be slim non-smokers who eat nutrient-dense food such as vegetables and exercise regularly. Gee, you could almost conclude that the ability to afford health care inspires people to live healthier lives!

Posted by: jaybee on February 16, 2006 at 5:03 PM | PERMALINK

But did they get healthy after the universal health care or are they the type of people who will complain about genetically modified foods and pay more to eat well. If you know everyone is healthy for the most part, then you are less resistant to instituting healthcare for all.

After Chad, after. This is everyone in Western Europe, everyone in Canada, everyone in Japan and Australia and New Zealand -- the poor, the working class, the middle class, the rich. Or are you asserting that everyone in those countries are the sort to "pay more to eat well" while Americans are lazy half-assed swine? Is it really your argument that Americans are weaker than those other countries?

Posted by: Stefan on February 16, 2006 at 5:12 PM | PERMALINK

Maybe we should adopt the "Cheney's Run" health care plan instead -- get to 78 and we shoot you. Saves on all that life-prolonging technology.

Posted by: Stefan on February 16, 2006 at 5:14 PM | PERMALINK

The liberals on this thread who think nothing will come of the HSA initiative are very wrong. They will replace employer-funded insurance. As another poster pointed out, it will be just like the move from pensions to 401Ks. If Bush's proposals get passed, all it means is that people will have better HSAs.

This is going to be reality, so you better get used to it. And those who think people won't buy into it are wrong. People have accepted their pensions disappearing, and they'll accept this. It'll be marketed as consumer choice, taking personal responsibility, and stopping others from exploiting the health care system. And America will respond to that language. And in any case, most people won't have a choice.

Posted by: Tom on February 16, 2006 at 5:48 PM | PERMALINK

Well, at least now you know what happened during the 14 hours Cheney waited to report his shooting. He was shopping around for the cheapest treatment for his seriously wounded pal.

Brilliant.

Posted by: Leslie on February 16, 2006 at 6:03 PM | PERMALINK

"BigRiver" is an insult to a great Johnny Cash song.

Posted by: brewmn on February 16, 2006 at 6:07 PM | PERMALINK
But Yancey has it right. The inevitable result of unfettered demand and limited supply will be rationing and price controls.Posted by: tbrosz
Except that, for some strange counterintuitive reason, that isn't the case in any country having single-payer health care. It is just another case of the "inevitable" conclusions of RepubliConTarian ideology not being the case. Why don't you try empiricism and pragmaticism, or are you inherently biased against empirical results? Posted by: Mike on February 16, 2006 at 6:21 PM | PERMALINK

If putting everyone on the same mediocre level of "good enough" care is better than excellent care for some and no care for others, fine.

Most countries with single-player have a private system running in parallel. People can purchase health insurance to receive benefits of both systems. I live in Australia, and got my knee ligaments fixed at a clinic that treats Olympic athletes and professional sportspeople from around the world. And I didn't pay any more than my $80 or so a month health insurance.

And if the top level of healthcare is poorer in these countries, prove it. The statistics showing the advantages of single-payer have been shown plenty of times; show us a comparable set of statistics showing its disadvantages. Otherwise, you're just blowing hot air.

Posted by: Shinobi on February 16, 2006 at 6:31 PM | PERMALINK
Except that, for some strange counterintuitive reason, that isn't the case in any country having single-payer health care.

That's not entirely true. Single-payer countries have "rationing" and "price controls". So, of course, do countries with other systems. Its just a matter of what method exists to allocate limited resources and set the price.

Ultimately, Yancey and tbrosz are arguing the "government intervention is always inefficient" line, even though the features which, in theory, make "free markets" efficient are notably lacking in the healthcare field, and, further, the empirical evidence shows that single-payer systems are more efficient.

But its an article of faith with them, so facts that contradict it are lies invented by the devil (or, in this case, "liberals") to mislead the faithful. Its no more rational than Young Earth Creationism.

Posted by: cmdicely on February 16, 2006 at 6:36 PM | PERMALINK

Can't you see the counter:

"So Little Timmy had a headache and a fever. We didn't want to spend more than we had to so we shopped around, found a doctor and saved about $10! He told us we needed some tests and we looked around some more, finding a place to do it for 25% less than the doctors quote about a week later. The tech told us Timmy had an earache but the doctor was busy and couldnt see our son for another week. We asked the doctor for some kind of help and the doctor proscribed some penicillin. We looked for the best price for the 20 pills the doctor said he would need, and we waited 3 more days to get a good deal from the Presidents Day sales. Camera pulls back, a hospital bed with a small child hooked up to every machine know to man. The doctors at the emergency room told us yesterday that the minor infection that could have been treated with a single shot 2 weeks ago, now they tell us that it has become spinal meningitis. Timmy may never walk again. All unnecessary if we hadnt wasted time having to look for good prices or had a decent medical plan. Camera closes on the father again. The visit to the emergency room also wiped out our entire Healthcare Savings Account, and were broke. I have a decent job but we got nothing left, were probably going to wind up having to sell the house just to pay for Timmys care. And the worst part his little sister Janie started coughing this morning.

Now keep this in mind: if the dad above cant or wont pay for the hospital stay, what happens? First the patients that can pay will find that their costs will go up to cover it, meaning that after a short while fewer and fewer can afford to pay in a never ending spiral. In areas where hospitals are scarce or in poor areas of major cities, the government will have no other choice but to step in and pay either through current dysfunction welfare system or block grants. These funds will not only have to pay the shortfall but all the associated costs of demanding the funds in the first place (you dont think the lawyers and lobbyists are working to get this cash for the hospitals for free do you?). This requires some source of funds even if this means a surcharge on current active health insurance policies, raising insurance costs, causing more and more businesses to simply give up on the idea of providing traditional insurance. And this is already happening even with the current insane system of health insurance we have now. So the bottom line is do we plan a move to a single payer system or do we simply do it via a vastly more expensive default fait-accompli.

Posted by: clyde on February 16, 2006 at 7:01 PM | PERMALINK

All I know is that when my blood gasses go south, I want Dr. House.

Posted by: Keith G on February 16, 2006 at 7:50 PM | PERMALINK

The AMA backed this putz, and you can bet your ass that i will be on the phone peppering doctors' offices about costs. You should too. Between you and 30 smartass friends you should be able to get 30 estimates from every doctor in town. Just calla nd say, "how much for a hernia operation. How much to remove 200 shots of birdshot from my eye?"

Posted by: joe on February 16, 2006 at 7:54 PM | PERMALINK

Normal people are going to haggle with their doctor? Rich sons of bitches might do that, but normal people will not.

For sure, some people will make better use of their HSAs than others. for Republicans and conservatives, that's an advantage of HSAs; for Democrats and liberals that's a disadvantage. but it doesn't have anything to do with rich sons of bitches. Self-efficacy cuts across class lines.

Posted by: republicrat on February 16, 2006 at 8:37 PM | PERMALINK

Last time you had to go to the hospital for surgery or whatever, did it occur to you to ask, in advance, what the price would be? In some cases, you can do that. But in most cases, they'll calmly tell you that they have no idea what the price will be. There are simply too many variables. They don't know in advance how many of what kinds of tests your doctor will feel compelled to order. They don't know what kind of complications will come up in your surgery.

So imagine a world in which you tried to shop your surgery. You call up several surgeons and ask their prices. If they want your business, they'll give you an estimate. Mr. Bush will be happy!

Just one teensy problem though: Upon what basis can you compare the estimates you get from different surgeons. You aren't a doctor. You don't play one on TV. You have far less expertise in medicine than in auto mechanics, and you already don't know how to shop around for car repairs.

With one mechanic, you get a story that your timing belt has to be replaced. Another tells you that you've blown a head gasket. A third, the low bidder, tells you that all you need is a tuneup. Do you trust the low bidder?

If you have trouble shopping car repairs, imagine what happens if you need to shop medical care. Imagine further that you need the answer NOW, because you're having a major medical incident and you must have surgery within the next hour or you'll die. What happens if you're unconscious? Who makes these decisions for you?

My current medical insurance isn't great, and it does nothing to combat the $10 charge for an aspirin, but at least the emergency room folks can dig into my wallet and find out what coverge I have, so there's no question about my ability to pay.

Posted by: Paul Harder on February 16, 2006 at 9:08 PM | PERMALINK

I agree this "salesmanship" is assinine, I also agree that this issue is the best arrow in your quiver; but can't the Dems do better? Gephardt offered the only legitimate alternative I've seen in recent years, and he was treated like he farted in the elevator.

Posted by: minion of rove on February 16, 2006 at 9:15 PM | PERMALINK

How pathetic to read these smug, self-congratulatory responses from people like republicrat that just ooze this "I have got it all figured out and it's just like Ayn Rand said" attitude.

Health care is too important to be so prideful and hard-headed. We could have universal health care for all in this country by raising taxes by tiny increments. Instead, we have a higher infant mortality rate than Cuba, due to these tax cut fetishes that conservatives suffer from. We have the money to pay for the best health care in the world for every American citizen. We just don't have the will for self-sacrifice.

How sad.

Posted by: Stephen Kriz on February 16, 2006 at 9:56 PM | PERMALINK

Gee whiz Kevin, Bush is a MORON, what else do you need to know??? I mean, why even ask the question???

Posted by: Fred on February 16, 2006 at 10:07 PM | PERMALINK

Why do you assume Bush thinks this is a politcal winner?

Posted by: Jeff on February 16, 2006 at 10:39 PM | PERMALINK

We could have universal health care for all in this country by raising taxes by tiny increments. Instead, we have a higher infant mortality rate than Cuba, due to these tax cut fetishes that conservatives suffer from.

You might want to recalculate that. For universal health care, even assuming we lower health care costs (which I still have never seen broken down) to what Canada spends per capita, we're looking at about a trillion dollars moved out of the private (largely employer-paid) insurance system into the Federal government.

One assumes that employers no longer having to pay for insurance would somehow be balanced by increased business taxes on those same employers (haven't seen numbers on that, either.)

That would probably be the simplest solution, and the money would still flow from roughly the same sources. Only difference would be that instead of running through competing insurance companies, it would be run through one of the largest government bureaucracies on the planet. Good luck with that. Remember the Defense Department and the Space Shuttle.

If you raise general income taxes by that amount, a lot of people are going to get screwed.

Large corporations burdened with massive employee benefits are probably going to come out smelling like a rose. Not sure about small businesses.

Somebody really needs to look into the details, and nobody ever does. How will the pharmaceutical companies operate under price controls? Other providers?

As an aside, it's amazing how people who wouldn't believe Bush if he said the sky was blue will believe Castro's numbers on infant mortality.

Posted by: tbrosz on February 16, 2006 at 10:46 PM | PERMALINK

But its an article of faith with them, so facts that contradict it are lies invented by the devil (or, in this case, "liberals") to mislead the faithful. Its no more rational than Young Earth Creationism.

Indeed. For decades, we heard that our healthcare system was and is vastly superior to all others. Now that the idea somewhat less tenable, what with 36 other countries's health care systems (all with some sort of national health insurance or healthcare) ranked by the WHO as better than ours, and whose populations are healthier by most every standard than ours, we'll hear how our new system of HSA's and personal responsibility, etc. is vastly superior.

So it remains breathtaking that all those stupid, stupid, stupid people in Spain, Italy, Ghana, France, Cuba, Macedonia, Great Britain, Quebec, Czech Republic, Liechtenstein, Sweden, Ireland, Iceland , England, Chile, United Kingdom, Switzerland, Pakistan, Poland, Wales, Belgian , Canada, Hungary, Finland, Denmark, Croatia, Scotland, Slovenia, Japan, Israel, Korea, Turkey, Germany, Morocco, Northern Ireland, Norway, Thailand, Russia, Costa Rica, Australia, Netherlands, Estonia, South Africa, New Zealand, Luxembourg, and every other industrialized country just haven't yet grasped the superiority of the HSA concept.

Yes, that's it, they must just be very stupid people.

Posted by: R.Porrofatto on February 16, 2006 at 11:05 PM | PERMALINK

As an aside, it's amazing how people who wouldn't believe Bush if he said the sky was blue will believe Castro's numbers on infant mortality.

Bush expounds on astronomy and Castro issues his own stats on infant mortality? Fascinating. Of course, for the latter, you might look to the World Health Organization, unless they, too, are Castro's stooges according to your philosophy.

Posted by: R.Porrofatto on February 16, 2006 at 11:28 PM | PERMALINK

Somebody really needs to look into the details, and nobody ever does. How will the pharmaceutical companies operate under price controls?

i suppose they'll buy a handful of GOP congressmen to write them some loopholes for certain kinds of drugs.

more likely, drug research and manufacturing, like everything else, will go to India and China who will produce them at 1/10th the cost of western firms. then Congress will pass protectionist laws to keep US pharma companies afloat.

Posted by: cleek on February 17, 2006 at 12:13 AM | PERMALINK

per Kevin:

"Current system (for those with insurance): When you get sick you go to the doctor. When your kids get sick, they go to the doctor. You don't have to quibble over costs or spend time second guessing your doctor over whether a test he recommends is really necessary. As Bush himself says, it seems like a pretty good deal.

Now here's what Bush is trying to sell: When you get sick, you should spend a lot of time shopping around for doctors to find one you can afford. You should put off tests that he recommends if they're expensive. You should haggle over the cost of drugs as if you were buying a used car. And when you get home you should worry about whether you made the right decision or not."


Interesting that the left automatically assumes that what people want is not to have to think for themselves.

Posted by: mark on February 17, 2006 at 12:15 AM | PERMALINK

Porrofatto:

So where does the WHO get its Cuban statistics?

Posted by: tbrosz on February 17, 2006 at 12:25 AM | PERMALINK

i suppose they'll buy a handful of GOP congressmen to write them some loopholes for certain kinds of drugs.

Could be. You think the "Iron Triangle" is big in defense spending, wait until medical spending is all funneled through Washington.

more likely, drug research and manufacturing, like everything else, will go to India and China who will produce them at 1/10th the cost of western firms. then Congress will pass protectionist laws to keep US pharma companies afloat.

You're probably right about some of that. High-cost research will become a luxury. Contrary to popular myth, most R & D in pharmacy is privately funded. Other companies, including foreign pharmaceutical companies who make big money selling to Americans, will just cut back. On everything.

Posted by: tbrosz on February 17, 2006 at 12:31 AM | PERMALINK

Mark:

Interesting that the left automatically assumes that what people want is not to have to think for themselves.

You may be in for an unpleasant surprise. I think there's quite a few people who would just as soon have the State make their tough decisions for them. Look at the hostility that comes up toward the idea of self-directed retirement.

And for politicians, the ideal constituent is a mindless and dependent prole who will vote for you if you give them a cookie. Independent, prosperous, and self-reliant people don't really NEED politicians all that much.

Posted by: tbrosz on February 17, 2006 at 12:39 AM | PERMALINK

Kevin, Kevin, Kevin, Kevin.

Relax. This Administration is run by financial geniuses and medical experts.

Yes, there've been a few slip ups.

http://tinyurl.com/bqr7o
"ABC News has learned today that President Bush will ask Congress for an additional $65.3 billion for operations in Iraq and Afghanistan. It brings the total funds requested this year to more than $110 billion for those operations."

"This increase would bring the cost of the war thus far to $400 billion -- a far cry from the administration's original estimates."

"Just before the invasion of Iraq in 2002, White House economic adviser Lawrence Lindsay estimated the cost would be $100 billion to $200 billion.

"That estimate was later dismissed by Mitch Daniels, then director of the Office of Management and Budget, who said costs would be between $50 billion to $60 billion."

http://www.washingtonpost.com/wp-dyn/articles/A12118-2005Feb9.html
"Some House and Senate Democrats called for a congressional investigation into the hard-fought 2003 Medicare prescription drug battle, in which an administration official said he was pressured to keep long-term cost estimates hidden from lawmakers.

"The White House defended its actions, disputing news reports that the drug benefit's 10-year cost would be $1.2 trillion and stressing that the actual net cost to the government after factoring in savings would be about $724 billion. Throughout the 2003 debate, supporters estimated the cost at $400 billion over 10 years."

And remember what Bush said about Social Security private accounts. This gem of wisdom is in your own archives, under the heading "Laura and Larry".
http://www.washingtonmonthly.com/archives/monthly/2005_05.php

"Because the -- all which is on the table begins to address the big cost drivers. For example, how benefits are calculated, for example, is on the table. Whether or not benefits rise based upon wage increases or price increases. There's a series of parts of the formula that are being considered. And when you couple that, those different cost drivers, affecting those -- changing those with personal accounts, the idea is to get what has been promised more likely to be -- or closer delivered to that has been promised. Does that make any sense to you? It's kind of muddled. Look, there's a series of things that cause the - - like, for example, benefits are calculated based upon the increase of wages, as opposed to the increase of prices. Some have suggested that we calculate -- the benefits will rise based upon inflation, supposed to wage increases. There is a reform that would help solve the red if that were put into effect. In other words, how fast benefits grow, how fast the promised benefits grow, if those -- if that growth is affected, it will help on the red."

The dwindling national deficit is proof that this Administration's counter-intuitive strategy of tax cuts is the right strategy to counter the effect of these little mistakes.


If Bush says HSAs are the answer to soaring healthcare costs, you can take that to the bank. And even get them to cash it if you take along your 28 gauge shotgun loaded with 7 shot.

Posted by: cowalker on February 17, 2006 at 12:56 AM | PERMALINK

"You may be in for an unpleasant surprise. I think there's quite a few people who would just as soon have the State make their tough decisions for them. Look at the hostility that comes up toward the idea of self-directed retirement."

Guess who'd be living in one of our upstairs bedrooms if my parents-in-law had been allowed to "self-direct" their retirement. My father-in-law is a bull-headed guy who fell for every Ponzi scheme and con-artist who came his way. Always sure he was getting in on the ground floor of something everybody else was too stupid to appreciate. Over and over again. Then his health went. My seventy plus mother-in-law is working part-time in a box store to make ends meet.

Would we have let them wander from homeless shelter to bus station if they hadn't been able to count on Social Security? Even if I never get a penny from Social Security personally, it's saved me a ton in money and peace of mind already. It's all very well to pretend that everyone can manage their retirement and health care money, but the fact is we are going to subsidize those who can't or won't. It's a lot less expensive to admit this and collect the money up front. Or most families will have to resign themselves to taking in the feckless brother-in-law when he can't work full-time anymore, or mortgaging their houses to pay hospital bills for a gravely injured nephew whose parents just didn't have the self-discipline to set aside $200,000 in their HSA account.

Posted by: cowalker on February 17, 2006 at 1:12 AM | PERMALINK

Tbrosz:

So you think we shouldn't trust Castro's statistics, huh? What about the other 35 countries ranked ahead of us with public-funded health care systems? They're all lying to the WHO as well, eh? Gee, that's sort of convenient, isn't it?

A better question is this: why aren't we the #1 country in the world in terms of the overall health of our population, via all those statistics? Why haven't we created a medical system that can do this for us? How dare we settle for less? We're the richest country in the world. What's our excuse?

I've heard the same old myths, and they make me angry. The end of medical R & D if we threaten pharma's monopoly profits? As if the united states was the only country in the world furthering medical research right now? As if it didn't exist before World War II? Haven't you noticed a big fucking advertising budget they could probably cut back on? Besides, can't the government fund medical research? Didn't president Bush just propose a bunch of publicly funded research in his SOTU? Was anyone complaining?

Do I want mediocre health care for everyone, rather than superb care for the rich and nonexistent care for the poor? Who decreed that this choice must be forced on me? I want excellent health care for everyone. It's not anything like impossible, anymore than putting television in every home was impossible. It's a question of priorities, period.

The consensus seems pretty clear that HSA's are almost entirely geared towards reducing health care expenditures and not geared at all towards getting health care to people who can't afford it.

As for unfettered demand and limited supply - this is a really easily solvable probably. Demand is nothing like unfettered for serious health care. If anything, the average guy is biased away from getting health care, even when he needs it. It's painful and unplesant and uncomfortable and risky. Economic disincentives aren't neccesary. This is completely unlike a consumer good. The only areas where demand is a function of luxury are with luxury medical care, like cosmetic surgery. This is the sort of thing that a government-funded system would not pay for, and shouldn't.

Lastly - demand much more unfettered now than it would be under a government system. Right now, as you really ought to have heard, insurers and doctors have perverse incentives to apply as much health care as possible to patients and rack up as many expenses as possible. The HSA will do nothing to change that. In fact, they will make it worse. The tax breaks will starve the government of revenue and and make rich consumers even more willing to play along with care-crazy doctors and insurance companies than before. Health care spending will rise even faster, and the government will be less equipped to deal with it.

Posted by: glasnost on February 17, 2006 at 1:15 AM | PERMALINK

http://www.washingtonpost.com/wp-dyn/content/article/2006/02/16/AR2006021601554.html

No End to the Phony Populism

By E. J. Dionne Jr.
Friday, February 17, 2006;

.....

"They want people "not making a lot of money" to have a chance to buy affordable health insurance. They are arguing that HSAs, as the accounts are known, would offer a lot of money to the most well-off among our fellow citizens without increasing health coverage. Indeed, there is good evidence, mustered this week by the liberal Center on Budget and Policy Priorities, that HSAs would instead lead to a net increase in the number of uninsured.

And, as Elisabeth Bumiller pointed out in the New York Times, a $5,000 contribution to an HSA would have saved a couple with two children and a combined income of $40,000 just $630 on their 2005 federal income taxes. (And that assumes the couple could have afforded to put away the whole five grand, which is unlikely.) But a comparable couple with an income of $120,000 would have saved $1,500.

In other words, HSAs give the smallest benefits to those least able to afford health insurance. That is not exactly showing respect for those who are "not making a lot of money." The elitism here lies with those making the proposal, not with its critics."

....

And I repeat that the whole damn point of this, just as in the whole phony baloney campaign for privitization of SS, is to hand Wall Street cronies billions of captive money to 'manage', for, like, fees and stuff. Woo-hoo!

Gotta keep that market going up or the global 'hot money' currently flowing in will melt away faster than an Andean glacier.

Posted by: CFShep on February 17, 2006 at 8:47 AM | PERMALINK

There are an interesting set of ideological concepts/contrasts in this issue . . .


"Ordinary people don't have the initiative and market sense to find the best health care. Not everyone can have the best doc, of course, but ordinary people could use the same approach to find the *cheapest* treatment..."

In a certain sense, what's going on is a very specific kind of class warfare - if that's even exactly the phrase I'm looking for. . . It's the usefully connected, the folks who know the rules and procedures (and loopholes), the proactives, the ones easily balancing everything on their plates, the folks with sufficient (time, money, etc), the ones who plan for the long term with reasonable assurance vs. the hassled, the over-stretched, the paycheck to paycheck people, the ones who just dropped a plate because they're balancing a kid and a bunch of dishes and the phone just rang and they're late for work, the folks with just enough - or never quite enough. The fault line here runs right through the 'middle' class, depending on circumstances.

"The inability to look at the effects of individual decisions on group is the common failure of thinkers(?) like GWB."

"Individual consumers are not going to drive down health care prices negotiating individually. The only chance . . . would be through collective bargaining strategies"

More and more pervasive - I hate those "Army of One" recruitads. From union halls to iPods.


"People who want to keep a little of their own money and retain a little more control over their own lives."
"It's use of choice and empowerment language is the same sort of appeal used by adverts that do the 'you make the call' or 'take control' riff. And it appeals to the idea that you are smart and you can find a deal that other's can't so you will get a leg up on others cause you found the best deal."

Yes, you can pick which of three sauces to go with your chicken wings! You ARE IN CONTROL!! Part illusion, ok, part chaos (some studies seem to show people get all stressed with an excess of even benign and unimportant choices, part cynically playing on/blindly ignoring the actual realities of power - yes, I'm in control, except for the time, knowledge, and bargining power bits . .

"Interesting that the left automatically assumes that what people want is not to have to think for themselves."

"t's all very well to pretend that everyone can manage their retirement and health care money, but the fact is we are going to subsidize those who can't or won't. . . the feckless brother-in-law . . .a gravely injured nephew whose parents just didn't have the self-discipline . . ."

Again, the bit about time, power, and knowledge - I have enough on my plate, how about you do the medical bargining for me (and that , which found that "more than 75 percent of students at 2-year colleges and more than 50 percent of students at 4-year colleges . . . lack the skills to perform complex [quantitative] literacy tasks, such as comparing credit card offers" is very pertinent here.
"For sure, some people will make better use of their HSAs than others. for Republicans and conservatives, that's an advantage of HSAs; for Democrats and liberals that's a disadvantage. but it doesn't have anything to do with rich sons of bitches. Self-efficacy cuts across class lines."
And to some degree, yes - but with very strong constraints (see money, power, knowledge again). Why is this a problem for Democrats and liberals? As above - there are real differences in both people's ability -intrinistic/learned/affected by circumstances - (intelligence, mindset, organization&decision-making/happy prefrontal lobe executive function-stuff (ie, how your brain maybe does the neat goal-directed planning, self-regulation stuff) and their real-life circumstances - and of course, the two play off each other both ways. And forget about chance!
We're the party that doesn't want the other folks to get screwed over.

We wander off into moral ground, because besides a certain Calvinist tint - my wealth is a sign that I am good! - all this is often seen in moral terms. They're poor because they make bad decisions and don't live properly. "Lack of discipline." Forgetting, of course, how class privilege/economic circumstances is a big help when it comes to this very Protestant kind of morality. This is also one of the reasons why ADHD causes such an uproar, as Tom Wolfe explains with characteristic cranky flair (while being quite wrong)

Anyone with a child in school knows the signs all too well. I have children in school, and I am intrigued by the faith parents now invest . . .in psychologists who diagnose their children as suffering from . . ADD. Of course, I have no way of knowing whether this "disorder" is an actual, physical, neurological condition or not, but neither does anybody else in this early stage of neuroscience. The symptoms of this supposed malady are always the same. The child, or, rather, the boy--forty-nine out of fifty cases are boys--fidgets around in school, slides off his chair, doesn't pay attention, distracts his classmates during class, and performs poorly. In an earlier era he would have been pressured to pay attention, work harder, show some self-discipline. To parents caught up in the new intellectual climate of the 1990s, that approach seems cruel, because my little boy's problem is... he's wired wrong! [snip] . . . Meantime, the notion of a self--a self who exercises self-discipline, postpones gratification, curbs the sexual appetite, stops short of aggression and criminal behavior--a self who can become more intelligent and lift itself to the very peaks of life by its own bootstraps through study, practice, perseverance, and refusal to give up in the face of great odds--this old-fashioned notion (what's a boot strap, for God's sake?) of success through enterprise and true grit is already slipping away, slipping away...slipping away...The peculiarly American faith in the power of the individual to transform himself from a helpless cypher into a giant among men, a faith that ran from Emerson ("Self-Reliance") to Horatio Alger's Luck and Pluck stories to Dale Carnegie's How to Win Friends and Influence People to Norman Vincent Peale's The Power of Positive Thinking to Og Mandino's The Greatest Salesman in the World --that faith is now as moribund as the god for whom Nietzsche wrote an obituary in 1882. " (italics added)
And pulling back a bit from these observations on the death of the soul, we start hiking through Lakoff framing-land, with the Daddy party wanting to give its offspring a kick in the pants and a toss out the door, making sure it learns self-discipline and responsible manliness (lowering medical costs along the way, and the Mommy party wanting to pitch in and help out (which is why framing might win elections but isn't that great for governing).

How, then, are liberals for freedom? Because we recognize the real constraints on people and work to help folks get around them, to have a fair chance. One ideology offers the freedom of extreme individualistic competition - the Army of One, the Player, the Hardass; the other, the freedom that comes from being raised in a well-functioning family, having good friends, living in a community.
(ahhrg - being sucked into frame . . must fight it . . .)
Which isn't to say, for example, that a form of HSA might be pretty helpful - it's the surrounding ideology that shapes how it works . . .

Looks up at ridiculously long, rambling, disjointed post - crap, I forgot to take my ritalin . . .

And yes - the comments above about people 'negotiating' with doctors - there's some work on class-based relationships with professionals - educators/administrators, etc, and it tends to be a big difference whether it's a discussion between social and economic equals (or the person has a higher status), and when it isn't . . .

Posted by: Dan S. on February 17, 2006 at 8:54 AM | PERMALINK

ahrg, sorry about runaway linkage - ok, that whole paragraph links to the study, just in case you have trouble clicking on one or two words. See, it's to help you out!

Posted by: Dan S. on February 17, 2006 at 8:56 AM | PERMALINK

Who does he think is going to be excited by this?

Grover Norquist? Ebeneezer Scrooge?

Posted by: nemo on February 17, 2006 at 9:42 AM | PERMALINK

Obviously Bush is unaware that typical health plans (like my Aetna HMO) have prescription drugs in formualaries with three cost (to the consumer) tiers. I for instance use the cheapest (oldest and not necessarily the best) statin, and found a thyroid medication which is equivalent to the usually prescribed one but on a cheaper tier. And it already costs me $20 to see a doctor, and $25 for a specialist, so I'm not exactly just dropping in the doctor's office on a whim.

I'm sure someone above has already pointed out that most health care money is spent on serious hospital stuff, mostly toward the end of life, which would be in the catastrophic area anyway.

Posted by: mja94116 on February 17, 2006 at 10:43 AM | PERMALINK

I would LOVE to see more detailed explanations which show the haggling and shopping part. That should kill this lame idea.

As you say, most people would NOT like the haggling and comparison shopping. Locally a couple car dealers have switched from the 'come in and let's haggle' approach to the 'best price' approach. They put their best price on the windshield and that's it. No haggling.

People like not haggling.

If they really wanted this approach to fly then they should require all Doctor's to publish their pricelists on the internet and let some company such as Orbitz or whatever show consumers the comparisons.

You think Doctor's would go for this? I don't think so.

Posted by: Tripp on February 17, 2006 at 10:58 AM | PERMALINK

tbrosz,

Independent, prosperous, and self-reliant people don't really NEED politicians all that much.

Thus we see the essence of your foolishness. This is your core blind spot.

"Independent, prosperous, and self-reliant people" need a stable society to keep the proles from taking their wealth. They need politicians even more than the people who have nothing.

I thought even the looniest capital L Libertarians were willing to admit the there is a need for government to enforce property rights?

Are you a Libertarian, or are you an Anarchist? You sound like an Anarchist.

Posted by: Tripp on February 17, 2006 at 11:12 AM | PERMALINK

What all people want is power. The power to control their own destiny.

The rich are selling the illusion of power to the poor telling them their true power is when they act individually.

This is an illusion because individually they have NO power. Their only hope for power is in collective action. Unity.

"United we stand" and all that. The rich are quick to demonize this with scare words such as communism, socialism, and even, God forbid, Unions! We all know how BAD each of those are! Why, it goes without saying - which is just how the rich want to keep it.

Posted by: Tripp on February 17, 2006 at 11:17 AM | PERMALINK

What gets me is that this "shopping around for best price" is already being done. It's what the insurance companies do for us (and their bottom line), and the influence of a big payer (the insurance companies) is stronger than the influence of onesy-twosy patients requesting a better price.

The dynamic between doctors and insurance companies over price and quality is a big factor in the cost of health care, but getting the insurance companies out of the picture isn't going to really make much difference in the short term. Heck, in the long term, we're all dead, anyway (or at least, I think I heard our Fearless Leader say so).


Ed

Posted by: Ed Drone on February 17, 2006 at 11:35 AM | PERMALINK

Bush: "Or you go to a specialist, maybe we can do this a little better old Joe does it for X, I'm going why don't you try it for Y?"

"Old Joe does it for X" -- gah, that faux-folksiness is sickening and so condescending. Can't people see he's treating them like rubes?

Posted by: Stefan on February 17, 2006 at 12:42 PM | PERMALINK

Thanks, Ed Drone. That's exactly what I was going to add to my previous post. Also for drugs - I'm sure Aetna in my case is paying Rite Aid a lower price than I would if I went in w/o insurance. And for chronic stuff I order through Aetna and get if I remember correctly a free month supply for every two. Which I assume actually costs Aetna less than their below retail Rite Aid cost. So all the costs covered by these hairbrained HSA schemes are already controlled by group insurance. Which should be provided to all citizens. Like in, you know, every other comparable country on the planet.

Posted by: mja94116 on February 17, 2006 at 12:51 PM | PERMALINK

Tripp:

"Independent, prosperous, and self-reliant people" need a stable society to keep the proles from taking their wealth. They need politicians even more than the people who have nothing.

I thought even the looniest capital L Libertarians were willing to admit the there is a need for government to enforce property rights?

Are you a Libertarian, or are you an Anarchist? You sound like an Anarchist.

In the context of my statement, I didn't mean "government" as a whole, I meant "politicians" in their current role as dispensers of government largesse in return for votes and contributions. Frankly, this occupies much more of their time than the legitimate limited functions of government that you listed. That goes for both parties.

BTW, "independent, prosperous, and self-reliant" is not always related to monetary wealth as such. The word "prosperous" relates to one's lifestyle and needs. My Dad says you're well-off if your income exceeds your expenses. As for independent and self-reliant, I know guys who sell hot dogs from their own stand on the street who qualify in this regard more than a lot of rich people I know.

"Anarchy means 'without leaders,' not 'without order.'" - Alan Moore, "V for Vendetta"

Posted by: tbrosz on February 17, 2006 at 1:46 PM | PERMALINK

Do I want mediocre health care for everyone, rather than superb care for the rich and nonexistent care for the poor? Who decreed that this choice must be forced on me? I want excellent health care for everyone. It's not anything like impossible, anymore than putting television in every home was impossible. It's a question of priorities, period.

Although the analogy with health care breaks down pretty quickly, I should point out that television didn't end up in everyone's house because of a National Right To Television Program back in the 1940s. Rich people bought them first, and created enough market to make more reasonably-priced TVs possible for the rest of us. Same for most consumer electronics. The government had a role in creating standards of frequencies, and basic safety standards, then sat back to let the private sector do the rest.

Any health care system we come up with had better have choice and competition somewhere in the system if we don't want to end up with miserable "good enough" monopoly health care. You don't want to deal with the kind of providers that know you don't have any choice in dealing with them. Sure as hell you don't want to eliminate private insurance completely. Maybe government vouchers for the poor to get health care or insurance?

Posted by: tbrosz on February 17, 2006 at 2:28 PM | PERMALINK

"Interesting that the left automatically assumes that what people want is not to have to think for themselves."

When my cold turned into bronchitis that turned into pneumonia, I could hardly get to the nearest pharmacy to pick up the antibiotics. Checking around for the best price would not have been an option.

Posted by: Cal Gal on February 17, 2006 at 2:40 PM | PERMALINK

wow, it seems like everyone on here has health insurance. i'm one of those evil people who has mulitple chronic illnesses. i'm ruining things for the rest of you. i'm a very, very bad person. i used to have insurance, but basically got screwed by their definition of pre-existing conditions, and the premiums went up so high ($400 a month, with a $2500 deductible) that i couldn't afford to stay "covered." now i'm considered uninsurable. your nightmare scenario of doctor shopping and finding out prices on all treatments beforehand is already my reality, and is the reality for a lot people today. and believe me, most doctors don't appreciate hagglers. they are NOT trying to give you the best healthcare they can when they're annoyed at you for haggling over prices. thus far, only one has even agreed to do any haggling whatsoever. and she's a chiropracter. i don't go to doctors now if i can in anyway avoid it. i research every single option as soon as i get even an incling of a diagnosis. i undermedicate my pain, trying to stretch my prescriptions out as long as possible. health and healthcare have become a luxury that's beyond my means. HSA's will do nothing to improve this. the ONLY way to help people like me universal healthcare. i'm not irresponsible with my money, this is not a matter of frivolous spending or my inability to manage either my expenses or my healthcare. it's a matter of piss-poor luck that i got stuck, starting at age 11, with bad health.

Posted by: EM on February 17, 2006 at 3:39 PM | PERMALINK

God bless you, EM. The U.S. needs universal healthcare. Conservatives like to say we can't afford it. I say we can't afford to not have it.

There is a myth of scarcity rampant in this country. It is false. There is more than enough wealth. It is simply in the hands of too few people. We need to (gasp!) redistribute it through higher taxes. If we can afford to piss $100 billion down our collective legs on national missile defense (a/k/a Star Wars), which is utterly worthless and is simply a redistribution of wealth upward, to defense contractors, we can afford national health insurance.

I will include you in my prayers.

Posted by: Stephen Kriz on February 17, 2006 at 3:46 PM | PERMALINK

Hey, me, I'm just trying to figure how someone in the throes of a debilitating stroke can shop around for the best prices and haggle with the doctors until she/he gets a favorable deal.

Posted by: tam1MI on February 17, 2006 at 3:48 PM | PERMALINK

tam1MI, you're absolutely right. they can't. and when i needed emergency surgery, it cost me $11,000 out of pocket. which i paid for, in full, over 4 years. and that was WITH health insurance that decided that despite the fact that the surgery diagnosed the condition, it was, in fact, a pre-existing condition because i'd complained of related pain in the past.

Posted by: EM on February 17, 2006 at 4:06 PM | PERMALINK

stephen k, despite the whiney tone to my post (which i apologize for), i'm actually not looking for sympathy. just pointing out that doctor shopping is already a reality. appreciate the well wishes, though.

Posted by: EM on February 17, 2006 at 4:10 PM | PERMALINK

If the the premiums that employers currently pay + the premiums and deductibles that individuals currently pay are treated as taxes and paid into a central government health care agency, which will negotiate with providers and drug companies, it seems to me that there would be plenty of money available for single payer health care. It's not like we would be paying more than we are already, only the middlemen are eliminated.

Posted by: Wombat on February 17, 2006 at 6:48 PM | PERMALINK

Raise your hand if you've ever had a doctor look for a better price for a drug for you....anyone?...anyone???

Posted by: secularhuman on February 17, 2006 at 11:27 PM | PERMALINK

``IMO, health savings accounts in their current form aren't really going to do it. Too little, too late. The key would have been making it easier at the beginning to find insurance outside your employer.''

Quick, somebody recommend several doctors I can haggle with so I can cure these heart palpitations: tbrosz just made sense and I don't know if my ticker can take it!
Of course, making it easier to find insurance outside your employer would necessitate a fair market of providers out there in true competition instead of a half-dozen monoliths who can perpetuate a fixed game -- and that's just not the way Republicans do things.

Posted by: secularhuman on February 17, 2006 at 11:38 PM | PERMALINK

I've already seen a couple of news items in which the hospitals are jumping mad at any suggestion that they reveal any prices for anything they do.

I waste a lot of time attempting to get letters from these cats for cost estimates for procedures to support claims for damages.

Lotsa luck.

That would involve an explanation of their dubious 'cost accounting' which spreads the cost for neo-natal care or the new whizbang $10M TomalCatScan onto every Tylenol or tissue.

>Raise your hand if you've ever had a doctor look for a better price for a drug for you....anyone?...anyone???
Posted by: secularhuman

Ever try to discuss cost of care with a doctor? Yeah, that guy. Same one who's busy booking you for tests with the lab he owns a piece of, for MRIs at that clinic where he's a majority stakeholder, and scheduling your surgery in the speciality hospital he also owns a substantial piece of... Bah!

Posted by: CFShep on February 18, 2006 at 8:06 AM | PERMALINK

The 1st thing to realize is the plan isn't mandatory. If you don't want to save cash in a tax deferred HSA account don't.

I like the fact I can pay for eye glasses or lasik surgery with pre-tax dollars. I also like the fact it might give me more flexibility for picking a doctor and/or hospital.

I really like the fact I can build a medical next egg for future emergencies and better care as a senior. Medicare doesn't cover everything.

More flexibility is always better.

Posted by: rdw on February 18, 2006 at 9:39 AM | PERMALINK




 

 

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