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Money Won’t Buy You Health Insurance

nytimes.com

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Re: Money Won’t Buy You Health Insurance

#411

Post by ThomPete »

pzxc wrote: post #405
ThomPete wrote: post #354

Earlier quoted context omitted.

How wrong you are. No man is an island. Neither you, nor anything you create is created in isolation. Dependencies are ever-present and failing to understand this leads to failed ideas such as "true free market" not unlike the idea of "true communism". In reality the very fact that you are alive to write your words is a testament of other peoples effort including your parents to guard you against the many many danger…

Then it's wrong in a very unfortunate Founding Fathers way also. Because the Declaration of Independence states that we DO have inalienable rights and they ARE natural laws (i.e., endowed by our creator, which is a religious way of saying natural law).

The Declaration of Independence is not a natural law it is in any sense of the word a political law.

The Founding Fathers declaration doesn't apply to the 5.8 billion people who lives outside the US.

And even if it did it would not by any metrics be a natural law. Property rights is a human construct nothing else.

Re: Money Won’t Buy You Health Insurance

#412

Post by bzbarsky »

dalke wrote: post #364
bzbarsky wrote: post #168

Earlier quoted context omitted.

The US pays more money because it has more health care being provided, in many cases. It just so happens that more health care doesn't necessarily translate to measurably better outcomes (e.g. cancer screening helps reduce mortality for some cancers but not others). It also just so happens that it's very rare to study whether a particular care regimen actually improves overall outcomes as opposed to just the thing it…

So we pay more money then other countries but don't get better outcomes? Could we save money and get the same outcomes? And since we get worse outcomes then they do, could we spend less and still get better outcomes? How do you defined "more health care?"

> So we pay more money then other countries but > don't get better outcomes?

Yes, exactly.

> Could we save money and get the same outcomes?

That seems like an obvious corollary of the above... But yes, I think we could.

> And since we get worse outcomes then they do

Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs".

> could we spend less and still get better outcomes?

This question is based on a premise which doesn't seem to be true, so probably no.

> How do you defined "more health care?"

Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.

Re: Money Won’t Buy You Health Insurance

#413

Post by Uhhrrr »

marshray wrote: post #118
Uhhrrr wrote: post #79

The article does not mention that money _can_ buy you health _care_. Given this, there should be market opportunity for a company which courts the supposed legions of people denied for picayune reasons.

Not in any fair-market sort of way. The price of prescription meds, tests, and procedures is "negotiated" between pharmacies, providers, and insurance companies. The Dr. bills "X" and the insurance company comes back with "X/2". The Dr. may try to collect the difference from you, but they usually don't. If you aren't paying with insurance, you have to pay many times higher prices than an insurance company would for t…

Which is to say, you can indeed purchase health care. You might not get the volume discount that Blue Cross et al do, but you can buy it.

And, in practice, if you tell the provider that you can only pay X, it is quite possible that they will prefer getting X to getting 0.

Re: Money Won’t Buy You Health Insurance

#414

Post by dalke »

bzbarsky wrote: post #412
dalke wrote: post #364

Earlier quoted context omitted.

So we pay more money then other countries but don't get better outcomes? Could we save money and get the same outcomes? And since we get worse outcomes then they do, could we spend less and still get better outcomes? How do you defined "more health care?"

> So we pay more money then other countries but > don't get better outcomes? Yes, exactly. > Could we save money and get the same outcomes? That seems like an obvious corollary of the above... But yes, I think we could. > And since we get worse outcomes then they do Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our…

Your logic works both ways. If you say it's hard to measure then how do you know that get the same outcomes?

"Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important.

Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes.

By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.

Re: Money Won’t Buy You Health Insurance

#415

Post by danssig »

iwwr wrote: post #369
danssig wrote: post #366

Earlier quoted context omitted.

Health care is, by definition, an inelastic market.

The point being? Sorry if I'm being dense, but no market is truly elastic.

Not true. I don't have to buy a smart phone, for example. I can live a wonderfully productive life with a normal cell phone. This means the price we see for a smart phone tracks very close to its value. You cannot do without health care. If you get sick you will pay any and every price to get well. If you die, your money is worthless anyway. A market you cannot opt out of is inelastic and normal free market forces wont be able to find the correct price as they would in a more elastic market.

Re: Money Won’t Buy You Health Insurance

#416

Post by danssig »

Tyrannosaurs wrote: post #378
danssig wrote: post #333

Earlier quoted context omitted.

For someone who puts so much faith in free markets you don't appear to understand how they work. In your studies, look up "market elasticity" for a clue.

The phrase "market elasticity" is meaningless. Elasticity in economics describes the relationship between two variables (normally price and demand which is price elasticity [of demand] but by no means exclusively). But unless you define your variables (or state what sort of elasticity) it's not a useful term and certainly not something I'd be bandying about while suggesting that someone else didn't have a clue.

>The phrase "market elasticity" is meaningless.

Nonsensical. What kind of market theory are you following that doesn't factor in market elasticity? Rush Limbaugh eco 101?

Re: Money Won’t Buy You Health Insurance

#417

Post by projectileboy »

Groxx wrote: post #22
acabal wrote: post #2

This really highlights how utterly insane our system is. I'm living off of my own business, which means that I don't have an employer to cover me under group insurance. But I really only make enough to live frugally and save a tiny amount each month--to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the…

> to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But thi…

I'd be interested to hear what you think a reasonable basement price would be. In Minnesota for a (very) healthy family of five, I pay over $600/month for a plan with an $11,000 deductible, meaning I essentially write a check every time one of my kids has a checkup.

Which brings up one of the biggest red herrings in this whole debate - the notion that the U.S. has a "market-based" system. The next time you go to the doctor, ask someone what it's going to cost. Guess what? No one outside the two people working in the basement billing office have the slightest clue, because it's all paid for by the insurance fairies. There's nothing even remotely resembling an efficient market for healthcare in the U.S., but the insurance companies like to spout otherwise, because it's entirely to their advantage.

Re: Money Won’t Buy You Health Insurance

#418

Post by Tyrannosaurs »

danssig wrote: post #416
Tyrannosaurs wrote: post #378

Earlier quoted context omitted.

The phrase "market elasticity" is meaningless. Elasticity in economics describes the relationship between two variables (normally price and demand which is price elasticity [of demand] but by no means exclusively). But unless you define your variables (or state what sort of elasticity) it's not a useful term and certainly not something I'd be bandying about while suggesting that someone else didn't have a clue.

>The phrase "market elasticity" is meaningless. Nonsensical. What kind of market theory are you following that doesn't factor in market elasticity? Rush Limbaugh eco 101?

Market theory as I was taught at university during my degree. And you?

As I said the term elasticity isn't meaningless, but without defining the variables you are defining as elastic (or inelastic) it doesn't make sense, at least not without assumptions which obviously may or may be wrong.

Personally by default I'd assume that you were referring to price elasticity of demand - that is the relationship between changes in price and the resulting change in demand, however there are many other types of elasticity (see http://en.wikipedia.org/wiki/Elasticity_(economics)).

So if you want to explain exactly which variables "market elasticity" refers to then that would be great, but as "market" is a very loose term, on it's own it's not very useful.

Re: Money Won’t Buy You Health Insurance

#419

Post by cdavid »

muhfuhkuh wrote: post #110
Groxx wrote: post #22

Earlier quoted context omitted.

> to me, an affordable health insurance plan would be between $50-$100 a month. Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation. This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But thi…

Japan forces their doctors to charge only what's published in a book that the government issues and negotiates prices periodically. Simple price fixing in an otherwise private healthcare market. In return, Japanese doctors and hospitals (FYI, there are more private hospitals in Japan than the US) are allowed to set whatever prices for ancillary services (like private or semi-private rooms) that they want. BTW, the av…

I think the issue is just too complicated to draw conclusions from broad inter-countries comparisons. I find the Japanese system terrible - I have been living there for 7 years and I have yet encountered a foreigner coming from a rich country who thinks the system is good.

The problem with comparing global stats like cancer survival rates is their weak correlation with the health care system. For example, the reason why colon/rectal cancer survival rate is high is because Japan is basically the only rich country where those cancers are the most common one (in other rich countries, prostate, breast, lungs usuallly come first for the concerned sex). There is also the issue of "free-ride", where most western countries benefit from research being done in the US and a couple other countries - which is not so easy to quantify either.

Designing good indicators is incredibly hard, and for that reason alone I think it will always be a political question first, and an economical one second (i.e. economics can help making a decision, but it won't give you the decision).

Re: Money Won’t Buy You Health Insurance

#420

Post by cdavid »

danssig wrote: post #332
tptacek wrote: post #207

Earlier quoted context omitted.

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

What are we discussing here? Do you not know the difference between elastic and inelastic markets? Health Care cannot ever be a free market because it is utterly inelastic.

By that argument, food, water cannot be a free market either. I am not saying that health care works best in a free market or not, but whether it is elastic/inelastic is not the only factor. Also, depending on which health care we are talking about, it is certainly elastic: sure, if you just got shot and are mortally wounded, you are pretty much ready to pay anything you can to get treated, but maybe that private room or new cancer treatment twice as expensive without proved benefits is not that necessary.
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