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Dennis Brust: Government control of health care

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Liberals want the government to control health care, and they want to keep the Affordable Care Act, or Obamacare. Conservatives want to repeal it and create a better plan. Republicans also believe health care decisions are between the patient and their doctor. It is also believed the ACA is unconstitutional, because it did not originate in the House of Representatives. The average of all polls indicates opposition to the ACA has always been greater than public support. The IRS is in control of the ACA, which will be a great expense, and they will have access to families’ health information — a very bad situation.

The Congressional Budget Office estimates 7 million workers will lose their employee-sponsored insurance by 2021. Currently, there are many lawsuits against the ACA by Judicial Watch and the Pacific Legal Foundation. There were several broken promises when the ACA was introduced, including the following.

■ “If you like your doctor or your plan, you can keep them.”

■ “Insurance premiums will go down by $2,500 per year, and deductibles will go down.”

Insurance companies are dropping hospitals out of their coverage; many organizations are putting pressure in Congress to repeal the ACA.

There were 4.7 million health insurance cancellations in 32 states in 2013. During the first half of 2014, employer-sponsored group insurance declined by 4 million, offsetting gains in individual enrollment by 61 percent.

The following are facts from my research.

■ “No family making less than $250,000 per year will see an increase.” The fact is, there are at least 18 separate tax increases in the plan and a total of $770 billion of increased taxes across 10 years.

■ “Our government will protect Medicare.” The fact is, $700 million was cut, which will significantly impact seniors.

■ There are fines to companies not offering health insurance with 50 or more employees.

■ All subsidies paid to low-income people are paid by taxpayers.

■ Half of all businesses will cut hours or replace full-time employees with part-time employees to avoid the mandate.

■ There are new taxes and 2,800 pages of job killing, business busting bureaucracy and building disasters with 12,000 pages of regulations.

■ Muslims and unions are exempt from the ACA and also are subsidized.

■ Taxes on businesses hurt job growth for full-time employment and jeopardize businesses to survive.

■ There is a 2.3-percent tax on medical devices, a 10-percent tax on indoor tanning services, a Blue Cross Blue Shield tax hike, excise tax on charitable hospitals which fail to comply, tax on health insurers and name-brand drugs and tax on compensation limits for health insurance for executives. There are individual and employee mandates which, if not met, incur a tax penalty. The annual, over-the-counter medicines no longer qualify as medical expenses for flexible spending accounts.

■ The ACA can’t explain $2.8 billion in subsidy payments to the insured.

The ACA is one of the most controversial issues negatively impacting all citizens with increases on insurance premiums, and the deductibles are higher.

The Republican-controlled House and Senate have promised the public they will repeal it, but nothing is happening to date.

Citizens should get involved on this issue and contact our elected officials to let them know our feelings.

The bottom line is, the ACA is taxing high earners to pay most of it. It is no wonder that the public and conservative politicians want the whole thing repealed and think we should start again to get a much better and fairer program.

Dennis Brust

Steamboat Springs

Comments

Chris Hadlock 11 months ago

I have contacted my representatives on this issue:

Cory Gardner has failed to respond to any correspondence I have ever sent him via snail mail or email. Zero, Zip, Nadda from my representative.

Scott Tipton - Has returned Republican Platitudes and talking points even when asked followup questions. I could have typed his responses from the RNC website.

Scott Bennett - Repllied to my email and intelligently answered followup questions.

DMB - Responded to my email. encouraged me to attend a meeting at Butcherknife brewery and gave me her personal cell phone number for further conversations.

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Scott Wedel 11 months ago

The healthcare system was in a state of failure prior to ACA with government paying over half of the healthcare system and the number of uninsured continuing to grow. If we were going to continue the old system then soon enough we would have to said that people, including children, without medical insurance don't get access to healthcare and will be allowed to die for lack of basic healthcare.

Healthcare is not a good fit for the insurance model because future costs are too predictable and not random enough. Any free market health insurance model would normally determine the portion of the population with ongoing health issues and exclude them from insurance.

ACA has flaws, but to get it passed they made compromises beneficial to segments of the healthcare industry. In particular, they limited competition by preventing health insurance being offered across regions. So, no one here can buy lower cost healthcare from Denver instead of more expensive local plans.

But since Democrats no longer have a controlling majority then they can no longer pass any corrections or improvements. The only thing that can currently happen with the ACA is the Republicans try to pass measures to repeal it. The Republicans have not proposed a single measure intended to fix some problem of the ACA by doing anything than actually or effectively repealing the ACA.

Lastly, the public likes key parts of the ACA even as the Republicans have successfully demonized the entire program. Democrats don't feel political pressure to repeal the ACA because they view they win by attacking Republicans for trying to repeal the popular patient protections within the ACA and so on.

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Eric Morris 11 months ago

If the Republicans actually wanted the federal government out of healthcare, they would have repealed Medicare and Medicaid between 2001 and 2006 when they controlled the presidency, Senate, and House. Instead Dennis the molester Hastert expanded Medicare. This stuff ain't going anywhere until the dollar collapses.

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david gibbs 11 months ago

A symptom of the coming collapses would be that public health becomes a major profit center and a required addition to GDP to keep all the balls in the air.

If an empire can not steal enough from others it must steal from its' own.

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Scott Wedel 11 months ago

Eric,

The underlying issue is that the public does not like the idea of people suffering or dying due to a lack of medical care. That combined with the healthcare industry successfully fighting attempts to provide lower cost care by any of the methods used successfully in other countries means it is expensive for us.

One of the reasons that dollar hasn't collapsed despite the debt and low interest rates is that the world knows it would be comparatively easy for the US to drastically improve federal budget. Eliminate corporate farm subsidies, eliminate ethanol subsidies, eliminate renewable subsidies (that industry was prepared to have expire), require competitive bidding for drug prices, eliminate the great majority of government grant programs to private industry and so on. And then we could also save a ton by stopping to fight stupid wars that we cannot even figure out who there is on our side. Gov't funding of hospitals as is done with VA even with all of their problems is far more cost effective than Medicare and Medicaid provided healthcare.

California eliminated urban redevelopment zones and that has been the best thing for urban development. Now, urban development isn't limited to the projects funded by taxes. Speculative property owners are not holding out for what property is worth if it lands a redevelopment tax credit. And governments are forced to deal with private developers if they want urban development.

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Ken Mauldin 11 months ago

In 1999, Venezuelan voters bought into the idea of making access to basic necessities an individual Right. Free healthcare. Free housing, Free food and free college. Democratic socialism, led by Hugo Chavez, was going to provide for everyone. I was there when they voted for socialism. The idea of everyone getting free housing, free healthcare and free education was very, very popular. The idea of making the perceived "rich" pay for it was irresistible.

Look at them now.

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Dan Shores 11 months ago

Scott is correct that healthcare is not a good fit for the insurance industry. A persons health, whether they live or die, should not be subject to the profit motive. People should not be faced with the prospect of losing their home, their savings and everything they have worked for simply because they got sick. Healthcare expense has been a leading cause of personal bankruptcy. Some seem to forget that health insurance costs were increasing at an unsustainable rate before the ACA. In fact, rising costs, the associated strain on the economy, and the problem of pre-existing conditions, were the main drivers of the legislation.

There are serious problems with the ACA, I think we can all agree on that. I have not heard of any better plan from the GOP, only vague references to tort reform and buying insurance across state lines. They continue to ignore the problem of pre-existing conditions. A repeal, without a better plan is not an option and would create total chaos.

The answer is universal health care for all. The insurance industry, and the profit motive, have no business being involved in health care. If we are to call ourselves a civilized society, access to health care must be the right of all citizens, not just the privileged few.

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david gibbs 11 months ago

Dan, I agree with the idea of universal healthcare.

Can the ponzi scheme known as the US economy survive retraction/restructuring?

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Ken Mauldin 11 months ago

Hi Dan Shores - When I was visiting Venezuela every year from 1995-2000 for a fishing tournament in Caraballeda, the concept of a "civilized society" was the foundational argument used to encourage people to vote for democratic socialism. It was the "civilized" thing to do, many good-hearted people argued. They were dissatisfied that some people had better access to basic necessities than other people. They saw that as "uncivilized" and decided to impose a "civilized" model through the ballot box. Now that they're eating dogs and cats and digging through trash for food in Caracas, I imagine many voters regret falling for the siren-song of democratic socialism and the promise of a "free lunch" or "free healthcare."

Even the more stable societies, like Denmark, that have implemented some form of democratic socialism, have been forced by the inherit economic inefficiencies of that system to dramatically lower levels of benefits and move back toward a model of market-based economies-of-scale.

It would be a serious economic mistake for America to embrace democratic socialism under the false-promise of "civility."

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Chris Hadlock 11 months ago

Ken, how then do you propose to fix the current problems in the health insurance and delivery systems. Under both the old and current systems, if someone shows up at the emergency room without the ability to pay, each and every one of us subsidizes the cost of that care in our premiums and healthcare costs.

As a self-employed two time cancer survivor, I can tell you in no uncertain terms that the previous system was broken beyond repair. While I am not a fan of what has taken place since the ACA was implemented, it is hard to argue with the "FACT" that insurance rates are rising more slowly now than they were in the 90's and early 2000's. This is especially true in the individual and small business markets.

Yes, I received insurance company letters increasing my premiums over 500% in 1998 and when the insurance company was told those increases were not allowed by law, they sent me another letter increasing my premiums by 40% per year for 7 full years. I still have a copy of both letters. At the time, I had been cancer free for almost 15 years. This was long before the ACA was discussed or implemented so please do not tell me that insurance costs were stable prior to the ACA.

What would you propose to control costs?

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Ken Mauldin 11 months ago

Hi Chris - Thanks for your reply. While healthcare represents a sensitive issue for us all, economics isn't sensitive to our personal issues in any way whatsoever and offers the same general results across industries and cultures. With food service, manufacturing and every other industry, only competition and the efficiencies that result from competition results in lower costs to the consumer. Lower costs can't be mandated by law. Prices may be fixed by law, yet these 'fixed prices' have zero impact on costs. As an example, the official 'fixed price' exchange rate of US dollars/Bolivars in Venezuela is 1/100, yet the market rate (actual cost) is much closer to 1/800 as price controls can only create price distortions - they can never result in lower costs.

As much as we both may want economics to behave in a different way, there is no evidence to support the belief that we can control the cost of products or services, including healthcare, through regulation. The evidence, and our recent history with the ACA, suggests that we can only cause harm pursuing those type of policies.

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Chris Hadlock 11 months ago

Ken, in general I agree with you assessment here with one great big large caveat when it comes to healthcare. Healthcare is anything but a capitalistic market. The Gov't has tinkered with multiple strategies over the years to try and get citizens to purchase or be covered by health insurance. Whether it is employer regulations, VA, VNA, medicaid, medicare or the laws that say hospitals must provide care to those that cannot afford it, the Governments fingers are weighting the scale in every direction.

If there was a "True" capitalistic Health Care delivery model, there would be a sidewalk outside of each hospital with potential patients begging for care or money and dying right there on that sidewalk because they could not afford to pay. The alternate solution would be to stuff them all into a run down government run facility with inadequate resources.

Given that Health Insurance and Care are already "Socialized" to a large extent it seems to me that your proposed solution would be to deny care to anyone that cannot afford it. Tell me how the outcome would be different because I do not see that path. Would you take the entire system apart and get rid of Medicare/Medicaid?

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Ken Mauldin 11 months ago

Hi Chris - Let me start out by saying how much I appreciate the dialog on economics. As I mentioned before, economics doesn't care about capitalism at all and responds to healthcare the same way as it responds to everything else, with the cold indifference of Mother Nature. There are natural laws at work here that can't be easily manipulated.

Providing a basic level of support for widows, orphans and the indigent have always been a proud part of the American experience. Every person that has a heart attack or hit by a car gets emergency treatment and I wouldn't change that one bit. Stopping to help someone that's been hit by a car is civilized in my mind. Providing emergency treatment to that person is also something that I believe a civilized society would do. These are examples of responding to a person in a time of immediate crisis and reflects decency. However, expanding this level of care to include every chronic ailment possible will collapse the system, economically.

While I concede that everyone needs healthcare and not a car; as a model that must allocate and balance inflows (revenue) with outflows (expenses,) insurance is insurance, whether it's car insurance, life insurance, health insurance or trip insurance for a fancy vacation. As either a public or private model that allocates costs, premiums and coverage, they are all exactly the same. Mother nature and the laws of economics doesn't recognize any difference at all between them; they can't pay out more than they bring in or they will collapse. Imagine if your car insurance were required by law to cover repairs, oil changes and emission inspections. How much more would that policy cost you for car insurance? Now, imagine that the law forbids exceptions to pre-existing damage and the insurance companies are forced to cover vehicle damage that preceded the policy coverage. How much more expensive would that policy have to be in price to the consumer? Independent of the price to the consumer, how would the car insurance company plan for the costs of these pre-existing conditions they're forced to cover? If we attempted to impose the same regulations on the car insurance market that we impose on the health insurance market, we would expect the car insurance market to collapse. We shouldn't expect anything different when we impose those regulations on the healthcare insurance market.

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Scott Wedel 11 months ago

The car insurance model does not work because people are not cars. You have a damaged car then you can get another car. If you have a damaged body then that cannot simply be replaced. Also, a car is not absolutely essential. A person can live in a city without a car. A person with bad health often cannot work.

Nor is people helping out and providing charity any sort of a solution. Someone gets cancer and whether or not that person gets treated depends upon if there are sufficient charitable contributions?

Society benefits overall if it provides decent healthcare for everyone. A person that is helped to recover can return to the workforce. A society needs to decide what are reasonably cost effective treatments. That is arguably death panels, but because a person able to return to work, parenting and so on then early death also has significant societal costs. Thus, universal health programs in developed countries are willing to spend over $100,000 to save a life.

In terms of any discussion, bringing up Venezuela automatically instantly discredits any point attempting to be made. The country is massively mismanaged with extensive corruption. Since it is the one abject basket case out of numerous countries with representative democracies, oil based economies and whatever attribute someone wishes to assign to it then it is obviously not what is with representative democracy and so on. It is only an example of what happens with massive mismanagement and extensive corruption.

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Ken Mauldin 11 months ago

Scott - Why do you imagine a resource allocation model that pays out more that it takes in revenue to be a sustainable model? Both private healthcare providers and public healthcare providers have that same limitation; they are not sustainable if they pay out more than they take in. Putting government in charge does not change this basic fact of economics. I think we're more likely yo find a solution if we focus on economics instead of how strongly we feel about something, (i.e. but healthcare is different than everything else. Because we feel so strongly, healthcare has a form of special economics that doesn't apply to any other resource allocation models.

When you say, "It is only an example of what happens with massive mismanagement and extensive corruption," you could have just as easily said "human nature" to make the same point. Where will we find these selfless angels among men to govern us and implement the utopian system of happiness and equality of every outcome? All socialist economies end the same, the only difference is the angle of descent and how long they last. Because of basic human nature, socialism, even democratically elected, is not a sustainable economic model. No resource allocation model can pay out more than it takes in.

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Scott Wedel 11 months ago

So then you are arguing that Venezuela proves that democracy or specifically that representative democracy is doomed to fail within 60 years of being established in a country?

Just as the free market can utilize individual's selfish intent to have a profit company to benefit society by providing better goods and services at lower prices, a democracy has a similar virtuous cycle. The public benefits far more from a stable government with a functioning economy than from looting the government. That is why Gates and Buffett are not complaining so bitterly about taxes because they know that government failing is far more of a threat to their wealth than taxes.

I think that Venezuela demonstrates that it is disastrous for a country to have a weak judicial system that cannot stop elected officials issuing decrees seizing property and businesses. That a weak judicial system undermines a country also explains Putin's Russia and other countries. While some complain whether ACA is constitutional as a tax, it did not attempt to do anything like seizing ownership of hospitals, pharma companies and so on which would have had far larger economic impacts.

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Ken Mauldin 11 months ago

Yes, Scott - democracies never last long. They commit suicide and consume themselves like Venezuela is doing right now. That's why America was NEVER a democracy, we're a Constitutional Republic. Certainly, you learned the difference between the two in civics class.

You're also certainly aware that American socialists want to nationalize the entire US healthcare industry, including hospitals and pharma. "How dare hospitals and the pharma companies make a nasty profit on healthcare!" the economic illiterates will loudly exclaim. These are emotional arguments, not economic arguments. That's how it started in Venezuela, too. I was there then and now I see many Americans make the exact same arguments here. Sad.

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Scott Wedel 11 months ago

You are going to argue that we are not a "representative democracy"? I just double checked that definition and there seems no question that we are a representative democracy. We are also a "Constitutional Republic" because out representative democracy is based upon a constitution. Not every country has a constitution. Venezuela has a constitution so they are also a "Constitutional Republic".

And there are racists that want to deny medical coverage to those that are not white. Some stupid proposal doesn't mean it is what much of the population believes. And it is inescapable that if US government were to nationalize or seize hospitals and healthcare companies then it must follow the laws and pay for it.

The large issue with the healthcare industry is not whether they generate profits, but what is the appropriate level of regulation. Healthcare and life saving drugs are not discretionary purchases. And yet we give companies patents and thus exclusive rights to sell life saving drugs at whatever price they choose. A life saving liver treatment is priced to be comparable to the cost of a live transplant and is thus expected to result in billions in profits for the drug maker. Other countries balk at that amount of profit margin and instead negotiate with the drug maker to bring the price down to a reasonable profit.

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Ken Mauldin 11 months ago

On a side-note, I'm not sure that the message "death panels will save societal costs" is very compelling marketing. Socialism, however, once implemented, doesn't rely on marketing it relies on force as there's no free choice involved.

In Denmark, for example, you can be jailed for offending people. There is no political freedom without economic freedom. All of the countries that have implemented less economic freedom have also implemented less political freedom. I think individual freedom and free-markets provides a more efficient economic model than a lack of economic freedom and centrally planned economies. I think the evidence is overwhelming that free markets provide a more stable political environment and culture in addition to a more prosperous economy. Free markets are better than compelled trade just as political freedom is better than political oppression.

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Scott Wedel 11 months ago

In Denmark I can offend you all day and night by calling you an ignorant jerk as many times phrased as many ways as I would desire. Where they draw the line differently than the US is that racist and blasphemy speech is not allowed because they have decided that too easily leads to violence.

USA has drawn an interesting line in that we don't prohibit hate speech, but we do recognize "fighting words" as being illegal. Denmark has decided that racist and blasphemy speech are fighting words.

I see no evidence that the Danes believe they have less political freedom than the US. They could look at their number of political parties and the relative ease of forming a political party as showing that they have greater political freedom. The US makes it far harder for an individual or new political party to be on the ballot.

Also, Western European countries that some might call "socialist" are not centrally planned. Different countries have different standards for starting businesses, business regulations and so on, but they are not "centrally planned".

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Scott Wedel 11 months ago

BTW, we have the equivalent of death panels today buried in insurance companies that decide what are covered treatments.

Every country has some version of that at some level within their healthcare system deciding what they can afford to treat.

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Ken Mauldin 11 months ago

Scott - When any economy turns the GDP into "the commons" you'll always see "the tragedy" shortly thereafter.

The 'tragedy of the commons' is basic economics and a simple lesson on what not to do. Put another way, the 'tragedy of the commons' provides a guide to driving an economic system to collapse on purpose. Some of the first American colonists, an overwhelmingly homogeneous group, took a collectivist approach and they all almost starved to death. Those that survived, only avoided starvation and the complete loss of the colony from abandoning the idea of collectivism for food. The realized they would have all starved had they not changed the model.

It's sad that there are people that want to relive the mistakes and hardships of the past rather than learn from them. Like in America today, there were people in Venezuela 20 years ago trying desperately to explain to people that history is replete with examples of failed socialists economies and they were making a mistake by believing that it would be different "this time." Look at them now. Anyone with a basic understanding of history should have known better. It's why they say that those that forget the mistakes of the past are bound to repeat them.

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Scott Wedel 11 months ago

The "Tragedy of the Commons" is not a guide of driving an economic system to collapse. It describes what happens under the capitalist system when failing to put a cost on a community resource. That the capitalist system rewards those that overgraze the community's common field and gives a competitive disadvantage to those responsible users that do not overgraze. The common grazing area analogy would also apply to industrial labor (as there were more potential workers than jobs), clean water, breathable air and so on.

Where Marx believed that argued against capitalism, most Western countries saw that as creating a need for regulations so that the commons were not free to use or abuse. Thus, countries enacted workplace standards so that it wasn't acceptable that a coal miner didn't die on average every day and so on.

The trouble with Venequela is not socialism per se. Communist Cuba without oil revenues has outlasted a decade of socialism in Venezuela. Germany would presumably also be described as "socialist" and they are doing quite well.

What plagues Venezuela is corruption across the board from tens of billions of oil revenues going missing, to government at all levels able to issue decrees to seize businesses of whatever size with no legal justification. Last week I was reading the story of a Venezuelan small manufacturer that was being threatened to be shut down because his bathrooms didn't have toilet paper as that is in very short supply. So when he had been getting some toilet paper then employees were taking extra to use at home. So then on the black market he acquired enough toilet paper and then the authorities seized the toilet paper, threatened to seize the factory and labelled him as a hoarder of toilet paper. Owner was ready to give up, but turns out local authorities just wanted to shake him down for a few thousand dollars.

That Venezuela has long had serious issues with corruption and this government has made it far worse by using corruption to reward allies and punish opponents.

I don't see any evidence that socialist countries are inherently any less corrupt that "free market" dictatorships. There has also been any number of failed free market dictatorships. What matters far more than political ideology is whether the rule of law and the judiciary have the power to investigate and prosecute corruption.

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Ken Mauldin 11 months ago

What is a "free market" dictatorship? Is that where a dictator orders people to be free or he'll put them in jail? Can you provide an example of "any number of failed free market dictatorships?"

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Scott Wedel 11 months ago

That is a dictatorship that claims to be a free market.

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Ken Mauldin 11 months ago

claims?! Ha! That's a good one. "The dictator claims that his people are really free! Never-mind the prisons full of political prisoners - they're all free, too!" HaHa!

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Scott Wedel 11 months ago

examples include Philippines under Marcos. Panama under Noriega. Any number of the dictatorships in Africa.

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Tim Keenan 11 months ago

"Republicans also believe health care decisions are between the patient and their doctor." If this is true, they must want to get the for-profit insurance companies out of the way. It's pretty simple. Do you want healthcare run by an entity whose purpose is to make maximum gain for its shareholders, or an entity whose purpose is to serve the people. Hmmm...

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Ken Mauldin 11 months ago

Hi Tim - You present a good example from an economic standpoint. Although I think the premise that "health care decisions are between the patient and the doctor" is more in alignment with the Roe v Wade decision and interpretation of the Right to Privacy and the 14th Amendment as it relates to medical treatment, and not necessarily, or exclusively, a "Republican" value.

Addressing the economic implications of the sentiment, I think it's wrong to believe that when healthcare is too expensive, that it may be made more affordable through regulation and adding additional layers and costs to the same service. A patient paying a doctor directly for services rendered would be an inherently more efficient model than a patient paying the funds into an organization of several layers of brokers and bureaucrats before the doctor is paid for his services from the funds submitted.

Imagine how much more expensive gasoline (as a commodity) or plumbers (as a service) would be if consumers couldn't buy from gas stations and plumbers directly, but had to pay through additional government-imposed levels of intermediaries in order to get the exact same gallon of gas or new faucet installed. At the risk of spoiling the surprise, I can assure you that it would lead to a higher price for the exact same gallon of gas and the exact same faucet installation. Neither gas nor faucet installation would be any better, they would only be more expensive and take more effort to get.

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Scott Wedel 11 months ago

Regulations on electric utility local monopolies does not mean there are a bunch of additional layers to get electrical service. It just means they have to follow certain consistent rules that the PUC and the utilities either agree upon or have a judicial process to determine what is reasonable for the business including rate of return on investment. We have had many decades of regulated privately owned (and customer owned co ops) electricity companies and we still have reliable electricity service. A PUC regulated electric utility cannot demand more of a deposit than it is credible that the customer could use prior to having service disconnected, but that doesn't create additional government administered lawyers to get electrical service. Just as food safety regulations requiring proper refrigeration does not mean there is a government administer controlling access to the walk in freezer.

Though, the absence of regulations can lead to corruption. For instance, as a municipal (town) owned electric enterprise, the Town of Oak Creek is exempt from PUC regulations. That allows the Town to charge $250 deposit for a residence heated by gas and so never has an electric bill more than $50. Likewise, Town of Oak Creek can pillage the electric company by taking 15% of revenues of the top without showing that is return on investment. In fact, there is no indication that Town has ever spent general funds to invest in the electric utility, but has from day 1 taken significant sums from the utility

There is no laws stopping town of Oak Creek from further pillaging the electric utility. There probably would be political opposition if local electric rates were too far above neighboring YVEA. So town has run the electric utility to support the rest of town government by performing bare minimum system maintenance. They still haven't spent the money to have automatic backup, but instead town employees must drive back and forth between the substation and the generator to manually switch to the generator and then back to the substation.

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Ken Mauldin 11 months ago

Hi Scott - Your example of Oak Creek's power allocation doesn't include the many layers of intermediaries and brokers that the ACA examples included and Oak Creek consumers aren't required by law to consume more than they need each month, like the ACA requires. However, monopolies are a reasonable example of an economy of scale; that higher volume allows for cost/price efficiencies. This only holds true in an environment of competition and the efficencies that economies of scale generate are more than off-set by the inefficiencies that result through a lack of market pressure.

Supporters of the ACA argued that because everyone was forced by law to participate that would make it more cost-effective through an economy of scale. What if Walmart was allowed to operate as a monopoly and people had no choice - would that make WalMart more efficient or less? Organizations that don't have to worry about price competition are generally terribly inefficient. Government controlled universal healthcare will provide the most inefficient cost/price model possible.

The ACA has already caused observable economic harm and universal healthcare will cause even worse economic consequences for America if implemented.

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Chris Hadlock 11 months ago

Ken, your examples of free market capitalism do not apply to the Health Care market for many reasons. First and foremost is that your insurance company tells you who the preferred provider is, and strengthen that preference with specialized pricing that you cannot get as an individual without having that particular insurance. Furthermore, different insurance companies negotiate different pricing for the same exact service.

Helth Care providers do not scale their efforts based on the size of the market, but each of them insists that this market must have all the best technology available. That is why we see the MRI in Yampa Valley costing over $2500 but going to the Front Range can get you the same exact test for $450. If health care was truly a capitalistic endeavor, those price discrepancies would not stand up for long.

How about the marvelous Colorado insurance market which refuses to allow Western Slope citizens to access the healthcare markets in Boulder/Denver. I would happily pay the insurance rates on the Front Range if the restriction was that I had to use Doctors there but do to profitability in the insurance market, that decision is not allowed.

Finally is the insurance companies desire to break citizens into ever smaller groups. Why, because the smaller the group size is, the bigger the risk factor is meaning they can charge higher premiums. If they were required to measure the risk accross their entire pool of insured customers instead of breaking them into ever smaller groups, premiums would drop like a rock.

All of this proves that insurance and healthcare delivery do not respond to normal capitalistic inputs and controls, but must be regulated. If Healthcare was forced into a normal business model, it would look more like the existing market for things like Chriopractic, Lasics, or other health related services not covered by insurance. Taking the AMA requirements out of treatment for things like wellness care, basic checkups and inoculations and making those services completely paid out of pocket would be a good start. Your analogy of the auto insurance market is actually a good example IMO.

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Ken Mauldin 11 months ago

Hi Chris - Thanks for your thoughtful reply. Your first sentence, however, is not based in economics, but personal bias. That's the trouble - healthcare is such a sensitive topic that people are convinced that basic economic forces don't apply, somehow.

When you say " If Healthcare was forced into a normal business model, it would look more like the existing market for things like Chiropractic, Lasics, or other health related services not covered by insurance" you make the point that healthcare has been forced into a very abnormal business model that distorts prices. Your observation is correct that "normal business models" like Chiropractic or Lasics can provide services at a much lower cost than if they were included in the broader healthcare market that has been terribly manipulated by government intervention, resulting in much higher prices. Universal healthcare would make those price distortions even worse.

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John Weibel 11 months ago

Chris,

I have found lower prices that I had to pay an additional out of pocket deductible for... so no insurance carriers do not always find the lowest rate.

some primary care doctors were dropping insurance payment options all together and requiring consumers to have a catastrophic plan, plus pay an annual payment to them for all services. Reducing the amount of overhead they had in their operations to comply with all the paperwork required for insurance.

Why is it that we fail to reward those who eat well, exercise and do not participate in activities that are more apt to injure one causing more health care costs. There are cardiologists that will not move out of the south because of the the high rates of service needed, to a healthier state. Gee, it seems to me that there ought to be a mechanism so that people are rewarded for eating nutrient dense foods (not laced with pesticides that will most likely cause one harm), exercise and the like if you are talking about reducing costs.

For that matter figuring out how to get the local hospital to charge less for services one can easily drive to Denver and pay significantly less for, as I have analyzed the costs of going to denver for a cat scan.

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Chris Hadlock 11 months ago

Ken, I do not completely disagree with your last post, however healthcare is not a normal capitalistic market because our society has long determined that poor people, the elderly and some poor schmo that got broad sided and cannot tell us who he is all receive care.

The health care market place will never be the marketplace that you desire unless you also decide that just like gasoline or bananas, No money = No product. This will have the added effect of letting people that cannot afford proper care either learn to do without or die without care just like when you cannot afford gasoline, your gas powered vehicles do not operate.

I can not see a solution that provides the benefit of health care to the indigent/elderly and still maintains a true capitalistic marketplace. Please try to explain at length how we can provide these kinds of services to those in need without adopting some sort socialized health care. The ACA tried to marry these two mandates together without much success, how would you do it differently?

No, I do not believe the conservative talking points about torte reform and coverage across state lines will even make a dent.

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Scott Wedel 11 months ago

The trouble with comparing medical procedures not covered by insurance is that means those procedures are not critical medical care affected by the need to provide medical care to those not able to pay.

ACA is motivated by the goal of getting everyone covered by health insurance. What to do about the uninsured is the huge problem needing action. Unlike cars where we can say that no insurance means not legal to drive, we are not willing to say that people and their kids should be allowed to die due to a lack of health insurance and an inability to pay for emergency care. So how do we pay for that?

This is not some theoretical issue because number of uninsured had grown significantly since 2000. The ACA, for all of its flaws, has reduced number of uninsured by over 9 million. The uninsured were also creating a growing problem for Medicare as people without health insurance were waiting until old enough to apply to Medicare and then had lists of health problems that Medicare was paying to deal with. So that was driving up Medicare costs.

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